India At Inflection Point In Robotic Surgeries, Pace Will Only Accelerate: Mandeep Singh Kumar, Intuitive Surgical

Intuitive Surgical dominates the market share in India with about 100 surgical robots deployed across the country, BW Healthcare World spoke with the Vice President and Country GM, Mandeep Singh Kumar on various aspects related to cost, health insurance, innovation, trends, and future plans of the company in India

Robotic-assisted surgeries (RAS) have gained significant ground in the recent years in India, patients are increasingly opting for the surgeries owing to its high clinical outcomes and minimal risks. The only hurdle that the patients are faced with is its expensive cost.

Over the years, India has not seen the robotic surgeries pick up pace when compared with the rest of the world, according to reports India at present has only 140 robotic surgical systems and performs around 10,000 to 12,000 robotic surgeries in a year, which is less than 0.1 per cent globally. 

With the pandemic-induced attitude shift, patients are now keeping health as their number one priority and looking for less risky options which the robotic surgeries offer, Intuitive Surgical dominates the market share in India with more than 100 surgical robots deployed across the country, BW Healthcare World spoke with the Vice President and Country GM, Mandeep Singh Kumar on various aspects related to cost, innovation, trends, and future plans of the company in India.


How do you think robotic surgery has evolved over the last couple of years and what are the trends that you are witnessing currently in the country?

From the point of view of interest, it has continued to increase among the Indian surgeons who are really passionate about robotic-assisted surgery and wanting to learn new skill sets, with the hospitals looking at providing the latest advanced technology and better outcomes to their patients. Similar interest has also been seen in the government setups. 

While the interest has always been there, in the last five years, we have seen a big acceleration of that. This is majorly because of the connect that Indian surgeons have with their counterparts abroad, and the exposure they have to the quality of work that has been done outside. The number of clinical publications that have been coming out has also led to multiplying the interest into many folds, both in large private hospital chains like Apollo, Max, and Manipal etc., and also in government teaching and referral institutions like AIIMS and Safdarjung.

To support this, we are also getting clinical publications, consensus statements on different therapy areas published out of India. There's a whole surgical community and robotic-surgery associations invested in showcasing the benefits and value of RAS. When surgical communities, academic societies and teaching institutions start supporting the technology, that's where the real acceleration happens. I think that is the inflection point and I see that the pace of adoption will only increase from here on.

How do you think robotic surgeries can be made more accessible and affordable in India, as robotic surgeries are an expensive affair?

We have to understand what exactly cost is. We talk about affordable care in India, but I think the dialogue should now move to the quality of care. For instance, somebody has cancer in the kidney. If the outcome was defined that the cancer needs to be removed, you can do an open surgery and remove the full kidney or do the surgery using a different technology to remove the cancerous part.  But this will also lead the removal of some extra part of the kidney.

The third option would be you remove exactly what needs to be removed. Neither leave a cancerous cell inside nor do you remove any extra cells. Now to remove kidney cancer, all three options would qualify. But, if the outcome was defined by how quickly a person will recover, how much of a functional kidney one would leave inside and how much less chance of remission of cancer would happen. The paradigm totally changes right? And that's how the cost needs to be looked at from an aspect in terms of what is the outcome. 

When it comes to insurance companies although IRDAI has already specified this and allowed this to be a part of standard policies, do you think there is a lag there?

There is a lag for sure. The IRDAI circular was a positive step. But it didn't start getting implemented the same way by every insurance company. And if you were to look at various insurance companies, you can see someone was looking at supplements, somebody was co-paying. But over the last couple of years, this has changed, as we have been working with some of the larger standalone health insurance companies, showcasing the value RAS by sharing required dossiers with them. And today, I'm happy to say that most of the large insurance companies have robotics fully insured without gaps or ceilings in a couple of their policies if not all.

Are there any plans to relook at the price bracket for DaVinci in the Indian market, with emerging players entering the market, and the price-based volatility of the Indian market taken into account?

We see the value of our technology in terms of the benefit it provides.  As we grow, expand and make technological advancements, which help us reduce costs, like our extended use program where we increase the lives of the instruments. We also have different models of procurement for hospitals, ranging from paper use to leasing. We will offer those kind of benefits. We don't look at price in isolation, or in relation only to competition. 

To summarise, we will see our products from a point of view of the value it provides, and will continue to invest a lot in technological advancement. And, whatever that technology advancement and R&D yields in terms of benefits and cost, we will be willing and happy to share that with our customers. 

But not only from a customer or a competitive standpoint. Because ultimately our goal is to deliver the best technology in the hands of the surgeons, so that they can generate world-class clinical outcomes. We have about close to 30,000 peer to peer-reviewed papers, which talk about the clinical outcomes that we produce.

Do you feel there is a challenge in updating or upgrading the old Da Vinci surgical systems as I have heard from some doctors that they are facing issues with older versions of the robot?

Not exactly. I think what they are trying to tell you is that if they have an old technology, they may not have certain feature sets, which the latest technology offers. To that extent, they are true because some of the latest upgrades have come only in fourth generation systems. But that is true for any and every technology.

So from a point of service, keeping those systems up and running, and maintaining very high uptime, there are no challenges. But, if a system has been designed to offer a certain set of benefits, and a new technology has come 10 years later, then the two systems obviously have a different set of features. For instance, if somebody is on a third generation system, then they don't have a boom mounting for the four arms of a robot. They will not have the same convenience of doing a multi-quadrant surgery.  

To address this, we work with some of our hospitals to upgrade existing third-generation programs. Either they return the system to us and take the new fourth-generation system against credit, or they move the third-generation system to a smaller unit just to introduce that unit to robotics and buy the latest technology in their newer centers. 

Recently Intuitive Surgical India touched the 100 mark for DaVinci robots deployed across the country. Tell us about landmark and your future plans in India.

See 100 is just a number, ultimately what we celebrate is when lives get touched and patients get to experience our technology. Robotics in India started as a niche technology for top-level institutions and big cities. But, today it is touching tier two and tier three cities, and speciality institutes while covering both government and private segments in large-scale hospital networks and standalone hospitals. I believe robotics is really going to grow from here because of the proof that the Indian surgeons are seeing in the technology. 

In India, our focus would be to create local evidence, work with the surgical communities to showcase the benefit and establish treatment protocols and continue to work with hospitals to make this technology easily accessible. At the same time, intuitive as a technology-driven company, we will have new product launches and new product designs globally. Our endeavor will also be to bring the latest technology to the market and couple that with the digital footprints that we have started creating with Intuitive Telepresence which assist surgeons, and My Intuitive App, so that the benefits can be seen, perceived and transferred more seamlessly across the set of consumers.

We have two key products that are in the pipeline, one is the Single Port, in that you need to work through the body only with one orifice or you can also use an actual natural body orifice so it would be totally scarless surgery. And the second is, a product which uses robotic technology for lung cancer detection. So it's a product called Ion for lung cancer diagnostics. Because the most important thing in lung cancer is to draw the right sample to do better diagnostics and given that India has a high incidence of lung cancer this product could be very relevant. 


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