The Next Era of Surgical Robots are Coming
Michael Spencer
A.I. Writer, researcher and curator - full-time Newsletter publication manager.
Hello Everyone,
Let me just say that I’m a huge robotics enthusiast, I even have a Newsletter dedicated to this.
?? I’m hope you are having a good summer. The current generation of the future of technology might lead us to a transhumanistic reality where we uplift our civilization’s science, healthcare, innovation and robotic helpers.
?? How will we end up enhancing our precision medicine, longevity, cognition, and well-being with technology in our lifetime? This is one of the most important questions for the future of healthcare today. There is a section of my Newsletter called Benefactor that often deals with healthcare being augmented by AI.
?? Our will to manifest a future technology might even help us redefine our humanity.
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We don't often consider the evolution of surgical robots as being part of the future of healthcare. But with aging populations in many countries, the costs of healthcare are going to rise in a staggering way. Think about it:
By the year 2030, as America's baby boomers enter their seventies and eighties, health spending will top $16 trillion, or 32 percent of GDP.
Today's Guest Post is By
Conrad Gray is the author of Humanity Redefined, one of the few Newsletters I pay to read. Conrad is what I call a ‘futurist’s futurist.’ He’s a prolific blogger with the best balance of depth and breadth of interest in future tech and its implications on our humanity. That’s essentially why I like to call Humanity Redefined a sister Newsletter of AI Supremacy.
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While I’m always watching the AI stocks, what about the robotic firms and stocks? In this article we’ll feature some public companies too, such as:
Stock Tickers of Surgical & Medical Robotics Companies
Surgical Robots are Getting Better Faster
Context:
?? Robots have been working in the manufacturing industry since the 1950s, but their entry into the realm of medicine was not until the 1990s, along with a demand for minimally invasive surgery.
?? Since then, the growth of the robotics industry, and the emergence of artificial intelligence (AI) technology, have driven advances in robotic surgery.
?? Robotic systems in medicine are relatively new, with the first arriving in just 1994.
I hope you enjoy today’s deep dive in healthcare robotics.
Image: British medtech firm CMR Surgical was profiled extensively over the course of 2019 as a key challenger to Intuitive Surgical’s market dominance. Credit: CMR Surgical
Surgical Robotic companies are going to get a lot better this decade. I asked Conrad for a further adaptation on what of his deep devices into the future of medical and surgical robotics.
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Meet Your New Surgeon–A Robot
By Conrad Gray
Do you remember that viral video of a surgical robot stitching a grape back together? That video was uploaded almost 10 years ago. Since then, the field of robotic surgery grew massively in terms of capabilities, investments and the number of robots deployed across the world.
These sophisticated medical machines promise to make surgeries less invasive, accelerate the recovery and healing process, and help patients to return to their normal lives more quickly. Surgeons, meanwhile, are offered a new way of performing surgeries with robots that provide unprecedented access to the human body and tools that feel like extensions of their own hands. Hospitals can benefit from increased patient turnaround and from the perception of being at the forefront of medical technology by having some of the most advanced medical devices available.
At least that’s what the advocates of surgical robots say.
In this article, we will explore the world of robotic-assisted surgery, what difference the surgical robots promise to make and meet nine companies, both established medical giants as well as young startups, innovating in this space.
The robot surgeons enter the operating room
It is needless to say that traditional surgeries are highly invasive procedures. To perform an operation, a surgeon must first make a large incision, wide enough to accommodate the surgeon's hands and tools, to access the problematic body part. Afterwards, the patient must recover from the surgery, a process that can be lengthy, painful, and uncomfortable.
To address the problems of traditional open surgery, surgeons invented laparoscopic surgeries (also known as keyhole surgeries). In laparoscopic surgeries, small incisions (usually 0.5–1.5 cm) are made in the abdomen to insert thin tubes with specialized instruments as well as tubes with a camera and light at the end. Because laparoscopic surgeries eliminate the need for large incisions, the recovery is quicker and less painful compared to traditional open surgery.
Laparoscopic surgeries are a significant advancement over traditional open surgeries, yet there is always potential for further improvements and innovations. One of those disruptive innovations is robotic-assisted surgeries (sometimes abbreviated as RAS). In many ways, robotic-assisted surgeries are similar to laparoscopic surgeries. Both procedures are minimally invasive and require only small incisions to insert the tools into the body. The key difference lies in the control of the tools: in laparoscopic surgeries, a surgeon directly manipulates the tools, whereas in robotic-assisted surgeries, the surgeon controls the tools via a robot. The surgeon uses specialized controls that translate their inputs into precise movements of the tools inside the patient's body.
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What does a robotic surgeon bring to the operating table?
