Breakthrough in Tele-Robotic Hernia Repairs: India's Pioneering Feasibility Study

In a significant advancement for surgical innovation, researchers from Sri Aurobindo University in Indore have published the first feasibility study on tele-robotic inguinal hernia repairs using the indigenous SSI Mantra robotic system. The study, detailed in the journal Hernia, demonstrates the safety and efficacy of remote robotic surgery within an institutional network. A recent correction to the publication, issued on March 21, 2026, addressed a minor typographical error in the lead author's name, underscoring the journal's commitment to accuracy in scientific reporting.

This pilot initiative marks a milestone in India's journey toward accessible advanced surgery, particularly for common conditions like inguinal hernias, which affect millions. By leveraging tele-robotic technology, surgeons can operate with precision from remote consoles, potentially bridging gaps in specialist availability across the country.

The Burden of Inguinal Hernias in India

Inguinal hernias, where tissue such as part of the intestine protrudes through a weak spot in the abdominal muscles, represent a major health challenge in India. Between 1990 and 2021, the age-standardized incidence rate decreased slightly from 143.85 to 137.05 per 100,000 population, yet the absolute burden remains high, especially among males aged 65-69 years, with rates up to 400 per 100,000. Estimates suggest 1.5 to 2 million Indians suffer from inguinal hernias annually, with prevalence as high as 7.7% in some population studies.

Traditional open surgery has been the mainstay, but it often leads to longer recovery times, higher infection risks, and chronic pain. Laparoscopic techniques improved outcomes, but robotic assistance promises even greater precision, reduced trauma, and faster recovery, making studies like this crucial for widespread adoption.

Evolution of Hernia Repair: Open, Laparoscopic, and Robotic Approaches

Hernia repairs have evolved significantly. Open surgery involves a larger incision, effective but with drawbacks like prolonged hospital stays. Laparoscopic repair uses small incisions and a camera for minimally invasive mesh placement, reducing pain and recovery time. Robotic-assisted surgery builds on this with 3D visualization, tremor filtration, and articulated instruments, allowing complex maneuvers in tight spaces.

In India, robotic ventral hernia repairs have shown lower pain, less analgesic use, and fewer complications compared to laparoscopy. For inguinal hernias, techniques like transabdominal preperitoneal (TAPP) repair benefit from robotics' precision. However, high costs and training needs have limited adoption until affordable systems like SSI Mantra emerged.

SSI Mantra: Features of India's Homegrown Robotic Platform

The SSI Mantra, developed by SS Innovations, is a modular multi-arm system with 3-5 arms, open-face console, 3D 4K vision, and ergonomic controls. Priced at around Rs 4-5 crore—about one-third of global competitors like da Vinci—it democratizes robotic surgery in India. Its telesurgery approval by CDSCO enables remote operations over secure networks, with over 150 telesurgeries performed, including cardiac and pediatric cases.

Key features include wireless connectivity for tele-operations, motion scaling, and eye-tracking, enhancing surgeon comfort during long procedures. This system's real-world performance in diverse surgeries positions it as a game-changer for resource-limited settings.

Study Methodology: Tele-Robotic Setup at Sri Aurobindo University

Conducted in July 2025 at Sri Aurobindo Medical College and PG Institute, the prospective case series involved 10 adult patients (6 indirect, 4 direct inguinal hernias). Surgeons operated remotely via SSI Mantra consoles within the institutional network, simulating true telesurgery. Procedures followed standard TAPP protocol: port placement, hernia sac reduction, mesh fixation.

Data collected included docking time, console time, blood loss, complications, hospital stay, and pain scores (VAS). Ethical approvals ensured patient safety, with descriptive analysis of short-term outcomes.

Impressive Outcomes: Efficiency and Patient Recovery

All 10 surgeries completed without conversion or malfunction. Mean docking: 7 min; console time: 36.8 ± 4.5 min; total operative: 42.6 ± 5.3 min. Blood loss <20 ml; no intraoperative issues. Patients ambulated same day, oral intake within 24h, hospital stay 1.6 ± 0.4 days, VAS 2.1 on POD1. No readmissions or wound problems.

• Short operative times highlight system efficiency.
• Minimal pain supports day-care potential.
• Quick recovery reduces healthcare costs.

Safety Profile and Feasibility Confirmed

The study's zero complication rate affirms tele-robotic hernia repair's safety using SSI Mantra. Compared to laparoscopy, robotics offers superior ergonomics and dexterity, vital for hernia's delicate anatomy. This aligns with broader data showing robotic repairs' advantages in precision and outcomes.

The correction notice, fixing 'Mahak Bhnadari' to 'Mahak Bhandari', was promptly published, reflecting rigorous peer review.Read the full feasibility study

Implications for Healthcare Equity in India

With surgeon shortages in rural areas, telesurgery enables expert interventions remotely. SSI Mantra's affordability (Rs 4-5 Cr vs Rs 15 Cr for imports) and CDSCO telesurgery nod accelerate adoption. Over 100 installations and 150+ telesurgeries show momentum.

For hernias affecting laborers, faster recovery means quicker return to work, boosting economy. Universities like Sri Aurobindo lead by integrating research, training, and clinical practice.

Challenges in Robotic Telesurgery Adoption

Despite promise, hurdles include high initial costs, training needs, reliable broadband, and regulatory frameworks. In LMICs like India, maintenance and cybersecurity are concerns. Standardization and long-term data on recurrence are needed beyond short-term feasibility.

Academic Contributions: Sri Aurobindo University's Role

Sri Aurobindo University, through its medical college, pioneers robotic programs, including fellowships and live telesurgeries like Ratlam demo. Lead author Dr. Mahak Bhandari, Pro-Chancellor, exemplifies university-hospital synergy in innovation.

Such research elevates India's NIRF rankings and attracts global collaborations.Sri Aurobindo Robotic Surgery Program

Photo by Cosmetica India Academy on Unsplash

Future Outlook: Scaling Tele-Robotics Nationally

With NEP 2020 emphasizing multidisciplinary research, universities can drive telesurgery hubs. Potential for AI integration, 5G expansion, and government subsidies could make robotic care routine. Long-term studies on recurrence and cost-effectiveness will solidify evidence.

This study paves the way for equitable, high-tech surgery, transforming lives one remote repair at a time.