Irish surgeon Barry O’Reilly became the first doctor in the British Isles to use a robot to remove a uterus back in 2007. Hysterectomies traditionally require cutting the patient open, which means long recovery times, not to mention health risks. But with the robot, O’Reilly inserted instruments into small keyholes, which he then operated using controls and a camera attached to the robots. The result? A more precise operation and a shorter recovery time.
Such pioneering — O’Reilly has since done many of these procedures — came at a price. A model of that original robot, called Da Vinci, produced by the U.S. company Intuitive Surgical, cost around $1.6 million at the time. After 10 years, Intuitive stopped servicing the robot, forcing O’Reilly’s hospital — Cork University Maternity Hospital — to buy a newer model, at a cost of $2.2 million.
Intuitive Surgical can do this because it holds a monopoly on surgical robots, based off a range of patents it acquired for its technology, first developed during the ’80s and ’90s at the California nonprofit research institute SRI International. Some of the technology was developed through research done by military R&D organization DARPA. But all that’s about to change.
IN THE NEXT TWO TO THREE YEARS, COMPETITION COULD BRING THE PRICE DOWN.
BARRY O’REILLY, IRISH SURGEON
Key patents are starting to run out for Intuitive. That has spurred a range of new companies to move into the market. Medtronic, a massive medical device company employing more than 80,000 people, is moving into the space. U.K.-based CMR Surgical has raised $380 million in capital to challenge Intuitive. And both Alphabet — Google’s parent company — and Johnson & Johnson are backing the startup Verb Surgical to push its own robots. It’s little surprise then that the global market for surgical robots is expected to nearly triple, from $4.5 billion in 2016 to $12.1 billion in 2025.
This push could make robotic surgery more accessible, and greater competition could prompt quicker innovation in the field, say experts. For patients, long recovery times might become a thing of the past for a range of surgeries.
Among Intuitive’s most famous technologies is the EndoWrist, a sort of multiheaded tentacle that can, for example, both hold tissue and make incisions. Several patents for that technology still remain for a few years with Intuitive, but other companies have been starting to develop their own alternatives and encroach on the incumbent’s terrain. In 2017, Ethicon, a Johnson & Johnson subsidiary, even sued Intuitive, alleging certain EndoWrist technologies violated its technologies. At the same time, other patents are expiring. One for a medical robotic arm attached to an operating table intended for cardiac surgery expired on Dec. 20, 2019.
Breaking the monopoly won’t be easy. “For years, there have been rumors of new players entering the market, but so far they haven’t arrived,” says Geert Vandenbroucke, a Belgian anesthesiologist who co-founded Orsi Academy, a training center for robotic surgeons. Intuitive could, for example, invest monopoly proceeds into R&D. Surgeons trained in Da Vinci systems will need to be retrained on new robots. Besides, it also takes a lot of time to get new robots medically tested and approved by authorities, which slows down competitors.
Nevertheless, with the entry of power players like Alphabet and Johnson & Johnson, “it looks like the monopoly is about to end,” says Emmanuel Vander Poorten, an assistant professor specializing in robotic surgery at KU Leuven, a Belgian university. “New systems are being tested, as we speak, in hospitals, and the companies behind this push to open the market aren’t exactly small players.”
Wider use of robots in the operating theater would in turn allow for other applications. Telesurgery — in which the robot isn’t operated by a surgeon in the same room but potentially by one on the other side of the world — could become more common. Coupled with new ultrafast networks like 5G, that could allow people living in rural areas or developing countries without surgeons to have surgeries in local hospitals equipped with a robot, instead of having to travel thousands of miles for treatment.
And robots could push surgery into the digital age. “The level of automation will increase,” says Vander Poorten, noting that when surgical procedures are robotized, tedious and repetitive tasks can start to be automated. Vandenbroucke adds that large batches of data might also enter the ward, improving medical safety in the future.
Even if its monopoly ends, Intuitive won’t necessarily go down. “I suspect Intuitive has plenty of capital ready to defend itself,” says Vander Poorten. But maybe that isn’t so bad. It would force the firm to take on its challengers with price and quality, not expensive surgical instruments. For patients, that’s good news.