Abdominal Surgical Robot Market Shares, Strategies, and Forecasts, Worldwide, 2017 to 2023

Published: Jun, 2017 | Pages: 524 | Publisher: WinterGreen Research
Industry: Pharmaceuticals & Healthcare | Report Format: Electronic (PDF)

Treatment via a robotic approach to abdominal surgery is useful for benign and malignant gynecologic conditions. Urologic and abdominal disease conditions are being treated increasingly with robotic surgery. Challenges still exist at a systems level. Implementation of a robotic program has a long learning curve. Resistance by surgeons on the team who are not adept at using the systems, quality of life, and financial challenges are being addressed in the industry. Challenges arise because of high capital expense, and organizational challenges continue to exist on an ongoing basis.

This is being addressed as more surgeons are trained and gain experience in the market. The world market for abdominal surgical robots is at $2.9 billion in 2017. The Robotic surgery equipment industry revenue is projected to increase to $12.9 billion by 2022. Robotic surgery equipment continues to comprise a fast-growing segment of the medical device industry. Demand for the less invasive procedure is high among patients and doctors. The number of procedures and disposable instruments increases.

Existing open surgery is set to be replaced by robotic-assisted surgery. Young surgeons have steady hands, but even the greatest surgeons have off days and they age. As this happens, the advantages of the robot are evident because the hand is steady every time with the robot.

During a robot assisted surgical procedure, the patient-side cart is positioned next to the operating table with the electromechanical arms arranged to provide access to the initial ports selected by the surgeon.

Technologies for abdominal robotic surgery applications has had growing adoption and commercialization. These technologies work in solving surgical approaches to many gynecology, urology, and general surgical issues. Robotic surgical procedures have reached a level of market acceptance that proves their value. Market saturation is a distance away, the industry is still in its infancy.

The technology available is becoming more sophisticated in order to overcome hurdles. The objectives of overcoming the limitations of fixed port access, limited dexterity, and limited visualization remain. The industry leader, the only company with a commercial footprint, within the robotic surgical market is Intuitive Surgical, Inc. (NASDAQ: ISRG), maker of the da Vinci® Surgical System.

According to Susan Eustis, lead author of the team that prepared the study, “Growing acceptance of minimally invasive surgery and robotic surgery is because the robotic surgery provides an improvement over current surgical techniques. Open surgery is a difficult thing. Demand for less invasive procedures is coming as patients realize the benefits of quality of care from robotic surgery. Patients feel better after robotic surgery and the surgeries are more likely to be successful.”

The worldwide market for abdominal surgical robots at $2.7 billion in 2016 grows to $15.8 billion by 2023. The complete report provides a comprehensive analysis of abdominal surgical robots in different categories, illustrating the diversity of uses for devices in surgery. A complete procedure analysis is done, looking at numbers of procedures and doing penetration analysis.

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Companies Profiled

Market Leaders
• Intuitive Surgical

Market Participants
• AdEchoTech / T-MedRobotics /
• Auris Robotics
• Avra Robotics
• Cambridge Medical Robotics
• Chinese Surgical Robots
• Fosun Pharma
• Freehand
• Freehand 2010 / Prosurgics
• Google
• IMRIS
• Johnson and Johnson / DePuy Synthes
• Medtronic / Mazor Robotics
• Medrobotics
• Medtronic
• Meerecompany / Eterne
• OMNI
• Smith & Nephew
• Stryker
• THINK Surgical
• Titan Medical
• TransEnterix
• Verb Surgical
• Virtual Incision
• Zimmer Biomet Acquires Medtech SA, Joins Surgical Robotics
• Selected Surgical Robot Companies

Key Topics
• Abdominal Surgical Robotics
• Surgical Robots
• Medical Devices
• Healthcare Robotics
• Surgical Enabling Technology
• Robotic-Assisted Minimally Invasive Surgery
• Robotic Surgical System
• Medical / Surgical Delivery Robots
• Surgical Assistive Technology
• Hospital Robots
• Robotic Surgery Equipment
• Surgical Robot Applications
• Next Generation Robotic Surgery
• Flexible Robot Platform,
• Minimally Invasive Surgery
• MIS

 Table of Contents

ABDOMINAL SURGICAL ROBOT EXECUTIVE SUMMARY	28
Abdominal Surgical Robotics Segment: Urology, Gynecology, General Surgery, Thoracic, Structural	
Heart, And Head/Neck				28
Abdominal Surgical Robotics Market Driving Forces	28
Surgical Robotics Market Driving Forces			31
New Entrants to Open Up Surgical Robotics Market	35
Abdominal Surgical Robot Market Driving Forces			35
Healthcare Abdominal Robotics Enabling Technology	42
Abdominal Robot-Assisted Surgery Market Driving Forces	42
Entrepreneurial Manufacturers with FDA-Approved Products	
Provide Sourcing To Larger Companies				45
Surgical Robot Market Risks				46
Medical Abdominal Surgical Robots: Market Shares			48
Robotic Abdominal Surgery Market Forecasts				51
Abdominal Surgical Robot Systems Forecasts			52

