Medical robots have great market potential, and the cost dilemma needs to be broken by domestic production.
1. Development scale of the medical robot market
In 2014, global sales of medical robots reached 1,224 units, a compound annual growth rate of 12.2% compared to 386 units sold in 2004.
The commercial robot market reached $5.9 billion in 2015, primarily benefiting from the rapid growth of medical and surgical robots, which account for a significant share of commercial robots. The market share is expected to reach $17 billion by 2025, replacing the military robot sector as the second-largest robot market.
As of January 2016, the global medical robot industry generates annual revenue of $7.47 billion, with an expected compound annual growth rate of 15.4% over the next five years. By 2020, the global medical robot market is expected to reach $11.4 billion, with surgical robots accounting for about 60% of the market share.
Currently, North America is the largest market, but due to increased government healthcare investment, restructuring of healthcare systems, and heightened awareness of minimally invasive surgery, the market focus will gradually shift to Asia. In 2013, global sales of surgical assistance robots reached $1.495 billion, with sales of the Da Vinci robot reaching $633 million, accounting for 42.43%. As of the end of 2014, there were 3,266 Da Vinci robots installed globally, with 2,223 in the United States (68%), 549 in Europe (16.8%), and 350 in Asia (10.7%), with 29 in mainland China (7.96%), of which 9 were in Beijing (2.76%).
2. Competitive landscape of the medical robot market
Medical robots are highly market-oriented in foreign countries, primarily determined by market supply and demand, leading to intense competition. The short technology iteration cycle characteristic of the industry also means that companies with core technologies and breakthrough innovative concepts will quickly seize market share.
Currently, medical enterprises in Europe and America occupy a large market share in the global medical robot industry, holding a dominant position in the market. Most of the top ten global medical robot companies are American and European firms. The U.S. medical robot industry is leading globally, having developed over 30 companies. These medical technology companies have extensive resource networks, comprehensive service offerings, and excellent R&D teams, capable of providing hospitals and other medical institutions with more scientific, precise, and safe surgical assistance services.
As demand for high-difficulty surgeries increases, medical infrastructure continues to upgrade, and healthcare costs rise, more foreign hospital departments and clinics are gradually increasing their support for assistive surgical medical robots. However, from the distribution of global medical robot market shares, in 2014, the North American medical robot market accounted for 40% of the global total, followed by Europe at 32%. Compared to the 5% or even lower market share of emerging countries, the competition in the medical robot market in Europe and America is more intense.
Related information: The current development status and prospects of global surgical robots
The robotic surgical system is a comprehensive entity that integrates multiple modern high-tech means. It is mainly used in cardiac surgery and prostatectomies. Surgeons can manipulate the machine to perform surgery from a distance, which is completely different from traditional surgical concepts, making it a revolutionary surgical tool in the field of minimally invasive surgery.
The first generation of surgical robots has been used in many operating rooms around the world. These robots are not true autonomous robots; they cannot perform surgery on their own, but they provide useful mechanical assistance during surgeries. These machines still require surgeons to operate them and input commands. The control methods for these surgical robots are remote control and voice activation.
While surgical robots have some advantages over human hands, there is still a long way to go before automated robots can perform surgery on humans without human involvement. However, with the advancement of computer capabilities and artificial intelligence, a robot is expected to be designed in this century that can identify abnormalities in the human body, analyze them, and correct these abnormalities without any human guidance.
Components
The reason for introducing robots into healthcare is that they can achieve unprecedented precision in controlling surgical instruments during minimally invasive surgery. So far, these machines have been used to position endoscopes, perform gallbladder surgeries, and correct gastroesophageal reflux. The ultimate goal in the field of robotic surgery is to design a robot capable of performing heart surgery without opening the chest. One manufacturer stated that in the U.S. alone, robotic devices can be used in over 3.5 million medical surgeries each year.
1. Da Vinci surgical system
2. ZEUS robotic surgical system
3. AESOP robotic system
On July 11, 2000, the U.S. Food and Drug Administration (FDA) approved the Da Vinci surgical system, making it the first robotic system approved for use in operating rooms in the United States. Developed by Intuitive Surgical, the Da Vinci system uses technology that allows surgeons to reach surgical points that are not visible to the naked eye, enabling them to work with greater precision than traditional surgery. The $1 million Da Vinci system consists of two main components:
1. Surgeon control console: The lead surgeon sits at a console located outside the sterile area of the operating room and uses their hands (through two main controllers) and feet (through foot pedals) to control instruments and a three-dimensional high-definition endoscope. Just as seen in a stereoscopic eyepiece, the tips of the surgical instruments move in sync with the surgeon’s hands.
