Robots Assist, But Humans Decide: Why Indian Surgeons Won’t Hand Over the Scalpel
AI and robotic technologies are rapidly reshaping healthcare worldwide, promising greater precision, efficiency, and improved patient outcomes. In surgery, these breakthroughs are game-changers, offering sharper visuals, greater precision, and less invasive options that could completely transform treatment. Oncology (the study of cancer), in particular, stands to gain from AI-driven diagnostics and robot-assisted procedures, giving patients better outcomes and faster recoveries. However, despite all this global attention on AI revolutionising healthcare, cancer surgeons at different hospitals in India say AI is hardly involved in surgical practices in India. “Basically, in the medical field, nobody is using it,” said Dr P Subramanya Rao, senior consultant in head and neck oncology at Apollo Cancer Centre Bengaluru in Bengaluru. “It is still very much in the research stage.” AI is being explored mainly in radiology and pathology, where imaging data is easier to work with. Even then, the implementation is limited. “The problem with healthcare, especially in India, is the data that we feed it [AI] is not very accurate,” said Dr Yeshwanth Rajagopal, consultant surgical oncologist at Apollo. Why AI Can’t Cut It Yet Dr Sumanth Bollu, consultant surgical oncologist for head and neck at Kailash Deepak Hospital in New Delhi (previously at Max Healthcare), agreed. “As of now, AI has no role in surgical options. The only things AI works for are automated processes and workflow support. It’s more about administration than surgical decisions.” When asked about integrating AI into day-to-day surgical tasks, the surgeons drew a line between theory and practice. AI may have potential in diagnosis and predicting treatment outcomes, but the absence of robust data and ethical clarity holds it back for now. Rajagopal outlined three major challenges: ethical, financial and legal. Consent, ownership of medical data, and the use of AI-trained models built on fragmented or skewed datasets continue to hinder this adoption. Even if consent is secured, AI algorithms require enormous volumes of high-quality data. In India’s fragmented healthcare ecosystem, this is easier said than done. “The only way forward for this would be to sensitise people to come out with data,” he said. “It will be a long process.” What’s the Deal with the Data? The promise of AI hinges on large, clean, diverse datasets, which is something Indian healthcare doesn’t have. “The data is very fragmented in India,” said Rao. “It’s not very accurate, and they don’t follow a policy, along with the fact that there’s not much data that gets collected.” Bollu added that while many centres are doing good work on this front, there is no uniform data collection system, even for cancer patients. Compared to centres abroad like MSK (Memorial Sloan Kettering Cancer Centre) or Johns Hopkins, we lack strict data entry protocols. There is also poor integration between public and private hospitals and minimal academic partnership in India. Without standardised clinical data, validation becomes impossible. Once clinical validation is done, they go for compliance. “I reviewed 420 published articles on AI in head and neck oncology, and only two addressed clinical validation. Without this, surgical use is still not feasible,” added Bollu. Ownership and consent are also unresolved issues. “Who owns the data? The company, the hospital, or the doctor who took the data?” This is still an unanswered question in an unregulated territory. This legal ambiguity makes it difficult to use patient data to train AI systems, especially for monetisation. Public mistrust further complicates the matter. When doctors tell patients that they may use their medical data for further research or study, “the patient always has a trust issue. Of course, you cannot use it without consent,” said Rajagopal. The doctors believe that building an AI system trained on Indian data would require a government-led initiative, including widespread public sensitisation. This is the only way to gain public trust and motivate patients to allow their data to be used to train Indian AI. Robots Are Here, But Thankfully, They Still Have a Driver Although AI is still largely theoretical, robotic surgery has already become a clinical reality. Oncology, urology, cardiac, and gastrointestinal procedures at Apollo now routinely involve robotic assistance. However, the surgeons want to make one area of concern very clear: These robots are ‘not autonomous’. “It is totally controlled by human beings—the surgeon and the team,” Rajagopal emphasised. “It cannot do any automatic movements.” The Apollo Cancer Centre uses the American biotechnology company