1.1  Open surgery	56
1.1.1	Abdominal Robotic Surgery Extends The Benefits of MIS	56
1.1.2	Business Model	57
1.1.3	Abdominal Robotic Surgery Systems	58
1.1.4	Intuitive Surgical Procedure Mix / Products	59
1.1.5	Abdominal Robotic Surgical System	59
1.1.6	Robotic Surgery As The Standard All Surgical Procedures	64
1.1.7	Focus on Key Institutions	65
1.2	Focus on Leading Surgeons to Drive Rapid and Broad Adoption	66
1.2.1	Maintain Market Leadership	66
1.2.2	Develop Industry Alliances	67
1.2.3	Increase Patient Awareness	67
1.3	Clinical Applications for Abdominal Robotic Surgery Technology	68

2. ABDOMINAL SURGICAL ROBOT MARKET SHARES AND FORECASTS	69
2.1	Abdominal Surgical Robotics Segment: Urology, Gynecology, General Surgery, Thoracic, Structural Heart, And Head/Neck	69
3.1.10  Abdominal Surgical Robotics Market Driving Forces	70
2.1.2	Surgical Robotics Market Driving Forces	73
2.1.3	New Entrants to Open Up Surgical Robotics Market	77
2.1.4	Abdominal Surgical Robot Market Driving Forces	77
2.1.5	Healthcare Abdominal Robotics Enabling Technology	84
2.1.6	Abdominal Robot-Assisted Surgery Market Driving Forces	84
2.1.7	Entrepreneurial Manufacturers with FDA-Approved Products Provide Sourcing To Larger Companies	86			
2.1.8   Surgical Robot Market Risks		87
2.2	Medical Abdominal Surgical Robots: Market Shares	89
2.2.1	Intuitive Surgical Dominates The Abdominal Surgical Robot Market	92
2.2.2	Intuitive Surgical Market Opportunity and Revenue	94
2.2.3	Intuitive Surgical daVinci Installed Base and Product Shipments, By Product Type, Si Systems,Si-e, Xi, Single and Dual Console, Units and Dollars, Worldwide, 2016	97
2.2.4	Intuitive Surgical Shipments by Model	103
2.2.5	Intuitive Surgical Unit Shipments	105
2.2.6	Intuitive Robotic Surgery Competitors	110
2.2.7	Intuitive Surgical Competitive Advantages	111
2.2.8	Intuitive Surgical Imaging Technologies	113
2.2.9	Intuitive Surgical Profitability	113
2.2.10  Intuitive Surgical Robotics da Vinci System	118
2.2.11  Intuitive Surgical and the Competition Overcome Market Saturation	119
2.2.12  Intuitive Surgical Recurring Revenue	120
2.2.13  Intuitive Surgical Robotic Surgery Strategic Positioning	124
2.2.14	Transenterix	126
2.2.15	TransEnterix	127
2.2.16  Google and Johnson & Johnson	128
2.2.17	Medtronic	129
2.2.18  Johnson & Johnson / Verb Surgical	130
2.2.19	Titan Robot	131
2.2.20	Titan Robot Partners	134
2.2.21	Titan Prospectus	135
2.2.23  Medicaroid	137
2.3  Robotic Abdominal Surgery Market Forecasts	137
2.3.1	Abdominal Surgical Robot Systems Forecasts	139
2.4	Segment Abdominal Surgical Robots Forecast Analysis: Systems, Instruments, and Services Dollars 142
2.4.1	Abdominal Surgical Robots Segment Analysis Products, Services, And Instruments And Accessories	143
2.4.2	Abdominal Surgical Robots Segment Analysis Gynecological, General Surgery, Urological,Cardio, and Head/Neck	145
2.4.3	Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological, Dollars and Units	152
2.4.4	Medical Robotic Surgery Challenges	161
2.4.5	Robotic Surgery: Risks vs. Rewards	164
2.4.6	Abdominal Surgical Robot Disposable Instruments Forecasts	168
2.4.7	Surgical Robot Systems vs. Disposable Instruments Forecasts	172
2.4.8	Robotic Surgery Market Challenges	173
2.4.9	Cancer Robotic Surgery Learning Curves	176
2.4.10  Abdominal Robotic Remote Surgery	177
2.4.11  Medicare and Medicaid Impact	177
2.5  Installed Abdominal Surgical Robot Systems	178
2.5.1	Abdominal Surgery Installed Systems Geographical Analysis	184
2.5.2	Intuitive Surgical Robotic Surgery Installed Systems, Number, Regional Analysis By Country,2016	189
2.5.3	Surgical Robot Regional Installations	190
2.6	Procedure Volumes Abdominal Surgical Robots Systems, Instruments, and Services by Segment and by Country		192
2.6.1  Abdominal Surgical Worldwide Procedures	193
2.6.2  Abdominal Surgical U.S. Procedures	194
2.6.3  Abdominal Surgical Procedures Outside of the U.S.	194
2.6.1	Intuitive Surgical Gynecological Procedures	198
2.6.2	Gynecology Robotic Surgery Procedures By Country	201
2.6.3	Intuitive Surgical Benign Gynecology Procedure Adoption Trends	201
2.6.4	Abdominal Surgical Robot Procedure Analysis	213
2.6.5	Intuitive Surgical Sacrocolpopexy	214
2.7  Urologic Procedure Volumes	215
2.7.1	Intuitive Surgical Robotic Urology Surgery Procedures	216
2.7.2	Urology Robotic Surgery Procedures by Country	219
2.7.3	Urologic Prostatectomy Surgery	219
2.7.4	Intuitive Surgical da Vinci Prostatectomy (dVP)	220
2.7.5	Urology Robotic Surgery Partial Nephrectomy	220
2.7.6	Robotic Urologic Prostatectomy Surgery	221
2.8  General Surgery Robotic Procedures	223
2.8.1	Intuitive Surgical Robotic General Surgery Procedures	223
2.8.2	Robotic General Surgery Procedure Volumes	228
2.8.3	General Surgery Cholecystectomy	229
2.8.4	Intuitive Surgical da Vinci Prostatectomy Cholecystectomy	231
2.8.5	Intuitive Surgical Procedure Mix	231
2.9  Head and Neck Surgery	232
2.9.1	Head and Neck Transoral Surgery	232
2.10	Cardiac Abdominal Surgical Robot	234
2.11	Abdominal General Surgery, Gynecology, and Urology Surgical Robot Procedure Category Discussion	235	
2.11.1	Abdominal General Surgery, Gynecological, And Urological Robotic Surgery Procedures By Country		236	
2.11.2  Intuitive Surgical Procedure Mix	239
2.11.3	Robotic Myomectomy	240
2.11.4	Intuitive Surgical Investments to Improve Surgery	244
2.12	Open and Robotic Surgery Procedure Detail Forecasts, US and Worldwide	247
2.12.1	Small Hospitals Lack the Procedure Volume To Justify The Upfront Investment In A Robotic Surgery System	248
2.13	Robotic Surgery Equipment Prices	248
2.13.1  Intuitive Surgical da Vinci Surgical System Prices	250
2.14	Abdominal Robotic Surgery Equipment Regional Market Segments	251
2.14.1  Intuitive Surgical Regional Revenue	255
2.14.2  Intuitive Surgical European Demand	257
2.14.3  U.S. Robotic Surgical Procedures	259
2.14.4  Chinese Imported Surgical Robots	261
2.14.5  Chinese Development of Surgical Robots	261
2.14.6  Chinese and Taiwanese Markets for Minimally Invasive Spinal Devices	262
2.14.7  BRIC (Brazil, Russia, India, China) countries	263
2.14.8	Aging Taiwanese Population	263
2.14.9  Korea Focusing On Creating A Growth Engine In Research & Development	264
2.14.10	Korea	264
2.14.11	Brazil	265
2.14.12  Surgical Care In Emerging Markets	266
2.14.13	Shifting to a Needs-Driven Equipment Purchase Method Presents Challenges In Emerging Markets	268	
2.14.14	Regional Analysis by Country	269

