Incumbent expanding robotic surgery monopoly
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Incumbent expanding robotic surgery monopoly
Robotic surgery is widely available in the US and strongly growing across Europe . With almost all US prostate cancer operations already robot assisted , we anticipate its high precision , minimally invasive advantages and synergy with digital imaging will see the technology increasingly adopted for removal of multiple cancer types . While newer players have emerged , long term market incumbent Intuitive Surgical enjoys a virtual monopoly in the US and increasingly in Europe . Intuitive ’ s extensive and growing installed base will present a significant hurdle to new entrants . We believe companies seeking to enter the market with alternative robotic surgical platforms will need first to gain a foothold in niche / specialist applications from which they can slowly establish market share .
Robotics expected to provide mass access to minimally invasive surgery
Surgery is nearly always the treatment of choice for early-stage cancers to prevent progression and metastasis . It is often used in combination with adjuvant treatments such as RT or chemotherapy . Traditionally , surgery was performed using open methods , with a later shift to laparoscopic methods in certain malignancies , and in the last decade , to robotic surgery . This method was typically used for urological procedures ; however , it is now increasingly used for cancers found throughout the body . As robotic systems availability increases , we expect further adoption in more malignancies to move to robotic-assisted surgeries . Both laparoscopic and robotic surgery have advantages over open methods for the patient , with smaller incisions leading to less infection risk , less blood loss , and a shorter recovery period . While both are technically difficult for surgeons , robotic-assisted surgery has been designed to overcome these deficits with the availability of trainer consoles to help trainee surgeons . Furthermore , with the technological improvements the ability for knowledge sharing and teaching on the systems have increased further with experienced surgeons able to highlight structures on the screen for the surgeon to avoid and can even do this from another country . The benefits are shown in ( Table 19 ). Intuitive Surgical ’ s da Vinci system still dominate this field despite patents expiring . Competitor companies are still struggling to break into this market with more da Vinci system installations per year than many competitors ’ total installations and da Vinci systems are increasingly being adopted outside of Europe and USA .
Figure 34 : Fulcrum effect
Handle
Port
Tip
Source : goetzpartners Research
Patient interior
Table 19 : Advantages and drawbacks of robotic surgery over manual laparoscopy Advantages
Disadvantages
Eliminates fulcrum effect Improved ergonomics Depth perception Reduction of physiological tremor Scaling of hand movements Seven degrees of freedom of the instruments Reduced surgeon fatigue Shallower learning curve Potential for telesurgery
Source : goetzpartners Research , NBCI , SAGES
Lack of tactile feedback High capital costs Bulky instruments and lengthy installation System maintenance Lack of direct access to the patient Unproven efficacy Chance of breakdown Surgeon is located outside the sterile field
While robotic techniques are common in specialities such as urology and gynaecology in the US , the cost of the available systems and their running expenses have restricted adoption either for other procedures or in more economically constrained , payor driven healthcare systems outside the US . However , this is changing with increasing adoption of the systems in Europe and Asia as the benefits from robotic surgery are superior .
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