Dr.Ananda Kumar
Dr. Ananda Kumar, a renowned figure in surgical gastroenterology, hepatobiliary surgery, and bariatric surgery, boasts an impressive career spanning over 31 years, with 25 years as a specialist. His journey in medicine began with a degree from Bangalore Medical College in 1992, followed by a period of honing his skills in general surgery under the guidance of Prof. M. Chandrashekar at the Kidwai Memorial Institute of Oncology. This experience laid the foundation for a career marked by innovation and expertise.
Earning the prestigious FRCS from the Royal College of Surgeons of Edinburgh, Dr. Kumar further specialized in surgical gastroenterology with a fellowship at Nizam’s Institute of Medical Sciences, Hyderabad. His tenure at NIMS was characterized by refining complex gastrointestinal surgical techniques and contributing to academic literature through papers and presentations. His career trajectory continued upward at Yashoda Hospital, where he expanded his expertise in hepatobiliary and pancreatic surgeries, including advanced procedures like the Whipple’s operation.
Globally, Dr. Kumar enhanced his skills with a diploma in laparoscopic surgery from the University of Strasbourg, France, and advanced training in bariatric surgery from the North West Endosurgical Centre in Houston, Texas. A significant milestone in his career was earning an MD in Liver Transplant from Seoul National University Hospital, South Korea, cementing his status as a distinguished liver surgeon.
As the Chairman and Founder of Ananya Hospitals, Dr. Kumar’s vision transcends surgical prowess, focusing on patient-centered care and the establishment of a gastroenterology day care unit. His contribution to the medical field is substantial, with over 10,000 surgeries under his belt, highlighting both his technical skill and compassionate approach.
Dr. Kumar’s career is a beacon of medical excellence, inspiring future medical professionals and instilling hope in patients. His extensive training, academic contributions, and commitment to patient care have established him as a leading figure in surgical gastroenterology and hepatobiliary surgery, both in India and internationally.
Recently, Raja Aditya interviewed Dr. Ananda Kumar for Neo Science Hub (NSH) YouTube, providing an insightful glimpse into the mind of this esteemed surgeon. The following abridged textual version of this interview showcases Dr. Kumar’s profound knowledge and his visionary approach to surgical gastroenterology:
Dr. Ananda Kumar, could you share with us what inspired you to pursue a career in surgical gastroenterology and hepatobiliary surgery?
My journey towards specializing in surgical gastroenterology and hepatobiliary surgery began back in 1994 when I was completing my MS in General Surgery. At that time, surgical gastroenterology was a nascent specialty, limited to a few institutions like AIIMS Delhi and Madras. During my general surgery training, which in India involves learning a wide range of surgical procedures across various organs, I was drawn more towards GI surgery, which is globally synonymous with general surgery. However, I felt a growing need for focused training in specific surgical fields, and surgical gastroenterology seemed to be the perfect fit.
My desire to become a surgical gastroenterologist was further shaped by my encounter with Dr. M Chandrasekhar, a renowned surgical oncologist in Bangalore, who was then the professor of surgical oncology at Kidwai. Before honing my skills in GI surgery, I wanted to ensure that I was proficient in performing complex surgeries, so that no patient would ever doubt my capabilities. Under Dr. Chandrasekhar’s mentorship, I focused on the epitopiary aspects of surgery. He was an extraordinary mentor, akin to a ‘walking God’ in surgery, and he played a crucial role in teaching me the fundamentals, especially in hepatobiliary and pancreatic surgery.
As I progressed through my surgical oncology training, I realized my emotional investment in achieving positive outcomes for my patients. In cancer surgery, the prognosis often remains uncertain even after surgery, which was emotionally challenging for me. My mentor advised that with my goal of achieving 100% success in surgeries, I would be better suited to benign procedures where positive outcomes were more assured, and patients could enjoy a longer, healthier life post-surgery.
This advice led me to the Nizam’s Institute of Medical Sciences, where I completed my training in surgical gastroenterology. I continued there as a faculty member, further refining my skills in hepatobiliary and pancreatic surgery. These organs are particularly sensitive, and surgeries involving them require a surgeon with immense patience and expertise to ensure successful outcomes.
