#APACExclusive | Robotic Surgeries in India: Present Successful, Future Hopeful

Robotic surgery assists surgeons perform complex operations and procedures with accuracy and precision. It also increases the flexibility and control of the procedures, which is otherwise difficult to achieve in traditional surgical procedures.

In most commonly used robotic surgical system, one arm has a camera attached to it, while the other has the surgical equipment. The surgeon sits near a monitor that displays an HD, magnified, 3D view of the surgical area. The surgeons have to operate the arms of the robot properly to complete the procedure. Often this robotic surgery is coupled with conventional surgical procedures as per the convenience and requirements of the case.

Robotic Surgery Timelines for India

• 2000: FDA approved the Da Vinci system for an urologic Robotic surgery.
• 2006: AIIMS New Delhi became the first hospital to install the system.
• 2007-2017: Decade of growth in robotic surgery in India.
• 2023: 66 Robotic surgery centers in India where 71 robotic systems have been installed.
• 2023: More than 500 doctors trained in using robotic systems for surgical procedures.
• 2023: 12,800 robotic surgeries have been conducted over the last 12 years.

Robotic Surgery Gaining Popularity in India

The need to maintain the distance during and after the COVID19 pandemic has encouraged Indian surgeons and hospitals to adopt robotic-assisted surgeries. The expert surgeons in robotic surgeries in India are becoming more well-known outside India too having performed several successful procedures.

While costs for robotic-assisted surgeries are still relatively high, Indian prices are often competitive, with top-notch medical facilities and high success rates. Most Indian hospitals offering robotic surgeries often have the best teams for clinical coordination and patient care. These factors combined together have encouraged many patients worldwide to come to India for robotic surgery.

According to the data from NCBI, the success rate of robotic surgery is around 94% to 100% in India. There are much fewer complications in robotic surgery as compared to conventional approaches. The duration of the operation has also decreased as a result. Robotic surgery also ensures significantly less blood loss making the success rates even higher.

Health insurance in India mandatorily covers robotic surgery procedures according to the guidelines issued by IRDAI. The factors that health insurance companies cover for robotic surgery include hospitalization charges, fees of surgery, fees of the doctor, cost of nursing facilities, ICU cost, pre and post-hospitalization cost and often the ambulance cost as well.

Robotic surgery is beneficial in the successful and precise completion of complex procedures. Many diseases have complicated processes involved and there robotic surgery is advantageous for the surgeon to keep up flexibility and control. Hence, nowadays, many surgeons in India turn to robotic-assisted surgeries to deliver the best results.

The success of any surgical program depends on the availability of a large number of cases, standardization of all surgical steps, and repeated exposure to the same disease reinforcing the stringent management protocols and ensuring efficient utilization of resources in a cost-effective manner. The alarmingly rising population of India, though a major social concern, results in very large number of patients being treated by a single surgeon. This is a blessing in disguise as it helps in the learning curve for most robotic surgeons and provides them ample learning opportunities.

Several institutes in India are today offering training programs in robotic surgeries, mentored by senior consultants at various government institutions and private hospitals. With the Vattikuti 1-year fellowship in robotic surgery, the training process has been streamlined with increased opportunities for upcoming young surgeons. Moreover, the da Vinci Basic Surgical Skills Training Center has been started in India to provide additional training opportunities.

Robotic technology has also increased the age of the surgical capabilities of surgeons by its improved ergonomics, motion scaling, and tremor filtration. It is particularly beneficial in a country like India where the demand of surgeons is ever increasing. Surgeons with excellent laparoscopic skills often have an edge and also a shorter learning curve in robotic surgery. Laparoscopy is well established in India. Hence, the transition from a laparoscopic surgeon to a robotic surgeon is smooth, which ensures a shorter learning curve and a faster dissipation.

