MISSION-REACH RURAL PEOPLE AND TEACH ROBOTIC SURGERY-DREAM MADE IN INDIA ROBOT-ROBOTIC CANCER SURGERY AND RURAL CANCER SURGERY IN LAST 20 YEARS-DID MAXIMUM RURAL CANCER SURGERIES AND INTRODUCED ROBOTIC CANCER SURGERIES IN KIMS,YASHODA AND AMERICAN ONCOLOGY INSTITUTE WITH SUPPORT & VISION OF RESPECTIVE HON MD’S & CEO’S

Thank God and my parents who made me a Cancerian by Zodiac sign and a Cancer Surgeon by passion

Our goal was simple – Never stop introducing innovation in cancer surgery ,leverage advanced and unique technology to transform the surgical scenario in Telugu States and at the same time do OPEN surgeries to the needy in rural areas

Today (11th July,2021)as I ride back to Hyderabad after seeing patients at Chelmeda Cancer Institute ,I just started looking back what we did to society inn general and cancer surgery in particular in last twenty years of my practice.

RURAL CANCER SURGERY: Happened to see 21 patients of which four crossed 10 years,a gastrectomy,an abdomino perineal resection,and two composite resection patients. They started bringing their relatives or friends for treatment and advise. It is a great confidence booster for us and makes us more determined to treat cancer patients.

A caring husband of a patient of floor of mouth cancer crossing 12 years introduced his dauhter who was in final year MBBS, another APR patient wanted me to come to Vemulawada and have DARSHAN of the Lord. Another gastrectomy patient brought in a nasopharyngeal case but unfortunately it was advanced and could not do anything. We saw another 5 patients who crossed 5 years. Later on we started seeing more advanced case as people are not consulting because of Covid pandemic. Unfortunately Cancer never stops growing unless treated early. We advised Vaccination for all patients.

Started discussing with my anaesthetist Dr. Sanjiv Rao how we used to do 12 to 14 cases a day during my visit and used to return at 3.30 am sometimes with blood spattered on my feet But used to get up refreshed with satisfaction of operating the poor and getting rid of cancer for some patients.

Reaching The Rural Population- I had done the maximum cancer surgeries in districts and seeing maximum cancer patients in the last 20 years. I had visited Karimnagar, Jagityal, Nizamabad, Jagityal, Bodhan, Armur, Nirmal, Adilabad,,Mancheriyal, Warangal, Miryalguda, Mahboobnagar, Zaheerabad, Sadashivpet, Vikarabad,Medchal, Siddipet, Shamshabad, Chutuppal, Nalgonda, Warangal, Gulbarga, Bidar, Raichur,Kurnool , Vijaywada, Rahahmundry, Vizag. I did feel initially what is this being a super specialist why I am travelling to districts but the LOVE shown by rural doctors and people is incomparable and In can never forget in my life. They are simple, understanding and caring. Didn’t get money and had to operate fee patients many times but it gave me satisfaction that I gave back to society what I learnt. It did earn me good will.

I did 5 years of government service in MNJ Cancer hospital for a meagre salary of Rs.12,000 . But had to leave it as there was no robot or laparoscopy in those days. I was doing free cases in Karimnagar anyway.

I then shifted my thoughts to acquire Robotic surgery skills and went to USA Rose Well Cancer Hospital and ever ace Robotic Institute in Seoul. That was the first time I got my passport and first travel abroad to pursue robotic skills.

When I went for the training some commented that I am a mad man and pursuing robotic surgery which doesn’t pay well,eventually they themselves bought robots.

I passed out of Kidwai Memorial Institute of Oncology in 1999 and joined MNJ regional Cancer Center as Assistant Professor. After working for a year I realized that lot of poor patients are dying in districts from cancer and there was 2 months waiting list in MNJ. There was no Cancer Surgeon in those days in districts, it was erstwhile Andhra Pradesh. Then I decided to visit different districts nearby and operate near their home and make local Surgeons aware about cancer surgery and principles. There are some great Surgeons in periphery who are doing great service but no Onco Surgeon.

