‘Our goal is to make distance clinically irrelevant’: Dr Sudhir Srivastava on doing cardiac surgery 20,000 km apart

After performing what has been described as the world’s longest-distance robot-assisted cardiac procedure, Dr Sudhir Srivastava has said that his goal is to make distance clinically irrelevant.

In an interview with Firstpost’s Madhur Sharma, Srivastava, founder and chairman of SS Innovations International, said that medicine has always been collaborative and that telesurgery strengthens that collaboration rather than replacing it.

“Clinical judgement comes from combining patient conversations, examination findings, investigations and experience. Technology enables the surgery, but it never replaces the relationship between the doctor and the patient,” Srivastava said.

Srivastava recently performed a left internal mammary artery (LIMA) takedown on a patient in Georgetown, Guyana, while operating from Indore, Madhya Pradesh. The principal surgeon and the patient were nearly 20,000 kilometres apart, with the procedure conducted across three continents.

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The procedure involved freeing the LIMA, an artery that runs along the inside of the chest, so that it could be used to bypass a blocked blood vessel supplying the heart. The surgeon separated the artery from the surrounding tissue and sealed its small branches while ensuring that the main vessel remained undamaged. Once prepared, the artery could subsequently be connected beyond the blockage, creating an alternative pathway for blood to reach the heart.

Edited excerpts from Sharma’s interview with Srivastava.

You have now performed the world's longest-distance robotic telesurgery over roughly 20,000 kilometres. Can you walk us through what actually happened during the procedure? How did the robot, communications network, and surgical teams work together to make it possible?

This procedure was the culmination of years of innovation, clinical validation and global collaboration, built on the experience of performing more than 180 successful telesurgeries across different parts of the world. Each procedure has helped us refine the technology, strengthen our clinical protocols and demonstrate that safe, precise remote surgery can be delivered consistently across long distances.

I operated from a surgeon console located nearly 20,000 kilometres away from the patient. Every movement of my hands was transmitted through a secure, high-speed communication network to the SSI Mantra surgical robotic system in the operating room. The robot translated those movements into precise surgical actions in real time, while high-definition 3D images of the operative field were streamed directly to my augmented reality glasses, providing an immersive, magnified view of the surgical field throughout the procedure.

The technology, however, is only one part of the story. A highly trained bedside surgical team was present with the patient throughout the procedure. They managed patient preparation, instrument exchanges and every aspect of perioperative care. I have always believed that telesurgery is not about replacing the local surgical team. It is about extending the reach of an experienced surgeon by combining advanced robotics with skilled clinicians on site.

At what moments did distance matter the most? Did it feel any different from operating on a patient in the same room?

Our goal is to make distance clinically irrelevant. What matters is precision, consistency and seamless communication. Naturally, the most intense concentration comes during critical parts of the operation, where timing and flow are essential. With a stable network, carefully controlled latency and extensive preparation, the experience felt remarkably natural. Years of testing and validation ensured that geography had no impact on the quality of patient care.

Doctors sometimes say that conversations with the patient, their instincts trained over the years, and physical examinations sometimes reveal more about a diagnosis than scans and formal case histories. How does that work in transcontinental robotic surgeries?

Surgery does not begin when the robot is switched on. It begins with understanding the patient.

Even in remote surgery, I meet the patient through detailed video consultations before the operation. We review medical records, imaging, laboratory results and discuss expectations, concerns and treatment options. The physical examination remains essential and is carried out by the local treating team, who work closely with the operating surgeon throughout the process.

Medicine has always been collaborative. Telesurgery strengthens that collaboration rather than replacing it. Clinical judgement comes from combining patient conversations, examination findings, investigations and experience. Technology enables the surgery, but it never replaces the relationship between the doctor and the patient.

One of the biggest concerns people have about telesurgery is internet reliability. Even a momentary interruption or delay could be catastrophic. How did you account for connectivity or network failures, and what redundancies were built into the system to ensure patient safety?

Patient safety guided every aspect of the system's design.

The communication architecture uses secure, high-quality connectivity with continuous monitoring of network performance. Before every procedure, we conduct extensive testing to confirm that latency, bandwidth and network stability remain within validated clinical limits. The bedside team is fully prepared to respond immediately if required, and every procedure follows established safety protocols.

Robotic surgery already incorporates multiple layers of safety. Telesurgery adds further safeguards through redundant communication pathways, continuous monitoring and clearly defined clinical protocols.

Is there a maximum latency beyond which you simply would not operate? What happens if connectivity is suddenly lost?

Yes. Every telesurgery programme defines validated operating parameters. If network performance moves outside those safety thresholds, the procedure should either not begin or should be paused. Patient safety always takes precedence over technological achievement.

