Govt assist vital to extend penetration of robotic surgical procedure in tier 2, Three cities: Dr. Sudhir P. Srivastava, SS Innovations

Despite a long time of profitable robotic-assisted surgical procedures globally which have positively impacted hundreds of thousands of sufferers, the entry is scarce at giant. The dominant present robotic system is pricey and related to a steep studying curve, ensuing within the restricted availability internationally of over six billion individuals. In an unique dialog with Financial Express Online Dr. Sudhir P. Srivastava, Founder, Chairman & CEO, SS Innovations stated that robotics shall be the way forward for surgical procedure, and he goals to create a technologically superior system that shall be cost-effective, straightforward to make use of, and will be utilized to all surgical specialties. Thus, benefitting most sufferers world wide. Compared to standard surgical procedure, robotic surgical procedure leads to smaller incisions, that reduces ache, scarring and results in faster restoration, he added. Excerpts:

What is the present state of the newest innovation and know-how in medical and healthcare, please elaborate.

Over the final 70 years, medication has superior considerably due to new discoveries, developments and newer applied sciences from a plain X-Ray to CT Scans, MRIs, ECHOs and 3D imaging to offer extra particulars concerning the illness course of.  Various Artificial Intelligence and algorithms can decide in a short time in relation to differential diagnoses.  There are machines that may give fast interpretations in distant areas the place there aren’t any medical doctors current, for instance to generate an EKG report with interpretation using AI and machine studying.  The utilization of know-how within the discipline of medication has at all times been necessary with the aim of advancing science.  An ideal instance of that is the comparability between minimally invasive surgical procedure and conventional open surgical strategies.  The conventional strategies carried with them an elevated threat of an infection, slower restoration occasions and post-operative ache which finally affected the standard of lifetime of the affected person.

There was an evolution of surgical procedure from these open strategies to laparoscopic, or keyhole, surgical procedure and at the moment robotic assisted surgical procedure.  Additionally, numerous therapy methodologies have modified, as a substitute of excision, now ablation of cancers inside the physique is finished to stop systemic negative effects of assorted therapies.  Nanotechnology is now being utilized in relation to drug supply in focused remedy for numerous systemic illnesses.  Stem cell analysis is ongoing with reference to the regeneration of organs and 3D printing is now getting used for modelling of organs to higher perceive the illness processes.  Lastly, telemedicine has come to the forefront with astonishing developments the place medical prognosis and care will be completed remotely and telesurgery, the place surgical procedure will be completed remotely using technological developments in connection speeds and bandwidth.

How far has medical robotic surgical procedure come from its origin?

In the 1980s the United States Defense Department and NASA funded analysis to develop applied sciences to have the ability to deal with sufferers in house and the battlefield, nonetheless, at the moment the know-how was not mature and bandwidth was not accessible for telesurgery.  Early robotic corporations got here into existence in 1988 with the PROBOT which was developed on the Imperial College of London to carry out prostate surgical procedure, then ROBODOC from Integrated Surgical Systems in 1992 to mill out exact fittings within the femur for hip substitute.  IN 1998 a Trans-Atlantic surgical procedure was completed with the Zeus system, nonetheless, there was important latency and the price was prohibitive however it did present {that a} telesurgery Proof of Concept might be achieved. Robotic surgical procedure began on the affected person degree in 1998 and over the past 20 plus years, over 7 million robotic operations have been carried out globally.  Even although so many procedures have been completed, when analysing the numbers, a fair world penetration has by no means been reached due primarily to the excessive capital value of the robotic system. Today there are over 5700 robotic methods on the planet, 93% are between the United States, Europe, and Japan. This means virtually 6 billion individuals on the planet should not have easy accessibility to this superior medical know-how, primarily as a result of value.  If you should not have entry to the system then you definitely can not prepare and change into higher at your strategies.

Even in elements of the developed world, the provision of robotic surgical procedure choices stay in bigger cities which implies that in smaller cities a affected person should journey in an effort to obtain higher surgical choices.  Over 140 corporations and analysis establishments are presently engaged on numerous robotic methods for a big spectrum of purposes.  There are over 20 robotic methods which have been launched however there are only some which might be being utilized in a medical setting.  In the subsequent 3-Four years there shall be an extra 10-15 corporations rising with respect to specialty particular applied sciences.

Tell us concerning the launch of MANTRA

Despite a long time of profitable robotic-assisted surgical procedures globally which have positively impacted hundreds of thousands of sufferers, entry is scarce at giant. The dominant present robotic system is pricey and related to a steep studying curve, ensuing within the restricted availability internationally. Taking this up as a problem and main with a imaginative and prescient to supply minimally invasive robotic surgical procedure options, now we have launched the MANTRA surgical robotic system. It is a value – efficient, modular surgical robotic system developed to carry out minimal entry surgical procedure with excessive precision, management & dexterity. It will be utilized for all main surgical specialties together with Urology, General Surgery, Gynaecology, Thoracic, Cardiac, and Head & Neck Surgery.

Dr. Sudhir P. Srivastava, Founder, Chairman & CEO, SS Innovations

How a lot time did you’re taking to take from inception to getting the product prepared?

I got here to India as founder and chairman of the International Centre for Robotic Surgery to have the ability to launch packages within the nation. After having come to India in 2011 and launching packages, I spotted that the price was a serious inhibiting issue for our sufferers to endure surgical procedure. The capital value was excessive and  the per process value was additionally costly. In 2012, I made a decision to take a position my money and time to provide you with a system that might be cost-effective. Initially, my mission took me to Germany, after which in 2013, I put collectively a workforce of engineers to start out trying into creating among the concepts that have been very completely different for a technologically completely different robotic methods that might even be cost-effective and have extra capabilities.

