“The patient is the ultimate beneficiary” for path breaking robotic surgeon Dr. Mahendra Bhandari
By Arunima Rajan
Padma Shri Dr Mahendra Bhandari is the CEO of Vattikuti Foundation, a US-based NGO. He is a noted Indian surgeon who has made substantial contributions to the fields of specialty of urology, medicine, hospital administration, robotic surgery, and medical ethics. Arunima Rajan connected with the multi-specialist for an exclusive chat, in which he speaks about his multifold experience as a robotic surgery specialist, medical educationist and innovator.
What are some of the major life lessons that you took away from your experience with building India-based solutions and how far along are you in achieving your goal?
With our experience of pioneering and disseminating 'Da Vinci' and 'Mako' robotic surgeries in India, we have come to believe that India offers a fertile ground for the successful adoption of cutting-edge technology. However, it all boils down to selecting the right surgeons to form expert committees to vet the technology and the right business models to make these surgeries cost-effective, in that there is a return on investment. It is all about the timing. Our model combined and needed the right mix of: high surgical volumes; extraordinary surgical skills; and a great degree of philanthropic hand holding, to help mitigate the financial risk of procuring capital-intensive equipment. We also believe that India, with its 501-million labor force, can not afford the prolonged hospital care and convalescence, following conventional surgery, that people are compelled to take to recover. They deserve the benefit of robotic technology, which is affordable, ensures quick recovery and in turn minimal loss of wages.
Padma Shri Dr Mahendra Bhandari
With respect to our growth and key achievements: as an organisation, we learnt appropriate ways to train committed surgeons and moulded them into leaders; who have now gone on to play a commendable role to grow the program further. We achieved our target, set during our invitation, to act as a catalyst for developing high quality and affordable multispecialty robotic surgery in India. To achieve this we had forecasted the need for 500 trained surgeons, of them 100 robotic surgeons were to be trained through our fellowship programs and we have already trained close to 60 young surgeons. Our Vattikuti fellowship program is visibly going from strength to strength.
What is your take on Artificial Intelligence? Do you think AI will help augment a medical practitioner's diagnostic abilities by automating repetitive tasks?
In the Indian context, we must first and foremost ensure that every Indian citizen, regardless of geographical location or economic status, has access to safe and high-quality healthcare. Apart from this, today, Indian physicians are already overwhelmed with caseloads and are in dire need of technological assistance to offload some of the burden off their shoulders.
Expansion of automation and technologies in hospitals will improve functional capacity, resulting in quick patient turnovers, higher efficiency, and a drastic reduction in physician burnout. Artificial intelligence-driven predictive models are already making patient outcomes predictable and helping to conserve scarce resources. AI algorithms in radiology have enhanced the accuracy and expedited the reporting of patient x-ray investigations, surpassing human performance. It has successfully compensated for the deficiency of manpower in the Radiology department. Likewise, there's a great scope in other branches of medicine as well.
You have had a long and illustrious career. You've straddled many profiles; these include that of a urologist; a kidney transplant surgeon; a robotic surgery specialist; medical educationist; innovator; and healthcare administrator. Which one provided you the most fulfilment?
Each role I have played during my professional journey was a natural progression in my career; it was not by design. It has contributed significantly to help build a strong bundle of attributes in me. Similar to a multitude of rainbow fibers, from different sources, forming one multi-coloured arc.
Particularly, in dealing with expensive, cutting-edge disruptive technology, such as robotics, I found that I am able to apply my domain knowledge as a urologist and kidney transplant surgeon. Likewise, my business sense, as a business executive, is drawn on when I have to put together different financial scenarios, ensuring return on investment.
Having said that, whatever role I may play, the patient is the ultimate beneficiary.
The trajectory of my career is such that it has offered me an opportunity to play multiple roles over 5 decades. I did my very best to fulfill these and thoroughly enjoyed the journey. That is my philosophy. For me, life is the game of not cherry picking, instead playing each role assigned to you, big or small, however, seemingly difficult it might be, with intensity, full energy and sincerity. In retrospect, I do believe everything in life has a purpose. The ultimate goal has always been personal fulfilment, so there is no one goal or achievement as such that has stood out.
Why did you move to the US in 2006?
