surgical navigation and robotics
TRANSCRIPT
Surgical Navigation and Robotics:The Time is Now
Venkat Rajan, Industry ManagerHealthcare
June 24th, 2008
2
� Market Overview
� Image Guided Surgery Market
� Robotic Assisted Surgery Market
� Robot Assisted Radio Surgery Market
� Orthopedic Navigation Market
� Cardiac Navigation Market
� End User Adoption Trends: Cardiac Navigation
� Conclusion
Focus Points
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Market Overview
•In 2007, the U.S. market revenues for the Robotics and Image Guided Surgery markets
were $721.4 Million.
•The revenues for this market are expected to reach by $3,879.5 Million by 2014, with a
compound annual growth rate (CAGR) for the period 2007 to 2013 is expected to be
26.4 percent
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Image Guided Surgery Market: Revenue Analysis 2007
27.3%
26.9%
32.4%
13.4%
IGS System
IGS Software
Service
Disposables
Image Guided Surgery Systems Market: Revenue Breakdown by Product (U.S.), 2007
Image guided surgery (IGS) resulted from the need to visualize surgical instruments inside the body during minimally invasive surgeries. It involves:
•Sophisticated methodologies of image acquisition modalities include approaches such as computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, fluoroscopy, and other optical techniques.
•Computing
•Image processing, and rendering to generate 3D reconstructions of the human anatomy.
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Image Guided Surgery Market: Utilization By Treatment Area
While the hardware for most IGS systems are fairly equivalent in terms of form and function, sophisticated software tools are used by firms to establish their identity in the market. Some of the ways a competitor can distinguish themselves:
•Software
•Ergonomics
•Anatomical Specialization
•Comprehensive pre and real time surgical planning
24.5%
28.6%16.3%
25.5%
5.1%
Neuro
Spinal
ENT
Ortho
Other
Image Guided Surgery Systems Market: Revenue Breakdown by Treatment Area (U.S.), 2007
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Robotic Assist Surgery Market: Procedure Volume forda Vinci Surgical System 2005-2009
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
2005 2006 2007 2008 2009
Year
Nu
mb
er
of
Pro
ced
ure
s
US Prostatectomy
US Hysterectomies
US Other
Technology Advances Supporting Adoption
•Hospital IT infrastructure to stream video. transfer files, incorporate and store high-resolution body scans.
•AI enabled software capable of profiling disease states and potential complications.
•Motion control intelligence to account for tremors.
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Install Base for Robot Assisted Radio Surgery Systems U.S. 2005-2007
Robotic assisted radiosurgery is a more targeted method for delivering traditional radiation oncology therapy.
These systems are designed to deliver a very high cumulative dose of radiation, in targeted treatments specifically targeted at the tumor rather than at a region surrounding the tumor area.
Being able to focus the beam, allows clinicians to deliver higher doses with out having to risk damage to other tissue.
These systems are ideal for applications in anatomy where precision is critical. The majority of current systems are used in neuroradiosurgical and spinal treatments.
Ultimately future growth will depend on hospitals weighing the costs of higher quality over cost efficiency for cheaper less automated systems.
0
10
20
30
40
50
60
70
80
2005 2006 2007
New System
Placement
Total Installed Base
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Orthopedic Navigation Market – MAKO Surgical
The most common reason for joint replacement is osteoarthritis. It is a progressive condition that can get worse over time and result in sever dehabilitative pain. Apart from being age-related, younger patients who have genetic deformities or suffered certain chronic or acute trauma are candidates for disease. Excess weight, joint fracture, ligament tears, or other injury can damage cartilage and cause osteoarthritis.
Depending on the degree of damage, a surgeon may be able to repair or replace a portion of the joint. However, when the entire joint is damaged, a total joint replacement is performed. To replace a total joint, a surgeon removes the diseased or damaged parts and inserts artificial parts.
MAKO Surgical has developed a robotics platform that utilizes tactile-guided robotics to perform surgeries for implantation and alignment of resurfacing implants through a keyhole incision. This system is FDA-cleared and one of the only systems commercially available, targeting the orthopedic market.
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Cardiac Navigation Market Opportunity
0
50,000
100,000
150,000
200,000
250,000
2004
2005
2006
2007
2008
2009
2010
2011
2012Year
Pro
ced
ure
Vo
lum
e
Atrial Fibrilation Other Arrhythmias
Complex Lead Placement Complex CTO
PFO Closure Percutaneous Valves Repair
•The atrial fibrillation market is considered to be the next major opportunity for growth in the cardiovascular space, particularly for companies focused on cardiac rhythm disorders.
•It is estimated that there are 2.5 million individuals in the United States with atrial fibrillation, of which one million are symptomatic and do not respond well to drug therapy.
•Approximately 200,000 new cases are diagnosed annually.
•Market estimates show that less than 20 percent of the addressable market for atrial fibrillation is being served due to limited regulatory approval and lack of provider training and expertise.
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End User Profile: Cardiac Navigation/Robotics Adoption
Profession/Speciality
Cardiologist
41%
Cardiac Surgeon
8%
Electrophysiology
Fellow
3%
Electrophysiologist
48%
Profile of Respondents:150 U.S. Cardiology Focused Clinical Specialists
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End User Profile: Awareness of Robotic Assist Technologies and
Brands in Electrophysiology and Cardiac Surgery Procedures
4%
4%
7%
59%
93%
14%
32%
27%
45%
0% 20% 40% 60% 80% 100%
None
Other
Intuitive Surgical
Hansen Medical
Stereotaxis
% Aw are
Electrophysiologists Others
Majority (72%) of doctors are familiar with robotic assist technologies. Stereotaxis is the brand they are most aware of.
Electrophysiologists have a high awareness of Stereotaxis and HansenMedical.
Very Familiar
5%
Familiar
26%
Slightly Familiar
41%
Unfamiliar
28%
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End User Profile: Likelihood of Adopting Robotic Assist Technologies in the next 12 months
Likely NO
23%Equally Likely
(YES/NO)
23%
Very likely NO
14%
Definitely NO
10%
Definitely YES
8%
Very Likely YES
6%
Likely YES
16%
8% of institutions represented are definitely adopting robotic assist technologies and another 22% are likely or very likely to
adopt it.
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Conclusion
The introduction of image guided surgery and robotics assisted surgery has sparked a new revolution in the practice of medicine. The industry shift towards minimally invasive and laparoscopic procedures has been taken one step further with the introduction of these sophisticated systems.
They allow surgeons the ability to perform high risk procedures in the smallest of anatomy, successfully performing procedures that were nearly impossible a decade ago. As the video game generation of doctors continue to supplant older more traditional surgeons, look for the expertise and applicability for these systems to accelerate in adoption.
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