The current state of robotic surgery in urology is one that is dominated by the da Vinci surgical systems, which has an installation base of 5764 units across the world as of June 2020 (https://isrg.intuitive.com/news-releases/news-release-details/intuitive-announces-second-quarter-earnings-0). The growing popularity of laparo-endoscopic single-site surgery and the introduction of extended-use instruments only add to the monopolization of the market. Additional factors, such as exceptional customer service, trainee familiarity with da Vinci products, and superior rankings for 'best workplace' based on employee feedback at Intuitive provide fertile evidence that they will continue to have a stranglehold on surgical robots for the immediate future. Nonetheless, with global annual revenues for robotic assisted minimally invasive surgery expected to grow 500% between 2018 and 2025, there is significant interest within the medical device industry to develop other options (https://www.gminsights.com/industry-analysis/surgical-robots-market). Whether it is the modular design that Versius offers, the lower cost 'German Robot' design by Avaterramedical, or the secretive 'Surgery 4.0' digital surgical platform by Verb Surgical, the landscape of surgical robots will be transformed in the near future. The next generation of robotic surgical systems will combine portability and affordability with the technical benefits of haptic feedback, single-port incisions, and machine learning (Figure 1).
As with any medical device, thorough testing and regulatory compliance is complex and time-consuming. The landscape for a soft tissue robotic surgical system is developing but will largely remain a monopolized marketplace for the next 5 years and likely longer as competitors find their niche and conduct necessary clinical studies. Urologists have continuously been at the forefront of new medical devices and surgical technologies, and it will be our responsibility to become familiar with novel robotic surgical systems as they become commercially available.
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Curr Opin Urol. 2021;31(1):37-42. © 2021 Wolters Kluwer Health, Inc.