Dr. Sudhir Srivastava, founder and CEO of SS Innovations, performing a robotic telesurgery for atrial septal defect (ASD) closure. | Source: SS Innovations International
Around the world, people living in rural areas struggle to access adequate healthcare. According to the Centers for Disease Control, rural residents in the U.S. face higher risks of death due, in part, to limited access to specialized medical care and emergency services. SS Innovations International Inc. hopes to change that with robotic telesurgery.
The Gurugram, India-based company has completed five robotic cardiac telesurgeries, of increasing complexity, across more than 250 km (155 mi.). These procedures are just an early step in its goal to democratize access to cutting-edge healthcare, Dr. Vishwa Srivastava, chief operating officer of SS Innovations, told The Robot Report.
“Our whole idea was that technology is great, but it doesn’t mean anything until people have access to it,” he said. “One of our mantras in the company is that we wanted to utilize technology to the best of our ability, so that more patients, and more people across the world, will be able to benefit from such a wonderful technology.”
The company’s latest system, the SSI Mantra 3, costs just a third of Intuitive Surgical’s da Vinci system, Srivastava said. Released in July 2024, SSI Mantra 3 received regulatory approval for remote surgery and teleproctoring from the Central Drugs Standard Control Organization (CDSCO), opening the door for remote surgeries and medical education.
The system has an open-faced ergonomic Surgeon Command Centre, a 32-in. 3D 4K monitor, and a 23-in. 2D touch-panel monitor to display all patient-related information. It also provides a virtual real-time image of the robotic Patient Side Arm Carts and can superimpose 3D models of diagnostic imaging.
SS Innovations extends from simple surgeries to complex cardiac procedures
The SSi Mantra 3 includes more than 40 different types of robotic instruments that can be used for different specialties including cardiac surgery. | Source: SS Innovations International
Srivastava and his father, founder and CEO Dr. Sudhir Srivastava, are both surgeons who got their training in the U.S. and Canada. When Sudhir Srivastava started the company, it was important to him that the company was on par with all regulatory and world-class ways of approaching clinical trials, no matter where it performed surgeries. So, the team started small.
“We first performed on inanimate objects, then we did an animal trial,” Srivastava said. “Then we did a simple cholecystectomy, which is a removal of the gallbladder, at like 5 km [3.1 mi.] away.”
After this, the team worked with Dr. Sudhir Rawal, the medical director and chief of genito-uro oncology at the Rajiv Gandhi Cancer Institute and Research Center. Rawal performed several cases of increasingly complex cancer surgeries at a distance of 40 km (24.8 mi.). These procedures included a prostatectomy (removal of the prostate), cystectomy (removal of the bladder), nephrectomy (removal of the kidneys), tumor excisions, and more.
“We’ve gone through every step to gradually increase the complexity, keeping in mind safety and efficacy and without causing any harm to the patient,” Srivastava said.
The team continued to increase the distance and complexity of these telesurgeries until it finally decided to take on cardiac surgeries. For example, it performed a robotic beating heart totally endoscopic coronary artery bypass (TECAB), one of the most complex cardiac surgical procedures.
To perform its surgeries, the company partnered with the largest telecom company in India, Airtel, to secure dedicated fiber optic lines. Srivastava said although it leased 100 megabytes per second through the line, its bandwidth requirement for the surgeries was just 25 to 30 megabytes per second.
In the future, SS Innovations said it hopes to keep pushing the boundaries. It plans to perform telesurgeries in France and Indonesia in the coming months to test its transcontinental abilities.
Robotic telesurgery provides a new training method
SS Innovations said its system provides greater visualization than other surgical robotic systems, which typically rely on 2D vision. This makes surgery easier for all surgeons, whether they’re new or have years of experience.
“Since day one of our inception, we have given 3D vision to the entire surgical team. So what that means is surgical performance is not compromised. If I’m operating in 3D, I can see everything that I could see in an open scenario,” Srivastava said. “But, if I’m operating in 2D, which is what robotic surgical companies except for us do, it’s like covering one eye and expecting myself to operate.”
Robotic telesurgery doesn’t just have the potential to bring world-class surgeons to rural areas; it can also be used to better train young surgeons, Srivastava added.
“Utilizing teleprompter, even at remote distances, we can coach and train the younger generation of surgeons,” he said. “And if they get stuck, then we can take over and get them through that step so they don’t have to give up and convert the surgery to an open procedure or a laparoscopic procedure.”
“We’re not looking at telesurgery as some rock star surgeon sitting in one place taking the patients away from all other up-and-coming surgeons,” he continued. “You might have heard this quote that a rising tide lifts all ships. We wanted to utilize telesurgery to be able to lift and carry others by providing them the support that they might need.”
