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Historically a monopoly , new entrants aim to drive down costs but Intuitive are difficult to compete with
A race to find niches after patent expiration Intuitive Surgical were formed in the mid 1990 ’ s and filed patents for their first system “ Leonardo ” towards the end of the century . Their 80 % control of the robotic surgery market for the last 20 years supported by patents has prevented other players entering . For example , the da Vinci 4 th generation is protected by around 70 patent families . Many have now expired after 20 years , and many other companies have developed systems and have patented various components . Large companies such as Google and J & J are developing products via Verb Surgical as a joint venture , although many smaller companies should be on investor ’ s radars too . The patents filed by many of the companies point towards who developing surgical robotics ( Figure 37 ). J & J have filed the most patent applications , unsurprisingly as a large , well-capitalised company . Intuitive still dominate the market and therefore companies will search for niches as entry routes to market . One possible niche could be developing smaller and cheaper systems to replace laparoscopic methods in more routine operations such as appendicectomies and cholecystectomies as an entry route to cancer surgery . One innovative technology is from Monteris Medical for robot guided laser therapy in brain metastases and gliomas . Many of these companies are targeting doctors with training and centres to persuade migration from da Vinci systems to their models , but largely doctors are reluctant to move away from the system they were trained on .
Figure
37 : Patent counts
Source : goetzpartners Research
More surgical disciplines involved in oncology are using robotic methods
Robotic-assisted surgery is moving outside of urology and gynaecology Robotic surgery initially started in urology with over 80 percent of prostatectomies and hysterectomies performed using the da Vinci platform . Surgery in most other fields is still primarily performed using open or laparoscopic methods , however this is now changing . Robotic surgery is starting to be used in general surgery where the Hugo system for Medtronic has been approved in Europe . In thoracic surgery potential oncological procedures include lung cancer and oesophageal cancer as well as HNSCC with the UK using the da Vinci system for these procedures . Although , patient oncological outcomes are similar , due to the numerous benefits of minimally-invasive surgery patient functional outcomes are generally improved . For example , a recent transoral robotic surgery trial in HNSCC in the UK reduced the need for a tracheostomy from 79 % with open surgery to 38 % with robotic methods . Intuitive Surgical have diversified their portfolio with a new system called Ion that has shape-sensing technology and allows a surgeon to perform a lung biopsy in the most peripheral of lesions . Furthermore , they believe it demonstrates the applicability it has in tubular structures and can be developed for similar anatomical tubes . We believe that robotic surgery will start to be used in more malignancies due to the improved recovery post operation .
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