According to a leader in this field of medical surgery, the time for greater access and affordability could be now

Advances in medical surgery have led to the use of robotic arms and systems to produce better outcomes in many scenarios.

In minimally invasive procedures, robotics can be used to help surgeons see better and achieve greater precision during the operation. Benefits include reduced post-operative pain and infections, less scarring and faster recovery and rehabilitation.

In India, the urology team at Fortis Hospitals, Bengaluru led by Dr Mohan Keshavamurthy, Senior Director, Urology, Uro-Oncology, Uro-Gynaecology, Andrology, Transplant and Robotic Surgery, has already completed 500 robotic surgeries in 53 months. He is excited to share his clinical experiences with readers here.

Dr Mohan Keshavamurthy, Senior Director, Urology, Uro-Oncology, Uro-Gynaecology, Andrology, Transplant and Robotic Surgery, Fortis Hospitals

What are the key surgeries that can benefit from robotic assistance?

Dr Mohan Keshavamurthy (MK): Robots are currently being used to assist in a wide range of surgeries:

    • The extra assistance helps in preserving function in colonic or prostate cancer surgery
    • It helps in sparing an organ: for example, in kidney cancer cases where the organ cannot regenerate.
    • The 10x magnification of the surgery site is useful in case of fine suturing, such as in kidney transplantation.
    • It is useful in compartmental surgery: for example, in reconstruction work like a pyeloplasty because it provides excellent and precise access and magnification in a small area.
    • It helps in normal passage surgery like robotics-assisted day surgeries such as vaginal hysterectomy, because there is almost no pain, no blood loss and patients can be discharged on the same day.

Despite so many advancements in MRI scans, why are accurate results still not guaranteed?

MK: MRI is advanced, but it is not biopsy friendly because the magnet is the core of the MRI and the needle gets attracted to the magnet. Prostate biopsy is done transrectally and hence ultrasound technology becomes essential.

However, when MRI is combined with ultrasound in a certain way involving advanced medical analytics, the accuracy is greatly improved and will continue to improve.

What are the challenges for a doctor in India using advanced robotics today?

MK: Some of the challenges include:

    • Absence of the tactile feel that humans are used to
    • Steepness of learning curve
    • Lack of training programs for robotic surgery in the country
    • Currently the equipment allows only compartmental access on the body, limiting usage in larger operations (open surgery)
    • Need for an emergency open surgery when a robot fails
    • High cost of robotics accessories

In India, where the medical field predominantly runs on the ‘personal touch’ and trust of a ‘family-doctor’, what is the acceptance rate of robotics-assisted surgery among suitable candidates? How much risk is India’s medical ecosystem is prepared to accept in using this tech?

MK: Robot assisted surgery is to do with niche procedures and at the moment there is no alternative to the technology for best outcomes, hence acceptance is implicit. 

The medical ecosystem is prepared to accept the usefulness of robotic surgery along with managing the risks: however, cost is the only constraint.

In the next three to five years, the technology could become more economical, especially when parts get manufactured in India — making such surgeries more affordable to all sector of society.

What are ways you expect India’s government to address robot-driven surgeries this year and beyond?

Dr Mohan I feel with cheaper robots every district government hospital will have a robot in the next five years. Some of the major policy changes we anticipate are:

Overall, in 2023 include we expect improvements such as cheaper robots, robots that offer a semblance of that “tactile feel”, and multiport single arm robots.