In India, the difference between the health infrastructure in metros and smaller towns is stark, and it is not uncommon for people to travel to big cities for complex surgical procedures and better medical treatments.
Image-guided surgeries (IGS) used for accessing deep tumours is one such procedure rarely performed in hospitals in smaller towns, one of the main reasons being the high equipment cost that varies from ₹1.5 to 3 crore making it unaffordable for smaller hospitals.
But what if the technology could be tweaked to make it more affordable and thereby accessible to the larger Indian market?
Arpit Paliwal | Photo Credit: Special Arrangement
This was the thought that prompted Arpit Paliwal to start HRS Navigation, a Bengaluru-based health-tech start-up that attempts to bridge the gap by coming up with a surgery navigation equipment designed for Indian circumstances, particularly considering hospitals in smaller towns and rural areas.
Founded in 2015, the start-up offers computer-assisted surgery solutions for image-guided surgeries at rates that are around 50% lesser than existing market rates. It claims to be the first domestic manufacturer of navigation systems for procedures such as neuro, ENT and spine surgeries.
Starting up
During his stint at Stryker, a global med-tech company, Paliwal noticed that most med-tech companies are focused on the Western Market and not doing much to suit their product for the Indian market. While Europe is the pioneer in the IGS technology, Paliwal felt there was a big need for such technologies in India too.
“During my tenure at Stryker, I have been to tier-2 and tier-3 cities in India. The infrastructure there is very different and healthcare facilities are not up to the mark. But more than 75% of the Indian population lives in these smaller towns. Many of them can’t afford to go to big hospitals and get these expensive surgeries done. I myself have seen people telling their doctors that they’d need to sell their houses to get a surgery done,” says Paliwal.
Seeing this gap in the existing infrastructure, he started HRS Navigation in 2015 by making use of his exposure to R&D, clinical medicine, marketing, and sales.
Surgical navigation equipment designed by HRS Navigation. | Photo Credit: Special Arrangement
Image Guided Surgeries
In image Guided Surgeries a computer-assisted navigation system is used to make the smallest possible incisions instead of operating over a large area. This is usually done for complex surgeries like scoliosis, brain tumour and so on where the error margin is very low.
For example, if a brain tumour is to be surgically removed, an MRI or CT scan of the brain is fed into the computer monitors. Using a tracking instrument and a camera, the location of the tumour seen in the scan report is matched to that on the brain. This helps the surgeon to precisely understand where to make an incision to access the tumour in the shortest and safest way.
According to Paliwal, what sets his start-up different is that its solution doesn’t require consumables or single-use components unlike in the case of equipment offered by others.
Typically, for image guided surgeries consumables like glions and batteries need to be changed after each surgery. Due to the high costs involved some hospitals continue to use it for a few more surgeries, but that would impact the precision, Paliwal notes.
HRS Navigation’s easyNav surgical navigation system used during operation. | Photo Credit: Special Arrangement
Consumable-less technology
HRS, on the other hand, has designed its system based on optical pattern recognition technology which uses a stereoscopic vision camera to detect and track specially marked objects. This eliminates the need for consumables.
“If you zoom into the image of a Chandrayaan lander, you can see a black-and-white pattern that looks like a chessboard. This is used for tracking. We are using similar technology. They are using those technology in high precision space navigation, we are using similar technology to navigate body space,” explains Paliwal.
According to him, the initial costs of HRS’s system come to about ₹50-90 lakhs, around 50% cheaper than the existing equipment in the market.
“There are no recurrent costs apart from the annual maintenance fee. So, the cost benefit over the long term is huge. This enables the hospitals to offer the surgeries at cheaper rates or for free for financially poor patients.”
Doctor-certified
At the Sri Ramachandra Medical College in Chennai, HRS’s system was installed a few months back.
Dr. Visvanathan Krishnaswamy, senior consultant neurosurgeon at the hospital, says surgeries have become more precise since.
“I have worked in hospitals abroad as well as in India and some of them had navigation systems. Sometimes, when you tell your patient that the surgery cost will go up since you’d be using a fancy system bought for a few crores, they may not appreciate it. With HRS’s system, you are getting the best of both worlds. It does its job and is cost-effective too,” he says.
According to Dr. Krishnaswamy, usage of navigation systems reduces overall expenses for the patient.
“Without a navigation system, for surgeries like brain tumour, we would be doing a much bigger opening, the operating time will be longer, and the patient would be staying in the hospital longer as well. With this, we can operate with a small straight incision, a smaller precise craniotomy. The patient is in and out of the hospital faster this way. This is the case with any navigation system, but for others the payback period will be longer due to the high cost of the equipment, for us it’s much shorter.”
Eyes on the globe
At the office of HRS systems in Rajaji Nagar is a map of India with star-shaped stickers on it. The stars indicate the systems sold in different geographies. A couple of stars are seen outside India in the region where Nepal is located.
“Interestingly those were some of our first sales,” says Paliwal, who now plans to step on his international expansion plans.
As per multiple studies, image-guided surgery systems is looking at a global market of around $17 billion by 2032-22. HRS has so far sold 105 systems out of which 100 have been installed. Around 80% of them have been in smaller towns of India.
“We want to expand globally. We already have installations outside India, but we have not been very aggressive since expansion outside the country also requires service and support,” says Paliwal.
HRS, which claims a 70% year-on-year growth, is also looking at robotics in healthcare. “Making it affordable and accessible will always be the thought process guiding us,” Paliwal notes.