Robotic Surgery Still a Costly Proposition

The robot currently costs around $1,500,000 as an initial investment with a yearly maintenance cost of $100,000. Besides the cost of the machine, the expenditure incurred in setting up a facility dedicated to robotic surgery is also huge. Much more concerning is the recurring cost of the instruments. A number of procedure-wise cost-effectiveness studies have shown that open/laparoscopic surgeries are much more cost-effective than robotic surgeries for pyeloplasty and prostatectomy.

The large burden of communicable diseases such as tuberculosis, malaria takes priority in the health sector budget of India. The expenditure on robotic surgery will increase the load on the health sector expenditure. Hospitals are also more likely to buy a robot for commercial publicity and superiority, and subsequently, to regain expenses, push surgeons into recruiting patients for robotic surgery.

Success Stories at Indian Hospitals

Stryker Mako Robotic System in Kokilaben Dhirubhai Ambani Hospital

Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai clinically launched its first ever robotic-arm assisted surgical system, Stryker Mako is an advanced ortho-robotic technologies in the world for joint replacement surgery. The first two cases using the new robotic system were successfully performed by Dr Subhash Dhiware, Consultant, Orthopedics, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai with his team. With this clinical launch, the hospital aims to perform over 80 per cent of knee and joint surgeries using the surgical system.

The Mako robotic system, approved by the US FDA is used for total hip, total knee and partial knee replacements. The evolution of technology in the field of orthopaedic surgery today enables precise and flawless joint replacements as compared to manual surgery. Mako’s CT-based planning creates a 3D model of the diseased joint to give the surgeon a complete view into the patient’s joint and the defect. This allows the surgeon to prepare a personalised plan for each individual patient. This is especially important as every patient’s joint structure is different, and arthritis or other joint damage resulting in further alteration of the joint.

Added Dr Dhiware,“This is invaluable in difficult cases and enables the surgeon to position the joint implant with extreme precision and accuracy. It prevents complications from injuries to surrounding normal tissues. Its haptic technology enables surgeons to cut precisely as per the plan with less soft tissue damage and greater bone preservation. Other advantages for the patient include improved outcomes like minimal blood loss, less post-operative pain, less use of painkillers, shorter hospital stay and an earlier return to normal with less physical therapy sessions required.”

CUVIS Joint Robotic System for total knee replacement in Artemis Hospital

Artemis Hospital, Gurugram has recently acquired CUVIS Joint Robotic System for Knee Replacement Surgery, which allows surgeons to preplan surgery through personalized 3D CT imaging. The system is simple to operate and offers flexibility to the surgeons with a range of cutting options. The procedures are accurate, minimally invasive and very safe for the patients.

With the help of the CUVIS JOINT Robotic System surgeons can perform precise implant placement which results in a more natural feeling after surgery. Patients also benefit as there is a reduced risk of injury to adjacent tissues and risk of infection after robotic surgery is also low. The patient loses less blood due to smaller incisions and the pain is substantially less. The implants have better longevity, thereby, patients’ have better long-term functioning of the knees and improved quality of life.

Informs Dr. I P S Oberoi, Chairperson, Orthopaedics Program & Chief-Robotic Joint Replacement and Arthroscopy Surgery, “With the advent of MRI, we are now able to diagnose knee injuries and problems in a lot of detail, especially diagnosis of ligament tears and rupture are more precise and detailed. The advent of better diagnostic tools and medical technology has paved way for early interventions, thereby, reducing further damage to the knees and improving the patient’s physical condition. However, we are witnessing that due to long years of neglect and apathy towards knee problems more and more people are now having severe problems and are being advised knee replacement surgery, especially patients with advanced stage arthritis.”

He further adds, “Sometimes, patients having arthritis like rheumatoid arthritis, also have severe knee deformities. The precision with which the implant is put after robotic surgery is much better even in severely damaged knees. Robotic surgery is a boon to most of the patients having knee arthritis. Younger individuals with knee pain should get investigations in form of MRI and X-ray scans done to see for the damage which have just started happening and if the damage is advanced or progressing, then there are techniques to get them back on to work as fast as possible with robotic computing assisted surgeries.”

