Update on the 12 major surgical robotics systems today

12 surgical robotics companies you need to know (Medical Design & Outsourcing)

Surgical robotics remains a hot area in medtech — even as it faces headwinds from the COVID-19 pandemic.

Intuitive Surgical (NSDQ:ISRG) pioneered robotic surgery through the early 2000s and remains the dominant player, but major companies including Medtronic (NYSE:MDT) and Johnson & Johnson (NYSE:JNJ) have big plans to enter the space and compete.

Meanwhile, Stryker (NYSE:SYK) has built a strong niche in the robotic ortho surgery space.

Read on to discover the status of 12 companies playing an important role in the robot-assisted surgery space.

Intuitive Surgical: Cutting prices to boost its lead

Intuitive Surgical da Vinci SP surgical system IDEA IDSA

The da Vinci SP surgical system [Image courtesy of Intuitive Surgical]Intuitive Surgical (NSDQ:ISRG) — the world’s dominant robotic surgery company — has found itself in the same boat as many medical device companies making equipment not directly related to the COVID-19 pandemic: Sales took a hit during the second quarter, about a fifth in Intuitive’s case.

The pandemic, though, may have also given Intuitive Surgical extra time to make an economic proposition for potential customers before medtech giants Medtronic and Johnson & Johnson each come out with their own robots to compete against Intuitive’s da Vinci robots.

Intuitive Surgical during the final months of the year plans to introduce an “Extended Use Program” offering select Xi/X instruments possessing 12 to 18 uses compared to the current 10-use instruments. The company during the fourth quarter will also lower the price of certain other instruments most commonly used in lower-acuity procedures.

“If you look out over a couple of years, we clearly think that customers want to use our products. … To the extent that we can help them with economics, we think they have a preference to use our products,” Intuitive CEO Gary Guthart said in a July earnings call transcribed by Seeking Alpha.

Meanwhile, Intuitive Surgical continues to seek expanded indications for its next-gen da Vinci SP robot.

Medtronic: Big plans in 2021

Medtronic Hugo robot-assisted surgery system

Medtronic’s Hugo robot-assisted surgery system [Image courtesy of Medtronic]Medtronic (NYSE:MDT) meanwhile continues to work on its new Hugo system that is meant to rival Intuitive Surgical’s da Vinci robots. CEO Geoff Martha said in August that the world’s largest medical device company had been able to manage through previously disclosed disruptions related to COVID-19 — as well as resolving software issues. The plan is to file for CE Mark and U.S. IDE approval in early 2021.

“We’re going to be a meaningful player in this market. Go big or go home,” Martha said.

Titan Medical (TSX:TMD;NSDQ:TMDI) has also entered into an agreement with Medtronic to progress the development of robot-assisted surgical technologies.

In the orthopedics space, Medtronic is looking to add enhancements to its Mazor X spinal robotic system.

Johnson & Johnson: Taking its time

JNJ Monarch

Johnson & Johnson’s existing Monarch surgery platform [Image from J&J]Johnson & Johnson (NYSE:JNJ) is taking its time on a general surgery robot to compete against Intuitive Surgical. J&J announced in July that it has decided not to follow a 510(k) clearance pathway; the company’s goal is to start first-in-human studies with the system by the second half of 2022.

The medtech giant has been working on combining technologies that came out of its previous Verb Surgical collaboration with the Alphabet (NSDQ:GOOGL) life sciences unit Verily — as well as its $3.4 billion purchase of Auris Health and its FDA-cleared Monarch platform.

“We continue to be impressed by the technology advancements we’re seeing with both the Verb and Verily and the Auris combination. Our teams are making very good progress as we speak,” J&J CEO Alex Gorsky said during a July earnings call transcribed by Seeking Alpha.

During the second half of 2020, J&J is planning a U.S. regulatory submission for robotic knee surgery as part of its Velys digital surgery platform. The robotic surgery technology came out of J&J’s acquisition of Orthotaxy in 2018.

Stryker: The big player in robot-assisted ortho surgery

Stryker Mako robot-assisted surgery orthopedics ortho

[Mako robot image courtesy of Stryker]Stryker (NYSE:SYK) saw its second-quarter sales slashed by a quarter amid the COVID-19 pandemic, but the company’s Mako robotic systems for knee and hip surgeries remain a bright spot. Stryker is arguably the dominant player in the robotic ortho surgery space, with the company passing the 1,000 mark for Mako installations.

