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Pandemic Has Accelerated Tech-led Innovation In Healthcare: Mandeep Singh Kumar

In an exclusive interaction with BW Healthcareworld, Mandeep Singh Kumar, VP and GM, Intuitive India, spoke about latest innovations in healthcare induced, specially by the pandemic. Excerpts:

What are the changes observed in the surgical landscape of the country over the last few years?

The country has observed a significant growth in developing innovative med-tech solutions that focus on ‘preventive care’, ‘curative care’, and ‘well-being.’ The latest advancements in surgical technology are aimed at supporting better patient outcomes and improving the operational efficiency for healthcare administration in hospitals.

Along with specialized surgical technology, high-end innovation and research facilities have also evolved over the last few years. For instance, we have observed that the surgical robots that support surgeons in specific procedures are now gaining increased traction. 

While we see that the developed countries are leading the innovation in this space, the products and solutions have also seen acceptance in India over the past few years. This can also be owed to the quality of surgeon training and their willingness to adopt new technologies. As the ecosystem continues to invest more in technology to improve operational efficiencies, it has been observed that more surgeons are looking at broadening their skills in using the latest technology, procedures such as Robotic-assisted surgeries (RAS) are finding more traction. 

In the past two years, technology adoption in healthcare has been at the forefront of tackling the adverse situations enforced by the pandemic. Has Intuitive taken any steps in this direction? If yes, what are they?

The adverse conditions enforced by the pandemic has accelerated the tech-led innovation in the healthcare industry in order to meet the demands. We have also witnessed the birth of several frugal state-of-the-art innovations associated with surgical devices those have the potential to improve patient outcomes.

As a part of it, we have also introduced our ‘Extended Use Programme’ (EUP) in India in an effort to offer additional value to our customers through product innovation within the existing robotics programme. With this EUP initiative, we have extended the usability of many of our instruments through innovation and design improvements within da Vinci Xi without compromising on its performance. EUP intends to lower the total operating cost of surgical systems for hospitals. Through this, we anticipate an average reduction of 15 per cent in price-per-use for the instruments under EUP, based on our internal calculations. For each hospital, actual savings may differ depending on future case mix and procedure growth. 

Additionally, as a customer service innovation, we have launched da Vinci OnSite, a service feature that allows the da Vinci Surgery Technical Assistance Team (dVSTAT) to remotely access the system status for real-time diagnostic feedback and troubleshooting. They can rapidly diagnose and, in some cases, resolve issues without dispatching a local Field Service Engineer. The system logs are automatically uploaded. This will enable dVSTAT Technical Support Engineers to actively monitor system performance and minimize unplanned service events.

All these innovations, while aimed at empowering surgeons, can impact patient outcomes as well. 

What are the new patient-centric innovations Intuitive is bringing in the Robotic Assisted Surgery space? 

At Intuitive, we want to expand the potential of healthcare workers to heal patients without constraints with the support of intelligent technology. We are driven by the Quadruple aim for our customers - better clinical outcomes, better patient experience, better care team experience and lower total cost to treat. 

As we continue to listen and pay attention to the requirements of the surgeons regarding the changes that they would require in our products to provide better patient outcomes in the operation theatre, it has helped Intuitive innovate and remain focused on patient safety. As a part of our innovation process, we developed and included Force Bipolar and DualGrip technology that provides surgeons better control of the procedure. We also developed the vessel sealer extender that has the capability to perform 90° seals and effective cuts. From a visibility perspective, we developed the Firefly Fluorescence technology.

In addition to this, we have recently launched India's first robotic-assisted surgical stapler called SureForm that comes equipped with SmartFire technology, an integrated software. With SureForm, the surgeon can fire the stapler from the console while performing the RAS procedure, retaining complete control and autonomy over the surgery. Surgical stapling with robotic staplers is the most advanced choice available to surgeons today for the resection, transection and/or anastomosis.

Has the industry seen an increase in the installations of RAS during the pandemic? How do you see the government’s support regarding the same?

COVID has increased the need for further adoption of minimally invasive surgeries (MIS) like Robotic-Assisted Surgery (RAS), as patients and caregivers wish to limit their hospital stay during the pandemic. 

As per the Association of Surgeons of India (ASI), many hospitals with robotics programmes have resumed operations and successfully carried out a number of surgeries. Intuitive has been witnessing an average year by year growth of around 30 per cent during the pandemic in terms of the installation of da Vinci robotic surgical systems in India. 

