Robotic surgery first appeared in the operating room more than 20 years ago. How do you evaluate its impact and what are the latest advancements?
The robotic surgery started at the patient level in 1998. And one company essentially has dominated over the last 20 plus years at this point, and over 7 million robotic operations have been executed so far globally. Robotic surgeries have come a long way, and there has been a continuous evolution of technology.
Even though so many procedures have been done, it has never reached an even global penetration. So, when we looked at the reasons for it, the biggest reason comes out as a cost.
Roughly over 5700 robotic systems exist today. And 93% are between the United States, Europe, and Japan. This means almost 6 billion people in the world do not have easy access, mainly because of the cost, and partly due to the associated learning curve.
And over the years, because of the patent issues, many companies just did not get into the field of development. But today, there are at least 15 to 20 companies that are at various stages of development. And what I see in the next three to four years, there will be more and more companies entering the clinical field. And so we must keep that in mind. If you take India, for instance, with a population of 1.4 billion people, we’re 32,000 hospitals in the country, we have only less than 100 systems. And that is sad in a way that patients not only in India, but many parts of the world do not have access to this wonderful way of doing a less invasive operation that is associated with less trauma, fewer complications, and very fast recovery that ultimately translates into huge benefits for the society and the healthcare system.
Your interest in Robotic Surgery ?
I left India in 1972, after finishing medical education in Ajmer, and lived in the United States for almost 38 years.
I was the founding Chairman of Alliance Hospital in Odessa, Texas, which I ran as a Chairman for four years, then moved on to the University of Chicago as an assistant professor and director of robotic cardiac surgery. Then I founded the International College of robotic surgery in Atlanta and led the field in terms of teaching and training.
I came to India as founder and chairman of the International Centre for robotic surgery to be able to launch programs in the country. After having come to India in 2011, launching programs, I realized that the cost was a major inhibiting factor for our patients to undergo surgery. The capital cost was high, then the per procedure cost was further expensive.
In 2012, I decided to invest my time and money to come up with a system that will be cost-effective. Initially, my mission took me to Germany. And then in 2013, I put together a team of engineers to start looking into developing some of the ideas that are very different, technologically different system, which will also be cost-effective and hopefully have more capabilities.
It has taken us about four years or so, to come up with this, the latest generation of the MANTRA system. We were able to use the new machines very recently in the first human biology study and clinical trials very successfully in some of the very complex procedures.
What it took really for this success in a relatively short time, and with limited financial resources was the association of a clinical experience with a very talented team of very young engineers. The majority of this team is from India, while we do have international engineers along the way who have helped us. These are renowned experts in the field of robotic engineering.
What differentiates MANTRA from the existing Robotic system in the market?
MANTRA is unique in its ways that it is modular with an open face console. So ergonomically, surgeon can sit as straight as compared to the da Vinci system, where you’re hunched over and then you don’t see anything else around you.
I can sit straight just like this. And with the 3d large monitor, I’m able to view the endoscopy 3d view of the inside of the patient’s body. Then with my hand motions, which are different in the sense of what controls I use compared to the da Vinci system, and to be able to control these modular robotic arms. We also have certain very advanced features, whereby the collision of the robotic arms or collision with the patient is detected and avoided.
The other major difference beyond technology is the application. Our system will be useful in all surgical specialties, except orthopaedic at this point. We will be including cardiac surgery as one of the focuses. No one in the world is focused on cardiac surgery. Apart from these specialties, we will also focus on cardiac surgery because the benefits are so huge in terms of having the entire complex operation done through tiny holes versus having the sternum split open, which is associated with a lot of trauma, surgical complications and very long recovery periods.
Another major factor that we considered in this development was the cost. The current da Vinci system in India at the highest level sells for something like 16 to 18 crores. As mentioned that there are a limited number of systems concerning the population and the number of hospitals in the country, we have less than 100 systems today.
Your future plans and vision to carry this forward.
Our vision is to develop a system that can get it to the masses, many more hospitals.
So our goal is to be able to sell to the end-user in India, somewhere between four to five crores. This will further keep the cost of procedures as well as the maintenance contract very affordable, so the hospitals can afford it; and in turn, more and more patients will benefit from it.
Our plans for the future include making the system commercially available later in 2021 and establish our manufacturing and assembly within India, with as many Indian companies as possible.
We have raised probably over 300 crores or so from various resources. But at this point, and hopefully, as soon as we finish our clinical trial, we will be launching our next round of funding. And the goal is to raise somewhere between 700 to 1000 crore to establish our infrastructure support systems, manufacturing and create a global company with our next round of funding. My dream and vision are really to make the robotic system available in most parts of our country including the remote areas. I sincerely hope that our success and our being in India inspires many young and bright minds to push if you have a great idea. Go for it because you can also achieve it.