According to Frost & SullivanFrost & SullivanAccording to data from Frost & Sullivan (hereinafter referred to as 'Frost & Sullivan'), the global market size for surgical robots will be2015year30USD billion growth to2020year83billion US dollars, with a compound growth rate of22.6%It is expected that the global surgical robot market will continue to maintain a rapid growth momentum, in2026Annual achievement336billion US dollars, since2020The compound growth rate from inception to26.2%.
What stage has the development of domestic surgical robots reached currently? What are the difficulties in popularizing them? In the market, imported surgical robots still dominate. What is the current technical gap between domestic and imported surgical robots? Is domestic substitution feasible? Apart from the technical gap, are there any other obstacles? Frost & Sullivan's consulting director for healthcare teams in Greater China, Zhang Dian, was interviewed.21Century Economic Report interviewed to jointly discuss the current development status and future trends of the domestic surgical robot market.
21Century Economic Report
At the recent AI conference, the Tuomei laparoscopic surgical robot from MicroPort Medical was a major highlight of the exhibition. The device consists of a doctor's console, a patient's operating platform, and an imaging platform. Doctors operate from the console, and the robotic arms on the operating platform can perform corresponding actions.
The incision is small, recovery is fast, and with higher precision, more complex operations can be performed. The emergence of surgical robots has undoubtedly been a tremendous innovation for surgical procedures. Although China started relatively late in this field, it is making rapid progress to catch up with the international first-tier teams.
According toFrost & SullivanBased on the data, the global surgical robot market size will be2015year30USD billion growth to2020year83billion US dollars, with a compound growth rate of22.6%It is expected that the global surgical robot market will continue to maintain a rapid growth momentum, in2026Annual achievement336billion US dollars, since2020The compound growth rate from inception to26.2%.
Among them, the market scale of surgical robots in China is4billions of dollars, accounting for the global market5.1%There is broad development potential. Currently, the most advanced technology is in the field of laparoscopic surgical robots, which are still in the clinical research phase for natural orifice and vascular surgery robots.
Monopolizing the imported equipment market, the goal of the 'latecomer' domestic medical robot industry is to achieve localization. An industry insider told21A reporter from Century Economic Report stated that their company is continuously optimizing and iterating products through policy support. At the same time, they are conducting hospital assessments for hospitals that have not installed imported equipment, establishing training centers to enable more doctors to access domestic surgical robots first.
Zhang Dian, consulting director of the medical team at Frost & Sullivan Greater China, said in an interview with reporters that in the context of China's aging population and increasing health awareness, surgical robots can alleviate problems such as public healthcare resource shortages and talent reserves. They have long-term value in health economics and clinical applications. Moreover, as the application fields and scopes of various products continue to expand, they will further unleash market potential and have a bright future outlook.
"
Pioneers and Challengers
In the field of surgical robots, Intuitive Surgical, a US-based company specializing in robotic-assisted minimally invasive surgery technology, is an undisputed king. Established1995In [year], Intuitive Surgical focused solely on researching robotic surgical systems, winning the favor of numerous capitals, and since2000The company went public on NASDAQ in [year], and with its Da Vinci surgical robot, monopolized the global laparoscopic surgical robot market for nearly20year.
Technically, the advent of Da Vinci surgical robots has been a huge change for traditional surgical procedures. The Da Vinci Surgical System is divided into three parts: the doctor's end, the patient's end, and the display end. Through this system, surgeons can sit at an ergonomic console to perform surgery while viewing three-dimensional high-definition images of the surgical area.
For doctors, the Da Vinci robot is like giving them a pair of stable and360The hand that moves freely and a pair of high-definition magnifying glasses3DEyes; for patients, the precision of surgery has been greatly increased, resulting in smaller incisions, faster postoperative recovery, and better healing.
The early entrants left no one in their wake, with Intuitive Surgical leveraging its pre-market advantage to2003Acquired its largest competitor at that timeComputer Motion, establishing a dominant position in a new field.2004After turning losses into profits in the year, the stock price soared all the way, from2US dollar/The stock soared to a maximum of over350US dollar/The stock, now with a market value of675.2billion dollars.