3	SURGICAL ROBOTS PRODUCT DESCRIPTION	272
3.2	Intuitive Surgical da Vinci Xi	272
3.2.1	da Vinci X Surgical System Provides Lower-Cost, Robotic-Assisted Surgical Option For Hospitals, Surgeons		273
3.2.2   Intuitive Surgical da Vinci Si-e, A Lower Price System	277
3.2.3   Intuitive Surgical da Vinci Xi Integrated Table Motion	277
3.2.4   Intuitive Surgical da Vinci X System		278
3.2.5	Intuitive Surgical da Vinci Xi Surgical System	283
3.2.6	Intuitive Surgical da Vinci Surgical System	285
3.2.7	Intuitive Surgical HeroSurg Robotic Platform Offers Tactile Response	291
3.2.8	Intuitive Surgical da Vinci Surgical System Components	292
3.2.9	Intuitive Surgical Patient-Side Cart and Electromechanical Surgical Arms	295
3.2.10  Intuitive Surgical 3-D Vision System	295
3.2.11  Intuitive Surgical Firefly Fluorescence Imaging	296
3.2.12  Intuitive Surgical da Vinci Skills Simulator	296
3.2.13  Intuitive Surgical Instruments and Accessories	297
3.2.14  Intuitive Surgical da Vinci Single-Site	297
3.2.15  Intuitive Surgical EndoWrist One Vessel Sealer	298
3.2.16	Intuitive Surgical, Inc. (NASDAQ:ISRG) and Shanghai Fosun Pharmaceutical (Group) Co., Ltd 298
3.2.17  Intuitive Surgical Accessory Products	300
3.2.18  Intuitive Surgical Da Vinci Minimally Invasive Surgical Product	300
3.2.19  Intuitive Surgical Cardiac Surgery	301
3.2.20  Intuitive Surgical da Vinci Mitral Valve Repair Surgery	302
3.2.21  Intuitive Surgical da Vinci Surgery - Coronary Bypass (Revascularization) Surgery	305
3.3	MedRobotics	312
3.3.1	Medrobotics Flex Retractor	317
3.3.2	Medrobotics Flexible Robot Platform	318
3.3.3	Medrobotics Snakelike Robots for Oropharynx, Hypopharynx and Larynx Surgery	318
3.4	Titan Medical	322
3.4.1	Titan Medical and Ximedica Resume Development of the Sport Surgical System	322
3.4.2	Titan Visualization Viewing Portal	341
3.4.3	Titan Integration Successful Deployments Into Single 25mm Incision in Abdominal Cavity	343
3.4.4	Titan Medical Surgical Robotic System	344
3.4.5	Titan Robotic Single Incision Platform:	345
3.4.6	Titan Medical Amadeus Robotic Surgical System	345
3.5	Johnson & Johnson	346
3.5.1	Johnson & Johnson Ethicon	346
3.6	Verb Surgical	348
3.6.1	Verb Surgical Digital Surgery Collaboration Partners	349
3.7	Medicaroid Corporation	349
3.7.1	Medicaroid Releases “SOT-100 Vercia”, Operating Table with the Function to Move Patients 349	
3.7.2	Medicaroid Corporation Commences Development of Medical Robots	351
3.8	Virtual Incision	352
3.8.1	Miniaturized Robot For Human Surgery	352
3.9	Olympus	354
3.9.1	Olympus Plasma Hysteroscopic Resection and Vaporization	354
3.9.2	Olympus EndoTherapy Solutions	356
3.9.3	Olympus Acquires Image Stream Medical	357
3.10	TransEnterix / SOFAR S.p.A.	359
3.10.1  TransEnterix Senhance Expands into Robotic Hernia Repair	359
3.10.2  TransEnterix Senhance Surgical System in Germany and France	360
3.10.3  TransEnterix Brand for Robotic Surgical System	361
3.10.4  TransEnterix Technology Innovations In Laparoscopic Surgery	366
3.10.5	TransEnterix SurgiBot System	369
3.10.6	TransEnterix Flex Instruments	370
3.10.7	TransEnterix SPIDER	371
3.11	AVRA Surgical Robotic System	371
3.11.1  AVRA Computer-Driven Automated Drill for Surgical Procedures	371
3.11.2  AVRA Light-Weight Robotic Arms	374
3.11.3	ASRS Surgeon Console	375
3.11.4	ASRS Instruments	376
3.12	Centerline Biomedical IOPS	378
3.12.1	Intra-Operative Positioning System (IOPS)	379
3.12.2	Robotic Cardiothoracic Surgery	384
3.12.3  Robotic Internal Thoracic Artery Dissection	385
3.12.4	Robotic Thoracoscopy	386
3.12.5	Cardiothoracic Surgery	387
3.12.6  Cardiothoracic Surgery Mitral Valve Repair.	388
3.12.7  Intuitive Surgical Cardiothoracic Surgeries	389
3.12.8  Robotic Coronary Artery Bypass	390
3.12.9	International Regulation	396
3.12.10  European Union and Canada Regulatory Process	397