“The lead that we have in robotics is clear, and it’s continuing, and it’s a really a global thing. We have over 28 countries now that have a Mako robot, and that growth will continue long into the future,” CEO Kevin Lobo said on Sept. 15 during a virtual healthcare conference held by Morgan Stanley.

Mako has proven to be a major growth engine for Stryker as health providers buy all of the tools and accessories around the system.

Stryker’s $500 million buyout of Mobius Imaging and its Cardan Robotics subsidiary in 2019 could provide it an avenue to compete against Medtronic in the robotic spine surgery space, though Lobo during the Morgan Stanley conference said the other option would be to come out with a more advanced option through Mako.

Siemens Healthineers (Corindus): Telerobotic surgery pioneer

robotic telesurgery Corindus Vascular CorPath GRX

The robotic arm, drive and cassette unit on Corindus Vascular’s CorPath GRX system. [Image courtesy of Corindus]Siemens Healthineers last year spent $1.1 billion to acquire Corindus Vascular Robotics and its robot-assisted device that is FDA-cleared for coronary and peripheral vascular procedures.

Corindus’ CorPath GRX vascular robotic system boasts robotic-assisted control of coronary guide catheters, guidewires and rapid exchange catheters — with sub-millimeter measurement and 1 mm movement for proper stent positioning.

The system has enabled Corindus to be a pioneer in telerobotic surgery. The company was recently the subject of a documentary reviewing the power and potential of 5G technology. Called “The Speed of Thought,” it documented the first transcontinental interventional procedure performed using Corindus’ CorPath system. (Listen to our most recent DeviceTalks Weekly, in which Corindus COO Doug Teany discusses how 5G could enable more remote surgeries.)

TransEnterix: Bringing more augmented intelligence to procedures


TransEnterix’s Senhance System boasts haptic feedback, surgeon camera control via eye sensing and improved ergonomics. [Image courtesy of TransEnterix]TransEnterix (NYSE: TRXCannounced in August that cost-saving initiatives and a $15 million underwritten public offering have provided enough cash to support operations into the second quarter of 2021.

Before the COVID-19 pandemic hit, TransEnterix had been seeking a better year for its Senhance Systems, which boast haptic feedback, surgeon camera control via eye sensing and improved ergonomics.

The company has made a push into augmented intelligence. The new FDA-cleared Intelligent Surgical Unit on the system enables the camera to automatically move for a surgeon during a procedure, responding to commands and recognizing certain objects and locations in the surgical field.

Hackensack Meridian Health Pascack Valley Medical Center in New Jersey recently completed its first surgical procedures using the Intelligent Surgical Unit.“The introduction of machine vision capabilities represents an important step in our goal to reduce variability in surgery and improve surgical outcomes by supporting surgeon decision making and reducing cognitive fatigue,” TransEnterix CEO Anthony Fernando said in a Sept. 23 news release.

TransEnterix has also experimented with robot leasing agreements to get Senhance into the hands of more surgeons.

Titan Medical: Seeking a niche in single-port robotic surgery

Titan Medical

Titan Medical has touted its Sport robotic surgery system as a versatile single-port system [Image courtesy of Titan Medical]Titan Medical (TSX:TMD;OTC:TITFX) faced a working capital deficit of $9.7 million in mid-2019. Fast forward to the end of Q2 2020, and the robotic surgery company had $21.7 million in working capital and was able to resume product development of its single-port robotic surgical system.

Titan executives were able to turn things around thanks to a $10 million license payment as part of its new development deal with Medtronic (NYSE:MDT). Titan also recently brought in $18 million from a public equity raise.

Titan Medical CEO David McNally in July noted the clinical success that surgeons are reporting while using Intuitive Surgical’s da Vinci SP — currently the only commercially available single-port offering — but the success involves surgical indications outside the initial target area that Titan is pursuing.

“We believe that our robotic-assisted surgical system, having been designed with a focus on single-port surgery, may provide competitive advantages for physicians and their clinical teams, hospitals and patients,” McNally said. “Should we be able to complete product development and achieve regulatory clearance in a timely manner, upon commercialization we expect our single-port system to expand the market for robotic-assisted surgery with attractive pricing, a reduced operating room footprint and greater portability within the hospital.”

Stereotaxis: Bringing robotics to cardiac ablation

Stereotaxis Genesis Robotic Magnetic Navigation

The Genesis robotic magnetic navigation system [Image courtesy of Stereotaxis]Stereotaxis (NYSE:STXS) earlier this month announced the installation in Helsinki, Finland, and Phoenix, Ariz., of the first Genesis Robotic Magnetic Navigation (RMN) systems to treat heart rhythm disorders.

