# Real-world performance of the SSI Mantra™ robotic system: a multi-centric multi-specialty study evaluating its safety and surgical applications

## TL;DR

The SSI Mantra™ robotic system shows good safety and performance in real-world surgeries across India, with potential to improve access to robotic-assisted surgery.

## Contribution

This study evaluates the real-world performance of an indigenous robotic surgical system in India, highlighting its feasibility and safety across multiple specialties.

## Key findings

- The SSI Mantra™ had minimal intraoperative adverse events (0.6%) and a 4.1% conversion rate across diverse procedures.
- Experienced surgeons had shorter console times and lower conversion rates, indicating a learning curve effect.
- No device-related adverse events were reported, supporting the system's safety and reliability.

## Abstract

Robotic-assisted surgery (RAS) in India remains limited by cost and accessibility. The SSI Mantra™ is an indigenous system that was developed to address these barriers. This retrospective cohort study (IDEAL Stage 2b) analyzed 3,694 consecutive RAS cases across 78 centers in India (Feb 2023–Apr 2025) to assess the feasibility, safety, and learning curves of the system. Patient demographics, intraoperative metrics, and outcomes were extracted from prospectively maintained databases. Surgeons were grouped by experience quartiles (Q1–Q4) to analyze console time, conversions, and length of hospital stay (LOS) using descriptive and adjusted regression models. Learning curves were evaluated using continuous cumulative sum (CUSUM) analysis. Mean age was 51 years ± 15.8, with 57.2% being male. Mean blood loss was 75.4 ml ± 52.6; intraoperative adverse events (AEs) occurred in 0.6% of cases. Median LOS was 3 days (IQR: 2–4). Overall conversion rate was 4.1% (95% CI: 3.6–5.0%), varying by the procedure type and surgeon’s experience. More experienced surgeons (Q4) had shorter adjusted console times (154 vs. 169.6 min, p < 0.001) and lower conversion rates. Longer console time was linked to lower conversion odds. LOS increased with conversions but was more stable for experienced surgeons. CUSUM charts showed clear learning curve differences. No device-related AEs were reported. These results suggest that SSI Mantra™ is feasible, with minimal intraoperative AEs for diverse and complex procedures, with consistent performance across centers and specialties. Its lower capital cost may expand RAS access in India. Surgeon experiences improved efficiency and outcomes, supporting structured training. Long-term outcomes and comparative effectiveness warrant further study.

The online version contains supplementary material available at 10.1007/s11701-025-03118-2.