Since robotic-assisted surgeries are in many ways upgraded laparoscopic surgeries, they inherit many of their benefits. They don’t need large incisions. Instead, they require only a few small holes, called ports, through which the instruments and camera are inserted into the body. This makes the recovery and healing process quicker, allowing patients to leave the hospital sooner. Patients returning faster to their normal life benefit hospitals, too, as it increases the hospital’s efficiency and reduces waiting times for procedures.
Surgeons also benefit from using surgical robots. Operations performed with these robots are less fatiguing. Instead of standing for hours and hunching over the patient, the surgeon can comfortably sit while operating the robot. The less physically demanding the procedures are, the lower the chances of mistakes. Moreover, thanks to better visualisation tools, surgeons can access more information about the surgery and the patient, such as 3D visualisations. Future surgical robots could be equipped with image recognition and built-in machine-learning algorithms to analyse in real-time the surgery and provide even more information to the surgeon.
Another benefit for surgeons is the increased precision provided by the sophisticated tools attached to the robotic arms. These tools, significantly smaller than traditional surgical instruments, offer a greater range of motion, and the robot can translate the surgeon's controls into precise movements in tight spaces within the body. Furthermore, as is the case with the introduction of new tools in any field, new surgical techniques could emerge that would be challenging or impossible to perform without a surgical robot. An example here is Neuralink’s surgical robot designed to insert electrodes thinner than a human hair for their brain-computer interface. The Neuralink team concluded that no human neurosurgeon is capable of manipulating those thin electrodes so they made a robot.
Additionally, robotic surgeons open the possibility of conducting remote surgeries. Remote surgeries are possible, but the biggest challenge preventing them from becoming common is network speeds. These kinds of procedures require ultra-fast networks with as low lag as possible. As networks become faster and more reliable, the prospect of remote surgeries becoming a common practice draws closer to reality. Such procedures can allow world-class specialists to perform surgeries in any place in the world from the comfort of their hospital, opening access to top surgeons to more patients, no matter where they are located.
Are we close to autonomous robotic surgeons?
Short answer, no. We are far away from autonomous robotic surgeons.
None of the currently available robotic surgeons are fully autonomous. Robots like Da Vinci are directly controlled by surgeons all the time. Some medical robots, such as the CyberKnife, a robotic system designed for radiotherapy, are to some degree autonomous but still require human supervision.
Creating a fully autonomous robotic surgeon is the Holy Grail of the field, yet there is no indication of such robots arriving anytime soon. The ability to autonomously perform a complex operation is an enormous challenge for robotics engineers. It is more likely that simpler aspects of surgical procedures will be automated first, such as suturing wounds, leaving the surgeon to focus on the main procedure.
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There are research projects pushing towards the vision of a fully autonomous surgical robot. An example here is STAR, a surgical robot developed at Johns Hopkins University (JHU), which successfully performed an almost autonomous keyhole surgery on a pig. Almost, because STAR needed some help from a human. As the team at JHU said, a fully autonomous STAR is likely decades away but they will continue work in the hope that in about five years, the technology will advance to the point where a first clinical trial on a human is possible.
But even if technological challenges could be overcome, the legal challenges could be the biggest barrier to fully autonomous surgical robots. A surgeon carries enormous responsibility. A single mistake can have dire consequences for the patient, and the surgeon can be sued if they make any mistakes. Adding an autonomous surgical robot to the mix only complicates the picture. If a robot makes a mistake and hurts the patient, who is to blame? The manufacturer? The surgeon overseeing the operation? The hospital?
The legal challenges that could face autonomous surgical robots remind me of the discussions surrounding self-driving cars and who is responsible if something goes wrong. However, in the operating room, the stakes are much higher.
Robotic surgery market
According to a report published by Bain & Company, the robotic surgery market was a $3 to $3.5 billion global market at the beginning of 2023, up from around $800 million in 2015. Another report estimated the value of the market at $5.16 billion in 2021 and projected it to reach $20.98 billion by 2030, while yet another report predicts the market value to reach $7.62 billion in 2024 and $11.76 billion by 2029. In either case, the image that emerges is that surgical robotics is a growing, multibillion-dollar market. As Bain & Company report states, 78% of US surgeons are interested in surgical robotics, which hints at the potential demand for these robots.
Robotic-assisted surgeries are frequently used by urologists, gynecologic surgeons, general surgeons, cardiothoracic surgeons, colorectal surgeons and orthopaedic surgeons.
Intuitive Surgical
Chances are that even if you haven’t heard about Intuitive Surgical, you have seen their robot. That video of a surgical robot stitching a grape back together - that was Intuitive’s Da Vinci robot.
