At the latest edition of Times Conversations on robotics organised by The Times of India in association with Narayana RN Tagore Hospital, Mukundapur, specialists across surgical disciplines came together to examine how robotic-assisted procedures are changing the possibilities of healthcare
The operating room is getting smaller — at least when it comes to the incisions patients have to endure. From cardiac and thoracic procedures to cancer surgery, hernia repair, gynaecological oncology and renal transplantation, the conversation revealed a technology that is moving steadily beyond its novelty to become an increasingly important part of surgical practice.
The panel brought together Narayana RN Tagore Hospital, Mukundapur, specialists including Dr Upasana Palo, consultant, Gynaecologic Oncology & Robotic Surgery; Dr Satyadip Mukherjee, consultant, Uro-Oncology & Robotic Surgery; Dr Manas Kr Roy, senior consultant, Gastrointestinal Oncology | Surgical Gastroenterology | HPB Oncology | Robotic Surgery; Prof (Dr). Amitabha Chakrabarti, senior consultant & Kolkata Cluster lead, Thoracic & Vascular Surgery and Robotic Surgery; Dr Lalit Kapoor, senior consultant, Cardiac Surgery & Robotic Surgery; and Dr Tarshid Ali Jahangir, consultant, General Surgery & Renal Transplant and Robotic Surgery. Also joining the conversation were Dr Ashish Kumar Ghosh, consultant, Obstetrics & Gynaecology and Robotic Sugery; Dr Lalima Banerjee, consultant, Obstetrics & Gynaecology and Robotic Surgery; Dr Sagar Sadhu, consultant, General Surgery & Robotic Surgery; Dr Abhishek Gangopadhyay, consultant, Surgical Gastroenterology, Surgical Oncology & Robotic Surgery; and Dr Manujesh Bandyopadhyay, consultant, Thoracic & Vascular Surgery and Robotic Surgery, reflecting the growing range of specialties in which robotic-assisted procedures are being explored and performed.For Dr Jahangir, robotics represents the next step in a progression that has already taken surgery from large open incisions to minimally invasive procedures. “The role of robotics has transformed the way we look at surgery,” he said, pointing to the continued importance of laparoscopy while noting the greater precision that robotic platforms can bring to procedures such as hernia repair.
Dr Sadhu joined his colleagues in examining how this shift towards minimally invasive intervention is broadening the possibilities of general surgery. In abdominal-wall reconstruction, Dr Jahangir said, recent research has suggested that robotic techniques can offer advantages over the laparoscopic era, allowing surgeons to perform procedures through smaller incisions while improving precision and patient recovery.
The potential is particularly significant in renal transplantation. With a high burden of chronic kidney disease and increasing numbers of obese patients, transplantation can be accompanied by a higher risk of postoperative wound and surgical infections.
“When the robots came into the picture we got the opportunity to give them a better option with robotic kidney transplantation,” said Dr Jahangir. The kidney can be placed through a small incision and the anastomosis performed with robotic assistance, he explained, offering patients another approach to a complex procedure.
A SMALLER WAY INTO THE HEART
The ability to perform major surgery without the trauma of a large incision is particularly compelling in cardiac surgery. Dr Kapoor explained that robotic cardiac surgery has returned to prominence after initially falling out of favour. For patients, one of the greatest psychological and physical barriers to conventional cardiac surgery is the prospect of having the chest opened. “Most patients get frightened,” he said. Robotic surgery can change that equation. Small ports can provide access to the chest while robotic instruments, equipped with wrist-like movements, allow surgeons to manoeuvre within a confined space with a degree of dexterity that conventional laparoscopy cannot provide.
The technology can be used for coronary bypass procedures as well as valve replacements and other open-heart procedures. In bypass surgery, robotic assistance can also allow surgeons to harvest conduits through small incisions rather than opening the entire chest.
“The cut is smaller, the recovery faster and we’re able to provide as good results,” Dr Kapoor said. For patients and their families, the difference can be substantial. Rather than looking and feeling like someone recovering from a major chest operation for months, patients can potentially return home within days. “It’s a move forward in patient care,” he said. The discussion also brought in Dr Bandyopadhyay, highlighting the close overlap between advances in robotic cardiac and thoracic surgery.
THREE-DIMENSIONAL VISION, SMALLER MOVEMENTS
In abdominal oncology, the evolution has followed a similar trajectory. Dr Roy described the transition from laparotomy to laparoscopy and now to robotic surgery as the next generation of minimally invasive intervention. Dr Gangopadhyay was also part of the discussion, reflecting the increasing application of robotic techniques across gastrointestinal and oncological procedures.