Patience, I believe, is a vital trait for any GI surgeon. It is essential to maintain composure and focus during surgeries, as the results depend not only on surgical skills but also on the surgeon’s ability to apply their knowledge calmly and effectively. My mentor used to say that when entering the operating theater, one should pray and operate with the mindset that it is not oneself, but a higher power performing the surgery. This philosophy of humility and dedication was something I deeply resonated with and strived to emulate in my practice. It is this combination of patience, skill, and a calm demeanor that has driven my passion for surgical gastroenterology and led me to where I am today in my career.
Doctor, in your view, what are the most significant advancements in gastroenterology and hepatobiliary surgery in the last 10 years?
The last decade has seen remarkable advancements in the field of gastroenterology and hepatobiliary surgery. When I was undergoing my training back in 1994, laparoscopy or minimally invasive surgery was just beginning to emerge. During my initial surgical training, I hadn’t even seen a laparoscope. It was only after completing my surgical training and working with senior mentors that I began to observe and learn about laparoscopic techniques. In those days, handling laparoscopic equipment required careful training, as most of us were accustomed to open surgeries, where the abdomen is fully opened for the procedure.
The technological shift in surgery began around 1998 in India, with the introduction of laparoscopic methods for abdominal surgeries. This technique involves making small incisions and using a camera to guide the surgery, a significant change from traditional open surgery methods. One crucial aspect of this transition is that a solid foundation in open surgery is vital for mastering laparoscopic techniques. This is because the anatomical perspectives in open and laparoscopic surgeries are quite different – what you see through the camera in laparoscopic surgery differs from the view in an open procedure.
I always advise that a good open surgeon will likely excel in laparoscopic surgery as well. For those of us with extensive experience in open surgeries, adapting to these new laparoscopic techniques was relatively smoother. Over the years, we’ve progressed from basic laparoscopic surgeries to more complex procedures in hepatobiliary surgery, such as liver resections and tumor removals, as well as gallbladder and stomach surgeries, including bariatric procedures. Most benign abdominal surgeries are now performed using laparoscopic methods.
In recent years, there has been a shift towards using laparoscopy for cancer surgeries as well, although the long-term benefits of this approach, particularly in cancer therapy, are yet to be fully established. However, the move from traditional open surgeries to laparoscopy and now to robotic surgeries, which incorporate artificial intelligence, represents a significant leap in surgical gastroenterology. This transition to advanced technology has truly marked an extraordinary era in the last decade, transforming the way we approach and perform surgeries in this field.
Sir, given your expertise in liver transplantation, what are the challenging aspects of liver transplant surgery today?
Liver transplant surgery, despite its perceived complexity, is essentially another surgical procedure. It primarily involves mastering a specific technique. The key for any surgeon wanting to specialize in transplant surgery is to have a profound understanding of liver anatomy.
The challenges in the field of liver transplantation, particularly in India, differ significantly from those in other countries. For instance, my training in Korea exposed me to a culture where people are highly educated about the importance of organ donation. They willingly donate livers to family members without reservations or negative perceptions. However, in India, the major challenge lies in convincing people about the benefits of organ donation. While the concept of donation from brain-dead patients is slowly gaining acceptance, there is still considerable reluctance, especially regarding live donations.
Since my return to India in 2010, there has been progress in establishing transplant units across various hospitals. This change reflects advancements in technology and a gradual improvement in public awareness and attitudes towards organ donation. However, the challenge persists, particularly when it comes to live-related donors. There is a prevailing fear among potential donors about the risks of donation, including the fear of death or future health complications.
Educating the patient and their family about the entire process, from the importance of donation to the criticality of post-operative care, is a significant challenge. Transplant surgery itself involves complex procedures like joining the duct, artery, and vein, but the post-operative care largely depends on the patient. Therefore, it’s essential for patients to follow their doctor’s advice meticulously and attend all follow-up appointments without fail. Neglecting even a minor issue post-transplant can lead to serious complications.