Versius Robotic Surgical System in Asian Institute of Medical Sciences

Asian Institute of Medical Sciences (AIMS), Faridabad has introduced its first 3D Advanced Minimal Access Surgical Robot in the region-the Versius Robotic Surgical System. The next-generation advanced surgical robot aims to revolutionise the field of surgery in oncology and urology (Kidney Nephrectomy), thoracic surgery, and general surgical procedures such as gall bladder stone, complex hernia among several other complex procedures.

With 3D visualisation, the advanced and efficient robotic solution backed by artificial intelligence and machine learning is designed to empower the surgeon ensuring greater accuracy, precision, and safety offering superior surgical solutions even in inaccessible areas.

Informed Dr N. K. Pandey, Chairman & Managing Director, Asian Hospital said, “Next-generation advanced robotic surgery offers enhanced accuracy with less tissue trauma, minimal blood loss, lesser chance of getting infection and less complication, better mobility and improved early functional recovery besides a shorter hospital stay for the patient after surgery.”

Sharing his views on the next-generation advanced robotic surgery, Dr Pandey said, “Though traditional procedures available for cancer, weight loss, and transplant surgery offer good outcomes, the next-generation advanced surgical robot is minimally invasive and gives accurate 3D visualisation that makes all the difference. Advanced robotic technology aims, and hope that these procedures will enhance accuracy and lessen the chance of infection and consequently further improve surgical outcome.”

Advanced Integrated Robotic System for Spine Surgery in BLK-Max Super Specialty Hospital

BLK-Max Super Specialty Hospital has introduced an advanced integrated robotic system for spine surgery. The technology utilises artificial intelligence to visualise spinal anatomy during complex surgeries. Robotic surgeries allow data integration which comes handy during these spine surgeries and doctors can customize the surgical plan for individual patients.

The integrated spinal robot is programmed to navigate spinal surgeries. Additionally, this robotic system combines surgical navigation and robotic guidance for spinal surgery, which offers significant advantages to spine surgeons. The system has been designed to facilitate procedural efficiency. Robotic surgery makes the procedure more objective as it is more plan driven.

Dr Puneet Girdhar, Senior Director & Head, Orthopaedic Spine Surgery, BLK-Max Super Speciality Hospital said, “In today’s advanced medical times robotic spinal surgeries are the safest route for procedures that require extreme precision and accuracy. They not only promise positive outcomes but also involve minimal complications throughout the surgery.”

Dr Girdhar has recently performed 10 complex spinal surgeries using the robotic navigation system with 100% successful outcomes. All of his patients could walk pain-free from day after surgery. One of his recent patients was suffering from severe back pain and severe compression of spinal nerves and difficulty in walking. He was afraid of the surgery, despite that being the only option in his advanced stage of disease.

Currently, Max Healthcare is one of the largest healthcare players in the country with 15 robotic systems across its Network hospitals. More than 4,000 robotic surgeries have been performed at our Network hospitals so far.

BLK-Max Super Speciality Hospital has also expanded its Robotic Surgical Program with the introduction of artificial intelligence enabled robotic system for Joint replacement surgeries.

This next generation robotic system for joint replacement works on artificial intelligence and helps surgeons in achieving more precision & accuracy and preserving more natural bone, minimal blood loss and ensuring a well-balanced joint.

Introduction of robot for joint replacement at BLK-Max Hospital will allow patients to benefit from combination of human insight and experience of senior clinicians backed by robust technology. The technology is engineered to replicate a patient’s individual joint structure, allowing for the relief of pain from failed replacements. The robotic device imitates the joints’ regular motion patterns, so minimising any excessive stress on the muscles, nerves, tendons and sinews. Robot aids the surgeon in achieving accuracy, alignment, and balance.

