Great expectations for medical robotics

Great expectations for medical robotics

by Pininvest Analysis

Medical Robotics for Surgery on

  • constituents
  • 87.3% 1y performance
  • 29.1% volatility
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One catch phrase for distinct areas of expertise

Medical robotics are something of a ‘catch-all’ device category, hardly making any sense to the medical profession, but quite an attractive concept for investors keen to ferret out a seam of profitable business

Though, at pininvest, we are not medical experts, we hope to approach robotics by describing the different fields of expertise under development, the resulting benefits patients may reasonably expect and the competitive edge of the innovative solutions

We wil argue that medical robotics should not be assumed to deliver as a matter of course vast riches benefiting early entrants in specialized robotics 

  • The size of the market is not necessarily as beguiling as the evaluations of the start-ups in the field suggest and projections remain shrouded in uncertainty. According to Grand View Research, the global surgical equipment market was valued $10.5 Billion in 2016 and is expected to grow at 7.8% CAGR from 2017 to 2025 to reach a value of USD 20.3 billion. More conservative estimates target $12 billion by 2025 : actual cost of the new systems expected to drive sales remain the critical variable, likely to constrain access in the developing markets where demand should be highest
  • The hospitals themselves and their operating theaters are vast, complex organizations and advanced technologies will be evaluated in a wider context, not only only on basis of their inherent qualities
  • Innovative surgery and rehabilitation devices will be all the more relevant if the data flow regarding the patient’s status is fully integrated with the device, giving immediate access to all the tests, pre-operation checks and post-operation follow-ups to the surgeon in the operation theater or to the medical practitioner in rehabilitation
  • Considering the challenge of these pluridisciplinary approaches, established medical devices specialists should enjoy a head start


Medical robotics can be classified in 4 distinct fields of expertise

Minimally Invasive Surgical robotics (MIS)

Source Intuitive Surgical 

Conducted primarily in the areas of urology, gynecology and general surgery, the success of the da Vinci® surgical system of Intuitive Surgical has led to further research

  • aiming at reducing invasiveness,
  • easing the training requirements for the surgeon
  • improving important aspects of the systems (mainly image guidance – opening potentially the field of teleoperations – and haptic feedback, meaning to give a ‘sense’ of touch for the softness of tissues)


Micro and nano-robotics


Micro-robotic designs would be expected to operate in diverse biological fluids and tissues, raising complex autonomous propulsion issues (motility) to reconfigure their geometry and adapt to tortuous heterogeneous biological environments

Ongoing research concentrates on propelling agents, bacteria-enabled drug deliver and robotic-tweezers cell manipulation


Image-guided surgical procedures

Medical imaging covers a diverse field including X-Ray fluoroscopy, CT (X-Ray computed tomography), PET (positron emission tomography scanner), MR Imaging (magnetic resonance imaging), Ultrasound imaging, Ultrasound-guided navigation and optical coherence tomography

The wide range of clinical applications - covering cochlear implant surgery, neurosurgery, breast biopsy, prostate cancer treatment, endovascular interventions, neurovascular interventions, robotic capsule endoscopy, and MRI-guided neurosurgical procedures and interventions – signals the potential of robotic devices and explains the focus of research labs on robotic systems incorporating image-guided modeling


Rehabilitation robotics and prostheses

Source Ekso Bionics

The field of orthopedics is transformed by the convergence of robotics, sensors and feedback to restore functional movements of the limbs through robotic training

Furthermore, with advances in miniaturization and designs of soft actuators (made entirely of soft materials and capable of delivering large strains), vast improvements in prosthetic lower limbs and ankles are being achieved


Versatility, imaging and data integration - a prerequisite

As alone-standing devices, medical robotics will aim at improving the quality of healthcare and at ensuring faster recovery

But the companies on track to deliver on these promises must combine multiple features to achieve market success in one of three broad categories

  • Diagnostics
  • Surgery - Minimally Invasive Surgical (MIS) robotics
    - enhanced flexibility aiming at a widening range of surgical specialties
    - ease of deployment across multiple operation theaters
    - integration of the entire imaging and test history of the patient, beamed directly into the operation theater
    - analytics of the data history of surgeries, featuring artificial intelligence and machine learning
  • Orthopedics and Prostheses
    - post-surgery rehabilitation
    - prostheses


Looking forward, health care providers should have sharply differing requirements

  • for diagnostics : alone standing devices will be expected to feature clear cost-health care advantages and feed test results into integrated data streams
  • for surgery : fully integrated second-generation robotics solutions are likely to dominate
  • for orthopedics and prostheses : specialized firms targeting unique traumas are in position to maintain their hold on a fragmented market place


In our view, the implications in the market place are hardly as exuberant as early investors may hope

  • Sales of medical robotics devices will grow moderately (and mainly to the benefit of Intuitive Surgical) until 2020 when major innovations are expected to come to market
  • Promising start-ups in diagnostics and orthopedics stand out because these firms may be in a position to launch innovative devices on their own strength – although partnerships or acquisitions by well-establish firms will be frequent
  • R&D in surgical robotics may result in breakthrough technological feats but to achieve a marketable device, acquisition of the know-how, or the research teams themselves, by one of the medical device conglomerates is bound to remain the only option to achieve fully integrated devices (combining imaging, data feed connectivity and, in a best case scenario, AI) and benefit from the crucial distribution network

If short and medium term developments bear out this assessment, the success story of Intuitive Surgical since 1999 will be recognized as a ‘one-off’, benefiting from first mover advantage with a true innovation, but not as play-book for promising start-ups planning to list in the future

We expect to discuss potential developments for the industry in further notes with

  • Intuitive Surgical's current market domination
  • evaluation of the technical advances of promising start-ups
  • the strategies of the large firms dominating the device industry
  • the options available for technological outsiders, hoping to leverage their expertise fine-tuned in industrial robotics