Here's how robotic surgery is slowly catching on in Indian hospitals

The surgeon sits in front of a console a few metres away from the operating table. She is looking at a 3D screen that gives her live pictures of the part of the body to be operated on. The pictures are being taken by two cameras mounted on robotic hands which can enter the body through a small incision. They give the surgeon the same visual fix of the organ that she would get if she were to see it while performing an open surgery with a large incision. The robotic hands are mounted with various instruments used for cutting, stapling, stitching or suturing. The surgeon controls them by using the two joysticks on the console — much like one would in a gaming machine. Happily, the instruments can reach deep inside the body parts, which is often tough to do by human hand.

Welcome to the world of robotic surgery, which is slowly catching on in Indian hospitals. Currently, over 70 robotic machines have been installed at hospitals around the country. When these machines were first introduced in India in 2003, just a year after they got FDA approval in the US, they were used only to help perform heart surgery. That experiment did not take off. Now, after more than a decade, robotic surgery has once again caught the fancy of the Indian medical establishment and the technology is being used for surgeries in urology, cancer,  hysterectomy, thoracic and chest surgeries, as well as in weight loss procedures.

Says Arvind Kumar, chairman, Centre for Chest Surgery and director of Robotic Surgery at Sir Ganga Ram Hospital in Delhi, “We do about 600 chest surgeries in our hospital and one-fourth of these are using robotics. Across all disciplines, we are conducting about 400 robotic operations a year. ”

For the patients, this is good news. The surgeon makes very small incisions (three or four) instead of the large cuts in open surgeries, leading to quicker recovery and reduced chances of infection. The catch, however, is that robotic surgery comes with a steep price tag: it costs about Rs 0.1 to 0.15  million more than regular laparoscopy surgery. Besides, most Indian insurance companies are not ready to pay the extra cost incurred by a patient in the case of robotic surgery.

The surgeons have to undergo training before they can start using robotics. Kumar says that whatever their discipline, surgeons go through a training course of two to 10 days before they can employ robotics in their operations.

Needless to say, there are huge advantages of using robotics in surgical procedures. This is particularly true in the case of complex weight loss  surgeries. Says Praveen Bhatia, robotic and  laparoscopy surgeon at Bhatia Global Hospital and Endosurgery Institute: “We recommend robotic surgery to patients who have morbid obesity with BMI of over 50. It is safer, recovery is faster and chances of infection are much less. Annually, 10 per cent of 12,000 bariatric surgeries done in the country use robotics.”

But overall, robotic surgery constitutes only about two per cent of surgeries performed in hospitals in India, Bhatia points out.

Robotic surgery is expensive primarily because the machine itself costs Rs 120-150 million. Moreover, its annual maintenance bill comes to about Rs 10 million, and the consumables are expensive too. Says Anant Kumar, chairman, department of urology, robotics, kidney TX and uro-oncology at Max Hospitals: “Naturally, hospitals have to recover the large investments that they make on the machine. Though the saving a patient makes from not having to stay in the hospital for an extended period is not much, the procedure involves less pain, quicker recovery and fewer complications due to the precision of the surgical process.”

One reason for the high cost of robotic surgery is that right now the US-based firm, Intuitive Surgical, is the only company that manufactures the machine, which is called Da Vinci. The company has a monopoly in this space. The instruments used on the robotic hands also come at a stiff price — about $3,000 apiece and a chip ensures that they are deactivated after 10 surgeries. Each procedure also needs 4-5 consumables, which adds another $1,200 to $1,500 to the cost.

New technological developments could make robotic surgery mimic the actions of human surgeons even more. Arvind Kumar says that work is on to provide doctors with a sense of touch on the computer screen — something that open surgery affords them. Robotic telematics, where the robots are operated remotely via the internet, could soon become a reality as well.

Says Kumar, “It is technically possible for a surgeon based in one country or city to operate on a patient in another country or city. But for that, one will require high-speed broadband with virtually no latency.” Telecom companies like Bharti Airtel already realise that this could be a huge potential area of business. CEO Gopal Vittal says that when the company launches its 5G services, this is one key application area they would be looking at.

There are indications that Intuitive Surgical may lose its monopoly in the market, which in turn would bring down the prices. Bhatia says that several big players are all set to enter the field. Alphabet (Google’s parent company) has tied up with Johnson & Johnson to manufacture these machines. Other large medical equipment manufacturers such as Ethicon, Verb Surgical, Medtronics and so on are also expected to introduce their robotic surgery machines in the near future. 

If the procedure becomes more affordable, it is just a matter of time before more and more patients turn to the sophisticated charms of robotic surgery.