4. ABDOMINAL SURGICAL ROBOT TECHNOLOGY AND RESEARCH	382
4.1	General Surgery, Gynecology, Urology	382
4.1	Surgical Robotic Clinical Applications	383
4.2	Government Regulation	392
4.3	Third Party Reimbursement	398

5. SURGICAL ROBOTS COMPANY DESCRIPTION	401
5.1	AdEchoTech / T-MedRobotics /	401
5.1.1   T-MedRobotics	402
5.2	Avra Robotics	402
5.3	Centerline Biomedical	403
5.4  Google	405
5.4.1	Google / Boston Dynamics	406
5.4.2	Johnson & Johnson Forms Verb Surgical In Collaboration With Google Verily	407
5.4.3	Google Robotic Division	408
5.4.4	Google Self-Driving Car	408
5.4.5	Google Cars Address Vast Majority Of Vehicle Accidents Due To Human Error	410
5.4.6	Google Business	411
5.4.7	Google Corporate Highlights	412
5.4.8	Google Search	413
5.4.9	Google Revenue	414
5.4.10  Google Third Quarter 2016 Results	415
5.4.11  Google Q4 2016 Financial Highlights	415
5.5  Intuitive Surgical	417
5.5.1	Intuitive Seeks to Replace Open Surgery	417
5.5.2	Intuitive Surgical Products Fall Into Four Broad Categories	418
5.5.3	Intuitive Surgical Procedures	419
5.5.4	Worldwide Procedures	420
5.5.5	Gynecologic Surgery	420
5.5.6	Urologic Surgery	421
5.5.7	General Surgery	422
5.5.8	Cardiothoracic Surgery	424
5.5.9	Head and Neck Surgery	425
5.5.10	Procedure Mix	425
5.5.11	Intuitive Surgical Revenue	432
5.5.12  Intuitive Surgical da Vinci Surgery Stimulates Procedure Growth	436
5.5.13  Intuitive Surgical ISI Investments	438
5.5.14	Intuitive Surgical Competition	439
5.5.15  Intuitive Surgical Market Analysis	440
5.5.16  Intuitive Surgical Procedure Efficiency	442
5.5.17  Intuitive Surgical Business Model		442
5.5.18  Intuitive Surgical Sales and Distribution Organization	443
5.5.19  Intuitive Surgical da Vinci System Leasing	443
5.5.20  Intuitive Surgical Service Revenue		444
5.5.21  Intuitive Surgical Procedures H1 2016		446
5.5.22  Intuitive Surgical Increases Share Repurchase Program to $3.0 Billion	451
5.5.23  Intuitive Surgical Robotics da Vinci Surgical System	451
5.5.24  Intuitive Surgical Robotics da Vinci Surgical System Xi	452
5.6  Johnson and Johnson / DePuy Synthes		453
5.6.1   Ethicon 510(K) Clearance For Echelon Circular Powered Stapler	454
5.6.2   Ethicon Acquires Megadyne Medical Products	455
5.6.3   Johnson & Johnson Forms Verb Surgical In Collaboration With Verily	456
5.6.4   Johnson & Johnson Business		457
5.6.5   Johnson & Johnson Consumer Segment	457
5.6.6   Johnson & Johnson Pharmaceutical Segment	458
5.6.7   Johnson and Johnson Medical Devices	459
5.6.8   Johnson and Johnson Geographic Areas	460
5.6.9   Johnson & Johnson Competition		460
5.6.10  Johnson & Johnson Management’s Discussion	461
5.6.11  Johnson & Johnson Revenue		462
5.6.12  Google Collaborating With Johnson & Johnson To Develop Surgical Robots	465
5.6.13  Johnson and Johnson / DePuy		465
5.6.14  Johnson & Johnson Caring for the World One Person At A Time	465
5.6.15  Johnson & Johnson / Ethicon		466
5.7  Medicaroid		467
5.7.1   Medicaroid US Subsidiary Operations in Silicon Valley	468
5.7.2   Medicaroid’s Capital Increase		469
5.8  Medtronic / Mazor Robotics		470
5.8.1	Medrobotics Raises $25M to Back FDA-Cleared Transoral Surgical Robotics System	472
5.8.2	Medrobotics Closes On $10 Million Financing	476
5.8.3	Medrobotics Several Generations Of Snake Robot Platforms	477
5.8.4	Medrobotics Advances Clinical Development of Snake Robot for Surgery	478
5.8.5	Medrobotics Positioning	478
5.8.6	Medrobotics Cardiac Surgery Gold Standard	479
5.8.7	Medrobotics Snake Robot Technologies For Use In A Wide Range Of Surgical And Interventional Applications	481
5.8.8		Medrobotics Technology & Research Center	483
5.9  Titan Medical	483
5.9.1		Titan Medical General Surgery Robot Market Opportunities	492
5.9.2		Titan Medical Robotic Surgery Target Opportunity	493
5.10	TransEnterix	495
5.10.1  TransEnterix Acquires SOFAR Surgical Robotics Unit in $100M Deal	495
5.10.2  TransEnterix Radical Hysterectomy with Senhance Surgical Robot	497
5.10.3	TransEnterix Strategic Positioning	498
5.10.4	TransEnterix	500
5.10.5	TransEnterix / Sofar	501
5.11	Verb Surgical	506
5.11.1	Verb Corporate Culture	511
5.12	Virtual Incision	511
5.13	Selected Surgical Robot Companies	511
WINTERGREEN RESEARCH,	520
WinterGreen Research Methodology	521

