Growth Prospects and Challenges in the Future of Robotic Surgery

Technological advancements in robotic surgery

Technological advancements in robotic surgery are marked by significant developments such as the integration of AI surgical planning and robotics, the achievement of over 1 million robotic procedures, and the launch of next-generation robotics. These innovations are driving increased adoption and standardization in surgical practices, enhancing clinical outcomes and economic efficiency.

"In March this year, Dr. Nicole Linares from the University of Texas Southwestern, along with colleagues from other hospitals and data support from the Intuitive Health Economics Outcomes Research Team, reported outcomes describing the use of robotic technology in emergency general surgery cases." --- (ISRG, earning call, 2024/Q1)

"And we see that continuing over the next several quarters here. And as Geoff mentioned, it's a combination of this technology portfolio, including AI surgical planning, including robotics, including power and surgical instrumentation imaging and navigation, putting that all together is creating this very attractive place where very good teams and reps and groups of people want to come together to work with Medtronic." --- (MDT, earning call, 2024/Q2)

"Also in the quarter, we reached over 1 million robotic total knee procedures performed to date with Mako and Triathlon. We expect the growing momentum in installations and utilization will continue to drive sustained growth in our hips and knees businesses." --- (SYK, earning call, 2024/Q1)

"It's one of the fastest growing navigation platforms in the U.S. So I would say the combination of triple taper stems, surgical impactors, and three different modalities of navigation put us in a position to regain market share in the U.S. and outside of the U.S. Outside of the U.S., we're going to be launching a second generation of robotics, hip posterior robotics, and that's another driver of share regaining." --- (ZBH, earning call, 2024/Q1)

"And you can see that grew by 52%. And this is where we see many of our customers moving from their operationalizing their robotics program to their standardizing now on robotics in surgery. And it's a function of their understanding of the clinical benefit and the fact that it's economically attractive because you get low complication rates, because you have lower length of step." --- (ISRG, event transcript, 2024/04/25)

Market demand and competitive landscape

The market for robotic surgery is experiencing significant growth driven by increased demand for system placements and technological advancements. However, competition is intensifying, with key players like Stryker and Intuitive Surgical navigating both domestic and international challenges to capture market share.

"Because our market shares are actually a little bit lower internationally, as we get Makos placed more of that business actually is coming from competitive accounts than they were in the United States." --- (SYK, earning call, 2024/Q2)

"The increase in system placements reflects an increase in demand for additional capacity by our customers as a result of procedure growth, partially offset by a smaller number of third-generation da Vinci systems available for trade-in." --- (ISRG, sec filing, 2024/Q1)

"That's an increasingly competitive market with another competitor in that space." --- (JNJ, conference, 2024/05/29)

"Consequently, the increasing prevalence of hypertension, the ongoing development of the industry, and the adoption of new technologies by market participants in the country are anticipated to stimulate the expansion of the market under study." --- (MDT, press release, 2024/07/16)

"So we've had tremendous growth, tremendous demand and our supply chain has really kicked in, in a strong way, and that puts us in a good position not only to deliver in the first quarter but also to deliver in the quarters ahead." --- (SYK, earning call, 2024/Q1)

Regulatory challenges in robotic surgery

Regulatory challenges in robotic surgery are significant, as evidenced by recent clearances obtained by Intuitive Surgical for their da Vinci SP system and other instruments in various markets, including Japan and the U.S. These achievements highlight ongoing efforts to navigate complex regulatory landscapes while expanding product offerings.

"In September 2022, we obtained regulatory clearance for our da Vinci SP surgical system in Japan for use in general surgeries, thoracic surgeries (excluding cardiac procedures and intercostal approaches), urologic surgeries, gynecologic surgeries, and transoral head and neck surgeries." --- (ISRG, sec filing, 2024/Q1)

"Additional Recent Highlights: Continued focus on site activations and patient enrollment of the BACKBEAT study.Company remains on track to provide strategic, clinical and regulatory updates on its Virtue SAB program in the second half of 2024.Appointed cardiovascular device industry expert John Mack, former President and General Manager of Cardiac Surgery at Medtronic, to the Board of Directors." --- (MDT, press release, 2024/08/12)

"Since 2022, we have additionally obtained regulatory clearances, approvals, and certifications for the following products: • In July 2024, we obtained FDA clearance for the use of our da Vinci SP surgical system in general thoracoscopic surgical procedures." --- (ISRG, sec filing, 2024/Q2)

"In 2019, the FDA cleared our Ion endoluminal system, which is a flexible, robotic-assisted, catheter-based platform that utilizes instruments and accessories for which the first cleared indication is minimally invasive biopsies in the lung." --- (ISRG, sec filing, 2024/Q1)

"In October 2022, we received regulatory clearance in Japan to market our 8 mm SureForm 30 Curved-Tip and Straight-Tip Stapler instruments and reloads for use in general, thoracic (except for cardiac), gynecologic, and urologic surgery." --- (ISRG, sec filing, 2024/Q1)

Cost implications for healthcare providers

Healthcare providers face significant cost implications with robotic surgery, as companies like Intuitive Surgical emphasize efficiency and alignment with hospital economic objectives. Understanding cost pressures and striving to lower treatment costs per patient episode are crucial for managing these financial impacts effectively.

