Medtronic’s Arvind Ramadorai answers questions on the past, present, and future of surgical robotics, including potential challenges.

IMAGE COURTESY OF MD+DI

Yesterday, at the current Boston MEDevice, MD+DI’s managing editor, Katie Hobbins, sat down for a live interview with Arvind Ramadorai, head of innovation for Medtronic’s surgical robotics business, to discuss the current state of surgical robotics and innovation opportunities for the future.

Below are some of his responses, highlighting the categorization of robotics, the potential for surgical robotics to improve access to healthcare for underserved communities, and the cost of adding such a device to a surgical practice or hospital.

How is robotics impacting healthcare in general?

Ramadorai: I started out with a roboticist a long time ago, and that was a time when mostly industrial automation people were using robotics. There were other applications that were slowly emerging. In the last probably 20 plus years. I think robotics has been tried or applied in healthcare in many, many areas. Obviously, surgical robotics is one of them.

There are adjacent spaces like rehabilitation, there have been elder care robot concepts that have been tried, there are robots that can help people with Alzheimer’s for social interaction, robots for running around in hospitals, for telepresence for stroke care, and so on. A lot of these things have been tried. Probably hundreds of companies have come and gone. But if you take a snapshot today and see where they are, obviously surgical robots are the biggest market.

Another area where robotics and healthcare has gotten a fraction [of surgical robotic popularity] is what I would call hospital operations. That [would be] pharmacy, automation, logistics, supplying food, and running around in hospitals. Those are a fairly big market. It’s probably about a billion dollars a year. For rehabilitation robots, it’s not that big, maybe a few hundred million dollars. Those are probably the three areas where robotics is getting some traction.

Some of these markets are still unproven, but they’re growing the long term. Surgical robotics is here to stay, and it’s getting a lot of traction.

What is state of robotics in surgery?

Ramadorai: If you look at robotics and surgery and go back, let’s say, from 1995 onwards, you have access to a database that kind of shows all the robots that there are.  There are over 500 surgical robotics companies, and they try to target every organ in the body — to cut or cure disease. That trend has actually accelerated in the last five to 10 years. There are probably 30 to 35 robotics companies spawned every year. It’s one of the fastest growing healthcare robotics markets. All of us know Lasix surgery. It’s a robot which makes probably $2 billion to $3 billion a year that’s been around for a while, and there is something like 40 million Lasix procedures that have been done.

Neurosurgery makes around a billion dollars or more, with robotics used to grab tumors to biopsy, and things like that. Then there’s orthopedic surgical robotics, which is between a half a billion to a billion-dollar market, for knee replacements, hip replacements, and among other procedures. There are cardiothoracic robots that are very specialized, like in endovascular robotics, and it’s a very small market considered an about $100 million market. But the biggest market is abdominal thoracic surgery, which is worth about $6 billion.

What are the different ways of categorizing the types of surgical robots?

Ramadorai: There is a way of categorizing it by specialty — neurosurgical, orthopedics, and so on. But, if you take more of a technology view, you classify it very differently. For example, heart tissue surgery, total hip, shoulder, and knee replacements, and maybe even neuro, are done by robots and generally called image driven robotics. This is where they take an image, they reconstruct the image, actually plan the surgery ahead of time, and the surgeon uses the robot during the surgery by registering that image with the actual patient during surgery, and then intraoperatively use the robot to position, among other things. That’s one category.

The other types of robots, like soft tissue, where it’s surgeon in the loop using kind of a remote-control drone. They go into the body, via the robot which manipulates soft tissue. There are several kinds of technologies there. There are multiple robots where you just make holes in the body like the Da Vinci, and the Hugo that I work on. There are endovascular robots that goes through your vasculature into the heart. That’s another way [to categorize surgical robotics].

How can surgical robotics improve access to healthcare, especially in underserved regions?

Ramadorai: I think there is a significant personnel shortage in the healthcare industry. One way to solve that is robotic so that people, even in the developed world, have the access to the care they need.

But if you go to underserved markets, there is shortage of well-trained staff. There’s shortage of access to training for surgery, and I think telerobotics and telesurgery can help a lot. There are procedures now being done in China from remote across a few 100 or 1000 miles, to improve access to care in surgery. Obviously, it’s been done for other applications for quite a while, but for surgeries catching up in that area will improve access to surgical care as well. The combination of telecommunications and robotics, combined with all the digital stuff, will improve access to care. It will work to solve surgeon shortages, personnel shortages, as well as getting the best technology out to remote areas.

What are the cost implications of implementing surgical robotics in healthcare systems, and how might they impact global adoption?

Ramadorai: Obviously, all healthcare systems are extremely stressed financially. Robotic systems typically have kind of three sources of expenses, aside from training an individual on the device…. just for the equipment there’s a huge capital cost, depending on the robot, that can vary from half a million to $5 million to get access to the technology. Then there’s obviously going to be the ongoing cost to maintain the equipment. There are a lot of costs, and that has been a barrier for adoption of robotics across the board. Manufacturers are challenged to come up with innovative business models to alleviate both cash needed and operating expenses. They are getting more and more innovative in that sense, like leasing models, pay-per-use models, and bundling rather than requiring upfront capital.

The other aspect is, if they have enough evidence, they can start tapping into the regular reimbursement, and that is slowly happening in robotics. Not all robotics procedures are reimbursed today. Many of them are not. But I think at the end of the day, there’s costs and benefits, and as long as robotics can deliver economic value in terms of procedural throughput and clinical value from outcomes, that is the equation that’s eventually going to shape robot adoption. Robotics are here to stay, and I think several years from now almost all surgeries will be done with a robot, and nobody will be calling it robotic surgery.

How do you see the future of collaboration between human surgeons and robots — will it always be a partnership, or could robots eventually replace surgeons entirely?

Ramadorai: I think there will always be a partnership with the surgeon. Technology is going to help the surgeons focus on the harder problems and leave the some of the routine stuff to the robots and that will go on. I think it will evolve the way cars do. We started fully in control of cars. Now, there are all kinds of sensors, heat features, departure warnings, backup cameras, and to some extent, autonomous driving in some conditions. It’s trending in that direction, but I don’t think it’ll be completely autonomous. It is going to be always a collaboration because things can go wrong, and surgeons have to intervene for safety reasons.

article source: MDDI