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AI-powered robotic surgery is redefining precision medicine, merging human skill with machine intelligence for safer, faster, and smarter operations.
In a landmark moment for India’s healthcare innovation, Prime Minister Narendra Modi, while inaugurating the first phase of the 450-bed Namo Hospital in Silvassa, Dadra and Nagar Haveli, witnessed the demonstration of ‘Misso,’ India’s first indigenously developed Artificial Intelligence (AI) powered robotic system for knee replacement surgery. Designed by Meril Life Sciences, Misso represents a major step in India’s medical technology landscape. Guided by AI, it aims to enhance surgical precision, reduce recovery time, and improve patient outcomes. Its launch underscores India’s growing self-reliance in advanced medical technologies and positions the country as a key player in global healthcare innovation.
In the coming years, the integration of AI into surgical workflows is expected to redefine surgical methodologies, ushering in an era of precision-driven, data-backed, and patient-specific healthcare delivery.
AI has already begun transforming multiple areas of medicine, particularly diagnostics and imaging. Systems can now analyse medical images and endoscopic videos to detect conditions such as gastrointestinal cancers or pulmonary lesions on CT scans. In the coming years, the integration of AI into surgical workflows is expected to redefine surgical methodologies, ushering in an era of precision-driven, data-backed, and patient-specific healthcare delivery. By merging AI’s cognitive capabilities with robotic dexterity, modern surgery is moving toward a future where operations can be planned, executed, and optimised with consistent accuracy.
Globally, AI-integrated robotic surgery is transforming how operations are conducted. One significant application lies in predictive analytics, where algorithms forecast surgical risks, potential complications, and patient-specific outcomes before procedures. This enables surgeons to plan each step more effectively. Real-time intraoperative guidance further enhances precision, while automated positioning and robotic navigation reduce setup times and surgeon fatigue — especially vital in complex fields like neurosurgery and orthopaedics.
AI’s influence extends beyond theory into surgical practice. Researchers recently trained a robotic system to perform segments of gallbladder removal surgery (cholecystectomy) using the ‘Surgical Robot Transformer-Hierarchy’ (SRT-H) model, which breaks down complex operations into smaller, manageable tasks, allowing a supervisory AI system to direct a robotic “resident“ in performing intricate procedures. Trained on real surgical videos and learning through observation and feedback in experiments on simulated models, the robotic system successfully identified the cystic duct and arteries, clipped them, and performed incisions autonomously, eventually operating without human commands. This demonstrates AI’s increasing reliability and autonomy in surgical contexts.
Though full autonomy is still distant, these experiments indicate that hybrid, human-AI collaboration could soon become the norm. AI may not replace surgeons, but it is fast becoming an indispensable ally, augmenting human judgment with algorithmic precision.
India is witnessing a rapid rise in AI-assisted robotic surgery, marked by growing investments and startup funding, expanding clinical use, and strong market growth. A major clinical milestone was achieved at KLES Dr. Prabhakar Kore Hospital, where doctors performed an AI-enabled pulmonary mechanical thrombectomy using the “Penumbra device” — an AI-powered system for selective clot removal through a minimally invasive ‘transfemoral approach’ — demonstrating life-saving precision in endovascular surgery. Corporate innovation is equally active. Meril’s ‘Mizzo Endo 4000,’ an advanced soft-tissue surgical robotic system, supports a wide range of specialities, including general surgery, gynaecology, urology, thoracic, among others. Equipped with AI-driven 3D anatomical mapping and 5G-enabled telesurgery, it allows for the remote operation of complex procedures. Similarly, SSI Innovations’ affordable, AI-assisted laparoscopic robot and Taurean Surgical’s AI-based 3D surgical microscope highlight India’s indigenous innovation pipeline tailored to local and global needs. Ventures such as Taurean Surgical attracting pre-seed capital from Indian and international investors further signal growing investor confidence in India’s AI-enabled surgical solutions and robotics.
The convergence of clinical adoption, indigenous innovation, and capital inflow in AI-augmented robotic surgery is set to strengthen India’s position in the global medtech ecosystem, improving access and affordability.
Market projections confirm this trajectory. The market revenue for India’s AI-based surgical robots was USD176.0 million in 2023, forecast to reach USD901.1 million by 2030 (CAGR 26.3 percent). The global market is expected to touch USD25.2 billion by 2030, offering India significant export opportunities. The convergence of clinical adoption, indigenous innovation, and capital inflow in AI-augmented robotic surgery is set to strengthen India’s position in the global medtech ecosystem, improving access and affordability.
