Publishers Note

With each passing day, there are numerous research

done to invent newer techniques, approaches & devices
which can help in early detection of medical conditions.
It is seen that early detection helps in arresting progress
of the disease and offering quick relief to the patient.

dvancements are noted in all the fields of medical science. The field of
Radiosurgery is seen progressing with notable advances in robotic technology.
This issue deals with one such technology that helps in precisely targeting tumors,
present anywhere in the body with pinpoint sub-millimeter accuracy. In the write-up on
Cyberknife Revolutionary Robotic Radiosurgery System, the author has emphasized
on the features, advantages and how Cyberknife treatment is more beneficial than the
conventional treatment.
Computer navigation is a recent advancement in joint replacement surgery that
enables the surgeon to create digital reproduction of the entire surgery. Computer
navigation helps in clearly viewing the component position, range of motion, ligament
tensioning, and overall limb alignment during every step of the operation. Various
benefits and details of computer navigation procedure is highlighted in the piece of
writing on Computer Assisted in TKR Surgery.
Oncology is another field where there is immense ongoing research conducted.
The article, MRI Scan Detects Treatment of Bone Marrow Cancer deals with the
innovation of one such revolutionary scanning technique. This scanning technique
images the entire body of the patient disclosing the cancer affected areas in the bones
and further directs the doctors in the choice of treatment. The scan demonstrates
the response of the patient to cancer treatments. This special issue on Surgical and
Oncology equipment further enlightens our readers regarding the advancements in
the said field.
Moreover, we feel pleasure to invite you at our MEA booth during Medicall Expo
2014 at Chennai during August 1-3, this year.
Please do send me your comments at pravita@charypublications.in

Pravita Iyer
Publisher
2

Publishers Note.indd 2

Mar-Apr 2014

Medical Equipment & Automation

5/14/2014 5:01:25 PM

C ontents
Computer Assisted TKR Surgery
Dr Satish Puranik

Director /Publisher

Pravita Iyer
Mahadevan Iyer

Editor

Mahadevan Iyer

As osteoarthritis progresses, the knee becomes more misaligned, stiff,

and deformed. Restoring alignment is critical for the long-term success
of a knee replacement. Precise position of the implants is another
critically important element of the durable knee replacement.

20

miyer@charypublications.in

Associate Editor

Gopal Krishna Anand

edit@charypublications.in

Sub-Editor
Editorial Coordinator

Dr Varsha V Sharma
Kshitija Kolhapure
Nafisa S. Kaisar
nafisa@charypublications.in

Advt. Department

Surgical Automation & Robotics

Dr Balbir Singh and Prof Dr Lakshmi B
Automation is an emerging trend providing outstanding quality of care,
combined with good treatment and service. Automation and use of
robotics has let healthcare not only to advance exponentially in terms
of dexterity, precision and comfort but also proved to be time saving,
simple and reliable.

22

Karan Singh
karan@medicalmagazine.in

Design

Rakesh Sutar

Subscription Department

Hemant Yelave
Nafisa Khan

Survival rate of Head & Neck Cancer patients

Dr Dhairyasheel N Savant

sub@charypublications.in

Administration

Dattakumar Barge
Bharati Solanki

Social Media

Abbas Saifee

Head and neck cancer is the largest component of the overall cancer;
with nearly 2,00,000 new cases being reported every year. In India
around one third of the total cancer incidents are Head and neck
cancers in contrast to only 4% and 8% in US and Europe respectively.

30

Our New Address

Editorial, Subscription & Advt. Office:
201, Premalaya, Next to Cafe Coffee Day,
Opp. Telecom Factory, Deonar, Mumbai - 400 088.
Tel.: (022) 2507 3300 / 01
Email: sub@charypublications.in
Follow us on:
www.facebook.com/medicalequipmentandautomation

Bariatric Solution for curing diabetes offers new hope

Dr Ramen Goel
Forty three-year-old S Nair had been diabetic for 15 years. His disease
was uncontrollable and had turned him blind. Just when he had given
up all hope, doctors suggested bariatric surgery to cure the condition.
Just 12 days after the procedure, his insulin was back to normal and
he was taken off all medication for diabetes.

32

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Printed and Published by Pravita Iyer

on behalf of Chary Publications Pvt Ltd, and Printed
at Finalcopy (India) Pvt Ltd, C - 18, Royal Industrial
Estate, Wadala, Mumbai 400 031 and Published at
311, Raikar Chambers, Govandi (E), Mumbai 400 088.
Editor : Mahadevan Iyer

Contents.indd 4

Screening of IDA and Thalassemia using Automated

Hematology Analyzerss
Divya Munshi
In the Indian context, the two most common etiologies for microcytic
hypochromic anemia cases are iron deficiency anemia & beta thalassemia
(a genetic hemoglobinopathy). As per the WHO estimate, 80% of children,
58% of pregnant women, 30% adults in India are suffering from IDA while
3.3% of Indian population is affected by beta thalassemia.

