Surgical Robots: Look Who's Coming To The OR

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The surgical artist
Robotic surgery today is virtually synonymous with the da Vinci system from Intuitive Surgical, which allows a surgeon to control a four-armed machine that can be used to perform minimally invasive surgery. Three of the arms are designed to wield surgical tools while the fourth probes the surgical site with a high-definition camera that sends a 3D image to the surgeon's console.

Although robots play other roles at hospitals, such as sorting and delivering medication, none of those applications has captured the public's imagination as much as the idea of robots performing surgery with inhuman precision. The da Vinci system is the most flexible example in production, capable of performing multiple operations. The next-most-significant surgical robots in use today are probably those from Mako Surgical, which are specialized machines for performing knee and hip replacement surgery.

Intuitive says it chose to name its product after Leonardo da Vinci because he designed the first "robot", a sort of animated suit of armor, plans for which were found in one of his sketchbooks. Intuitive's armor has been its patent portfolio. Competitors also face the steep challenge of designing a complex medical device and getting it approved for use.

Hospitals are looking for alternatives because of the cost of the da Vinci robot and its questionable impact on clinical outcomes. However, according to The Advisory Board Company, a healthcare technology advisory firm, the alternatives are years away from commercial availability. While those products are in development, Intuitive also has the opportunity to continue improving its own products.

"Competitors are going to have to come to market with something that is significantly cheaper or that demonstrates an outsize clinical benefit," said Rachel Klein, a research and insights consultant at The Advisory Board Company.

Competitors might be able to find a market opening, because the da Vinci system costs almost $2 million and comprises several large pieces of equipment that use up a lot of space in a hospital, Klein said. A couple of years ago, hospitals looking to showcase their cutting-edge technology were talking about adding a second robot. Today, they're more likely to be thinking about how to maximize the effectiveness of the equipment they already have.

With some studies questioning the assumption that robotic surgery really delivers superior clinical results, hospital leaders are also taking a second look at whether the da Vinci robot is being used effectively at their facilities and when its use is necessary, according to Klein. There seem to be a few procedures for which the da Vinci legitimately delivers superior results, she says. In other cases where other techniques for laparoscopic surgery are available, bringing a robot into the operating room could add to the cost and complexity of a procedure unnecessarily.

All that's needed to change the cost-benefit equation is the demonstration of greater benefits, ideally combined with lower cost and smaller units. But the upstarts will find Intuitive to be a formidable competitor.

Photo: Intuitive Surgical

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