One Cardiac Surgeon's Dream To Bring Robotic Surgery To The Masses Is Becoming A Reality

According to the Mayo Clinic, Robotic surgery allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with traditional procedures. Most often, a robotic surgery system includes a camera arm and mechanical arms with surgical instruments attached to them. The surgeon controls the arms while seated at a control center, called a surgeon console, near the operating table where he/she sees a magnified, high-definition, 3D view of the surgical site. The surgeon leads other team members who assist during the operation.

Dr. Sudhir Srivastava M.D., chairman and CEO of SS Innovations SSII, launched the first robotic surgical system made in India in 2022 with a simple, two-pronged approach to transform minimally invasive procedures in his homeland and beyond. 

"Our goal at SS Innovations is to decentralize and democratize access to robotic surgery," Srivastava said. "Cost has become an issue across the world, and this is why almost 7 billion people do not have easy access to the wonderful technology and these time-tested techniques." 

Robot-assisted procedures — spanning oncological, gynecological, urological and cardiac surgeries, as well as orthopedics and general uses, among others — have redefined medicine since neurosurgical biopsies were first performed in 1985. 

Intuitive Surgical, which manufactures the industry's ubiquitous Da Vinci Surgical Systems, later revolutionized the field in the early 2000s, providing improved treatment options to patients by equipping surgeons with enhanced dexterity, better visualization and improved precision. 

The Da Vinci robotic systems, including more than 7,500 in 70 countries, have performed more than 14 million procedures globally. The devices that flawlessly mimic trained specialists and vastly improve traditional laparoscopic methods boast the largest set of robotic-assisted surgery data currently available — and a surgeon starts operating with the sophisticated machines every 16.8 seconds, according to Intuitive's website. 

"One wonderful system that has enjoyed a monopoly for a very, very long time," Srivastava acknowledged. 

That dominance, however, has contributed to increasingly unaffordable and inaccessible high-end robotic surgical systems, particularly in remote or rural regions, the veteran cardiac surgeon said. 

"If you take the global situation, almost 90 percent of the penetration has been in the United States, Europe and Japan," Srivastava continued. "That means the rest of the world – a very large population – doesn’t have access to it because of the cost." 

Srivastava, a 75-year-old native of Gurugram, India, has studied medicine since 1970 and held prominent cardiac surgeon roles at facilities from Vancouver, Canada, to Odessa, Texas, where he co founded Alliance Hospital in July 2003. The trained robotic maestro later performed the world's first single-vessel, beating-heart totally endoscopic coronary artery bypass (TECAB) procedure. 

The surgeon's latest creation, a five-armed robotic surgical system called the Mantra, can impeccably perform that complicated cardiac surgery, as well as others — like mitral valve replacement — and a host of procedures across urology, gynecology and general surgery. 

"The best part is we've encountered zero mortalities, zero complications and no injuries," Srivastava said. "We're really trying to establish the highest possible standards while maintaining cost-effectiveness." 

SS Innovations, which was recently named as a finalist in the 2024 Surgical Robotics Industry Awards in the "Outstanding Company" category, will unveil their next generation Mantra 3 system for the first time in the U.S. at the Society Of Robotic Surgery's annual meeting in Orlando, Florida on June 20th The predecessor, Mantra 2 has been used to successfully perform 1,400 multi-specialty procedures, including 100 cardiac surgeries, throughout nearly 50 installations in India, SS Innovations announced last month. Roughly half of the coronary bypass operations were carried out by Dr. Nitin Kumar Rajput at the Narayana Institute of Cardiac Sciences in Bangalore. 

"I have found that SS Innovations now has the most advanced system for coronary and intracardiac robotic cardiac surgeries, and we have performed bypass procedures, valve repairs and atrial septal defect closures." 

The Mantra surgical platform, which has been granted regulatory approvals in Ecuador, Guatemala and Indonesia costs roughly $750,000 — just one-third the cost of the latest da Vinci model, Srivastava said. 

Regulators in Indonesia just approved Mantra in the world's fourth most-populous nation, where affordable and accessible robotic surgical options elude the overwhelming majority of more than 279 million people. The country's first robot-assisted platform at Bunda Hospital, for example, has only completed about 700 surgeries since 2012, according to SS Innovations. 

"We look forward to broadening surgical horizons for Indonesians and continuing to expand our innovative surgical services and options across the globe," Srivastava said. 

While not yet approved in the United States, the Mantra system is already prepping the next generation of specialists at John Hopkins University's Minimally Invasive Surgical Training and Innovation Center. 

Srivastava said SS Innovations has also begun discussions with regulators in Brazil, with hopes to receive approval in other key markets like the United States and Europe in 2025. 

"If everything goes well, by this time next year, we should have FDA approval," he said.  "We're moving very rapidly … We've got quite a few orders from various countries around the world." 

Srivastava credits Mantra's ergonomic design, user friendly features and relative low cost for the meteoric rise in demand. The system, which features a 32-inch, 4K ultra high-definition monitor and capability to operate a fifth arm, enables users to perform complex yet minimally invasive cardiac surgeries without splitting the sternum translating in less trauma, blood loss, risk of infection and ultimately a faster return to functional status postoperatively.  

"The goal is to change the direction of medicine, specifically how surgeries are done in the future," he said of advancements in robotic surgery like the Mantra System. "There is a need for it across the world and if you can make a difference in the lives of people, why not?" 

The "phenomenal" work being done by the SSi Maya division that is a part of SS Innovations reminds Srivastava of something out of "Minority Report," the futuristic 2002 sci-fi thriller starring Tom Cruise set in 2054. But the technology's real-world impact is anything but fiction, he said. 

"One thing I tell surgeons is it will actually extend their careers because you can sit and operate when the body doesn't cooperate," Srivastava said, referencing hand tremors that can develop during the natural aging process. 

Once implemented on a wider scale, Srivastava insists robotic surgical systems like Mantra — part of a global market projected to exceed $188 billion by 2032 — will significantly benefit patients by extending the careers of highly skilled specialists like cardiac surgeons. 

"We are looking at it in a very holistic way to help surgeons in every possible aspect by making our system different, with more features, including the only console in the world that can control five arms," he said. "The competition has done a great job, but there are many things that could be done to make it better, safer and more affordable so more patients will actually benefit from it." 

SS Innovations' Mantra will ultimately prove to have more effective and user-friendly operating systems at significantly lower costs than competitors like Intuitive, Medtronic, and other companies that offer higher cost systems, Srivastava insists. 

"Anything that does not change with time is not good in the field of science today," Srivastava said, including robotic surgical platforms. "So, how could we make it better? How could we make it significantly advanced, but also cost-effective? With that vision, I undertook this journey."

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