Mar-Apr 2014

37

Medical Equipment & Automation

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Contents
MRI Scan Detects
Treatment of
Bone Marrow Cancer

46

Dr Varsha Sharma Kapila

Brand Recall in
Healthcare

Publishers Note

02

Editorial

06

Newsline

08

Feature

48

P Ashoka Varma

Diagnostic Radiation
The ALARA Mantra

50

Departments

Dr Sharad Maheshwari

Free Light Chain (FLC)

Analysis in Plasma Cell
Dyscrasias
Dr Vijay S Bhat

56

29, 45 & 55

Hospital Update

70

Event

73

Product Review

74

Advertisers Index

77

Biography

78

Medical Wizard

79

Interview
Dr Kamal Kiran Mukkavilli
Nephrologist, Kamineni Hospitals

Technology and
Innovation to stay
game changers

62

Anjan Bose

CYBERKNIFE
Revolutionary Robotic
Radiosurgery System

64

Dr Ch. Mohana Vamsy

Osteoporosis
How you can help
yourself!

66

34
Dr Anil Potdar
MD, DNB (CARD.), MNAMS, FACC
Parisoha Foundation Pvt Ltd

Dr Gerd Mueller

Quality Medical
Education
Dr Jayshree Mehta

68

40

Disclaimer: Chary Publications does not take responsibility for claims made by advertisers relating to ownership, patents, and use of trademarks, copyrights
and such other rights. While all efforts have been made to ensure the accuracy of the information in this magazine, opinions expressed and images are
those of the authors, and do not necessarily reflect the views/collection of the owner, publisher, editor or the editorial team. Chary Publications shall not
be held responsible/ liable for any consequences; in the event, such claims are found - not to be true. All objections, disputes, differences, claims and
proceedings are subject to Mumbai jurisdiction only.
Medical Equipment & Automation

Contents.indd 5

Mar-Apr 2014

5/14/2014 5:56:12 PM

Editorial

Managing Cancer, Treatment and Therapies

arm reduction can be assumed as abstinence from all forms of tobacco Nicotine,
the addictive component of tobacco alters neural circuits to promote addiction,
and altered activity of these neurons may undermine efforts to quit smoking. The rate
of developing esophageal squamous cell carcinoma (ESCC) nearly doubles in those
who both smoke and drink compared to those who only smoke or drink, according to
new research published in The American Journal of Gastroenterology. According to
National Cancer Institute, it is estimated, in 2014 there will be over 18,000 new cases
of esophageal cancer in US, and over 15,000 deaths from disease.

Global
market for
biological
therapies
for cancer is
to reach
$53.7 billion

Evidences indicate - avoidance of smoking, increased consumption of fruits and

vegetables, physical activity, reduction of alcohol consumption - effect in reducing rate
of cancer. In the realm of cancer management, measuring effectiveness of treatment on
survival alone is not enough. Quality of life may get affected post surgery and treatment
causes physical, emotional and psychological difficulties for concerned individuals.
Standard care requires surgeons to remove the tumor and some neighboring tissue
that may or may not include cancer cells. Often a second surgery is recommended
to remove additional tissue - and checked for the presence of cancer. Cancer cells are
difficult to see, even under high magnification. Recently, high-tech glasses developed
at Washington University School of Medicine in St. Louis may help surgeons visualize
cancer cells, which glow blue when viewed through the eyewear.
Choice of treatment for cancer depends mostly on the type of primary cancer. For
some cancers chemotherapy works better and for others radiotherapy. The global
market for biological therapies for cancer is to reach $53.7 billion in 2014 and for
Predictive Breast Cancer diagnostic and drug Technologies valued at $21.2 bn in 2011
is expected to reach $24 bn by 2016.
Approximately 12.5 million new cases of cancer are being diagnosed worldwide each
year and considerable research is in progress for drug discovery for cancer. Most drugs
used to treat lung, breast and pancreatic cancers also may promote drug-resistance
and ultimately spur tumor growth. As drug resistance occurs, tumor cells acquire stem
cell-like properties that give them the capacity to survive throughout the body and
essentially ignore the drugs. The findings were published during April, 2014 online
issue of Nature Cell Biology. Over and all, drug discovery and delivery remains a
challenge in management of cancer progression.
Gopal Krishna Anand

