The India-Developed SSi Mantra Surgical Robot Had 154 Installations in India by the End of 2025, and Trials Show What Robotic Surgery Changes

SS Innovations, the Gurugram-headquartered maker of the SSi Mantra surgical robot, reported in its annual filing that 168 of its systems were installed by 31 December 2025, 154 of them in India, and that they had been used in more than 7,800 operations. On 26 May 2026 the company’s founder, the cardiac surgeon Sudhir Srivastava, operated from Georgetown in Guyana on a patient in Indore, over a fibre line of about 20,000 kilometres, which the company describes as the longest robotic telesurgery on record.

Robotic surgery has been compared with standard operations since the FDA’s first clearance in 2000. The results differ by operation: no difference on some measures, a gain on others. This article sets out what the trials measured and then what India’s machines have shown so far.

A surgeon-controlled machine

The US Food and Drug Administration (FDA) calls these machines robotically-assisted surgical devices. Its website says the device is “not actually a robot because it cannot perform surgery without direct human control.” The surgeon sits at a console and looks into a three-dimensional view of the operation. A bedside cart carries three or four hinged arms holding a camera and instruments, which the surgeon controls from the console.

The operations are laparoscopic, meaning they are done through a few small cuts with a camera and long instruments instead of one large incision. Research systems that carry out steps on their own are a separate subject, covered in our piece on the da Vinci and surgical autonomy, and prosthetic limbs are another corner of medical robotics, covered in our piece on bionic limbs that feel back.

The FDA clearance of July 2000

On 11 July 2000 the FDA announced that it had cleared the da Vinci Surgical System, made by Intuitive Surgical of Mountain View, California, for laparoscopic gall bladder and reflux disease surgery, and called it the first of its kind. The agency’s release said the maker had compared 113 robotic patients with 132 who had standard laparoscopic surgery, and found the robot comparable in safety and effectiveness. The robotic operations took 40 to 50 minutes longer, which the FDA attributed in part to surgeons’ lack of experience with the technology.

Intuitive’s later annual report fills in the route. The company had applied for the stricter premarket approval in November 1999. In June 2000 the FDA decided that route was inappropriate and reclassified the device as Class II, so the earlier 510(k) application was reactivated and went ahead. Three more clearances followed: non-cardiac thoracoscopic surgery in March 2001, laparoscopic radical prostatectomy (removal of the prostate) in May 2001, and thoracoscopically assisted cardiotomy, an operation that opens the heart, in November 2002.

The FDA’s page today lists cleared uses in general, cardiac, colorectal, gynecologic, head and neck, thoracic and urologic surgery. It also says the agency has not granted marketing authorization to any robotically-assisted device specifically for the prevention or treatment of cancer.

Rectal cancer: one trial found no gain, a larger one found several

The ROLARR trial, published in JAMA in 2017, randomised 471 patients with rectal cancer at 29 sites in 10 countries to robotic or conventional laparoscopic removal of the tumour. Its main measure was conversion, meaning the surgeon had to switch to a large open incision partway through. Conversion happened in 8.1% of robotic cases (19 of 236) and 12.2% of laparoscopic cases (28 of 230), a gap the authors found was not statistically significant (P = .16). The share of patients with cancer cells at the edge of the removed tissue, 5.1% robotic and 6.3% laparoscopic, did not differ significantly either, and neither did any of the other eight prespecified secondary end points. The authors concluded that, with surgeons of varying robotic experience, the robot gave no advantage.

The REAL trial in China randomised 1,240 patients with middle and low rectal cancer at 11 hospitals. Its JAMA paper in 2025 reported, at a median follow-up of 43 months, a 3-year locoregional recurrence rate (cancer returning in or near the original site) of 1.6% after robotic surgery and 4.0% after laparoscopic surgery, a hazard ratio of 0.45. Three-year disease-free survival was 87.2% against 83.4%. Three-year overall survival, 94.7% against 93.0%, did not differ significantly. The authors concluded that robotic surgery improved long-term cancer outcomes in their trial. ROLARR measured conversion to open surgery and REAL’s main measure was recurrence, so the two did not test the same thing.

Prostate and gynaecological surgery

A trial at the Royal Brisbane and Women’s Hospital in Australia assigned 326 men with prostate cancer to robotic or open surgery. At 12 weeks, reported in The Lancet in 2016, urinary and sexual function scores were not significantly different. Neither was the share with cancer cells at the cut edge (10% after open surgery, 15% after robotic, P = 0.21). Postoperative complications were 9% in the open group and 4% in the robotic group, a gap that did not reach the usual 0.05 threshold (P = 0.052).

At 24 months, in The Lancet Oncology in 2018, function scores were still similar. Rising blood PSA after surgery, called biochemical recurrence, occurred in 9% of the open group and 3% of the robotic group, and the statistical test called that difference significant. The authors advised caution, because care after surgery was not standardised and some men had extra cancer treatment. They wrote that the benefits of the robotic approach were largely tied to its minimally invasive nature.

