With a record of more than 414 successful robotic surgeries with Versius Robot under his belt, the wizardry of Dr. Raj V. Nagarkar, Surgical Oncologist, Managing Director & Chief of Surgical Oncology and Robotic Services, HCG Manavata Cancer Centre Nashik, is now legendary. By bringing world-class cancer care facilities to Nashik and opening Cancer Care Centre, he aims to transform the way cancer is treated and healthcare service is provided to the people around the region. As the single largest private Cancer Hospital in India with 272 beds, the hospital is rapidly emerging as a leading academic centre and a global health destination hub.
The momentous India@75, is a major milestone in the nation’s history. How has your journey and experience been so far?
In 1990, my dream and ambition, was to become a petro-chemical engineer after completing my 12th standard. As destiny would have it, my grandmother was detected with cervical cancer. When the word cancer was uttered, I could see the pall of disturbance, dilemma and despondency descend on the family. I accompanied her to TATA Memorial Hospital in Mumbai and there, I met late Dr Shashank Shinde, who later on was my mentor when I joined his unit after completing my internship. His words still ring loud and clear, “Why do you want to become an engineer? Become a doctor and serve mankind better,” which touched my heart to the extent that I made up my mind to become a cancer surgeon and wished to return to work in Tata Hospital. That one journey from Pune to Mumbai changed the journey of my life. My father Mr. Vasantrao Nagarkar was a firm support.
Why did you decide to settle in Nashik and not go abroad or join a corporate hospital in India?
After completing my MBBS from Jawaharlal Medical College, Belgaum, and soon after my internship, I secured one of the six seats after clearing the all-India level test for admission to MS in Oncological surgery at Tata Memorial Hospital. Five years later, I went on to do my MRCS at the Royal College of Surgeons Edinburgh, UK, and I was among the first few Indians to have completed my MRCS. I also did my DNB from the National Board of Examination. Many offers came my way from prestigious medical organization, but I was not charmed by UK or Mumbai either, for the reason, when I was away from home from 1998 to 2000, more than 4-5 family members were diagnosed with cancer. So, I had to come back to Nashik because the town did not have any cancer surgeon. I was the first trained oncologist for the whole of north Maharashtra that covers 13 districts and caters to a population of around 12-14 million.
How was the experience of your first surgery in Nashik?
When I actually started medical practise, I realised that it was not a cake walk. I had trained at the highly premier Tata Institute and then in UK where I was exposed to the latest ultra-modern gadgets, the multidisciplinary approach, the team approach and the SOP’s and protocols in place. From there I was literally thrown into wilderness where medical infrastructure, so to speak of was hardly there. It was an era when private practise in Nasik was nowhere close to the environment I was exposed.
I started my medical practise with late Dr Vasant Pawar, a very eminent surgeon and ex-member of Parliament. I recall vividly that I reached Nashik on 2nd July and met Pawar sir who said, “We have a stomach cancer patient, why don’t you come tomorrow and operate at 4 in morning?” I was taken aback, but committed to operate. The next morning when I entered the OT, my eyes swept the room in search of the Cautery machine and was aghast to see any. At that time only open surgeries were done and people were operated with knife and scissors. I broke into a sweat, but dared not reveal the fact that I could not operate because I had not performed any surgery without a Cautery machine. I was left with only two options either to admit to Pawar sir that I cannot operate or take up the challenge. I overcame the dilemma and chose to go ahead. The surgery took 4 hours, which was the worst nightmare of my life and I cursed myself every second for doing so. I was so frustrated on the futility of continuing here and in the gush of emotion the first thought was to pack my bags and run away to England as it was impossible to survive like this. Towards the end of the surgery, Dr Pawar and Dr Vasant Bele, senior anaesthetist commented that it was an excellent surgery, something they had never seen before. For me it was the worst surgery of my life. That was the moment when the thought crossed my mind on what kind of surgery the people of this part of the country were going through. The first thing I did was arrange for an Eclipse Cautery machine, the first in the whole of north Maharashtra. Those harrowing four hours gave me the opportunity whether to regret, repent and show may back and quit. Thereafter, I took an oath that I will make sure that the best of healthcare comes to my region. And that was how the journey of my surgical oncology practise started.
What makes HCG Manavata Cancer Centre different from other Cancer Hospitals?
The first NABH accredited hospital in entire central India, Manavata Cancer Centre, was inaugurated on 14 th May 2007, which also coincides with my father’s birthday. The state-of-art cancer centre providing comprehensive and integrated care began with a humble 35 bed cancer facility and a dedicated team of 35 people to grow into a 270 bed and over 720 dedicated team today, who provide the best of services with empathy. As a result, the footfall has improved manifold with patients coming from as far as Dubai, Africa, Uzbekistan, Bangladesh, Yemen. We have brought smiles to many patients and it is a joy to see those operated 15-20 years ago hale and hearty. These success stories are actually what the society should know more about.