I came to the United States to reinvent myself in a highly competitive and charged environment and to experience American university education, which I have thoroughly enjoyed. Here, I am always surrounded by smarter colleagues than I.
How was the experience working at Henry Ford Vattikuti Urology Institute?
I joined Dr Mani Menon and the Vattikuti Urology Institute in 2006, working as a pace setter. I made one of the largest data sets on robotic radical prostatectomy; published a number of high-quality research papers; led teams to our network institutions; and developed robotic surgery of the kidney; robotic kidney transplant surgery; and robotic surgery in children using our fast- track model. My coming to the United states, after having worked in India, gave me the advantages, the best of both the worlds. It also provided me with a fertile ground for learning.
What are some of the major achievements of the Vattikuti Foundation in India?
The foundation has managed to fabricate and bring high-quality, cost-effective multispecialty robotic surgery to India. It has assisted in the training of approximately 400 robotic surgeons. It is also running a highly competitive fellowship program for younger surgeons and has instituted the KS Awards which is a competition adjudging videos demonstrating cutting-edge robotic techniques. It is also managing robotic surgery databases on the versatile platform of the Vattikuti Collaborative Quality Initiative (VCQI), which has come to be a rich source for the field of patient outcome research.
What were some of the major learnings you gained from working at the King George’s Medical University, and from your time at the Sanjay Gandhi Postgraduate Institute, both in Lucknow? What are the current problems in India's medical education system, how can we make it better?
Working in Lucknow for 18 years and heading two premier institutions was my privilege, which has enriched my experience of working in a highly charged political environment. It was a tightrope walk to protect institutional autonomy while ensuring the growth of institutions and faculty.
Indian academic medical institutions need autonomy, the right merit-based leadership, and resources to produce high-quality healthcare manpower that can be trusted as the custodians of the health of our people.
You have also established Uttar Pradesh's first Kidney Transplant Program. What were the major challenges in setting this up?
Yes, in July 1989, barely a year after the Sanjay Gandhi Institute of Postgraduate Institute started functioning, we established the first kidney transplant program in Uttar Pradesh. We were the first in the country to start our program with a kidney donated by a brain-dead cadaver. We could do it even when our country had no cadaveric law. We got support from the institution, the government and legal luminaries due to the goodwill our institution enjoyed. Since then, this institution has emerged as one of the most prominent kidney transplant programs in India owing to the high volume of cases it deals in.
As a practitioner, how much do you think about ethics related to healthcare data?
India could be the hub of healthcare applications of AI as it has a very rich data collecting landscape and one of the strongest IT bases in the world. Yes, while using this data for building AI algorithms, we must ensure patient confidentiality and the protection of intellectual property rights. But these AI models can turn out to be major disruptive commercial breakthroughs, so it is important that we encourage innovation in this space.
You have been included in the Smithsonian Institution National Museum of American History in Washington. Can you elaborate more on that?
A few years ago, the Smithsonian Museum of American History added a new wing titled "Many Voices, One Nation" to encapsulate 500 years of the history of immigration to the United States. They approached the foundation as our success in robotic surgery had a compelling story. Vattikuti Urology was the birthplace of the DaVinci surgery program. Dr Mani Menon developed Vattikuti Institute Prostatectomy (VIP) and several robotic procedures in urology. Dr Menon had his medical education in India. The Vattikuti Urology Institute at the Henry Ford Hospital was founded by the philanthropic support of Raj and Padma Vattikuti, who also migrated to the United States from India and made their wealth in the US. I was entrusted with the responsibility of taking the technology back to India. The theme of the exhibit is that immigrants not only benefited the United States but also gave back to their home countries. Currently, my O-1 Visa (under the Extraordinarily Brilliant-1 EB1 category granted to me by US immigration) is on display in a museum in the United States.
How do you balance multiple roles, that of an innovator and a practitioner?
After moving to the United States, I did not perform surgeries, but in India, I combined these roles. By decentralising different functions and trusting people, one could comfortably wear multiple hats.
What are the 3-4 technological innovations that you believe don’t exist today but could happen?
Technological applications on neurological disorders by developing computer and brain interfaces, technological anti-aging solutions, surgical decision support systems, and many more are likely to be major exponential breakthroughs.