Robotic surgery, sometimes referred to as robot-assisted surgery, is perhaps the most cutting-edge medical technology of modern times. And the da Vinci system arguably has the sharpest edge.

Established in 1995, American robotic surgical system manufacturer Intuitive Surgical Inc. focuses on products that allow surgeons to perform laparoscopic (or minimally invasive) surgery, a modern surgical technique in which operations are performed far from their location through small incisions elsewhere in the abdominal wall. Its star product, the da Vinci robotic surgical system, has held a large market share since becoming the first robot-assisted laparoscopic surgical system to gain the approval of the U.S. Food and Drug Administration in 2000.

The system is called da Vinci in part because Leonardo da Vinci's study of the human anatomy eventually led to the design of the first known robot in recorded history (ca. 1495).

Intuitive Surgical dominated the global surgical robotics market by holding over 79 percent of the market share in 2020, according to BIS Research, a U.S. market research and advisory company. Its market value stood at $5.46 billion that year.

But as Intuitive Surgical was building its empire, Xu Kai, a Ph.D. student at Columbia University, New York, was exploring new medical robot technologies under the mentorship of Professor Russell Taylor and Professor Nabil Simaan. Hailed as the father of medical robotics, Taylor predicted da Vinci would prevent other players from entering the market over the next 15 to 20 years, due to the company's dominating holding of intellectual properties. His words inspired Xu, who decided to develop a new-generation surgical robot.

"That was the start of my story with single-incision laparoscopic technologies and other innovations in the field. And when it comes to this cause, I am still all in," Xu told Beijing Review.

Fantastic robotics

Thirteen years have passed since Xu refused one tempting offer after the other in the U.S. and decided to return to China. Today, he is a professor at the School of Mechanical Engineering at Shanghai Jiao Tong University and runs his own medical robot company, Beijing Surgerii Technology Co. Ltd.—established based on the university's tech transfer policy.

His company's minimally invasive surgical system features single-port access and snake-like robotic instrument technology with exclusive intellectual properties. The single-port robotic system has so far received good feedback and generated improved clinical outcomes, e.g., less blood loss during surgery and faster patient recoveries compared to traditional multi-port laparoscopic procedures—which involve more abdominal incisions.

The robot's trocar, a protective multi-channel port, can enter the abdominal cavity through one small incision. It is designed to deliver a 10-mm 3D high-definition robotic endoscope (an inspection instrument composed of a pair of image sensors, an optical lens and a light source), and three surgical instruments all at once so that surgeons can operate toward the surgical site through this single access port.

"In terms of laparoscopic surgical robots, Intuitive Surgical has been a market leader for more than two decades. Yet in the field of single-incision products, if we highlight innovation and less invasiveness, we can become a global competitor," Xu said.

At the same time, medical equipment entrepreneurs should develop products based on international quality standards and operate their businesses in accordance with international rules and regulations given they should be looking at the global market instead of working behind closed doors, he added.

"And we are doing well in these areas, that of intellectual property included," Xu emphasized.

Supply and demand

China's robot industry has been developing swiftly, injecting new élan into the country's economic and social development. Its robot market value is projected to reach $17.4 billion by the end of this year, with an average annual growth rate of 22 percent in the past five years, according to a report released by the Chinese Institute of Electronics (CIE) during Beijing's World Robot Conference in August.

However, compared with achievements in the automobile, communication and consumer goods sectors, surgical robots are still in their infancy.

According to the CIE report, recent years have seen considerable improvements in the quality and reliability of Chinese medical robots. The industry is experiencing a period of rapid growth, Zhang Dian, Senior Consulting Manager at American business consulting firm Frost & Sullivan, told 21st Century Business Herald, a leading Chinese business newspaper, in September.

Xu thinks the biggest advantage of China's robot industry is its complete domestic supply chain. "It includes every link to support our development and manufacturing. And Chinese suppliers can adjust to our pace and demands throughout the process," he said, adding it is a unique and unbeatable feature of the made-in-China robotic devices.

"But our suppliers need to further enhance abilities to upgrade their services and products," he also suggested.

In the first six months of this year, nine surgical robots manufactured by Chinese companies, from robotic endoscopes to products in the field of orthopedic surgery, concerned with conditions involving the musculoskeletal system, received approval for clinical use, exceeding the total number of surgical robots greenlit in 2021, according to Zhang. "This shows how Chinese brands are breaking the bias that domestic customers can only depend on imports," she said.

Plus, China's surgical robot manufacturers have their own superiorities compared with their foreign peers, the consultant added. "Besides having a better understanding of Chinese doctors and patients, they provide more affordable services, such as accessories replacements, training and maintenance, upping their market competitiveness," she explained.

In December 2021, the Ministry of Industry and Information Technology and the National Health Commission unveiled a blueprint for the development of China's medical equipment sector during the 2021-25 period. The outline specified priorities and measures to accelerate technological modernization in said field to support community-based senior healthcare and respond to problems that come with an aging population.

What's more, to ease the financial burden for patients, Beijing and Shanghai in 2021 became the first cities to have the government-backed basic medical insurance scheme partially cover the cost of robotic surgery. More robot-assisted services will be included over time, and this can increase the public's acceptance of these surgical techniques, Zhang said.

"That can in turn stimulate the expansion of robot manufacturing, leading it to become a more affordable and better-quality business," she concluded.

(Printed Edition title: Cracking The da Vinci Code) 

Copyedited by Elsbeth van Paridon

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