Patient Positioning and Why Manipulators Are Left Out of Cancer Cases

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.

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.

The protocol places the patient in a low lithotomy position with the lower limbs abducted, moderate flexion and internal rotation at the knee joint, with mandatory shoulder braces and chest support, because the degree of Trendelenburg tilt required is more extreme than in standard laparoscopy.

Multiple studies have raised concern that manipulation of the uterus can risk spreading tumour cells. In cancer cases, no manipulator is used, and vaginal closure is performed as part of the procedure instead.

Yes, manipulators are used routinely in benign gynaecological procedures. Their use is reserved for these cases and withheld entirely once a case is confirmed malignant.