List of Figures

Figure 1.   Abdominal Surgical Robotics Positioning for Appeal to Surgeons	30
Figure 2.   Abdominal Surgical Robot Benefits	31
Figure 3.   Abdominal Surgical Robotics Market Driving Forces	32
Figure 4.   Surgical Robot Key Factors Driving Market Growth	33
Figure 5.   Surgical Robot Key Market Challenges	34
Figure 6.	Abdominal Surgery Robotics Market Driving Factors	34
Figure 7.	Abdominal Surgical Robot Medical Specialties Addressed	37
Figure 8.	Surgical Robot General Surgery Gynecology, and Urology Conditions Treated	39
Figure 9.	Innovative Surgical Robot Features	40
Figure 10.  Surgical Robot Market Positioning	40
Figure 11.  Healthcare Abdominal Robotics Enabling Technologies	42
Figure 12.  Robotic-Assisted Minimally Invasive Abdominal Surgery Market Driving Forces	43
Figure 13.	Abdominal Surgical Robots Market Shares, Shipments, Dollars, Worldwide 2016	50
Figure 14.	Abdominal Surgical Robot Forecasts, Combined General Surgery, Gynecological, Head and
Neck, and Urological Forecasts Dollars, Worldwide, 2017-2023	54
Figure 15.	Medical Multi Articulating Arms	61
Figure 16.	Instruments That Support Multiple Approach Paths To A Surgical Target	62
Figure 17.  Robotic Surgery Improved Visualization Features	63
Figure 18.  Robotic Surgical Specialties Procedure Marketing Efforts Focus	65
Figure 19.  Abdominal Surgical Robotics Positioning for Appeal to Surgeons	71
Figure 20.  Abdominal Surgical Robot Benefits	72
Figure 21.  Abdominal Surgical Robotics Market Driving Forces	74
Figure 22.  Surgical Robot Key Factors Driving Market Growth	75
Figure 23.  Surgical Robot Key Market Challenges	76
Figure 24.  Abdominal Surgery Robotics Market Driving Factors	76
Figure 25.  Abdominal Surgical Robot Medical Specialties Addressed	79
Figure 26.  Surgical Robot General Surgery Gynecology, and Urology Conditions Treated	81
Figure 27.  Innovative Surgical Robot Features	82
Figure 28.  Surgical Robot Market Positioning	82
Figure 29.  Healthcare Abdominal Robotics Enabling Technologies	84
Figure 30.	Robotic-Assisted Minimally Invasive Abdominal Surgery Market Driving Forces	85
Figure 31.	Abdominal Surgical Robots Market Shares, Shipments, Dollars, Worldwide 2016	91
Figure 32.	Abdominal Surgical Robots Market Shares, Worldwide 2016, Table Format	92
Figure 33.	Abdominal Surgical Robots Market Shares by Segment, Systems, Services, and Instruments/ Accessories, Units and Dollars, Worldwide, 2016	93
Figure 34.	Intuitive Surgical Systems and Instruments and Accessories Revenue by Segment 2016,	
2015, 2014	95	
Figure 35.	Intuitive Surgical da Vinci Installed Base and Product Shipments for Surgical Systems	
Segment Analysis by Model	98
Figure 36.	Intuitive Surgical Revenue, Segment Growth, and Regional Analysis Q1 2016 and Q1 2017 101	
Figure 37.	Intuitive Surgical Product Shipments, By Model Type, Si Systems, Si-e, Xi, Single and Dual
Console (in Number of Units), 2014, 2015, and 2016	103
Figure 38.	Intuitive Surgical Shipments by Model, Si, Si-e, and Xi, Q1 2017	103
Figure 39.	Intuitive Surgical Shipments by Model, Si, Si-e, and Xi, 2016	104
Figure 40.	Intuitive Surgical Unit Shipments	105
Figure 41.	Intuitive Surgical 2016 Objectives	107
Figure 42.	Abdominal Surgical Robot Systems Hospital Market Trends	108
Figure 43.	Surgical Robot Systems Hospital Return on Investment (ROI)	109
Figure 44.	Intuitive Surgical da Vinci Sp	115
Figure 45.	Intuitive Surgical Technology Market Positioning	116
Figure 46.	Intuitive Surgical Benefits	117
Figure 47.	How Intuitive Surgical Gained Dominant Position in Robotic Surgery	124
Figure 48.	Intuitive Surgical Robotic Surgery Strategic Positioning	125
Figure 49.	Intuitive Surgical Challenges	126
Figure 50.	Titan Surgical Robot	131
Figure 51.	Titan Medical Novel Robotic Platform for Single Port Access Surgery	132
Figure 52.	Titan Medical Amadeus Composer Surgical System	133
Figure 53.	Titan Medical Prospectus Timeline for SPORTTM Surgical System	136
Figure 54.	Abdominal Surgical Robot Forecasts, Combined General Surgery, Gynecological, Head and
