It’s hard to believe it has been almost two decades since the launch of Intuitive Surgical’s first da Vinci system. And yet the robotic-assisted surgery field is still in its infancy in many ways.
“Today, there is no university program on robotic-assisted surgery,” said Sal Brogna, Intuitive’s executive vice president and chief operating officer. “We’re in the early stages of creating a whole new technology sector. I assume you’re going to universities one day and they’re going to have robotic-assisted surgery courses, but we’re creating it now.”
“It was a great journey for us, very rewarding,” Brogna told MD+DI. “Obviously we started in a very simple place that was a very compelling story,’ let’s make robotics help cardiac surgeons by bypassing. We never met all the cardiac surgeon requirements, but as we moved in and other people saw the technology–and that was the fun part about the business–as other surgeons saw the technology emerge, they found applications that were relevant, the urologists being the first to bring it into the prostate [procedures]. Over the years, it has been a great learning experience because we work closely with surgeons and as more and more specialties came to us, we had to add features and capabilities that previous generations did not have.
“The fourth generation da Vinci product family, specifically the da Vinci Xi platform, was strongly focused on the general surgery market, Brogna said. There’s technology from our da Vinci SP that we’re just releasing that’s been released four years ago in our Xi product. Getting to Da Vinci Sp took us 12 years and it was a tremendous learning challenge.
Brogna also touched on the latest technological development of the company, which is a flexible catheter program that FDA is still reviewing. If cleared, this device allows surgeons to navigate the body through natural orifices without the need for surgical incision. Raynham, MA-based Medrobotics, has been given clearance by FDA to market its Flex Robotic System for colorectal procedures, making it the first such system to reach the U.S. market for this indication. The technology, described as slithering as a snake, is expected to provide new treatment options for colorectal surgeons that may not be possible with traditional instruments. “Many of the ideas we see coming from competitors are ideas we’ve tried and rejected in some cases, whether for workflow improvements or safety or cost-effectiveness requirements,” Brogna said. “Each of them is beautiful and novel, and we welcome their inventiveness and welcome the challenge they bring to the marketplace.” Competition is good for the industry, he added, partly because it encourages Intuitive to come up with the opportunity and strengthen its own product lines.
“We’re following the competition, we’re hoping they’ll be able to get to the market because it validates a market we’ve taken 23 years to get really established, and it’s encouraging to see,” Brogna said. “At the end of the day, I think all patients will have better outcomes and less variability, and I think robotic-assisted surgery will clearly be the future of all surgery. It’s just a matter of how long it takes for us to evolve and give all the surgeons they need.”
This isn’t Your Father’s Spine Surgery
One of the most promising areas of robotic-assisted surgery is in spine procedures. Last week, Medtronic made a big splash with the news it agreed to acquire Caesarea, Mazor Robotics based in Isreal. Through a multi-phase strategic and equity investment agreement, the two companies first began working together in May 2016. Last year, Medtronic became the Mazor X system’s exclusive global distributor, leading to more than 80 Mazor X systems installed since its launch. In 2011, Mazor launched its Renaissance Guidance System for brain and spine procedures and in October 2016 launched the Mazor X spine procedures system. While the company no longer discloses direct placement numbers, at the end of 2017 Mazor had a worldwide 188 installation base, including 129 in the U.S. Geoff Martha, executive vice president and chairman of Medtronic’s Restorative Therapies Group, took some time to talk to MD+DI about the company’s vision for robotic-assisted surgery during this week’s North American Spine Society meeting in Los Angeles. “The vision is bold enough. I mean, the vision is to transform spine surgery, “said Martha.” Right now, the outcomes in spine surgery are not sufficiently consistent, there are too many variations across the board, and this has led to patients lacking confidence in spine surgery. It’s something that’s needed if you have a structural problem in your back, but unfortunately the results have been too variable.
“The days of open spine surgery where the surgeon relies on his or her experience over time without the help of enabling technologies such as intraoperative imaging and surgical navigation to come to an end.” We think it’s definitely moving to a spot where it’s going to be possible. That’s where Mazor is coming in. “People are talking about robotics, but we think robotic surgery is much more than just a robotic arm,” he said. “It’s pre-operative planning software, a robotic arm, interoperative 3D imaging, navigation, powered instruments… all of this needs to work together seamlessly to enable these better outcomes.”
Martha noted that Medtronic also has experience in seamlessly integrating these types of technologies into the workflow of the surgeon to remove some of the barriers of adoption. “This is the first meaningful and sustainable competitive differentiation we’ve seen over the past decade in the spine industry,” he said. “This is something we believe the industry will define.” That said, other large spine companies are also helping to shape the market with robotic surgical systems.