Medicine’s biggest killer isn’t disease. It’s distance.

Where you live still decides whether you live.

If you’re in a city with top hospitals, your odds go up.

If you’re not, you wait longer, you travel farther, and the risks stack higher.

In the U.S., rural patients face higher odds of death after emergency surgery and trauma compared to those in cities.

Around the world, families drive hours or even days to reach an operating room, and often, they arrive too late.

Globally, five billion people lack access to safe, affordable surgical care.

Five billion.

The gap is so brutal that the Lancet Commission on Global Surgery estimates we need 143 million more operations every single year just to meet basic demand.

Distance kills.

It steals precious minutes in emergencies. It adds stress to bodies already failing. It turns survival into a lottery rigged by geography.

On Monday, I told you about my aunt and her long journey from Florida to New York for one of the hardest operations in medicine. She had one of the best surgeons alive, a man with decades of experience and a flawless record.

And still, she never came home.

What if she didn’t need to travel so far? What if the best surgeon could have reached her, instead of her being forced to cross states to reach him? Would things have ended differently?

We’ll never know.

But medicine is beginning to build an answer to that question.

When Distance Disappears

Now picture the opposite. Picture a world where distance doesn’t decide your odds.

In June 2025, Dr. Vipul Patel made history.

From a console in Florida, he performed a prostatectomy on a patient more than 7,000 miles away in Angola. The first FDA-approved transcontinental robotic telesurgery.

The best surgeon didn’t have to get on a plane, and neither did the patient.

In India, Dr. Mohit Bhandari carried out two remote bariatric surgeries across 560 miles using the SSi Mantra 3 system from SS Innovations.

In China, Toumai reports hundreds of successful remote surgeries, including satellite-enabled operations. These aren’t experiments on dummies. They’re real patients with real outcomes.

When this scales, everything changes.

In the UK, robot-assisted operations in the National Health Service jumped from 6,600 in 2014 to nearly 70,000 in 2024, with a target of half a million by 2035.

That’s a public system betting that robots won’t just be for elite hospitals, but for everyone.

In emerging markets, the growth is explosive.

Apollo Hospitals in India have already performed thousands of robotic surgeries and continue to expand access.

Fortis Healthcare has reported sharp year-over-year increases in robotic procedures. This is becoming everyday medicine before our very eyes.

And remember: by 2036, the U.S. alone could be short 20,000 surgeons.

That gap can’t be closed by training alone. The only way to multiply reach is through machines. Robots are how you stretch human expertise.

Companies Pushing the Frontier

Like I mentioned on Monday, my team and I haven’t decided what companies to feature in the portfolio… yet.

But that doesn’t mean we’re not looking at some of the more promising ones.

If you missed last Monday’s list, you can see it here.

And below are some names worth paying attention to:

SS Innovations in India — building low-cost robotic platforms like the SSi Mantra 3 so emerging markets don’t get left out.

CMR Surgical in the UK — creating the Versius system, modular and mobile, so smaller hospitals can afford to join the future.

Toumai in China — pushing satellite-enabled telesurgery to prove skill can travel anywhere, even to the most remote patient.

As my team and I dig into this area, we’ll be sending Premium Members updates on which stocks we’re buying.

Why This Matters

My aunt had to leave her home, her family, her comfort to chase the surgeon she needed. It wasn’t anywhere near as brutal as the travel many people have to endure just to access medical care, but…

The distance added stress, risk, and complications. And still, she didn’t make it.

Now imagine a different future.

A woman in Florida lying in her own bed while a surgeon in New York operates.

A farmer in India treated by a Delhi specialist without leaving his village.

A patient in Angola healed by one of the top surgeons in the world without crossing an ocean.

That’s what telesurgery promises: a world where your ZIP code doesn’t decide your survival.

And yet, this still isn’t the end of the story.

Because today, every telesurgery still requires a human on one end of the machine.

What happens when the machine itself begins to take on the work?

At Johns Hopkins, with collaborators at Stanford and Columbia, researchers demonstrated an autonomous soft tissue surgery system that completed eight bowel anastomoses on porcine models with 100 percent success.

AI driven systems are now automating subtasks such as suturing, dissection, and tissue identification with growing reliability.

That’s where we go next. On Friday, I’ll take you there… into the frontier of autonomy, where robots don’t just extend human hands, they begin to replace them.

And we’ll have to face what that means for all of us.

See you on Friday,

Double D

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