Cancer is a relentless disease. But there is some relief for cancer patients though a bot revolution. With robotic surgery or robot-assisted surgery becoming the norm for many intricate surgeries, cancer patients can look upon it for precision during radiation and chemotherapy. “The distinct advantages of robotic assistance are high resolution three-dimensional visuals and 10-fold magnification, wristed instruments with seven degrees of freedom of movement, filtration of tremors of surgeon’s hands and motion scaling to suit the speed and experience of a surgeon,” says T Subramanyeshwar Rao, medical director and chief surgical oncologist, Basavatarakam Indo American Cancer Hospital, Hyderabad.
Robotic surgery methods give magnified views of the damaged tissue and provide the very fine and precise instruments needed to get access to them inside the body and bring relief. The robot has four flexible arms that enter the human body through tiny incisions and can be guided to make the repairs needed. It is the next breakthrough step in minimally invasive surgery and a major step up from laparoscopic procedures. “The da Vinci Surgery is considered the gold standard in minimally invasive surgery. Surgeons can experience the capabilities of a da Vinci surgical robot in removing cancerous tissue while retaining healthy tissue,” says Gopal Chakravarthy, CEO of Vattikuti Technologies that distributes the da Vinci robot created by US-based Intuitive Surgical Inc. The da Vinci robot has brought precision and efficiency to surgical operations as it has cut risks by minimising errors. Surgeries with this robot have expanded to 47 hospitals in 20 Indian cities in the last six years.
The da Vinci surgical robot, that combines the best of science and medicine, is a whole 1000 kg of hardware. Its brains are equivalent to software packed in several PCs. It includes 2,250-odd patents with 1,550 more pending and so is filled to the brim with innovation. Unlike open surgeries, it provides surgeons magnified, high-definition, 3D-image of the body’s intricate anatomy. It helps in reaching out to those cancerous cells which are difficult to locate. The special surgical instruments are smaller, flexible and more manoeuvrable than the human hand. The surgeon can operate with enhanced precision, dexterity and control even during the most complex procedures.
“With advancements in medical technology, precision and specificity are reaching new highs in the domain of surgery; robotic surgery, or robot-assisted surgery is one such example,” says Utkarsh Palnitkar, partner and head, infrastructure, government and healthcare, life sciences, KPMG India. Leading robotic surgeons say that rising healthcare expenditure, technological advancements, increasing incidence of chronic diseases, rise in consumer spending on healthcare and high incidence of medical errors are some of the factors pushing the demand for robotic surgery. In addition, rise in need for faster recovery, reducing pain and increasing awareness about benefits of robotic surgery are expected to drive the market for robotic surgery. “Laparoscopic surgery is an extremely difficult field. To perfect it, you need a lot of training, mentorship and clinical practice. In spite of that, to excel, it needs a lot of time and perseverance,” says C Mallikarjuna, MD and senior urologist, Asian Institute of Nephrology and Urology, Hyderabad. “Robots make that learning curve easy, so that the expertise can come earlier. It literally means you can be better within a shorter time.”
However, Palnitkar warns about the high cost of installation. The instruments not only have a high cost of installation but also have a large recurring cost due to the disposable nature of instruments and ancillaries. There are only a few companies who manufacturer the equipment for robotics surgery. The monopoly enjoyed by a few players and the high acquisition cost are making it difficult to expand robotics surgery in the Indian healthcare system. Unavailability of trained manpower for robotic surgeries is another major challenge. There is a need for establishment of fellowship programmes and provide structured training to surgical teams. With the growing acceptance of robotic surgeries, the number of procedures carried out are also expected to increase and thus a need for training of doctors for such surgical processes. However, training and certifying surgeons still remains a challenge in India. “The cost of robotic surgeries along with high cost of cancer treatment increases the overall financial burden on patients. There is a need for collaboration between hospitals and insurance companies to devise innovative ways to tackle the high cost of robotic surgeries,” adds KPMG’s Palnitkar.
Market research reports say that North America, followed by Europe, has the largest market for robotic surgery. The global market for medical robots is expected to increase from $4.90 billion in 2016 to $12.8 billion in 2021, growing at a CAGR of 21.1%. Surgical robotics constitute the leading segment of the market. With the rising adoption of medical robotics, developing nations such as China, Japan and India are expected to experience the highest growth in future. “The increasing number of cancer patients in India and a growing influx of medical value travellers are leading to greater adoption of new-age surgical robots in hospitals in metro cities. The increasing focus of hospitals on patient centricity and superior patient outcome is encouraging adoption of new-age techniques; given these advantages, robot-assisted surgery is expected to make inroads into tier-II and tier-III cities in India,” Palnitkar says.
NP Gupta, former professor and robotic surgeon, AIIMS, New Delhi, and chairman, Kidney & Urology Institute, Medanta Medicity, Gurugram, says that robotic surgery delivers better results, higher success rate, fewer complications. “Robotic surgery started two decades ago and significant improvements are visible in this technology. Many new entrants will emerge with better equipment which are more refined and are smaller in size,” he says. Thereafter, robotic surgery has extended across different specialties such as cardiac, general surgery, gynaecology, head and neck, vascular and pediatrics. India has witnessed a rise in the number of robotic procedures in the last few years; nearly 4,000 robot-assisted surgeries were performed in 2015, representing a five-fold increase over 2011. “Robotic technology has been a game changer as it has brought about a paradigm shift in the way a surgeon performs the surgery. The only limitation is its prohibitive cost. But as years pass by and there is competition in the market, the price of robotic systems will follow the path taken by computers and cellphones,” says Arvind Kumar, thoracic, thoracoscopic and robotic surgeon and chairman, Centre for Chest Surgery and Lung Transplantation and director, Institute of Robotic Surgery, Sir Ganga Ram Hospital,New Delhi.
Globally the costs associated with oncology care are higher than the treatment costs for any other disease, leading to demands for more robust evidence of treatment success. According to a few reports, advanced R&D facilities and new product developments are addressing the demand for cost effective healthcare in the medical robots industry. Moreover, development of nanorobots is also expected to support the growth of the medical robots market.
Medical robots can be categorised into noninvasive radiosurgery robots, surgical robots, rehabilitation robots, hospital and pharmacy robots and others. By type, the surgical robots lead the medical robots market, as surgical robots reduces the complication rate of surgeries and improves the accuracy of the procedure. Surgical robots are further categorised into orthopedic surgical robots, laparoscopy robotic systems, steerable robotic systems, neurosurgical robotic systems and others. The laparoscopic robotic systems lead the surgical robots market; whereas, the neurosurgical robotic systems segment is expected to grow fastest due to increasing demand for minimally invasive surgeries.