Tomorrow's Medicine, Ep. 11: Robotic Surgery Explained - Dr. Vishal Soni

With Dr. Vishal C Soni, Gastrointestinal & Bariatric Surgeon. Hosted by Arseniy Arsentyev. Published December 28, 2025.

https://aarsentyev.com/podcast/ep11-vishal-soni

Machine-transcribed and lightly edited: filler words and false starts are removed, and the wording is otherwise as spoken. Where the two differ, the recording is the record. Times are minutes into the recording. Not medical advice.

[0:00] Arseniy Arsentyev: Hi everyone, it's the 11th episode of Tomorrow's Medicine. My name is Arseniy and today I'm talking to Dr. Vishal Soni. Dr. Vishal is the Director of the Apollo Centre of Excellence for Robotic Surgery. Dr. Vishal, please introduce yourself and tell us more about what you do.

[0:19] Dr. Vishal C Soni: Thank you. Thank you so much for having me today. My name is Dr. Vishal Soni. I'm a consultant robotic GI, bariatric and hernia surgeon based out of Ahmedabad, Gujarat, India. I basically am in the western end of the country and I'm associated with the Apollo hospitals where I function primarily. My main field of interest and work is gastrointestinal surgery and the subspecialty that I deal with is robotic surgery, hernia, abdomen wall reconstruction and bariatric surgery.

[0:58] Arseniy Arsentyev: Okay, let's outline our episode as follows. First, we'll talk about your background a little more. I have a certain questions for you. Then we'll dive into the world of robotic surgery and finish with tomorrow's medicine. Does it seem right?

[1:13] Dr. Vishal C Soni: Yeah, absolutely. Seems perfect.

[1:15] Arseniy Arsentyev: Okay, so the first question on your background. What was the exact moment when you decided to be a surgeon? Could you provide us with some kind of a lens?

[1:24] Dr. Vishal C Soni: Yes. Oh, I think so. This would be a trip down the memory lane. I believe it was way back in during my schooling days, when people would often ask that when you grow up what you wish to be. And I always was fascinated about doing things with my hands. Okay, I'm a person who is more of a doer than thinker, maybe if I have to put it that way. So science excited me. Okay, the ability to do things with my hand kind of compounded that feeling and way back in India, okay, there's this interesting channel that had got launched, which is called as Discovery Channel. Okay, so it was it was a lot about science and technology. It was the first gateway to what happens in various professional spaces.

[2:16] And one of the spaces that excited me the most was a hospital setup and emergency room, for example, I was barely 10 year old, 11, maybe and I started seeing these episodes where I would see doctors, surgeons to be very specific, taking charge of the situation, performing surgeries, changing life in matter of minutes. And I think so then it was only about connecting the dots and carving out a journey which got me here today.

[2:48] Arseniy Arsentyev: That's an inspiring journey. And when in that journey, did you realize that robotic surgery becomes a thing and started to learn, started to progress in that direction?

[3:01] Dr. Vishal C Soni: So I did my residency program from 2010 to 2013. That's what 12, 13 years ago now. When I had just entered in the surgical specialty, I realized that this is a fast moving world. And what becomes relevant today becomes irrelevant in matter of say, a decade at the max, on the on the higher side. So what I saw was laparoscopic surgery, like I say, about one and a half decades back was considered a norm or a regular thing. And robotic surgery was kind of just coming up in India 15 years back. It was just coming up globally. It's the presence was there since before that as well. So during my residency, I got introduced to this wonderful topic.

[3:53] It took me almost seven, eight, nine next years to get my hands on the robot for the first time. During my fellowship, I had some small exposure, but not direct training on it. But a few years down the lane, I got trained on it. And that is where the entire robotic journey began. So sometime in 2020, 21, five years back, that is where we started our robotic journey and robotic program.

[4:23] Arseniy Arsentyev: And you've said, and of course that time was different, there wasn't an exposure in India to robotic surgery and globally I think it was on completely different levels. So could you address what changed in the surgeon's work? How during these years, your maybe daily routine, the things you do have transformed?

