If you are having prostate surgery in the US, it is highly probable your procedure will be carried out by a robot.
Robot-assisted surgery has been available for more than a decade and has gained popularity because it allows operations to be carried out with potentially smaller incisions than conventional procedures. A YouTube video that shows two robotic hands delicately suturing a flap of skin back on to a grape demonstrates the precision that can be achieved. In many cases, patients now demand robot surgery.
“In the US, where patients have more choice in medical care, hospitals have to have these systems to attract customers,” says Simon Burnell, technology expert at PA consulting. “Whether it is right or not, this plays a significant part in the uptake.”
To date, the market has been dominated by a handful of companies, including: Intuitive Surgical, whose da Vinci system dominates the laparoscopic, or keyhole, surgery market; Hansen Medical, which makes robotically controlled catheters that can be inserted into blood vessels; and Mako Surgical, which makes robots used for knee resurfacing and hip replacements.
These companies have fared well. There are more than 3,300 da Vinci systems installed worldwide, and Intuitive had revenues of $2.13bn in 2014. The company, which is listed on Nasdaq, has a market capitalisation of $18.24bn. Hansen Medical made a loss in 2014 but is valued at $130m. Mako Surgical was bought by medical equipment maker Stryker for $1.65bn in 2013.
The problem with robotic surgery has been the expense, says Emmet Cole, a Texas-based technology writer who specialises in robot technology. A da Vinci system costs $1.25m-$2.3m, and instruments, which are limited to a maximum of 10 uses, cost a further $1,300-$2,200. For a da Vinci to be financially viable, hospitals need to perform between 150 and 300 procedures annually for six years, he says.
It is also unclear whether robotic surgery always offers clear benefits over traditional methods such as laparoscopy. In 2013 the American College of Obstetricians and Gynecologists (Acog) said robotic surgery was not the best, or even the second best, option for hysterectomies. “A study of more than 264,000 hysterectomy patients in 441 hospitals found that robotics added an average of $2,000 per procedure without any demonstrable benefit,” Acog said in a statement.
Companies entering the market may change some of these dynamics. Titan Medical is close to being given approval by the US Food and Drug Administration for its Single Port Orifice Robotic Technology surgical system, similar to da Vinci, but which is expected to have a lower cost of about $600,000.
The benefits may also increase as technologies develop. Aeon Scientific, a Swiss company, has developed a system of catheters that can be guided through blood vessels remotely using magnetic fields. “It is a safer system for patients, as the catheter in the patient is softer, reducing the risk of perforation,” says Dominik Bell, Aeon’s chief executive.
Aeon has so far installed one surgical system in Switzerland, and is reliant on funding from private investors.
Meanwhile, researchers at the Massachusetts Institute of Technology in the US are developing “squishy” surgical robots, which would be less likely to damage tissue when they travel through the body.
Other benefits could come from connecting surgical robots to other devices and sensors, which would provide a richer stream of feedback for surgeons while they are operating.
Aeon’s Dr Bell says: “Once clinics begin [to use more connected systems], we can get feedback, we can refine the sensors and algorithms, so the robots cannot only be steered more precisely but they can process the information to help the surgeon make better decisions.”
PA’s Mr Burnell says non-traditional companies are also entering the field. Google, for example, recently signed a deal with Johnson & Johnson’s medical device company, Ethicon, to create surgical robots that use artificial intelligence. Manufacturers may be expert at creating the surgical equipment, but Google will bring its big data analysis capabilities that will take this technology to a different level, he says.