The Robots are Coming. The Robots are Here.
A growing, aging population means a greater need for surgery. Increased life expectancy will be the primary driver behind increased surgical volume, and there are not enough surgeons to meet the demand.
WHAT ROBOTS ARE DOING NOW
Autonomously suturing soft tissue (pig intestine) as well or better than human surgeons in an experimental system.
Milling bone with submillimeter accuracy prior to placing joint implants.
Semi-autonomously harvesting and implanting individual follicles for hair transplantation.
Assisting neurosurgeons treating epilepsy. Robots place electrodes into the brain instead of on the brain surface and need 2–3 mm holes in the cranium instead of a 4×4 cm craniotomy. Robots can reduce operative time by half.
Assisting orthopedic surgeons in knee and hip replacement. Platforms offer real-time virtual imaging and robotic-arm guidance for cutting and removing diseased tissue and placing implants.
Assisting gynecologic, general, ENT and urologic surgeons in over 700,000 soft tissue procedures per year.
SEPARATING HYPE FROM REALITY
Today, we are still in the very early stages of the robotic surgery revolution.
Robotic surgery (or robotic-assisted surgery) promises to alleviate some of the anticipated surgeon shortage, but, for now, the technology doesn’t necessarily mean better health outcomes, decreased cost or across-the-board efficiencies.
Current data on the clinical benefit of robotic surgery is equivocal. For soft tis-sue, most studies show (at best) parity between robotic surgery and established methods of minimally invasive surgery. Though robotic surgery often cuts down on post-op recovery time, actual operative time is increased for many procedures (decreased for fewer), due in part to surgeons’ learning curve with the technology. Except in certain situations (prostate cancer, for example) there has been little ironclad evidence for robotic surgery’s improvement in morbidity or mortality.
For orthopedics, the data show that operative variables (implant positioning, soft tissue balancing) are better controlled with robotic surgery than with manual surgery. However, there have been few high- quality studies on patient functional outcomes and survivorship.
PLATFORMS IN HUMAN TRIAL PHASE OR APPROVED BY FDA OR CE MARK
Smith & Nephew
Smart Tissue Anastomosis Robot (START)
In 20 years, people will think it’s crazy that a doctor still does surgery.
ROBOTIC SURGICAL SYSTEMS COST A LOT UP FRONT AND HAVE HIGH RECURRING COSTS
A da Vinci laparoscopic robotics system (Intuitive Surgical) will set you back $1.5–$2 million. Annual service contracts run between $100,000 and $170,000, not including the cost of consumables—single use tools and supplies. It’s estimated that a facility needs to perform 100 robotic surgeries per year to produce a viable financial return within six years. Per case, da Vinci costs $3,000 more than traditional laparoscopic surgery for removal of an ovarian cyst, and up to 3x more for gallbladder removal.
Orthopedic robots can cost about $1 million up front. Knee joint replacement costs $2,700 more with a robot.
However, in a value-based reimbursement environment, costs will eventually be outweighed by improved outcomes and consequent savings.
» The economics of robotic surgery will win out. As the financial sophistication of healthcare organizations increases, and as value-based medicine takes hold, there will be more rigorous evaluation of major purchasing decisions, i.e., for surgical robots and robot assistants. Joint replacement, for example, costs more when performed with a robot. But with the advent of new bundled cost containment models (CMS’s Comprehensive Care for Joint Replacement Model), improved outcomes (fewer hospital admissions and joint revisions) will result in increased institutional revenue. If robots improve outcomes, thereby lowering overall costs, institutions will buy them. Goldman Sachs estimates that the number of robotic surgeries will double in the next two years.
» Efficacy data will improve. Robotic platforms that can demonstrate improved clinical outcomes and greater efficiency will dominate the market. In the next 20 years, premier robotics companies will lock in their customer base, and continue to make money off recurrent revenue streams (service contracts and consumables).
» Efficiency will improve as surgeons become more familiar and comfort-able with robotic platforms.
» New models of financing robot utilization (e.g., OMNIBotics’ pay-per-procedure) will lower the barrier to entry for healthcare organizations.
» The calculus behind whether to purchase a robot will change. Currently, the decision to purchase a surgical robot is often not based on cost considerations or improved patient outcomes, but rather on marketing and recruiting objectives: patients want the newest technology, conflating technology with quality; new surgeons, trained in robotics, want to employ those skills. Smaller hospitals in particular feel they are in an “arms race” for patients and talent against larger institutions, but their surgical volumes can be low. With increased hospital consolidation and the move toward providing surgical care at high-volume centers, smaller, lower volume institutions will evaluate hard cost-benefit metrics against softer ones like marketing and recruiting.
In 100 years, we will think it was crazy that we used to cut the body open.