Surgical Robotics in India flourishes

Robotic surgery is the conglomeration of the experience of skilled surgeons and advanced computer technology. This surgery includes the procedures that are performed through tiny incisions and therefore it is generally associated with minimally invasive surgery. This type of surgery provides the biggest advantage to the surgeons in terms of precision, control and flexibility when compared to the conventional laparoscopic surgery. When compared to open surgery, robotic surgery provides anatomical clarity. Here are a few benefits for the patients:

• Reduce in number of complications
• Reduce in pain
• Quicker recovery
• Smaller and lesser scars

The robotic surgical system includes a mechanical arm and a camera arm along with surgical instruments that are attached to them. The surgeon can control the arm while being seated at the console near the operating table. The console provides a magnified view of the surgical area.  

Current status:

Along with the da Vinci Surgical System, Robotic surgery has been approved in the year 2000 by the Food and Drug Administration. Ever since the introduction of anaesthesia, robotic surgery is the biggest break. The technique has been rapidly adopted by the hospitals in Europe and the US and the number of surgeries has increased by 30% almost every year since its introduction. In the US alone, there are more than 1000 robots. According to reports, 55000 cases of radical prostatectomies has been performed with da Vinci robotic assistance. More than 70000 surgeries were performed worldwide in the year 2008. Such robot-assisted surgery has gained popularity in Australia, Europe and Asia and it has spread to different specialities that include otorhinolaryngology, oncology, gynaecology, cardiothoracic surgery and gastrointestinal and bariatric surgery. There has been a significant evolution of robotic surgery over the past 10 years and it is estimated that over the next decade, robotic surgery will be overshadowed by greater advances. 

Is it safe?

Even though robotic surgery is considered safe, according to the reviews by the FDA, there has been an increase in the number of related complications. FDA was forced to conduct an inquiry after it has been found out that there has been a 34% per cent increase in the number of deaths between 2011 and 2012 alone. However, surgeons claimed that there are a lot of advantages when performing procedures involving a robot. According to the surgeons, a computer screen magnifies everything that ultimately improves the surgeon’s vision; the hands of the robot can even reach into tighter spots which are otherwise not possible with human hands and additionally, the software can even correct a surgeon’s hand tremor. The procedure also tends to reduce fatigue of the surgeon since he is required to be seated at the console controlling the robot. 

Surgical Robotics in India:

Robotic surgery is still growing in India. As of the year 2016, 30 Indian health facilities are performing high-end robotic surgeries. 12 of such facilities are present in Northern India that includes Apollo, Rajiv Gandhi Cancer Institute, AIIMS, Fortis, Sir Ganga Ram Hospital and Medanta. 8 hospitals are in Western India that includes Tata Memorial Hospital, Kokilaben Dhirubhai Ambani Hospital and Jaslok Hospital. 7 are in southern India including Aster Medicity, Kochi, the Krishna Institute of Medical Sciences (KIMS) and the Amrita Institute of Medical Sciences. One of such surgical robotics user is Apollo Gleneagles Hospital, Kolkata. The robotic evolution has been with the guidance of the All India Institute of Medical Sciences. There has been an increase in the robotic surgeries performed in India with the increase in the facilities that guides robotic surgeries. The first ever robotic surgery took place in New Delhi in the year 2006. The technology is being used today in both government and private hospitals and according to the Vattikuti Foundation (Southfield based nonprofit organisation, founded to serve healthcare purposes of India), almost 120 surgeons are able in performing robotic surgeries. According to reports, there were 4000 robotic surgeries performed by 190 surgeons in areas such as urology, vascular, gynaecology, cardiac, paediatric, head and neck and general surgery. Urological procedures include reconstructive surgeries such as ureterolithotomy, pyeloplasty, pyelolithotomy, vesicovaginal and ureterovaginal fistulae repairs. Gynecologists now perform radical myomectomies and hysterectomies. Robot-assisted surgeries are performed by ENT surgeons in oro/hypopharynx and nasopharynx for malignant and benign lesions. Various gastrointestinal procedures include esophageal fundoplication, colorectal and pancreaticoduodenal procedures. 

One of the major reasons for the slow progress of robotic surgery in India is the financial factor. The recently released da Vinci system costs about $1.75 million while the basic da Vinci system costs about $1.2 million. It is beyond the reach of many healthcare institutions as the annual maintenance cost (which remains the same irrespective of the number of surgeries performed in a day) and disposable supply cost is huge. Another major drawback is the absence of robotic surgery fellowship in India. Specialised training is required along with certification from Intuitive Surgical and for surgeons based in India, these are not quite obtainable or affordable. Robotic technology has not yet entered the mainstream healthcare system so there is inadequate access to the technology along with insufficient education opportunities.