Dr. Bipin Jha on AI Integration, Surgical Precision & Robotic Surgery Training in India (Part-2)

Dr. Bipin Jha: That’s a very important question. If you had asked me this question 5 months ago my answer would have been different. Earlier, robots lacked tactile feedback, but the Da Vinci 5 now includes haptic/force feedback, similar to the vibration you feel on a smartphone.
Even on platforms without haptics, robotic surgeons say “seeing is feeling” because the 3D, high-definition, magnified view lets you judge tissue tension precisely. Since most robotic surgeons are already skilled laparoscopic surgeons, they quickly adapt.

The one thing you miss is the traditional sensation of blood or tissue on your gloves, but robotics offers a different kind of precision and control.

Dr. Bipin Jha: Surgical evolution has been dramatic.

• Open surgery lasted over 100 years.

• Laparoscopy dominated for the last 4–5 decades, when gynecologists started to use it for tube ligation.

• Robotics emerged to overcome laparoscopy’s limits, restricted wrist movement, 2D vision, and natural hand tremors.

The medical robotics was developed to address these limitations in 1999 by Dr. Fredericl Moll, American surgeon. Robotics changed that with tremor filtration, wristed instruments, and 3D depth perception. In difficult areas like the narrow pelvis or near critical nerves, robotics offers unmatched safety and precision.

For patients, benefits appear as:

• less pain

• less bleeding

• faster recovery

• better neurovascular bundle preservation

• quicker return to work

• less scarring and complications

As technology improves and costs fall, use of robotics continues to expand.

Dr. Bipin Jha: Learning curves depend on where you are in your career when you start robotics training.

• An established laparoscopic surgeon needs roughly 20–40 cases to gain robotic proficiency.

• Early trainees who learn robotics from the start of his surgical career, have a much shorter curve.

• In the US, residents learn robotics routinely from the beginning.
  In the UK, they only learn after a fellowship after residency, which has begun to change now. And slowly in India, similar training is being introduced.

After completing proper training and proctorship, the learning curve largely depends on the surgeon’s prior experience. If they have already performed basic robotic procedures, like an appendectomy or cholecystectomy, they may need only 15–20 additional cases to perform more complex procedures such as a right hemicolectomy.

The learning curve is very individual-specific, but generally speaking, a good laparoscopic or robotic surgeon can become proficient in a particular robotic operation within 20–30 cases. Essentially, you are performing the same surgery but with a different tool. You must go through structured simulation, mentorship, and proctorship to ensure patient safety at the same time.

Dr. Bipin Jha: During my training period in England, robotic surgery was initially reserved for very specific and difficult colorectal procedures, such as low anterior resections, ultra-low resections, and abdomino-perineal resections, because laparoscopic surgery had limitations in those areas. Robotic radical prostatectomy was already well-established by then.

Due to high cost, robotic surgery used to be restricted to these challenging procedures. But now, with many new robotic platforms and reduced running costs, the trend has shifted. Today, any procedure that can be done laparoscopically can also be done robotically. For example, instead of a laparoscopic appendectomy, if I have access to a robot, I prefer performing a robotic appendectomy.

In the U.S., surgeons increasingly use robots for most procedures. More robotic use also makes programs more sustainable and cost-effective. So whatever can be done laparoscopically can be done robotically, often with added benefits.

Dr. Bipin Jha: AI has already entered the field of robotic and minimal access surgery. Earlier this year, while at Portsmouth University Hospital (UK) with my mentor in robotic surgery, we saw how AI is transforming the field.

For example, AI can now reconstruct vascular anatomy from CT scans, giving a precise 3D model of the vessels we will encounter during surgery. This allows for individualized planning.

During surgery, AI-assisted systems can project a laser-guided light that indicates exactly where to cut. I used to dream that one day the laparoscopic monitor would tell me, “This is the ureter - don’t cut it!” AI has now made that a reality.

With indocyanine green (ICG) imaging, structures are color-coded :

• the ureter may flash yellow,

• vessels appear green,

• nerves can be highlighted exactly like in an anatomy textbook.

This is only the beginning. As more data enters these systems, AI will continue to grow smarter.

Dr. Bipin Jha: AI-integrated robotic surgery has just begun in the UK, but technological adoption in India is very rapid. I don’t think it will take a decade. Realistically, within a couple of years, these features will be available in India.

Dr. Bipin Jha: The benefits of laparoscopic and robotic surgery are similar, but robotic surgery amplifies those benefits.

• Smaller incisions → less pain
  Laparoscopic incisions are small (5–10 mm). Robotic instruments cause even less tissue trauma, so patients experience even lesser pain.

• Better visualisation →Less bleeding:
  Robotic surgery provides approx. 30x magnification and 3D vision, enabling very precise dissection.
  Tiny vessels are clearly visible, reducing blood loss.

• More precise dissection →Protection of important structures
  Critical neurovascular structures are less likely to be damaged, which improves long-term quality of life. Less abdominal wall damage.

• Faster recovery, shorter hospital stay
  After a robotic right hemicolectomy, patients can sometimes go home in 2–3 days and return to work in 10–12 days. For professionals who cannot take long breaks, this is a major advantage.

  However, these benefits depend on properly trained surgeons, which is why proper training, mentorship, and fellowship are essential.

Dr. Bipin Jha: The biggest misconception is that “the robot does the surgery by itself,” and that a machine could malfunction, go erratic and harm them.
We reassure patients that the surgeon controls every movement and they are not in isolation with the robot. The robot simply holds instruments.

If robotic surgery becomes difficult due to technical issues, we can immediately convert to laparoscopic or open surgery. Patient safety is always the first priority. We never insist on robotic surgery if it poses any risk.

Dr. Bipin Jha: The biggest barrier is access to a robot, due to high initial costs. Even Indian systems cost around ₹6.5 crore, and not all hospitals can afford that. Chinese systems entering the market may reduce prices further, but robotic platforms will still be a significant investment. There is also the ongoing cost of disposable robotic instruments.

Patient affordability is another issue. Not all insurance companies cover robotic surgery yet, though this is expected to change soon.

However, with better patient education, awareness programs, and media outreach, people will increasingly recognize the benefits of robotic surgery over conventional methods.

Dr. Bipin Jha: It’s no longer necessary to go abroad. Many good robotic programs and fellowships are now available in India, especially in major corporate hospitals. Government hospitals may still lack fully developed fellowships, but this will change as public-sector hospitals begin adopting robotic platforms.

I am personally very keen on teaching. As my program expands, I hope to take 2–3 fellows per year. Of course, exposure in top centers in Europe or the U.S. has its own advantages, but it is no longer a mandatory pathway to learn robotic surgery.