Question 1

How do you control fibrosis, meaning adhesions in the lung, following resection of empyema, and is lung transplantation possible after pulmonary tuberculosis?

Dr. Shaiwal Khandelwal · Accepted Answer

After empyema surgery in young patients, both a visceral and parietal decortication are performed, and dense adhesions do form afterward, that is simply the nature of the disease and the aim of surgery is to release the lung and prevent fibrothorax, not to avoid adhesions altogether. Lung transplantation after pulmonary tuberculosis is very challenging, particularly if the patient has already developed fibrothorax; a unilateral transplant may be possible in some cases, but it depends entirely on the individual patient and no generalised statement can be made. Deceased-donor lung transplant is also not available to international patients under Indian law, which permits only living donors.

Question 2

How do you avoid the laryngeal nerves while operating in the thoracic region using robotic tools, and is the robot able to resect tumours completely when they are closely related to sensitive areas like the laryngeal nerves?

Dr. Shaiwal Khandelwal · Accepted Answer

The robotic platform's vision is excellent, so nerves that are difficult to identify by standard VATS are very clearly seen with the robotic system, and it also allows much finer dissection. These sensitive structures are therefore better identified and better protected specifically because of the robotic system's magnified 3D vision and precise instrument control.

Question 3

Can you elaborate more on hyperhidrosis surgery, specifically how patients are selected and how the procedure is performed?

Dr. Shaiwal Khandelwal · Accepted Answer

Surgery should never be offered to every patient with hyperhidrosis; a detailed assessment is required first, and all non-surgical options, oral medication, local treatment, creams, and Botox, should be exhausted first. Surgery is reserved only for high-grade hyperhidrosis where the hands are literally dripping, since every form of surgery carries some side effects, and the benefit of dry hands has to be weighed against them. Patient selection and precise technique matter more than the surgery itself: robotic assistance allows accurate identification of the ganglia, which is very difficult by standard VATS, and Dr. Khandelwal's own technique of setting the sympathetic chain close to the third ganglion with a grey ramicotomy at that level has produced good results with fewer side effects than older, less precise approaches.

Question 4

Is it possible to invent artificial lungs, and is there any research going on for this? Also, how far away is xenotransplantation, using organs harvested from animals?

Dr. Shaiwal Khandelwal · Accepted Answer

Devices like Novalung or ECMO are sometimes loosely called artificial lungs, but these are only a transition to tide a patient over, not a permanent solution. Xenotransplantation for lungs is not a reality and is still limited to animal labs, with no near-term prospect of harvesting an animal lung for human transplantation. What is genuinely advancing is ex vivo lung perfusion (EVLP), where a harvested lung is brought to a lab and optimised before transplant, this has meaningfully increased organ utilisation and allows transplant surgery to be done electively rather than only at odd hours, though it remains expensive even in Western countries.

Question 5

For doctors practising in resource-constrained settings, what is the trigger or the symptom threshold that should tell them a case is complex enough that it may need to be referred abroad, even if they aren't fully sure and want to check first?

Dr. Shaiwal Khandelwal · Accepted Answer

Technology has made the world smaller, so practically everyone is living next door to expertise now. Any case can be raised by email or WhatsApp, with a response guaranteed within 24 hours, and the case can often be investigated or even treated locally with guidance if the necessary technology and facilities are available there. When the expertise or facilities are genuinely not available locally, the patient can then be brought to India, but sharing the case first, even just to check whether it meets the threshold for referral, is always the right first step.

Question 6

Would it be possible to run occasional medical camps where you come to Africa and perform specialist surgeries there directly?

Dr. Shaiwal Khandelwal · Accepted Answer

Surgery isn't just about surgeon skill, it also depends on OT infrastructure and trained technical staff, and not everything required can be exported to run a camp abroad. A more practical model already in use is a structured online OPD: patient details and reports are shared in advance on an agreed schedule, and the African doctor partner, the Jivo team, and the Indian specialist jointly review the case and decide what can be treated locally versus what genuinely needs travel to India, with real patient satisfaction from this approach so far.

Question 7

Approximately how many thoracic surgery patients from Africa have you treated, given that you practise in New Delhi?

Dr. Shaiwal Khandelwal · Accepted Answer

A large number of patients from various African countries have been treated, most commonly for bronchiectasis and various tumours of the lung and chest cavity, even without ever having personally visited Africa. For heart transplantation specifically, deceased-donor transplant is not possible for international patients under Indian law, so the more common referral for advanced heart failure from abroad is for an LVAD (left ventricular assist device), which has very good outcomes and has itself reduced overall demand for heart transplant.

Question 8

What are the success rates of lung transplantation?

Dr. Shaiwal Khandelwal · Accepted Answer

Deceased-donor lung transplantation is not possible for international patients in India under current law, but in general, outcomes vary significantly by the underlying pathology, results are good for pulmonary hypertension, while outcomes for cystic fibrosis, bronchiectasis and other conditions vary by the individual disease process rather than following one single success rate.

Thoracic Surgery: Basics to Robotics

Questions Doctors Asked Dr. Shaiwal Khandelwal