Since its first FDA clearance 15 years ago, the Da Vinci surgical robot by Intuitive Surgical has evolved into a more compact and capable machine. The newest FDA approved model, da Vinci Xi, has thinner arms, wider range of motion, longer reach within the body, and better visualization capabilities than ever before. By the end of 2014, approximately 3,266 da Vinci systems have been installed worldwide and were responsible for over 570,000 procedures in 2014. While more robotic procedures are being performed each year, procedure volume growth has been declining, from 16% in 2013 to 9% in 2014. Concurrently, revenues fell for 6 straight quarters between 2012 and 2014, going down by a total of 6%. The efficacy of the da Vinci system is also under fire as medical experts consistently reported minimal differences in the outcomes of robot-assisted surgery compared to conventional laparoscopy. This is certainly not enough to justify its $2 million USD upfront cost and a recurring service fee of over $100K per year. While Intuitive Surgical has gotten away with this through aggressive marketing tactics three years ago, in a time of Obamacare and healthcare cost containments, the future of robotics surgery does look a little grim today.

Amidst the growing concerns for the feasibility of robotic surgery, the US Department of Defense surprised us with a 5-year $430 million deal with Intuitive Surgical this March. Shortly after, Johnson & Johnson and Google announced a partnership to develop a new brand of surgical robots which could potentially integrate the surgical expertise of Ethicon with the user interface and data analysis experience of Google. This is to follow a long list of companies already developing their own robots, including TransEnterix, Titan Medical, MAKO Surgical, Mazor Robotics, and Memic Innovative Surgery. Are companies and investors simply jumping on a bandwagon, or is the value of surgical robots in fact greater than what many of us perceive?

Right now, all of the known surgical operations are on the scale of human eyes and hands. Robots can potentially shrink the scale of surgery to micrometers and perform operations previously unimaginable. Robotics can also make long-distance surgery possible. Having fewer personnel in the operating room and allowing doctors to operate on patients across the ocean could lower the cost and improve the quality of healthcare in the long term. At present, the biggest obstacle is the cost of the machine, which is currently regulated by the sole manufacturer­?Intuitive Surgical?with the only FDA-approved system. But as more players are coming into the market, the competition for manufacturing a cheaper system will drive the cost down to more affordable levels. If we had dismissed the cumbersome mainframes of the 50s as impractical and expensive, we wouldn?t be enjoying laptops and smart phones today.

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