I called my freind Dr. Kishan, an anaesthetist in Nizamabad and met Dr. Laxma Reddy sir of Pragati Hospital abd decided to visit every 2nd Sunday. I took a bus in Jubilee bus stand and waiting for it to start and then I thought why I am going to Nizamabad, won’t get money and have to self pay travel charges. But I thought let me try to do some service. Since then till now I am visiting periphery though Corona stopped me now because of travel risk. Had operated together with Dr. Jeevan Rao sir, Dr. Narayan Rao sur, Dr. Sambhashiva Rao sir, Pragati Hospital, Dr.Rama Devi mam, Dr, Kavita Reddy,Dr.Savita, Mahalaxmi Hospital and many more.

I realised peripheral people are very loving,  caring, down to earth and want best treatment.  They speak with affection and have high expectations. And not many can come to Hyderabad so I started carrying a black suitcase with operating instruments like good retractor, fine scissors, forceps etc., and started operating. They used to pay with whatever they have but never counted it, their love was satisfying me. I used to come home with my feet having blood or fluid spatters as they didn’t have hypotensive anesthesia those days in districts. Was too tired to wash and used to doze off.

Then I was invited to Karimnagar Meena hospital by Dr. Rammohan sir,Dr.Sagar Rao sir, Dr. Naveen sir, Dr. Prashant Sir, Dr. Azam sir. My first case in Karimnagar was Ileo Ceacal tuberculosis and next was a Parotid tumor at Surya hospital and was invited by Dr. Vishnu Reddy and Dr. Ravinder Rao sir. There I met first Dr. Narsimha Reddy sir. I noticed compunders were coming in banyans and outside pants into OT and then wearing surgical gown over it after scrubbing. But no patient developed complications or infections.  There started my journey of rural cancer surgery.

I then visited Jagityal, Nirmal, Armoor, Adilabad, Bodhan, Mahboobnagar, Siddipet, Kurnool, Miryalaguda, Rajahmundry, Bheemavaram, Vizag, Nellore, Zaheerabad, Sangareddy, Warangal,Bhongir,Medak.

In Mahbbobnagar had operated in SVA hospital, Dr. Vishnu Janardhan sir, Dr. Madhusudan, Dr. Anil, Dr. Hariprasad, Dr. Venkateshwar and many more.

I can proudly challenge and say that I have done naximum no of cancer surgeries in rural districts. Though I didn’t get Paisa it gave me name and above all satisfaction. Many patients call me now and ask ne బాగున్నావా సారు and asthunnava(are you coming). And see them alive after a decade or two. That is enough for this life.

Many Surgeons gave me lot of love too and they showed it privately and publicly many times. First 4 years I went in red bus because my salary was Rs. 12,000. Later on I travelled in a Maruti 800 but felt it risky.  Once me and my assistant Dr. Vijayanad Reddy who was driving slept abd car took its own route down.  We were lucky no serious injuries occured,I had to hide it otherwise I would have been stopped. Then on I always used a driver. I remember that day we were doing radical hysterectomy under spinal anaesthesia and patient in between sir, IV fluids bottle is empty and then sister who was assisting us turned around with same gloves and reattached another bottle and joined surgery with just changing gloves. Initially we were shocked at the carelessness, later laughed a bit but I decided never to go that hospital again.

I remember some wonderful associations with many Surgeons and variety of challenging cases. I remember once Dr. Satish sir from Jagityal called me to come urgently for a bad uterine mass and together we operated successfully. Dr.Mohan Reddy sir, Dr.Guruva eddy,Dr.Chandrasekhar and many others always loved after us well, posted proper cases and sometimes used to call me if I have reached home safely. Sometimes I wonder how I did this routine twice in a week for almost 15 years. Used to start at 5.00 am and return at 2 pm many times. Get down at Siddipet for a cup of tea. Karimnagar and Jagityal doctors treated me very well, breakfast on arrival, good lunch and lots of affection. Those memories always float in my mind. Their children were students and now they have become Surgeons too like Dr. Arun. I also started with Dr. Bhoom Reddy sir, his son and his grandson now.