[4:46] Dr. Vishal C Soni: I would break my surgical journey into three bits. The first bit is when I was training residency program. The second bit was the fellowship and the early professional career pre-robotic surgery and then it will be the post-robotic surgery. So we talk in three bits. I did my residency in one of the busiest public hospitals in the country. It is called as LTMMC, Lokmanya Tilak Municipal Medical College and Sion Hospital. It's based out of Mumbai. It's in a huge metropolitan city. And well, it was an overwhelmingly huge workload with regards to patients. Okay. So as I said, it's a busy unit. You have a chockload of patients walking in all the day and night. So there the entire flavor of the surgical care was how do we take care of everyone in the best possible way?

[5:42] We would always remain in a resource constrained environment. Okay. And technology and the access to technology was limited. If I have to put it that way, it wasn't something that you can ask for in middle of the night or you can post multiple cases in a day and get away with it. So learning surgery, honing your skills to become a surgeon and then dealing with a huge volume. These were three kind of challenges that we tackled during our residency. Not only me, I believe a large batch of my contemporaries would have gone through the same grill to reach in their careers today.

[6:30] The second bit happened once I completed my residency program. So in India, the residency program is only three years. It's not the way it works in US, for example. So in three years, you become a qualified surgeon, after which you need to decide how do you pursue further? Do you do a super specialization in a specific field or you do fellowships and you hone your skills? I chose the second route. I knew for sure that I am interested in gastrointestinal surgery. Minimal access is something that excited me the most. I could see through very clearly that the world wants minimum scars or no scars and the technology is allowing us to perform the same surgery with almost no cuts or minimum cuts. So I did two fellowships in minimal access surgery.

[7:24] And that is exactly where I realized that this is the present and the next generation equipments are already there on the horizons. So after having some training in minimal access surgery and some exposure to robotic surgery, I started my practice as a professional, as a private practitioner sometime in 2015-16. Okay, so I started working since then. And then it took me a few years to master the art and science of surgery and to slowly excel in minimal access platform, which basically formed the base for what was coming ahead.

[8:10] And this is something that I keep on recalling in every lecture that I give: the basis of a good robotic program is your minimal access techniques, the understanding of the endoscopic anatomy and the way you tackle that view where you're not directly aligned with your hands. You're looking at something else and you're operating somewhere else. So that eye-hand coordination and that muscle memory just takes so much of time to develop. So that was the second phase of my surgical professional career. So my third phase came sometime in 2020-21.

[8:54] Paradoxically, while the world was grappling with a tough situation and the healthcare was in a mess, surgeons took a break. Okay, elective surgeries were not happening because of the COVID and that gave us a time to introspect in a different way. So I got down to the drawing board again and I asked myself that, you know what next and what do we do from here? We were unsure when we'll start, but I knew for sure that the next time we start, it has to be very different than what we did like till date. So I started seeing and consuming more surgical videos on YouTube, which would be robotic surgery without having even exposure to it, without having trained, being trained in it.

[9:42] The sheer excitement was epic that okay, there is this whole different way to do the surgery if the instruments get better. So, six months later, when things got a little calm and our electives started in a nice way, I proposed to the place where I work, the management, that let's take the leap of faith and the next jump and see what we can do with the robot. So that is where the robotic surgery, the training and the teaching came in picture. So I got trained on the robotics, I got my certifications done. And 2021 is when we started robotics in a very serious way.

[10:27] And since 2021, I can tell you, I can fast forward it in a small way that every time we dock a robot, we realize that we could do things better, sharper, in a more controlled and a predictable fashion. And that, I think so got us latched. And then there was no looking back. We, as of today, we are very bullish on the technology. We believe that if it is minimal access, it needs to be robotic. That is, it has to be that clear. And I believe in it and I do it. So, yeah, this is how we reach 2025.

[11:08] Arseniy Arsentyev: Great, great story. Let me follow up with a question. Could you describe what is Apollo Center of Excellence for Robotic Surgery? Is it the place you're currently working? And if so, what it does?