"The $0.40 to $0.45 per share increase in this estimate is primarily related to care provider financial support and costs for producing and mailing the consumer notifications that will begin later this month." --- (UNH, earning call, 2024/Q2)

"How efficient is it? How much autonomy do they have? And finally, and of course, typically, where you have high health care costs relative to GDP, we look for lowering total cost to treat per patient episode." --- (ISRG, AGM, 2024/04/25-27)

"We think we have a much better handle on hospital based physicians and the cost pressures there this year than we did last year." --- (HCA, conference, 2024/06/05)

"And so we think about the economic objectives of our hospital customers and we look to align our value that we create for them economically also." --- (ISRG, event transcript, 2024/04/25-26)

Impact on patient outcomes and satisfaction

Robotic surgery is positively impacting patient outcomes and satisfaction, as evidenced by improved satisfaction metrics and strong early outcomes from new technologies. Companies like HCA and Medtronic emphasize their focus on enhancing clinical performance and addressing patient backlogs, which further supports timely and effective care.

"Our patient satisfaction continues to improve on a year-over-year basis in our emergency rooms and also on a sequential basis." --- (HCA, earning call, 2024/Q1)

"But to I think, Rich, to your earlier question about how the data from SMART and small annulus patients might then be extended to the broader patient population, I think it's really putting it all together in context, which is that we keep seeing and we know from prior gradients lead high gradients lead to bad outcomes in the future." --- (MDT, event transcript, 2024/04/07)

"Therefore, we expect that the impact of patient backlogs will be less significant on procedure volumes in 2024 than in the prior year." --- (ISRG, sec filing, 2024/Q1)

"So really strong growth in that category. Again, we are focused on throughput, patient satisfaction and high clinical performance with what we call our ER revitalization program." --- (HCA, earning call, 2024/Q2)

"And we're excited to ramp this technology up and make it available. The -- I will say that the level of excitement we're getting from physicians and from hospital systems about this new service line they can offer, as well as patients and the early outcomes for patients that have been treated on the sort of case-by-case basis have been really phenomenal." --- (MDT, earning call, 2025/Q1)

Future trends and innovations in robotic surgery

Future trends in robotic surgery are marked by increasing adoption in knee and hip procedures, driven by innovation that enhances patient experience and reduces surgery times. However, there remains uncertainty about the broader implications of these advancements.

"Our Knee growth reflects our market-leading position in robotic-assisted knee procedures and the continued strength of our installed base." --- (SYK, earning call, 2024/Q1)

"And so innovation in that context is in my opinion the strategy. And so if you're thinking that the comments on overall markets one step further, would you sort of say like, okay, we've had this sort of fluctuations with COVID, but right now we're in this sort of period of very stable strong utilization, but the real sort of juice is on the innovation side." --- (MDT, conference, 2024/06/11)

"What that means for future surgery, I think there's a range of opinions and I would not hang a lot of confidence on any of them just yet." --- (ISRG, earning call, 2024/Q1)

"And every quarter, the percent of hips and knees on the robot is actually increasing." --- (SYK, earning call, 2024/Q2)

"Now this innovation means a less stressful surgery for the patient and potentially shorter procedure times." --- (MDT, earning call, 2025/Q1)

Integration with existing surgical practices

Integration of robotic surgery with existing practices is advancing through technologies like Stryker's SurgiCount+ with Triton AI, enhancing real-time assessments. Companies like Medtronic and Intuitive Surgical are also focusing on integrating digital solutions and infrastructure improvements to support seamless adoption in surgical workflows.

"Our SurgiCount+ system integrated with Triton AI technology helps provide real-time assessment of blood loss during surgical procedures." --- (SYK, Twitter, 2024/06/14)

"With our specialty-specific EHRs, practice management, revenue cycle management and analytics solutions as well as products for patient engagement, payment processing and marketing, we are trusted by over 35,000 providers to drive clinical and operational success." --- (MDT, press release, 2024/04/10)

"You'll see some elements that get integrated into the existing platform and then you'll also see some additional digital products that will be also incorporated into the system over this sort of planned rollout of the system." --- (ISRG, conference, 2024/05/15)

"We also continue to invest in basic infrastructure in our facilities, whether it's capabilities and technology for our nurses or surgical equipment and so forth." --- (HCA, earning call, 2024/Q1)

"Retained surgical items can transpire in many departments, not just the operating room. No matter if you’re in an OR or labor and delivery department, track surgical sponges and assess real-time blood loss across the continuum of care with support from Stryker’s SurgiCount+ system, now integrated with Triton." --- (SYK, Twitter, 2024/07/17)

Training and skill development for surgeons

Surgeons are increasingly engaged in hands-on training and testing of new technologies, as highlighted by Intuitive Surgical's extensive involvement with hospital administrators and surgeons. Companies like Stryker and Medtronic emphasize innovation and skill development to enhance surgical outcomes, addressing the competitive landscape that necessitates continuous training for surgeons.

""While focusing on innovation and the integration of our implants, instrumentation and enabling technologies, we strive to help surgeons perform safe and efficient procedures that enable better patient outcomes. The first clinical cases using Spine Guidance Software with Copilot will begin in September, with a full commercial launch expected later this fall."" --- (SYK, press release, 2024/07/30)

""We bring in hospital administrators, surgeons to really, I would say almost 2,000 or so that were doing test drives."" --- (ISRG, conference, 2024/05/15)

"And then a couple of 3 years in for a Chief Operating Officer, maybe a little longer for a Chief Nursing Officer or even a CFO, there's a development program that's more formal for more of a early careerist where we're developing the talent, we're exposing them to corporate learnings, They're learning in the field." --- (HCA, conference, 2024/05/28)

"Medtronic has been putting technology into surgeons' hands for more than 60 years — and we’re continuing this innovation with software and computing." --- (MDT, press release, 2024/08/14)

"So you have surgeons that actually are getting squeezed out of operating because the ORs are being used for, let's call them more higher value, higher revenue producing procedures." --- (SYK, earning call, 2024/Q2)