Last month, the U.S. Food and Drug Administration announced clearance of the Auris Health Monarch Platform, a flexible surgical robotics system that can help fight lung cancer. The system lets doctors more accurately diagnose, and eventually treat, small and hard-to-reach nodules in the periphery of the lung, Auris said.
With the FDA clearance of its system for diagnostic and therapeutic bronchoscopic procedures, Auris said its goal is to improve patient outcomes, enhance physician capabilities, and lower costs. Founded by Frederic Moll, M.D., Auris Health (formerly Auris Surgical Robotics) has raised more than $500 million in equity capital. Moll was also one of the founders of Intuitive Surgical, which created the Da Vinci surgical robotics system.
Massive growth, massive costs
The market for surgical robots continues to show massive growth as companies invest more money and resources into creating platforms that can help doctors more efficiently and accurately perform procedures. The global surgical robotics market to reach $12.6 billion by 2025, predicts a January 2018 report by Research and Markets.
Research firm IDC is forecasting a market of $5.4 billion by 2021, with a compound annual growth rate of more than 24% each year through 2021. The company said this number covers spending on the robotic technology as well as hardware, software and services.
However, the high cost of surgical robots doesn’t necessarily reflect a deep adoption of the technology, noted John Santagate, research director for service robots at IDC.
“This is a factor that is impacting the ability for hospitals to invest, although the technology is helping to improve the skills of surgeons and improve patient outcomes,” he said.
What started with a single robot — the da Vinci Surgical System received FDA approval in 2000 — has now ballooned to more than 40 different companies, with enough robots to cover surgical procedures in almost every area of the human body.
Dr. Roger Smith, chief technology officer at the Florida Hospital Nicholson Center, said he started collecting information on surgical robotics companies about six months ago to write profiles on them for his LinkedIn page. He said he thought that there would be about a dozen companies and that it would be a quick project.
“I’ve now posted on almost 40 robots, and my list isn’t done,” Smith said.
The Nicholson Center provides education on surgical robotics and other medical devices. Open since 2001, the center started training surgeons on laparoscopic instruments, but then expanded into robotic surgical systems a few years later. The center began training surgeons on Intuitive’s da Vinci surgical robots around 2007, Smith said.
A few years ago, the center expanded to include training of other robotic surgery systems, including the Mazor Robotics Mazor X spinal robotic system, and the Mako Robotics (now Stryker) robotic arm for joint replacement. More recently, the center has worked with Titan Medical and its SPORT Surgical System and TransEnterix and its Senhance surgical robotic system. According to Smith, discussions are continuing with additional robotics companies.
Companies work with the Nicholson Center to help train surgeons in the robotic systems both before and after they receive FDA approval, Smith said.
“If they haven’t passed FDA, they’re recruiting practicing surgeons to do specific procedures and measure their effectiveness with those procedures, and that data becomes part of their FDA application,” he said.
After the approval, the companies usually work with the training centers to give additional training support to surgeons and other medical staff.
“You don’t want to have a robot for sale and only have trained three surgeons on it,” Smith said. “You need to get a dozen or two dozen surgeons up to speed on it around the country.”
With more than 40 different companies making surgical robots, it can be hard to keep track of who is doing what. Here’s a quick overview:
|Company||Robotic system||Part(s) of the body|
|Intuitive Surgical||Da Vinci Surgical System||Abdomen, lungs, ENT (throat)|
|Titan Medical||SPORT Surgical System||Abdomen|
|Mazor Robotics||Mazor X, Renaissance Guidance System||Spine, brain|
|Strkyer / MAKO||Mako robotic arm||Knee, hip, joint replacement|
|Restoration Robotics||ARTAS Robotic System||Hair replacement|
|Auris Health||Monarch Platform||Lungs|
|TransEnterix||Senhance Surgical System||Abdomen|
|Medrobotics||Flex Robotic System||ENT (throat, larynx)|
|Medical Robotic Technologies||Preceyes||Eyes|
|Virtual Incision||Virtual Incision RASD||Abdomen|
|Veebot LLC||Veebot Venipuncture robot||Phlebotomy (veins)|
|EDAP TMS||Ablatherm HIFU||Prostate|
|Corindus Vascular Robots||CorPath GRX System||Heart (cardiovascular)|
|Hansen Medical||Magellan Robotic System||Heart (endovascular)|
|THINK Surgical||TSolution One Surgical System||Knee, hip, joint replacement|
|Smith & Nephew||NAVIO Surgical System||Knee|
|Medineering Surgical Robots||Brainlab CIRQ, Endoscope Robot||Brain, throat, head, neck|
|Synaptive Medical||Modus V digital microscopy||Brain|
|Zimmer Biomet (Medtech)||ROSA surgical robot||Brain, spine|
|Monteris Medical||NeuroBlate System||Brain|
Other systems include:
- AVRA Medical Robots’ AVRA Instrument Guidance System (AIGS).
- Johnson & Johnson Medical Devices, which recently acquired Orthotaxy.
- Renishaw neurological products and therapies.
- US Medical Innovations’ Canady Hybrid Plasma Scalpel.
- Verb Surgical’s digital surgery platform.
- Avatera’s robot-assisted surgery (Germany).
With this many robotics companies on the market, Smith said he expects some consolidation in the space, especially with robots that perform the same procedures.
IDC’s Santagate agreed, stating that consolidation over the next few years would be good for the overall market.
“I believe we will see companies expand their portfolio of surgical robotics technology, which will allow them to go to market with a common theme and be better positioned to drive adoption of the technology,” Santagate said.
Cost considerations for hospitals
In purchasing a surgical robot, hospitals need to consider additional costs beyond that of training the surgeon, Smith said. For example, supporting doctors and medical staff require training.
“The surgeon has to learn to use the robot [as well as] the operating room team, your physician’s assistant, the surgical techs who sit in the room,” he said. “They all have to learn something unique as well in order to support that surgery.”
In addition, hospitals would need storage space, training for sterilization technicians who have to clean the instruments, as well as other issues like scheduling personnel. (Only those trained on the system would be able to perform the surgery.)
“That’s where things start to become, just from an operational perspective, very difficult,” Smith said. “You start to think that there’s some absorption capacity of a hospital, where a hospital [administrator says], ‘At some point, I can’t absorb any more robots. It’s not that they’re not useful; it’s just that I can’t function with that many complex pieces of equipment in the OR.'”
That question is likely to happen down the road, though, as it’s still early in the market for surgical robots being placed in many hospitals. Smith said the emergence of new companies in the short term could reduce costs and stimulate competition among robot companies, especially those that compete for the same procedures.
Paging Dr. Robot; is autonomy down the road?
All of the robots coming out now are robot-assisted systems, which give the surgeon extra precision when performing the procedure. Smith said he expects fully autonomous robots down the road, but that robots would likely perform autonomously on certain tasks, not the whole procedure.
“There are certain things, like grasping a piece of tissue just so you can move it out of the way, that a robot might be able to take that job over, while the surgeon did the cutting and suturing,” Smith said. “Eventually, the robot itself might do the cutting and suturing, but you start with the little easy things, and you hand that off to the robot and then move on.”