[11:24] Dr. Vishal C Soni: Yeah. So Apollo Hospitals is a chain of private hospitals in India. They are upwards of 70 hospitals in the country. It's one of the largest chain of hospitals in the country. And I work out of Ahmedabad, Gujarat, which is in the western part of the country. Apollo has a strong multi-speciality robotic program, which includes GI, uro, gynae, gynae-onc, cardiac surgery. So all of the services put together, we form the Apollo Center of Excellence for Robotic Surgery. And that is where I function today.

[12:04] Arseniy Arsentyev: Okay, great. Let's proceed to the more specific questions related to robotic surgery and the first one is, in simple terms, describe how these surgical systems work.

[12:19] Dr. Vishal C Soni: Lovely. So, let me also tell you that this is the commonest question you would be facing in the office when the patients and the family, they're sitting in front of the desk and they're trying to understand that when I utter the word robot, what does it mean? Does it mean that there's a machine that comes in, operates on its own and you are sitting somewhere having your coffee? Answer is no. Robot is a smart piece of equipment. Think of it in this way that anything that is a combination of software, hardware and some automation qualifies to be called as a robot.

[12:59] And with that definition, the cell phone that you have in your hand or a car that you drive technically can also be called as a robot. For that matter, even a vacuum cleaner or any of these equipments can be turned as a robot. So, a specific set of software, hardware and some automation. When I say some, which means there would be some small steps which can be done in a more smoother way. But essentially, we are not looking at a system that has a brain of its own.

[13:32] There's a very famous way to put it as a master-slave concept where surgeon always remains the master of the system. And whatever instructions in the way of hand movements are given to the robot just copies the same in the patient's body. And that is basically the premise of a robot. So, a very advanced equipment for the surgeon to perform surgery. Essentially, the surgery is done by the surgeon and not by the machine.

[14:03] Arseniy Arsentyev: That's what I want to double-click for my audience. That robotic system for surgery is a system 100% controlled by the surgeon with safety measures to prevent certain mis-movements or certain glitches that can harm the patient. That's very important for everyone to understand. And Dr. Soni, what is this super skills that the surgical system can do that the human hand cannot or maybe it's so hard for a human to do?

[14:36] Dr. Vishal C Soni: Yeah. If I just show you the image of the patient-side cart, the biggest puzzle that the patients would have is it has four arms and how do you even control four arms? So, this is where I tell them that, you know what, one of the arms holds the camera the way I want to hold the camera. And the other three arms, they hold the instruments the way I want them to be held. And because of the augmented hardware capabilities and the software capabilities, I can actually control three arms instead of me physically having only two arms. Now, this is where you're pushing the technology to its new dimension that you become your own camera holder.

[15:25] So, for patients, now this one is for patients, that when you get operated in a minimal access way, there is someone who's holding your camera. There is a surgeon who's operating using both his hands. And then sometimes there will be a person who's also assisting with another instrument. So, there are sometimes three people involved in performing one surgery. How do you combine all of them into one? That is what robot does. So, the robot holds the camera for you. The two arms, the primary arms would hold my two instruments and my assistant arm is controlled by myself. So I become my own assistant. So in a way, this is a pure surgeon driven care and pure surgeon driven surgery that happens without any interference from the outer world, so as to say.

[16:17] Okay, this is how the four-arm concept works like. How is it very different than laparoscopic surgery? Well, when a machine is holding your camera, the first thing that goes away is tremors. So you pick up any video of any robotic surgeon across the globe, and you compare it with any surgical video of a laparoscopic approach, you'll see that there is some tremor and some instability that will be very apparent with the laparoscope because you know, it's a long stick. No matter how stable your hands are, there will be some micro movements that happen. And those micro movements will also mean that the surgeon's visual field keeps on moving.

[17:02] And that is the first thing I think so which makes a huge difference for a surgeon that I get a super stable vision, which is high definition, which is three dimensional. So it's an immersive experience. For me, it is like being in a patient's abdomen, it is as as immersive as it gets. And with specialized hardware and software, my micro tremors of my fingers and hands, they are taken care of. So inside the movements are smooth, like the painting strokes of a brush. Okay, so I start performing more beautiful surgeries. So I sometimes tell my patient that I share the credit with the robot, that what makes me look good is actually the robot, not just my surgical skills. But yeah, it augments the surgeon's capacity to a great extent.

