Wednesday 16 March 2016

The Transplantation of the Human Organs (Amendment) Act, 2011. A case for legalizing sale of organs. By Indiritta Sngh D'mello, Director, Hospital Guide Foundation

It is paradoxical that even though there has been a medical breakthrough in terms of organ transplantation, people are still dying due to the non availability of vital organs. This is certainly not because of the lack of organ donors, but because the law unwittingly becomes an impediment to making organs available. Working in the area of healthcare, I routinely encounter patients who are facing death because of non availability of organs. As an NGO, we are often helpless when these patients approach us, with the hope that we will be able to give them some miracle solution.
The very reason that the Transplantation of the Human Organs Act (THOA) was passed, was to encourage altruistic donations in order to meet the demand of organs for therapeutic purposes and to curb commercial dealings. This intent has, unfortunately, been defeated. Twenty years after the original THOA was passed, and even after it was amended to include more stringent punishments, organ trafficking still continues to thrive. Case in point is the recent Odisha kidney sale racket where the medical director of a corporate hospital was arrested in June 2014. According to the World Health Organization, almost 10,000 organs are traded illegally every year globally. This means that an organ is being sold in the black market almost every hour. The trade has a few identified hubs - of which India, with its high population of poor - is one. Unofficial estimates are that almost 1,000 kidneys are sold every year in the country.
“When a product is desired, a market (legal or illegal) will develop; prohibition simply drives markets further underground. Clamping down on unlawful organ sales without expanding the organ pool will not result in less criminal activity.” Organ trafficking thrives because the organ donation story has been a virtual non starter in India. The demand for organs is high in India and the supply does not meet the demand even remotely. India is projected to be the diabetes capital of the world with 80 million people suffering from diabetes in 2025, which means the number of people who are going to have kidney failures in the near future is only going to spike exponentially. The lack of supply of organs in India is certainly not because of scarcity of population (1.21 billion according to the 2011 census). In case of cadaver donors, even if 5% to 10% of all brain dead patients became organ donors, it would mean that there would be no requirement for a living person to donate an organ. However, the proportion of organ donors in India is amongst the lowest in the world. India had 0.16 donors per million population in 2012 compared to 35 for Spain, 27 for Britain and 26 for US. In India, 12 people die everyday for want of an organ. Some 2.1 lakh require a kidney transplant annually but only 3000-4000 get it. In such a situation where it is a question of survival both for the patients who need the organs and for the poor who are trying to make ends meet, organ trafficking is bound to thrive. “The choice before the poverty stricken people is whether to sell one kidney and live, or keep both kidneys and die of starvation!”
Because of illegal trafficking, the poor get exploited at the hands of the middlemen, receiving only a fraction of the funds extracted for their organs. The donors are not informed properly of the risks and at times do not even know their organ is being removed; they suffer from poor health outcomes due to the lack of medical follow ups because of the clandestine nature of the transaction; and the recipient risks contracting diseases from the poor quality of the organ received like Hepatitis and AIDS. By legalizing the sale of organs, one can regulate the market and allay the ill effects of the illegal market.
In fact, the THOA sometimes even works against willing donors who are legally allowed to donate their organs. The thrust of the Act concentrates much on curbing the sale of organs, which creates cumbersome procedures resulting in procedural delays and can cost human lives. It also deters hospitals from encouraging organ donations from donors that are not ‘near relatives’ for altruistic reasons, as they fear getting involved in legal entanglements. The Act says that the donor can only donate for reasons of affection and attachment. Can one really establish when a person is genuinely donating for altruistic reasons specially in cases of not ‘near relatives’? The Authorization Committees want to play it safe, often falling victim to overkill, so not only in cases of those donors that are not ‘near relatives’ but also ‘relative donors’ they have rejected approval of organ transplantation. Even if the court orders these Authorization Committees to reconsider, this delays the whole process and puts the patient and family through more distress than what is necessary. These delays cause deterioration in the patient’s condition, often endangering their life.
However, the truth is that there is no utopian solution as far as live and cadaver donors are concerned. Live donor transplantations are sub-optimal for the donors in terms of risks of death and morbidity rates. Cadaver donor transplantations are sub- optimal for the recipient. Dr. Ajit Huilgol, Transplant Surgeon states that “the success rate in cadaver donor transplantation is 15 to 20% less than live donor transplantation.” If that be the case, it cannot be argued that an ideal solution is to have a cadaver donor program with less dependence on live donors or vice versa. To develop a successful cadaver donor program will have a set of its own challenges. One of the many challenges being the public outlook towards cadaver donors which is entwined with religious sentiments of keeping the sanctity of the dead body. And to be able to increase the number of organs available through living donors, altruism as the only incentive is not enough as there is pain, risk and financial loss involved in donating. Thus there is a need to legalize sale of organs in living donors, so that it can aid in meeting the demand of organs.
Even if it is assumed that a cadaver donor program is an ideal situation, then it may be argued that to legalize commercial dealing will dampen the cadaver donor program. However, the two are not mutually exclusive. “To argue that it is morally imperative to legalize the trade in human body parts is not to argue that other methods of organ procurement should be abandoned. Since one of the main reasons for advocating that such a market be legalized is to increase the supply of transplant organs, it is clear that any ethical means of achieving this should be encouraged.”
On ethical grounds, there is a case for legalizing sale of organs. Where human lives are concerned, no legal barrier should supersede the need to save lives provided it is done through ethical means. The law is not supposed to define ethics; on the contrary, the law is developed on ethical principles. It is these principles that define what is good for the individual as well as for society, and establishes the nature of obligations or duties on the basis of which laws are framed. “Society owes a duty to save the life of a dying man and in the event of failure to do so, it is absolutely immoral to interfere with his own arrangements by making unrealistic laws.” If the argument is used that we are encouraging commodification of organs, then the law makers cannot have double standards. By proposing The Assisted Reproductive Technologies Bill 2010, they have already endorsed commodification of reproductive body parts. To illustrate this point, we must consider that the risk of dying from renting out your womb is six times higher than from selling your kidney. If we are all right with commodifying reproductive body parts where it is not a question of life and death and the risk to the person who is commodifying her womb is higher than the person selling the kidney, then there is no reason why selling of vital organs in order to save lives should not be endorsed.
A utopian solution does not exist and will never exist. Taking into account the cultural and economic context of India, in legalizing the sale of organs in living donors, the pros far outweigh the cons. Apart from allaying the ill effects of the illegal market, we might be successful in saving the lives of many people waiting for transplant organs, as well as improve the quality of life of the many people who would otherwise have to undergo debilitating and painful procedures to stay alive. Such a step will have other positive effects like improving the economic conditions of the poor donors. Additionally the cost effectiveness for both, the patients and the healthcare system cannot be overlooked.
“Instinct often trumps logic. Sometimes that's right. But in this case, the instinct that selling bits of oneself is wrong leads to many premature deaths and much suffering. The logical answer, in this case, is the humane one.”

