Robotics, AI, and telesurgery: How urologic surgery is evolving globally

Robotic surgery in India is entering a period of rapid evolution, shaped as much by technological expansion as by practical realities of cost, access, and patient choice. In the following interview, Sadashiv Bhole, MBBS, MS (Surgery), MCh (Urology), DNB (Genito-Urinary Surgery), FMASI, director and chief urology consultant at Ketki Nursing Home and Urology Hospital (Bhole Urology) in central India, offers an on-the-ground perspective on how robotic platforms are being adopted across the country, from high-volume metropolitan centers to emerging programs. Drawing on his own experience, he explains why the conversation is no longer framed as robotics vs laparoscopy, but rather how the 2 can be thoughtfully integrated to deliver optimal outcomes while remaining sensitive to patient financial constraints and disease complexity.

Bhole also reflects on the growing ecosystem supporting surgical innovation in India, including the introduction of multiple robotic platforms, increasing competition, and the close collaboration between surgeons and engineers that has long defined urology as a technology-driven specialty. He discusses how advances in instrumentation, visualization, and suturing have expanded what is surgically possible and how these gains are often driven by engineering breakthroughs.

Looking ahead, the conversation turns to emerging frontiers such as artificial intelligence (AI) and telesurgery. Bhole shares his views on how AI is already influencing diagnostics and operative efficiency, the ethical guardrails that must accompany its use, and why human judgment will remain central for the foreseeable future. He also describes the early but promising experience with telesurgery in India, outlining its potential to democratize access to expert care and redefine how surgical expertise is shared across regions and borders.

Urology Times®: How would you describe the current adoption of robotic surgery in India? Are you seeing a turn back toward laparoscopy, or are the 2 being integrated?

Bhole: Robotic surgery India has taken great leaps in the last 5 years. The whole thing started about a decade back, but then there was COVID, and everything came to a sudden stop. Now, we have so many centers coming up in India; around 300 to 320 centers are equipped with robotic platforms. We have multiple options for different platforms. You can either have an American system, the DaVinci system—they are the pioneers of robotic surgery in the world. I started my center with the daVinci Si system, and now we are trying to phase it out. Now we also have an SSi Mantra robot, which comes at a very affordable price. The expenditure per case is low. Then we have many Chinese companies who are coming with their own platforms, and they are making huge gateways into Indian markets.

There was a time when a particular system had complete dominance in the market. Many of us were thinking whether, in a country like India, is it really relevant? You need these kind of robots for complex surgeries, but most of your work is done with 3D laparoscopy or simple laparoscopy. There is no dearth of facilities in laparoscopy in my city or in India as a whole. Laparoscopy is universally available here today. I would say now we are in the process of integrating it. So, we see the patient, we decide what kind of complexities there are in a particular case, and then we sit with the patient and talk to him and give him all the options: simple 2D laparoscopy, 3D laparoscopy, and robotics. If you're talking about a case of a complex prostatectomy, then obviously we would stress and we would tell them that we can do it with laparoscopy in 3D, but robotics is much more superior. As for a complex partial case, you have a big advantage with the 3D visualization with the robotic platform and the ease with which we can suture. Except bearing a few cases, maybe yes, laparoscopy is relevant.

The other thing to look into is the patient's budget. In India, many people are spending from their own savings; they have a savings for their health and income. It's not as different as in the United States, but still the cost difference between laparoscopy and robotics is quite good. We discuss that as well, and then we ask the patient to make a conscious choice of what he wants. The last 3 prostates I did laparoscopically, because people were not insured and they did not want to go for robotics, so we combined things and integrated things as well. Integration helps you in keeping the cost low and keeps your end results better, giving you that freedom.

One more thing, which is especially true in my country is most of us who are owners of the hospital, it doesn't make a difference if you don't earn out on a single case. If I have a very interesting and critical case, we can just do this in the cost of a 2D or 3D laparoscopy. As long as the case goes, the medicines are brought by the patient, and there's no extra cost involved. For prostate cancer, for example, most of the patients’ reach us when they're in advanced stages. The number of patients coming with organ confined disease who are ideal candidates for a radical prostatectomy is really low. So here, the integration becomes healthy; you can always bring down the bill for the patient. We are happy because we are doing a case, and ultimately you have given standard end result to the patient. With the relevance of multiple platforms and also advances in laparoscopic surgery, we are in a process of rapidly integrating everything into one.

Urology Times: How do you see the collaboration between surgeons and engineers evolving to shape the future of robotics?

Bhole: We are here because of the engineering. If Professor Harold Hopkins would not have described how the light travels through a fiber, there would not have been any cystoscopes. It's a very strong bond and a mutually beneficial relationship. Urology is a technological branch. When it comes to specialty branches, we are highly dependent on engineering. We are highly dependent on technology. We are highly dependent on the other resources that technology provides.

AI, for example, has come a long way. Look at the first PC that was installed in United States. Now we have a small phone which is much more powerful. All of these results have improved, not because of the skills which we have acquired, but because of the equipment and the apparatus the engineers have given us.

Technology will go on evolving. When we were operating with a 7.2 Fr ureteroscope (URS), we were thinking, this is the end of it. Now we have 6 Fr flexible URS which can be used [in pediatric cases] so we can do stone surgery in children, which is quite common in India, unfortunately. When we think that the technology has reached a dead end, they open a new avenue.

Urology Times: You mentioned AI, which is having an increasing role in surgical decision making. How are these tools being used? What are some of the ethical frameworks or safeguards that are currently in place to ensure some of the responsible use of these technologies?

Bhole: Everywhere you go today, everybody's talking about AI. AI in diagnostics particularly, is going to make a massive difference. It is cutting down operative times by 25%, and it is decreasing complication rates. Whether you like it or not, it is growing upon us. It is a good thing that we should adopt, and we should try to integrate it into day-to-day work as fast as possible, because you cannot run away from it.

There are multiple ethical issues involved here, but the fact remains that it's going to stay. The ethical issues with the use of AI will remain, and they will become more complex as time goes on. The only thing is it should not become like Mission: Impossible-7. It should not tell us what to do and what not to do. People always say that a time will come where surgeons will stop operating, and AI will decide the approaches, AI will plan surgery, and the robots will do it. I don't think that's in the near future, but yes, we will be influenced massively by AI in the coming decade. That's what my future prediction is.

Urology Times: Could you touch on the current environment surrounding telesurgery in urology? What are some of the practical considerations for introducing robotic surgery in this way?

Bhole: Telesurgery is hugely promising. It helps you, sitting in the center of the city, to be the remotest part of the world. One of the platforms, which is Indian platform, the SSi Mantra, makes it possible and feasible. In India, one of my colleagues, Dr. V. Chandra Mohan, from Hyderabad, operated on 2 patients around 2000 miles away. We were amazed, because there was hardly any delay. This will be a game changer. It will put surgical expertise from one corner of the world to the remotest part of the world, and it will make it easy for patients from remote areas to access the same kind of skilled health care as people in the metro cities. Things are just getting started, so it's just the beginning, but I think over time it will become a very big platform where people will exchange their skills and techniques. Using these tools, I can ask my colleagues from West Virginia to operate here in Nagpur, and I can do something from here to maybe Vietnam.

India is percolating at a rapid pace. The pace at which we are adopting these things is quite fast. We have a huge factor of perseverance, where once we start, we want to go at the maximum pace, because we have a huge population. That’s when things become very exciting. I'm looking forward to it. Telesurgery will make a surgical village where surgeons will operate at the comfort of their own operating room.