Why Robotic Cardiac Surgery is Not Reaching Most of the Indian Patients Who Need It

India has come a long way in the management of cardiovascular disease. With advances in diagnostics, interventional cardiology and cardiac surgery, patients with complex heart conditions have more options than ever before. However, access to newer surgical technologies is patchy. Robotic-assisted cardiac surgery is one such technology.

This type of technology has been available in India for several years and may provide a minimally invasive option for selected cardiac procedures. By allowing surgeons to operate through smaller incisions with specialised instruments, robotic assistance can potentially reduce surgical trauma and support recovery in appropriately selected patients. Despite these possibilities, robotic cardiac surgery remains concentrated in a limited number of specialised centres and is not yet accessible to a large proportion of Indian patients who may be considered for such procedures.

The question, therefore, is not whether India has access to the technology. It does. The larger challenge is creating the clinical ecosystem required to make it available safely and appropriately to a wider patient population.

Robotic cardiac surgery is not a replacement for conventional surgery. Its role is procedure-specific and depends heavily on patient selection. The nature of the cardiac condition, anatomy, previous surgeries, age, overall health and other medical factors all influence whether a patient is suitable for a robotic approach. In several cases, conventional surgery remains the most appropriate option.

This makes the expertise of the treating team particularly important. A robotic cardiac programme requires more than installing a surgical system. Surgeons need specialised training in robotic techniques, while anaesthetists, perfusionists, nurses and operating-room staff must understand the workflow and technical requirements of these procedures. Critical-care teams also need to be equipped to manage patients after surgery.

Building this experience takes time. Robotic surgery involves a different operating environment from conventional cardiac surgery and teams need to develop familiarity through regular practice. The ability to manage unexpected situations, including conversion to an alternative surgical approach when necessary, is also an important part of maintaining patient safety.

Access to Robotic Cardiac Surgery Beyond Metropolitan Centres

This requirement has contributed to the concentration of robotic cardiac programmes in large metropolitan hospitals. India has a wide network of cardiac centres, but access to highly specialised surgical expertise is not evenly distributed. For a patient living in a smaller city, obtaining an opinion from a robotic cardiac surgeon may require travelling to another State or a major urban centre.

The burden does not end with the operation. Patients and families may have to arrange accommodation, take time away from work and manage postoperative consultations away from home.

For older patients or those with limited family support, these practical considerations may present significant obstacles to pursuing advanced treatment.

Cost is another factor that cannot be overlooked. Robotic programmes require a significant investment in equipment, maintenance, specialised instruments, training and infrastructure. These costs can increase the price of some procedures compared to conventional surgery.

For patients paying a significant part of their healthcare expenses themselves, affordability can influence treatment decisions. At the same time, the economics of surgery should not be judged only by the initial hospital bill. The duration of hospitalisation, time away from employment, rehabilitation and the ability to return to routine activities also affect the overall cost to a patient and family.

Some minimally invasive procedures may offer advantages in terms of recovery, but these outcomes differ between procedures and individuals. They should therefore be discussed as part of an overall treatment assessment rather than presented as automatic benefits of robotic surgery. This is also why patient awareness matters.

Building Clinical Expertise and Patient Awareness

Robotic surgery is increasingly discussed in healthcare, but public understanding of its role in cardiac care remains limited. Patients may associate the word "robotic" with a completely automated operation, when in reality the surgeon remains in control of the procedure. Others may assume that robotic surgery is necessarily better than conventional surgery because it involves newer technology.

A meaningful discussion should explain why a particular procedure is being considered, whether robotic assistance is clinically suitable, what alternatives exist and what the expected recovery may look like. Patients should also be made aware of the experience of the team performing the procedure and the hospital's ability to manage the complete spectrum of cardiac care.

The responsibility for improving access therefore extends beyond hospitals. Referral networks between cardiologists, cardiac surgeons and hospitals can help identify patients who may benefit from assessment at specialised centres.

At present, a patient may undergo several consultations before learning that a minimally invasive or robotic approach could be considered. Greater awareness among referring physicians can help ensure that suitable patients are evaluated earlier, without suggesting that every patient should be directed towards robotic surgery.

Training will be another important part of the next phase of growth. If robotic cardiac surgery is to expand beyond a small number of established programmes, India will need more structured pathways for developing surgical expertise. Simulation-based training, fellowships, mentorship and collaboration between experienced and emerging centres can help build these capabilities.

The expansion of expertise also needs to be accompanied by appropriate standards. Robotic surgery should be integrated into established cardiac-care systems rather than treated as a standalone technology. Centres should have access to imaging, intensive care, emergency support and conventional surgical capabilities so that patient care does not depend on a single technique.

How Can India Expand Access to Robotic Cardiac Surgery?

Digital healthcare may offer another way to reduce some geographical barriers. Remote review of medical records, imaging and investigations can help specialists determine whether a patient needs an in-person evaluation. Tele-consultation cannot replace a detailed clinical assessment, but it can reduce unnecessary travel and help patients reach the appropriate specialist more efficiently.

There is also a need to consider how healthcare financing will evolve. As new technologies become part of clinical practice, insurance coverage and reimbursement frameworks need to keep pace with evidence and appropriate use. Wider access will be difficult if advanced treatment remains financially out of reach for a large section of patients.

However, expanding robotic cardiac surgery should not become an objective in itself. The number of robotic procedures performed is not a measure of progress unless those procedures are being offered to patients for whom the approach is appropriate and are being performed safely.

This distinction is especially important in India. The country continues to face a substantial burden of cardiovascular disease and the priorities of prevention, early diagnosis, risk-factor management, timely referral and access to essential cardiac surgery remain fundamental. Advanced technology should strengthen this continuum of care rather than exist separately from it.

Robotic cardiac surgery should be viewed as one component of India’s evolving cardiac-care landscape. Its value lies in offering appropriately selected patients another surgical option, while conventional surgery and interventional treatments will continue to remain essential.

The onus should be on translating advances in cardiac care into meaningful patient outcomes. For robotic surgery, it would be about creating the expertise, referral pathways and infrastructure to responsibly integrate the technology into routine cardiac care.

“It’s not about the number of robotic systems or procedures. It’s what really matters, which is, are patients getting the right treatment at the right time from the right team?”

About the Author:

Dr. Nikhil Pollo Jaik Theckumparampil is a Chennai-based cardiothoracic and vascular surgeon with 10 years of experience. He specialises in minimally invasive cardiac procedures, including TAVR, TMVR, and atrial fibrillation surgery. With advanced surgical training and board certifications from the United States, he brings international expertise to cardiac care, combining innovative surgical techniques with a personalised, patient-focused approach to treatment.