Pearce Medical

1. To begin, could you provide a brief overview of your perspective on the current state of Robotics and Automation Systems (RAS) on a global scale, including key trends and factors influencing the industry? Additionally, how do you see your expertise aligning with the challenges and opportunities present in the field?

The topic of RAS is still very exciting but still in its early days, since the introduction of robots into medical use in the '90s, many companies have taken on this challenge. To date, all systems are not versatile and can be used across areas. This means that the healthcare system has to cope with ever more and higher costs.

Today we can proudly say that a telemedicine robot delivers promising results. The further development of robotics in medicine will continue to bring us exciting developments for a very long time. In my opinion, to advance robotics, it is more than necessary for the diagnostic information available to the patient to be synchronized when using a robot. This means that entry into AI (Augmented Intelligence) is still not being used enough. The introduction of AI into medicine requires the integration of technologies from areas outside of medicine. The use of augmented intelligence should be controlled in such a way that it guides but does not take over the doctor's decision.

2. Considering the current global landscape of Robotics and Automation Systems, can you highlight a specific industry or sector where the impact of RAS is most pronounced, and discuss the driving factors behind this prominence?

The RAS issue has already become an integral part of medicine today because one of the most important achievements of telemedicine is the protection of the doctor to treat the patient longer and better. Just imagine, like a shot putter, trying to push such a heavy ball as far as possible with your arm and shoulder over and over again for many hours every day. This would probably work well for a while, but after a few years, you can only do this with pain. Fatigue of the bone structure and arthrosis of the joints would occur in most cases, which in turn would lead to major restrictions on mobility, and thus the treatment of the patient makes it almost impossible. That's why with this technology, the doctors and their years of experience will be retained much longer and will be able to operate and treat us as patients in the best possible way

3: In the realm of RAS, what recent technological advancement do you find most transformative, and how do you foresee it reshaping the global industrial landscape in the coming years?

The robot arms today have up to 7 DOFs (Degrees of Freedom), so freedom of movement is guaranteed. The introduction of articulated instruments has also achieved 7 DOFs, now it is time to integrate AI into robot technology.

The introduction of 3D visualization simplifies the use of robots. The first company has already integrated various options into telemedicine, 2- and 3-dimensional distance measurement, and the placement of markers, these features are very promising, and it is to be expected that more and smaller features will be added here in the coming years an improvement in the application of the RAS.

4. Could you delve into a notable case of innovation within the RAS market, discussing the role of a key player and the strategic implications it has for shaping the industry on a global scale?

The Company Asensus Surgical was the first to jump on the bandwagon of real “augmented intelligence” and is already implementing or introducing the first AI features that make it easier for doctors to make decisions. Unfortunately, data protection is one of the biggest hurdles for the introduction of AI, as here too the needs vary from country to country.

5. Looking ahead, what do you believe will be the most influential trend in the field of Robotics and Automation Systems over the next decade, and how might it redefine the dynamics of global industries?

Due to the immensely growing costs in the healthcare sector, a RAS should be able to be used flexibly. So a hybrid approach would be a path that should be pursued. In visceral surgery, most companies talk about putting the doctor in a chair at a console far away from the patient and operating on the patient from there via telemedicine. I think this approach is good, but a hybrid approach where the doctor can operate the robot from a console or directly on the patient at the operating table or, if necessary, with the same instruments that can be disconnected from the robot arm and the doctor can operate on the patient can continue to operate without loss of time, this should be our aim to give the doctor 100% control over his actions. This also means that a RAS should not be limited to specific areas of application.

Furthermore, the instruments should not be reusable to a limited extent; the costs for the instruments are already well over 60% of the costs incurred by the robot. There are already new approaches here, and I very much hope that these will become established in medicine in the short and medium term. As a rule, instruments with a diameter of 8 to 7 mm are used, but here too the aim should be to minimize the instruments. 5mm, 3mm or even smaller. From 3mm or smaller there is also a cosmetic aspect, as there are no scars and this could also shorten hospital stays.