Glaucoma and Cataract

Glaucoma and Cataract! Some questions were raised by a patient/attendant on Glaucama and Cataract. Answers were given by Dr Umang Mathur, Medical Director, Dr. Shroff Charity Eye Hospital, Daryanganj, Delhi for Hospital Guide Foundation.
1.Is it safe to have a cataract surgery for a patient with Glaucoma in the same eye? Are there any alternatives?
Yes, it is safe to undergo cataract surgery with co-existing Glaucoma. The decision to be made is whether just a cataract surgery is to be done or cataract should be combined with trabeculectomy (surgery for glaucoma). This decision has to be made by the treating ophthalmologist, based on severity of glaucoma, whether eye pressure is managed on a single drug or more and compliance (ability to put drugs regularly and come for check-ups).
No there is no alternatives to surgery for cataract. If the cataract is causing blurred vision, it needs to be operated to improve vision.
2.Can a Glaucoma specialist do a cataract surgery? Or is there a separate cataract specialist the patient should consult?
Most glaucoma surgeons also perform cataract surgery, except for a few who restrict themselves to only glaucoma procedures
3.We were informed that the cataract surgery is typically done using special equipment but given patient’scondition, it might be done manually. Is this the usual procedure for a patient with both conditions?
Let the surgeon decide whether it should be a Phacoemulsification procedure or manual cataract surgery. This would be dependent on the hardness of the cataract and other factors in the eye. The results can be equally good with the latter. The only difference is that spectacles are prescribed after 6 weeks instead of 3 weeks.
4.Are there chances of her loosing vision due to the surgery? Are there any post-op complications we should be aware of?
If you get operated in good conditions with good quality systems, chances of loosing vision are remote