Behind it is its perceived as a commercial textbook's “razor+Blade' business model. Under this model, the revenue from the Da Vinci surgical robot business mainly comes from three sources: system revenue, consumables revenue, and service revenue. After selling robots, the company provides corresponding accessories, replacement of instruments, as well as after-sales services such as training and maintenance. As the inventory gradually increases, the growth of system revenue slows down, while consumables and services become stable.Growth in revenue sources.2009In the year, the revenue proportion of intuitive surgical consumables and services exceeded that of the system for the first time, reaching53.4%,2021In the annual financial report, this proportion has exceeded70%.
Whether it's technology or business model, Intuitive Surgical has firmly established its position at the forefront. Its absolute strength in the entire ecosystem dwarfs many newcomers, making them hesitate to join.2021The annual financial report shows that Intuitive Surgical's revenue reached57.10billions, accounting for more than50%as of2022year6At the end of the month, the cumulative global installation of Da Vinci surgical robots7135table, coverage70In multiple countries and regions, the cumulative number of surgeries executed has exceeded1000Ten thousand cases.
It is understood that the total installed capacity of Leonardo da Vinci in China has approached300Taiwan, total number of surgeries exceeding32Ten thousand units. Although this has brought considerable pressure to China's surgical robot company, a rising star, the brave never fear.
2010In [year], China's first orthopedic navigation robot with independent intellectual property rights was introduced to the market. Since then, it has developed rapidly, and the market scale has grown from2016year8.53RMB billion increased2020year29.35Yuan, with an annual compound growth rate of36.2%estimated2030Year is coming584.26100 million yuan.
The momentum in the past two years has been even more rapid.2021In the year, there were more than30A home surgical robot company has received financing.2022More than a year later, several domestic surgical robots wereNMPARegistration has accelerated the commercialization process. In the field of domestic surgical robots, Weigao Surgical Robots, minimally invasive 'Tuomei' products, and Kangdu Surgical Robots have successively passed the review by the National Medical Products Administration, filling a domestic gap.
"
Zhang Dian is accepting21According to an interview with a reporter from Century Business Herald, domestic surgical robots are still in the early stages of development, but2022The year started entering a period of rapid growth, with9A domestic surgical robot has been approved, covering multiple sub-application areas such as laparoscopy and orthopedics. The number has exceeded2021The number of approvals throughout the year also indicates that domestic products are breaking through import monopolies.
"
The R&D investment is substantial
Domestic surgical robot companies are in the initial stage and therefore must face a longer investment period.
Taking Tianzhihang, the "first domestic surgical robot stock", as an example, its2022The annual semi-annual report shows that revenue reached6094.54Ten thousand yuan, a year-on-year decrease20.23%; net profit attributable to the parent company was in deficit4417.85Ten thousand yuan, with a year-on-year increase in losses547.17Ten thousand yuan.
An important reason for the widening of losses is the continuous increase in research and development expenses.2022In the first half of the year, Tianzhihang's R&D investment was5163.52Ten thousand yuan, a year-on-year increase10.59%, accounting for as high as84.72%.
Another leading company in the field, MicroPort Medical Robotics, is also facing a similar situation. As of2022year6month30RMB 10,000,000, accounting for 95.67% of the reported revenue104.8Ten thousand yuan, mainly arising from the sales of Dragonfly Eye, rather than its core product, surgical robots. The loss has increased significantly compared to the same period last year, with a net loss in the first half4.64Yuan billion, a year-on-year increase91.09%Net loss for the same period last year2.43100 million yuan.
Regarding the significant increase in the company's net loss for the first half of the year, MicroPort Robotics explained that there are three reasons. First, there has been an increase in investment in the research and development, clinical trials, and product registration of ongoing products. Second, the commercialization of surgical robot products has led to increased sales and marketing expenses. Additionally, the progress of research and development and business layout have resulted in an increase in the number of employees, with employee costs including stock-based compensation also rising.