Shushruta cancer hospital where I gave service gave me lot of satisfaction.  All were poor arogyashree patients.  We started from scratch and built an Institute but management used us but never acknowledged us. But every patient still meet me and remember our service.  I had great time there with Dr. Riaz a special friend,Dr. Arun,Dr. Sanjiv Rao, Dr. Hemant,Dr  Nagesh, Dr. Krishnaveni. I pray for their health and happiness.  I now visit Chelmeda Cancer Hospital and meet Dr. Ezhilarsi Mam and Dr.Surya Narayan Reddy sir and give service to poor patients there

I met Dr. Jagan Mohan Reddy ,radiaton Oncologist and Dr. Hussamuddin a CT Surgeon in Nizamabad and we three used to  visit Nizamabad  by car pooling. There was no huge highway those days and we used to travel through forest, villages ,and enjoy Jesudas songs , Hussam bhai’s sher,dhaba food on our drive. It was a great journey which I will always cherish.

Another Surgeon in Armoor Dr. Madhusekhar has given his life to rural population and I visited his place for a decade with Jagan and Dr. Narsimha Reddy sir. We used to have delicious Ankapur chicken there and did many surgeries. Another Surgeon who was an inspiration is Dr. Suresh Chandra Hari who gave enormous service to Nirmal and was my teacher in my first clinical posting in Osmania General Hospital

After I joined KIMS hospital I got a chance to operate in Rajahmundry Vijaywada, Vizag, Nellore, Bheemavaram. Some politicians and self centered people have caused division of region amongst us but Andhra people were intelligent, loving, caring and hard working. Their hospitality is amazing. I especially enjoyed sea food there and the greenery. I was once gifted a 7 kg fish and had to employ person to carry it in railway station but ended giving it to hospital employees accompanying me who were looking with interest at the fish. I was introduced to delicious pootha rekulu and kotai kaja there.

Had operated many tricky cases, complications of others and complicated cases. Once a hemicolectomy case had low hemoglobin and his group was A+ve and as blood was not available, I donnated a pint and operated him. Nothing will happen with one pint of blood donation to us but it can save someones life in need.

I never stayed overnight and used to travel back even if its 2 pm, I guess God has been around.

Maybe I should have started a cancer hospital somewhere and make some money but I was pursuing my dream of becoming Robotic Surgeon in Hyderabad and got hooked to advanced technology to treat cancer patients. Robotic Surgery is another field which doesn’t make money but fills my heart with satisfaction and happiness.

My rural cancer surgery taught me to be patient, humble, listen to every patient and help a doctor when needed. There was a driver who money from my bag , an assistant who silently forgot to handover my fees and a student who learnt from me and started robbing my cases. But that is life I will never know how much they robbed because I never counted my fees to avoid discriminating friends on payment basis.This part of journey had joy of giving back to society in rural area, helping friends, tears of travel, painful disc prolapse twice, life long friends and supporters. I thank all rural doctors who helped me in my RURAL CANCER JOURNEY and God bless them and their families. Above all I thank God and my patients for giving me opportunity to serve them and seek forgiveness from those whom I couldn’t cure but will definitely keep trying as long as possible. I also seek forgiveness from people I have hurt during my journey but it was unintentional , from friends and family whom I could not give time.

It’s been a passionate journey for me , a dream fulfilled for our team in the field of Robotic Assisted Surgery in Hyderbad. We started on June 11th,2011 with training by Dr. Dan and Dr. Peabody from USA at Krishna Institute of Medical Sciences. It was the first case in Hyderabad with Si on that day. After that I did my first Robotic Surgery a case of carcinoma Esophagus. I called Mr.Srinivasan of Intuitive for any videos done earlier but he said they don’t have. I used the knowledge of thoracoscoic esophagectomy and completed the case successfully by robotic equipment. I felt like walking in clouds that day and my journey started ever since. We were in Yashoda Secunderabad before that and shifted to KIMS for the love of Robotic Surgery even though we were paid higher there. Technology always drives us and will do so every time. We were anxious as we had left excellent practice in Yashoda but our dream of doing robotic surgery was achieved.