Neck, and Urological Forecasts Dollars, Worldwide, 2017-2023	140
Figure 55.	Abdominal Surgical Robot Forecasts Dollars, Worldwide, 2016-2022	141
Figure 56.	Abdominal Surgical Robots Market Shares, Dollars, Worldwide, 2015	143
Figure 57.	Abdominal Surgical Robot Market Segment Forecasts, Products, Services, and Instruments / Accessories Dollars, Worldwide, 2017-2023	144
Figure 58.	Abdominal Surgical Robot Market Segment Forecasts, Products, Services, and Instruments/ Accessories Percent of Total, Worldwide, 2017-2023	145
Figure 59.	Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological, Dollars and Units, Worldwide, 2017-2023	146
Figure 60.	Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological, Cardio, Cardio Thoracic, and Head and Neck Dollars, Worldwide, 2017-2023	147
Figure 61.	Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery. And
Urological Products, Services, and Instruments / Accessories Dollars, Worldwide, 2017-2023	147
Figure 62.	Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery. And
Urological, Cardio, and Head/Neck, Products, Services, and Instruments / Accessories Percent, Worldwide, 2017-2023	149	
Figure 63.	Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological, Cardio, Cardio Thoracic, and Head and Neck Dollars, Worldwide, 2016-2022	151
Figure 64.	Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological Dollars and Units, Worldwide, 2016-2022	152
Figure 65.	Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery. And Urological Products, Services, and Instruments / Accessories Dollars, Worldwide, 2017-2023	153
Figure 66.	Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological, Dollars and Units, Worldwide, 2017-2023	155
Figure 67.	Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery. And Urological, Percent Dollars, Worldwide, 2017-2023	156
Figure 68.	Abdominal Surgical Robot Market Segment Forecasts, Head and Neck, Cardiac and Cardio Thoracic, Dollars and Units, Worldwide, 2017-2023	157
Figure 69.  Intuitive Surgical Revenue by Segment, 2015 and 2016	159
Figure 70.  Intuitive Surgical Revenue by Segment, 2014 and 2015	159
Figure 71.  Challenges of Open Surgery and Minimally Invasive Surgery	162
Figure 72.  Challenges of Developing Medical Robotic Surgery Systems	163
Figure 73.  Surgical Robotic Product Development Challenges	164
Figure 74.  Minimally Invasive Procedure Market Penetration	167
Figure 75.	Abdominal Surgical Robots Instrument and Accessory Market Forecasts, Dollars,Worldwide, 2017-2023	169
Figure 76.	Abdominal Surgical Robot Market Segment Forecasts, Instruments / Accessories Dollars,Worldwide, 2017-2023	170
Figure 77.	Surgical Robot Instrument Types	171
Figure 78.	Surgical Robot Systems vs. Disposable Instruments Forecasts, Dollars, Worldwide, 2016-2022	172	
Figure 79.	Surgical Robot Market Challenges	173
Figure 80.	Intuitive Surgical Issues Addressed Successfully	174
Figure 81.	Benefits of Robotic Surgery For The Surgeon	175
Figure 82.	Benefits of Robotic Surgery For The Patient	175
Figure 83.	Benefits of Robotic Surgery For The Hospital	176
Figure 84.	US Robotic Surgery Treatment Penetration Rate by Procedure, Percent, 2016	179
Figure 85.	US Robotic Surgery Treatment Penetration Rate by Procedure, Percent, 2016	180
Figure 86.	Penetration of Open Surgery Market Opportunity	181
Figure 87.	Intuitive Surgical da Vinci System installed base 2016	182
Figure 88.	Number Intuitive Surgical Robotic Shipped and Installed Systems, US, Europe, Asia, and Worldwide, 2014-Q1 2017	183
Figure 89.	Intuitive Surgical Robotic Surgery Installed Systems, Number Regional Analysis by Country,2014, 2015, and 2016	185
Figure 90.	Number Intuitive Surgical Robotic Surgery Installed Systems, Total, US, International 2012-Q3 2016	188	
Figure 91.	Intuitive Surgical da Vinci System Installed Base by Region	191
Figure 92.	Intuitive Surgical daVinci Target Procedures, Gynecology, General Surgery, Urology, Cardio-
Thoracic, Head and Neck, Number of Procedures and Percent, US, International, and Worldwide, 2016	195
