August 02, 2016      

“Surgical robotics market to be worth $20 billion by 2021”


Robots in the OR

Scheduled for an inguinal hernia repair, I casually asked my surgeon if he’d be doing my repair using a robot-seeing they are so popular seemingly everywhere these days.

“Never!” he snarled, which seemed odd coming from the director and chief surgeon of gastrointestinal surgery at a mighty famous hospital in Boston.

Actually, I felt kind of relieved with his defiant snarl, and comforted as well that it would be a human in physical contact with my body rather than a multi-armed machine operated by a surgeon sitting at a console on the other side of the operating room.

Why was that a concern of mine?

Especially in view of the fact that since 2000, more than two million operations worldwide have been performed by about 3,000 da Vinci surgical robots.

Then too, I’d be out cold during the operation, so from my body’s perspective, who cares what or who’s doing what to me?

Was I being too cavalier with my health?

Intuitive Surgical, the California-based maker of the da Vinci surgical robot ($1.5 to $3 million) has faced at least 26…lawsuits from patients. Complaints include punctured blood vessels or organs, severe bowel injuries and sepsis (life-threatening infection).

Intuitive’s robot systems are also linked to at least 70 deaths reported to U.S. regulators since 2009, according to a review by Bloomberg.

My surgeon had a mini-laundry list of issues against surgical robots that maybe was a contributing factor for my shaky confidence level of machine laparoscopy.

Then too, we’ve all read the many publicized horror stories about surgical robots having an off day in the OR: massive bleeding after a robotic instrument inadvertently nicked a blood vessel or those who have been injured in other ways, such as accidental punctures, tears or burns.

The rise of such “adverse events” during various robotic procedures has led to new government scrutiny, as well as a cautionary statement from the American College of Obstetricians and Gynecologists: “Robotic surgery is not the only or the best minimally invasive approach to hysterectomy…nor is it the most cost-effective.”

That being said, there’s a veritable army of robot surgeons marching toward surgical suites.

Is a no choice moment hurrying near?

Even though many doctors see need for improvement-including wary patients like myself who don’t quite trust them-surgical robots are poised for big gains in operating rooms around the world.

Someday in the not-too-distant future maybe I won’t have a choice…and neither will my surgeon. It’ll be all robots all the time.

Reuters reports that “within five years, one in three U.S. surgeries – more than double current levels – is expected to be performed with robotic systems, with surgeons sitting at computer consoles guiding mechanical arms. Companies developing new robots also plan to expand their use in India and China; that’s a combined population of 2.6 billion.

Contenders and competitors

In addition to the aforementioned Intuitive da Vinci, the gold standard of OR surgical bots, here’s the lineup of the da Vinci’s contenders and competitors:

  1. Auris Surgical Robotics offers ARES, or Auris Robotic Endoscopy System, as a bronchoscope to visualize and treat lung conditions. Acquired Hansen Medical in April of 2016.
  2. Blue Belt Technologies (acquired by Smith & Nephew for $275 million) offers the Navio surgical system. Unicondylar and patellofemoral knee replacement software applications to guide surgeons in creating implant plans that localize components and balance soft-tissue.
  3. Corindus Vascular offers CorPath for robotic-assisted vascular interventions for radial, coronary and peripheral procedures.
  4. Hansen Medical, which makes robotically controlled transvenous catheters (acquired by Auris Surgical in April of 2016).
  5. Health Robotics (acquired by Aesynt) offers IV automation solutions. Aesynt is now the only company to offer automation solutions at every stage of medication delivery
  6. Mako Surgical (acquired by Stryker), which makes robots used for orthopedic procedures, such as knee resurfacing and hip replacements.
  7. Mazor Robotics offers robotic guidance systems for spine surgery. Additionally, Mazor’s Renaissance generally specializes in robot orthopedic surgery or neurosurgery.
  8. Medtronic, the second-largest maker of medical devices, acquired Covidien and plans to integrate Covidien’s electrosurgical hand pieces and accessories into a combined Medtronic/Covidien surgical robot similar to Intuitive’s product line (announcement expected Q3 2016).
  9. Titan Medical offers SPORT for Single Port Orifice Robotic Technology surgical robot, which is similar to the da Vinci system with its 3D visualization and intuitive finger controls, However, Titan looks to compete by offering its robot at a much more affordable price.
  10. TransEnterix offers ALF-X (acquired from Sofar in 2015 for $100 million); it’s a multi-port robotic system with platform-exclusive features, such as haptic feedback and eye-tracking camera control.
  11. TransEnterix offers the SurgiBot System which is a single-port, mobile, and robotically enhanced laparoscopic surgical platform, which – unlike the da Vinci system, which requires surgeons to sit behind a fixed console away from the patient – lets the surgeon operate in the sterile field. Failed to gain FDA approval in 2016; will try again.
  12. Verb Surgical (created by Johnson & Johnson’s (Ethicon) and Google) to create a surgical robotics platform that combines J&J’s device-making capabilities with Google’s machine learning, imaging analysis, and data analytics expertise.

Looks like fraidy cats like me will have little future choice than to have a surgical robot do the job.

To gain an edge, new robots will need to outperform laparoscopic surgery, said Dr. Dmitry Oleynikov, who heads a robotics task force for the Society of American Gastrointestinal and Endoscopic Surgeons.

Reuters’ New crop of robots to vie for space in the operating room report that surgeons “want robots to provide a way to feel the body’s tissue remotely, called haptic sensing, and better camera image quality.

“New systems also will need to be priced low enough to entice hospitals and outpatient surgical centers that have not yet invested in a da Vinci, as well as convince those with established robotic programs to consider a second vendor or switching suppliers altogether.

“That is where competitors can differentiate,” said Vik Srinivasan of the Advisory Board Co, a research and consulting firm that advises hospitals.

“Developers say they are paying attention. Verb Surgical, the J&J-Google venture that is investing about $250 million in its project, said creating a faster and easier-to-use system is a priority.

“Verb also envisions a system that is “always there, always on,” enabling the surgeon to use the robot for parts of a procedure as needed, said Chief Executive Scott Huennekens.”

Intuitive said it too is looking to improve technology at a reasonable cost, but newcomers will face the same challenges.