Robot-assisted surgery in India: A SWOT analysis

Abstract

INTRODUCTION Sushruta, in his Sushruta Samhita, has said, “A great surgeon is one who possesses courage and presence of mind, a hand free from perspiration, tremor less grip of sharp and good instruments and who carries his operations to the success and advantage of his patient who has entrusted his life to the surgeon.”[1] The age-old teachings of Sushruta still hold true albeit for the fact that the hands of the surgeon are slowly being replaced by the tremor less grip of the robotic arms. After the US FDA approval of the da Vinci system in 2000,[2] India got its first urologic robotic installation at the All India Institute of Medical Sciences, New Delhi, in 2006. The following decade saw an unprecedented growth of robotic surgery in India. There are currently 66 centers and 71 robotic installations as on July 2019, with more than 500 trained robotic surgeons in our country. More than 12,800 surgeries have been performed with robotic assistance in these 12 years. The numbers are expected to increase as more robotic surgeons get trained and other surgical specialties increasingly utilizing this platform. The trend suggests that the rise of robotic surgery in India has been, and is, going to be a rapid and huge one; therefore, we scrutinize this rise of robotic surgery in India, and its future, using a strength-weakness-opportunities-threats (SWOT) analysis. STRENGTHS Patient volumes The success of any surgical program depends on the availability of a large number of cases, standardization of all surgical steps, and repeated exposure to the same disease reinforcing the stringent management protocols and ensuring efficient utilization of resources in a cost-effective manner. The alarmingly rising population of India, though a major social concern, results in very large number of patients being treated by a single surgeon. This blessing in disguise leads to an early crossing of the learning curve for most robotic surgeons and ample learning opportunities. Growing economy India is the world's 7th largest economy by nominal gross domestic product and the 3rd largest by purchasing power parity. In the financial year 2015 and 2018, India's economy became the world's fastest-growing major economy, surpassing China.[3] The healthcare sector has become one of the India's largest sectors, with healthcare market likely to have threefold jump by 2022, driven by the growing incidence of lifestyle diseases and rising demand for affordable healthcare delivery systems.[4] The growing economy and the rapidly expanding healthcare sector have resulted in decentralization of institutions and are expected to bring in more hospitals offering robotic surgeries, resulting in a decline in the cost of the treatment. Good laparoscopic surgeons The need of laparoscopic experience prior to robotic surgery is debatable. However, there is no denying the fact that surgeons with excellent laparoscopic skills would have an edge and also a shorter learning curve. Laparoscopy is well established in India. Hence, the transition from a laparoscopic surgeon to a robotic surgeon is smooth, which ensures a shorter learning curve and a faster dissipation. Training and proctorship Several institutes in India are offering training programs in robotic surgery, mentored by senior consultants at various government institutions and private hospitals. With the Vattikuti 1-year fellowship in robotic surgery, the training process has been streamlined with increased opportunities for upcoming young surgeons.[5] Moreover, the da Vinci Basic Surgical Skills Training Center has been started in India to provide additional training opportunities.[6] Increase in experienced surgeon cohort Robotic technology has also increased the age of the surgical capabilities of surgeons by its improved ergonomics, motion scaling, and tremor filtration. It is particularly beneficial in a country like India where the demand of surgeons is ever increasing. Increased insurance (National Health Profi