A Cochrane review in 2017 found two randomised trials of laparoscopic or robotic against open prostate surgery, 446 men in all. It found no high-quality evidence on cancer outcomes and said urinary and sexual quality of life appeared similar. Hospital stay was shorter after robotic surgery in one trial, by about 1.7 days, and the review rated the evidence on fewer blood transfusions after laparoscopic or robotic surgery as low quality.

A Cochrane review in 2019 covered robot-assisted gynaecological surgery: 12 trials with 1,016 women, mostly hysterectomy. For benign disease it rated the evidence low certainty and said complication rates might be comparable to conventional laparoscopy. Operating time was longer with the robot in both comparisons that measured it, by about 40 minutes, on low or very low certainty evidence. The authors found no survival data for cancer surgery and called robot-assisted surgery an “operator-dependent expensive technology.”

What the SSi Mantra has done

SS Innovations began developing the SSi Mantra in 2014. Its annual filing says the system received approval from India’s Central Drugs Standard Control Organisation (CDSCO) for sale and use in India, and that sales began in late 2022. The upgraded SSi Mantra 3 received CDSCO approval in November 2024. As of 31 December 2025 the company counted 168 installed systems, 154 in India, in use at 153 hospitals, with more than 7,800 procedures including about 400 cardiac operations. The system has also been approved in Colombia, Ecuador, Guatemala, Indonesia, Kenya, Oman, the Philippines, Sri Lanka, Ukraine and the United Arab Emirates.

A peer-reviewed study in the Journal of Robotic Surgery in 2026 analysed 3,694 consecutive cases at 78 centres in India between February 2023 and April 2025. Intraoperative adverse events occurred in 0.6% of cases, conversion to open surgery in 4.1%, and median hospital stay was 3 days. The authors reported no device-related adverse events. The study was retrospective and made no comparison with another system, and two authors sit on the company’s advisory board or board of directors, as the paper discloses. The authors wrote that long-term outcomes and comparative effectiveness still need study.

Telesurgery from Delhi to Guyana

CDSCO’s telesurgery approval came in December 2024, and the company’s filing says it is the first in India to hold one. The distances grew in steps. According to the filing, clinical trials began with six operations at the Rajiv Gandhi Cancer Institute in Delhi, about 35 kilometres from the company’s telesurgery lab in Gurugram. Five cardiac telesurgeries then followed to a hospital in Jaipur, about 286 kilometres away, and in March 2025 a surgeon in Gurugram operated on a patient in Bengaluru, over 2,000 kilometres.

The Cureus journal published a case report of an operation on 8 August 2025 in which a surgeon in Salem repaired a left inguinal hernia in a patient in Chennai, using a dual-console SSI Mantra 3 over a secure fibre network. The patient went home on the first day after surgery. The company’s links run over fibre networks, and the rural leg of India’s fibre is the subject of our piece on BharatNet.

For the Guyana operation the company reported a network delay of 290 to 300 milliseconds and described the procedure as a robot-assisted heart operation, a left internal mammary artery takedown. It said 22 cardiac telesurgeries and 173 telesurgeries in all had been done with the SSi Mantra by 4 June 2026. These counts come from the company, and the Chennai to Salem case is the only one of these telesurgeries with a peer-reviewed report among the sources read for this article.

How many robots, and what they cost

tuput could not find an official national count of installed surgical robots. At a Society of Robotic Surgery conference reported by IANS on 3 October 2026, Union Health Minister JP Nadda said India is increasingly an important global destination for surgical technology. The conference figures were 44,857 robotic-assisted procedures in India in 2025, up from 8,912 in 2021, and about 39 hospitals with robotic systems in Delhi NCR.

In public hospitals, AIIMS New Delhi said on 20 January 2026 that its Department of Surgical Disciplines had done more than 1,000 robotic surgeries in 13 months. Department head Sunil Chumber said robotic surgery cut postoperative pain by 50% compared with open surgery, and that robotic patients had 30% shorter hospital stays and 40% fewer surgical site infections. The Akashvani report does not cite a study for those figures.

The Atal Institute of Medical Super Specialities at Chamiyana in Shimla, a Himachal Pradesh government institute, received a robot bought for Rs 28 crore (Rs 280 million), the Tribune reported in June 2025. Chief Minister Sukhvinder Singh Sukhu said in March 2026 that about 150 operations had been done there, and that charges at IGMC Shimla are capped at Rs 30,000, or Rs 50,000 in a special ward, against around Rs 3 lakh in private hospitals.

SS Innovations’ quarterly report filed on 13 August 2026 says it sold 46 SSi Mantra systems in the first six months of 2026, and that its FDA and European CE mark applications, filed in 2025, were still ongoing.