Robots represent a vision of the future, a vision that inspires two parts amazement and one part fear of being replaced by superior machines. In manufacturing, robots have been deployed since the 1960’s to exceed human precision and productivity. This same potential exists in the provision of healthcare, but to date robots have barely made a dent. Despite the $20B market cap of Intuitive Surgical, less than 2% of worldwide surgeries are performed robotically today, and penetration of this pioneering surgical robotic platform may be peaking.
A robotic invasion could be on the way, though, with a number of forces converging to give robots a boost in the healthcare sector.
Robotic technology is advancing
The current surgical robots essentially take a highly skilled surgeon and “super-humanize” them, with the help of 3-D visualization and enhanced precision through minimally invasive incisions. Intuitive is selling these benefits primarily in urology and gynecology cases, Mako Surgical for knees and hips (implantable hardware included), and Mazor Robotics in spine and ultimately brain procedures. Moving from the OR to the interventional suite, robots promise not just precision but also distancing the clinician from the radiation-emitting fluoroscopy in the procedure room. Hansen Medical, Stereotaxis and new entrant Corindus are targeting the vascular and electrophysiology labs with this value proposition.
The really game-changing robots, though, may be cooking in academic labs, taking advantage of ever increasing processing power and communication technologies to truly extend beyond human and even geographic boundaries. The Raven surgical robotic platform, was initially funded by the US Army in pursuit of telerobotic surgery, the concept of a highly trained surgeon in one location performing surgery on a truly remote patient (e.g. in space). Back on earth, the Harvard Biorobotics Lab is leveraging the Raven’s open source software and powerful computing capabilities to enable beating heart cardiac surgery using real-time 3-D ultrasound imaging to guide surgical instruments in tandem with moving heart structures. IBM’s Watson is now training its supercomputing smarts on complex diagnoses and treatment pathways, showing how logarithmic increases in processing power might one day drive not just clinical decisions but the interventions themselves.
Robots will get less expensive
In general, prices fall when production efficiency and competition increase; the robotics field is no exception. Over the next few years, Intuitive will be joined by new robotic surgery entrants starting a few Moore’s Law cycles ahead of da Vinci (see this S2N Blog on price disruption in med tech). Emerging robotic competitors include Titan Medical, audaciously naming its robot after another classical dead genius (Amadeus), and Medrobotics, with a flexible robotic system able to reach places the straight-armed da Vinci can’t access.
As robots fall in price, they will not only gain traction in high-value surgical and interventional procedures but also start performing more mundane healthcare functions. Several efforts are underway to develop “personal robotic assistants” or NurseBots, with Asia, motivated by a rapidly aging population in need of care and companionship, leading the charge. Panasonic has been piloting a hairwashing robot for hospitals and nursing homes, complete with 16-finger massage and hairspray application. A robot conceived at the Korea Institute of Robot and Convergence can sniff out soiled diapers and other problem situations is now being deployed in trials at nursing homes.
The data will catch up
Beyond whiz-bang engineering and reasonable price points, what the robotic revolution needs most is a compelling rationale for cash-strapped hospitals and health systems to get on board. So far Intuitive has sold the da Vinci more on sizzle than statistics, ultimately generating robot fatigue, skepticism and counter-data such as the recent JAMA article showing no advantage for robotic hysterectomies. Emerging competitors and Intuitive itself appear to be getting the message, investing more in controlled clinical and pharmaco-economic trials to support capital acquisition and utilization.
For the right technologies and applications, backed by sound data, the robotic future in healthcare should be a bright one.