Editorial.indd 6

Mar-Apr 2014

Medical Equipment & Automation

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Surgery

Surgical
Automation
&
Robotics

22

Surgical Automation and Robotics.indd 22

Mar-Apr 2014

Medical Equipment & Automation

5/12/2014 4:40:04 PM

Surgery

Automation is an emerging trend providing outstanding

quality of care, combined with good treatment and service.
Automation and use of robotics has let healthcare not only
to advance exponentially in terms of dexterity, precision and
comfort but also proved to be time saving, simple and reliable.
Use of robotics can prevent patient from undergoing lengthy
and painful procedures by way of minimally invasive surgery.
Robotic surgery can provide highest level of accuracy while
retaining the expertise of a surgeon.

utomated laboratory and

medical systems help
clinicians make accurate
diagnoses and provide
effective treatment. They help
medical researchers find new
lifesaving cures and help hospitals
and clinics provide efficient care.
Healthcare providers do a better
job and patients receive better care
when these systems are faster,
more precise and more reliable.
With higher-performing, more
reliable equipment, the whole
healthcare system works better,
benefitting everyone from patients
and caregivers to hospitals and
clinics and the machine builders
who serve them.
Now the hospitals have the
technology
and
engineering
knowledge to solve the toughest
motion challenges. Modern day
robotics offers the widest standard
product selection, with the ability
to rapidly modify products for an
exact fit to meet the requirement
of specific applications. Present
day machines can be simplified by

Medical Equipment & Automation

Surgical Automation and Robotics.indd 23

Mar-Apr 2014

utilizing direct-drive technology,

removing
transmission
components for greater accuracy,
repeatability, reliability and a
lower total cost of ownership. In
addition, they can help to integrate
motion systems along with optics,
fluidics and pneumatics for higher
performance and precision.

Surgical Automation
Minimally invasive surgery is
the way of the future. Improving on
the technologies of conventional
laparoscopy and arthroscopy,
surgical robots are providing
surgeons with greater visibility,
dexterity, precision and comfort
than ever before. Todays surgical
robots decrease operative trauma,
improve patient outcomes and
shorten lengths of stay in prostate,
cardiac, gynecological and many
other types of surgery. And their
growth potential is unlimited as
new surgical applications are
developed and as hospitals add
new capabilities to better compete
for patients.
23

5/12/2014 4:40:15 PM

Surgery
engineering and support network,
the components and expertise
to keep robots performing are
always near at hand. So the robot
is always on the job.

Surgical Simulation

The Most Demanding Motion

Environment: Operating Room
Precise control of multi-axis
motion, with coordination across
all surgical controls, cameras
and instruments, is the key to
surgical robotics. This requires
the highest-quality servomotors,
drives and motion controllers
working together seamlessly
over a high-bandwidth motion
network. But its not just about
quality. It takes a complete
motion
solution,
integrating
components that are designed
to work together within the
most demanding application
requirements
and
space
constraints.
Right Tools and Skills
Industry prefers most advanced
servomotors in configurations and
torque ranges to meet virtually any
specification. Compact frameless
and cartridge motors provide
24

Surgical Automation and Robotics.indd 24

direct rotary motion for the

stiffest, most exact motion in the
smallest possible space without
the need for complicated and
bulky transmission components.
Additionally, the integrated drives,
controls, development tools and
expertise is needed to bring
an optimized motion solution
from the drawing board to the
operating room.
A Tireless Assistant
Quality should always be
the number-one concern in
the healthcare setting. Repair
and maintenance time is time
that could be spent treating
patients, instead of rescheduling
their
appointments.
Through
the Danaher Business System,
kaizen-based quality assurance
and continuous improvement
programs have made providers
the recognized leader in high-end
motion. And with global supply,

Simulation is another big

concept in modern medicine.
Simulation is particularly attractive
in the field of surgery because
it avoids the use of patients for
skills practice and ensures that
trainees have had some practice
before treating humans. Surgical
simulation may or may not involve
the use of computers.
One of the barriers to
development of virtual reality
surgical simulation has been
the large amount of computing
capacity that has been required
to remove delays in signal
processing, but this is being
addressed by systems that break
down the tasks by concentrating
on chains of behavior. Designers
of surgical simulators attempt to
balance visual fidelity, real-time
response and computing power,
and cost.
What Currently happens in
Surgical Training?
Surgical training consists of
developing cognitive, clinical, and
technical skills, the latter being
traditionally acquired through
mentoring.
Fewer
mentoring
opportunities have led to the use
of models, cadavers, and animals
to replicate surgical situations and,
more recently, to development
of surgical skills centers or
laboratories.
However,
the
effectiveness of skills laboratories
in teaching basic surgical skills
(eg, instrument handling, knot
tying, and suturing) is not yet
proven.
Is Simulation an Effective
Method of Training?
Attempt is to gauge the
Mar-Apr 2014