2. Bedside robotic arm system: The bedside robotic arm system (Patient Cart) is the operational component of the surgical robot, primarily designed to support the instrument arms and the camera arm. Assistant surgeons work at the bedside robotic arm system in the sterile area, responsible for changing instruments and endoscopes, and assisting the lead surgeon in completing the surgery. To ensure patient safety, assistant surgeons have higher priority control over the movements of the bedside robotic arm system than lead surgeons.
3. Imaging system: The imaging system (Video Cart) contains the core processor of the surgical robot and imaging processing equipment, located outside the sterile area during surgeries, operated by circulating nurses, and can accommodate various auxiliary surgical devices. The endoscope of the surgical robot provides a high-resolution three-dimensional (3D) lens, magnifying the surgical field more than ten times, allowing the lead surgeon to obtain three-dimensional high-definition images of the patient’s cavity, enabling better distance control during operations and improved anatomical structure recognition, enhancing surgical precision.
Operation methods
The surgeon stands next to the control console, a few centimeters away from the operating table, looking through the viewing lens to study the 3-D images sent by the camera inside the patient’s body. The images display the surgical site and two surgical instruments fixed at the ends of the above two rods. The joystick-like control handle, located directly below the screen, is used by the surgeon to operate the surgical instruments. Each time the joystick moves, the computer sends an electronic signal to the instrument, causing the instrument to move in sync with the surgeon’s hand.
Another robotic system awaiting FDA approval is the ZEUS system, produced by Computer Motion, which is already available in Europe. However, whether it is the Da Vinci system or the ZEUS system, every procedure used for surgical planning must be approved by government departments. The $750,000 ZEUS system is similar to the Da Vinci device. It features a computer workstation, a video monitor, and control handles for moving the surgical instruments mounted on the operating table.ZEUS is currently only approved for medical trials in the U.S., while German doctors have already performed coronary bypass surgery using this system.
ZEUS is assisted by the automated endoscope positioning (AESOP) robotic system. Released by Computer Motion in 1994, AESOP was the first robot approved by the FDA for use in the operating room to assist in surgeries. AESOP is much simpler than the Da Vinci and ZEUS systems. AESOP is essentially a mechanical arm used by doctors to position the endoscope—a surgical camera inserted into the patient’s body. Foot pedals or voice software are used by doctors to position the camera, freeing up their hands to continue performing the surgery.
Recently, the University of Calgary in Canada announced that a research team led by Dr. Garnet Sutherland, a surgical expert, has collaborated with MDA, the company that developed the Space Shuttle robotic arm, to create a surgical robot system named the “NeuroArm.” Experts believe this system will revolutionize surgical procedures, leading to groundbreaking breakthroughs in microsurgery.
Future research
Surgeries, especially neurosurgeries, are limited by the accuracy of human hands. The microsurgery technology developed in the 1960s has allowed surgeons to surpass the limits of precision, flexibility, and endurance of human hands, while the “NeuroArm” system significantly enhances the precision of surgical procedures, allowing surgical techniques to evolve from the organ level to the cellular level. Using this system, surgeons can manipulate the “NeuroArm” in conjunction with magnetic resonance imaging to perform microsurgeries at a microscopic scale.
Researchers have stated that the “NeuroArm” needs to operate in conjunction with a magnetic resonance imaging device with a strong magnetic field, and its development has been a collaborative effort involving medical, physics, electronics, software, optics, and mechanical engineers. At the project’s inception, MDA engineers worked with surgeons at the University of Calgary to determine the technical requirements for designing the “NeuroArm” robot. As doctors and engineers are only experts in their respective fields, communication has posed significant challenges in translating surgical terminology into technical vocabulary. Currently, Dr. Sutherland’s research team is collaborating with the Calgary Health Region and faculty from the University of Calgary Medical Education to conduct a training program for surgeons who will use the “NeuroArm” system.
Dr. Sutherland stated that they not only aim to develop the “NeuroArm” robot but also to design a medical robot teaching curriculum. They hope that this new technology can be applied globally. To achieve this goal, he plans to promote this technology more among students and young experts, as they are more receptive to new technologies and are the backbone of clinical applications of new technologies.