Intuitive Surgical’s Da Vinci Xi robot for enhanced surgery vision, precision, and mobility. Released in 2014, this surgical robot, now over a decade old, has become a common tool for Indian surgeons and a primary platform for learning robotic procedures. The robot makes controlled movements that the surgeon modulates. “It gives 10 times magnification, minimum,” said Rao. “The Da Vinci Xi is the benchmark in robotic surgery,” said Bollu. “It provides excellent 3D visualisation and precision. It’s truly the gold standard today.” Though Indian-made robots like The Versius by CMR Surgical and SSi Mantra from SS Innovations have entered the field, most surgeons continue with Da Vinci, the system they were trained on. “Mantra is a great initiative and very promising for institutes looking to start with robotics,” Bollu noted. “But these systems are like gaming consoles; if you’ve trained on Da Vinci, others feel different, even if functional.” What’s in It for the Patients? Patients undergoing robot-assisted surgeries benefit from less pain, smaller incisions, reduced blood loss and quicker recovery. “They can go back to work faster, and we can do what we call directed surgeries,” explained Rajagopal. Using dyes and near-infrared imaging through the robotic equipment, surgeons can now identify only cancerous lymph nodes and leave the rest untouched, preventing the time-consuming procedure of removing all lymph nodes. This is what they call a direct and targeted surgery. “Previously, surgeries like those for oral cancer needed wide openings through the jaw. Now, with robotics, we can operate via natural orifices, discharge patients in a few days, and resume a normal diet quickly,” Bollu explained. It can go from being admitted for 10 days in a regular procedure to being discharged in one night for a robotic one. But while the complications are fewer and recovery quicker, it does increase the cost, he said. “The government is not realising that a patient not staying in the hospital for a longer time is beneficial,” Rajagopal said. “They can return to work faster and contribute to society and the economy sooner.” The Insurance Black Hole Insurance policies for patients in India is another bottleneck. They do not yet cover robot-assisted surgeries, making affordability a major barrier. Bollu identified a few insurance firms that have begun accepting robotic surgeries, “but many like CGHS (Central Government Health Scheme) still don’t cover them,” he said. “This limits patient access despite clinical advantages,” he added. “If cost is not the factor, I would choose a robotic system over a laparoscopic system for any surgery, any patient,” said Rao. Moreover, training for robotic surgery is not yet part of standard medical education. “Very few colleges have a course on that,” he said. Mostly, it is the private institutes and most surgeons first train in open surgeries before transitioning into robotics. No Job Cuts in the OT While AI evokes fears of job loss, robotic surgery hasn’t displaced human roles in the operating theatre. In fact, according to the doctors, it has added to the crew. Rao confirmed that additional people are now required to maintain and operate the robot. “There is always a technician in the OT,” said Rao. Robots serve more as sophisticated tools than independent contributors. Bollu added that robot-assisted oncology surgeries require assistants to dock the robot and technicians to monitor equipment. Even a minor instrument error can cost lakhs, so expertise is crucial. They require maintenance, trained staff, and constant supervision. Even for doctors, robotics offers ergonomic benefits and filters out hand tremors, improving precision. However, it’s not a substitute for foundational surgical skills. “Some tremors will be filtered out by the robot, but if my hand is severely shaking, it will not control this. If you don’t know how to manage an open surgery, you should not operate robotically,” Rao clarified. AI in Indian healthcare remains more theoretical than practical, especially in surgery. Regulatory challenges, the absence of organised data, and low trust stand in the way. Robotic surgery, though, delivering tangible results, remains cost-restricted. As Rao stated, “The day the robot starts to do everything, I think that would not be a good day for the patient.”
“The day the robot starts to do everything, I think that would not be a good day for the patient.”
“The day the robot starts to do everything, I think that would not be a good day for the patient.”
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An information designer who loves to learn about and try new developments in the field of tech and AI. She likes to spend her spare time reading and exploring absurdism in literature.