Good old Aspirin for Cardiac Emergency, by Dr. Gourdas Choudhary

Good old Aspirin for Cardiac Emergency
Heart attacks are common above 40, often coming at odd times, without warning, and are the commonest killer of our modern times. The best chances of reducing the severity of an acute attack and improving the chances of survival are by chewing aspirin at the very start and reaching a hospital within 2 hours.
A doctor colleague of mine, Dr Anil Behl, has started a unique form of social service, of putting 4 aspirin tablets in a plastic pouch and keeping it available at all times with the security check-post of his housing colony. He has backed up this simple act by informing all residents of his colony by email and posters, that should anyone have early symptom of heart attack, they should immediately procure the pills from the security room and chew them while waiting for further help to arrive.
During a heart attack, blood clot forms in the arteries of the heart blocking the flow of oxygen-rich blood to heart muscles. Clot formation begins with clumping of small blood particles called platelets. What aspirin does is that it prevents stickiness and clumping of platelets,. When taken during a heart attack it therefore slows clotting and decreases the size of the clot.
Most cardiologists swear by aspirin for several reasons.
For those who have had a previous heart attack, long-term use of aspirin reduces the chances of having a second one.
It is useful for those who have never had a heart disease before but are at increased risk of having one. This group includes people above 40 who have diabetes, high blood pressure, increased blood levels of cholesterol and smokers. Those with a strong family history of heart disease also come in the “risky” category.
A daily dose of low-dose aspirin has been shown to reduce the risk of a first heart attack in this group. Cardiologists also recommend aspirin to all those who have had a cardiac artery bypass surgery or angioplasty. The reasons are much the same. It prevents platelets to clump thus reducing the chances of clot formation in the arteries of the heart.
Heart attack presents as heaviness or pain in the center of the chest, often radiating to the neck or left arm or back, sometimes associated with sweating and uneasiness. It is often felt as “gas” and vomiting by some.
Aspirin is of course the first step that can be taken at home or on the way to a hospital. An angiography, and opening up of the blocked arteries by angioplasty, performed within the first 6 hours, reduces damage and death of heart muscles, and the best chances of long-term survival.
It makes sense to keep aspirin handy at all times, not just for you, but others around you who might need it in an emergency.

Sunday 1 March 2015

Five surprising benefits of Green Tea

One of our favourite beverages to beat those signs of fatigue and get our concentration levels
running is a heady cup of green tea. The tea has been hailed as a healthier alternative to black tea
and is often enjoyed without sugar by health-conscious individuals. However, besides its well-known
properties of being a good source of anti-oxidants in your body, how else does green tea benefit
you? We give you the low-down:

Reduces inflammation

Inflammation is a very common occurrence in the human body and is linked to many conditions
ranging from sore throat to arthritis. A cup of green tea has been linked with reducing these
inflammations and alleviating pain. Due to this quality, the tea is also believed to protect you from
various cardiovascular diseases.

Boost your vision

It’s not just carrots that can vouch for your eyesight. Green tea’s anti-oxidant properties can
penetrate the tissues of your eyes and boost their performance. Besides aiding you to see better,
the tea is also linked with keeping cataract away.

Alternative to sunscreen

Run out of sunscreen and you have to make that trip in the afternoon sun? A cup of green tea can do
wonders! The catechins found in green tea safeguard your skin from UV rays and helps keep
premature ageing at bay. The redness and soreness that’s caused by being in the sun for too long
can also be alleviated by green tea’s anti-inflammation properties as well.

Anti-allergen properties

With the weather constantly changing, it’s no surprise that you are susceptible to allergies that can
bring about a common cold or an eye infection. Green tea is known to have quercetin, a type of
flavour that fights histamine reactions in your body. Add a teaspoon of honey to your green tea and
you can boost its anti-allergen properties.

Healthier teeth and gums

Even though tea is historically known to leave your teeth stained because of the tannic acid found in
it, green tea is believed to boost your dental health. Catechin, found in green tea, is known to reduce
symptoms of periodontal diseases. Besides that, it also reduces the acidity of saliva and controls
bacteria build-up in the mouth.