Prospects
In today’s operating rooms, there are generally two to three surgeons, one anesthesiologist, and several nurses, even for the simplest surgeries, requiring this many personnel. Most surgeries require nearly ten people in the operating room. Surgical robots are fully automated, which will minimize the number of operators required. Looking ahead, surgical procedures may only need one surgeon, one anesthesiologist, and one or two nurses. In this spacious operating room, doctors will sit at a computer control console inside or outside the operating room, using surgical robots to perform surgeries that previously required many people.
The use of computer control consoles from a distance has pioneered the concept of remote surgery, allowing doctors to perform precise surgeries from far away. If doctors do not have to stand next to the patient to perform surgery, but instead control the robotic arms from a computer console a few centimeters away, the next step will be to perform surgery from even further away. If a computer console can be used to move robotic arms in real-time, a doctor in California could perform surgery on a patient in New York. The main obstacle to remote surgery is the time delay between the movements of the doctor’s hands and the robotic arms’ responses. Currently, doctors must be in the same room as the patient so that the robotic system can quickly respond to the doctor’s hand movements.
The reduction of personnel in the operating room and the ability of doctors to perform surgeries remotely will reduce healthcare costs. In addition to being cost-effective, robotic surgery offers advantages over traditional surgery, including greater precision and reduced patient trauma. For example, heart bypass surgery currently requires a “30.48 cm long incision” on the patient’s chest. However, using the Da Vinci or ZEUS systems, it may only require three incisions of about 1 cm in diameter for heart surgery. Because the incisions made by surgeons are very small rather than a long incision down the chest, patients experience less pain, less bleeding, and recover faster.
Robots also save surgeons’ physical strength during long surgeries lasting several hours. Surgeons can become fatigued during such lengthy procedures, which may lead to hand tremors. Even the most stable human hands cannot compare to the arms of surgical robots. The Da Vinci system is programmed to compensate for the disadvantage of hand tremors, so if the surgeon’s hand trembles, the computer will ignore that tremor and keep the robotic arm stable.
The advantages of the Da Vinci surgical robot in treating diseases are:
1. The Da Vinci surgical robot features three-dimensional imaging technology, providing surgeons with high-definition three-dimensional images that surpass the limits of human vision and can magnify the surgical area by 10-15 times, making the surgical effect more precise.
2. The robotic arms of the Da Vinci surgical robot are highly flexible and possess unparalleled stability and precision, capable of performing various high-difficulty delicate surgeries.
3. The Da Vinci surgical robot causes minimal trauma, requiring no open surgery, with surgical incisions only about 1 cm in size, greatly reducing blood loss and postoperative pain, and significantly shortening hospital stays, facilitating postoperative recovery.
In recent years, robots have not only been used in industrial fields but have also been promoted and applied in the healthcare system. For instance, the well-known surgical robot (Surgical Robot) has made significant progress in just a decade since its inception. Currently, research on the application of robots in the medical field mainly focuses on surgical robots, rehabilitation robots, nursing robots, and service robots. Among them, surgical robots are the most widely used and promising, overcoming issues such as poor precision, lengthy surgical times, surgeon fatigue, and lack of three-dimensional precision vision in traditional surgeries. In fact, surgical robots are a combination of instruments and devices. They typically consist of an endoscope (probe), surgical instruments such as scissors, a mini camera, and control rods. According to foreign manufacturers, the working principle of currently used surgical robots is based on wireless operations for surgical procedures, where doctors sit in front of a computer screen, carefully observing the condition of the lesions inside the patient through the screen and endoscope, and then precisely excising (or repairing) the lesions using the surgical knife held by the robot.
This system, named MIS by foreign scientists, is the foundation for designing all surgical robots. Taking the Da Vinci surgical robot currently used in hospitals worldwide as an example, as long as a tiny incision is made on the patient’s skin and the probe is inserted into the body, the location of the patient’s lesions can be observed, and then the lesions can be excised using the surgical knife held by the robot.
Da Vinci Si surgical robot surgery
Additionally, surgical robots can perform organ repairs, vascular anastomoses, or bone milling surgeries that require exceptional precision. In recent years, surgical robots have been used in various critical surgeries, including gene transplantation, neurosurgery, and remote surgeries, significantly increasing the survival rates of critically ill patients.