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Surgery

instructional
effectiveness
of
surgical simulation (that repeated
use improves performance), as
well as construct validity (that the
simulator measures the skill it is
designed to measure). Validity
studies of surgical simulation
(mostly computer simulation)
have shown mixed results for
construct validity while other
important aspects of validity (such
as predictive validity) and reliability
are frequently not tested. The
ultimate validation is for simulation
training to show a positive
influence on patient outcomes.
Simulation can not only be
used for surgical training, but
also to assess surgeons. For
example, the U.K. General Medical
Council is using it to assess poorly
performing surgeons referred to
the Council.
Costs of Surgical Training
While the costs of simulation
systems can be high, ranging
from about U.S. $5000 for
most laparoscopic simulators
to up to U.S. $200,000 for
highly sophisticated anesthesia
simulators,traditional Halstedian
training is not without cost either.
Medical Equipment & Automation

Surgical Automation and Robotics.indd 27

Mar-Apr 2014

Bridges and Diamond calculated

that the cost of training a surgical
resident in the operating room for
4 years was nearly U.S. $50,000.

Robotic Surgery
Robotic surgery is also known
as
Robot-assisted
surgery;
Robotic-assisted
laparoscopic
surgery; Laparoscopic surgery
with robotic assistance.

Robotic surgery is a method to

perform surgery using very small
tools attached to a robotic arm.
The surgeon controls the robotic
arm with a computer. Here the
patient is given general anesthesia
so that he is asleep and pain-free.
The surgeon sits at a computer
station and directs the movements
of a robot. Small surgical tools are
attached to the robots arms.
The surgeon makes small cuts
to insert the instruments into
the body.
A thin tube with a camera
attached to the end of it
(endoscope)
allows
the
surgeon to view enlarged 3-D
images of body as the surgery
is taking place.
The robot matches the doctors
hand movements to perform
the procedure using the tiny
instruments.
Why the spike in robotic usage?
Back in 2000, there were only
1,000 robotic surgeries worldwide. That number surged to
360,000 in 2011 and 450,000 last
year. Analytics say the practice is
on the rise because of its strong

27

5/12/2014 4:40:34 PM

Surgery
benefits. For the patient, theres
usually less blood loss, a shorter
hospital stay and less reliance on
postoperative pain medication.
Theres also the cosmetic benefit
of no big scars, As in laparoscopic
surgery, the instruments enter the
body through small incisions.
For surgeons, the procedures
can be less tiring. They dont
have to bend over an operating
tablethey can sit in front of a
screen with a magnified, full-color
3-D view of the surgical field. For
maneuvering in very tight spaces,
like the back of the throat, the
enhanced screen image makes it
much easier to see what actually
is being done.
Benefits of Robotic Surgery
Robotic surgery is similar to
laparoscopic surgery. It can be
performed through smaller cuts
than open surgery. The small,
precise movements that are
possible with this type of surgery
give it some advantages over
standard endoscopic techniques.
The surgeon can make small,
precise movements using this
method. This can allow the
surgeon to do a procedure
through a small cut that once
could be done only with open
surgery. Once the robotic arm is
placed in the abdomen, it is easier
for the surgeon to use the surgical
tools than with laparoscopic
surgery through an endoscope.
The surgeon can also see the area
where the surgery is performed
more easily. This method lets
the surgeon move in a more
comfortable way, as well.
Robotic surgery can take
longer to perform. This is due
to the amount of time needed
to set up the robot. Also, many
hospitals may not have access
to this method. Robotic surgery
may be used for a number of
different procedures, including:
28

Surgical Automation and Robotics.indd 28

Coronary artery bypass, Cutting

away cancer tissue from sensitive
parts of the body such as blood
vessels, nerves, or important body
organs, Gallbladder removal,
Hip replacement, Hysterectomy,

to anesthesia like reactions

to medications and problems
breathing and risks pertaining
to actual surgery like bleeding
and infection.Robotic surgery
has as many risks as open and

Kidney
removal,
Kidney
transplant, Mitral valve repair,
Pyeloplasty, Pyloroplasty, Radical
prostatectomy, and Tubal ligation.
Risks and Recovery in Robotic
Surgery
Like any other surgery the
risks includes one pertaining

laparoscopic surgery. However,

the risks are different.
As surgical cuts are smaller than
traditional open surgery recovery
is smoother with faster recovery,
less pain and bleeding, less risk of
infection, shorter hospital stay and
smaller scars.

