 Healthcare services are being swept over by technological advancements, telling us how to live well given the constraints of time, resources and hazards of modern-day living. From emergency rooms going wireless to robotic surgeries to genome mapping, technological inventions are revolutionizing health services and saving lives. And in this constantly changing scenario, I'm pressing the pause button to stop and understand how it's all working together in improving our lives. Welcome to Manipal Hospital Presents, Changing Phase of Medicine. sequencing technology in the field of genetics and genome biology have revolutionized treatments related to cancer, prenatal testing and effective detection of genetic mutations. Genetic disorders and abnormalities that show up during pregnancies leave the patient even with a family history clueless as to how to deal with such a situation often leaving them with no other option but to terminate the pregnancy. We have several of our patients who come with their families who are referred to us because they have one member or their child is affected or there's a family history of lots of neurological disorders and they're worried whether they will be affected or you know even breast cancer for example that their mother has breast cancer and then the daughters are very scared now so they want to know whether they are at risk of having the same you know abnormality or the gene mutation. She is my elder sister who is pregnant right now. Rajni 32 is visiting the Department of Genetics at Manipal to get a better understanding of the implications that her unborn child has owing to the genetic abnormality that her first born carries. So this child has a condition called lamellar ectiosis. Now this is a genetic disorder which is inherited in an autosomal recessive way that means that this child has both the copies of the genes are mutated and the parents are normal but they carry one copy of the gene which is mutated and the other gene is normal so every time they have a child they if they both give the abnormal gene they can have a child who's affected again. With the human genome project sequencing of this human genome we have a new cutting edge technology called the next generation sequencing and with this we can sequence whole genes single gene or exome sequencing or whole genome sequencing. So the entire gene can be sequenced we are going to offer her the corionic villus sampling and take a little bit of the fetal tissue and test this fetus for the same mutation which her first child is carrying and if it is carrying the same mutation the choice is theirs so they're able to make an informed choice about the future of their pregnancy. When we talk about modern technology robotics come to our minds and the use of robotic sciences in medicine has ensured that most complex surgeries are now handled more efficiently. In cancer cases patients who have to undergo surgery the difficulty of losing an affected organ is ever present but with the robo-assisted surgery this can be avoided effectively just like in the case of Mr Ramanathan. I was diagnosed with a tumor in the left kidney they said that to get it done in Bangalore options are three either an open surgery where you have a bigger cut in your abdomen or you need to go in with a laparoscopic surgery or you can go for robotic assisted surgery which is done in Manipal Hospital. So when they explained the benefits of the robotic assisted surgery it became fairly clear the choice was simple. The real name for robotic surgery is robot assisted surgery. The robot is a device which is used by the surgeon to perform the surgery. The main preconception that the robot does the surgery is not true it is a surgeon controlled robotics. The surgeon uses the robot to perform the surgery. The traditional way of doing the surgery for a kidney tumor was to make a big cut in the tummy and then taking the whole kidney out. That is quite a complex operation where you want to preserve the kidney at the same time remove the tumor which is the type of a cancer. And how to do that with the minimal invasion that is without making a big cut. And this is where the robot has really come into into great use and we are able to remove many tumors from the kidney thereby preserving the kidney and leaving it intact so that it has benefit for the patient. By using a multifaceted robot this state of the art technology enables the doctor to execute complicated and long drawn procedures with utmost precision as compared to an open surgery. With the robot what happens is the technology allows us to do a precision surgery the forehand robotic with endogenous technology and a hugely magnified 3d video very very stable platform and a surgeon sitting comfortably on a chair and then doing very fast. So all these combined together makes us do a complex cancer surgeries do at a short time with negligible pain to the patient with minimal blood loss and a very good cancer clearance and a fantastic outcome and quality of life. In my case I chose robotic for two reasons one was like everybody you know the when I spoke to the doctor he said it's going to be very you know easy on your body you will not feel the pain and the second reason was my tumor was very very close to a part where you know a very precise operation was needed very very to you know to the point of fume mms so when he said that I need to do robotics only because we need to save a certain part of your body we don't want we don't want you to live with a bag and attachment on your body for the whole life you know and that was a major decision so I decided to go for this in addition to the robotic technology Manipal hospitals has also been using the hyperechnology for a sustained treatment of patients coming in at extreme stages of cancer you see that in India unfortunately the uterine cancers the colon cancers the oberian cancers and then something called a pseudo mixoma misothelioma they all come to us when it has spread everywhere in the tummy in advanced a third or fourth where there is no cure possible so there is a technology called as hypec that is a hyperthermic intrapytonal chemotherapy the case of Mr. Sravankumar Latt who was detected with the latest age of stomach cancer had to undergo a hypox surgery owing to the complex nature of his cancer he had a peculiar condition called pseudo mixoma peritonine where it was all spread everywhere in the tummy with multiple nodules I explained him that surgery alone will not cure you but I'll do this hypec for you and we went back and did this surgery we cleared all his cancer we put back this pump machine and cleared and circulated the cancer at 42 degree centigrade with a special fluid today it is one year he walks back and he's a businessman he sits in the shop whole day he's so active and healthy had we didn't have this technology called hypec it would have been impossible to cure him by any amount of surgery or IV chemotherapy time travel is a reality now take for instance wearable technology or a health app on your mobile phone we are now transferring information related to our health to our doctor who may be sitting miles away from us so it's not just about shrinking distances it's also about forecasting your health report card wearable devices are one of those innovations in technology which have had a huge impact on health care services a number of medical devices are now becoming wearable including glucose monitors ecg monitors pulse oximeters and blood pressure monitors and the role of such devices to track and monitor chronic diseases is also gaining momentum as is in the case of this remote sensing device available for an all-round fetal monitoring using this is simple just by attaching electrodes on their bodies expectant mothers can easily track the movements and other vitals of a growing fetus and share this information through smartphones and tablets