So, how is the development of such powerful surgical robots going? What are the research and development companies? What are the subfields? What is the situation in China? How will it develop in the future? Don’t worry, let me explain slowly.
Emerging Forces
At the beginning of March this year, Google announced that it had reached a cooperation agreement with medical device company Johnson & Johnson to jointly develop a robotic platform to assist doctors in performing surgical procedures. It is reported that this robotic surgical platform will help advance minimally invasive surgical techniques, addressing patient issues such as scarring, pain, and prolonged recovery times. Google will inject visual systems and image analysis software into this robotic platform, providing surgeons with better visual space and assisting them in obtaining other relevant information.
By mid-May, Boshik Co., Ltd. announced that it planned to invest 100 million yuan to establish a wholly-owned subsidiary, Boshik High-end Medical Equipment Co., Ltd., and intends to invest in minimally invasive surgical robots and intelligent instrument projects through Boshik Co., Ltd. or its subsidiaries.
On July 31, 2015, RIVERFIELD, a company founded by Tokyo Institute of Technology and Tokyo Medical and Dental University, announced that the endoscopic surgical assistant robot “EMARO: Endoscope Manipulator Robot” would be launched in August 2015.
EMARO is a system that allows the lead surgeon to operate the endoscope through head movements without the assistance of an assistant (the doctor holding the endoscope). Professors Kenji Kawashima from Tokyo Medical and Dental University and Koutaro Okino from Tokyo Institute of Technology spent about ten years from the start of research to the launch of EMARO.
The system uses pneumatic drive technology, achieving flexible movements, and can avoid contact with humans during operation, ensuring high safety. Compared to existing endoscopic holding robots driven by motors, the entire system is also a significant feature of being lightweight and compact. The system can be operated by the lead surgeon using a head-mounted gyro sensor, and in emergencies, manual operation is also possible. It can be controlled using buttons on the control panel attached to the body.
The background of its birth is that minimally invasive surgeries using endoscopes have become increasingly popular in recent years to replace open surgeries that impose significant burdens on patients, aiming for a method that allows for all surgeries to be completed with an incision the size of a 1-yen coin. A typical example is laparoscopic surgery, where instruments and endoscopes are inserted through small incisions in the patient’s abdomen to remove cancerous tissues. The Da Vinci system, known as a representative of surgical assistant robots, is also a system that assists in endoscopic surgeries.
TiRobotOrthopedic Surgery RobotRobot
Although endoscopic surgeries are becoming increasingly popular, the need for assistants in endoscopic surgeries is challenging to guarantee. Especially in small and medium-sized hospitals, the shortage of assistants is said to be a serious problem. The emergence of EMARO aims to solve this issue.
It is reported that RIVERFIELD’s robotic claw system has been tested on animals and simulated internal organs, and the seventh product is currently under development. It is scheduled to be launched in 2019. Initially, it is intended for diseases and surgeries similar to those of the Da Vinci system, and the company expresses confidence in stating, “We will also expand to areas that the Da Vinci system cannot address.” A Japanese robot that surpasses the Da Vinci system is thus born. EMARO will become the first test stone.
In November 2015, Ally Bridge Group, a fund focused on cross-border medical investments, announced that it would invest $15 million in the French company Medtech SA in the form of convertible bonds and stock warrants. Medtech is an innovative developer of surgical robot systems and is currently listed on the Pan-European Stock Exchange.
Founded in 2002 and headquartered in Montpellier, southern France, Medtech is a global leader in developing surgical assistant robot systems. The company’s flagship product, ROSA Brain Robot, has been approved in Europe, the U.S., China, Canada, and Australia. In July 2014, the ROSA Spine Robot also received CE mark certification and is expected to obtain FDA approval in the U.S. soon.
Currently, the company has installed 51 surgical systems worldwide in major neurosurgery centers, including the Cleveland Clinic and Massachusetts General Hospital. Four top neurosurgery hospitals in China have also installed the ROSA robotic surgical system.
In 2013, the company was named “European Company of the Year” in the neurosurgery robot category by global growth consulting firm Frost & Sullivan.