[17:54] So these are ways in which we perform those precision surgeries in the OR.

[18:02] Arseniy Arsentyev: Can we also say that the system kind of helps surgeon to not spend that much strain and mental effort? For example, if you have five surgeries in a row, is it easier to do them with robotic surgery? Easier for you, from the strain, cognitive perspective, or does it require more concentration and much more tough?

[18:28] Dr. Vishal C Soni: You asked a very interesting question, which I've been debating, paradoxically. So I come across a subset of surgeons who either get frustrated, or who are very unhappy with the entire robot in front of them, because they feel it slows them down, it takes away some efficiency in their workflow. So our experience has been totally reverse. And we proved it multiple times where we could finish a huge list of cases in a short span of time, most of the times in regular hours, just because the team got efficient, and we were beyond our learning curves. So these are two issues that kind of are the roadblock for all the surgeons to perform surgeries in a much smoother way.

[19:15] When it comes to ergonomics in robotic surgery, well, there is no substitute for comfort when it comes to operating sitting down on a chair, and being comfortable vis-a-vis standing and having a neck posture, which is abnormal, and operating using that posture for a few hours. I think so. That kind of ergonomics is not forgiving for the surgeons, and surgeons start developing a lot of musculoskeletal issues. Having said that, even robotic surgery needs learning how to sit properly, how your posture needs to be correct, how your head needs to be placed, so that the strain on the head and the neck and the back is minimized. And this is where, again, the learning curve becomes a reality.

[20:00] So you need to understand the system well, you need to be comfortable with the system, and only the efficiency then comes as a byproduct of these two things, not from the word go. And once your side of the story is completed, then the team building and the team efficiency comes in picture because you may be the fastest surgeon on the globe. But if your team doesn't know how to, for example, do the instrument change, how to help you dock the robot, how to position the patient well, how to decrease the turnaround time between two patients, well, then it becomes a logistical nightmare and you see teams struggling to do multiple cases in a day. So here is a journey which has to be parallel.

[20:43] So your team learns, team keeps on getting efficient and you keep on getting efficient in the same time space. And that is when things get smoother.

[20:55] Arseniy Arsentyev: And often I hear this argument for the criticism of robotic systems that you have static controls and you do not have this tactic feeling of operating this pressure. What can you say about this? Is it a problem and will it change?

[21:17] Dr. Vishal C Soni: So the issues around haptics. Now, this has been again a source of debates amongst academicians here. Let me give you a perspective: the expected, anticipated or perceived haptics in laparoscopic surgery, and let me put it this way, it is perceived haptics, it's not true haptics, even in laparoscopic surgery is either very limited or it's part of an illusion. You feel that you are feeling something with the tip of the instrument or you're feeling something in between the jaws. OK, that need not translate identical to the haptics that you're feeling in between the handle.

[22:04] That translation is never 100%, sometimes not even 1%. So even in laparoscopic surgery, what we are doing is we are relying on visual cues to understand what am I feeling in my hand. It's that way all the time. Barring probably feeling a stone in the cystic duct or the gallbladder. That is the only situation where I felt that giving unrealistic pressure, actually, I would usually not hold a bowel like that, but I could hold that stone or feel the stone through the gallbladder and realize, OK, there's something here. But you know what? If your visual cue and understanding of visual cue is really good, you would get all that information on the surgical robot itself. And that is where we are trying to explain to the surgeon the entire concept of visual haptics.

[22:55] You use tissue distraction and tissue elasticity to make a judgment regarding what tissue are you handling? How do you go into the right plane and how do you not injure the tissues? So what was a piece of imagination and some made up reality in laparoscopic surgery? I think so on the robot, you get a chance to undo that deed and go straight away to visual haptics. This is how surgery needs to be done. And let me tell you very candidly that not once have I regretted not having haptics when I sat on the robot or when I was doing any surgery. Maybe it's a gallbladder surgery, fundoplication, getting a cancer out, repairing a hernia, doing an abdomen wall reconstruction.

[23:45] I think it's all about how can you retrain your brain to understand what you see more clearly.

