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Welcome to the Next Wave of Robotic Surgery

You’ve been left for dead by your former mentor, abandoned near a molten-lava river, both of your legs lost below the knee by way of lightsaber strikes. Gone, too, is most of your left arm.

You’d already lost your right arm in previous combat and had it replaced with a fully functional cybernetic prosthesis, but, still, you’re nothing more than a stump.

Heat from the river lights up your whole body, and the hot gas you’re inhaling is destroying your lungs.

You’re rushed to a team of robots for emergency surgery, where you’ll become “more machine than man,” supported by a mobile life-support system encased in armor.

It’s easy to dismiss robotic surgery as a thing of sci-fi, a pivotal moment in the saga that saw Anakin Skywalker become Darth Vader.

Consider, however, the cinematic version of another beloved work of sci-fi/fantasy, Orson Scott Card’s Ender’s Game.

A major character in that legendary narrative suffers a catastrophic head injury during a combat exercise. He undergoes an operation, during which a robot opens his skull to fix his brain.

The robot used in the film was conceived and built at the University of Washington. To film the surgery scene, engineers operated the robot for 14 hours, including a close-up shot.1

The U-Dub’s BioRobotics Laboratory’s Raven II is actually a second-generation surgical robot, the follow-up to Raven I, which was built following an inquiry 10 years ago by the U.S. Army about technology for remote medical care.

Indeed, “Surgical robots have entered the field in force.”2 And that, according to the journal Annals of Surgery, was as of 2004.

Robotic surgery is actually part of our past. It’s also a rapidly developing technology in the present and a critical part of the future of medicine.

The first “minimally invasive surgery,” a laparoscopic cholecystectomy, was performed in 1987.2

Since then we’ve seen considerable progress in technologies that have augmented the critical aspects of surgical robotics – including the ability to make extremely fine movements with extremely small implements, integration of large amounts of data and ultra-precise imaging, and a huge advance that enhances perception and manipulation via the sense of touch.

The list of procedures has grown to include additional lower gastrointestinal (GI) surgeries as well as upper GI procedures, gynecological procedures such as benign and malignant hysterectomies, urological procedures such as nephrectomies and prostatectomies, and other operations including cardiothoracic and transoral operations.

But the “learning curve” (“the period during which a surgeon finds the procedure more difficult, takes longer, there is higher rate of complications and lower efficacy because of inexperience”3) remains both steep and long.

ECRI Institute actually recommends as part of its set of robotic surgery standards and practices that surgeons “perform at least 20 procedure-specific robotic surgeries” on patients just to maintain “annual privileging.”4

And procedures can be complicated by factors such as positioning of the patient vis-à-vis equipment, adding to the time the patient is under anesthesia.5

The advantages for patients, however, are many, including smaller scars, shorter hospital stays, quicker recovery times, and lower overall costs.

And for investors, the growth prospects are tantalizing.

Analysis by Bank of America Merrill Lynch, based on work done by Grand View Research, suggests the global market for medical robotics and computer-assisted surgical equipment will grow to $17.89 billion by 2022.6

Based on an estimated market value of $7.47 billion in 2014, that’s a compound annual growth rate of 13.29% over the next seven years.7

The advantages for patients, however, are many, including smaller scars, shorter hospital stays, quicker recovery times, and lower overall costs.

Intuitive Surgical Inc.’s (ISRG) da Vinci platform is the dominant robotic laparoscopic surgery system right now, with approximately 570,000 procedures completed in 2014. That’s up from about 320,000 in 2009.4

Several potential competitors are investing heavily in research and development in order to capitalize on broader health care trends as well as the specific growing demand for minimally invasive surgical procedures.

In December 2015 Alphabet Inc.’s (GOOG) Google and Johnson & Johnson (JNJ) announced the formation of Verb Surgical Inc., the offspring of the strategic partnership between Ethicon, a medical devices subsidiary of J&J, and Verily Life Sciences, formerly Google Life Sciences.

The two behemoths will benefit from a tech platform developed by one of the world’s top independent research and technological development shops.