With the rapid development of the robotics industry, the development of medical robots has received significant global attention. The U.S. has classified surgical treatment robots, prosthetic robots, rehabilitation robots, psychological rehabilitation assistance robots, personal care robots, and intelligent health monitoring systems as six major research directions for future development. Europe plans to establish a “Robotics for Healthcare” network to promote the development and application of medical robots in Europe.
Every development has its origins, and before further exploring surgical robots, let’s first understand the development history of surgical robots from AESOP to Da Vinci.
From AESOP to Da Vinci
The AESOP robot, which appeared in 1994, was designed to receive instructions from surgical doctors and control the laparoscopic camera. Its three-stage products, AESOP-1000, AESOP-2000, and AESOP-3000, fully reflect the characteristics of interventional surgery. The machine can mimic the functions of a human arm, achieve voice-controlled settings, eliminate the need for auxiliary personnel to manually control the endoscope, and provide more precise and consistent lens movements than human control, offering surgeons direct and stable views. By 2014, surgeons had performed over 75,000 minimally invasive surgeries worldwide using “AESOP.”
In early 1996, based on the AESOP robot, a powerful visual system was developed, launching the Zeus robot, which features master-slave remote control operations. The Zeus robot consists of a Surgeon-side system and a Patient-side system. The Surgeon-side system consists of a pair of master hands and a monitor, allowing doctors to sit and control the master hand handles while viewing the patient’s internal conditions captured by the endoscope on the monitor. The Patient-side consists of two robotic arms for positioning and one robotic arm for controlling the endoscope’s position.
The Da Vinci surgical robot is currently the most successful and widely used surgical robot globally. It represents the highest level of today’s surgical robots, primarily consisting of three parts: 1. The surgeon control system; 2. The three-dimensional imaging video platform; 3. The mechanical arms, camera arms, and surgical instruments that make up the mobile platform. During surgery, the lead surgeon does not have direct contact with the patient, operating through a three-dimensional visual system and motion scaling system, with mechanical arms and surgical instruments simulating the surgeon’s technical movements and surgical operations.
The Da Vinci Surgical Robot
Based on earlier models like AESOP and Zeus, the Da Vinci surgical robot, developed by Intuitive Surgical in the U.S., is currently the most widely used and technologically advanced surgical robot worldwide. By the end of 2014, there were 3,266 Da Vinci surgical robots installed globally, having completed approximately 570,000 surgeries.
Globally, the industrialization and technological breakthroughs of surgical robots are currently at a sweet spot, with excellent tech companies like Da Vinci and Rewalk emerging, while some domestic automation companies are also actively developing medical robot products through collaboration with research institutions and the introduction of foreign technologies, currently at the early stages of industrialization. Industry insiders believe that while surgical robots have a larger absolute space, foreign investment shares are excessively high and monopolistic, making the competitive landscape unfavorable for domestic companies in the short term.
However, due to the vast market potential and high technological barriers, it is advisable to view domestically produced surgical robot-related companies from the perspective of technology stocks, focusing on companies actively researching and investing in related fields and building medical robot platforms.
In fact, compared to surgical robots, other medical robots that penetrate various aspects of medical care are even more worthy of investment, including orthopedic robots, endoscopic robots, diagnostic robots, dental assistant robots, nursing robots, etc. These categories are replacing human experience and manual nursing in different fields, improving medical efficiency and precision, and giving rise to a number of new companies specializing in specific subfields.
Subfields
Orthopedic surgical robots are a subfield of surgical robots. Notable examples include the ROBODOC surgical system launched in 1992 by Integrated Surgical Systems, which has merged into CUREXO Technology.
This system can perform a series of orthopedic surgeries, such as total hip replacement and total knee replacement (THA&TKA), and is also used for revision surgeries of total knee replacements (RTKA). It includes two components: one is a computer workstation equipped with proprietary software for three-dimensional surgical planning, ORTHODOC (R), and the other is a computer-controlled surgical robot, ROBODOC (R) Surgical Assistant, used for precise cavity and surface treatment in hip and knee replacement surgeries. This device has been widely used in over 20,000 orthopedic surgeries worldwide.
In 1997, the German company OrtoMaquet launched the CASPAR surgical system, which is used for bone milling in THA&TKA and tunnel entry point positioning for anterior cruciate ligament reconstruction, achieving a milling precision of 0.1mm, which has been adopted in some hospitals in Europe.
The dental assistant robot is another submarket of surgical robots. Currently, there are dental beauty robots and denture robots.