[23:53] Arseniy Arsentyev: Thank you. Okay, and these systems have like 10x microscopic vision. Does it change the way you understand the human body, the way you perceive the human anatomy?

[24:07] Dr. Vishal C Soni: Absolutely, absolutely. So, I frequently use the statement that in laparoscopic surgery, entering into a plane and developing a plane and dissection is, most of the times, a matter of chance. You got a good chance to go into the right plane. In robotic surgery, it's always by choice. You can enter a microplane, you can do dissection, which is sub-millimeter level precise and this is not by chance. Every single time, you can perform the same thing. So, how did it translate and help us in our daily cases? So, the moment I'm dealing with the recurrent cases, a recurrent hernia, for example, where the tissues planes are fused, everything is a piece of rock, I can still go in and I can get a sliver of tissue out and make a plane that I exactly want to.

[24:59] So, operating with a microscope opens like a whole new world to you, which I believe in laparoscopic surgery, we are just not ready. When you're standing and you're trying to have instruments in your hand, having those chopsticks in your hand and trying to maneuver something, even if your assistant manages to go very close to the tissue, even the smallest amount of movement translates into a huge movement inside because of the fulcrum effect, and you're not able to get that steady vision which allows you to perform those kinds of surgeries.

[25:38] So, I think so it is given that the world is going micro where everything has to be super precise instead of you trying to figure out, okay, where am I going? What should be? And then doing a corrective measure and coming in the right planes doesn't happen that way. And we also take leaves of learning from our colleagues in say neurosurgery and plastic surgery. The moment they start using their microscope, they function differently. You see a plastic surgeon or a neurosurgeon operating open with a surgical loupe and the moment they sit on a chair, they dock a microscope and you see their hand movements, they completely change. In fact, they resemble a surgeon sitting on the console and using hand controls. So, it's exactly microsurgery in action when you dock the robot.

[26:33] Arseniy Arsentyev: And what are the key players on the market right now? Is it purely da Vinci systems? Because I know that you work on this da Vinci robot.

[26:43] Dr. Vishal C Soni: So, the world keeps on progressing, I think. So, that's good for science, that's good for patients. Way back, 30 years back, I think, da Vinci was the only or the dominant player. Luckily, now we have a lot of systems. So, in India, if I have to give you an insight, commercially, there are multiple systems available. So, if I have to name a few, Medtronic has their system which is called as Hugo. You have CMR, which has a system called as Versius.

[27:16] You have SSI, which has a system which is called as Mantra. So, these are three dominant players, the non-da Vinci players. And come 2025 and 26, there are at least two more companies which are trying to kind of penetrate in the country. One is Toumai. So, they are coming up with their robot as well. And there's another company called as Meril, which is coming up with Mizzo. So, these are two new entrants, the new babies on the block. So, that makes it six.

[27:50] And what I hear and learn is that over next year, there will be at least two more companies coming in. So, the field is progressing like on a lightning speed.

[28:01] Arseniy Arsentyev: What are the differences between these systems? Do they change the way you control the surgery? Or is there new instruments?

[28:11] Dr. Vishal C Soni: So, I believe Intuitive sat on the patents for their robotic technology, the platform, the interface for a long period of time, I believe till almost 2022. So, the moment those patents, they expired, that opened the doors for systems which can be kind of branching out of those platforms. So, there would be some variations and there will be some similarities. So, there are systems which use a boom where all the arms are anchored on a common kind of the trunk and the arms pan out.

[28:50] And then there are other systems which are individual unit arms. So, bedside unit kind of system where individual arm needs to be positioned or stationed next to the patient. The instrument needs to be attached and that's how the surgery is performed. So, SSI Mantra, CMR Versius, the Medtronic Hugo, these are individual bedside unit kind of systems where there are individual arms rather than a common boom. And the second remarkable change is instead of a closed console system, then these all systems, they offer an open console system except the Toumai which is now coming up with a closed console system.

