Humming gently under his breath, ace heart surgeon Dr Naresh Trehan pushes past swinging doors and enters the spanking clean, brightly lit operation theatre in Delhi's Escorts Heart Institute and Research Centre (EHIRC). The patient he is to operate on for a complex coronary bypass is already lying on the table.

RADICAL SHIFT: Trehan (on console) operates using the robot at Escorts

Unusually, Trehan, who has performed over 30,000 such surgeries, doesn't spend minutes obsessively scrubbing his hands with disinfectant. He just slips on his surgical gloves, mask and head covering. The usual array of scalpels that puts patients into a funk is nowhere in sight. Remarkably, Trehan isn't even going to touch his patient during surgery and yet is all set to make Indian medical history.

Trehan asks his assistants to prepare the patient. In the past that would have meant plenty of gore with surgeons literally sawing open the patient's chest, drawing apart the ribs with clamps, then stopping the heart and directing blood flow to a heart-lung machine before directing their scalpels into the gash in the chest. Blood would spurt in all directions making the operation theatre look like a set of a horror movie.

This time they just wheel what is called "an arm cart" towards the anaesthesised patient. It is a science fiction buff's dream machine. It has three slim, chopstick-like black arms with pivots and pistons connected with cables. On the tip of one of them is an endoscopic camera that gives a three-dimensional image and can magnify objects by as much as 10 times. The other two have what are called endowrists that are fitted with tiny robotic fingers capable of remarkable movement. Using microscopic tools they can be directed to cut, snip, sew, swivel, pan, tilt, roll and grasp-more than any surgeon's fingers can do. Trehan's assistants make three small incisions, each the width of a pencil, at the side of the patient's chest and slide in the magical arms gently. The patient is now ready.

Dr Naresh Trehan, Executive Director, EHIRC "It's a revolution in surgery and it drastically cuts down on after care costs."

Trehan eases himself into the surgeon console whose design appears greatly influenced by video gaming machines. He peers through two binocular-like eyepieces that are connected to the camera slipped into the patient's body. Through it he can see the patient's heart brightly illuminated-a moist, pulsing mass of pink muscles, lined with strips of yellowish fat and streaked with rivulets of blood vessels. "I can see the heart like a football," he jokes. He can control the direction of the camera by pressing on foot pedals.

As he spots the blocked artery, Trehan slips his fingers into the instrument's controllers that act like a joystick. Only these are no playthings. The fingertip controllers are linked directly to the robotic arms positioned in the patient's chest. To Trehan's finger commands they move in almost slow motion close to the heart. For every inch he moves, the tips of the endowrists move a millimetre. It also eliminates errors arising out of even the slightest tremor of a surgeon's hand. "It is like shrinking your fingers and putting them in places where you would normally never be able to reach," says Trehan.

Then for the next two hours he is all concentration using the instrument controls to direct the robotic arms with remarkable precision. His assistant surgeon hovering near the patient is at hand to change the microscopic tools required for each task. A large TV screen above allows him to see what Trehan is doing.

Trehan first makes neat incisions on the blocked artery in the patient's heart. He then uses his foot pedal to pan the camera searching for another tiny artery on the chest wall. He snips a piece of it, then directs the metallic arms to suture the piece over the blocked artery. It acts like a flyover and Trehan smiles as he sees the blood flow smoothly again through the operated artery. He tells his assistants, "Okay, boys. Stitch him up."

With that the first fully robotic heart surgery in India was successfully executed last week. Within two days, the patient, a 50-year-old salesman, was back home, the three tiny incisions in his chest already on the mend. In comparison, a patient who undergoes a conventional open-heart bypass surgery would have taken four weeks to recuperate in hospital, apart from having an ugly foot-long scar on his chest. With the robotic arms enabling the surgeon to operate on a beating heart, the risk of blood getting infected, common in heart-lung machines, and the post-surgical mental disorientation are all but eliminated. In terms of costs it is almost equivalent to that of conventional surgery and is sure to drop. Predicts Trehan, who is executive director of EHIRC: "Computer and robotic assistance will have a revolutionary impact on cardiac surgery."

EHIRC is the first heartcare centre in Asia to import the endoscopic coronary bypass system manufactured by the US-based Intuitive Technologies. Costing $1.5 million (Rs 7.2 crore) the machine called Da Vinci has already galloped its way into medical centres in the US after it received clearance from the health authorities six months ago.

The robosurgeon was actually developed way back in the 1980s by NASA, the premier US space organisation, to operate on astronauts in case there was an emergency when travelling in space. But faced with severe budget cuts for its ambitious space exploration programmes, NASA junked the technology. A decade and a half later, Intuitive bought the rights and honed it to perfection. Yet though it is just out, Trehan feels the machine is only like the "Model T of robots". The revolution has just begun.