Founded in 1995, Intuitive Surgical is the pioneer and the biggest company in the space of surgical robotics. They were the first surgical robot company to receive FDA approval in 2000. Since then, Intuitive has risen to become the leader in the space of surgical robotics.?
Intuitive Surgical currently offers a family of Da Vinci robots - Da Vinci 5, Da Vinci Xi, Da Vinci SP and Da Vinci X. The company boasts on their website that over 12 million procedures have been performed worldwide using Da Vinci systems up till 2022. In 2023 alone, the company added 2.3 million surgeries to that number. Every 17 seconds, somewhere in the world, a surgeon starts a procedure using one of over 7500 Da Vinci robots.
Today, Intuitive Surgical is a publicly listed company with a market capitalisation of $152.52 billion. It employs over 13,000 people. In 2023, the company generated $7.12 billion in revenue and $1.82 billion in net income. In 2024, Intuitive entered the Fortune 500 list, ranking #497.
Medtronic
Medtronic is the world’s largest medical device company, developing and producing all sorts of medical equipment since 1949 to treat more than 30 chronic diseases, including diabetes, chronic pain, cardiovascular diseases, and more.
In 2021, Medtronic entered the robotic-assisted surgery scene with Hugo to directly compete with the market leader, Intuitive Surgical. The first procedure using Hugo took place in 2021, at a hospital in Chennai, India. In 2022, the company announced the first procedure performed with Hugo in the US at Duke University Hospital in Durham, North Carolina. The same year, the first procedure using Hugo was performed in Europe, at OLV Hospital in Aalst, Belgium, and the robot received regulatory approval in Japan, Canada and the EU.
[Caption: Medtronic Hugo system]
Hugo combines wristed instruments, 3D visualisation, and Medtronic’s cloud-based surgical video capture and management solution, Touch Surgery Enterprise. The idea is to offer a multi-quadrant platform for a wide range of soft tissue procedures.
CMR Surgical
Based in Cambridge, UK, CMR Surgical began its journey in 2014 with a wooden prototype that would later become the surgical robot we know today as Versius.
Versius is a small and mobile surgical robot that can be easily moved across the hospital from one operating room to another. Unlike other robots that require the surgeon controlling the robot to sit inside a closed console, somewhat disconnected from their team, Versius features an open console, allowing the surgeon to maintain visual contact with their team. According to CMR, the open console design facilitates clear verbal and non-verbal communication within the surgical team.
As of 2023, 160 Versius robots have been installed in hospitals, performing 17,000 surgeries per year.
To date, CMR has raised $1.1 billion. In the latest funding round in September 2021, the British startup raised $600 million, bringing its valuation to over $3 billion.
Johnson & Johnson
Johnson & Johnson (J&J), a giant in the medical and pharmaceutical field, has been eyeing an entrance into the field of surgical robots for some time. In 2015, together with Verily, Google’s life science division, the company founded Verb Surgical to develop a surgical robot. In 2019, J&J took over Verb Surgical after Verily exited the partnership. Additionally, in an effort to build its internal medical robotics capabilities, J&J acquired two surgical robotics companies - the French company Orthotaxy in 2018 for an undisclosed sum and Auris Health in 2019 for $3.4 billion.
Currently, Johnson & Johnson is developing its own surgical robot named Ottava. Revealed to the public in 2020, Ottava is positioned to compete with surgical robots offered by Intuitive and Medtronic. Ottava will feature four robotic arms integrated with a standard-size surgical table, which will be hidden under the table when not in use.
In 2023, J&J announced plans to submit Ottava to the FDA for an investigational device exemption application, with the hope of beginning the first clinical trials in the second half of 2024. Initially, Ottava was scheduled to begin the verification and validation processes in 2021 and start clinical trials the following year.
Stryker
Stryker, another giant in the medical field, entered the robotic surgery field through the acquisition of MAKO Surgical Corp. at the end of 2013 for $1.65 billion.
Mako is a robotic surgery system designed for orthopaedic procedures, more specifically for total knee, total hip, and partial knee procedures. The robot combines three key technologies - CT scans, haptic feedback and analytics - to help the surgeon perform procedures more effectively and help patients recover quicker.
[Image caption: Stryker Mako. Source: Stryker]
Mako is a successful robotic system with over 1 million procedures performed in more than 40 countries. In Q4 2023, Stryker reported a record number of Mako installations globally in the quarter. In the US, Stryker saw 60% of its knee replacements and 34% of its hips performed using Mako at the end of the year.