Dr Balbir Singh

Prof Lakshmi B

Dr Balbir Singh is serving as Assistant Professor (UGC-NET qualified)

in Health Studies Area, Centre for Human Development at Administrative
Staff College of India. He is Bachelor in Medicine, has PG Diploma in
Preventive & Promotive Health Care and MBA in Health Care Management
from Apollo Institute of Health Care Management. He is a certified Project
Management Professional from IIT, Delhi. Sample of his trainings and
CMEs include programmes from Harvard Medical School, Johns
Hopkins Center for Public Health, The University of Edinburgh, Stanford
University, Asian School of Cyber Laws, NIOS and IGNOU.
Prof Dr Lakshmi B is Dean of Management Programs, Director of Centre
for Human Development, and Chairperson of Health Studies Area at the
Administrative Staff College of India (ASCI). She is BA, MA, MPhil. and
PhD. She has Postdoctoral Masters in Hospital Administration (MHA)
from Sydney. She is a Fellow of Australian Institute of Management
(FAIM). In the international arena, Prof. Lakshmi conducted MDPs for
the Commonwealth and multinational sponsored programs for the South
Pacific Islanders in Papau New Guinea.

Mar-Apr 2014

Medical Equipment & Automation

5/12/2014 4:40:40 PM

Feature

World
Cancer Day
T

he history of World
Cancer Day dates back
to 1933 when Union for
International
Cancer
Control (UICC) first observed the
significance of this day at Geneva,
Switzerland. It was an initiative
of UICC to unite the entire world
in order to reduce the global
cancer burden, to promote greater
equity, and to integrate cancer
control into the world health and
development
agenda.
World
Cancer Day is celebrated annually
on 4th of February all over the
globe and aims to save millions of
preventable deaths each year by
raising awareness and educating
about cancer, and pressing
governments and individuals
across the world to take action
against the disease. In 2014 it has
been focused on Target 5 of the
World Cancer Declaration: Reduce
stigma and dispel myths about
cancer, under the tagline Debunk
the myths. According to UICC its
importance lies in preventing the
inevitable global cancer epidemic
by raising awareness against the
deadly disease.
Currently, 7.6 million people
die from cancer worldwide every
year, out of which, 4 million
people die prematurely (aged
30 to 69 years). Therefore the
need of the hour is to raise
awareness about the disease and
to develop practical strategies
to address cancer. By the year
Medical Equipment & Automation

Feature-World Cancer Day.indd 45

Mar-Apr 2014

2025, premature cancer deaths

are projected to increase to 6
million per year. The estimate
of 1.5 million lives which are at
threat due to cancer could be
saved per year if strategies are
adapted to achieve the World
Health Organizations (WHO) 25
by 25 target to reduce premature
deaths due to non-communicable
diseases (NCDs) by 25% by 2025.
Cancer Control in India
World
Cancer
Day
is
an
important
date
where
organizations and individuals
are encouraged to project the
day for a concerted advocacy
push, calling on governments to
live up to the new and ambitious
commitments in the emerging
NCD framework, and ensure that
cancer interventions, prevention,
early
detection,
treatment
and palliation, are adequately
addressed in the global health
platform. There is now a need for
a worldwide commitment which
would aid advancements in policy
and encourage implementation of
comprehensive National Cancer
Control Plans.
India is one of the few
developing countries that have a
National Cancer Control Program
organized by the Ministry of Health
and Family Welfare. Its primary
objectives include prevention
of tobacco related cancers and
other prevalent forms like cancer

of uterine cervix, mouth and

breast as well as extension and
strengthening
of
therapeutic
services including pain relief on
a national scale through regional
cancer centers and medical
colleges
(including
dental
colleges). The current program
envisages- Recognition of new
Regional Cancer Centers (RCCs);
Strengthening of existing RCCs;
Development of oncology wings in
medical colleges; District Cancer
Control Program; Decentralized
NGO Scheme which together
would aid the concerted network
of cancer control.
Cancer Research in India
Cancer control program is
perfectly complemented with
current trends in cancer research
in India which aims to unravel
the diverse molecular and
biological changes underlying
cancer
development
and
progression. The
research on
cancer is more oriented towards
understanding the tumour micro
environment, mechanisms that
restrain
tumorigenesis
and
translating novel findings towards
cancer diagnosis, prognosis
and therapies. The new era
science is more concerned with
personalized treatment strategies
with targeted agents that are
directed specifically to the
molecular abnormalities that are
driving specific tumours: PIB.
45

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Micromaster Back Cover Ad to print.pdf

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