It has taken us about 4 years or so, to provide you with the newest era of the MANTRA surgical robotic system. Recently, in our first in human medical pilot research using the MANTRA surgical robotic system, we efficiently accomplished 18 complicated abdominopelvic procedures on the Rajiv Gandhi Cancer Institute, the premier hospital for Oncology Surgery in India.

Tell us about your workforce, who labored on this challenge?

What it took actually for this success in a comparatively brief time and with restricted monetary sources was the affiliation of a medical expertise with a really gifted workforce of  younger engineers. The majority of this workforce is from India, whereas we do have worldwide engineers alongside the way in which who’ve helped us. These are famend specialists within the discipline of robotic engineering. The SSI workforce has been aided by world famend robotic surgeons and extremely skilled consultants from world wide. The dedicated and targeted efforts have resulted in an inexpensive multi-arm SSI Mantra Surgical Robotic System that might profit many extra sufferers world wide to decentralise entry and excellence.

What are your plans for enlargement and additional growth?

Our imaginative and prescient is to develop an inexpensive system that may change into accessible to the lots.  Our aim is to have the ability to promote to the end-user in India at someplace between 4 to 5 crores. This will additional hold the price of procedures in addition to the upkeep contract very inexpensive. The hospitals can afford it and in return, increasingly sufferers will profit from it. Our plans for the long run embody making the system commercially accessible later in 2021 and establishing our manufacturing and meeting inside India. We have raised over 300 crores or so from numerous sources however at this level. We shall be launching our subsequent spherical of funding for which our aim is to boost someplace between 700 to 1000 crore to determine the infrastructure assist methods, manufacturing and to position ourselves as a worldwide robotic surgical procedure firm. My dream and imaginative and prescient are actually to make the robotic system accessible in elements of the world the place sufferers would in any other case not have entry.  Additionally, we might hope that our system might be positioned throughout Indian Medical Colleges in order that, simply as surgeons come out of their PG programs as skilled laparoscopic surgeons, they might even have the chance to coach as robotic surgeons as effectively.

What differentiates MANTRA from the present Robotic system out there?

MANTRA is exclusive in its ways in which it’s modular with an open face console. This design offers superior ergonomics for the surgeon whereas giving full view of hand controls, foot pedals and surgical workforce.  The surgeon can view the whole working room for energetic steering. Modular Robotic Arms with a number of changes are mounted on particular person motorised carts for simple motion, positioning and docking. The design permits for complete flexibility as to variety of arms for particular procedures (3-5 Arms), positioning primarily based on track anatomy and physique habitus. The numbers of arms used are customisable primarily based on varieties of procedures, finish consumer necessities and budgets.
Our system shall be helpful in all surgical specialties, besides orthopaedic at this level. Additionally, we shall be together with cardiac surgical procedure as considered one of our focuses. Currently, no different firm on the planet is concentrated on all facets of cardiac surgical procedure, particularly robotic cardiac bypass procedures. The advantages in cardiac surgical procedure are so large when it comes to having the whole complicated operation completed by way of tiny holes versus having the sternum cut up open, which is related to numerous trauma, surgical problems, and really lengthy restoration intervals.

Another main issue that we thought-about on this growth was the price. The present dominant system in India on the highest degree sells for between 16 to 18 crores. As talked about, our imaginative and prescient is to develop a system that may profit the lots and plenty of extra hospitals, as such, our system shall be accessible at on-third of that value.

As part of Make in India, what’s the assist you might be looking for from the federal government?

As part of the Make in India initiative, we want for the federal government to increase a serving to hand in direction of the robotic surgical procedure phase by decreasing the import obligation on important digital parts and different parts that aren’t indigenously produced in India. Government assist can also be vital to extend the penetration of robotic surgical procedure know-how to the tier 2 and tier Three cities to make sure that it ought to be simply accessible to sufferers throughout the nation at an inexpensive and backed fee.  Create partnerships to have the ability to develop healthcare to distant areas.  Robotic surgical procedure protection underneath Ayushman Bharat for half a billion individuals.

For robotic surgical procedure to enter the mainstream healthcare infrastructure, the federal government ought to introduce robotic surgical procedure at instructional establishments. This will assist the brand new era to affiliate with this revolutionary know-how. If fellowships are supplied in robotic surgical procedure, and post-graduate programs are began on this discipline, then a pool of well-trained robotic surgeons and world-class infrastructure will be developed inside the nation.  India actually has a chance to change into world leaders in robotic surgical procedure, with our giant inhabitants base and want to advance amongst the medical group,  an enormous database primarily based on the cumulative medical expertise that can be utilized to advance additional analysis and growth and instructing and coaching.    With regards to enhancements in infrastructure, telesurgery will be achieved however it will require excessive velocity bandwidth throughout the nation in an effort to facilitate this novel utility.

The following steps would additional assist to make sure penetration of robotic know-how within the nation:

1. Supporting the institution of robotic surgical procedure packages in public hospitals and placing insurance policies in place that facilitate the adoption and entry to the know-how
2. Providing the required infrastructure to localize the manufacturing of surgical robots.
3. Giving choice to Indian merchandise over foreign-made merchandise if the standard requirements are the identical.
4. Promoting indigenous manufacturing of assorted digital parts, motors, and drives, and many others.

Could you throw some gentle on the challenges and roadblocks you confronted throughout this challenge?

Apart from the pandemic on account of which the challenge was delayed by virtually an 12 months, the largest hurdle that slowed us down is the dependency on international manufactures for importing refined tools. We are hoping that the federal government will take vital steps to supply important services to indigenous robotic surgical procedure start-ups.
Apart from the above, we being a begin -up confronted the identical set of challenges as each begin up akin to procurement of funds and expertise, assembly the funding milestones, manufacturing delays and many others., which we overcame with time, effort and consistency.



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