The First North-to-South India Tele-Robotic Cancer Surgery Across 2,100 km Using the SSI MANTRA Robotic System: A Prospective Case Series.

BACKGROUND

Robotic-assisted surgery has transformed the surgical management of complex oncologic diseases by enhancing precision, visualization, and surgeon ergonomics. However, access to expert robotic oncologic care remains geographically restricted. Telesurgery offers a potential solution to overcome this disparity, though concerns regarding latency, reliability, and oncologic safety have limited its widespread adoption.

OBJECTIVE

To evaluate the technical feasibility, safety, and perioperative outcomes of the first North-to-South India tele-robotic cancer surgeries performed using the SSI MANTRA robotic system over a dedicated fiber-optic network.

METHODS

Two patients, one with locally advanced lower oesophagus and gastro-oesophageal junction tumour, and one with locally advanced carcinoma low rectum underwent tele-robotic surgery in March 2025. The Master Surgeon Console was located in Gurugram (North India), while the patient-side robotic system was positioned in Bangalore (South India), separated by approximately 2,100 km. A secure, encrypted, dual-redundant fiber-optic network was established. Network performance parameters, intraoperative events, and perioperative outcomes were prospectively recorded and analyzed.

RESULTS

Both procedures were completed successfully without network interruption, robotic malfunction, or conversion. Total system latency ranged from 160-170 ms, bi-directional network latency from 35-40 ms, and packet loss remained below 0.1%. Operative time, blood loss, and postoperative recovery were comparable to conventional on-site robotic surgery. No major intraoperative or postoperative complications occurred.

CONCLUSION

This study demonstrates that North-to-South India tele-robotic oncologic surgery using the SSI MANTRA system is technically robust, clinically safe, and oncologically sound when supported by dedicated fiber-optic connectivity. This approach represents a scalable strategy to improve access to advanced cancer surgery across geographically diverse regions.