Figure 93.	Intuitive Surgical daVinci Target Procedures Number of Procedures, Worldwide, 2016	195
Figure 94.	Over 4 Million da Vinci Procedures Have Been Performed To Date	197
Figure 95.	Intuitive Surgical Robotic Surgery Gynecological Procedures, Number Regional Analysis by
Country, 2016	198	
Figure 96.	Intuitive Surgical Procedures	208
Figure 97.	Intuitive Surgical Robotic Urology Surgery Procedures, Number Regional Analysis by	
Country, 2016	216	
Figure 98.	Intuitive Surgical Urology Procedures	219
Figure 99.	Intuitive Surgical da Vinci Surgical System Improved Visualization Of The Gross Anatomy 222	
Figure 100.	Intuitive Surgical Robotic General Surgery Procedures, Number Regional Analysis by Country, 2016	224	
Figure 101.	General Surgery Colorectal Procedures	230
Figure 102.	Abdominal Surgical Robot Market Segment Forecasts, Head and Neck, Cardiac and Cardio Thoracic, Dollars and Units, Worldwide, 2017-2023	232
Figure 103.	Definition of Abdominal Surgical Robot Categories	237
Figure 104.	Intuitive Surgical Procedure Aspects	241
Figure 105.	Reported Clinical Benefits of da Vinci Hysterectomy Procedures for Benign Conditions 242
Figure 106.	Intuitive Surgical da Vinci Xi Product	244
Figure 107.	Intuitive Surgical Average Cost to Hospital by Procedure Type	251
Figure 108.	Surgical Robot Regional Market Segments, Dollars, 2016	253
Figure 109.	Abdominal Surgical Robot Regional Market Segments, 2016	255
Figure 110.	Number Intuitive Robotic Surgical Procedures, Detail of General Surgery, Gynecology,	
Urology, Head and Neck, Cardiac and Cardio Thoracic, Regional Analysis by Region, 2015	258
Figure 111.	Number Intuitive Robotic Surgical Procedures, Detail of Gynecology, Benign	
Hysterectomy, Malignant Hysterectomy, Sacral Colpopexy, Endirmetrosis Resection, Regional Analysis, 2015 260
Figure 112.	Intuitive Surgical Robotic Surgery Installed Systems, Number, Regional Analysis by	
Country, Asia and Rest of World, 2014, 2015, and 2016	269
Figure 113.	da Vinci X Surgical System from Intuitive Surgical	274
Figure 114.	Intuitive Surgical da Vinci Xi Surgical System Features	276
Figure 115.	Intuitive Surgical da Vinci System	279
Figure 116.	Intuitive Surgical da Vinci Surgical System	285
Figure 117.	Intuitive Surgical. da Vinci Surgical System EndoWrist Instruments	287
Figure 118.	Intuitive Surgical. da Vinci Surgical System Vision System	288
Figure 119.	Intuitive Surgical da Vinci Surgical System Features	289
Figure 120.	Intuitive Surgical Da Vinci Xi Surgical System Surgeon Console Features	292
Figure 121.	Intuitive Surgical. da Vinci Surgical System Surgeon Console	29Figure 122.	Intuitive Surgical. da Vinci Surgical System Patient-Side Cart	294
Figure 123.	Intuitive Surgical Da Vinci Surgery	300
Figure 124.	Intuitive Surgical Da Vinci Surgical System Components	301
Figure 125.	Intuitive Surgical da Vinci Mitral Valve Repair Benefits	303
Figure 126.	Minimally Invasive Da Vinci Surgery Benefits To Cardiac Patients	308
Figure 127.	Intuitive Surgical da Vinci System State-Of-The-Art Robotic Surgical Platform	309
Figure 128.	Intuitive Surgical da Vinci Si Surgical System Core Benefits:	309
Figure 129.	Intuitive Surgical da Vinci SI Surgical System Dual Console Used For Training And	
Collaboration	310	
Figure 130.	Intuitive Surgical da Vinci Surgical System Patient Side Cart	311
Figure 131.	MedRobotics Flex Robotic System	313
Figure 132.	Medrobotics Flex Robotic System Target Surgical Sites	314
Figure 133.	Medrobotics Technology	315
Figure 134.	Medrobotics Flex Retractor	317
Figure 135.	Medrobotics Snakelike Robot Tested for Heart Surgery	320
Figure 136.	Medrobotics Medical Field Target Markets	321
Figure 137.	Titan Single Port Orifice Robotic Technology SPORT Surgical System	322
Figure 138.	Titan SPORT Surgical System:	323
Figure 139.	Titan MedicalSPORT Surgical System Patient Benefits:	325
Figure 140.	Titan MedicalSport Surgical System Surgeon Benefits:	326
Figure 141.	Titan MedicalSport Surgical System Patient Benefits:	327
Figure 142.	Titan MedicalSport Surgical System	328
Figure 143.	Titan MedicalSport Surgical System User Touch Points	329
