In the ancient Sanskrit text, Sushruta Samhita―a treatise on medicine and surgery―the author, Sushruta, lists the qualities of a great surgeon. These include courage and presence of mind, a hand free from perspiration, and a tremor-less grip of sharp and good instruments. But what if the grip of the surgeon was replaced by the firmer hold of robotic arms? And what if your robotic surgeon was made in India?
SSi Mantra is the first robotic surgical system to be made in India. It is unlike any other system in the world for the broad spectrum of surgical procedures for which it can be used (from throat to gynaecological surgeries) and its cost effectiveness.
Named after its founder, Sudhir Prem Srivastava, among the world’s best known robotic cardiac surgery experts, SS Innovations International Inc fulfilled its first international order for the SSi Mantra in August 2023. The unit was delivered to Aster Hospital, Dubai.
Dr Somashekhar S.P., chairman, medical advisory board, Aster DM Healthcare, and director, Aster International Institute of Oncology, said that the first installation of the system outside India marked a major medical milestone for the country. “This robotic system, which has world-class technology and was developed by some of the best physician leaders in the industry, offers affordable cutting-edge medical technology to all those who are in need of complex surgical care, regardless of income,” he said.
The use of robotics in surgery, in theory, goes back to 1967. However, the first fully functional multipurpose surgical robot was developed by the US department of defence, in conjunction with innovative startups and established research agencies, only 30 years ago. It was this system, named after Leonardo da Vinci, that was first installed in 2006 at the All India Institute of Medical Sciences, New Delhi. Its cost then was around Rs9 crore; now it is closer to Rs15 crore.
There is much in favour of robotic surgery. It makes it easier to cater to high volumes of patients and bolsters medical tourism. India has earned around $7.4 billion from medical tourism over the last decade.
While the use of the da Vinci system has grown steadily since its introduction, its cost is a deterrent to deeper market penetration in India. At Rs4-5 crore, Mantra costs roughly one third of the da Vinci.
Mantra has been granted regulatory approval by the Indian Central Drugs Standard Control (CDSCO). It has been clinically validated in India through use hundreds of times in more than 40 surgical procedures, including those for cancer, head, spinal and heart surgeries. CDSCO approval is accepted in 56 countries. The company has begun the process of filing for FDA (the US) and CE (European) approval. It hopes to receive these in 2024 and 2025, respectively.
In October 2023, Mantra scripted medical history by successfully performing an ultra-low anterior resection for rectal cancer at Aster DM Healthcare, Bengaluru. It is a surgical procedure involving the removal of part of the left side of the colon including the entire rectum. This also involves removing the supportive tissue to the bowel including the draining lymph nodes to that section. With robotic surgery, the entire procedure was done with minimal invasion, thereby ensuring reduced blood loss, less postoperative pain, shorter hospital stay and faster recovery. It is estimated that recovery from a robotic rectal resection generally takes two to three weeks compared to four to six weeks for conventional open surgery.
Mantra has user-friendly features for the surgical team, which will make training much easier. India currently has no standardised curriculum for the training and credentialing of robotic surgery. Government-funded hospitals remain the mainstay for formal training. SS Innovations is offering on- and off-site training to use the system.
Besides its broad-range surgical capabilities, Mantra has modular, 3D vision, open-console design and superior ergonomics, and engages machine learning to improve safety and efficiency during procedures.
“This is just the beginning,” said Srivastava. “Mantra shall remain a work in progress with constant improvements.”
And some day, it might be the most recognised surgeon in India.