The denture robot utilizes imaging and graphic technology to obtain computer models of the oral soft and hard tissues of edentulous patients, employing a self-developed non-contact three-dimensional laser scanning measurement system to acquire the geometric parameters of the edentulous jawbone shape, completing the statistical analysis of the full denture artificial teeth through expert system software.
Sinora’s dental carving robot is a typical dental beauty robot that has broken through traditional dental restoration methods, using a digital oral restoration network platform and 3D intelligent digital technology system for direct design, avoiding errors caused by materials or operations, and preventing issues such as incorrect mixing of materials or errors in setting times, completing the entire process from diagnosis, imaging, design, to production and trial fitting in one go. For example, a full porcelain tooth that previously took a week to make can now be completed in about an hour, with “pure” polishing time requiring only 8-10 minutes. It is currently the most effective and safest dental beauty technology.
The endoscopic robot and surgical robot are both medical robots, differing only in their methods of performing surgery. Currently, the endoscopic robot primarily consists of capsule endoscopic robots. Patients only need to swallow a capsule-sized endoscopic robot, allowing doctors to examine the stomach and small intestine. This remote-controlled capsule endoscopic robot integrates various sensors and employs innovative magnetic field control technology, transforming the capsule endoscope into a “robot with eyes and feet.” Due to its small size, it enters the body without any foreign body sensation or discomfort, alleviating patients’ anxiety and significantly improving their tolerance for examinations.
Global R&D Situation
According to a report by WinterGreen Research, the surgical robot market size was $3.2 billion in 2014. The report indicates that the North American market is currently the largest, but due to increased government healthcare investment, restructuring of healthcare systems, and heightened awareness of minimally invasive surgery, the market focus will gradually shift to Asia. Moreover, with the release of next-generation devices, systems, and instruments, surgical robots will expand from current large open surgeries to cover small parts of the body. It is expected to reach $20 billion by 2021.
Over the past 20 years, with technological breakthroughs and advancements in healthcare, surgical robots have undergone three upgrades, from single-arm robots like AESOP to three-arm robots like Zeus, and finally to the most advanced four-arm robots like Da Vinci. The Da Vinci system was developed and manufactured by Intuitive Surgical (ISRG) in the U.S., receiving CE market recognition in 1999 and FDA approval for use the following year. This surgical system was initially primarily used for minimally invasive surgeries in urology, such as prostatectomies, and is now increasingly used in cardiac, gynecological, and pediatric minimally invasive surgeries.
According to statistics released by IFR, the total sales of global surgical assistance robots reached $1.495 billion in 2013, with Da Vinci robot sales reaching $633 million, accounting for 42.43%. By the end of 2014, a total of 3,266 Da Vinci robots were installed globally, with 2,223 in the United States, 549 in Europe, 350 in Asia, and 29 in mainland China, of which 9 were in Beijing.
Besides Intuitive Surgical in the U.S., other companies have also begun focusing on the fields of ophthalmology, neurosurgery, and orthopedics that the Da Vinci system has not yet occupied, such as CUREXO Technology’s ROBODOC surgical system and the surgical medical system from the British company Acrobot. The surgical robots mentioned above have not received particular attention in the market due to their small target market and high equipment costs, but they are successful cases of the commercialization of surgical robots.
Domestic R&D Situation
Due to the current technological and market monopoly of surgical robot manufacturers, the purchase costs of surgical robots, surgical costs, and maintenance costs are high. This directly leads to the low penetration rate of surgical robots in hospitals in China, which is far less than that in Europe and the U.S., and even lower than that of neighboring countries like Japan and South Korea.
Currently, domestic researchers are accelerating the development of various surgical robots and their auxiliary devices and consumables. In the long run, the current technological monopoly of surgical robots may be broken, and the decline in the usage costs of surgical robots is an inevitable trend. China’s independent research and development of surgical robots started relatively late and is still in the experimental stage. The main research institutions include:
a. The Navy General Hospital and Beijing University of Aeronautics and Astronautics jointly developed the robotic system CRAS (Computer and Robot Assisted Surgery, CRAS). CRAS is a pioneer in domestic surgical robot systems, having completed the development and clinical application of its fifth generation. The first generation of robots was first applied clinically in May 1997. The second generation was successfully developed in 1999, achieving frameless stereotactic surgery. The fifth generation of robots, in addition to the features of the previous four generations, has more advanced automatic positioning capabilities, achieving visual automatic positioning, reducing surgical errors, and making surgical operations more efficient and safer. This system can perform remote surgeries over the internet.