The Medtech industry has been receiving support from the government. However, there are more areas where further support is needed, like a decrease in import duties for specialised medical technology products, which could result in increased patient access to the latest in medical and surgical technology. The other area could be the inclusion of the latest surgical procedures like RAS into all insurance solutions that are provided to the masses. This will help ensure that in the coming months and years, modern healthcare and treatment methods can reach their full potential in India, resulting in a more effective healthcare system and a healthier population.

Currently, is RAS limited to hospitals in metros cities? Are you seeing hospitals installing RAS technology in non-metro cities as well?

The RAS installation in metro cities has been comparatively higher. However, we have observed an increase in the number of installations in non-metro cities during the pandemic.

Intuitive is working closely with hospitals to provide the latest surgical technology even in non-metro cities.  Max super specialty hospital in Vaishali (UP) recently announced the installation of da Vinci Xi, the latest RAS technology by Intuitive, making it the first private hospital in UP to offer the latest in minimally invasive surgical technology. Narayana Hrudayalaya (NH) also recently installed the latest RAS systems in their centre in Howrah. In the recent past, we have installed our systems in government institutions such as AIIMS Jodhpur and AIIMS Rishikesh.

The increased number of installations will be a great opportunity for people in smaller cities to avail themselves of minimally invasive procedures for various treatments without having to travel to nearby metros during the pandemic. But for further adoption of RAS in non-metros, we need to further educate the healthcare community and patients about the advantages of RAS. 

What are the initiatives you are taking to increase the adoption of advanced surgical technology among surgeons and patients?

To make sure that RAS/dV is adopted confidently by surgeons, Intuitive is enabling product experience, educatory programmes, training and assistance during surgery to potentially shorten the learning curve. We aim to provide the best-in-class training and support to surgeons in India throughout their careers – from initial exposure to the technology to the advanced training, ensuring that they have the skill and experience necessary to perform procedures using the da Vinci Surgical System. However, we train only on the usage of the da Vinci surgical system, not medical knowledge to perform the procedure. 

Alongside, we have also introduced RAS familiarization and education programmes like I-ROPE (Intuitive Robotic Onboarding Programme and Education) and Roving Robot. This is mainly to overcome the lack of awareness about RAS among healthcare community, which is one of the major roadblocks for further adoption of RAS in India. 

As a part of our roving robot programme, we are conducting hands-on workshops for surgeons and medical students across the country.  Through this initiative, we aim to familiarize the medical fraternity with robotic-assisted surgery, its technology, clinical applications and its benefits. The execution of such Robotic-Assisted Surgery (RAS) familiarization and education programmes is a key step towards nurturing adopters of advanced surgical technologies by enhancing knowledge and awareness about RAS. In this context, the Intuitive Roving Robot Programme’s goal is to support India’s surgical healthcare landscape's evolution, with a potential to improve the clinical outcomes.  

Through I-ROPE, an industry-academia partnership, we collaborate with top government medical institutions to expose resident surgeons to Robotic-Assisted Surgery. Through this initiative, we aim to familiarize these resident surgeons with robotic-assisted surgery, its technology, clinical applications and its benefits. 

As a pilot, AIIMS Delhi ran this programme in their oncology divisions. Based on the surgical students’ feedback, we extended this programme to other specialties and institutions across India. Currently, around 250 resident surgeons are going through this programme across institutions such as RMLH Delhi, Armed Force Medical College - Pune and AIIMS Bhubaneswar. We are planning to further expand this programme to more institutions across India in the coming months.

What according to you, is the future of advanced surgical technology like RAS in India? What is the support the sector needs for further growth?

As the Indian surgical technology market is in an evolutional stage now, I see a great future for next-gen technology like RAS in India. This is primarily because we are a vast country with growing healthcare needs and limited healthcare facilities, which will take time to scale. However, with the help of medical technology, it is not only for people to access quality healthcare but also because it has the potential to improve clinical outcomes by making it easy for the existing healthcare infrastructure to service more people in less time while providing them with the best possible care. 

As medical technologies keep advancing, the primary driving force behind newer inventions will be focused on minimising hospital stay and associated costs while ensuring minimal post-operative complications so that people can get better sooner and reduce the number of post-operative check-ups.

All that the sector needs for further growth is the ecosystem to open up a bit more. From including RAS in medical insurances to more surgeons up-skilling themselves with the latest that global medical technology can offer, we still have a lot of ground to cover before RAS can become widely adopted.



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