India at inflection point in robotic surgeries

The country is on track to become a leader in robotic-assisted surgery with its increasing adoption of the technology

Robotic surgery is the most advanced minimally invasive surgery performed through small (finger size) incisions. There are various advantages of robotic surgery, which include faster recovery and quick return to daily routine, less blood loss and less risk of infection, lesser pain and trauma, less blood loss and infection, and better access, which enables the surgeon to perform complex procedures.

Robotic-assisted surgery is being adopted across the globe. It has a long history in India.  The first procedure performed with a robotic-assisted surgical system took place in India in 2002.

Robotic surgery is one of the most practical use of robotics. In this surgery, instead of using the surgical instruments by hand, robotic arms are used, which  are controlled by efficient surgeons with the help of advanced computers. The movement of surgeons is translated to the robotic arms while observations are made through computer screens.

Robotic surgery in Gynecology

Women suffer from painful periods, heavy menstrual bleeding, fibroids, endometriosis, and other disorders. Robotic surgery can give these women more control by causing less trauma, hospitalization, and blood loss. Today, no woman should be subjected to an open surgery, and minimal access surgery (MAS) should be available to all.  But while minimal access surgery is now available in every hospital, including in small towns, the skill and infrastructure required for performing complex gynecology surgeries are in short supply. 

Most gynecological conditions, including a few malignant ones, can be treated using robotic assisted surgery. At present, most robotic surgeries do not give a significant advantage over conventional laparoscopic surgery in benign gynecological diseases. However, robotics do give an edge in more complex surgeries. The conversion rate to open surgery is lower with robotic assistance when compared to laparoscopy.

Robotic surgery in cancer management

The incidence of cancer is rising steadily, both globally as well as in our country. Cancer not only impacts the person’s health but also has social, psychological, and economic implication. Management of cancer usually involves a multimodality treatment approach with site specific onco-surgery, systemic therapy including chemotherapy, immunotherapy, targeted therapy, hormonal therapy and radiation therapy to achieve the best results in terms of survival as well as quality of life.

Surgery plays an important role in the management of cancer. In the early stages, it defines the accurate stage of the disease, based on which the decision of adjuvant treatment of either systemic therapy or radiation therapy or both is made. Cancer surgery is typically difficult and performed with oncological principles and precision in mind. Open surgery involves long incisions. Hence, there has been a paradigm shift to robot assisted minimal access surgery in oncology. 

Robotics offers multiple advantages and has revolutionized the surgical approach in many complex oncological procedures. In recent years, robotic surgery has become the standard of care for many cancers. The oncological outcomes of robotic surgery are comparable to those of open surgery, and in some cases, they are even better, with much reduced perioperative morbidity. This has led to an increase in the practice of robotic surgery in oncology.

Robotic surgey in India

India appeared to be a significant destination for robotic surgeries among international patients owing to its low cost and short waiting time as compared to other countries.

The practice of robotic surgery is on the rise with the increasing installation of operating robots across  institutions. Change is inevitable, and integrated digital technology and robotics in surgery are driving that change for the better. Technologies and solutions are being developed and used at key centres globally to help reduce intra-surgeon variability through intelligent and adaptive training tools.

The main reason of non-acceptance of robotic assisted surgery is its cost.  Owing to their effectiveness and efficiency, the cost of performing robotic surgeries is a bit higher than regular procedures. The high costs of purchase, disposable supply, and annual maintenance of surgical robots act as significant financial constraints for adoption. Furthermore, the robot-assisted surgeries are not covered by the Indian medical insurance providers, which leads to a mounting economic burden on patients.

We need to address the issues related to the acceptance of robotic assisted surgery. Awareness about robotic assisted surgery should be carried countrywide. Various parts of the country should have access to robotic assisted surgery at a reasonable cost. 

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