By Dr. Victor Raúl Castillo Mantilla
CEO and President, Hospital Internacional de Colombia – FCV
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Surgery has moved steadily toward greater precision and less invasive approaches. Robotics marks another step in that evolution, extending what surgeons can do while keeping clinical judgment, experience, and responsibility at the center of every decision.
At International Hospital of Colombia (HIC), our experience has reinforced a fundamental lesson: owning a robot is not the same as having a robotic surgery program. A program requires trained teams, appropriate patient selection, clear protocols, outcome measurement and an organizational structure capable of integrating technology into everyday clinical practice.
Our journey began in orthopedics, with Mako for joint replacement surgery. It then expanded to a multi-specialty platform with SSI Mantra 3 and, in 2026, reached one of the most technically demanding fields: robotic cardiovascular surgery.
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Orthopedics: From Technology to a Clinical Program
In 2023, HIC introduced the Mako robotic system, developed by Stryker, for total knee replacement, total hip replacement and partial knee replacement procedures. The system combines CT-based three-dimensional planning, individualized anatomical analysis and haptic technology that establishes virtual boundaries during bone preparation.
This distinction matters because robotic surgery is still often misunderstood. The robot does not operate autonomously; the surgeon remains in control throughout the procedure, from planning and clinical decision-making to execution. The technology supports that process by providing additional information, precision and tools that help translate the surgical plan more accurately into the operative field.
In joint replacement surgery, variations of just a few millimeters can be significant. Implant positioning, alignment, soft-tissue balance and bone preservation can influence joint stability, mobility, and postoperative recovery.
With Mako, planning begins before the patient enters the operating room. A CT scan is used to create a three-dimensional model of the patient’s anatomy. Based on that model, the surgeon can determine the size and position of the prosthetic components and anticipate necessary adjustments.
During surgery, virtual boundaries help guide the robotic arm within the previously defined area. Incorporating Mako also required specialized training, workflow changes, operating-room team education, new protocols and time to move through the learning curve. Over time, the technology became part of our orthopedic practice.
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That is the difference between acquiring technology and building a program. An innovative procedure can be performed once. A program must be able to deliver it safely and consistently across dozens and, eventually, hundreds of patients.
In our case, that experience grew quickly. By late August 2026, HIC had performed 690 Mako-assisted hip and knee replacement procedures. That volume reflects the accumulated experience of surgeons, anesthesiologists, surgical technologists, nurses, rehabilitation specialists, biomedical engineers and the many teams involved throughout the patient journey.
At the same time, our Centers of Excellence for Hip and Knee Joint Replacement received international certification from Joint Commission International, strengthening a model in which technological innovation advances alongside international standards of quality and safety.
For us, this combination points to an increasingly important principle in modern medicine: technological precision requires clinical governance. A robot can enable extremely precise movements, but precision alone does not guarantee excellence. It must be supported by protocols, performance indicators, training, follow-up and a culture of continuous improvement.
The Next Step: A Multi-Specialty Robotic Platform
Our next step required a different kind of technology. In 2026, we introduced SSI Mantra 3, a robotic surgery platform developed by SS Innovations and designed for soft-tissue procedures across multiple specialties.
HIC became the first institution in Colombia to begin performing procedures with this platform. The initial surgeries were carried out in areas such as digestive surgery and urology, but the vision from the outset was broader.
Unlike Mako, which is specifically designed for orthopedic surgery and joint replacement, Mantra 3 is a multi-specialty platform. Its architecture includes an open surgeon console, high-definition three-dimensional visualization and modular robotic arms that can be configured according to the procedure and the patient’s anatomy. This allows the platform to be used in areas such as general surgery, urology, gynecology, thoracic surgery, head and neck surgery and cardiovascular surgery.
That changed the scale of our strategy. With Mako, we learned how to build a robotic program around a highly structured clinical pathway. Mantra raised a broader question: could robotic surgery become an institutional platform shared across multiple specialties? That possibility significantly expanded the potential role of the technology.
A robotic surgery program can support training, simulation, the development of new techniques, international collaboration, clinical research and, eventually, remote surgery. During 2026, some of those possibilities began to take shape.
When Distance Becomes Less of a Barrier
One of the most significant moments in our program came in July 2026. From a console at International Hospital of Colombia in Piedecuesta, Santander, robotic cardiac surgeon Dr. Sudhir Srivastava, founder of SS Innovations and creator of the Mantra platform, performed a robot-assisted sleeve gastrectomy on a patient in India. The surgical signals traveled more than 22,000 kilometers. The significance of this experience extends far beyond the distance itself.
For decades, high-complexity care has largely required patients to travel to major cities and referral centers, where specialized expertise and advanced care are concentrated. Telesurgery challenges that model by creating the possibility for expertise to reach patients where they are.
This does not make geography irrelevant. Telesurgery still depends on reliable connectivity, strong clinical teams at both locations, technical support and rigorous safety protocols.
During the Colombia–India procedure, for example, a surgical team remained with the patient as part of the safety and backup protocol. The experience points to an important possibility: as robotic platforms, connectivity and clinical networks evolve together, physical distance may become less of a barrier to certain forms of specialized surgical expertise.
In Latin America, where specialists are unevenly distributed between major cities and more remote regions, this possibility deserves serious consideration.
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The New Frontier: Robotic Cardiovascular Surgery
Just days after that telesurgery experience, our program entered one of its most technically demanding stages. In August 2026, specialists from the International Hospital of Colombia and its Cardiovascular Institute, accompanied by Dr. Sudhir Srivastava, performed Colombia’s first robotic cardiovascular procedure using SSI Mantra 3: a totally endoscopic coronary artery bypass, known as TECAB.
