KARACHI: Patients at a public hospital in Pakistan can receive robot-assisted surgery, including complex cancer operations, free of charge. Nearly three years into the program, its surgeons say they concentrate on complex cases after criticism of the cost of using the technology for routine operations.

The Jinnah Postgraduate Medical Center (JPMC) in Karachi says it has performed more than 1,500 robotic procedures since launching the service in October 2023, with the Sindh provincial government covering the cost to patients. Its surgeons use a Versius system to control instruments from a console during minimally invasive operations, including colorectal and other cancer surgery.

The question of which patients benefit enough to warrant its use matters in a country where public health expenditure was 0.8 percent of gross domestic product in the 2024–25 financial year, according to Pakistan’s latest economic survey.

JPMC is not alone in offering robotic surgery in Sindh: the Sindh Institute of Urology and Transplantation also provides it free of charge.

“This is a government-sector hospital. This is taxpayers’ money, so ultimately we have to use it appropriately,” Dr. Syed Muhammad Shafqatullah, an associate professor of general and colorectal surgery at JPMC, told Arab News.

“That is why we have tried to use robotic surgery as much as possible for complex procedures.”

The cost debate began soon after JPMC introduced the system. Sindh’s then caretaker health minister, Dr. Saad Khalid Niaz, questioned the expense of performing operations such as gallbladder removal robotically when they could be done laparoscopically.

On Nov. 21, 2023, JPMC’s then executive director, the late Prof. Shahid Rasool, announced that the hospital had stopped “unnecessary and minor” robotic procedures.

Shafqatullah said he performed around 30 robotic gallbladder removals early in the program. Of approximately 120 robotic operations he has performed overall, he said around 88 were colorectal procedures, sleeve gastrectomies or operations for stomach and pancreatic cancers. He said the instruments’ greater range of movement was particularly useful in difficult-to-reach areas, such as during some colorectal cancer operations.

“In the United States, robotic cholecystectomy is very commonly performed because insurance pays for it… It is taxpayers’ money,” he said, referring to gallbladder removal.

Shafqatullah said JPMC could not routinely use the robot for basic operations because it is a public hospital spending taxpayers’ money.

The shift toward more complex cases does not, by itself, establish that JPMC’s robotic operations produce better results than conventional laparoscopy. The hospital did not provide a breakdown of its more than 1,500 procedures by type, its acquisition price or cost per operation. It also did not provide comparative figures for complications, readmissions, hospital stays or other patient outcomes.

WHAT THE EVIDENCE SHOWS

Research elsewhere suggests the technology can be used safely, while leaving questions about its added value. A 2025 review of nine studies covering 561 colorectal operations using Versius found no major safety concerns, but said much of the evidence was observational and called for stronger comparisons.

A 2026 study at a British hospital compared 290 colorectal cancer operations performed laparoscopically or with Versius or a different robotic system. It found comparable cancer-related outcomes, but Versius operations took about 37 minutes longer than laparoscopy after adjustment, and patients in both groups had a median hospital stay of five days.

The authors said further research was needed on cost effectiveness. Those findings cannot establish what happens to patients at JPMC, where equivalent outcome data were not supplied.

“There is no doubt that the cost increases when you use the robot,” Shafqatullah said, though he argued that easier surgery in complex cases, less pain and quicker recovery could potentially offset some of the added expense.

Shahid Kamal, an operating theater technician who oversees robotic surgery at JPMC, said the team had become faster with experience.

“When the robot was new, people were worried… They would say, ‘Please do it laparoscopically, don’t do it with the robot’,” he said.

“But as our training progressed and we performed more surgeries, the operating time also became shorter.”

JPMC said its robotic procedures to date would otherwise have been worth more than Rs600 million ($2.1 million) but did not explain how it calculated that figure.

Without the hospital’s actual costs and comparative patient outcomes, it is not possible to assess whether concentrating robotic surgery on complex cases has improved the program’s value for public money.