Saturday 12 July 2014

Don't lose hope by Rama (Disclaimer: Hospital Guide Foundation provides a neutral platform for Patients/attendants & Doctors to express their opinions/experiences. These views are of the writer.)

I would like to share the difficult moments which we underwent during the treatment of my husband.  It was way back in 2012, when we were happily settled in Coimbatore after a hectic life in Mumbai where both of us were working.  We used to shuttle between Coimbatore and Bangalore, where our both the daughters were settled after marriage, to spend some time with our grandchildren.

In January, 2012, one day my husband suddenly complained of severe stomach pain and went to the doctor.  There the Dr. prescribed some pain killers and asked him to go for an ultra sound.  We then went to the family doctor who asked us to go for a ct scan immediately, though the pain had subsided by then.  The CT scan showed some mass in the gall bladder area and we consulted a senior surgeon who said that the patient has to undergo an operation for removal of the mass and further investigation.  So with the help of our family doctor, my husband underwent all the tests before the operation and he was found to be ok in all the tests.  On 30th January, 2012, he underwent an open surgery and even while undergoing the operation, the mass was sent for a pathological test and that gave me the shock of my life, my husband is suffering from cancer of the gall bladder.  The surgeon removed the gall bladder and advised us to see a oncologist for further treatment.  This news gave me a terrible shock, I started thinking why God has given me this again, 20 years back my father died of cancer.  But I was assured by the surgeon that things have improved a lot in the last 20 years and we should have a positive approach.  

Our next visit was to the oncologist.  He went through the reports and told us that my husband has to undergo chemotherapy once in 15 days for six months.  The oncologist was very positive and he assured us that he is confident of treating him and that we should also have a positive approach.  At this point, I should surely mention about the way my husband took the whole thing, he was very.......... positive and was so confident that he will be out of it.  The whole family, particularly my daughters and the sons-in-laws were so supportive.  They decided in consultation with their family doctor, that we will continue the treatment in Bangalore.  Thus started our visits to the hospital every 15 days for the chemotherapy.  One day before the chemo, he was asked to undergo blood tests. The oncologist was very helpful and the whole staff of the hospital were very cooperative.  We followed the instructions of the doctor strictly and the whole treatment went on very smoothly.  Sometimes he vomited and was little down at times because of the food restrictions and restrictions on his movement outside the house.  But we regularly went on our daily walks, we visited Coimbatore twice during the treatment.  My husband did not lose his hair and jokingly he used to tell people that he had to spend money for a haircut!!  After the six months chemo, the oncologist took a pet scan and we were very happy with the result, the cancer has not spread and he now requires only a regular medical check up once in three months.

We went back to our house in Coimbatore and resumed our routine.  My husband was very happy, back to his friends and his regular badminton.  We had our regular check ups and  slowly even forgot the chemos and other treatments.  We started visiting our family functions, marriages etc.  We even went on a holiday to Kodaikanal with our daughters, sons-in-law and the grandchildren.

After a period of 8 months since his last chemo, my husband suddenly developed itching all over the body.  There was no other problem, but the itching became unbearable.  We consulted even a dermatologist who said that it may be due to the dry weather of Bangalore.  We tried all sorts of lotions and creams.  Then one day in the mid of the night, after going to the toilet, he told me that he passed some blood.  We got worried with this development and next day early morning we called up our oncologist who advised us to go for a LFT.  I must mention here one thing, all the doctors inspite of their busy schedules, were always responding to us though we called them any time of the day or night.  Immediately my husband went for a LFT and the report showed very high level of bilirubin.  Then started our ordeal of visits to the doctors - oncologist, urologist, liver specialist etc.  Inspite of stenting two times, his bilirubin went on increasing and the sodium level went down.  The doctors said that it is due to a block in the bile duct - obstructive jaundice.  After the first two months during which time he was hospitalised 3-4 times, we could see that he was becoming weak day by day.  His daily routine got affected and was becoming quite irritated.  With even a slightest strain, he was developing high fever.  The bilirubin level was constantly on the rise.  During this time the oncologist asked us to go for a Pet scan, the report showed that the cancer might have resurfaced, the report was not very clear, but the oncologist felt that the disease has surfaced again, but is progressing very slowly.  The oncologist wanted to again try chemo for him, but only after the bilirubin level comes down.  But that did not happen at all.  My husband started having water retention in the body, his abdomen, feet were swollen, he was finding it difficult to move around.  The doctors pumped out the water from his abdomen, but that did not give him much relief.  We could see that his condition was deteriorating, our family doctor told us that his condition is worsening and nothing much could be done.  One day the surgeon who had operated him visited the patient in the hospital.  He told us since nothing much could be done at this point, better to go for palliative treatment.  We followed his advise.  My husband was brought home and we tried to make him as comfortable as possible.  Though he was getting a little frustrated as he started depending on us for even going to the toilet, yet he still had a positive approach to the whole thing.  Never he said that he is fed up with the treatment, only he was a little scared of the pain he had when they were piercing needles for the intravenous injections and the drips.  It is this positive approach which gave him and also us the strength to fight the disease.

