THINK Surgical Enters the 'Handheld' Era with TMINI Robotic System Following Acquisition

Since the advent of the da Vinci Surgical System, surgery has entered a new era—the era of surgical robots.

Orthopedic surgical robots represent a distinct category among the various types of surgical robots. Like other surgical robots, they impose high demands on the dexterity of robotic arms and the performance of navigation systems. Due to the specific nature of orthopedic procedures, these robots have even more stringent requirements for imaging technology.

Due to the numerous subspecialties in orthopedic surgery, each with distinct surgical focuses, orthopedic surgical robots are broadly categorized into three major areas: joint, spine, and trauma.The earliest joint surgery robot was developed in 1992 by Integrated Surgical Systems in the United States.Subsequently, through continuous mergers, acquisitions, and restructuring, THINK Surgical was formed as it exists today.

In 2022, THINK Surgical, dedicated to the development of robotic systems for knee replacement surgery, was acquired.$100 million(approximately RMB 720 million) in financing, ushering in a new revolution in orthopedic surgical robots.

The knee joint is a crucial synovial joint, closely linked to the majority of the human body’s motor capabilities.

In the 20th century, with the maturation of surgical techniques and advancements in material wear resistance, knee arthroplasty became feasible. This procedure, which involves removing damaged joint surfaces and replacing them with artificial implants to alleviate pain and improve joint function, has been hailed as the “surgery of the century.”

Currently, the most common treatment for knee joint diseases such as advanced hip osteoarthritis, avascular necrosis of the femoral head, hip dysplasia, and rheumatoid arthritis is knee arthroplasty. However, clinical practice still faces challenges with postoperative complications such as dislocation, leg length discrepancy, and limping. The primary cause remains related to individual patient differences.

With conventional surgical instruments, procedures such as prosthetic implantation, soft tissue alignment, and ligament stretching rely heavily on the surgeon’s individual experience, introducing a degree of operational uncertainty that may cause patient discomfort. Consequently, researchers have been striving to develop solutions that enable more personalized surgical procedures and enhance patient experience.

As the clinical specialty most closely integrated with advanced technologies, orthopedics has drawn inspiration for its researchers from the industrial sector.In 1992, IBM’s Thomas J. Watson Research Center in the United States collaborated with the University of California to establish Integrated Surgical Systems.(ISS), and developedThe World's First Joint Replacement Surgical Robot: ROBODOCIn the same year, the surgical robot was applied clinically for hip replacement surgery, opening the door to robot-assisted artificial joint replacement.

It is reported that ROBODOC is a fully active robotic system.. It enables preoperative planning based on the patient’s CT scans to determine the appropriate type and size of the prosthetic joint. Intraoperative reaming of the femoral medullary canal is performed entirely by a robotic arm. The robotic arm can precisely shape the bone as required, enhancing implant stability while minimizing incision size, thereby facilitating postoperative recovery.

Clinical data demonstrate that ROBODOC-assisted hip arthroplasty achieves significantly superior femoral stem positioning compared with conventional surgery, thereby reducing the incidence of intraoperative fractures and postoperative leg-length discrepancy.At that time, the accuracy of manual femoral alignment adjustment by surgeons was only 75%, whereas ROBODOC-assisted procedures achieved an accuracy of 96%.

In 1994, ROBODOC was approved in Europe for assistedTotal Hip Arthroplasty; by 2000, its indications had expanded toKnee Arthroplasty.

In 2007, the company developed an active robotic system, TSolution One, for knee arthroplasty. This robot can automatically match patients with suitable prosthetic bones and joint surfaces, striving to achieve personalized medicine. Meanwhile, this robot also supports a multifunctional open platform, providing surgeons with the flexibility to use various implants.

By 2014, to meet development needs,ISS was acquired by Curexo Technology Corporation and renamed THINK SurgicalMeanwhile, the core technology TSolution One, developed during the ISS era, has been preserved and carried forward, becoming the foundational technology of THINK Surgical.

ISS and Curexo Technology Corporation have accumulated extensive technical expertise and team resources for THINK Surgical. As a result, upon its establishment, THINK Surgical already possessed multiple products, including TSolution One, ROBODOC, and the CUVIS series, thereby establishing a comprehensive solution chain spanning from joint replacement surgical robots to rehabilitation surgical robots.

Although ROBODOC is a product of the last century, it continues to deliver significant commercial value to Think Surgical. In 2018, more than 17,000 joint replacement procedures worldwide were performed with the assistance of the ROBODOC robotic system.

And around 2022,Think Surgical has also lived up to expectations by launching TMINI, the world’s first miniature robotic system.Unlike traditional surgical robots, TMINI is only the size of a hair dryer, allowing physicians to hold and operate it with one hand. This creates opportunities for surgical robots to be deployed in small operating rooms and clinics.

TMINI Schematic Diagram (Image Source: THINK Surgical)

Despite its compact design, the TMINI retains the functionalities of a robotic arm and 3D surgical navigation.The entire TMINI is a handheld robotic arm equipped with an open medical device implantation platform, offering greater flexibility and adaptability, allowing physicians to select the most suitable implants based on each patient’s specific needs.

Additionally, TMINI can assist surgeons in performing total knee arthroplasty under the guidance of CT-based 3D surgical planning, and automatically correct the surgeon’s movements to enhance positioning accuracy.

In May 2023, THINK Surgical announced that TMINI had received FDA 510(k) clearance, officially entering the commercialization phase.

In 2016, China’s first domestically produced orthopedic surgical robot received official approval, nearly two decades later than ROBODOC, developed by SSI. However, in recent years, the gap between Chinese orthopedic surgical robots and overseas products has been gradually narrowing, with an increasing number of related products approved for market launch.As of January 2024, a total of 38 orthopedic surgical robots have been approved in China, including 27 from domestic brands.

It is not only a breakthrough in quantity; in terms of technology, domestic brands are also gradually breaking the monopoly. For instance, the Honghu surgical robot developed by MicroPort was approved in 2023 as China’s first orthopedic surgical robot equipped with a proprietary robotic arm, thereby breaking the monopoly held by foreign enterprises over robotic arms.

Furthermore, the Tianzhi Hang Tianji Orthopedic Surgical Robot has achieved a sub-millimeter (<1mm) breakthrough in clinical precision, reaching an internationally leading position. Meanwhile, its indications already cover trauma surgeries for the pelvis, acetabulum, and extremities, as well as full-segment spinal surgeries.

With continuous technological upgrades and growing market demand, domestically produced orthopedic surgical robots are gradually gaining recognition in both domestic and international markets. In the future, these Chinese-made orthopedic surgical robots may play an increasingly important role in the healthcare market, delivering high-quality medical services to more patients.