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Paging Dr. Robot

In India, we have seen the gradual adoption of robotic surgery. These systems are highly evolved and are proving to be good assistants to surgeons

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As per global research data, The global surgical robotics market is expected to grow at a CAGR of 10.2 percent up to 2031. The market value for surgical robotics was $5.46 billion in 2020 and is expected to grow to $16.77 billion by 2031. In India, we have seen the adoption of these techniques in the government sector as well - the Indian surgical robotics market is estimated to grow to INR 26.01 Bn by 2024. We caught up with Dr. Anupama R, professor & head, department of Gynaecologic Oncology, Amrita Hospital, Kochi to understand how Robotic surgery is being looked at in India. 

What is the da Vinci Surgical System robotic surgery? 
The da Vinci surgical system is a computer-enabled machine that helps surgeons to do complicated surgeries in a minimally invasive way. Every surgery is an injury to the patient albeit for benefit. The lesser the size of the cut on the abdomen, for instance, the less pain he will have and can recover faster. Robotic surgery can be done with specialised instruments with tiny cuts on the patient’s body. The surgeon controls all the instruments and the camera sitting on the console close to the patient.  

How does Robotic Surgery assist the doctor? 
Earlier, most of the surgeries were done the traditional way through big cuts on the patient’s body. With the onset of laparoscopic surgery, many of the surgeries are being done in a minimally invasive way. But complex surgeries like those for cancer are still being done the traditional way. This means that the cancer patients take longer to recover, delaying their chemotherapy and radiation. Cancer surgeons are not keen on laparoscopy because of the long learning curve and complex nature of the surgery which requires a lot of precision. Here robotic surgery offers an advantage such as the high definition 3D camera, fine precise instruments, and a computer-assisted platform. So, definitely, an asset if the surgeon is comfortable with it.  

Which areas of Oncology benefit the most from it? 
Gynaecological Oncology, surgical oncology, gastro oncology, head and neck oncology, thoracic surgery, and urology share the da Vinci surgical platform. 

What are some of the challenges with it? 
There is training involved for the surgeon to master the technique and learn the machine thoroughly before they can use the system. Another challenge in our country is the cost associated with such techniques. There is a huge upfront cost required for the machine and there is a recurring cost involved for the instruments and their maintenance. This cost prohibits many hospitals from acquiring the system as this leads to an increased surgical cost. 

How prevalent is it in India as compared to other countries? 
Globally, there are 7000 robotic systems of which 4000 are in the United States. India has 96 installations till now. The capital investment for the machine and the recurring investment in terms of instruments and annual maintenance run into several crores. Right now in India out of the 95 systems, only 7 are in the government sector. This means that only people with good insurance schemes can benefit from it.  

Medical education will need to include Robotic surgery in their curriculum. Your view? 
The number of robotic systems that we presently have doesn’t allow for robotic surgery to be a compulsory part of the medical curriculum. But it is advantageous for the students’ especially surgical residents to get exposed to robotic surgery. Residents get better exposure to the anatomy and surgical techniques by watching the surgeries and the young generation if trained in robotic surgery; tomorrow more patients are likely to get benefit from robotic surgery.