AI in robotics: How Mumbai hospitals are using artificial intelligence in operation theatres

Recently, Mumbai-based Dr Mudit Khanna completed 100 successful robotic arm-assisted makoplasty procedures. The minimally invasive joint replacement surgeries were done over four months, according to Wockhardt Mumbai Central Hospital, where he is an orthopaedic and joint replacement surgeon. In 2023, a team led by Dr Gaurav Chaubal, director of the Liver, Pancreas and Intestine Transplant Program and HPB Surgery at Global Hospitals, Parel, performed a total robotic donor hepatectomy for a liver transplant on a baby, diagnosed with Crigler Najjar syndrome. It helped by only giving a smaller scar and enhanced precision and control, reducing blood loss during surgery and has lower rates of complications compared to open surgeries.

The same hospital also conducted a robot-assisted coronary artery bypass graft and robot-assisted bypass surgery in the same year, as Dr Chandrashekhar Kulkarni, senior consultant CVTS and Heart Transplant Surgeon, introduced advanced technology for minimally invasive cardiac procedures. These are just some of the achievements that doctors across Mumbai have achieved over the last year. It simply goes to showcase the role of artificial intelligence in surgery in the larger healthcare ecosystem today.

With a belief in the potential of robotic technology to enhance surgical precision and patient outcomes in the field of arthroplasty, the city doctor is only one among several doctors in the city who use artificial intelligence in robotics to carry out their surgeries in operation theatres. As more and more advancements are made in the field of healthcare daily, the growing role of AI cannot be ignored. While they have already been incorporated into technology and systems in healthcare, their role in the operation theatres demands surgical precision and that can often be challenging especially when the cases are challenging. While healthcare experts like Khanna come with years of experience, it is also important for AI and robotics to match up their expertise. However, they are slowly making their way and Dr Khanna's use is only one such successful feat.

Artificial Intelligence and Robotics in Orthopaedics
He explains, "AI and Robotics together have ushered in a new era in orthopaedic surgery. The landscape of joint replacement surgeries is rapidly changing, and AI and Robotics are at the helm of this transformation. These technologies working synergistically have introduced unprecedented levels of precision and personalisation to surgical procedures thereby significantly enhancing patient outcomes."

At the hospital, Dr Khanna says they currently have the MAKO SMART Robotics system for performing joint replacement surgeries. With that, robotic-assisted surgeries are procedures that are done with the help of a machine programmable by a computer. "They assist surgeons in carrying out complex actions with unparalleled accuracy and safety. Integration of AI-based tools such as Image Recognition, Path Planning, and Machine Learning into the Robotic System, have significantly improved the decision-making process, surgical planning, accuracy, and repeatability of surgical procedures while offering unmatched safety or soft tissue protection," he adds.

It goes to show how the use of AI in operation theatres has only enhanced existing treatment methods. With the expertise of AI coupled with robotics, surgeons cannot only get optimum results but also aid the system in helping better the outcome of the surgery in the future. So, how does it assist in orthopedic surgery? Dr Khanna explains, "Robotic-assisted system integrates information from preoperative imaging, intraoperative surface mapping, specific bone landmarks and the ligament balancing intraoperative to propose surgical planning, secondarily adjusted according to the surgeon's requests and targets. A robotic arm allows performing bone resections with a real-time automatic feedback system that improves the surgeon's accuracy and decreases the risk of errors." Progressively, the Mumbai doctor says the algorithms of robotic systems integrate machine learning models to improve surgical planning from data analytics of a large subset of previous surgeries.

It is also why he highlights that robotics-assisted Total Knee Replacement (TKA) surgeries help with accurate knee alignment, implant positioning, ligamentous balance, and soft tissue protection. More controlled studies in his experience have shown that they have better outcomes compared to traditional TKA.

While how it is used sounds revolutionary, Khanna highlights the need for it. He says, "AI models are now also being used to predict patient suitability for different types of knee surgeries, showcasing their valuable role in guiding surgical decisions. These emerging applications of AI in robotics warrant ownership, leverage, and application by orthopaedic surgeons to better serve their patients and deliver optimal, value-based care."

With the ongoing application of AI in so many different fields, there is an ongoing fear among many people that its use will replace humans, but Khanna is quick to dispel that misconception. He says that robotic systems do not aim to replace surgeons but to be an accurate and consistent delivery tool. "The major benefit of robotic systems is accurate and reproducible bone preparation," Dr Khanna shares.