In December 2005, two stereotactic surgeries were successfully performed over the internet between Beijing and Yan’an. However, the CRAS surgical robot still faces many issues regarding expanding its applicability and practicality.
b. In November 2013, the national “863” plan funded project—“Minimally Invasive Laparoscopic Surgical Robot System,” was successfully developed by the Robot Research Institute of Harbin Institute of Technology and passed the acceptance of the national “863” plan expert group. According to researchers at Harbin Institute of Technology’s Robot Research Institute, the domestically produced minimally invasive laparoscopic surgical robot system possesses independent intellectual property rights. Researchers have made significant breakthroughs in mechanical design, master-slave control algorithms, three-dimensional (3D) laparoscopes, and system integration for various minimally invasive surgical procedures, applying for multiple national invention patents. This project’s breakthroughs are seen as breaking the technological monopoly of imported Da Vinci surgical robots and will accelerate the realization of domestically produced minimally invasive surgical robots assisting in surgical procedures.
c. In April 2014, Xiangya Third Hospital of Central South University successfully completed three surgeries using domestically produced robots, marking the first clinical application of a domestically developed surgical robot system. This surgical robot is the “Miaoshou S” system developed by Tianjin University, which has independent intellectual property rights.
The “Miaoshou S” system has three technical advantages over similar products abroad. First, it employs a decoupled design technology for minimally invasive surgical instruments with multiple degrees of freedom, solving the motion coupling problem, ensuring fixation, anti-skid, and anti-loosening, which is more conducive to maintaining precision. Second, it achieves a reconfigurable layout principle and implementation technology from the operator’s hands, making the robot’s “arms” lighter and more suitable for surgical needs. Third, it utilizes a system of heterogeneous isomorphic control model construction technology, solving the consistency of hand-eye-instrument motion in a three-dimensional visual environment. It is understood that the “Miaoshou S” surgical robot system is expected to be put into production within three years.
In 2014, the total scale of the domestic medical device market was nearly 255.6 billion yuan, but the import value of medical devices accounted for 40% of the market share, with foreign manufacturers dominating the mid-to-high-end market, accounting for over 70%. Currently, domestically produced surgical robots are mostly still in the R&D or clinical trial stages, and there is still a distance to commercialization.
Looking to the Future through History
From the birth of the first surgical robot to now, automated surgery has traversed nearly 30 years. When the first surgical robot, Puma 560, was produced in 1985, the company that manufactured it prohibited its use for surgeries due to safety concerns. However, now, the most advanced surgical robot systems perform thousands of various surgeries each year. One cannot help but marvel at the rapid development of medical technology.
Now, we are still curious about what the future of robotic surgery will look like.
Currently, doctors around the world are looking forward to the development of telemedicine and remote surgeries, which would allow a doctor to perform surgery on a patient in another city, state, or continent. This means we could establish surgical centers in different parts of the world, where a doctor could go to a surgical center, sit at a control console, while the patient is in another surgical center, and the doctor could operate the robot to perform the surgery.
In fact, in 2001, a remote surgery was completed between New York and Strasbourg, France, using a robot. This groundbreaking surgery was termed the “Lindbergh Operation.” Although the surgery was successfully completed, there was a delay in the transmission of images and the operation, making remote surgery difficult to achieve. However, with the increase in internet speeds and the reduction in bandwidth costs, the delays will undoubtedly improve.
In the future, we will have the conditions for telemedicine, allowing doctors to perform surgeries on patients in other parts of the world. I do not believe this is an unattainable scientific fantasy; I think in my lifetime, this will become a reality. Moreover, the development of telemedicine also means a higher level of competition among doctors. This will raise the entry barriers for surgeons, making them excel in their fields.
Another possibility is that in the future, we may be able to perform surgeries through a single incision, perhaps through the navel, inserting a snake-like robotic arm. Currently, to facilitate the entry of robotic arms into the body, several small incisions are left on the patient’s body.
The continued development of this technology will mean that doctors only need to make a small hole in the patient’s body and then insert a snake-like robotic arm. That would be a truly disruptive technology, potentially changing the nature of surgery forever. How cool is that? (Source: Electronic Engineering World)
