How sensor technologies will transform the surgical robots of the future
We are delighted to have Technology & Market Analyst, Dr. Marjorie Villien, member of the Medical Technologies (MedTech) business unit at Yole Développement joining MediSens on the expert speaker line-up. Dr Villien has produced the analysis below on how far sensor technologies have come and where they’re set to go next.
After spending two years at Harvard, Marjorie served as a research scientist at INSERM in the field of medical imaging for the treatment of Alzheimer’s disease, strokes and cancers. Marjorie has spoken in numerous international conferences and has authored or co-authored 11 papers and 1 patent. She exchanges views daily with clinicians, researchers and industrial partners to better understand technology issues and to ensure the connection between R&D and applications. Dr. Villien graduated from Grenoble INP and holds a PhD in physics & medical imaging.
Sensor technologies have already reshaped the medical imaging market. How will they transform the surgical robots of the future?
Sensors are key components of medical devices and are changing the medical industry. The medical imaging field is directly impacted by technology shifts in the sensor market, whether in X-ray, endoscopy or molecular imaging applications. Surgical robotics is one of the applications of endoscopy with the highest requirements in terms of image quality, while the surgical robotics market is also being directly impacted by other sensor technologies such as haptics. Sensors are key enablers of these new technologies available in medical robotics and are slowly transforming the healthcare system.
Sensor technologies are changing the medical imaging industry
The medical imaging equipment industry is a huge $35B market with a few mega-players, and a comfortable +5.5% CAGR for the next 5 years1. Medical imaging equipment encompasses X-ray imaging (general radiography, computed tomography, dental x-ray, etc.), molecular imaging (PET and SPECT mainly), endoscopy, optical coherence tomography and ultrasound imaging.
Sensor technologies are at the heart of these systems and are slowly creating disruptive market forces within the industry. The solid-state medical sensor market, which encompasses CCD, CIS, a-SI FPD, a-Se FPD, SiPM, and now cMUT and pMUT, has reached $350M in 2016 and is expected to grow at +8.3% CAGR from 2016 – 2022, representing $600M by 20221.
Sensors are becoming key technology know-how for tomorrow’s medical equipment manufacturers. The world is becoming increasingly data-driven, with ever more applications using artificial intelligence, machine learning, and big data. Doctors and scientists expect continuous improvements in image quality, while also developing new applications where these solid-state imaging capabilities can be used to their full extent. PET/MRI hybrids and endoscopy are examples of solid-state technology becoming the key enabler.
PET and MRI complement one another perfectly, but traditional PET detector technology (photomultiplier tubes) is not compatible with MRI’s technology. Solid-state SiPM is the answer to this technological challenge. Solid state technology is well suited to combined PET and MRI due to compatibility of the high magnetic fields and the capabilities of miniaturization. APD was chosen by Siemens for the first commercially available whole-body simultaneous PET/MR scanner (Siemens Biograph mMR®). GE chose SiPM for the first whole-body simultaneous TOF-PET/MR scanner (GE Signa PET/MR®). Solid-state is currently used not only in the combined PET/MR scanner but also in the new PET/CT system, due to its interesting properties and cost efficiency. This is dramatically changing the supply chain of the PET detectors industry.
In the case of endoscopy, usage of CCD or CMOS has now completely transformed the landscape and the digitization process is almost complete. Laparoscopes, rigid endoscopes used during surgery, are using CCD and CMOS chip-to-the-tip image sensors, where the use of multiple sensors allows for stereovision. Today more than 95% of rigid endoscopes are equipped with CCD sensors, and surgical robots include a laparoscope. Surgical robotics is only one application of the much bigger market of endoscopy, but the trends seen in this field undoubtedly also impact the surgical robotics market. As an example, Intuitive Surgical’s Da Vinci surgical robot is capable of 3D imaging thanks to two HD sensors at the tip of the laparoscope.
Sensors, key enablers of medical robotic technology
Dozens of sensors are required for a robot to function and respond to its environment: position and torque sensors for articulations, gyroscopes and accelerometers for positioning and moving parts, pressure sensors, image sensors, etc. These sensors can be divided into two groups:
- key enabler sensors at the interface between the human and the machine
- Other sensors not specifically developed for medical robotics applications2.
In the field of surgical robotics, the robot functions as the surgeon’s hands and eyes. Surgeons want technology that allows them to “feel” the body’s tissue remotely, a process called “haptic sensing”, as well as better camera-image quality. Both issues can be addressed using new sensor types: haptic sensors and high-resolution CCD or CMOS cameras.
Haptics is probably the technical feature most requested by physicians in the surgical robotics field. Of the five senses, touch is the most proficient, the only one capable of simultaneous input and output. Touch is at the core of personal experience. Despite persistent effort, reliable solutions for haptic feedback in robot-assisted minimally invasive surgery have yet to find their way into practice. TransEnterix is the first to propose a surgical robot with haptic feedback capabilities and they are beginning the commercialization of the product.
