Surgical Robotics Technology

Performance-Guided Surgery – What’s Next?

From the invention of smartphones and computers to electric cars and virtual reality, there’s no doubt that humankind has experienced a technological revolution in the 21st century. Innovation has been widespread across industries, but the application of technology in the surgical field has, for the past few decades, remained stagnant. This has allowed the field to become rife with human error in performance and inconsistency in patient outcomes.

At a value of $6.4 billion in 2021, the global surgical robots market is projected to reach $14.4 billion by 2026 – growth which can be attributed to the advantages of robotic-assisted surgery, and the increasing adoption of technological advancements in the operating room. This momentum has given rise to a new era in surgery – called Performance-Guided Surgery – which leverages robotics, augmented intelligence, and deep learning capabilities to digitize the interface between the surgeon and patient and improve surgical outcomes.

Stimulated by an increase in demand for more precise and accurate surgical techniques, we’ll see changes in the coming year within the surgical robotics market. This article speculates on what changes we will see as we approach a future where Performance-Guided Surgery becomes the norm of surgical standards and the market drivers propelling these innovations. 

Complex Procedures and Surgeon Comfort

The art of surgery has evolved from open to laparoscopic to robotic and now digital laparoscopic surgery, with Performance-Guided Surgery on the horizon. This natural evolution along the minimally invasive continuum provides many patient and surgeon benefits that have not been available in the past. Performance-Guided Surgery leverages robotics to perform complex procedures with geometrical precision, and more impressively, in anatomical areas that are difficult to reach by human surgeons. Performance-Guided Surgery offers the assurance of reduced surgical variability and lower procedure cost with standard reusable instruments and an open-platform architecture strategy that enables hospitals to leverage existing technology investments. The introduction of 3mm instruments presents another advantage previously unavailable in the robotics market, allowing for reduced invasiveness and patient cosmesis.

From a surgeon’s perspective, Performance-Guided Surgery delivers significantly meaningful benefits from a physical and a cognitive point of view. Improved ergonomics alleviate the physical burden and reduce physical fatigue, which can in return, reduce technical errors and procedure time. The integration of digital technology such as, augmented intelligence and machine vision capabilities provide surgeons with real-time clinical insights that will help the accurate analysis and consistent decision making to help reduce the cognitive burden of the surgeon. This is especially important given the aging surgeon demographic and looming surgeon shortage. Digital Laparoscopic surgery provides precise movements based on laparoscopy to mimic traditional training methods, an eye tracker to control the camera based on eye movements to free up the surgeon’s hands, and the ability to very simply switch from digital laparoscopy to hands-on if direct access to the patient is required.  With a better open working environment, surgeons can extend their careers and attract new talent to the field.

Efficiency and Low Operation Costs

Long-term, robotics-assisted technology has the potential to support high volume, low-cost procedures that are typically performed within ambulatory surgery centers (ASCs), freestanding facilities specializing in surgical, diagnostic, and preventive procedures that do not require hospital admission.

Robotics-assisted and digital technology is well-suited for this setting because the inherent low operating expenses are passed on to the ASCs, keeping cost-per-procedure comparable to traditional laparoscopy, and enabling an increase in the adoption of robotics-assisted and digital technology in this space.

To offset a decrease in hospital budgets worldwide, new surgical platforms and technology ownership models are on the horizon. However, this overall offset will also depend on a decrease in the price of innovative technologies like robotics-assisted technology that are becoming more widely adopted. As a result of wider adoption, costs will decrease as new innovations such as augmented intelligence and machine vision technologies are introduced. 

Augmented Intelligence

Artificial intelligence (AI) is currently being used across many areas of healthcare to improve outcomes and efficiencies by replacing or augmenting human labor. But in surgery, and in the operating room (OR), the integration of humans and machines should be to elevate surgeon’s skill level and performance, not replace them. As such, there’s an alternative conceptualization of AI, called augmented intelligence, that focuses on AI’s assistive role and has the power to transform how surgery will be performed.

To date, technological innovations in the OR have focused on surgical tools to improve the “acting” portion of the surgical decision chain when the surgeon is executing a chosen decision. However, there has been very little focus on improving the intraoperative, or decision-making aspects of the surgical process, which is crucial in the high-pressure, highly variable situations that drive surgical outcomes.

Augmented intelligence enables a robotic-assisted platform to perceive (computer vision), learn (machine learning), and assist (clinical intelligence) in surgery—providing a true digital surgical assistant for the first time—one that does not replace the human, but assists in improving the human’s performance. In the surgical field, augmented intelligence can enhance surgical workflows and enable new levels of precision and accuracy to be carried out with the ultimate goal of delivering predictability and consistently superior surgical outcomes. We will continue to see the expansion of robotics-assisted technology and the integration of augmented intelligence to improve workflows.

What’s Next?

Next-level technologies like Performance-Guided Surgery where augmented intelligence and robotics-assisted technology are seamlessly integrated and embedded, completely change the scope of what is possible in the surgical field. As this technology continues to evolve, the future outlook of the surgical industry is bright, as is the potential it has to change the world we live in. 

The foundation of digital laparoscopy is growing and adding machine vision, augmented intelligence, and deep learning capabilities will help move the industry beyond inefficiency, unpredictability, and outdated technology. By digitizing surgery that is smarter and more instinctive, better patient outcomes will become a reality.


Anthony Fernando

Anthony Fernando has been President and CEO of Asensus Surgical since October 2019. He joined Asensus in 2015 and had previously been Chief Operating Officer and Chief Technology Officer.

Mr. Fernando serves on the board of directors of Advanced Medical Technology Association (AdvaMed-Accel).

Mr. Fernando has a broad business and technology career across multiple industries and has operated in and out of the U.S. Asia and Europe.

After holding R&D and general management positions at Varian Inc., he spent 9 years in Asia with Perkin-Elmer leading R&D, Becton Dickinson leading emerging market product development and Stryker leading innovation and technology focused on international markets at the VP of Innovation and Technology.

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