[29:35] The way these two systems are different is in the closed console system, there is a binocular three-dimensional vision and the surgeon would duck their head inside, kind of cut out from the rest of the world that's happening all around and being connected with a mic and a speaker. And in an open console system, it resembles laparoscopic surgery basically. You wear a three-dimensional goggles, 3D goggles and the screen projects a 3D image and you have hand controls with which you'll be controlling the instrument just the way you do it in da Vinci as well.

[30:17] And hand controls is the third different, remarkably different field. So, da Vinci relies on a pincer-like hand controls which are fixed to the system, the surgeon's console. There are some variations, for example, SSI Mantra, they have come up with a joystick, a PlayStation kind of thing where the instruments are in your hand, you can move them pretty much freely and they are attached to the surgeon's console using a wire. So, the bedside units are different, the surgeon's console is different and the hand controls are different. Now, when it comes to instruments, I believe the biggest spread of instruments is with da Vinci where they have their own grasping, cutting, suturing instrument. They have all the energy sources available including harmonic on their platform and they have their own staplers as well.

[31:16] Other systems are kind of trying to catch up with da Vinci. I see incremental improvements every few months where they come up with a new energy device or a stapler now that is more compatible with their system. But essentially, they're not there yet. So, there will be some deficiency, so as to say, in other systems.

[31:41] Arseniy Arsentyev: How long does it take for a person who, for example, worked on a da Vinci system to relearn, learn new skills? Because I think controls work differently as you outlined. And how long does it take for a person to restudy what they studied earlier?

[32:00] Dr. Vishal C Soni: So, let me put it this way. The baseline, or the ground, for being a good robotic surgeon would always start from being a good surgeon and having excellent knowledge of your anatomy, of endoscopic anatomy and of surgery. So this is a non-negotiable. Then comes if you have some knowledge of laparoscopic surgery. That is an addition but sometimes not a necessity for you to start your robotic journey. Then most of the times, all the surgeons would have some exposure to da Vinci, the way da Vinci works.

[32:39] Now, da Vinci is now in DV5 which is the 5th generation robot. They have refined their system over 30 long years. Okay, and the other systems, most of them are in their first or the second version of their technology. So there are differences. Having said that, if and when a surgeon has been trained on da Vinci, they get oriented with robotic platform. They get oriented the way you use the robotic interface between you and the patient to perform these kind of surgeries and going on to the next system which may not be da Vinci should not be a very difficult aspect.

[33:20] I believe, if I have to give you a number, maybe 25 cases and a month's time with good simulation would do the trick and a da Vinci surgeon would definitely be able to work, although a little unhappily maybe, but would be able to work on the other systems as well.

[33:41] Arseniy Arsentyev: I'm asking because I'm also excited by the changes in the market for robotic systems. We see new players, we see this kind of flow and yeah. As another thing, if you're an expert on something, catching up, learning new skills, for example, in my field in computer science, you can also study, you need to study actually every year new technologies. And I feel that's kind of similar. And speaking about safety, because we haven't addressed it yet. How do you react to alarms? Are there any alarms during the surgery? And what are the safety measures to make sure the robotic system will not mess up the human being?

[34:29] Dr. Vishal C Soni: So, robotic platform is an interface between you and the patient. Okay. The better it's in sync with your thoughts and your actions, the better surgeries you can perform. Now, that's the premise of using a robotic surgery and a robotic platform. The companies, they try to make this interface as transparent as possible, which means the more intuitive way in which the instruments function, the arms work, the better you can perform when you are on the surgeon's console and the robot is docked.

[35:08] There are a ton of safety measures that I can see and I've come across on the da Vinci. So, every step, for example, has an auditory feedback that is given. So, for example, when one is docking the surgical robot, at multiple steps, there will be an auditory guidance that, okay, this is what you need to do now. And this is what has been done. Along with that, there will be specific beeps that happen. So, the entire team actually now knows, okay, once the team knows the auditory cues, I think they perform better. And then there are color-coded alarms which pop up if things are not going well. For example, there is an amber alert and there is a blue LED that flashes when things are going good.

[35:58] There are green lights which are used when the instruments are getting exchanged and they reach in the right the way it's supposed to. There are red alerts when things are malfunctioning. So using visual cues and auditory cues on the patient side cart and on the surgeon's console, you will get another set of instructions or alerts if things are not moving in the right direction. So I believe there are multiple checkpoints with which the robotic systems ensure that the things are moving in the right direction. And when they are not, the surgeon and the entire team is aware that things are incorrect.