The challenges in liver transplant surgery in India span from patient education about donation and surgery to the financial aspects and the crucial need for comprehensive post-operative care. While the surgery itself might be comparable to other surgical procedures in terms of technicality, the success of a transplant extends far beyond the operating room. It requires a commitment from both the medical team and the patient to adhere to stringent post-operative guidelines and regular follow-ups. This comprehensive approach is vital for ensuring the longevity and quality of life of the transplant recipient.
Doctor, where do you see the field of surgical gastroenterology heading in the next 10 years, especially in the context of emerging technologies?
I have always been a proponent of open surgeries because, to achieve optimal results, it’s essential to acknowledge that there is no substitute for open surgery. In this era of burgeoning technology, I foresee potential challenges in the coming years. The shift towards minimally invasive approaches, including the use of robots and artificial intelligence, poses a risk. When trainees move from basic to advanced surgery, if they lack proficiency in the open technique – that is, manually opening the abdomen – they may find themselves at a loss in situations where artificial intelligence fails or technology breaks down.
Technology is transient and ever-evolving. Consider, for instance, scenarios involving power outages, instrument malfunctions, or machine failures. In such instances, the ability to immediately switch to open techniques could be life-saving. While technology is likely to increasingly intercede in human activities over the next decade, this is not an entirely positive trend for medical science. The dexterity and tactile feedback provided by a surgeon’s ten fingers are irreplaceable. If a machine malfunctions and the surgeon is unskilled in open techniques, the situation is akin to not knowing how to cook from scratch; reliance on machines for every aspect of a task can lead to helplessness when technology fails.
I advocate for technology as a supportive tool rather than an exclusive one. Robots, for example, should complement but not replace traditional skills. Mastery of open surgical techniques is crucial. The trend towards mannequin surgeries and reliance on artificial intelligence for anatomical learning is concerning. Nothing can substitute for the hands-on learning that occurs with cadaver dissection, where each tissue and structure is closely examined. Training that overly depends on technological simulations, such as computer programs, could lead to disastrous outcomes in patient care. While artificial intelligence will continue to advance, I caution that it could potentially lead to detrimental effects in human society.
Doctor, what advice would you give to medical students or young surgeons aspiring to specialize in gastroenterology or hepatobiliary surgery?
My constant advice to students I have mentored is that to become an excellent and technically proficient surgeon, you must not rely solely on the standard duration of training. In my view, a surgeon’s career truly begins after the age of 40, not at 35. By the time you complete all your training, you’ll likely be around 32 or 33 years old. Following this, it is crucial to spend an additional 6 to 7 years under the tutelage of an expert who is well-versed in open, laparoscopic, and robotic surgery. This comprehensive training is essential before you perform surgery on a new patient. This approach will shape you into a skilled and capable surgeon, ensuring positive outcomes.
Merely completing your degree and immediately starting practice can lead to unfavorable results. I urge new students to learn hands-on with human patients under the guidance of a skilled mentor. If you are eager to experiment, do so in medical colleges or similar environments where your teacher can guide you step by step. Relying solely on computer simulations or mannequin-based learning for surgical training is insufficient when transitioning to operating on humans.
My own experience is a testament to this approach. I spent three years with my mentor, focusing not on financial gain but on honing my surgical skills. I requested only knowledge and the opportunity to become a competent surgeon. The current generation often rushes into practice immediately after completing their surgical training, driven by the desire to earn money. However, I caution against this. Entering the medical profession with the primary goal of financial gain is misguided. A doctor typically does not earn a substantial income until their fourth decade, once they are an experienced surgeon. Therefore, I strongly recommend thorough and extensive training before performing surgery on any patient. This commitment to learning and skill development is the foundation of a successful surgical career.
Doctor, could you please elaborate on your philosophy of patient care, especially in complex surgeries?
Most patients who seek my expertise have either been turned away elsewhere or have undergone multiple surgeries. They come to me specifically for complex surgical procedures, not for simpler ones. For straightforward surgeries, I don’t spend much time discussing, but when it comes to intricate operations like liver resections, pancreatic surgeries, or other challenging cases that demand immense patience, I engage in extensive discussions with the patients, often over several hours and multiple sessions.
