Robotic arms take strides in operation theatres

When one thinks about surgery, the image that comes to mind is of surgeons standing and performing operations, making cuts and drafts, working on rectifying the faulty organ. However, things have changed in the last few years, with robots entering the operation theatre. In India, one of the major players in this space is Intuitive Surgical, a global giant in robotic-assisted surgery and the creators of the “da Vinci Surgical System”. In the United States, their products are widely used in general surgery.

The company began direct operations in India in 2018. It serves multiple surgical disciplines, including general surgery, urology, gynaecology, thoracic, and trans-oral surgery.

What they do

Intuitive Surgical develops new, ‘minimally invasive’ surgical platforms and future diagnostic tools to help solve healthcare challenges

Unlike regular surgeries, in the da Vinci Surgical Systems, the surgeon sits at a console, viewing the image of the target anatomy. They grasp the master controls with their hands and wrists naturally positioned relative to their body. Robotic arms, holding an endoscope (camera) and surgical instruments, carry out the surgeon’s commands. Mandeep Singh Kumar, Vice President and General Manager, Institutive Surgical India, says the system translates the surgeon’s hand, wrist, and finger movements into a precise, real-time movement of the surgical instruments positioned inside the patient’s body. These instruments can bend and rotate far greater than traditional lap instruments as well as the human wrist.

During the surgical procedure, the vision system displays 3D HD imagery to the surgeon via the console and to the operating room staff via the vision cart.

RAS vs Laparoscopic

According to Kumar, laparoscopic surgery is also ‘minimally invasive’ but robotics surgery gives the surgeons much better access.

“Laparoscopically, you work on a chopstick principle, with movement around a single hole, while RAS ensures deeper access on deep-rooted tumours, better control; additional capabilities to scale motions, reduce traverse motions and certainly, better visibility,” points out Kumar.

No added risk

In reference to the risk in the functioning of the robotic systems, Kumar says that the surgeon is always in control and the access is given to highly-qualified surgeons to ensure a better clinical outcome. “We can’t turn bad surgery into good surgery. We have taken care of certain crucial things. For instance, if the surgeons put their head out of the console, the system stops working.”

He states, “Risk is inherent in any surgery, this technology is not adding to it.”

While Kumar mentions that removing ‘assisted’ in Robotic Assisted Surgery (RAS) is too risky an idea, and he does not see anything happening in that direction by anyone, he says, the more practical ambition would be to figure out ways to add more and more value to the ‘assisted’ part of the surgery.

Where the technology is available

“Intuitive has a long history in India, but it was primarily through a local distributor, Vattikuti Technologies. We have a firm belief in the capability of Indian surgeons,” said Kumar.

Presently, the company is running more than 65 robotic programmes in the country. In terms of the institutions they are present in, Kumar explains,“There are large corporate chains- like Apollo; large scale single-rooftop standalone hospitals - like Kokilaben Dhirubhai Ambani Hospital and Hinduja hospital, and government-run academic and research institutions like All India Institute of Medical Sciences (AIIMS), Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. It is being used in surgical procedures in these hospitals.”

In India, the procedural focus is on urology and gynaecology and primarily revolves around prostatectomy, hysterectomy and adenectomy. “We are new to India. Our focus has been to build the right team. We are building a network of training centres and case observation sites. It’s a heavy lift to make this programme successful,” says Kumar.

The India move

Kumar explains, “There are three prerequisites for the success of the company— surgeries where robotic systems can provide the desired clinical value, a pool of trained surgeons, or passionate surgeons who can be trained in robotic surgery and strategic planning to develop a team that can work towards creating an ecosystem for these procedures.” In India, he adds, the company found the confluence of these three, which prompted the decision to go direct.

Training programme

Surgeons and others using these tech tools undergo an extensive training programme.

“In these training programmes, we make sure they understand the clinical aspects of the disease they are focussing on, the technological aspects of the product we are selling and understand how to model the sales and the go-to-market strategies,” he says.

There are three phases spread over 3-6 months. Earlier, the surgeons were sent to the US or Switzerland for training. Due to visa and other related issues, the company is working on establishing the training ecosystem in India.

According to Kumar, in India, there is a huge demand for technology, but getting investment is a tough job “Not many institutions are willing to invest. We are also looking at ways where we could bring down the cost.”

“We want the monopoly to be broken because that states that the market is going to expand. We are excited to see more competition coming in.”