From the data, during the reporting period, the sales and marketing expenses of minimally invasive robots reached6416Ten thousand yuan, an increase compared with the same period last year337.74%; R&D expenditures reached3.36Yuan, a year-on-year increase110.16%.
"
"Profit is a gradual process, and most domestic manufacturers are currently still in the research and development phase or the initial commercialization stage," said Zhang Dian. Due to the large upfront investment in surgical robot research and development and various links, companies are also continuously investing in new product research and development. Moreover, it is difficult to achieve rapid commercial application in the short term, making it challenging to generate profits in the early stages.
"From the perspective of the commercialization model of Da Vinci robots, what truly supports their cash flow operations and the scale effect of commercialization is the continuous revenue from consumables and services. However, this process also requires consideration of how to truly meet the needs and interests of hospitals, doctors, and patients, which will be a major challenge." Zhang Dian told.21Reporter of Century Economic Report.
Apart from the initial difficulties, it is not easy for domestic surgical robots to capture the market. Imported manufacturers have established barriers through core technology patents and continuously iterate their product technologies to maintain market dominance. For example, in terms of hardware, the Da Vinci surgical robot possesses three key core technologies: the patent for the turnable surgical instrument.3DHigh-definition imaging technology and human-machine interaction design of the console. In terms of software, Da Vinci'sOperating SystemThe software system has been upgraded to the fourth generation, providing information such as instrument utilization rates, supporting data communication between components, and possessing surgical simulation technology.
Industry insiders with surgical robots said21According to a reporter from Century Economic Report, at the technical level, domestic robots can basically perform the same operations, but there are still gaps in performance such as algorithms and machinery, which are most evident in the doctors' senses, such as smoothness of operation, lagging effects, and delays. 'These real issues affect the doctors' surgical experience and are factors that doctors will prioritize.'
The domestic robotics sector has received widespread attention, with a large amount of capital injected into it.2021More than30A home surgical robot company has received financing.2022In 2023, several more domestic surgical robots were launchedNMPARegistration is accelerating, which means the competition in the market is becoming increasingly fierce. 'If there is a dominant company, it can seize the market share of Leonardo da Vinci, but if Leonardo da Vinci has already occupied...90%, and we're left with10%"It's more difficult to expand inside," the person in charge said.
In the existing market, domestic surgical robots exhibit strong regional characteristics. For example, Shandong Weigao, Shanghai MicroPort, and Shenzhen Jingfeng in the field of head surgery have basically covered the markets of North China, East China, and South China. Companies that cooperate with hospitals in their respective regions have an advantage. 'As far as I know, some companies have expanded their business to the southwest and northwest regions,' said an industry insider.
"
Policy dividends give rise to blue oceans
According to industry insiders, domestic surgical robots do not lack advantages compared to imported products. 'We have made some improvements in design to better suit the usage habits of Chinese doctors. There are still some issues with implementation that require optimization and iteration through successive product generations.'
The state encourages innovation and investment in this field.
2021year12In the monthly report, the '14th Five-Year Plan' for the development of medical equipment industry focuses on enhancing the performance levels of intelligent surgical robots such as laparoscopic and orthopedic surgical robots. The plan proposes that by2035In [year], the research, development, manufacturing, and application of medical equipment were upgraded to world-leading levels; China has entered the forefront of innovative countries in medical equipment, providing strong support for ensuring comprehensive and lifelong health services for the people.
2022year5In the month, the General Office of the State Council issued the '14th Five-Year Plan' National Health Strategy, proposing to optimize and strengthen the health industry, promote the manufacturing and production of high-end medical equipment and health products, and streamline the registration review process for innovative medical equipment.9month3On the same day, the National Healthcare Security Administration's website released "The National Healthcare Security Administration's Response to the Fifth Session of the 13th National People's Congress4955The Reply to the "Proposal No. 12" states that the non-application of volume-based procurement for innovative medical devices has provided space for their innovative products to expand into new markets.
