A surgeon in Pampanga reaches 1,380 kilometres to remove a gallbladder

The instruments moved in Cotabato. The hands moved in Pampanga. Between them ran fibre-optic line, carrying every small decision of a cholecystectomy across the archipelago and back fast enough that the delay never became a problem. Blood loss was minimal. The operation finished inside the hour.

Then the direction reversed. At Cotabato Regional and Medical Center, Dr. Al-Jazzer M. Angas and Dr. Louis Gerard Agustin took the console and operated on a patient back in Pampanga, using the same SSI Mantra system. Two procedures, two directions, one afternoon that quietly dissolved the distance between a regional hospital and the specialist expertise its patients have always had to travel for.

Both hospitals are retained by the Department of Health. CRMC serves the Bangsamoro Autonomous Region in Muslim Mindanao, a part of the country where a referral to a surgeon has long meant a journey, a cost, and often a decision to simply wait. Under the department's zero balance billing policy, neither patient was charged.

Dr. Sudhir Shrivastava flew in from New Delhi to watch. He founded SS Innovations, the company behind the Mantra, after a career as a cardiothoracic surgeon in Texas, Chicago and Atlanta — more than 1,400 robotic cardiac cases, roughly 800 of them endoscopic bypass operations. His company's system sells for about a third of a da Vinci's price, which is much of why it is standing in a government hospital in Pampanga at all.

That machine's Philippine story began a year earlier, when Quiambao performed Central Luzon's first robotic surgery with it — also a gallbladder, assisted by Dr. Armin Mendoza, Dr. Charisse Santos and the anaesthesiologist Dr. Rose Peregrino. It was the first Mantra used anywhere in the country.

There is a symmetry worth pausing on. The world's first transatlantic telesurgery, in 2001, was a gallbladder removal too: Jacques Marescaux in New York, a 68-year-old woman in Strasbourg, 6,200 kilometres and about 150 milliseconds apart. A quarter of a century later the same humble operation marked the moment a patient in Cotabato stopped having to leave home to reach a surgeon.