Elsewhere, Dr Jaydeep Palep, who is with the Department of Bariatric and Metabolic Surgery at P. D. Hinduja Hospital & Medical Research Centre in Mahim has also been actively using it at the hospital and believes in its use with each passing day. He shares, "AI is being incorporated in every walk of life and hence AI must be absorbed in healthcare keeping in mind the delicate balance between human judgement and Artificial Intelligence." At the city hospital, the health expert says they have the latest da Vinci Xi (Intuitive Surgical) surgical robot, with a compatible motorised operating table giving the doctors the most cutting-edge technology to use while operating their patients.

Dr Palep shares, "We use the robot for a plethora of surgeries like gastrointestinal, urology, gynaecologic, head and neck and thoracic surgeries (both in benign and malignant conditions). For example, radiological images of the patient undergoing surgery are taken and integrated so the surgeon sitting and operating the robot can superimpose them on the real-time image to achieve more accuracy and precision." The applications of AI in the hospital are plenty - right from radiologists to surgeons using a voice-based software app to document surgical findings of surgery performed with 100 per cent accuracy. "These modalities are meant to improve patient outcomes by achieving quicker diagnosis, better planning of a surgery or medical management of a patient, better planning of patients' post-surgery treatment protocols," he adds.

Aiding operation theatres
Dr Pradeep Rao, who is the director and senior consultant, Urology and Renal Transplant at Gleneagles Hospital in Parel is humble enough to add that it not only improves surgical outcomes but also takes away the emotional aspects of human thinking as well as human forgetfulness. He shares, "Robotic surgery is a game changer because it scales away tremors, offers huge magnification and gives 360 degrees of freedom with its wrested instruments. Together, these technologies will far improve decision-making as well as precision and the quality of surgery. By making a database of videos of live surgery, AI will start to identify major anatomical structures and using Augmented reality, superimpose these on the surgical field during surgery to help surgeons identify difficult anatomy."

Making use of the da Vinci Xi robot, Dr Rao says it has helped revolutionise complex surgeries at the hospital. Beyond the precision and accuracy factor, he says, "Robotic surgery offers several potential benefits over traditional surgical techniques, including faster recovery times, better outcomes, less pain and scarring, reduced risk of infection, and accurate results. It is done for various problems such as prostate cancer, bladder cancer and kidney cancer as well as for large simple prostatectomies and complex reconstructive surgeries when it comes to urologic surgery." Beyond that, the hospital also launched a Robot-Assisted Heart Surgery Program which aims to reduce recovery time and complications for patients in need of delicate heart surgeries.

The use of AI in robotics and thus the robotic arm also helps beyond the applications in logistics. "The DaVinci Xi system features boom-mounted arms with multi-position set-up joints designed to maximise the surgical workspace, internally and externally. From a single cart location, there are greater arm positioning capabilities and the surgeon can easily operate across multiple quadrants with the freedom to complete a wide range of procedures," he adds.

The use of AI in robotics is now a part of the system but the need for training cannot be stressed now more than ever. It is also why Professor Jignesh Gandhi, Gastrointestinal, Laparoscopic & Robotic Surgeon, at Gleneagles Hospital in Patel says it is a high priority. "We have also prioritised training and education for surgeons and other healthcare professionals like operating room staff to familiarise them with the technology and enhance their proficiency in leveraging the surgical technologies and AI to improve patient outcomes."

The role of AI in robotics cannot be overstated but Gandhi says robotic-assisted procedures by using advanced technologies like the da Vinci allow surgeons to do surgical procedures through tiny incisions resulting in minimised scarring and blood loss leads fewer post-operative wound infections. "The advanced features of such robotic surgical systems enable surgeons to navigate procedures, including those involving obese patients with high BMI and intricate tumour positions, even in cases with significant co-morbidities. The precision, control, and dexterity provided by the system enable surgeons to perform surgeries with greater accuracy, minimising trauma to surrounding tissues and ensuring faster patient recovery."

All in all, the Mumbai-based professor says those who undergo robotic-assisted surgeries experience less pain in comparison to those who undergo traditional procedures. "This can be attributed to the system's precision and 3D vision, which aid in guiding instruments and manipulating tissues more effectively, ultimately leading to improved clinical outcomes. As a result of fewer post-operative wound infections, patients experience faster recovery and leave the hospital feeling more satisfied and happy. This indirectly impacts the health economics of the hospital system as well," he concludes.