A 56-year-old man in Jaipur has become the first patient to undergo a robot-assisted coronary artery bypass graft (CABG) surgery with the surgeon controlling the robot remotely from Gurgaon, 270km away, Indian robot-maker SS Innovations’ executives claimed on Thursday.
Robots have assisted in surgeries for over 25 years, helping in gallbladder removal, gastric operations, hysterectomies and prostate removal, among other procedures. But, according to the executives, the robotic telesurgery in Jaipur marks an advance that could make the technology widely accessible.
Robotic CABG is a less-invasive alternative to improve blood flow to the heart for patients with blocked coronary arteries and promises shorter hospital stays and faster recovery than conventional open-heart surgery. The controlling surgeon uses a robotic machine to perform the surgery through relatively small cuts on the chest, instead of sawing the breastbone, or sternum, in half in the open heart procedure.
“Remote robotic CABG will eliminate the geographic barrier for a rather complicated surgery,” said Manjusha Agwan, a robotics engineer and head of intellectual property at SS Innovations, which has built a series of homegrown surgical robots since 2019. “An expert surgeon need not be physically present at the surgical location,” she said.
A team of SS Innovations' surgeons and engineers, led by cardiac surgeon and founder Sudhir Prem Srivastava, demonstrated robotic telesurgery through a clinical trial on five patients using the company’s flagship SSI Mantra Surgical Robotic System during June and July 2024. One patient underwent gallbladder removal, two patients underwent urinary bladder removal, and the fifth patient had a hysterectomy.
The Si Mantra 3 Surgical Robotic System at work during the world's first robotic cardiac telesurgery, connecting Gurgaon and Jaipur across 270km
Following the trials, the Central Drugs Standards Control Organisation, India’s apex regulatory authority for drugs and medical devices, last month granted approval to SS Innovations to use its surgical robots for telesurgery.
In the remote robotic CABG which took place on Wednesday, Srivastava controlled the robot from Gurgaon while the patient lay below the robot at the Manipal Hospital, Jaipur.
A team of cardiac surgeons at the hospital were also in the operating theatre, watching and on standby, ready to take over. But the operation which took about an hour proceeded without disruption, a surgeon said.
The concept of robotic telesurgery, however, isn’t new.
Surgeons in New York demonstrated the first landmark telesurgery across the Atlantic in 2001, using a robotic system to remove the gallbladder of a patient in a hospital in Strasbourg, France.
But surgeons familiar with the field say that while the technology has existed for over two decades, the number of such robotic telesurgeries has been limited by factors ranging from the high cost of the robots to concerns about time lags — latency periods — in remote robot control.
“Our clinical trial has established that our time lags are negligible,” Agwan said. The telesurgery relied on a dedicated fibre network connecting each hospital site in the trial to the SS Innovations research centre in Gurgaon. The latency period was less than 50 milliseconds, the surgical team reported describing their trial results in the Journal of Robotic Surgery in November.
V. Devagourou, a cardiac surgeon at the All India Institute of Medical Sciences, New Delhi, who was not associated with the surgery said a remote robotic CABG would be a significant advance. “Robotic CABG via telesurgery would have major applications in training surgeons in robotic surgery,” Devagourou said.