"If anything holds the further developments in robotic surgery, it's price. There's only one company right now that has a clinical robot and they have a monopoly on that," says Dr. Nguyen. "Because of that monopoly, they have different attitudes about customer service and about how to make things cheaper. You either deal with them or you don't deal with the robot at all and that's very difficult."

Dr. Nguyen says many of the instruments can only be used a specific number of times before they are locked out and need to be replaced. Compared to the cost of open surgery, the robotic approach is much more expensive.


Cukic says that the parts must be replaced because of safety concerns.

"Our instruments are designed to be used as much as they can. Most of them can be used 10 times," he says. "Whatever the limit is on its life is based on its performance. If it's programmed to work for 10 uses, then we weren't able to get it to be safe and efficacious beyond 10 because of stretching of cables or dulling of knife blades or whatever the rate-limiting factor was. That's comparable to basic disposable laparoscopic instruments that are used once and are thrown away."

Dr. Nguyen says that to lower the cost of the surgeries, his surgical team tries to control the length of the time it takes to complete a procedure in the O/R. In addition to the clinical robot, Children's Hospital Boston also has a research robot. However, the hospital had to cancel its service contract for that machine because it was too expensive.

Other surgeons recognize the problem of having one manufacturer dominate the market, but also point out that the company made the technique a reality.

"Intuitive Surgical is the only manufacturer of the robot, but they've built a field out of nothing, so that tells you that they've done some things right, but not everyone is perfect," says Dr. Patel. "The good thing is that they have introduced a technology that we can utilize and has become widespread. It made a big contribution to medicine because the technology has helped hundreds of thousands of people around the world."

Although Dr. Wood, who compares Intuitive Surgical to "Shell Oil in the 1920s," hopes to see other manufacturers enter the market, he isn't too optimistic about the success of potential competitors.

"From a business standpoint, I think it's going to be highly unlikely, because most hospitals have already made this very large capital equipment purchase," he says. "And then to go ahead and just throw that away and go with a new vendor that's clearly not going to have the same track record would be difficult."

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