When robotic surgery was first introduced to the Minimally Invasive Surgery (MIS) world more than a decade and a half ago, it was viewed as a revolutionary technology compared to the then available alternative of laparoscopic surgery.
The first pioneer in the field of robotic surgery, Intuitive Surgical, has marketed its da Vinci robotic surgery system by emphasizing that its technology can deliver improved dexterity, visualization and consistency in outcomes compared to manual laparoscopic surgery. While one of the downsides of robotic surgery compared to laparoscopic surgery is a perceived lack of tactile feel, surgeons who sit at a console a few feet from the patients are impressed with the immersive 3D stereoscopic high definition vision offered by the robotic surgery system. Robot-assisted surgery with fully wristed instruments gives a surgeon better precision and dexterity and a better 3DHD view of the surgical site. Surgeons no longer have to stand throughout the surgery and, therefore, do not tire as quickly. The robotic surgery system filters out hand tremors. Finally, the surgical robot can continuously be used by rotating surgery teams.
Since the turn of the century, da Vinci robot surgery placements and procedures have grown substantially. Robotic surgery is viewed as a standard of care by urologists who treat prostate cancer and by surgeons who specialize in cancer hysterectomy and in hernia repair. Approximately 750,000 da Vinci procedures were performed in 2016, up 15% from the previous year. This increase is a testament to the recognition by the surgical community of the significant advantages offered by robotic technology. In their most recent quarterly earnings report (Q1 2017), Intuitive Surgical reported that revenue grew to $674 million which is 13% higher than the $595 million in revenue generated in the first quarter of 2016.
While Intuitive with its da Vinci system has demonstrated clinical advantages in treating a variety of cancer procedures, and more recently hernia repair, the relatively high initial capital outlay and high operational costs of its robotic system continue to be an ongoing concern to hospital administrators. With a price tag approaching two million dollars, the cost for many hospitals can be prohibitive. In today’s healthcare environment, with steady downward pressure on reimbursements, many hospitals have struggled to achieve a return on investment (ROI) for their investment in robotics. Another concern is that OR efficiency is being compromised because there is a significant learning curve for experienced surgeons and OR team members. Finally, hospitals also continue to tackle the question of training and accrediting robotic surgeons and robotic OR staff. Whether the price of the robotic surgery systems will fall or rise or whether the OR efficiency will improve or get worse is a matter of conjecture. Some believe that as technology improves and more experience is gained with robotic systems, the price will fall and the efficiency will improve as the new entrants arrive in the market.
There are a number of companies that are currently developing robotic surgery systems. Each has its own unique advantages and approaches to robotic surgery. These new robotic surgery systems under development feature new surgical access approaches (single port vs. multi-port), and some have a relatively smaller footprint, more mobility and a lower price tag than current systems.
As the only supplier of robotic surgery systems, Intuitive has benefitted from the many new surgeons, particularly those in urology and gynecology, who received robotic surgical training as residents and who now want to work at only those hospitals that have robotic technology. Many hospitals have also touted their investment in robotics as their leadership in recognizing cutting-edge technology. Based on that perception, patients sometimes choose a hospital with a da Vinci system over one without.
New entrants in the robotic surgery market may change some of the market dynamics. For example, Titan Medical is approaching the anticipated filing of its U.S. FDA 510(k) application in the second half of 2018. Its robotic surgical system is a single incision robotically-assisted surgical system whereas many other currently available systems and those that are under development are multi-port systems. Intuitive has continued to innovate and has clearly seen strong potential in a single port surgical approach, as it is working on a single incision robotic surgery system known as “SP”. Although Intuitive has referred to the development of this new model as recently as its last investor conference call in April, the date of market introduction remains unclear.
Other new entrants include Medtronic and Johnson & Johnson, which has teamed up with Alphabet’s Verily in its VERB Surgical venture. TransEnterix has already entered the European market with its Senhance system. The only other company to have received FDA clearance on its soft-tissue robotic system is Medrobotics. Its Flex robotic system has received clearance for use in ear, nose and throat and colorectal surgery.
These new entrants with their unique approaches to robotic surgery further validate a growing demand for a robotic surgery market that is searching for lower cost alternatives with improved operational efficiency and enhanced clinical capabilities, at a time when healthcare costs and resulting patient outcomes are being more closely scrutinized in the United States and abroad.
Beverly Brooks, President, Brooks Communications, is a media relations advisor to Titan Medial Inc. Titan Medical is listed on the TSX (TMD) and the OTCQB (TITXF).
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