Robotic Surgery: Future Opportunities and Challenges

Technological advancements and integration in robotic surgery

Technological advancements in robotic surgery are marked by increased integration of AI, navigation, and imaging, enhancing surgical precision and training. Companies like Intuitive Surgical and Medtronic emphasize overcoming implementation barriers and improving outcomes, while Stryker reports significant growth in robotic procedures, indicating a robust future for the field.

"As robotic surgery continues to increase in emergency general surgery, barriers to implementation need to be addressed and optimized through coordinated efforts across stakeholders. I will now turn to our financial outlook for 2024." --- (ISRG, earning call, 2024/Q1)

"So robotics, navigation, interoperative imaging, powered instruments, AI based surgical plans, all integrated together to take a spine surgery from an art to a science, take variable outcomes to make them less variable, take average surgeons, make them good surgeons." --- (MDT, conference, 2024/06/11)

"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/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/Q2)

"The digital interface of surgical robots enables a shift in the paradigm of surgical training, facilitating shorter learning curves that are more comprehensive and notably reducing the morbidity and mortality associated with them." --- (ISRG, earning call, 2024/Q2)

Market growth potential and cost implications

The robotic surgery market shows promising growth potential, with companies like JNJ and SYK projecting 5% to 11% growth rates. However, inflation poses cost challenges, impacting pricing strategies across the industry. Overall, the sector remains optimistic about future sales and market expansion despite these cost implications.

"And we've seen that, but we expect that to normalize in the back half. We remain consistent in our belief in the 5% to 7% growth for our end markets and that we will perform well within that. As it relates to pricing, inflation has not been a friend to our industry, and we have put a lot of effort into really ensuring that we can secure preferential pricing across the world." --- (JNJ, earning call, 2024/Q2)

"But following the pandemic, our growth momentum has continued and we had an absolutely outstanding year of sales growth of over 11% organic growth in 2023. Turning to the next slide, you can see that we are a very well diversified global medtech leader with strong market positions in orthopedics and spine and med surg and neurotechnology." --- (SYK, event transcript, 2024/05/09)

"Including Other revenue and the impact of foreign currency exchange, if recent foreign currency exchange rates hold, FY25 revenue growth on a reported basis would be in the range of 2.4% to 3.7%." --- (MDT, press release, 2024/05/23)

"Worldwide MedTech sales of $8 billion increased 4.4% with growth in the U.S. of 5.7% and 3.2% outside of the U.S. Acquisitions and divestitures had a positive impact of 40 basis points on sales growth in the quarter." --- (JNJ, earning call, 2024/Q2)

"We remain bullish about our deal pipeline and we expect continued activity as we move into the back half of the year. We delivered quarterly adjusted EPS of $2.81, reflecting 10.6% growth compared to the second quarter of 2023." --- (SYK, earning call, 2024/Q2)

Regulatory challenges facing robotic surgery

Regulatory challenges in robotic surgery include the need for robust training and proctoring networks, as highlighted by Intuitive Surgical's focus on these areas for their new platform launches. Additionally, obtaining FDA clearances, like for the da Vinci SP system, demonstrates progress in navigating regulatory hurdles.

"That's been a challenge. But we are seeing some shifting of procedures to lower acuity settings to make room." --- (MDT, earning call, 2025/Q1)

"We will be measured in our thoracic indication launch, as we work to build a robust training and proctoring network, as well as bring stapling to our SP platform. In closing, we are committed to our 2024 priorities, supporting our measured launch of da Vinci 5 and our other new platforms by region, supporting surgeons adoption of focus procedures, continuing to improve product quality and margins and finally improving productivity in those functions that benefit from global scale. I'll now turn the time over to Jamie, who will take you through our finances in greater detail." --- (ISRG, earning call, 2024/Q2)

"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)

Training and education for surgeons

Surgeon training and education are pivotal for advancing robotic surgery. Companies like HCA Healthcare emphasize their role in training physicians, while Intuitive Surgical highlights surgeons' adaptability and enthusiasm. Medtronic's positive feedback from training initiatives further underscores the importance of effective education in this evolving field.