SRI Robotics “is licensing next-generation robotics technology to Verb Surgical that we believe will impact both the open and minimally invasive surgery markets and ultimately make the benefits of robotic surgery accessible to more patients around the world.”12

SRI was founded in 1946 as Stanford Research Institute. Independent since 1970, the non-profit organization is focused on finding “world-changing solutions to make people safer, healthier, and more productive.”

Verb will use SRI’s tech as it integrates “advanced imaging, data analysis, and machine learning to remove variation, enable greater efficiency and provide better outcomes across the spectrum of surgery.”12

(As TechCrunch reported in April 2016, SRI “is spinning off part of its robotics division into a new company called Superflex. It won’t be focusing not on industrial robots or the like, but rather robotic augmentations for people – mainly to help the disabled take on everyday tasks.”8

(So, it seems SRI’s engineers the go-to guys if you ever find yourself stumped by lightsabers, scorched by molten lava, and in need of new cybernetic limbs for the day-to-day stuff related to dominating the known galaxy.)

It’s a broad market, with the potential for literally millions of procedures that can be done.

For example, Israel-based Mazor Robotics Ltd.’s (MZOR) flagship Renaissance system has been used to perform more than 16,000 spinal surgeries, and in 2014 it got the OK from the Food and Drug Administration for use in brain surgeries.

Based on an estimated market value of $7.47 billion in 2014, that’s a compound annual growth rate of 13.29% over the next seven years.

In May 2016 Medtronic Plc (MDT) bought 4% of Mazor for about $12 million, with the option to buy an additional 11% of the company should it meet certain sales benchmarks.

Privately held Virtual Incision Corp.’s miniature robot will enable minimally invasive alternatives to colon resection surgeries for patients with lower gastrointestinal diseases such as colon cancer, Crohn’s disease and ulcerative colitis, and diverticulitis.9

It completed a successful first-in-human colon resection in March 2016.

Here’s the really startling part of Virtual Incision’s innovative approach to minimally invasive surgery:

“In contrast to today’s large mainframe-like robots that reach into the body from outside the patient, Virtual Incision’s less-invasive robot platform design features a small, self-contained surgical device that is inserted in its entirety through a single incision in the patient’s abdomen. Designed to utilize existing tools and techniques familiar to surgeons, Virtual Incision’s robot will not require a dedicated operating room or specialized infrastructure, and, because of its much smaller size, is expected to be significantly less expensive than existing robotic alternatives for laparoscopic surgery. Due to these technological advances, the system could enable a minimally invasive approach to procedures performed in open surgery today.”10

Virtual Incision’s technology earned a 2015 Game Changer Award from Robotics Business Review in the Medical and Surgical category.

Because it’s relatively simple and relies on “existing tools and techniques known to surgeons,” there’s significant potential for Virtual Incision’s in vivo approach to solve the learning curve and duration-of-operation issues.

Merriam-Webster defines “in vivo” as “in the living body of a plant or animal.”11

So the robot goes inside your body to help the surgeon perform the operation.

That’s the kind of stuff that will drive robotic surgery into a huge growth phase, beyond the dramatics of the silver screen.

Money Quote

“It is health that is real wealth and not pieces of gold and silver.”

–Mahatma Gandhi

Smart Investing,

David Dittman
Editorial Director, Wall Street Daily

1 Michelle Ma, “UW Surgical Robot Featured in 2013 Movie ‘Ender’s Game,'”
2 Robotic Surgery: A Current Perspective
3 Learning Curve in Robotic Surgery: Review of the Literature
4 Robotic Surgery: Arm yourself with the latest information on pricing, performance, clinical efficacy, and safety
5 Anesthetic Considerations for Robotic Surgery
6 Thematic Investing: Robot Revolution – Global Robot & AI Primer
7 Medical Robotic Systems Market Analysis by Product and Segment Forecasts to 2022
8 Devin Coldeway, “SRI International Spins Off Robotics Project as Superflex, Aiming at Human Augmentation,”
9 Evan Ackerman, “Video Friday: Mini Surgical Robot, Precision Drones, and Bioinspired Robotics at Harvard,”
10 Virtual Incision Named a ‘Game Changer’
11 Merriam-Webster
12 SRI International Engineers New Robotic Technology for Verb Surgical

David Dittman

, Contributing Writer

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