6: Considering the rapid evolution of RAS technologies, what ethical or regulatory challenge do you perceive as the most critical on a global scale, and how would you propose addressing it?

The regulatory hurdles are the biggest brake on innovation; in my opinion, significant improvements are also possible in this area.

It now takes years to bring innovative medical products to the point where they can be used on patients in a country on our planet. The hurdles have been built so high that many innovations don't even make it onto the market. A globally uniform regulation would help many people/patients all over the world.

7: In the context of advancing RAS technologies globally, how do you envision the role of international collaboration among governments, industries, and research institutions, and what benefits can such collaboration bring to the field?

It would certainly be desirable if all of the above-mentioned bodies worked together, but I would like to point out that, in my opinion, this will slow down innovation rather than speed it up as necessary.

8: From an economic perspective, can you discuss a specific instance where the adoption of Robotics and Automation Systems has demonstrably enhanced a particular industry's competitiveness and contributed to economic growth on a global scale?

No, because to date the price is significantly higher than a traditional laparoscopic operation, and the reimbursement/reimbursement at RAS goes beyond the normal reimbursement framework. Depending on the country, this can result in up to 200% higher costs. This has also been discussed in many publications.

In terms of the competitiveness of a hospital, it is still very clear that the clinic that offers the use of RAS as a routine operation also has an advantage over hospitals that do not have a RAS.

9. Addressing the societal implications of increased automation, how would you propose managing the potential challenges related to job displacement and ensuring a positive societal transition in the face of growing RAS adoption?

The use of a RAS in daily routine also means that human resources can be reduced for use in the operating room. The right approach for me would not be to cut positions at short notice, but rather to use these freed-up resources where they are needed.

10. Considering the diverse global landscape, can you elaborate on factors that contribute to regional variations in the demand for Robotics and Automation Systems, and how these factors influence technological priorities in different regions?

Unfortunately, when looking at the market data, it must be noted that in most cases RAS is used in universities and state public institutions. These hospitals are supported by land. It would be desirable for these prices for the use of an RAS to benefit the patient with the funds available. In figures, this means that since 1997, with the introduction of the first RAS, less than 1.5% of all patients who had to undergo laparoscopic surgery could be treated with a robot. The reason this is so is the very high cost of purchasing a RAS and the high cost of the necessary instruments needed for surgery.

11. Reflecting on the integration of RAS with existing systems, what significant challenges and opportunities do you anticipate on a global scale, and how can organizations address these complexities effectively?

The price of RAS will be the deciding factor for global integration. As long as we have to work with very high prices in this sector, adaptation will progress more slowly than desired.

12. Considering the growing emphasis on environmental sustainability, how do you see Robotics and Automation Systems contributing to a more eco-friendly future, and what specific measures can be implemented to ensure these technologies align with sustainable practices on a global scale?

Most companies still rely on instruments with a very limited period of use, also known as disposable products, or equip their instruments with chips to limit the period of use.
The goal should be to have instruments that have a long service life; they should be cleanable and re-sterilizable according to standards. There are already initial approaches to this.

13. As we conclude our discussion on Robotics and Automation Systems and their global landscape, is there any aspect or perspective you would like to add or emphasize? Additionally, how do you envision your expertise contributing to the advancements and challenges within the evolving field of RAS on a global scale? 

My goal is to drive innovation forward, to question things, and to give us impetus. Many companies are on the right track. I will not presume to question the pioneers of RAS, but I very much hope that all patients on our planet will have access to such exciting technology. Despite laparoscopic technology, open surgery is the most commonly used technique, although TLP has been available since the 1980s, and a very small proportion of these TLPs (1.5%) are performed with a RAS.

Unfortunately, the situation is different when it comes to costs. Therefore, I think there is still a lot to do in this decade.