India stands at an inflection point in surgical care, where the pressure to meet rising demand is colliding with the imperative to keep surgery safe, predictable and patient-centric, writes Prof. (Dr.) Atul N. C. Peters, Principal Director, Dept. of Bariatric, Minimal Access and Robotic Surgery, Centre of Excellence, Max Smart Super Specialty Hospital, Saket, Delhi. While the country performs far fewer surgeries per capita than global benchmarks, the real challenge is not just closing this numerical gap, but ensuring that every additional procedure is delivered within a disciplined system that protects outcomes and preserves patient trust. In this context, robotic-assisted platforms are not merely symbols of technological progress; they are potential enablers of scalable, standardised surgery if embedded within robust workflows, rigorous training frameworks and team-based models of care.
India’s surgical demand is intensifying rapidly. This gap is reflected in access metrics, where India performs approximately 1,385 surgeries per 100,000 population, significantly below the ~5,000 per 100,000 benchmark recommended by the Lancet Commission on Global Surgery. As access expands across metros and emerging centres, the real question is whether surgical care can be delivered safely and consistently at scale, without diluting the patient experience.
Scalability in surgery is often misunderstood. It is not about moving faster or doing more in less time. It is about building systems in which safety, discipline and coordination are embedded into routine practice. In high-volume environments, outcomes must be repeatable rather than dependent on individual virtuosity. As structured workflows mature and multidisciplinary coordination strengthens within surgical programmes, performing up to 25 procedures in a single day can become feasible with surgical systems such as da Vinci within a disciplined ecosystem focused on training, consistency, patient safety, efficiency and coordinated care pathways.
Robotic-assisted surgery represents one of several evolving approaches within minimally invasive care. As adoption grows, the conversation must move beyond adoption and focus on standardisation. The key question is whether these advanced platforms can help deliver precision and consistency within defined clinical pathways, especially in high-demand settings like India.
This is in line with findings from a recent prospective study on robotic cholecystectomy performed using the da Vinci Xi Surgical System and published in Cureus. With careful patient selection, hospital stays were shorter, the rate of intraoperative complications was very low, and none of the cases was converted to open surgery. The patient’s recovery process may be smooth, and they can quickly get back to their daily lives.
For health systems operating under sustained capacity pressure, these outcomes matter beyond the operating room. When recovery is more predictable and complication rates remain low, hospitals are better positioned to optimise bed utilisation and maintain flow across services. In a country where tertiary centres often function at high occupancy, predictability is not a marginal gain; it is central to system resilience and continuity of care.
Efficiency in robotic-assisted surgery is also frequently misunderstood. While early adoption may appear time-consuming, structured programmes often become more streamlined over time. Our published findings indicate a progressive decrease in docking times across subsequent cases, reflecting greater familiarity, coordination and workflow maturity. In this context, efficiency is less about speed and more about reducing variability.
As programmes mature, more procedures can increasingly be integrated into routine minimally invasive pathways with greater consistency and coordination. This shift is not about expanding indications indiscriminately, but about applying structured systems, training and coordinated execution to selected cases with greater consistency.
This is why technology alone does not create scalable surgery. Training frameworks do. Structured onboarding, simulation, proctorship and progressive case selection are essential to responsible programme development. Training and team-based workflows supporting the transition require substantial commitment from the institution; this includes investing in capability-building activities to achieve a sustainable level of growth.
The findings of our Cureus study indicated that experienced laparoscopic surgeons could develop competency and proficiency in performing robotic cholecystectomies after approximately 40 cases; this points to the importance of having a clearly defined learning pathway. However, transitioning requires more than just developing the technical ability of any one professional surgeon; it also requires bringing the entire surgical team along as they all advance their skills and capabilities together, especially in patients with prior surgical history or anatomical variation, where communication and adaptability are paramount.
Patients value their surgical experience based more upon surgical consistency than on surgical innovation when using any surgical platform; therefore, technology applications must be placed within a disciplined pathway that begins with selecting appropriate cases and ends with recovery planning by the surgical team. Without that structure, adoption can remain uneven. With it, programme growth becomes more reliable and sustainable.
The future of scalable, safe surgery in India will not be determined by technology alone, but by how responsibly innovation is integrated into team-based models of care. With structured systems, evidence-based validation and coordinated training, India can build surgical programmes capable of delivering safe, repeatable care at scale.