"We're the largest trainer of graduate medical education physicians in the country." --- (HCA, conference, 2024/05/28)

"And I think that the surgeons here are building on that. They're learning from and adapting what they see in the rest of the world and getting excited about it." --- (ISRG, earning call, 2024/Q1)

"And, of course, we love our position. And as you have seen, the demand for Mako would not be this strong if you didn't have surgeons that are really excited about doing all of these procedures. And I think I mentioned earlier, July is off to a very strong start." --- (SYK, earning call, 2024/Q2)

"Since gaining approval last year, we've been training physicians, and we're getting very favorable feedback from both clinicians and patients." --- (MDT, earning call, 2024/Q2)

"And then the workforce development agenda that we have as a company with our Galen College of Nursing, with our graduate medical education programs and so forth are going to allow us to integrate the next generation of talent into our company culturally, systematically in ways that we think are going to be more efficient for us." --- (HCA, conference, 2024/05/14)

Patient outcomes and effectiveness of robotic surgery

Robotic surgery is enhancing patient outcomes through increased adoption of minimally invasive techniques, as noted by Intuitive Surgical. Medtronic highlights phenomenal early results, while HCA emphasizes leveraging data to improve care. Stryker's technology supports surgeon precision, further contributing to enhanced safety and effectiveness in surgical procedures.

"The opportunity for these procedures is relatively modest, but continues to support the adoption of minimally invasive robotic surgery across a growing set of procedures. Now turning to the clinical side of our" --- (ISRG, earning call, 2024/Q1)

"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)

"We won't do it overnight. Some areas we can, but this is a tremendously exciting agenda for us as a management team, because we can improve on our patient outcomes and really get to achieving our mission at a higher level because we're leveraging the last real opportunity of scale in our company, and that is to use this incredible database to narrow the variation that exists in healthcare inside of our company and help support better outcomes across just about every dimension of our business." --- (HCA, conference, 2024/06/05)

"This innovative technology is designed to support surgeon precision by providing auditory and sensory alerts when approaching anatomical boundaries during spinal procedures and enhanced patient safety and outcomes." --- (SYK, earning call, 2024/Q2)

"System utilization remained strong, while capital placements continue to be impacted by delayed tenders and emerging domestic robotic systems.Now turning to the clinical side of our business. Each quarter on these calls, we highlight certain" --- (ISRG, earning call, 2024/Q2)

Future trends in robotic surgery technology

Future trends in robotic surgery technology indicate strong surgeon enthusiasm and ownership incentives, alongside rapid technological evolution. However, market dynamics, such as competition in China and uncertainties in specific procedures like bariatrics, may pose challenges to growth. Overall, demand for new technologies remains robust.

"There's just -- this is an undeniable trend. Surgeons love it. They get a piece of the action in terms of their ownership interest." --- (SYK, earning call, 2024/Q2)

"Placements in China continue to reflect the impact of domestic robotic competition and delayed tenders due to a broader central government focus on systematic governance across sectors, including healthcare." --- (ISRG, earning call, 2024/Q1)

"Sean Salmon: Thanks, Larry. First of all, the business is doing exceptionally well in the sequential growth that we've seen and the demand and interest coming out of both HRS and ERA for our new technologies is really astonishingly great." --- (MDT, earning call, 2024/Q2)

"The underlying technology is evolving rapidly. And I see it as a long term journey for everyone across the field." --- (GOOG, event transcript, 2024/06/07)

"It is unclear whether the decline in U.S. bariatric procedures will continue to be a temporary pause as patients evaluate new drug therapies or if growth in U.S. bariatric procedures will return in future periods." --- (ISRG, sec filing, 2024/Q2)

Competitive landscape in robotic surgery market

The competitive landscape in the robotic surgery market is evolving, with companies like Abbott and Stryker reporting growth driven by new products and international demand. Medtronic emphasizes its competitive edge, while Intuitive Surgical sees increased placements of its da Vinci systems, indicating robust market dynamics.

"In the U.S. with competitive activity, that’s kind of slowed down a little bit of the growth, but I think with TriClip now coming into the market and gaining traction, we’ll be able to provide a value proposition across both repair systems and drive there. So structural heart, the growth rate has accelerated from Q1, doing very well." --- (ABT, earning call, 2024/Q2)

"Thank you so much. It seems like orthopedic robotics update stepped up for the market in Q1 or at least it was better than expected." --- (ZBH, earning call, 2024/Q1)

"Our strong results were led by double-digit organic growth in instruments, neuro cranial and Mako and high single digit growth in our medical, endoscopy, neurovascular, trauma and extremities and knee businesses. Internationally, our organic sales growth accelerated from the first quarter with strength in Europe, emerging markets, Australia, New Zealand and Japan." --- (SYK, earning call, 2024/Q2)

"got a nice competitive product now. We've got even industry leading product coming." --- (MDT, conference, 2024/06/11)

"The increase in system placements was primarily driven by 70 da Vinci 5 system placements and continued 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/Q2)