Four Cases: How Robotic Surgery Changed the Surgical Outcome

It is definitely possible to train in robotics directly, and many surgeons find it easier to learn than laparoscopic surgery, especially if they are already comfortable with open surgery. India has a three-step pathway supported by Intuitive: Level 1 is simulation-based certification, Level 2 requires 30 to 50 procedures completed independently or under supervision, and Level 3 is advanced training. There is no requirement to learn laparoscopy first, though prior exposure helps. Most surgeons gain confidence within a year of focused training, with a trained bedside assistant supporting the docking and undocking process.

Yes. BLK-Max takes two robotic fellows every year, one in surgical oncology and one specifically in gynaecologic oncology, each for a one-year fellowship in minimally invasive robotic surgical oncology. The full application procedure and selection criteria would be shared afterward through the Jivo Healthcare team.

Cost depends on the exact procedure. For endometriosis surgery, whether it involves removing the uterus or only a cystectomy changes the figure, but in Indian currency the cost is typically 4 to 5 lakhs, roughly 4,000 to 5,000 US dollars.

A basic surgical background is required. Admission into a robotic training course in India requires an MS in Obstetrics & Gynaecology or MS in General Surgery, with at minimum some exposure to procedures such as LSCS, so the surgeon understands the underlying operative anatomy and principles. Without that foundation, the transition is very difficult. Requirements vary by country, and it would be worth checking what pathways exist locally.

A 42-year-old with a haemoglobin of 6 grams per decilitre and severe pelvic and ovarian endometriosis underwent robotic hysterectomy with unilateral salpingo-oophorectomy and contralateral salpingectomy, preserving part of one ovary. She was discharged on day 4 and had no recurrence at one year.

A 56-year-old with early-stage endometrial carcinoma underwent robotic hysterectomy with ICG-based sentinel lymph node dissection, avoiding a full pelvic lymph node dissection. She had no evidence of disease after six months of observation.

A 60-year-old with chemoresistant low-grade serous ovarian carcinoma underwent bilateral peritoneal stripping, bilateral ureteric dissection, a type 2 radical resection removing the ovarian mass en bloc with the rectosigmoid, and bilateral diaphragm peritonectomy, with the obturator nerve preserved on both sides. She has been disease-free for eight months after second-line chemotherapy.

A robotic modified radical hysterectomy with pelvic lymph node dissection achieved clear margins and a well-resected parametrium. All Peters and Sedlis criteria were negative, meaning the stage 1A1 patient required no adjuvant treatment and remained disease-free for ten months.