The patient had significant coronary artery disease involving two major vessels. Rather than treating the entire condition with a single technique, the team designed a hybrid revascularization strategy. A robot-assisted totally endoscopic coronary bypass was performed on the left anterior descending artery, while interventional cardiology subsequently treated another coronary lesion with a stent.
That multidisciplinary approach is central to the way cardiovascular care is evolving. Cardiovascular surgery, interventional cardiology, imaging, anesthesiology and technology can increasingly be combined around the needs of each patient to create more individualized treatment strategies.
Robotics adds another option within that therapeutic spectrum. Traditionally, many coronary bypass procedures are performed through a median sternotomy, which requires opening the sternum to access the heart.
In a totally endoscopic robotic procedure, access can be achieved through small incisions or ports in the chest. A high-definition three-dimensional camera and robotic instruments are introduced through these ports and reproduce the movements of the surgeon at the console. The key point remains the same: the robot does not replace the surgeon.
Every movement of the instruments originates with the surgeon at the console. The system functions as a highly sophisticated extension of the surgeon’s hands and vision, providing enhanced visualization of the surgical field, tremor filtration and highly controlled movement within confined anatomical spaces.
In carefully selected patients, minimally invasive approaches may reduce the surgical trauma associated with larger incisions and support recovery.
For a cardiovascular institution, the significance of this first procedure extends beyond a single case. It opens a new path for development, and robotic coronary surgery may be only the beginning.
Over time, these programs may expand to selected valve procedures, interventions for septal defects and other cardiothoracic surgeries. They must be, supported by continued training, rigorous patient selection, ongoing outcomes evaluation and a gradual expansion of indications.
The Most Important Investment Is Not the Robot
When robotic surgery is discussed, the cost of the equipment often dominates the conversation. These platforms require significant investment in technology, maintenance, infrastructure, training and technical support. Yet the most important investment is in people.
A robotic program needs surgeons willing to work through a new learning curve, anesthesiologists able to adapt to the specific demands of each procedure and surgical technologists, nurses, biomedical engineers and support staff who understand how the system works. It also depends on operating-room teams prepared to respond to technical and clinical contingencies and on leaders capable of making a fundamental decision: knowing when robotic surgery truly adds value and when it does not.
Robotic surgery is not necessary for every patient, nor does it automatically improve every procedure. Technology should strengthen clinical judgment rather than substitute for it. Our first robotic coronary procedure illustrates this well: the team chose a hybrid strategy based on the patient’s anatomy and disease pattern, combining different techniques where each offered the greatest clinical value.
Robotic surgery begins to mature when the question shifts from “Can we perform this surgery with a robot?” to “Which patients benefit most from this technology, in which settings, and with what outcomes?” That is the question that should guide its use.
Building Evidence Around Innovation
The next phase of robotic surgery will be shaped by data. Health care systems will need to look beyond the technical success of a procedure and evaluate operative time, conversion rates, complications, blood loss, transfusions, pain, length of stay, readmissions, functional recovery, patient-reported outcomes and the total cost of care.
Orthopedics offers a useful example. Scientific literature has examined robotic systems such as Mako in areas including the precision of bone preparation, implant positioning, postoperative pain, analgesic use and functional recovery. No hospital, however, should assume that outcomes reported elsewhere will be reproduced exactly in its own patient population.
Each organization needs to generate its own evidence. The value of a technology must be assessed within the context in which it is used: with its patients, surgeons, clinical processes, and the characteristics of its health care system. As our robotic surgery program grows, the data supporting it must grow as well.
This means building the evidence needed to follow the patient’s full journey and measure outcomes over time, from preparation before surgery through recovery and return to daily life. The goal is to understand not only what happens in the operating room, but also how the procedure affects recovery and quality of life.
A Conversation Latin America Needs to Have
Latin America faces a paradox. The region has highly trained physicians, internationally recognized hospitals, and medical centers capable of delivering highly complex care, yet access to that level of care remains deeply uneven.
Robotic surgery could widen that gap if it becomes concentrated in only a small number of high-cost centers. It could also help narrow it if it is integrated into broader models of training, collaboration, and knowledge sharing. The outcome will depend on how the technology is implemented.
In this context, high-complexity innovation does not have to be limited to the world’s largest capitals. From Bucaramanga, Santander, we have progressively built capabilities in cardiovascular medicine, orthopedics, complex surgery and technological innovation.
In 2025, International Hospital of Colombia became the first hospital in Colombia and South America to join Mayo Clinic Care Network, creating new opportunities for knowledge exchange and international clinical collaboration.
Robotic surgery is part of that same vision. For Latin America, the challenge goes beyond acquiring advanced technology. It also requires the people, infrastructure, clinical governance and connectivity needed to use it responsibly and extend its impact.
Telesurgery, remote mentoring and teleproctoring may become part of that evolution, allowing experienced surgeons to support the development of robotic programs in other cities or countries.
In regions where access to specialists is limited, these capabilities could become as relevant as the robotic systems themselves.
Beyond the Robot
Our experience over the past several years has given us a clearer view of the role robotic surgery can play in clinical practice.
The challenge now is to continue identifying the patients and procedures for which it can improve precision, support recovery, expand treatment options and strengthen specialized care.
Technology will continue to evolve. Our responsibility is to incorporate it with sound judgment, experience and a consistent focus on the patient.
Víctor Raúl Castillo Mantilla is a member of the Newsweek CEO Circle, an invite-only executive community of subscribers.
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