[36:41] Arseniy Arsentyev: And to become this kind of a symbiosis between a system and a person, you spend lots of time actually working on it. And I'm curious, how long is a typical operation? Are there any cases that you're sitting like four or five hours on the thing? Or what's the time frame that you actually need to sit behind that console?

[37:06] Dr. Vishal C Soni: Yeah. So I'll tell you, I believe the shortest operative times would be in a non-inflamed gallbladder, which would take anything between, say, 10 minutes and 20 minutes. Okay. A primary hernia surgery will take anything between 30 minutes and 60 minutes, depending on the complexity of the case. And a fundoplication will take 60 to 90 minutes. And when I'm doing a colectomy or an LAR, it'll take anything between 90 minutes to 180 minutes, again, depending on the difficulty. So as you take on either a multi-quadrant surgery or you take on from dissectional surgeries to resectional surgeries, your times would keep on increasing. So the primary hernia surgeries and gallbladders would become minimal dissectional surgeries. You'll finish them faster. And most of the onco surgeries would take a long period of time.

[38:06] I believe the longest would be HPB surgeries. They may take up to five, six, seven, eight hours.

[38:12] Arseniy Arsentyev: Sorry, what's the hernia surgeries? I'm not familiar with it.

[38:17] Dr. Vishal C Soni: So hernia, do you know what is hernia basically? So think of your abdomen wall as the roof of your abdomen when you're sleeping. There are some places where the roof can get cracked. Things just pop open. The gap between the muscles in the simplest possible way, that small gap, which is because of some disease or because of thinning, that is what we call as a hernia, H-E-R-N-I-A. And using the robot, we keep on repairing these kinds of things. So, yeah, that is a hernia surgery for you.

[39:21] Arseniy Arsentyev: Thanks for outlining, Dr. Vishal. And I feel, let's proceed to the final part of the episode, speaking about the future of the system. My podcast is named Tomorrow's Medicine because I want to truly get different ideas from people who interact with medical system, how it might look like in the future. So what's your stance on this? In, say, 10 to 15 to 20 years, what we should do and how our healthcare systems all around the globe should evolve?

[39:32] Dr. Vishal C Soni: Thank you for that question. So, everyone keeps on getting super excited when we talk of robotics and we talk of future of surgery, because people want more predictable outcomes. People want zero or no complications. And these would form the premise of what lies in future, for sure. 20 years, 15 years would be too difficult to predict. But if I go by movies, essentially we are looking at automated surgeries where a press of button selection of the case and the robot probably would be able to finish a surgery. That's the futuristic 15-20 years down the lane.

[40:15] But if you ask me what comes ahead, say, next 5 years, I think that is the space which is becoming a little more predictable. So there is a ton of AI-ML integration that is happening with the surgical robot. Now I feel there is a space where surgical robots are catching up with what is happening globally. There are other fields where AI-ML has got super integration, but when it comes to healthcare, when it comes to surgery, one needs to be mindful. That even rarest of the rare misadventure can put down an entire technology to bad light. So probably that's why you're seeing this in a more slower and a protracted way.

[40:56] So what we have already seen coming up in final stages of tech is integration of radiological data into your surgical system so that when you're moving in the surgical console, you're moving the camera, there is a three-dimensional augmented reality or virtual reality interface, which would move along with it. So you exactly know where to cut, how to cut, which is the right plane to enter in. The next exciting thing that is being stitched up is a no-fly zone kind of a concept where multiple, so the robotic systems have been fed data from multiple surgeries so as to make them understand that, okay, this is the area which is unsafe, this is the area which is safe.

[41:48] Based on that understanding of the anatomy, when you put in a camera, your robot can fire up with different colors and say that this is the red area. You don't go there. For example, if you're doing a gallbladder surgery, your common bile duct can be anticipated and then it'll be color coded with red that this is an unsafe area for dissection. So kind of no-fly zones are coming in a great way and some small automations where, say, if there is a linear or a defined circular geometry where suturing needs to be done, you can actually automate that some small step and the robot would finish it.