I don’t rush into suggesting surgery immediately upon their first visit. Instead, I take the time to sit with them, speak politely and patiently, and establish a connection that goes beyond the clinical aspects. I encourage them to write down all their queries, advising against reliance on internet information. We then go through these questions one by one, ensuring they are fully informed and comfortable. In subsequent meetings, I repeat this process for clarity and reassurance.
It is vital that patients are thoroughly educated before undergoing major surgery due to the significant risks and complexities involved, especially in hepatobiliary surgeries. Once the surgery is done and the abdomen is closed, some complications may be irreversible. Therefore, it’s crucial to be supportive and understanding throughout the patient’s journey to recovery. Compassion is key; a patient in pain deserves empathy and care.
My philosophy places the patient as the top priority. I ensure they and their families are well-informed throughout the recovery process. Often, it’s the attendants or family members who need the most support, as they are anxious about their loved one’s recovery. As a surgeon, I become part of their support system, guiding them through the emotional and physical challenges of the surgery.
I firmly believe that while the technical aspect of surgery is critical, the outcome also greatly depends on the surgeon’s compassion and ability to connect with and support the patient and their family. My surgeries are performed with precision, but for a successful recovery, three elements are crucial: trust in the surgery, the patient’s self-belief in their recovery, and patience for the natural healing process. There is no medication that can substitute for a strong will and mindset.
I ensure holistic management encompassing psychological, technical, and medicinal aspects, even post-recovery. Major surgeries usually require a recovery period of 3 to 6 months to fully rehabilitate the patient. Throughout my surgical career, I have strived to maintain this compassionate, empathetic approach with all my patients.
Doctor, how important is team collaboration in complex surgical procedures, and how do you foster this practice in your team?
In complex surgical procedures, team collaboration is not just important, it’s essential. The process of surgery, which can vary in duration from 3 to 10 hours, is heavily dependent on the effectiveness and coordination of the team involved. I firmly believe that the care journey begins right at the hospital entrance, starting with the security staff. This belief extends to every individual interacting with our patients, including the reception staff who often deal with patients in pain or distress. Everyone’s role is crucial in creating a supportive and positive environment for our patients.
Within the operating theater, the importance of synergy between the surgeon and the team cannot be overstated. My own success as a surgeon is intrinsically linked to three key groups of people: the ward nurses, who are dedicated and compassionate, caring for patients in challenging situations without any reservations; the theater nurses, whose role in the surgery is pivotal as they anticipate every step and the necessary instruments; and the assistant surgeon, who plays a critical role in the procedure, facilitating my actions and ensuring everything runs smoothly.
Over the past 20 years, I have considered my team as a family. This family ranges from my secretary to my theater nurses and critical care team. Despite any differences, we have learned to adjust and collaborate effectively, ensuring that our combined efforts translate into successful surgical outcomes.
In the wards, the role of the nurses is particularly crucial as they are the ones providing constant care to the patients after the surgery. The success that I have been able to achieve in complex surgeries is a testament to the dedication and skill of my entire team. I always attribute our achievements to this collective effort, rather than taking individual credit. To the patients, it might appear that I am the one who has brought them back to health, but in reality, this is a shared accomplishment among all team members.
The journey of a successful surgeon is marked by the presence of a supportive and evolving team. The pressure in the operating theater can be immense, and it’s crucial for this pressure to be distributed among the team members, with each individual taking on their part of the responsibility. This approach is what makes a surgery successful.
Over the years, I have developed a team that functions seamlessly, and I encourage every surgeon to foster such a team for achieving the best results in complex surgeries. The team’s role extends beyond the operating theater. In the wards, the nurses are the ones who spend the most time with the patients, offering care and support 24/7. Their role is indispensable in the recovery process.
I have always emphasized the importance of every team member, recognizing that a surgeon’s success is deeply intertwined with the team’s support and expertise. Every person, from the one who welcomes patients at the gate to those in the operating room and the wards, contributes to the patient’s journey through surgery and recovery.
