C H Unnikrishnan
One of the major breakthroughs in the area of gynaecological endoscopy that the world is now waiting for is cheaper robotic surgery. And, it is shortly expected from India, a country that has already produced many innovative endoscopic devices and is also home to many of the the world’s most skilled endoscopic surgeons, says Prof. Liselotte Mettler, who is loved and respected as a great teacher by most of India’s well-reputed endoscopists. Prof. Mettler,an Austrian-German surgeon specialised in endocrinology, reproductive medicine, gynaecological endoscopyand gynaecological oncology, is a professor emeritus of the Department of Gynaecology and Obstetrics at Kiel University, Germany. Mettler, who conducted one of India’s first endoscopic surgeries at Mumbai’s Breach Candy Hospital in 1973 and has also authored more than 600 publications and several books on gynaecological endoscopy, spoke to C H Unnikrishnan for Straight Talk on the sidelines of a three-day International Society for Gynaecologic Endoscopy (ISGE) conference held in Pune in September. Edited excerpts:
You have been very regular to India as many of your students successfully practice here and you have also conducted several endoscopic surgeries in Indian hospitals. What are the key differences that you see in India and the West as far as the practice of this speciality is concerned?
There is not much of difference in both these markets as far as the technology and the skill-set of doctors are concerned. In the field of endoscopy in particular, the technology and procedures are almost the same that Kiel Hospital — Gynaecological Endoscopy Department in the University of Kiel,introduced in the early seventies. But, Indian doctors have really put more skills into it. I would say Indian doctors are far more efficient as they manage complex surgeries here despite limited infrastructure and low affordability of patients. Since most patients in the West are insured and they don’t have to pay out of pocket, costly equipment and advanced procedures are easily affordable there. But, the situation in India is different and the doctors actually use their capabilities much more efficiently to overcome the limited resources. Many of the devices that Indian doctors use in endoscopic surgeries today are indigenous and very innovative, which have made these surgeries cheaper here.
But, does it make the surgeries poor in quality as well here as compared to the West?
Not at all. You have brilliant doctors in India, who are capable of using the limited resources for optimum utility by putting their skills in it. The country has technical as well as manufacturing talent to innovate products that suit this market in terms of cost. The other important fact that I would like to add here is that many brilliant doctors in India are also quite passionate about the work that they do and they put their hundred percent in such surgical procedures. I have seen that Indian doctors, who are well-versed with endoscopic procedures, have really modified the techniques and modalities to make it much easier for the doctor as well as the patient.
If that is the case, India can very well attract patients from even Western countries isn’t it?
Of course, there have been patients coming from the West for such surgeries. I have sent a couple of my own patients from Germany to India for gynec-oncology surgeries to a hospital in Pune, where one of my old students, who is a brilliant endoscopic surgeon, operated on them. I am sure there are all possibilities that patients can come from even developed countries to India as the procedures and expertise that is available are not less than any other place and there is also a significant cost difference as compared to the US and Europe. I would say that the cost here would be around one tenth of the cost that prevails in those markets.
How equipped are Indian hospitals as far as quality standards and the overall healthcare systems are concerned to cater to patients, who are used to an evolved set-up in the developed markets?
Indian hospitals are no more the same as they were in the seventies or eighties. Though the public or government healthcare set-ups, except a few centres of excellence, are still poor in terms of infrastructure and latest technologies, many in the private sector are comparatively much better now. Indian hospitals in general were in a very bad condition as far as infrastructure and quality standards were concerned earlier. I myself have witnessed doctors and other staff eating even in the operation theatres and throwing the bones on the floor, which is no more the case now. Indian hospitals are getting better and cleaner, though there is still scope for improvement.
What are the latest breakthroughs in endoscopic surgery?
Thoughthe basic technologies that are used in the endoscopic surgery are more or less the same today as I mentioned earlier, there have been a lot of improvisations and modifications that have taken place in the devices and supportive systems over the last few years as medical technology is a fast evolving area. While 3D endoscopy and robotic surgeries are comparatively later breakthroughs, it is still very expensive all over the world. This is the same situation in India too, though there are only very few hospitals that have facilities for robotic surgery and 3D endoscopy here at present. In this context, one of the most sought-after and shortly expected breakthroughs in endoscopy is a robotic surgery developed by India using its inherent talent in inventing cheaper and better variants of expensive products and systems. As far as I know, the efforts for developing a cheaper robotic surgery in India are at a very advanced stage currently, and once it is out in the market, it will be a big revolution across the world. I am eighty now, and I hope I will see this revolution.