If communication is interrupted, the robotic system is designed to enter a safe state. At the same time, the trained surgical team at the patient's location remains in complete control of patient management. Telesurgery works because technology is supported by rigorous clinical planning and experienced teams.

Cardiac surgery is among the most demanding surgical disciplines, and you accomplished that safely over a record distance. Was choosing a cardiac procedure intended to demonstrate that if remote surgery can be performed safely for the heart, it can be performed for almost any other specialty? Or are there still procedures you would not attempt remotely?

Cardiac surgery is one of the most technically demanding specialties. Precision is absolutely non-negotiable.

Successfully performing a complex cardiac procedure over such a long distance demonstrates the maturity and reliability of the technology. At the same time, it would be incorrect to assume that every operation should immediately become remote.

Each surgical specialty requires its own clinical validation, surgeon training and regulatory approval. Our philosophy has always been evidence before expansion. This milestone in cardiac surgery is important, but responsible adoption means building evidence one specialty at a time.

How did you convince the patient to undergo what was, effectively, a world-record remote surgery? Were there additional ethical approvals or informed-consent requirements because of the experimental nature of operating across continents? Understandably, the patient could have been nervous about the nature of the surgery.

Patients deserve complete transparency.

The patient was fully informed about the nature of the procedure, the technology involved, its potential benefits and the associated risks. Every question was answered thoroughly, and informed consent was obtained only after the patient was comfortable with every aspect of the surgery.

These procedures are performed under institutional oversight and established ethical frameworks. Trust cannot simply be requested. It has to be earned through evidence, careful preparation and openness. Ultimately, patients place their confidence in both the surgical team and the technology supporting their care.

Telemedicine was originally envisioned as a way to bring healthcare to underserved and remote communities. Yet robotic telesurgery requires sophisticated robots, high-speed fibre networks, and specialised operating rooms.

Do you believe that telesurgeries can still achieve the original idea of telemedicine considering robots and infrastructure involved costs too much?

It is a valid question, and it reflects the way most transformative technologies evolve.

Initially, advanced technologies are expensive because adoption is limited. As manufacturing scales, utilisation increases and competition grows, costs generally come down.

The real value of telesurgery is not that every hospital needs its own world-renowned specialist. Instead, an expert surgeon can support patients across multiple locations without requiring them to travel long distances. That has the potential to reduce delays, improve access to specialised care and strengthen regional healthcare systems.

Our vision has never been limited to building surgical robots. It has always been about democratising access to high-quality surgical expertise.

India has spent decades building itself into a destination for medical tourism, where patients travel to India for specialised care. If telesurgery becomes routine, could the model eventually reverse — with Indian surgeons operating on patients while they remain in their own countries? How might that reshape medical tourism? Do you think SSI has figured out a model that could completely flip the medical tourism sector?

That is a very real possibility. India has built exceptional surgical expertise over several decades. Traditionally, patients travelled here to access that expertise. In the future, the expertise itself may travel digitally while patients remain close to their families, local physicians and healthcare systems.

Rather than replacing medical tourism altogether, telesurgery could create a new model of international collaboration. Local clinical teams would continue managing patient care, while highly specialised surgeons contribute remotely whenever appropriate.

This represents an opportunity not only for SS Innovations but also for India to become a global exporter of advanced clinical expertise.

Do you see telesurgery becoming a niche capability for exceptional cases, or do you envision it eventually becoming a routine part of surgical practice? Will it primarily complement conventional surgery, or could it replace much of it in the long run?

I believe telesurgery will gradually become part of mainstream surgical practice, although that transition will take time. In the early years, adoption will focus on carefully selected procedures, specialised centres and situations where access to expert surgeons is limited. As clinical evidence grows, communication infrastructure improves and more surgeons receive training, its role will naturally expand.

It is important to remember that telesurgery is not intended to replace surgeons. It extends their ability to deliver specialised care safely, regardless of where the patient is located.

Looking ahead 10 years, what is the biggest obstacle preventing telesurgery from becoming commonplace? Is it the technology itself, regulation, cost, communications infrastructure, or simply convincing surgeons and patients to trust the system?

Technology is advancing rapidly. The larger challenges now lie beyond the technology itself. We need harmonised regulatory frameworks for cross-border practice, robust communication infrastructure, broader surgeon training and reimbursement models that support adoption. Most importantly, we need continued clinical evidence demonstrating safety and patient outcomes across different specialties.

Trust is built through consistent results, not bold claims.

If we continue generating high-quality evidence, make robotic platforms more accessible and train more surgeons, I believe telesurgery will become an integral part of global healthcare over the next decade. Not because it is futuristic, but because it addresses a very real clinical need by bringing expert surgical care to patients regardless of geography.