Will da Vinci’s Supremacy of Robotic Surgery End?
We, Urologists in India, are aiming to embrace Robotic Assisted Procedures and in recent years many centres across in India have acquired Robots and at present the monopoly of Intuitive are evident.
They have monopolized the field from the inception of Robot Assisted Surgeries. They also authored the non development of many other Robots by other manufacturers by timely interventions.
The idea of Robotic Technology for Surgeries commenced in 1990 when Stanford Research Institute developed a prototype which caught the imagination of some notably Defense Advanced Research Projects Administration (DARPA).
Frederick Moll, a surgeon was impressed with the technology and became acquainted with venture capitalist John Freund in 1995. Together with engineer Robert Younge, Moll and Freund began their enterprise to improve minimally invasive surgery—Intuitive Surgical – da Vinci System. The da Vinci surgical system was commercialized in 1999 in Europe, and a year later came to the U.S, In June 2000.
They introduced modified platforms needed and suited for various varieties of Surgery and in May 2018 introduced the SP Platform.
The system features three, multi-jointed, wristed instruments and a fully wristed 3D HD camera. The instruments and the camera emerge through a single canula and are properly triangulated around target anatomy to avoid external instrument collisions. Surgeons control the fully articulating instruments and camera on the same surgeon console as the da Vinci X and Xi systems.
After nearly two decades holding a near monopoly on the surgical robotics market, new competitors are emerging for Intuitive. TransEnterix Surgical Inc. won FDA approval for its Senhance Surgical Robotic System in 2017. At the time, it was the first new entrant into the abdominal surgical robotic field since 2000. The Senhance augments laparoscopic surgical instrument and endoscopic camera precision, visualization, and control. It utilizes an open architecture so hospitals and surgeons can leverage existing technology in the OR with the Senhance.
Senhance and da Vinci are similar in many respects. Both allow surgeons to perform high-precision surgeries from workstations near the patient by controlling robotic arms. Both target similar procedures. However, there are also some differences that could be significant advantages for TransEnterix.
One of those differences is that the Senhance system incorporates haptic feedback. The da Vinci system does provide subtle physical feedback to surgeons holding the controls, but it doesn't go nearly as far as Senhance does.
Another key difference between the two systems is that Senhance allows the surgeon to control the camera mounted on the robot arms by moving his or her eyes and head. Da Vinci doesn't support this functionality.
Perhaps the biggest draw for hospitals, though, is that Senhance's instruments are reusable. This makes TransEnterix's system more cost-effective over the long run. By comparison, Intuitive Surgical makes more money from selling replacement instruments and accessories than it does from selling new da Vinci systems.
Initially, Senhance system was used for Gynaecological and other abdominal surgeries and not for Urological procedures notably RP. This scenario appears to be changing with the publication (Published Online July 25th) of ‘Extraperitoneal RP with Senhance Robotic Platform first 40 cases’ (Article provided).
There are many newer Robotic technologies likely to enter the market in near future leading us even to consider Microbots as a reality. Jens J. Rassweiler et al (2017) published an excellent article addressing ‘Future of Robotic Surgery in Urology’ in which they have addressed most of the competitors for da Vinci.
This article is complemented by another article published in 2020 by an article by Karl Khandalavala, Dmitry Oleynikov* et al (2020) on ‘Emerging Surgical Robotic Technology Progression towards Microbots’.
Reading together, one can appreciate the competition that Intuitive with da Vinci is likely to face in near future. So far da Vinci Robotic systems have resisted all newcomers from entering their monopoly.
The Robotic war is bound to escalate. At present it is like ‘David fighting Goliath’. In the mythology, as is well known David defeats Goliath but in the present Robotic War can this happen. With the penetration that Intuitive had in the past 2 decades, it is unlikely a dramatic change will occur in near future. With most Robotic Urological Surgeons used to da Vinci Platform with its modifications are unlikely to make any changes into other systems in near future. The cost of procuring a Robotic system is very prohibitive even for the most affluent countries; they are not likely to replace them with newer systems that are likely to enter the market. But who knows the reality. If these new entrants can make a foray into the field by proving their ability in the few centres they have entered, then it could become another story. Goliath appears to be winning the war at present but it could be possible that David will win eventually.
With warm regards,