(UroToday.com) Sunday was the first day of the plenary session in the 39th World Congress of Endourology and Uro-Technology. The first session, named "Wave of the Future", was about innovation and new technologies. It started with a lecture by Dr. Roger Sur and Dr. Jaime Landman. It was followed by a lecture on the History of Surfing by Mr. Scott Brass, a lecture on Imagination and Creativity by Dr. Ralph Clayman and a lecture on Innovation based on personal experiences by war hero Mr. Derek Herrera. Those talks were followed by a lecture by Dr. Duke Herrell III on Emerging Robotics Platforms demonstrating the history of da Vinci robots, competitors robots launched in the past few years, and even future robots on testing.
Dr. Herrell started the lecture by presenting the history of the Intuitive Surgical da Vinci robots. He started by showing that even the da Vinci robot initially originated from innovation based on academia (in this case, at Stanford) and therefore academia is usually involved in innovative and new technologies. He then outlined all the robots from da Vinci (Intuitive Surgical) (Figure 1) and then questioned if anyone can and who, where, and when the competition will come from.
Figure 1. Da Vinci Robots (Intuitive Surgical)
The presentation showed the impact of Intuitive Surgical on the market, with a monopoly on the past 20 years, over 300 patents, deep market penetration, widely accepted, and with continuous innovations. Therefore, there would be a lot of walls to penetrate for competitors to reach the impact of the Da Vinci robot, despite competition being important and this market being estimated on 5.5bi in 2018 and expected to increase to >24bi in 2025 (Figure 2). However, da Vinci Xi is still the standard robot as it is the only FDA-approved robot for urological robot-assisted laparoscopic surgery in the United States as of today.
Figure 2. Global Market Insights: surgical robots market
He followed the presentation by talking about robots from competitors. The Revo-i (Figure 3) is a robot approved for South Korea that looks like the da Vinci and has yet to be approved by other countries. In Japan, the Hinotori (Figure 4) robot has a fascinating headpiece that is adjustable to the person (instead of the person adjusting to a fixed console). The next robot presented was the Kang Duo (Figure 5), used in China, but still not approved elsewhere.
Figure 3. Revo-i robot (South Korea)
Figure 4. Hinotori robot (Medicaroid, Japan)
Figure 5. Kang duo robot (China)
The next robots presented were the Cambridge Medical Versius (Figure 6) and the Medtronic RAS Hugo (Figure 7). He showed the interesting console design of the Versius robot and the success it has been making in Europe and in Middle East. Then, he presented the Hugo robot which has been also having success in Europe and in South America. Both, however, are not FDA-approved yet. Lastly, he presented J&J Ottava robot (Figure 8).
Figure 6. Versius robot (Cambridge Medical)
Figure 7. Hugo robot (Medtronic, RAS)
Figure 8. Ottava robot (J&J)
After presenting the traditional laparoscopic robot, he proceeded to present other robotic platforms. Regarding single-port robots, Da Vinci is still the only FDA-approved, but he also showed the Titan Enos SP (Figure 9) and the Vicarious. (Figure 10) Another robot presented is the Anovo (Israel) which is only FDA-approved for transvaginal hysterectomy.
Figure 9. Enos SP robot (Titan Medical Inc) FIGURE TITAN ENOS SP, VICARIOUS, ANOVO
Figure 10. Vicarious single-port robot (Vicarious Surgical)
After that, he proceeded to show the Monarch Auris (Figure 11), a flexible scope that is being cleared by FDA for endourological procedures such as robotic ureteroscopy with mini-percutaneous surgery. He showed the electromagnetic tracking system on the Monarch Auris. He also showed Intuitive Surgical’s Ion (Figure 12) which is at the moment only used for bronchoscopy but has a similar design and could be used in Urology in the future. He showed the Procept Aquablation (Figure 13), a semi-automated device for benign prostate hyperplasia. Lastly, showed the Virtuoso (Figure 14), a robot for flexible endoscopy with 1mm instruments allowing two-handed transurethral procedure, but still not FDA-approved. He proceeded on showing a potential series of applications of the Virtuoso in other organs, which could be something really interesting to look for in the near future
Figure 11. AURIS Monarch robot for ureteroscopy.
Figure 12. Ion (Intuitive Surgical)
Figure 13. Procept Aquablation
Figure 14. Virtuoso robot
To summarize, Dr. Duke Herrell brilliantly gave a lecture on all existing and in design robotic platforms in the Urological field. He proceeded to thank his team and quoted Dr. Ralph Clayman that innovation is teamwork. Lastly, he quoted a recent Elon Musk tweet about robots in the future being cheaper than a Tesla, explaining the huge rise in robotic systems now.
Presented by: S. Duke Herrell, MD Vanderbilt University, Nashville, TN
Written by: Antônio Rebello Horta Görgen, MD, Research Fellow, Department of Urology, University of California Irvine, @antoniogorgen on Twitter during the 39th World Congress of Endo urology and Uro-Technology (WCET), Oct 1 - 4, 2022, San Diego, California.