[42:33] We are sitting on a small automation of stapling right now. For example, for stapling, you just press a button and the robot staples the entire bowel, on its own pretty much. So that automation is there. There is an extension of that automation coming up for some more steps. This will be a wishful thinking for the surgeons. Not there yet. I believe in next two, three years, we will start seeing at least on trial basis. And the third exciting, fourth exciting thing that is coming up is telesurgery. Okay. Now, the system is already capable of telesurgery since a decade back. But because of various, let me put it, medical legal reasons, we want to be super sure that there is a surgeon who's thousand miles away trying to control a robot and perform that surgery.

[43:23] Now, it's an exciting field. How correct it is? How feasible is it? Would it be safe for the patient? These are questions. The answers, lie in the future. But I can tell you that that technology is already there in 2025. Our surgical robots pretty much can be controlled by any surgeon console across the globe. It's about probably plugging in and maybe allowing the same. So these are the bare bone minimum things. I also believe there is more. More work happening in enhancing the vision of the surgeon. So the better visual surgery you give to the surgeon, the better surgeon operates. So for example, the ICG that we use today, the indocyanine green dye, it kind of helps you colour code the tissues.

[44:14] And it exactly tells me that this is where I need to cut and this is where I do not need to cut. So you give an injection to the patient, you put an infrared mode on the camera and the tissues would light up fluorescent green. And the tissues which do not take up that colour, they will be grey or black. So that kind of differentiation because of various injections or modes on the optics is into development. And we'll see more of it coming in the next few years maybe. So this is a small peek into what lies ahead in maybe five years and what's coming ahead in maybe 15 and 20 years.

[44:54] Arseniy Arsentyev: That's fascinating. Speaking about the visual field, I can imagine how it will work. This AI systems that will, as you said, colour different stuff that will pop up. Maybe like phone notifications, what you're doing wrong and what you should do in other way. I can imagine that. But speaking about telesurgery, that blows my mind. People sitting in other cities, in other countries. For some reason it bumps this kind of image of a room with like 20 surgeons at the same time operating different cases.

[45:37] And that is crazy. But it leaves me to a question. Do you feel pressured? Do you feel that there would be a close time when, as you said, like in the 20 years we can live in the sci-fi future with robot operating? Do you worry about it? What do you think about it?

[45:59] Dr. Vishal C Soni: Not really. You know what? The other day I saw a clip from 1945 and the talk track that we have today was identical. That you know what? Machines would come over. Machines would take over our jobs. And it's a scary future, that's coming up. And it's about 75 years and things are actually getting better. Humans, surgeons would learn how to use these machines in the best possible way for delivering things which were not feasible, say 10 years back, 20 years back. Okay. It would be enhancing their capabilities rather than competing with their capabilities. See, there is no substitute for a human being. No machine will be able to give the empathy and the emotions and understand the suffering that a person has as good as a doctor.

[46:54] So I feel that way surgeons should be really relaxed. That your job is not getting away anytime soon. And rest, I think so, we'll put these machines to best use and enhance our capabilities. Perform amazing surgeries and decrease the complications to zero, which should be the ultimate goal that you achieve the best surgery. You have zero complications. Patients, they have minimal pain and they're happy in their lives the way they should be. So I'm not someone who has a doomsday philosophy that things are really going to go bad or go the other way. I am a very pro tech and I believe every advancement in science is just going to improve our life for good.

[47:45] Arseniy Arsentyev: There is no substitute to human being. What a great phrase to end the episode. Thank you very much, Dr. Vishal. It was an interesting discussion. We covered all the topics we plan to cover. And yeah, I believe everyone now understands robotic surgery better. Thank you.

[48:05] Dr. Vishal C Soni: Thank you for having me. And it was a very nice discussion. So yeah, I wish you all the best and more such interesting podcasts to come. And I would be watching out for this show.

[48:20] Arseniy Arsentyev: Thank you. Everyone, you know what to do. Subscribe to Tomorrow's Medicine for our episodes and see you in the episode number 12. Bye bye.