The Robots are Coming!: to Save Your Life and Keep You Healthy

A robot designed by researchers at John Hopkins University recently performed complex soft tissue surgery on a pig without being guided by a doctor. This brings closer the day when AI-controlled androids perform operations on humans.

In the meantime, robot-assisted surgery is already here and primed for exponential expansion. Robotic arms allow surgeons to carry out procedures with greater precision, smaller incisions, less pain, reduced risk of error and shorter recovery times.

A number of commonly used technologies, including microwaves, GPS and digital photography, were born out of military or space exploration research. Robotic surgery has roots in both; NASA and the US military ran research programmes that pioneered some of the tech now being employed in operating theatres.

The use of a PUMA 560, an industrial robot arm, to insert a needle into a patient’s brain to remove a piece of tissue during an operation in California in 1985 is credited as the first robotic surgery. The automated arm eliminated the danger of any tremors in the surgeon’s hand, the slightest of which can be catastrophic in brain surgery.

A few years later a dedicated surgical robotic arm was developed at Imperial College London, while back in California another team was working on the Robodoc system that would soon be used for knee and hip replacements.

The 1980s and 1990s also saw the rise of laparoscopic surgeries: operations carried out using tiny cameras that allowed doctors to see inside patients and therefore required much smaller cuts, with all the benefits that come with that. Robotic surgical arms were the perfect complement to these so-called minimally invasive surgeries.

The da Vince mode

FDA approval in 2000 of the da Vinci Surgical System from California-headquartered Intuitive Surgical for multiple procedures was an undisputed game changer for robotic surgery. With four robot arms and a high-definition camera, the system is operated by a surgeon from a console, usually inside the operating theatre.

With 3D, high-resolution images displayed on a screen in the console, doctors have far better visual access to the vital area than during a regular operation, while being seated throughout helps reduce fatigue during long procedures.

More than 7 million operations using the da Vinci have been performed around the world, according to Intuitive Surgical. It is not without its critics, who most often point to the $2 million-plus price tag and high annual maintenance costs, leading to more expensive surgeries. There are also claims that for some procedures, patient outcomes are no better than they are with traditional surgery.

Opening the floodgates

The da Vinci has dominated robotic surgery for two decades, but many of the thousands of patents that Intuitive Surgical holds began to expire in 2019, opening up the market to intensified competition.

Ireland-based Medtronic, a major medical device firm, gained approval for its Hugo system to be used in surgeries in Europe last year, and it has already been employed in test cases in both South America and Asia. It is targeting FDA approval in the US for the second half of this year. Meanwhile, the UK’s CMR Surgical, which raised $600 million in funding last summer, currently has its Versius robot undergoing FDA approval.

DePuy Synthes, a Johnson & Johnson (J&J) subsidiary, is planning human trials this year for its robotic knee replacement system Velys. It will compete against Stryker’s Mako joint replacement system, which is already well established in that space, and Zimmer Biomet’s solution, which was approved last year.

J&J’s six-armed Ottava system, set to compete with da Vinci, has hit development issues and human trials have been pushed back from this year to 2024.

Domestic players

In addition to the major players, a host of start-ups and new entrants are looking to enter the robotic surgery field, including a number in Japan.

Kobe-headquartered Medicaroid, a joint venture between Kawasaki Heavy Industries and diagnostics specialist Sysmex Corp, became the first domestic robotic surgery company to have its tech approved by the Ministry of Health, Labour and Welfare. Its hinotori™ Surgical Robot System was used in a remote surgery simulation in April last year, carried out in collaboration with Kobe University and utilising Docomo’s 5G network.

The deployment of 5G, with super-high capacity and ultra-low latency (almost no delays), opens up the possibility of truly remote robotic surgery, where the doctor could be in a different city or even country (this was what sparked the US military’s original interest in robotic surgery, a plan to have surgeons operate remotely on soldiers injured in battle) .

Other potential market entrants include low-cost surgical robots from Riverfield, a start-up from the Tokyo Institute of Technology, and from A-Traction, a start-up from the National Cancer Center Hospital East in Chiba.

These new ventures are predicted to help drive the global surgical robot market from around $6.4 billion last year to $14.4 billion by 2026, according to MarketsandMarkets.

While robotic systems will not eliminate medical errors completely – they are still controlled by fallible humans – they should reduce incidents of harm to patients as the technology continues to advance. Growing competition should both further spur progress in the field and bring down the cost of procedures, making them accessible to more and more of those who need them.

By Gavin Blair