Meet your next surgeon: Dr. Robot

Frank Clement glimpsed the robot only once. After the operating room attendant finished shaving his chest, she asked him if he wanted to be knocked out or if he would like to see the machine that would soon be inside him, navigating the space beneath his rib cage, cutting and cauterizing, and then sewing two of his arteries back into his heart. Clement wanted to see the machine. It was draped in plastic, its four jointed arms folded back toward its body. In a few months Clement would celebrate his 71st birthday, and the idea of submitting to such a device felt futuristic. He was fascinated. Then he felt a warm rush all over -- the anesthesia kicking in -- and he fell into a deep, drug-induced slumber.
Clement's body disappeared under a blue smock, his chest swelled from the CO2 pumped in to keep it expanded, and his skin appeared an unreal yellow from layers of disinfectant painted on pre-op. The surgeon, Eric Lehr, grasped a scalpel and made three quick incisions on either side of Clement's rib cage, the cuts blooming open but hardly bleeding. Lehr placed three metal tubes, called cannulas, into the three wounds, twisting them into the chest until they were planted. An attendant wheeled the robot over to the operating table, positioned it alongside the patient, and took hold of the robot's arms, extending them over Clement while an assistant connected a camera, a cauterizer, and a clasping tool to three of the robot's appendages.
Intuitive Surgical's da Vinci robot, photographed at company headquarters in Sunnyvale, Calif.

Advances in surgery usually attempt to ameliorate surgery's essential nature: cutting someone to cure him. The less severe the tissue damage, the faster the patient heals -- less time in recovery, less money spent recovering from the wounds. In health care this is known as "lowering the downstream costs," and it is what is driving hospitals to invest $2 million a pop for surgical machines. Surgeons -- a particularly exacting bunch -- have adopted robotics in droves. While physician buy-in is crucial, patients are also driving demand. Last year the Journal for Healthcare Quality reported that 41% of hospital websites advertised robotic surgery; of these, 37% did so on their homepage. Hospitals with robots are pulling in more and more patients, and in some cases, the existence of the robot actually increases the number of surgeries performed. A study conducted by the American Cancer Society found that the number of radical prostatectomies has "risen substantially" in the past decade, and patients travel great distances to be operated on with a robot. Today, four out of five prostatectomies are performed with a robot. The result is an industry at an inflection point. Robots have arrived, and hospitals, doctors, and patients are scrambling to adapt to this new technology.
The most popular of such surgical robots -- the one used on Frank Clement during his operation last fall at Swedish Medical Center in Seattle -- is the da Vinci. Patented and manufactured by Intuitive Surgical (ISRG) -- a publicly held Silicon Valley--based company that posted revenue of $1.76 billion, a 24% increase over 2010 -- the system costs up to $2.3 million. It includes the console, the robot, and a tall server bay that connects them. It is, in more ways than one, the iPhone of its category: Surgeons say it is easy to use and elegantly designed. And like iPhone maker Apple (AAPL), Intuitive has developed a closed model: Its software and hardware are proprietary, and the company controls all aspects of the da Vinci's production, bringing new meaning to the term "closed operating system."
Despite its dominant position (Mayo Clinic alone has seven machines), its success is far from assured. Another, just-formed robotics company's robot offers a competing vision of what might be possible in the operating room of tomorrow. Made by Applied Dexterity, a startup, and called the Raven, it is a smaller, cheaper experimental machine built on an open-source model, which makes it hackable, and more like Google's (GOOG) Android platform for mobile phones. Put another way, innovation at Intuitive tends to come from within the company, while nearly anyone can invent, add to, and study the Raven. Both models are pushing the field into previously unimagined territory. The $50 billion question for the future of surgery: Will there be (operating) room for more than one kind of robot?

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