Dr. Bhushan Nariani, Senior Director and Head, Centre for Joint Replacement, BLK-Max Super Specialty Hospital said, “This new robotic navigation technology allows the surgeon to pre-plan the surgery by assessing the individual patient’s disease state and predicting the joint stability over the full range of motion. This ensures precision and reduces the chances of malalignment of implants”.

Currently, BLK-Max Hospital has two Da Vinci Xi robots and they are used in performing surgical procedures across specialties including cancer, liver and kidney transplants, heart, urology, gynaecology, paediatric. BLK-Max Hospital has conducted more than 1200 robotic surgeries in various specialties with success to date.

Intuitive deploys 100th surgical systems in India at UN Mehta Institute of Cardiology, Ahmedabad

Sunnyvale, California-headquartered Intuitive recently installed its hundredth robotic-assisted surgical system in India at the UN Mehta Institute of Cardiology, Ahmedabad.

Most of Intuitive’s robotic programmes are installed in leading private and government hospitals, medical education institutes and state government medical colleges across the country. Prior to this most recent milestone, Intuitive has advanced minimally invasive care in India through advanced robotic technology, supported by an innovative and expanding ecosystem of learning, services, and solutions. More than 800 surgeons have been trained on Intuitive’s da Vinci technology and are helping drive the significant increase in its adoption.

“We strive at Intuitive to help Indian surgeons and their care teams improve patient outcomes, improve the patient and care team experience, and lower the total cost to treat,” said Mandeep Singh Kumar, Vice President and General Manager, Intuitive India.

While commenting on the installation of Intuitive’s da Vinci Xi system, Dr. Chirag Doshi, Head, Cardiovascular and Thoracic Surgery, UN Mehta Institute of Cardiology, said, “We are always in the forefront in finding newer ways to offer advanced and affordable healthcare that help improve patient outcomes. With the installation of Intuitive’s da Vinci Xi surgical system, we hope to potentially enhance academic research and residency training programmes in the field of cardiothoracic surgery and continue our efforts towards improving patient care and experience.”

Apollo Delhi Conducts First Robot-Assisted Total Arterial Bypass Surgery in North India

Indraprastha Apollo Hospitals, New Delhi conducted the first robot-assisted total arterial bypass surgery for triple vessel coronary artery disease, the first of its kind in North of India. The surgery was conducted under the supervision of Dr MM Yusuf, Specialist Consultant, Robotics and Minimally Invasive Cardiac Surgery, Dr Mukesh Goel, Senior Consultant, Cardiothoracic surgery & Dr Varun Bansal, Consultant, Robotics and Minimally Invasive Cardiac Surgery, Indraprastha Apollo Hospitals.

Dr MM Yusuf, who led the robot assisted surgery, said, “Robotic assisted CABG is the least invasive cardiac procedure. It is a symbiosis between state-of-the-art technology and surgical expertise. It offers great short and long-term benefits by subjecting patients to minimal cuts, less bleeding, less pain, early recovery and quick return to active life; which is a distant target by open chest surgery. Total arterial bypass surgery also provides best long term outcome with less risk of reintervention later in life. Dr MM Yusuf & his team have been performing this procedure routinely at Apollo Hospitals Chennai over the past 2 years.

Speaking about the procedure, Dr Mukesh Goel said, “While fewer acute heart attack cases are being admitted to hospital emergency units, there is a marked increase in deaths from cardiac arrest at home, probably due to the postponement and delay in seeking medical attention. It is, therefore, important to emphasise that heart patients must not ignore any deterioration in symptoms and/or delay medical attention. Apollo Hospitals have been known to introduce the latest medical technology in India for the benefit of the patients. Minimally invasive cardiac surgery avoids sternal split and aids in a quick recovery”.

Dr Varun Bansal added,” Technology has ushered in a paradigm shift in healthcare. From performing complex surgeries to providing remote care with telehealth, it has brought a massive transformation, taking medical treatment to unimaginable heights. Even though the use of robots in surgery isn’t new, emerging technologies and innovation have expanded their scope to help doctors perform difficult medical procedures and surgeries easily with more precision, comfort and speed.”

