How robotic surgery’s past is informing its future

From transcontinental telesurgery to AI-powered procedures, tech is reshaping how and where surgery happens.

Robot-assisted surgery, which allows physicians to control a mechanical arm equipped with surgical instruments and a high-definition camera, has been a big part of this transformation.

The first robot platform was used on a human patient in 1985, though the field didn’t really take off until Intuitive Surgical’s da Vinci system for minimally invasive surgery launched in 2000. By 2018, 15.1% of US general surgery procedures involved robotic surgery, a 2020 JAMA Network Open study found.

Some studies suggest this technology makes minimally invasive surgery easier for physicians, reduces the length of hospital stays, and improves patient outcomes for procedures like prostatectomies and pancreatectomies. Countries including the UK are working toward using it for most minimally invasive surgeries, according to a June statement from the National Health Service in England.

But some experts question the cost effectiveness of robotic surgical systems.

A 2021 review of abdominal and pelvic procedures found robotics might not provide much improvement, noting there weren’t big differences in complication and mortality rates, the New York Times reported.

Other studies suggest they’re only worth the investment for “high-volume” systems.

They’re also not available to everyone. A 2022 analysis in the Journal of Robotic Surgery found US patients who were older, Black, or living in urban areas were less likely to receive robot-assisted surgeries.

Nonetheless, many medical professionals swear by robotic surgery. They believe, combined with technologies like machine learning or telemedicine, surgical robotics will continue to evolve worldwide and even help bridge care gaps.

“We’re not done yet by any means,” Russell Taylor, a Johns Hopkins professor and former IBM researcher who many consider one of the fathers of robotic surgery, told us. “There’s a lot of promise—both seen by commercial entities and by academics—about the future.”

AI opportunities

Juo-Tung Chen, a PhD student at Johns Hopkins University working on imitation learning for surgical robots, believes AI will take surgical robotics beyond its current capabilities, allowing the tech to fill more gaps in care amid surgical staff shortages.

He’s working with a team to develop algorithms for robotic surgical systems like da Vinci to perform surgery without help, learning via imitating videos. In July, Chen and others published a paper in the journal Science Robotics detailing how their system had successfully performed surgery on eight ex vivo gallbladders, a small step toward that future.

“In remote settings where they don’t have access to expert surgeons…having some kind of system that can perform basic surgery, that could definitely help,” Chen said.

Commercialization of this is a long way off, though—a matter of years, not months, he estimated.

Barriers to entry

These systems also come with a hefty price tag. A da Vinci system costs between $700,000 and $3.1 million, plus $100,000 to $225,000 in annual service fees, according to a July 23 10-Q filing by the company. (Intuitive didn’t respond to a request for comment.)

Safety-net hospitals, which treat low-income and Medicaid patients regardless of their ability to pay, struggle to afford that, Siva Vithiananthan, chief of surgery for Cambridge Health Alliance, a safety-net health system located just outside Boston, told Healthcare Brew.

In some cases, however, studies on specific conditions like large ventral hernias find the cost of robotics is made up in savings from factors such as shorter hospital stays. Robotic systems also make surgery less physically demanding for surgeons, theoretically allowing older physicians to stay in the field longer before retiring, Vithiananthan said.

Despite the high cost, “robotic surgery in safety-net hospitals has demonstrated tangible benefits for patients, providers, and institutions,” Vithiananthan said.

In addition, key US patents on many of Intuitive’s inventions expired starting in 2016, opening up the market to more competition from rivals like Medtronic, and—hopefully—cheaper prices.

The global surgical robots market was estimated to be worth $4.3 billion in 2024 and is projected to reach $9.6 billion by 2033, according to Grand View Research.

Going global

Meanwhile, telesurgery, where a surgeon remotely operates a robot from hundreds or thousands of miles away, has been held up as another way to improve care in under-resourced health systems.

The first transatlantic procedure was performed in 2001. But network connections weren’t fast enough to avoid noticeable lag times, and it didn’t take off. Though 5G has since decreased that lag time, the FDA still hasn’t approved a long-distance telesurgery device.

In June, the field got closer to that goal. Vipul Patel, a surgeon at Florida-based AdventHealth Global Robotics Institute, performed a robotic prostatectomy on a man in Angola—nearly 7,000 miles away—to treat prostate cancer, the most deadly cancer for men in the country, per the World Health Organization.

This was the first time the FDA had issued an investigational device exemption for transcontinental telesurgery, according to membership and advocacy group the Society of Robotic Surgery, of which Patel is executive director. This exemption authorizes the shipping of a device without premarket approval.

“Being able to democratize surgery globally, making expert surgical care not a factor of geography anymore through remote surgery, would be one of the greatest achievements of modern medicine and technology,” Shady Saikali, senior clinical fellow at the AdventHealth Global Robotics Institute, told Healthcare Brew.

Though that’s easier said than done. Robotic surgical systems are huge investments requiring sufficient network connections that some low-income countries don’t have as well as an additional $3,000 to $5,000 for each procedure, per a 2022 review in the Annals of Medical Surgery.

Of course, there are simpler ways to bridge the care gap, Saikali said. This includes increasing training opportunities for local surgical teams, bringing in out-of-state surgeons, or flying patients to countries that have the required resources.

“The underserved community should have a true lack of surgical expertise in multiple specialties with a gaping surgical inequity to justify investing in telesurgery as opposed to cheaper alternatives,” Saikali said.

This is one of the stories of our Quarter Century Project, which highlights the various ways industry has changed over the last 25 years. Check back each month for new pieces in this series and explore our timeline featuring the ongoing series.

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