2018 could see a robotic surgery shake-up

surgery

Since Intuitive Surgical’s da Vinci system earned the FDA nod in 2000, the company has enjoyed a sizable head start in the minimally invasive robotic surgery field. Competition has been brewing for years, from players large and small, but 2018 could be the year the market finally sees a shake-up.

North Carolina’s TransEnterix scored an FDA nod for its Senhance system in October, triggering a 75% bump in its stock price. The device, a rare new entrant to the robotic abdominal surgery market, is designed to make it easier to perform laparoscopic surgery. It is cleared for colorectal and gynecological surgery and features haptic feedback, so the surgeon can “feel” the tissue that the robotic arm is touching.

“New choices [for laparoscopic surgery] are needed that enhance the senses, control and comfort of the surgeon, minimize the invasiveness of surgery for the patient and maximize value for the hospital,” said TransEnterix CEO Todd Pope at the time.

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The increasing interest in robotic surgery is a natural consequence of the shift in patient care from inpatient medicine to outpatient medicine, and from invasive procedures to less invasive ones, said Andrew Schiff, managing partner at Aisling Capital, which invested in TransEnterix in 2009.

And just because Intuitive was first, doesn’t mean it’s getting complacent.

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“We place high value on continuing to innovate and invest roughly 10 percent of our revenues into research and development,” said Myriam Curet, Intuitive’s chief medical and scientific officer, via email.

“Hospitals and surgeons in cost-sensitive countries have told us that offering a variety of systems, at an array of price points, and with flexible financing options, is important,” Curet said.

With its latest system, the da Vinci X, CE-marked and FDA-cleared this year, Intuitive now offers a lower-cost base model to break into the market in “cost-sensitive countries.”

TransEnterix now faces the challenge of stimulating uptake of its Senhance system in hospitals. But Schiff doesn’t think of it so much as competition as an expansion in the robotic surgery field.

“It strikes me that there is plenty of room, as surgery becomes less invasive, for a number of companies to be in the area,” Schiff said.

“I think that having other companies in the robotic surgery market just raises awareness, in the same way that Prozac was one of the first selective serotonin reuptake inhibitors,” he said.

So what can we expect from this expanding field?

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In addition to working on its own robotics program, medtech mainstay Medtronic has been partnering with Israel’s Mazor Robotics on the latter’s guidance system for spine surgeries. The system launched in October 2016 and Medtronic assumed global distribution rights for the device in the spine market.

Medtronic also aims to launch its own robot in 2018 and start making “material revenues" the following year. Johnson & Johnson is also looking to enter the field, with Verb Surgical, its joint venture with Verily.

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Titan Medical is aiming for a 2019 launch—the Toronto-based company recently installed its first single-port robotic surgery system at a Florida hospital. Its unique selling point is the use of one port, or one incision, to perform procedures.

The U.K.’s Cambridge Medical Robotics is trying a new tack—instead of selling robots to hospitals for millions of dollars, it aims to provide modular robotic arms as part of a managed service. Hospitals would agree to perform a certain number of procedures over a period of time and CMR will do the rest—from surgeon training to instrumentation to assistance.

And who knows—maybe this is the robotics business model of the future.

“I think that a number of business models will probably be considered,” Schiff said. “Many of these companies have consumed a large amount of capital getting to where they are, so [the business model] may be somewhat dependent on their capacity to enter into agreements with hospitals and hospitals’ willingness to sign up for certain amounts of procedures. That discussion will evolve over the next few years.”