CARE Hospitals Hyderabad Performs First Gynaecology Procedure in Asia Pacific Using Robotic-Assisted Surgery

System Hyderabad based CARE Hospitals Group and India Medtronic Private Limited performed the first gynecology (hysterectomy) procedure in Asia-Pacific using Hugo robotic-assisted surgery (RAS) system. The milestone procedure was performed by the expert clinical team of CARE Hospitals, led by Dr. Manjula Anagani, at the group’s flagship facility located at Banjara Hills.

The patient, a 46-year-old woman, was suffering from prolonged Adenomyosis, a condition that causes the uterus to thicken and enlarge. She underwent a robotic-assisted total hysterectomy procedure where the affected uterus was removed using the Hugo RAS system. CARE becomes the first hospital in Telangana and Andhra Pradesh to install this new robotic-assisted surgery system from Medtronic.

Talking about the surgery, Dr. Manjula Anagani said, “Utilizing the new RAS system from Medtronic for hysterectomy, which was APAC’s first gynecological procedure, is a testimony to our dedication to provide high-end clinical care. It is a proud moment for all our teams, and we look forward to using this innovative robotic system to expand access to the powerful benefits of minimally invasive surgery to more patients.”

Elaborating about the Advanced Robotic program, Dr. Nikhil Mathur, Group Chief of Medical Services said” This landmark surgery will open up new opportunities for our team of world-class surgeons to further use the Hugo RAS system in other clinical specialties. We look forward to using this innovative robotic system to expand access to the powerful benefits of minimally invasive surgery to more patients looking for treatment under General Surgery, Urology, Gynecology and more.”

The Hugo RAS system is a modular, multi-quadrant platform designed for a broad range of soft-tissue procedures. It combines wristed instruments, 3D visualization, and Touch Surgery Enterprise, cloud-based surgical video capture and management solution, with dedicated support teams specializing in robotics program optimization, service, and training. It is designed to bring the benefits of minimally invasive surgery —fewer complications, smaller scars, shorter hospital stays, and a faster return to normal activities1–3,† — to more patients around the world. And, in doing so, help address global inequities in access to care.

SSI MANTRA Launches First Indigenous Medical Robotics Surgery System at Rajiv Gandhi Cancer Institute (RGCI), Hyderabad

SS Innovations has launched the SSI Mantra (Multi-Arm Novel Tele Robotic Assistance) Surgical Robotic System), India’s first medical robotics surgery system. The MANTRA system was recently utilised for the first in human pilot study at Rajiv Gandhi Cancer Institute (RGCI), where the surgeons successfully completed 18 complex Urology, Gynaecology and General Surgery procedures in less than a month. While robotic driven surgery first happened in India in 2001, first in AIIMS in 2006 and in RGCI in 2011, this is the first time a completely indigenous robotic surgery system has been developed in India. Dr Srivastava informed that till now 85 LoIs have been received for MANTRA including those from government hospitals. There are 72 systems currently available (2 more are coming) and about 400 surgeons with the relevant training to perform surgeries using the system.

“Robotics shall be the future of surgery, and my vision is to create a technologically advanced system that will be cost-effective, easy to use, and can be applied to all surgical specialities. Thus, benefitting most patients around the world. Compared to conventional surgery, robotic surgery results in smaller incisions, that reduces pain, scarring and leads to quicker recovery.” said Dr. Sudhir P. Srivastava, SSI Mantra and one of the early pioneers in minimally invasive and robotic cardiac surgery.

Dr. Sudhir Rawal, Medical Director RGCI added, “The dedicated team of engineers and scientists at SS Innovations have been working hard under Dr. Srivastava’s guidance for the past few years to develop a cost-effective robotic surgical system. I congratulate them on this launch. I have been closely involved in the clinical trials myself, and the results have been outstanding.”