The attraction of the robotic platform, Dr Roy explained, lies partly in what the surgeon can see. Complex abdominal procedures can last four to five hours, making the stability of a robotic camera a significant advantage over a manually held laparoscopic camera. “The beauty of the robot is that the camera is absolutely still,” Dr Roy said. The platform also provides a three-dimensional image that can be magnified, allowing the surgeon to see structures in considerably greater detail. But technology cannot become a substitute for sound oncological principles. Whether cancer surgery is performed through an open incision, laparoscopically or robotically, the operation must remain oncologically sound. “The bottom line is in any oncological surgery whether it is open laparoscopic or robotic it has to be an oncologically sound,” he said, adding that robotic surgery need not compromise the extent of cancer surgery.
WHERE THE HUMAN HAND CANNOT GO
For Dr Mukherjee the greatest advantage of robotics is what it allows the surgeon to do in the narrowest parts of the human body. He identified three major advantages: magnification, manoeuvrability and tremor filtration.
“In robotic surgery you have higher magnification,” Dr Mukherjee said, explaining that the surgeon can work with images magnified several times beyond what the naked eye can see. The robotic wrist is equally important. Its ability to rotate and manoeuvre allows instruments to reach difficult corners that would otherwise be challenging to access.
This becomes particularly significant in prostate cancer surgery, where the prostate sits deep within the pelvis. Robotic surgery can allow greater precision in cancer clearance while helping surgeons preserve nerves and structures associated with urinary continence.
The technology is also useful in kidney cancer, where nephron-sparing surgery can allow surgeons to remove a tumour while preserving the healthy portion of the kidney. The benefits extend beyond the operating table. Smaller incisions, reduced blood loss, shorter hospital stays and faster return to work can all affect the patient’s recovery. “The major advantage of robotic surgery is quicker return to activity also,” Dr Mukherjee said.
PRECISION IN THE PELVIS
The confined anatomy of the pelvis also makes robotics particularly relevant to gynaecological oncology. Dr Palo said robotic surgery has an important role in the management of gynaecological cancers and is the standard of care in endometrial cancer.
Dr Ghosh and Dr Banerjee, both consultants in the same department, were also part of the discussion, bringing the wider gynaecological perspective to a conversation increasingly shaped by minimally invasive and robotic techniques.
Procedures can include hysterectomy and lymph-node dissection, while robotic platforms also allow the use of Firefly technology for sentinel lymph-node identification. Robotic surgery is also being used in ovarian cancer, including for selected medically frail patients who may not be able to tolerate extensive open procedures.
But Dr Palo cautioned against treating robotics as a universal solution. “Robotic surgery should be used in the right patient and by the right surgeon and in the right appropriate technique,” she said. She also addressed one of the most persistent misconceptions surrounding the technology. The robot is not independently performing the operation. “It’s actually the surgeon who is operating the robot and it’s not the robot who is operating by himself on a patient,” Dr Palo said. The platform instead gives the surgeon enhanced precision, three-dimensional vision and the ability to operate through minimally invasive access—advantages that can be particularly useful in the confined space of the pelvis.
FROM LUNG CANCER TO DIFFICULT THORACIC CASES
Robotic surgery is also expanding the possibilities of procedures involving the chest. Prof (Dr). Chakrabarti, said his unit is the first robotic thoracic unit in eastern India. Dr Bandyopadhyay also participated in the discussion, underlining the expanding role of robotics in thoracic surgery. A wide range of thoracic procedures can be performed robotically, Prof (Dr). Chakrabarti said, including lung cancer surgery, procedures related to complications of tuberculosis, mediastinal tumours, oesophageal disorders and diaphragmatic diseases. Robotic surgery is a very versatile thing and the manoeuvrability, the precision, the vision, everything has revolutionised this surgery,” Prof (Dr). Chakrabarti said.
The advantages become especially apparent in difficult-to-reach areas and around small lesions, where enhanced visibility can provide surgeons with an important edge over conventional approaches.
Across the specialties represented at the conversation, the message was consistent: robotics is not about machines replacing surgeons. It is about giving surgeons greater control over the most difficult parts of an operation.
The progression, therefore, is no longer simply from open surgery to minimally invasive surgery. It is towards precision surgery—smaller access, better visualisation, finer movements and, potentially, a shorter road back to everyday life for the patient. The real transformation may ultimately be measured not by what the robot can do inside the operating room, but by what the patient is able to do sooner once they leave it.
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