Surgical Robotics Innovations

First invented in 1985, surgical robots have reshaped surgery experience for patients and surgeons over the past 30 years. As Intuitive Surgical dominates this sector today, more players are entering, intensifying the competition and introducing innovations in new applications.

As of 2019, the surgical robots market size totaled approximately $5.3 billion. This includes robotic systems, disposable instruments and accessories, and services/maintenance contracts. The market is expected to increase at a CAGR of 16.0%, reaching approximately $9.7 billion in 2023.[1] 2020 has been a tough year due to the COVID-19 pandemic. However, as vaccines are being introduced and postponed surgeries are coming back to schedule, it’s possible for us to see a bounce back next year.

There are three primary drivers of this foreseeable continuous growth:

1. Aging population with global burden of disease;

2. Surgeons’ and patients’ increasing needs for minimally invasive surgeries;

3. Robotic surgeries could deliver more accurate and reproducible surgical outcomes.

SURGICAL ROBOTICS REVENUE SEGMENTATION

Breaking down the revenue model, surgical robotics has a typical razor and blades business model. As one can see from the revenue segmentation of the $5.3B market, disposable instruments and accessories account for almost half of the total revenues.[1]

Different types of robots emerged in the past 20 years. In general, all robotic platforms integrate visualization, navigation, and data analytics, which benefit from pre-operative planning, intra-operative support and post-operative analysis.

· The pre-operative planning software adopting AI enables more precise surgical outcome prediction.

· Direct visualization of anatomy and real time imaging could help surgeons make better decisions during a procedure.

· Intra-operative data collection and intelligence could collect more data of the patients and surgeries, which has enormous values. It could be used in procedure improvement, patient diagnosis and other applications.

Looking into specific applications, in general surgery, Intuitive Surgical’s da Vinci is no doubt the market dominator with 2019 revenue of $1.3 billion. Not only does it provide robot systems, Intuitive Surgical has also successfully trained the first batch of robotic surgeons, setting an industry standard and switching barriers for competitors. However, as the protection provided by Intuitive’s original patent portfolio started to expire, more companies have already entered this market. Sharing a similar flexible robot station design, Medtronic’s Hugo and CMR Surgical’s Vercius are launching in the next couple years, viewing themselves as the more cost-effective alternative to da Vinci. Virtual Incision’s MIRA reduces its size to a further extent and abandons the multiple-robot-arms design.

Other hot areas in surgical robotics are orthopedic, spine and cranial surgeries. These robots share a similar platform that integrates pre-operative planning software with procedure precision. The software can build a patient model through imaging and allow surgeons to refine procedural and implant decisions to achieve the best outcome. Medtronic’s Mazor, Stryker’s MAKO, Globus Medical’s ExcelsiusGPS and Zimmer Biomet’s ROSA all have this capability. They will be joined by Johnson & Johnson’s VELYS in the not so distant future.

Besides the above crowded playing fields, many robots have been invented to address other specific needs. Siemens Corindus’ CorPath, Stereotaxis’ Genesis and Catheter Precision’s Amigo assist catheter, balloon and stent implants in Interventional cardiology. Accuray’s CyberKnife and ZAP Surgical deliver targeted beams of high-dose radiation in radiosurgery. Neocis’ Yomi takes a similar pre-operative planning with anatomical visualization to enable haptic-guided dental implant surgery.

The aesthetics have started to adopt robotics too. Restoration Robotics’ ARTAS is the first automated hair implant robot. LRI’s lipolysis robot is in development. Both aim to reduce huge labor needs and achieve better outcome with the help of image planning tools.

SURGICAL ROBOTICS IN DIFFERENT SPECIALTIES

As surgical robots’ adoption gets wider, we could predict a few future trends. Because surgeries are becoming less invasive, endoluminal robots have the potential to reshape the traditional surgical robot design and hence the procedures. It has high prospect in single incision laparoscopic surgery, GI surgery, endobronchial lung surgery, endovascular heart surgery, and minimally invasive cranial surgery. However, current endoluminal robots can only perform limited surgeries and diagnosis. Intuitive Surgical’s Ion could perform biopsy and endoscopy for lung cancer patients. Auris Health, acquired by Johnson & Johnson, and Noah Medical target at similar specialties. Medrobotics’ Flex gives ENT physicians the ability to access anatomical locations that were previously difficult or impossible to reach minimally invasively.

In the long term, surgical robots will develop towards autonomous execution with incremental progression.

· In the pre-operative phase, as AI and machine learning technologies become mature, the robot software could automatically choose the best surgeries based on patients’ conditions.

· In the intra-operative phase, the robot will incorporate with haptic feedback and prevent surgeons from malfunctions to maintain procedure quality. Activ Surgical invented a visual device that could provide real-time tissue perfusion during the surgery.

· In the future, we expect to see some simple operations automated, i.e. autonomous suturing and bone removal.

Robotics’ combination with VR and 5G also needs our attention. Vicarious Surgical, a stealth mode company, will commercialize its VR enhanced surgical robot. Meanwhile, many surgical robots upgrade with the teleoperation modules, which could potentially solve medical resource imbalance.

Surgical robots are still relatively new and the global market is underpenetrated. But I believe it will be the future foundation of medical technology. As new technologies such as AI, machine learning, VR and 5G becomes more mature, they will bring on the next generation of more integrated and automated surgical robots.

[1] Robotically Assisted Surgical Devices Market, Meddevicetracker