electronic fetal monitoring the variable technology has helped us in promoting the remote control fetal monitoring wherein we use the same electrodes we teach the patient how to use them on herself and we can get a tracing on our smartphones or on tablets so that the patient carries with it to her house and monitors at least two to three times a day this way we are able to continue pregnancies people with high-risk pregnancies people with feeling of decreased movements previous intrauterine deaths are all candidates who can use this they can be comfortable we can rest in peace that the babies are fine some of these solutions truly put into perspective the use of modern technology in medicine today but i believe we have only scratched the surface when it comes to this subject let's slip into a short break and let's explore more when we come back welcome back to Manipal Hospital presents changing face of medicine may i now introduce you to Dr Ajay Bakshi he is MD and CEO of Manipal hospitals and we are trying to understand from him the dynamics of running a multi-speciality hospital morning Dr Bakshi hi how are you i'm doing well having a busy day yes just reviewing some patients okay i'm gonna borrow him for some time sure yeah so doctor how many hours do you clock in during the day i don't count really it starts in the morning and depends on the day sometimes it may end up at 6 p.m sometimes it may go on till dinner with some visitors or some other doctors tell us more about the journey of Manipal hospitals in the sense the significant milestones that have been clocked so it's actually one of the oldest health care groups in India the original medical education enterprise started in 1952 with Dr TMA Paya founding Kasoba Medical College in Manipal and that has grown into a 2000 bedded hospital and it is one of the best medical schools in the country where we are standing right now is corporate part of Manipal group which is corporate hospitals Manipal hospitals and this started in 2005 so the last 10 years we have grown to nearly 5500 beds we have 16 hospitals across the country with a lot of dominance in Karnataka presence in Andhra Pradesh Tamil Nadu Goa and we recently have a hospital in Chepur as well so Manipal has grown significantly in terms of both the medical education piece which is a separate entity and the corporate hospitals which i am responsible for Dr Bakshi medical technology is growing leaps and bounds and before you even read it it's outdated at times what are the technological advancements that you're seeing in the world that you have been able to bring in to the Manipal hospitals so when i was a medical student in the 80s we used to have a thick register book called index medicus which listed all the papers that were published that month that is now all computerized and you will be surprised to learn that almost 100 new research papers get published every day around the world so the bottom line of technology advancement is that we know more we know more about disease we know more about patients we know more about demographics and that knowledge is leading to technology as well so we can diagnose diseases much better we have high-end MRI machines we have PET CT machines which do nuclear medicine tests of the brain and so on and so forth so there's a whole panoply of diagnostic equipment which allows doctors to understand what's happening in the body very carefully so that's why i think the second thing is our ability to make changes in the human body has all have also improved and increased dramatically so i trained as a neurosurgeon but today we can do a brain operation without even opening the skull there is something called a gamma knife for example there is i'll just give you some example there is a robotic surgery possibility there are uh interventional techniques by which through a small puncture in the femoral artery or a radial artery you can go and fix the heart so that's how doctors put stents inside the heart so this is almost like science fiction this 20 years ago one could not have imagined that all of this would have become possible but today it is actively practiced in this hospital where you're standing right now doctor how challenging is it to manage a multi-speciality hospital it comes with its own dynamics you have technological advancements you have inflow of patients you have highly skilled professionals and paramedical staff how do you manage all that so you know for us everything starts with a patient and we deal with every patient as a human being just to give you a sense we have almost 75000 patients work through a system every month so every day nearly two three thousand patients will come be seen by a doctor get admitted get operated and it's so it's a very high volume system that makes some challenges right so we have to individually greet everybody we have to recognize who they are we have to make sure that they get the directions to go to the right doctor we have to make sure that they don't have to wait many hospitals end up having this problem that between every intervention of a doctor or lab you may have three four hours of waiting time so the summary of what we do is we measure everything we deploy a lot of technology to understand starting from a website who came on our website what were they looking for and did they get what they wanted now today you can go on a website and get an appointment so we have created almost like a web checking system you get an appointment online you pay online you go directly to your doctor so you don't have to stand in line to pay somebody 500 rupees so that's the kind of technological innovation we are doing in patient flows another managerial challenge as you mentioned is we have thousands of doctors we have thousands of nurses but what we try to do more and more is that doctors must collaborate with each other a typical patient will be say for example a 65-year-old male with a heart attack with a kidney problem with some past history of spinal injury now this person has to be seen by a cardiologist by a nephrologist by probably an endocrinologist because he's likely to have diabetes and for sure by some neurological specialist because he has had a spine surgery so now all of these doctors have to work together they have to have information about the patient they have to have information about the disease what other doctors have been doing so we create technology platforms which enable doctors to collaborate so that all of them can converge on a patient have a common point of view of treatment so that it's not lost in translation many many patients in hospitals complain that doctors don't know what they are doing even doctor does not understand what the other one is doing so we have sort of overcome that challenge by creating technology systems by which each doctor has complete information about the patient and can talk to each other not via email but even through sms-based systems and WhatsApp type of system so that they can communicate well with each other so that's very important it goes back to improving the management of patients and before I let you go doctor one last question about what do you see as the next benchmark for Manipal hospitals so we want to be the most respected and the most sought after destination both for doctors to work in and for patients to come and seek that care so we want to push ahead on better quality of care we want to push ahead on more research programs emanating from our doctors we want to push ahead on deploying latest technologies in making the lives of our patients comfortable thank you so much for talking to us and I wish you all the best for all your plans we saw today how technology is advancing and is being embraced by modern medicine in the next episode of Manipal Hospital presents the changing face of medicine we look at the more human aspect of medical sciences stay tuned