Presentation (CTI)

OBJECTIVES: A central value proposition for telesurgery (remote robotic surgery) is improving equitable access to surgery by extending expert care to underserved populations. This review examines whether it can realistically narrow India's geographic surgical access gap—concentrated in rural and public-sector settings—and whether it is feasible where need is greatest.
METHODS: A targeted literature review (2015-2026) synthesised peer-reviewed studies, policy and health-system reports, and grey literature (conference proceedings, manufacturer disclosures). Evidence on telesurgery activity and the surgical access gap in India was organised across four dimensions: magnitude of the access gap, demonstrated feasibility, infrastructure and connectivity, and distribution of access.
RESULTS: India accounts for roughly one-fifth of the global population lacking timely access to safe, affordable surgery. National surgical volumes remain far below the Lancet benchmark (~1,400 vs 5,000 per 100,000), and in rural India only an estimated 7% of major surgical need is met. Using an indigenous, CDSCO-cleared robotic platform, India has reported over 165 telesurgeries, including oncologic and cardiac procedures across distances exceeding 2,000 km. These demonstrate feasibility under controlled conditions with dedicated connectivity and patient-side infrastructure. However, documented cases linked established tertiary centres to one another, rather than reaching peripheral, underserved facilities. Telesurgery relocates the console surgeon but requires a patient-side robot, theatre, anaesthesia, critical care, and trained local team. Although rural connectivity remains uneven and surgical-grade telesurgery requires dedicated links, the more decisive barrier is financing and distributing the patient-side ecosystem to underserved facilities.
CONCLUSIONS: In India, telesurgery is technically feasible but remains confined to well-resourced tertiary centres, rather than the peripheral public-sector facilities where unmet need concentrates. Without a public financing pathway to equip peripheral facilities, it is unlikely to meaningfully narrow the rural surgical access gap.