In my practice, fostering this collaborative environment involves regular communication, mutual respect, and a shared commitment to patient care. We hold regular meetings to discuss cases, share insights, and ensure everyone is aligned with the treatment approach. I make it a point to acknowledge each team member’s contributions and encourage an atmosphere where everyone feels valued and empowered to contribute their best.
My philosophy has always been that a successful surgical outcome is the result of a team effort. It’s about bringing together different skills, perspectives, and experiences to ensure the best care for our patients. This collaborative approach has been a cornerstone of my practice and something I believe is vital for all surgeons to adopt.
Team collaboration in complex surgical procedures is not just a part of the process; it’s the backbone of successful patient outcomes. In my practice, fostering this collaboration has been about building a family-like team that shares a common goal of excellent patient care. It’s about understanding that while the surgeon plays a critical role, the collective effort of every team member is what ultimately leads to successful surgeries and patient recoveries. This philosophy has been integral to my approach and is something I strongly advocate for in the surgical field.
As a surgeon, what advice do you often give to patients regarding lifestyle and preventive care?
The majority of our health problems, about 90 percent, can be attributed to lifestyle disorders. Nowadays, we are seeing an increase in diseases among the 20 to 35 age group. This rise is largely due to unhealthy habits. Many people in this age bracket lead sedentary lives, are under constant stress, and often suffer from inadequate sleep. A lack of proper lifestyle habits, such as eating healthily and on time, and maintaining good personal habits, plays a significant role in their health issues.
When you talk to most young people today, you’ll find that 99 percent engage in activities like drinking, smoking, or other habits that negatively impact their health. Additionally, they are frequently under the stress of a 24/7 lifestyle. These factors contribute significantly to the new age diseases, most of which can be managed or cured by making lifestyle changes.
My advice centers on four main aspects: firstly, eat nutritious food; secondly, avoid addictive substances; thirdly, ensure adequate and quality sleep; and finally, maintain a positive mindset. Being content with what you have is crucial, rather than constantly comparing yourself to others who may appear wealthier or more successful.
I also emphasize the importance of physical activity but advise against excessive gymming. Instead, I recommend simpler and more natural forms of exercise like walking, jogging, or cycling. These are not only cost-effective but also generally healthier options. People who regularly walk or engage in similar exercises tend to be healthier than those who primarily workout in gyms.
In summary, taking care of your health is essential, and most health issues are the result of poor lifestyle choices. My main suggestion to the younger generation is to focus on these four aspects of their lifestyle to improve their overall health.
Doctor, can you please tell us more about Ananya Gastroenterology and its inception?
The concept of a specialized gastroenterology practice in Hyderabad was initially centered around one well-known hospital. When I transitioned into private practice, there was a noticeable absence of surgical gastroenterologists in the city’s corporate hospitals. This gap prompted me to start my own clinic. Despite some skepticism about the viability of a surgeon running a private clinic, I was determined to establish my practice.
The clinic, named Ananya Gastroenterology after my daughter, who I consider my lucky charm, started as a modest 9 by 9 room. Despite initial doubts that I, as a surgeon, might not attract patients to a private clinic, I envisioned and projected Ananya Gastroenterology as a virtual hospital in the minds of potential patients. This approach gradually led people to perceive it as an actual hospital.
Over seven years, I transformed what began as a small clinic into what is now known as Ananya Hospital. This growth was achieved without resorting to the common practice of paying commissions for patient referrals. I dedicated myself entirely to patient care, and it is the patients themselves who have played a crucial role in building this hospital. I have always strived to be an example in the medical community by not engaging in the quid pro quo of commission payments for referrals. Instead, any savings or concessions that could be considered a commission, I preferred to pass on to the patients in the form of lower costs.
This approach has set Ananya Hospital apart in terms of patient care, honesty, and ethical practice. From its beginnings as a small, virtually conceptualized clinic, it has grown into a large, well-regarded hospital. This growth has been based not on soliciting patients through commissions but on providing honest, high-quality care, which has been the cornerstone of our practice since its inception.