Another trend, already observed in the endoscopy market is the move towards disposable image sensors to achieve a disposable laparoscope. This trend is not yet visible in the surgical robots market, but will probably surface in the future as regulations evolve towards more disposable scopes. This would completely change the number of cameras sold to surgical robot-makers, shifting from a single camera per robot to as many as one camera per surgery.
In a more distant future a breakthrough will come from software development with automation of some aspects of the procedures.
Medical robotics: Who is doing what?
The Medical robotics supply chain is mainly organized in 4 segments: the sensor providers, such as AMS, Sony, Panasonic; the manufacturers of the mechanical part, where the main player is Kuka; the integrators, such as Intuitive Surgical, Stryker, Accuray; and the distributors, such as Medtronic.
In 2000, the field’s current main player, Intuitive Surgical, was one of the first firms to bring a surgical robot to market. It is still difficult for new-comers to compete with Intuitive Surgical directly as they already have a solid installed base, over 33,000 surgeons trained in its use, and are used by 100% of the top ranked US hospitals in the key specialty they are targeting. But newcomers are arriving with new features asked for by physicians, such as haptic feedback introduced by TransEnterix.
The neurosurgery surgical robotics field has evolved a lot since 2016 with major changes in the leaders’ corporate strategies. Medtronic, a giant of the medical device industry, is investing a lot in Mazor Robotics, whereas MedTech was sold to Zimmer Biotech.
Indeed, since 2016 Medtronic has made two major moves into surgical robotics: its acquisition of Covidien for $50B, and its emergence as Mazor Robotics’ lead investor. Medtronic-Covidien owns an extensive patent portfolio in the surgical robotics field, and the company should be watched closely over the next few years since they are probably working on a new product. They could also make a big splash by acquiring one of the leading companies in the field.
Another threat for Intuitive Surgical is coming from the collaboration of Johnson and Johnson, a giant from the biopharmaceutical industry, with Google, a leader in the data science field. Verb Surgical is very secretive about the technologies they are developing, but we can be sure that the surgical robots developed through this collaboration will make a significant impact in the field.
How is medical robotics reshaping the healthcare system?
Robotics has only impacted the healthcare industry over the past 25 years. Unlike industrial or consumer robots, medical robots are facing challenges linked to regulations or healthcare organization: reimbursement policies, cost of entry, differences in healthcare systems.
The surgical robotics market will experience an impressive 17% compound annual growth, from $3.4B in 2016 to $8.8B in 20222.
The two biggest obstacles to the adoption of robotic-assisted surgery until recently are: first, the cost, and second, the training. Robotic surgery is still very expensive which can make it prohibitive for many hospitals and health-care centers. Studies have shown, however, that robotic surgery cuts down on the trauma and healing time for specific applications. As surgeons become more familiar with using robots for surgery, and as more companies provide medical robots, there will come a day when robots are used in almost every hospital. Each “participant” sees added value in this technology: minimal invasiveness for the patient, enhanced microsurgery and precision capabilities for the surgeon, and cost optimization for the healthcare system, due to patients’ shorter recovery time.
Sensor technologies have already reshaped the medical imaging market, and are now impacting the medical robotics market. This evolution is clearly showing the strong importance of sensor technologies for the development of new systems, such as robots.
Sensors are fostering the development of new products to improve people’s life in every domain from automotive to consumer goods and healthcare. 2018 is just the beginning. Tomorrow will see more and more disruptive technologies and product innovations.
At Yole Développement, we follow the medical industry and related technologies continuously to identify technical breakthroughs and business opportunities. Medical imaging, robotics, organs-on-chips, liquid biopsy, neuro-technologies, artificial organs… are part of Yole Développement’s interests. Stay tuned with Yole Développement to better identify the latest innovations and understand their impact on the industry!
References: Solid-State Medical Imaging report, Yole Développement, 2017  Medical robotics technology & market analysis report, Yole Développement, 2017
About the Author
As a Technology & Market Analyst, Dr. Marjorie Villien is member of the Medical Technologies (MedTech) business unit at Yole Développement, the “More than Moore” market research and strategy consulting company. She is active in the development of MedTech, contributing to a dedicated collection of market & technology reports as well as custom consulting projects. As an example, Marjorie was involved in a project focused on videoscopy for endoscopy applications, to understand the benefits of the CCD/CMOS solution and identify business opportunities. In parallel, she performed an analysis of PET detectors technology to evaluate the impact of innovative Solid-State technologies on the evolution of the nuclear medicine industry. After spending two years at Harvard, Marjorie served as a research scientist at INSERM in the field of medical imaging for the treatment of Alzheimer’s disease, strokes and cancers. Marjorie has spoken in numerous international conferences and has authored or co-authored 11 papers and 1 patent. She exchanges views daily with clinicians, researchers and industrial partners to better understand technology issues and to ensure the connection between R&D and applications. Dr. Villien graduated from Grenoble INP and holds a PhD in physics & medical imaging.
Hear from Dr. Marjorie Villien on day two of the MediSens conference (26-27 February 2018 at the Royal Marsden Hospital, London) discussing “How will sensor technology impact the medical robots of the future?” Book your ticket today >>