AIIMS’ Dr Sarat Chandra’s ROTCH Robotic Technique Revolutionises Epilepsy Surgery; Successful Israel-AIIMS Collaboration Expands Global Hope

A new era in the treatment of drug-resistant epilepsy is underway at the All India Institute of Medical Sciences (AIIMS), Delhi, thanks to the pioneering work of Dr Poodipedi Sarat Chandra, Professor and Head of the Department of Neurosurgery, AIIMS, New Delhi. Dr Chandra and his team have developed the Robotic Thermocoagulative Hemispherotomy (ROTCH) technique, which harnesses advanced robotic technology for minimally invasive, "bloodless" surgery. Unlike traditional approaches, ROTCH uses a robotic system to deliver precise radiofrequency energy, disconnecting pathological brain tissue while reducing the need for large craniotomies and minimising surgical risks.

This innovative procedure represents a major leap forward for patients suffering from severe, drug-resistant epilepsy caused by hemispheric pathology. The technique delivers greater accuracy, improved patient safety, and reduced recovery times, offering hope to those for whom conventional treatments have failed.

Highlighting the impact of global medical collaboration, leading globally reputed neurosurgeons from Tel Aviv Medical University in Israel, Professor Jonathan Roth and Professor Ida Strauss, recently joined AIIMS specialists in Delhi to study the ROTCH technique and explore future avenues of joint research. Their visit exemplifies the international recognition of Dr Chandra's work and its potential to shape epilepsy care worldwide.

Hemispherotomy is an extreme and one of the most effective surgical treatments for hemispheric epilepsy. The surgery is often performed in children with very aggressive epilepsy, refractory to endless medical treatments.

Following surgery, the epileptic outcome often has seizure freedom, and despite the hemispheric disconnection, children typically improve their function compared to their presurgical condition.

Open Hemispherotomy is considered a very major surgery, followed by several days of recovery, and amongst young children, there is often the need to give various blood products.

Over recent years, about 40 children have undergone this innovative surgery, with excellent outcomes. The cost of surgery is low (as there is no need for disposable probes), and the surgical insult (incisions, blood loss, risk of bleeds and infection) is minimal. This technique was wholly developed at AIIMS, Delhi.

On Wednesday, November 20th 2025, Prof. Jonathan Roth and Prof. Ido Strauss from the Neurosurgical Department at the Tel Aviv Medical Centre performed the first “outside AIIMS” ROTCH procedure.

Following a visit to Prof. Chandra at AIIMS for learning the technique, the procedure was successfully performed on a 12-year-old girl with EPC (epilepsia partialis continua) originating from the left side of her brain. Before surgery, the child was non-communicative and unable to move her right side of her body. The following morning, the patient was awake, speaking to her parents, moving her right side, and with no seizures.


Caption: Photo of the first procedure being done in Israel, with permission from Prof Jonathan Roth and Prof Ido Strauss

 Thanking Prof. Chandra and his team for their friendship and guidance, Prof. Jonathan Roth said, ‘I'm sure, more mutual projects will follow”.

This clinical collaboration between the TLVMC and AIIMS, along with research collaborations, emphasises the crucial role of keeping open minds to learn from one another, with a direct impact on patient care.

Prof Manjari Tripathi, Head of Neurology, stated that “there are over 50 million people with epilepsy worldwide over and over 12 million in India. Though epilepsy is primarily treated with medicines (over 75%), over 25% are drug-resistant epilepsies and require surgical intervention. We run one of the largest and most well-known surgical programs globally but many more such International collaborations will be required to conquer this malady. We are indeed very happy that Israel has benefited from our expertise”.

In conversation with Health Dialogues, Dr Chandra has elaborated on the ROTCH technique and international collaboration.

Ques: How does the ROTCH technique differ from traditional surgery for drug-resistant epilepsy, and what are its main advantages for patients, such as results, recovery time, or risks?

Dr Chandra: It is a robotically directed bloodless surgery. No large openings are made. Using prior planning, small holes (2.5mm) are drilled through which radio-frequency probes are directed by a robot. These electrodes then burn the interface between the affected hemisphere and the rest of the brain, hence performing a disconnection. This is different from the opening surgery, where large openings are made and associated with significant blood loss, morbidity and even mortality

Ques. Why did you choose the ROSA robotic system for this procedure, and how does it enhance precision and safety during surgery?

Dr Chandra: It can be done using any robotic system. We used ROSA as that is one of the most well-known neuro robot and available with AIIMS. It provides precision surgery to reach the target and saves a lot of time. If one were to do this using a traditional stereotactic frame, it would take a much longer time, making surgery not feasible.

Ques. What criteria do you use to select patients for ROTCH, and which types of drug-resistant, hemispheric epilepsies benefit the most from this approach?

Dr Chandra: Drug-resistant epilepsies with seizures arising from one whole hemisphere. It is a very severe form of epilepsy.

Ques. Can you share recent outcome data or real-world experiences, for example, success rates or long-term improvements, for patients treated with ROTCH compared to those who receive other therapies?

Dr Chandra: We have performed 40 procedures at AIIMS. The seizure-free outcome is around 80%. This is a revolutionary technique that changes the entire outlook of management

Ques: What impact do you see this innovation and international collaborations, such as with Tel Aviv University, having on the future of epilepsy care and neurosurgical research in India?
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Dr Chandra: This is the way to move forward. Only such international collaborations can close the treatment gap for this terrible condition. We are very happy to assist this advanced centre from Israel in implementing this technique.

Dr Sarat Chandra’s contributions to neurosurgery reach far beyond the ROTCH method. He has also developed other game-changing procedures such as endoscopic hemispherotomy, endoscopic corpus callosotomy, and robotic-guided radiofrequency thermocoagulation for hypothalamic hamartomas. These developments have dramatically expanded the possibilities of minimally invasive epilepsy surgery, offering new therapeutic options to patients with complex medical needs.

The ongoing exchange of surgical knowledge and skills at AIIMS continues to empower healthcare professionals and improve patient outcomes, pushing the boundaries of neurosurgical innovation across India and internationally.

AIIMS had earlier helped setting up epilepsy surgery programs in several places in India and also in other countries like Morocco and Indonesia.