Observation of the Shifting Market Dynamics in Minimally Invasive Surgical Procedures

by Ryan Gloede

Vizient Medical-Surgical Sourcing Director

Health care is constantly changing and evolving and with the continual movement towards technological integration, the competitive landscape for minimally invasive surgical procedures using robotics will change over the next few years. We expect to see the rollout of new robotic equipment and more manufacturers entering the market. The question is, how will this affect the future of robotic-assisted surgical procedures being performed within your health system?

In the early 2000s, the market saw the introduction of the robotic surgical system which offered providers a revolutionary way of delivering minimally invasive surgical procedures like a prostatectomy, for example. The robotic-assisted surgical systems give surgeons enhanced viewing capabilities with 3D visualization and increased dexterity that allows them to reach and view areas otherwise not possible without making a large incision.

Since market introduction, however, product innovation has been minimal and the landscape for surgical robotic options in the U.S. has been constrained by a lack of competition. Further, the market has experienced high costs associated with the purchase of large robotic systems and proprietary connected products.

As payers do not reimburse robotic-assisted surgical procedures at a higher rate than non-robotic procedures, the overall costs associated with robotic procedures are leaving many health care providers questioning their return on investment when compared to manually performed procedures. Some hospital systems may even consider their minimally invasive robotic system as only a marketing tool to appeal to patients looking for the latest technology.

Now, roughly 20 years later, new manufacturers are preparing to enter the market providing hospitals with more choice in systems and more competitive pricing.

Signs of an evolving market

The market is poised to change over the next one to three years. Conformité Européene’ (CE) Mark approvals in the European markets and investigational device exemptions from the U.S. Food and Drug Administration are either underway or have already been approved for several new manufacturers. In tandem, existing manufacturers are reacting to the anticipated competition by offering options that may be more cost-effective for health systems, such as leasing robotic equipment instead of the historic purchasing requirement.

While we don’t expect to see increased payments from insurers, as the market competition expands, we’re optimistic that new entrants will help drive down the cost of robotics systems, bringing those procedures more in line with the costs associated with manual procedures, helping to improve hospitals’ return on robotic investments.

Market dynamics indicate this may be accomplished through some robotic surgical systems leveraging compatibility of instrumentation that providers are utilizing today in manual procedures, minimizing the costs associated with additional products and staff training. Other areas of product evolution include robotic surgical systems with a smaller footprint that makes it easier to move them to other surgical locations within the health system, operating room, outpatient surgical center or eventually even into trauma situations in the emergency room.

The use of augmented reality, though still in its infancy, may help to create better precision and perception for the provider through the use of intraoperative images and virtual markers during the procedure. In addition to this, a strong focus on artificial intelligence and machine learning through data algorithms and analytics could help providers and health systems gain insights leading to opportunities and best practices that can be shared industry-wide.

Cloud-based connectivity is being used today and will continue to be enhanced with simultaneous software and system upgrades in addition to providing a repository and resource accessible for provider education and disease research.

As more robotic options become available in the market, we also expect that patient demand will continue to increase with the anticipation of high-quality clinical outcomes using the most advanced technology. Clinical data on robotic-assisted surgical procedures are already beginning to be collected by third parties in the market, as well as through Vizient’s Clinical Data Base. Although currently limited in scope, insights suggest that some procedures with the use of robotic-assisted surgical systems can produce optimal patient outcomes with reductions in bleeding, scarring, surgical site infections as well as the length of stay. However, each health system and provider must determine the optimal outcome based on procedure and patient, as not all procedures produce superior outcomes with the use of a surgical robot.

We’re also seeing an increased interest from medical students at academic medical centers who have an interest in understanding and training on robotic-assisted surgical procedures. As they are entering the workforce, health systems should be thinking about, and possibly preparing for, a dedicated robotics program within the system that will encourage, train and develop this knowledge base and capitalize on this unique skillset.

Planning for the future

As the market and technology continue to evolve, we anticipate that hospitals and health systems will be able to obtain this type of capital equipment more cost-effectively, prompting the move from a marketing tool used to attract patients into an integrated patient care solution that consistently delivers quality outcomes in a cost-effective way. If you need assistance sorting it all out, feel free to reach out to me via email.