ARTICLE SUMMARY:
New soft-tissue systems have advanced features, specificity, and applications, and are increasingly augmented by artificial intelligence. Excerpted from our recent feature, "Surgical Robotics in 2025: Noninvasive, Force Feedback, Multimodal."
The surgical robotics market is currently valued at more than $8 billion, growing at a double-digit rate, with sales expected to more than triple by 2032, according to the investment firm Gabelli Group. Robotics pioneer Intuitive Surgical continues to be the dominant player with greater than 80% market share, nearly 10,000 da Vinci systems placed, and revenue growth in the mid to high teens, more than 20 years after it introduced the da Vinci robot (see Figure 1). Opportunities for competition remain wide, however, as only 2% of surgeries use robotics.
Dozens of companies are developing soft-tissue systems with advanced features, specificity, and applications, increasingly augmented by artificial intelligence. A recent panel organized by Gabelli Group and the Columbia Business School highlighted several of these achievements, focusing on Intuitive’s fifth-generation da Vinci and HistoSonics’ noninvasive Edison Histotripsy System.
Intuitive Surgical received FDA approval for the da Vinci 5 in March 2024. Now in a pilot phase, with a full commercial launch planned for mid-2025, it has 10,000 times the computational power of the previous generation of robots and increased automation, said panelist Gretchen Jackson, MD, PhD, VP and scientific medical officer at Intuitive Surgical.
Moreover, for the first time, the system is integrated with a hub that allows the capture of intraoperative video images, which generate data and allow surgeons to bookmark certain actions for later review. Real-time streaming of audio and video intraoperative data enables surgeons to consult remotely with colleagues, Jackson pointed out. Jackson, a past president of the American Medical Informatics Society and associate professor of surgery at Vanderbilt University, noted that the system’s benefits also include force feedback, which measures the push and pull of multidirectional forces at the tips of instruments and transmits that back to the surgeon through the hand controllers.
The da Vinci 5 also features Case Insights, an AI-powered tool, which integrates data from surgical videos and robotic systems’ activities, such as the use of different instrumentation, or energy, as well as kinematic data. This feature captures intraoperative information that provides objective metrics of surgical performance, such as precise timing of specific surgical tasks and the degree to which a surgeon rotates their wrist during a procedure. “We are just at the beginning of our journey of learning about what those insights mean,” Jackson continued. “The literature tells us that those objective insights of what happens during surgery can be stronger predictors of outcomes than patient or disease factors. “Almost all surgical, quality work has been patient focused. This is the missing piece of the surgical outcomes puzzle.”
HistoSonics, in contrast, is in the early stages of launching its noninvasive tissue liquification technology. The Edison Histotripsy System, which scientists at the University of Michigan pioneered, took 15 years to develop into a commercially viable product. The surgeon presses a button that powers the robot to steer tissue particles through a treatment that uses pulsed sound waves to induce “bubble clouds” from gases naturally present in targeted tissue. These clouds form and collapse in microseconds, creating mechanical forces that are noninvasive and nonthermal, yet strong enough to destroy tissue.
The system was cleared under a 510(k) De Novo pathway in late 2023 for removing cancerous tissue in the liver, where the disease often metabolizes. Its ability to liquify targeted tissue without damaging surrounding critical structures, like blood vessels and nerves, allows for a very precise treatment approach compared to traditional surgical or radiation-based methods. The liquefied tissue is then reabsorbed by the body over time and disappears.
The Edison system has the potential to disrupt traditional surgical approaches in many areas, said panelist Josh Stopek, PhD, HistoSonics’ VP, R&D. It could reduce the need for open or laparoscopic surgeries, leading to faster recovery times, fewer complications, and lower costs. Clinical trials underway are aimed at expanding its use in many other organs.
Much like the da Vinci robot, it integrates imaging and robotic positioning. In addition, histotripsy, which FDA has designated as a breakthrough therapy, enables real-time visualization, which the surgeon can use to draw up a three-dimensional treatment plan.