Our second hospital came up in 2017 and we grew rapidly to cross the 90,000 patient mark, as on date, in treating cancer patients. Alongside, we focused on academic programs. We are affiliated to Maharashtra University of Health Sciences, National Board of Examinations, New Delhi for DNB training in Surgical Oncology, Radiation Oncology, along with Breast Fellowship, Clinical Research. Academics has also taken up a forefront, where we have a multidisciplinary team approach. DNB students get tremendous exposure in our hospital. I think academics is the best way to progress, and I also get to update my skills and knowledge.
Your hospital is a fully equipped facility. Can you share more about it?
We have been among the first to install gadgets like the linear accelerator radiation machine, PET CT scan, IMRT, Tomotherapy, Bone Marrow transplant in the state, after Mumbai. In 2017, when we purchased the third radiation machine we settled for the Rs 22 crore worth Tomotherapy HD machine, because I did not want to compromise on precision and quality, investing heavily, so that patients from rural areas have the best choice for treatment and not compromise for a sub optimal treatment just because they cannot travel to the metro city. Every year on 14th May, I ensure that some new gadget is purchased for our hospital. More than the equipment and infrastructure the passion of our team to ensure the well-being of our patients is what puts us apart.
How has Robotic Technology impacted the healthcare sector and medical intervention, particularly cancer?
In 2018, I started thinking about adding the robotic platform to our profile which was really appealing and needed. So, we finalized the Da Vinci machine and everything was going as planned when I get a call informing me about a CMR Robotic System and was pursued to have a look at it. Though in two minds, I went there and was very impressed, but I had not heard about or seen anyone treated on that machine. So, after a fortnight, I flew to work in the cadaveric lab on that machine and was impressed. The machine was installed in our hospital and I performed my first surgery on CMR platform on 9th of October 2019. My goal was very clear, I believed in volumes and by that point of time I had already performed 45,000 cancer surgeries.
Congratulations on completion of over 400 robotic surgeries. How has the Versius Robotic System helped you achieve this number?
We want to make surgery more safe and more acceptable to the patient with lower risk of infection and complications, therefore, as compared to the other conventional ones, Versius is far superior in its outcomes. Till date, I have performed 414 robotic surgeries, most of them during a global pandemic. Of the 20 months of having the Versius Robot about 16 months were during Covid 19 and yet this could have been the fastest number that anyone could have achieved in India or in the world. CMR Surgical were kind to give me the tagline, “The most experienced Versius User in the world” ! It is less than 20 months since I started working on the robotic platform. Before, I used to take 90 minutes to perform a robotic hysterectomy surgery and now it takes only 35 mins and the patients are out of the hospital in 48 hours. With experience comes speed. I feel that robotics is most suitable for people who cannot afford to recuperate for a long time at home as they have to make ends meet. I believe that whoever needs robotic surgery should definitely get the benefit of it.
With the number of surgeries conducted, how has this Robot benefited the patients and you as a Surgeon as well?
The advantage of Versius is that it provides a three-dimensional image, which is magnified 16 times along with precision where blood loss is less, co-lateral damage to tissues is less, chances of infection are less, post-operative pain is very less and recovery is faster. Versius is cost effective both for the hospital and the patient and it is less taxing as far as the surgical part is concerned. I have done 6 robotic surgeries in a day without getting exhausted. In the decade to come, Verisus or any other robotic platform will be part of every surgical armamentarium. It’s our responsibility to pass on the knowledge and expose young doctors to robotic surgery. Even I would personally recommend robotic surgery even for my family members because I have seen the advantages of that technology.
What are the immediate expansion plans and social support initiatives launched by you?
With the 272 bed Cancer Centres we are already catering to more than 500 cancer patients daily irrespective of their socioeconomic background. We are adding another 180 beds of super speciality and 90 beds in mother and child care, because North Maharashtra needs quality, and ethical services at the doorstep, which are cost effective. The immediate expansion plans include another 50 bed cancer hospital in Parbhani, in the Marathwada region, where there is no development as far as oncology is concerned. My idea is that the common man should be the beneficiary, and we have been supported by the society very well.
On the social upliftment front, we have done a programme called Aarogya Saheli, which is a woman’s care initiative for free screening for breast and cervical cancer, managed by an all-women’s team. Till date, we have screened more than 30,000 women free of cost.
Our hospital and Its impeccable services has branded Nashik as a world-class cancer care centre, where it is not just about technology, but also bout empathy and our passion to make sure that cancer is treated.
This journey could not have been possible without support from my better half Mrs Prarthana. I feel I have been a good doctor to inspire my children Viren & Aastha to follow my path of healin
