Choosing Cancer Patients for Robotic Surgery: The Rules That Cannot Bend

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.

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.

Pre-invasive lesions of the cervix, early-stage carcinoma of the endometrium, small and benign ovarian masses, interval cytoreductive surgery for ovarian cancer after neoadjuvant chemotherapy, exenteration procedures, cervical cancer, and selected central recurrences.

The tumour must be small, under 2 centimetres, and preferably post-conisation. Manipulators are not used, vaginal closure is performed, and the radicality of the surgery is never compromised for the sake of the approach.

Studies have shown better outcomes with robotic radical hysterectomy than laparoscopic radical hysterectomy in cervical cancer, but randomised controlled trial data is still awaited, so robotic use is restricted to very early, micro-invasive disease until that evidence arrives.