Robotics is steadily becoming part of routine surgical planning rather than an exception

The ASPIRE study challenges the long-held perception of robotic surgery as a tool reserved for complex cases. Is the Indian surgical ecosystem ready to reposition robotics as a mainstream modality rather than a premium alternative?

Dr Jain: Robotic surgery is increasingly being applied across a wider spectrum of ventral hernia cases, including smaller defects. This reflects growing confidence in the platform and its ability to deliver more controlled, precise repairs along with improved early recovery. In the Indian context, while adoption is not yet uniform, the trajectory is clearly toward wider integration. As more centres build experience and infrastructure, robotics is likely to move from being a selective option to a more routinely considered approach within minimally invasive surgery. The transition may be gradual, but the direction is fairly evident.

Dr Wadhawan: In centres where robotic programs are established, it is already becoming part of routine surgical planning rather than being limited to complex cases. Increased familiarity with the system naturally expands its use across a broader range of hernias. When procedures can be performed with greater precision and patients experience smoother recovery, it shifts how the modality is perceived. The larger shift toward mainstream adoption is less about whether robotics can be used, and more about how quickly access and capability can keep pace. So, while adoption may not be uniform across the country, in centres with the right setup, robotics is steadily becoming part of routine surgical planning rather than an exception.

While the study reports improved early recovery, lower pain scores, and quicker return to daily activities, how should clinicians and hospital administrators interpret these gains—incremental improvements or clinically meaningful differentiation?

Dr Jain: The improvements in pain scores, analgesic use, and early recovery reflect a clear and consistent trend. These outcomes point to a more stable postoperative course, with less discomfort and a quicker return to normal function in the early phase. In surgical practice, multiple advantages across different recovery parameters tend to reinforce each other, leading to a more predictable and stable recovery trajectory. Robotics appears to support that refinement in outcomes. Such consistency is important, particularly when evaluating patient experience alongside clinical endpoints.

Dr Wadhawan: These improvements translate directly into how patients experience recovery. Lower pain levels, reduced need for medication, and earlier return to daily activity contribute to a more comfortable and confident postoperative phase. Recovery is shaped by the overall experience rather than individual metrics, and improvements across multiple areas make a tangible difference in how patients feel and function. For many patients, this means getting back to routine life sooner, with fewer disruptions to work and daily responsibilities. This is where robotic assisted surgery adds clear value, by making recovery smoother and more manageable in real-world settings.

Given that laparoscopy remains the gold standard for small ventral hernia repairs, what clinical or operational gaps is robotic-assisted surgery effectively addressing that conventional methods have not?

Dr Wadhawan: Laparoscopy remains a well-established and effective approach for small ventral hernias, with strong outcomes and wide accessibility. Robotics builds on this foundation by addressing certain technical limitations inherent to conventional minimally invasive surgery. Enhanced visualisation, improved ergonomics, and more precise suturing allow for better control during defect closure and mesh placement, particularly in anatomically favourable planes. These technical advantages support greater consistency in surgical execution and contribute to advancing the quality of minimally invasive repair.

Dr Jain: The distinction becomes more evident in how the procedure is performed. Robotic-assisted surgery allows greater precision in suturing and mesh positioning, which can be technically demanding with laparoscopy. This enables more anatomical repairs with improved control and consistency, especially in cases where precision plays a key role in outcomes. It also helps address the gap between what is technically achievable and what can be consistently delivered in routine practice. Rather than replacing laparoscopy, robotic-assisted surgery extends its capabilities and allows surgeons to achieve a higher level of technical execution.

The economics of robotic surgery continue to be debated in India’s cost-sensitive healthcare environment. In light of these findings, does the value proposition of robotics stand up to scrutiny when scaled to routine procedures?

Dr Wadhawan: The economic dimension remains an important consideration in the Indian healthcare environment. At the same time, evaluating robotic-assisted surgery in routine practice requires looking at the broader care pathway, including recovery time, complication rates, and overall hospital utilisation. In centres with established programs, increasing experience and structured workflows are contributing to more consistent surgical delivery. When these factors are considered together, the value of robotic-assisted surgery is being assessed not just in terms of procedural cost, but in how it supports more efficient and predictable care over time.

Dr Jain: In routine surgical practice, the focus is often on how reliably a technique can be applied across a wide range of patients. Robotic-assisted surgery offers surgeons greater control and precision, which can help in maintaining consistency across procedures. This can translate into a more predictable surgical experience and recovery for patients. As its use becomes more common in everyday cases, its role is increasingly being considered in terms of the stability and quality of outcomes it can support, alongside other established approaches.

As robotic platforms begin to move beyond niche, high-complexity interventions, what systemic shifts-training, infrastructure, or policy support will be critical to sustain responsible and equitable adoption across Indian healthcare?

Dr Jain: Sustained adoption of robotics will depend on strong clinical foundations. Structured training, proper credentialing, and clearly defined case selection are essential to ensure consistent outcomes across centres. As adoption expands, standardising techniques and protocols will be key to maintaining reliability. A systematic approach to implementation will be critical to delivering these benefits consistently.

Dr Wadhawan: Scaling robotics will require parallel growth in training, clinical readiness, and institutional processes. This includes well-trained surgical teams, standardised protocols, and seamless integration into routine clinical workflows. Alignment with insurance and reimbursement systems will help support wider patient access as adoption continues to grow. As these elements come together, robotics is expected to become an increasingly integral part of surgical care delivery.

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