"
Zhang Dian said that in terms of equipment configuration, the introduction of multiple policies has simplified the approval process for medical institution equipment use and further relaxed restrictions on equipment configuration planning. This is also favorable for domestic surgical robots to enter the market.At the same time, domestic manufacturers understand the characteristics of local markets better in terms of promotion, and with lower prices, there is hope for increased production.
Meanwhile, Beijing and Shanghai have taken the lead in including surgical robot costs in their medical insurance directories, which is expected to reduce patients' financial burden. It is reported that the Shanghai Medical Insurance Bureau has included laparoscopic robot surgeries under Class B medical insurance with the name 'Artificial Intelligence-Assisted Treatment Technology', with patients paying out of pocket.20%The scope of medical insurance reimbursement includes radical prostatectomy, partial nephrectomy, total hysterectomy, and radical resection of rectal cancer. The Beijing Medical Insurance Bureau has issued a document clarifying that 'robot-assisted orthopedic surgery' as an auxiliary operation is subject to government pricing, and it is included in the Beijing medical insurance payment catalog together with 'one-time robot-specific instruments'. This means patients can obtain100%Full reimbursement.
"
Zhang Dian believes that in the future, it is expected that more product or robot-assisted surgical services will be included in the medical insurance reimbursement list. This will reduce the patient's payment burden and increase both doctors and patients' acceptance of surgical robots. The entry of more manufacturers will also make price cuts an inevitable trend, driving downstream applications and market growth.
*This article is reprinted from21Century Economic Report Author: Dong Jingyi Original title: Domestic robots "take charge" of operating the scalpel ">
QWhat stage has domestic surgical robots currently reached, and what are the difficulties in their popularization?
A: Currently, the technology of domestic surgical robots is mainly achieved through joint research relationships established by enterprises, universities, and research institutes for clinical application and commercial transformation. Some enterprises have also crossed over from the field of industrial robots into the surgical robot sector. Domestic surgical robots are still in their early stages of development, but from2022It entered a period of rapid growth at the beginning of2022In the first half of the year, there was9A domestic surgical robot has been approved, covering multiple sub-application areas such as laparoscopy and orthopedics. The number has exceeded2021The number of approvals throughout the year also indicates that domestic products are breaking through import monopolies. In some niche areas where domestic products have not yet been commercialized, products will gradually enter the market. For example, the first domestically developed single-port laparoscopic surgical robot has entered the clinical trial phase. Surgical robots in different fields vary in their development stages in China due to differences in timing of development abroad or introduction into the country. The most advanced are laparoscopic surgical robots, while those for natural or vascular surgery are currently still in the clinical research stage.
Due to the significant procurement funds required for surgical robots themselves, as well as the need to accumulate and prepare for applying for prices and establishing surgical service fee items, there are certain obstacles in commercial promotion and downstream application stages, making widespread popularization difficult. Additionally, at present, the allocation and procurement of Class B large medical equipment (including surgical robots) in China have clear plans and complex procedures. Most only large tertiary hospitals with large medical equipment configuration licenses can purchase such equipment. In limited circumstances, hospitals tend to prefer purchasing imported surgical robots that have entered the market first and whose clinical value has been verified. Moreover, since surgical robots will also change the clinical habits of surgeons, market education and popularization require a certain amount of time.
QIn the market, imported surgical robots still dominate. What is the current technological gap between domestic and imported surgical robots?
A: Importers build barriers through core technology patents and continuously iterate product technologies to gain market dominance, leading in technology. For example, in hardware, the Da Vinci surgical robot possesses three key core technologies: the patent for the bendable surgical instrument.3DHigh-definition imaging technology, as well as the human-machine interaction design of the console. In terms of software, Da Vinci'sOperating SystemThe software system has been upgraded to the fourth generation, providing information such as instrument utilization rates, supporting data communication between various components, and possessing surgical simulation technology. The continuous upgrading of hardware and software still gives imported manufacturers a technological advantage, but domestic products are not inferior in performance to imported ones and are relatively more cost-effective.