Robotic magnetic navigation provides robotic precision and safety to cardiac ablation, a common minimally invasive procedure to treat arrhythmias, according to St. Louis–based Stereotaxis.

“This technology allows us to positively address the increasing number of patients with complex arrhythmias. In addition, it provides us a competitive advantage to other Nordic centers concerning education and learning,” said Antti Vento, medical director of the Helsinki Heart and Lung Center.

Smith+Nephew: A handheld options for robotic ortho surgery

Smith+Nephew Cori surgical system

The Cori surgical system [Image courtesy of Smith+Nephew]Competition continues to heat up in the robotic orthopedic surgery space, with Smith+Nephew (LON:SN) over the summer announcing the launch of its next-gen Cori surgical system.

Cleared by FDA and available for both total and unicompartmental knee arthroplasty, the handheld Cori robotics platform is meant to be faster than S+N’s previous Navio system. In addition to Cori, the British medtech giant also launched its Real Intelligence suite of digital surgery solutions that are meant to improve patient engagement, pre-operative planning, digital and robotic surgery, post-operative assessment and outcomes measurement.

The Cori surgical system represent next-generation robotics, according to Dr. Jimmy Chow, an orthopedic surgeon at the Orthopedic Institute of the West.

“Its efficient handheld form factor is ideal for surgery centers, which is where the market is moving, and it just erases away bone with the new bone milling technique,” Chow said in a recent Smith+Nephew news release. “The smart, intuitive software helps place and size the implant as well as balance gaps based on patient-specific anatomy and disease state.”

The new Cori system is small and portable, making it a good fit for ambulatory surgery centers (ASCs) and outpatient surgery. Its modular design means that S+N could scale Cori to handle other types of orthopedic surgeries.

“The introduction of the Cori surgical system’s handheld robotics, patient engagement tools and outcomes measurement are the very first steps in a long-term strategy to advance orthopedics using enabling technology,” said Skip Kiil, global president of orthopedics at Smith+Nephew.

Zimmer Biomet: Competing against Stryker’s Mako

Zimmer Biomet Rosa robot-assisted surgery orthopedics ortho

[Rosa robot-assisted surgery system image courtesy of Zimmer Biomet]Zimmer Biomet (NYSE:ZBH) is also seeking to compete against Stryker in the robot-assisted knee surgery space through its Rosa platform. The Rosa system boasts 2D X-ray and 3D pre-operative planning tools, allowing surgeons to conduct virtual procedures ahead of the actual surgeries — as well as real-time intraoperative data on soft tissue and bone anatomy.

Zimmer Biomet acquired the initial Rosa technology through its roughly $132 million purchase of French robot-assisted surgery firm Medtech in 2016.

As of August, the company had 150 Rosa knee systems placed around the world.

“Based on the volume of accounts in that pipeline, we’ll be very disappointed if we don’t have between 200 and 300 Rosa systems out in the market by the end of this year,” Zimmer Biomet CEO Bryan Hanson said during an August earnings call.

Zimmer Biomet also has a Rosa spine system and its Rosa One Brain system for neurosurgical procedures

Vicarious Surgical: Combining robotics with virtual reality

Vicarious Surgical

[Image courtesy of Vicarious Surgical]Vicarious Surgical in August announced that it had raised $13.2 million in funding — on top of tens of millions of dollars already raised in recent years. The Cambridge, Mass.–based startup is seeking to develop and commercialize its technology, which applies robotics and virtual reality to minimally invasive surgery.

The FDA provided breakthrough device designation for Vicarious’ robot in December 2019.

Monteris Medical: Robot-assisted brain surgery with MRI

Monteris Medical NeuroBlate

This illustration shows the laser probe in Monteris Medical’s NeuroBlate robot-assisted brain surgery system. [Image courtesy of Monteris Medical]Monteris Medical (Plymouth, Minn.) recently announced through an SEC filing that it has raised another $9 million, about four months after it crossed the 3,000 mark of people treated with its NeuroBlate robot-assisted brain surgery device.

Nearly all of the people treated so far with NeuroBlate had epilepsy, gliomas, brain metastases and radiation necrosis.

“Patients appreciate the minimally-invasive nature of NeuroBlate,” Dr. Stephan Schuele, chief of epilepsy and clinical neurophysiology at Northwestern Feinberg School of Medicine in Chicago, said in a May news release from Monteris announcing the 3,000th patient.

“They usually return home with a minimal hospital stay. It’s become an important tool in our kit for helping people with epilepsy and can make a real difference in people’s lives,” Schuele added.