Figure 144.	Titan MedicalSport Surgical System Instruments	330
Figure 145.	Titan Medical Next Generation SPORT Surgical System Uses	331
Figure 146.	Titan Medical Next Generation SPORT Surgical System Market Opportunity	332
Figure 147.	Titan Medical Next Generation SPORT Surgical System Competitive Positioning	333
Figure 148.	Titan Medical Next Generation SPORT Surgical System Market Business Model	334
Figure 149.	Titan Medical Next Generation SPORT Surgical System Development Strategy	335
Figure 150.	Titan Medical Next Generation SPORT Surgical Instruments	336
Figure 151.	Titan Medical Next Generation Sport Surgical Instruments	337
Figure 152.	Titan Medical Next Generation SPORT Surgical Instruments	338
Figure 153.	Titan Medical Next Generation SPORT Surgical Instrument Controllability	339
Figure 154.	Titan Medical Next Generation SPORT Surgical Instrument Usability Studies and Data	
Analysis	340	
Figure 155.	Titan Medical Next Generation SPORT Surgical Instrument Visualization	341
Figure 156.	Titan Medical Next Generation SPORT Surgical Instruments	342
Figure 157.	Titan Integration Successful Deployments Into Single 25mm Incision in Abdominal Cavity
	343	
Figure 158.	Titan Robotic Surgical System Benefits:	344
Figure 159.	Titan Amadeus Features	346
Figure 160.	Johnson & Johnson Ethicon Minimally Invasive Procedures As They Apply To Specific	
Conditions	348	
Figure 161.	Medicaroid SOT-100 Vercia	351
Figure 162.	Olympus Plasma Hysteroscopic Resection and Vaporization	356
Figure 163.	TransEnterix Senhance Surgical Robotic System	361
Figure 164.	TransEnterix Rebrands the ALF-X to Senhance	362
Figure 165.	TransEnterix Surgical Robot Technology	366
Figure 166.	TransEnterix Provide Patients With Less Invasive Surgery	367
Figure 167.	TransEnterix Device is Patient-Side	368
Figure 168.	TransEnterix Device is Patient-Side	368
Figure 169.	TransEnterix SurgiBot System Reduces-Incisions	369
Figure 170.	TransEnterix Flex Instruments	370
Figure 171.	AVRA Computer-Driven Automated Drill for Surgical Procedures	372
Figure 172.	ASRS Instruments AVRA Mobility Intelligent, Independent for Surgeon Control	376
Figure 173.	Centerline Biomedical Simplifies Endovascular Procedures	378
Figure 174.  Endovascular Procedure Limitations	379
Figure 175.  Centerline Biomedical IOPS Electromagnetic Tracking Functions	381
Figure 176.  Robotic Abdominal Surgery Surgical Specialty Focus	384
Figure 177.  Intuitive Surgical Robotic Cardiac Procedures	388
Figure 178.  Surgical Robot Cardiothoracic Conditions Treated	391
Figure 179.  Google Autonomous Vehicles Technology	409
Figure 180.  Intuitive Surgical Recurring Revenue Model	447
Figure 181.  Intuitive Surgical Pricing by System Model	448
Figure 182.  Intuitive Surgical Tip of the Iceberg ROI Cost Factors	448
Figure 183.  Intuitive Surgical da Vinci Ecosystem	449
Figure 184.  Intuitive Surgical 2016 Objectives		450
Figure 185.  Intuitive Surgical Platform, daVinci Xi	452
Figure 186.  Johnson and Johnson Family of Companies Comprises:	464
Figure 187.  Medrobotics Positioning 2016		474
Figure 188.  Medrobotics Cardiac Surgery Improvements	480
Figure 189.  Medrobotics Snake Robot Technologies For Use In A Wide Range Of Surgical And
Interventional Applications		481
Figure 190.  Medrobotics Snake Robot Technologies Specialist Areas Served	482
Figure 191.  Titan Medical Investment Summary	486
Figure 192.  Titan Medical Business Goals and Timetable	487
Figure 193.  Titan Medical Describes Robotic General Surgery Market Potential	492
Figure 194.  Titan Medical Robotic Surgery Target Opportunity	493
Figure 195.  Titan Medical Robotic Surgery Target Opportunity	494
Figure 196.  TransEnterix Strategic Positioning	499
Figure 197.  TELELAP Robotic Surgical Unit	502
Figure 198.  TransEnterix ALF-X Robotic Surgery	503
Figure 199.	TransEnterix ALF-X Breaking Barriers Supporting Precision	505
Figure 200.	Verb Surgical Digital Platform Elements:	509
Figure 201.	Key Players In The Abdominal Global Medical Robots Market	518
Figure 202.	Key Players In The Global Medical Robots Market	519