Even though we perform complex surgeries it is important to see and interact with Surgeons across the World as it will help us to know if we are on the right path and we are doing a good job in treating patients who expect a lot from us. So in June 2012 I went to the best Robotic Institute in the World,Severance Robotic Institute in Yonsei University,Seoul. It was my first visit to Korea was scary as very few speak english in Korea. But soon I learnt that Koreans are very humble, respectful to everyone, talented and futuristic. They are almost 10 years ahead. First time I regretted for not visiting Korea earlier. I perfected my Robotic Surgery skills especially in Colo Rectal and Neck Scar less Thyroidectomy

From Hrishikesh to Chennai, from Mumbai to Kolkatta I visited many Centers and interacted with my teachers, seniors and juniors, shared my experience and it was reverse learning to me too.

MUMBAI: My biggest dream was operating at Tata Memorial Hospital there and Dr. George a Thoracic Surgeon asked me to demonstrate a Esophagectomy. I had the opportunity of showing my GAJA’s technique there to George and Dr. Sabita Jiwani. TATA is Great Institute with exemplary surgeons and Great protocol;s. They do so much service there and God will always bless them. Dr.Anil HEROOR had invited me for a case, his first another terrific surgeon at Fortis. The HIMALAYAN MAN Dr. Lala my senior at Kidwai invited me for few cases at Hinduja Hospital and his center has the only motion table in India which moves with robot. Nanavati Hospital made famous by Amitabh Bachan , invited me twice for robotic cases. Dr. Donald at Mumbai Hospital is another surgeon with whom I did cases twice.

MANGALORE: I visited thrice Yenopaya University. My teacher Dr. M Vijay Kumar Sir invited me to demonstrate and it was a moment of pride for me helping my teacher. And have a great buddy there Dr. Akbar, a clean hearted, jovial man. Gretaly appreciate Vijy Kumar sir for his crystal clear concepts, fine surgery and leadership capabilities.

HRISHIKESH: AIIMS has my favourite Robot Xi with dual console. It’s a treat to operate on this system. The Institute is led by a dynamic director and has exemplary Surgeons. I was there during their 200 th case and it’s celebration. It also helped me in visiting the holy places there and in Haridwar. I paid tribute to my father and mother at Ganga Kinare and thanked them for my upbringing. Ganga Harathi sends waves of reverence in believers.

JODHPUR: Head of Dept of Gynec Oncology and Dr. Shashank a dynamic young Gyneac Oncologist have invited for few cases. Again AIIMS there has dual console and director EA’s mu senior Dr. Sanjeev Mishra who helped me in Kidwai where he was my room mate. I still remember I starved for a day as I dint know the area well and my other room mates ignored me . But he realised my plight and offered me his cook. Kidwai was a jungle ot aught me HOW TO LIVE ,my own state mates didn’t help me but others did.

LUCKNOW: SGPGI remains in my eart for ever. We did the first robotic case in Uttar Pradesh and SGPGI. Dr. Amit Agrwal from dept. of endocrine surgery as very encouraging and we did more than 25 scarless thyroidectomies in the institute by BABA, Trans Axillary etc,. So also helped initiate Urologist their first case. Lucknow has heritage buildings and SGPGI enriched my scarless Thyroidectomy experience.

My most memorable experience was going and helping Dr. Arvind Krishna Murthy,Head of Thoracic Surgery at ADYAR CANCER INSTITUTE. We did a robotic Esophagectomy there. Cancer Institute was nurtured,and developed by Legends Dr. Krishna Murthy sir and Madame Dr. Shantha. The institute is most academic, unbiased, protocol based hospital. My dream of operating at Adyar was fulfilled. Dr. Arvind and Dr. Ramakrishnan are two dynamic and academic specialists there I have friendship with.