Editor’s note: This is the first in a series of stories profiling medtech companies that are changing the field of robotic surgery.
SS Innovations International is bringing robotic surgery to more people, in more places, by providing a differentiated system at a lower cost than market leader Intuitive Surgical.
Founder and CEO Sudhir Srivastava, a heart surgeon, became convinced of surgical robotics’ clinical benefits as an early adopter of Intuitive’s pioneering da Vinci system in the early 2000s. The less-invasive robotic approach eliminated the need to split the sternum to reach the heart. Patients were back on their feet much faster than after open heart surgery, with great results, said Srivastava.
After performing more than 1,400 cardiac cases with da Vinci in the U.S., including about 800 endoscopic coronary artery bypass surgeries and a mix of other procedures, Srivastava returned home to India in 2011 with a plan to launch robotics programs in the country using Intuitive systems. However, the physician soon found the cost of having a robotic procedure was out of reach for most patients.
Intuitive’s robot was gaining acceptance among surgeons, hospitals and patients worldwide, but market penetration was concentrated in the U.S., Europe and Japan. Billions of people around the globe did not have access to the technology, said Srivastava, “and the main reason was the cost.”
When a 22-year-old patient with a congenital heart defect came to Srivastava hoping to avoid a sternotomy, it proved to be a turning point. The woman, a perfect candidate for robotic surgery, couldn’t raise the money for the procedure.
“I literally made a commitment and a mission that we must do something with my personal clinical experience,” said Srivastava. He credits Intuitive and its co-founder, Fred Moll, for opening a pathway, via robotics, to advance less-invasive surgical technologies beyond laparoscopy, a technique that also involves operating through small incisions, but by hand. Moll is now vice chairman of SS Innovations’ board.
Still, the price of robotic surgery was preventing most people in India from accessing it. Surgeons would train to use the system, only to give up on it when not enough patients could afford to have the procedures.
“It becomes a vicious circle,” said Srivastava. “If you don’t do enough, you won’t be good at it and usually stop.”
The heart surgeon-turned-entrepreneur set out to change that equation, even if it meant depleting his own savings and selling off personal belongings to fund his dream. “Whatever it took, literally, I was absolutely determined that we must do it,” he said. “It was not easy.”
The sacrifices are paying off. Today, more than 100 SSi Mantra robots have been installed globally, and the robot has been approved for use in seven countries, including India, Indonesia and the Philippines. Physicians have performed more than 5,000 surgical procedures with the system.
In India, the SSi Mantra robot is less than one-third the price of an Intuitive system, said Srivastava, and related consumable items and maintenance agreements are a third to half the cost of the competition.
„Although [Intuitive] created a wonderful technology, there are always opportunities to make things better. Newer ways are being discovered, and we can use our thought processes to advance it further.”
Sudhir Srivastava
SS Innovations founder and CEO
SS Innovations is now working toward regulatory authorization in the U.S. and Europe. The company is preparing to submit a 510(k) application to the Food and Drug Administration at the end of October for multiple indications for the SSi Mantra 3, and expects to receive Europe’s CE mark during the first half of 2026.
SSi Mantra 3, the company’s newest robot, was launched in June 2024. The system includes up to five modular robotic arms and more than 40 surgical instruments to support numerous specialties, including cardiac surgery.
Srivastava said it was important to design a robot that was different, more user friendly and, hopefully, better than Intuitive’s.
“My whole goal was always not to copy. Although [Intuitive] created a wonderful technology, there are always opportunities to make things better,” he said. “Newer ways are being discovered, and we can use our thought processes to advance it further.”
The surgeon console, hand controls, visualization, mounting and size of the robotic arms were all areas of focus, with the aim of improving clinical outcomes.
While the system is designed for use across a range of surgeries, a big priority for SS Innovations is expanding robotic surgery in heart procedures. Robotic cardiac surgery has been slower to develop than other specialties due to the complexity and level of risk involved. “I want to revive this field,” Srivastava said.
About 250 heart surgeries have been completed with the SSi Mantra robot. SS Innovations is also working on a new instrument for coronary artery bypass surgery that Srivastava expects will “absolutely revolutionize” how the procedure is done, bringing more predictability to the operation.
Robotic cardiac surgery, said Srivastava, “levels the playing field in terms of the human skill level.”
The promise of telesurgery
Srivastava sees telesurgery, where the surgeon performs a procedure from a remote location, as another important way to expand the reach of less-invasive technologies to more people. Reducing travel time for both surgeons and patients is economical and efficient, and can mean faster diagnosis and treatment. “We at SSI are really focused on this,” said Srivastava.
SS Innovations says it is the only company to have received regulatory approval from the Central Drugs Standard Control Organization, India’s equivalent of the FDA, for telesurgery and teleproctoring.
Cardiac surgery is among the procedures that have been performed long distance using the SSi Mantra robot. Srivastava himself has done several of the cardiac telesurgeries, sometimes sitting thousands of miles away from the patient.
Advances in high-speed connectivity have made it possible.
“Now we have the technology and we have the speed,” said Srivastava. “This will really change how care is delivered in the future.”