Stryker plans to extend Mako’s capabilities to also include spine and shoulder surgeries. The former is coming in the third quarter of 2024 while the latter is coming near the end of the year. Additionally, the company is looking into incorporating new AI and machine learning features into Mako as well as the Microsoft HoloLens 2 mixed-reality headset.
Asensus Surgical
Founded in 2006, Asensus Surgical offers Senhance, a surgical robot that received FDA approval in 2017. Senhance has a track record of over 10,000 surgeries performed in 12 counties, with over 2,700 performed in 2023 alone.
Asensus is currently developing a next-generation surgical robot named LUNA. LUNA promises to have a 30% smaller footprint than Senhance, feature real-time surgical image analytics, and improved ergonomics. The company plans to complete the design this year and aims to receive FDA clearance in 2025.
Moon Surgical
Founded in 2019 in Paris, France, Moon Surgical is one of the young companies in the robotic surgery space and it brings Maestro, the robotic surgery assistant, to the table.
As Anne Osdoit, the CEO of Moon Surgical, explains in an interview with MedTech Dive, Maestro aims to bring surgeons to the table, not behind the screen away from their team and the patient. The robot is designed to assist the surgeon and hold the tools, a task that was previously done by assistants. With Maestro, the company hopes the staff can focus more on what matters the most—the patient.
Moon Surgical also hopes that, thanks to its lower price, simplicity, and smaller footprint compared to other surgical robots, Maestro will find a place in smaller, rural hospitals that otherwise would not be able to afford a machine from companies such as Intuitive.
Moon Surgical's Maestro System obtained the CE mark in September 2023 and has been used to treat over 200 patients to date in general, bariatric and gynecologic surgery at two European pilot sites. At the beginning of June 2024, Moon Surgical received the green light from the FDA and clearance for the commercial version of Maestro. The company will now be deploying its Maestro System in the United States and Europe in a Limited Market Release, ahead of a broader launch in 2025.
To date, Moon Surgical has raised a total of $92.2 million. Their last Series B funding round was in May 2023 and raised $55.4 million from companies such as Nvidia, Johnson & Johnson, and others.
Vicarious Surgical
Founded in 2014 by MIT alumni, Vicarious Surgical had an interesting vision for surgical robots. Inspired by the 1966 sci-fi movie Fantastic Voyage, Vicarious Surgical aims to develop tiny robotic versions of surgeons for abdominal surgeries.
To make that vision come true, Vicarious Surgical developed a tiny surgical robot with two arms that are very similar to human arms, complete with elbows and wrists. The robot is also equipped with a miniature 3D camera that sends images from inside the body to a VR headset worn by the surgeon. By combining human-like miniature robotic arms and VR, Vicarious’ solution allows surgeons to feel as though they are inside the patient’s body.
[Image caption: Vicarious Surgical Beta 2. Source: Vicarious Surgical]
Vicarious Surgical is a publicly traded company. The company entered the NYSE through a $1.1 billion SPAC deal in 2021. Before its IPO, the company raised $240 million and received investments from Bill Gates, Khosla Ventures, and others.
As the company was finalising its IPO, it was predicting that it would reach $1 billion in revenue by 2027 and planned to begin first-in-human trials in mid-2024. But that’s not what happened. At the beginning of 2023, Vicarious laid off 14% of its staff to streamline its operations. According to this article from The Robot Report, the company had at that time two years of cash runway. In November 2023, the company announced another round of layoffs.
Vicarious Surgical is currently focused on building Version 1.0 of their robot, which is expected to be completed in autumn 2024. The company plans to submit for FDA de novo approval in early to mid-2026.
Distalmotion
Dexter is a surgical robotic system developed by a Swiss company Distalmotion. Founded in 2012 as a spin-off from the Robotics Lab of the Swiss Federal Institute of Technology in Lausanne (EPFL), Distalmotion revealed Dexter in 2019. A year later, the company received a CE mark, making the robot ready for clinical trials in Europe. Dexter performed its first clinical case in 2021.
According to Distalmotion, Dexter was designed to make robotic surgeries more accessible. The robot fits into every clinical setting and it can be easily integrated into existing clinical infrastructure. Thanks to its mobility, Dexter can be easily moved around and shared across departments.
[Image caption: Source: Distalmotion]
Currently, Distalmotion’s Dexter is used in hospitals in France, Germany, and Switzerland. In May 2024, the company celebrated achieving over 1000 successful procedures using Dexter. The robot is used in general surgery procedures as well as in gynecology and urology procedures. Distalmotion says Dexter is well suited for both high-volume and complex surgeries.
Distalmotion has raised over $240 million so far. In their latest Series F funding round in April 2023, the company raised $150 million, which will be used to help the company receive FDA approval to enter the US market and to continue its expansion in Europe.
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