  Then on 22nd September, 2013, his sister, brother and some more relatives had just left after visiting him, I insisted that he should  have a bath and eat his lunch.  He was reluctant for having a bath as he required help, which I was always ready to do.  He had his bath, ate his simple lunch and went to bed.  Around 3.30 pm he called me, said he wants to go the toilet, I helped him get up from the bed, he got up, but was not steady, he started collapsing.  I called my son-in-law who came and held him, but then my husband was breathing very heavily.  My daughter tried to get his pulse, but could not and we could see him passing away from us.  The doctor was called and he said that 'he is no more'.  Thus came his end at 3.50pm.  The end was quite peaceful.

All this experience of nearly 18 months has made me quite strong to face any adversaries.  If we are destined to suffer we have to.  In these trying times, it is the positive approach of the patient and the family support gives us all the strength.  What I wish to share with others who are in the same condition, don't lose hope, have a positive approach, follow the doctor's advise, have faith in the doctors and above all in the God almighty.  

Wednesday 30 April 2014

What is Robotic Surgery by Dr. Arun Prasad. Senior Consultant Surgeon - Minimal Access Surgery, Apollo Hospital. (Disclaimer: Hospital Guide Foundation provides a neutral platform for Patients/attendants & Doctors to express their opinions/experiences. These views are of the writer.)

Robotic surgery, computer-assisted surgery, and robotically-assisted surgery describe the technological developments that use electro mechanical systems to help a surgeon perform surgery.
The davincirobot which is currently the market leader is not Mr. Data from Star Trek performing precise surgery on the human body.
The general term "robotic surgery" is used to refer to the technology, but it is easy for people to get the impression that the robot is performing the surgery. Actually, the current Robotic Surgical System cannot run on its own. This is due to the fact it was not designed as an autonomous system and lacks decision making software. Instead it relies on a human operator for all input.
All functions- including vision and motor functions— are performed through remote human-computer interaction. The current system is designed merely to replicate seamlessly the movement of the surgeon's hands with the tips of micro-instruments, not to make decisions or move without the surgeon’s direct input.
In other words it is like a PS3 or an Xbox where you control the movements completely and hence the outcome of the ‘game’.
Robotically-assisted surgery was developed to overcome both the limitations of minimally invasive surgery or to enhance the capabilities of surgeons performing open surgery.
In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance. In 1988, the PROBOT, developed at Imperial College London, was used to perform prostatic surgery. The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement. Further development of robotic systems was carried out by Intuitive Surgical with the introduction of the da Vinci Surgical System.
According to the manufacturer, the da Vinci System is called "da Vinci" in part "because Leonardo da Vinci invented the first robot", and also because he used anatomical accuracy and three-dimensional details to bring his works to life.
The system consists of a surgeon’s console that is typically in the same room as the patient and a patient-side cart with four interactive robotic arms controlled from the console. Three of the arms are for tools that hold objects, act as a scalpel, scissors, bovie, or unipolar or bipolar electrocautery instruments. The fourth arm is for an endoscopic camera with two lenses that gives the surgeon full stereoscopic vision from the console.
The surgeon sits at the console and looks through two eye holes at a 3-D and HD image of the procedure, meanwhile maneuvering the arms with two foot pedals and two hand controllers.