Another major technical gap lies in high-end performance components upstream. Currently, most domestic manufacturers mainly rely on imported suppliers for these components, such as purchasing robotic arms and then assembling them themselves.
QThe 'Regulations on the Administration of Medical Devices' encourage increasing the market share of domestic products and accelerating the import substitution of medical device products. In your opinion, is domestic substitution feasible? Apart from the technical gap, are there any other obstacles?
A: Currently, although more domestic manufacturers have joined the field of surgical robots and more products have been approved, domestic surgical robot enterprises are still concentrated in the midstream manufacturing sector. As mentioned above, high-end performance components upstream still mainly rely on imports, thus not achieving complete domestic substitution. In the long run, dependence on overseas supply chains upstream is also not conducive to increasing corporate profit margins and commercial stability, posing certain risks and obstacles to commercialization. However, for domestic manufacturers that control upstream technology, such as the minimally invasive robot company with its own robotic arms, their long-term commercial advantages will gradually become apparent. As more key components achieve domestic substitution, the true significance and advantages of domestic substitution will further come into play.
Although technology and commercialization are somewhat correlated, commercialization itself is also a major obstacle. The application of surgical robots is a process that gradually cultivates surgeons' habits and acceptance, thus having a certain degree of usage stickiness. Coupled with factors such as conversion costs, products that enter the market first will have an advantage. At the same time, continuous use after admission also requires constant exploration and improvement. Looking at the commercial model of Da Vinci robots, what truly supports their cash flow operation and commercial scale effect is the continuous income from consumables and services. This process also needs to consider how to truly meet the needs and interests of hospitals, doctors, and patients, which will be a significant challenge.
Against the backdrop of domestic substitution, policies will also encourage the application of domestic surgical robots. For example, in terms of equipment configuration, several policies have been introduced to simplify the approval process for medical institution equipment use and further relax restrictions on equipment configuration planning, which will also be beneficial for domestic surgical robots entering the market. At the same time, domestic manufacturers are more familiar with the characteristics of local markets in their promotion efforts, coupled with lower prices, so there is hope for increased production.
QDomestic surgical robots such as Minimally Invasive Surgery (MIS) have excellent technology, but their commercialization is still a challenge as shown in the financial reports. What do you think are the main reasons for the difficulty in profitability?
A: In the past two years, policies oriented towards epidemic prevention have also led hospitals to shift their funds to areas with more urgent needs under limited budgets. Although surgical robots provide long-term solutions that benefit medical quality by reducing operation time, minimizing wound size, and improving precision, they have encountered certain commercial obstacles due to the need for hospitals to prepay millions for equipment costs. This is particularly true in the context of the pandemic.
Profit is a gradual process, and most domestic manufacturers are currently still in the research and development phase or the initial commercialization stage. Due to the large upfront investment in surgical robot research and development and various links, companies are also continuously investing in new product R&D. Moreover, it is difficult to achieve rapid commercial application in the short term, making it challenging to generate profits in the early stages. However, after the commercialization model and company profit model gradually mature, the cost rate of each link is expected to decline and remain stable, which will also lead to profitability.
QWhat is the future outlook?
AIn the context of China's aging population and increasing health awareness, surgical robots can alleviate issues such as public medical resource shortages and talent reserves. They have long-term value in health economics and clinical applications. Moreover, with the continuous expansion of application fields and scopes of various products, market potential will be further unleashed, and the future prospects are quite bright. Additionally, driven by favorable policies, multiple medical expenses related to surgical robots have been gradually included in medical insurance (for example, Shanghai has included certain procedures of the Da Vinci robotic system in Class B medical insurance, Beijing has included robot-assisted orthopedic surgery in medical insurance, and the People's Welfare Insurance in many provinces can now reimburse part of the costs of self-paid surgical robots). In the future, it is expected that more products or robot-assisted surgery service items will be included in the medical insurance reimbursement list, which will reduce the patient's payment burden and increase both doctors and patients' acceptance of surgical robots. The entry of more manufacturers will also make price cuts an inevitable trend, driving downstream applications and market growth.