In the European Union, the Medical Device Regulation 2017/745, Article 2(1) defines ‘medical devices’ to include instruments, apparatus, or software intended for diagnosis or treatment, encompassing AI-assisted robotic surgical systems. Such devices must thus comply with strict safety, performance, and clinical evaluation standards, meeting European requirements for medical devices. Complementing this, the EU AI Act could include AI-driven surgical systems as high-risk AI, subject to additional requirements on risk management, transparency, data quality, and human oversight. Consequently, AI surgical robots in the EU may need to meet both MDR and AI Act standards to ensure safety, accountability, and patient protection.
In India, ethical and data protection frameworks are evolving to govern responsible AI in healthcare. The Indian Council of Medical Research (ICMR) released the ‘Ethical Guidelines for Application of Artificial Intelligence in Biomedical Research and Healthcare’ (2023), emphasising transparency, patient consent, and human oversight control over AI systems/ outputs. However, the guidelines do not explicitly address AI-assisted robotic surgery, a fast-growing domain requiring clear governance for intraoperative decision-making, real-time oversight, and patient consent. Explicit inclusion could enhance regulatory clarity and accountability. On data privacy, India’s transition from the Information Technology (Reasonable Security Practices and Procedures and Sensitive Personal Data or Information) Rules, 2011, to the Digital Personal Data Protection Act, 2023 (DPDPA) represents a paradigm shift. Once implemented, the DPDPA will redefine how personal data, including health information, is collected, processed, and stored. It will mandate explicit patient consent, data security, and accountability for AI developers and healthcare providers handling sensitive medical data.
Despite remarkable progress, AI integration in robotic surgery faces several ethical, technical, and regulatory challenges.
Transparency and Explainability: AI’s “black box“ problem could make it difficult for surgeons and patients to understand how algorithms make intraoperative decisions. Since trust is central to clinical contexts, AI systems must be interpretable and capable of explaining their reasoning to both surgeons and patients. Explainable AI could build confidence, enhance safety, and support ethical accountability.
Since trust is central to clinical contexts, AI systems must be interpretable and capable of explaining their reasoning to both surgeons and patients.
Data Privacy and Security: AI-assisted surgeries generate and process large volumes of sensitive data, including patient histories, imaging, and physiological metrics. Ensuring confidentiality through encryption, anonymisation, and secure storage is critical to prevent misuse and data breaches. Healthcare institutions and developers must adopt robust cybersecurity frameworks aligned with data protection laws.
Algorithmic bias: AI surgical systems trained on limited or homogenous datasets risk producing biased or unsafe outcomes. For instance, a robot trained primarily on data from a single demographic may perform suboptimally for others, leading to inequitable care. Mitigation requires diverse, representative, and high-quality datasets, ensuring equitable outcomes across populations.
Training and Skill Development: Effective human-AI collaboration demands that surgeons understand the systems they use, their capabilities and limitations, and learn how to collaborate effectively with advancing AI systems. Continuous medical education, simulation-based training, and interdisciplinary collaboration between engineers and clinicians are essential. Hospitals could also upgrade digital infrastructure, including high-speed data networks and interoperable systems, to support robotic operations.
Regulatory Harmonisation: Regulatory bodies could work toward harmonising global standards for AI-assisted robotic surgery to address the challenges of cross-border development and deployment. Inconsistent regulations can hinder innovation and compromise safety assurance. Establishing a structured framework for knowledge exchange between regulatory agencies and medical associations can facilitate the sharing of best practices, clinical insights, and ethical guidelines. Such collaboration would support common standards for AI validation, data governance, and clinical safety, ensuring that AI surgical technologies are developed, evaluated, and deployed responsibly, while promoting international cooperation and accelerating safe, equitable adoption in healthcare systems worldwide.
Ethical vigilance, transparent design, rigorous data protection, and continuous surgeon upskilling must remain at the forefront of this technological evolution. If guided responsibly, AI-driven robotic surgery holds the promise to democratise advanced healthcare, potentially extending its reach from urban hospitals to the remotest corners of the world.
Artificial Intelligence and robotics are together shaping the future of surgery, offering unparalleled precision, efficiency, and personalisation. From India’s indigenously developed Misso and Mizzo Endo 4000 systems to the United States and European Union’s regulatory initiatives, the global landscape reflects a collective effort to merge human expertise with technological intelligence. However, realising AI’s full potential in surgery demands healthy caution coupled with continuous innovation. Ethical vigilance, transparent design, rigorous data protection, and continuous surgeon upskilling must remain at the forefront of this technological evolution. If guided responsibly, AI-driven robotic surgery holds the promise to democratise advanced healthcare, potentially extending its reach from urban hospitals to the remotest corners of the world.
Debajyoti Chakravarty is a Research Assistant with the Centre for Digital Societies at the Observer Research Foundation.
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Debajyoti Chakravarty is a Research Assistant at ORF’s Center for New Economic Diplomacy (CNED) and is based at ORF Kolkata. His work focuses on the use ...
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