It scales, filters and translates the surgeon's hand movements into more precise micro-movements of the instruments, which operate through small incisions in the body.
To perform a procedure, the surgeon uses the console’s master controls to maneuver the patient-side cart’s robotic arms (depending on the model), which secures the instruments and a high-resolution endoscopic camera.
The instruments’ jointed-wrist design exceeds the natural range of motion of the human hand; motion scaling and tremor reduction further interpret and refine the surgeon’s hand movements.
There are multiple safety features designed to minimize opportunities for human error when compared with traditional approaches.
At no time is the surgical robot in control or autonomous; it operates on a "Master:Slave" relationship, the surgeon being the "Master" and the robot being the "Slave."
So the decisions on what to cut, where to cut, how to cut, when to cut, where to stitch, how to stitch etc are all taken by the surgeon and robot just replicates the hand movements.
This has been designed to improve upon conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on his/her patient-side assistant to position the camera correctly. In contrast, the da Vinci System’s ergonomic design allows the surgeon to operate from a seated position at the console, with eyes and hands positioned in line with the instruments. To move the instruments or to reposition the camera, the surgeon simply moves his/her hands.
Some major advantages of robotic surgery are precision, miniaturization, smaller incisions, decreased blood loss, less pain, and quicker healing time. Further advantages are articulation beyond normal manipulation and three-dimensional magnification, resulting in improved ergonomics. Robotic techniques are also associated with reduced duration of hospital stays, blood loss, transfusions, and use of pain medication.
In addition, surgeons no longer have to stand throughout the surgery and do not tire as quickly. Naturally occurring hand tremors are filtered out by the robot’s computer software. Finally, the surgical robot can continuously be used by rotating surgery teams.
By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction.
However there are some downsides too. Surgical procedures performed with the robot take longer than traditional ones. Critics say that hospitals have a hard time recovering the cost ( Robot costs 1 million dollars to set up and a recurring cost of about 1500 dollars per surgery ).
A Medicare study found that some procedures that have traditionally been performed with large incisions can be converted to "minimally invasive" endoscopic procedures with the use of the Robot, shortening length-of-stay in the hospital and reducing recovery times. But because of the hefty cost of the robotic system it is not clear that it is cost-effective for hospitals and physicians despite any benefits to patients since there is no additional reimbursement paid by the government or insurance companies when the system is used.
Robotic Surgery has been successfully used in the following procedures:
General and Gastrointestinal Surgery: Cholecystectomy, Hernia repair,Appendicectomy, Nissenfundoplication for hiatus hernia, Heller myotomy for achalasiacardia, gastric bypass, adrenalectomy, splenectomy, small intestinal surgery, colonic and rectal surgery etc.
Bariatric Surgery: Gastric bypass, gastric sleeve resection and gastric banding.
Thoracic Surgery: Thymectomy, mediastinal tumor, lung resections, esophageal surgery.
Urology: Radical prostatectomy, pyeloplasty, cystectomy, nephrectomy, ureteralreimplantation.
Gynaecology: Ovarian cyst, Hysterectomy, myomectomy and sacrocolpopexy.
Cardiac Surgery: Coronary artery bypass, Mitral valve repair, endoscopic atrialseptal defect closure.
Head and neck: Transoral resection of tumors of the upper aerodigestive tract (tonsil, tongue base, larynx), transaxillarythyroidectomy

The computer-enhanced technology and robotic precision ensure a level of surgical precision never before possible. The use of robotics is changing medicine dramatically. As the technology continues to advance and patients experience the benefits of robotic surgery, the demand for robotic procedures continues to increase.
Apollo Hospitals is taking a major step to bring the benefits of this technology to cancer patients in India.
Compared with traditional open surgery and standard laparoscopic surgery, patients treated with robotic cancer surgery benefit from more precise and accurate surgery of the concerned region in addition to decreased blood loss. This leads to less pain, fewer complications, shorter hospital stay and faster recovery.
The greater precision and maneuverability allow the surgeon to perform complex robotic cancer surgery procedures in areas that may be beyond the reach of traditional or standard laparoscopic surgery.
It appears now that this is an option restricted to few select hospitals in the world. No one knows what the future holds and this is best illustrated by the following statement by Professor Douglas Hartree, Cambridge mathematician in 1951:
“All the calculations that would ever be needed in this country will be done on the three digital computers which are being built — one in Cambridge, one in Teddington, and one in Manchester. No one else, would ever need machines of their own, or would be able to afford to buy them."