Wang Tianmiao: Navigating the 'Ice and Fire' of Surgical Robotics to Shape Its Future

Endovascular interventional therapy plays a crucial role in the treatment of cardiovascular and cerebrovascular diseases.

However, given that the anatomical complexity of cerebrovascular and cardiovascular structures far exceeds that of peripheral vessels, the requirements for procedural precision and safety are exceptionally high, which undoubtedly increases the difficulty of surgical operations. Meanwhile, the training cycle for interventional surgeons is relatively long, making it difficult to rapidly meet the growing medical demand. Against this backdrop of supply-demand imbalance, robot-assisted interventional therapy has emerged.

According to Frost & Sullivan data, the global market size for pan-vascular surgical robots was estimated at approximately USD 160 million in 2022 and is projected to grow to USD 1.6 billion by 2026.

On May 10, 2024, at the Cardiovascular Innovation Forum of the VBEF Future Healthcare Ecosystem Expo hosted by VCBeat,Wang Tianmiao, Honorary Director of the Robotics Institute at Beihang University and Dean of the Zhongguancun Zhiyou Research Institute, shared his profound insights on the development and application of surgical robots in the cardiovascular field.

Wang Tianmiao pointed out that there are currently four main factors driving the development of surgical robots: First, current surgical robots offer advantages such as greater precision, minimal invasiveness, reduced operational errors, and smaller incisions, which significantly lower the risk of error and provide patients with a safer and more comfortable surgical experience. Second, advancements in technology now allow for close-range or remote operational control to some extent, thereby reducing radiation exposure and alleviating physicians' workload. Third, minimally invasive surgical robots can effectively minimize complications and blood loss, whereas traditional open surgeries may involve significant hemorrhage, potentially leading to critical shortages in blood bank supplies. Fourth, big data support before and after surgery provides precise data backing for diagnosis, treatment, and rehabilitation.

Currently, the surgical robotics sector presents a landscape of “extreme contrasts.”

On one hand, surgical robots are ushering in an era of unprecedented opportunity. To promote the development of innovative medical devices, the Chinese government is introducing a series of favorable policies to encourage domestically produced medical devices to obtain regulatory approval and accelerate their entry into clinical application, thereby changing the current situation where high-end medical devices are largely monopolized by foreign companies. “Currently, an increasing number of hospital departments are joining in the exploratory application of surgical robots. There is a widespread consensus that robots are poised to become standard equipment for surgical treatment in hospitals,” said Wang Tianmiao. Meanwhile, domestic innovative enterprises are continuously making efforts, and cardiovascular surgical robots are expected to achieve a breakthrough from zero within this year or next.

On the other hand, this field also faces its most severe challenges. Serious homogenization, valuation misalignment between primary and secondary markets, poor integration of surgical robots with physicians’ traditional clinical experience, as well as cost and safety issues, are all urgent problems that need to be resolved. “Some physicians believe that while using surgical robots for research purposes is feasible, their specific clinical value as clinical assistants warrants deeper consideration. For instance, certain surgical steps that may take a physician 20 to 40 minutes to perform manually could require one hour or even more than two hours when performed with a robot. This is primarily due to the additional time consumed by preparatory procedures such as calibration, sterilization, positioning, and error compensation. Therefore, improving the clinical application efficiency of surgical robots remains a challenge to be overcome,” said Wang Tianmiao.

Based on in-depth research, study, and systematic analysis, Wang Tianmiao proposed four strategic directions to break through involution and homogeneous competition.

First, innovation should be rooted in the integration of medicine and engineering. China has accumulated a wealth of expertise from medical professionals. We should actively collaborate with renowned hospitals and physicians to leverage their experience and strengths in innovation. Rather than placing undue faith in foreign equipment and processes, we must ensure that all innovations are tailored to China’s specific context. In doing so, we are poised to forge an innovation pathway with distinct Chinese characteristics.“Most importantly, in this process, we do not necessarily need to pursue full automation or robotization. Instead, through in-depth exchanges with hospital experts, we clarify the specific requirements for surgical robots in handling difficult and challenging cases,” explained Wang Tianmiao.

Second, do not follow the path of integration; instead, pursue bold innovations in underlying software, AI vertical models, vision systems, core components, and training systems.Only by integrating surgical robotic systems with physicians and patient-centered treatment workflows can manufacturers ensure that their products are not replaced by other medical devices in a highly competitive market.

Third, while addressing complex and refractory diseases, we should actively engage with hospital experts to discuss which areas have broad and high-volume applications for surgical robots, which treatment procedures entail excessively high costs for patients, and which technologies are suitable for mountainous villages and remote areas.Only by starting from this point can we address the pain points, widely disseminate the professional knowledge and experience of hospital experts to different hospitals, and benefit more patients.

Fourth, going global is imperative.In the face of centralized procurement, strict price-control systems, and a challenging competitive landscape, the industry widely agrees that achieving sustainable profits and influence requires collaborating with hospitals and professional engineering service personnel, while appropriately increasing the proportion of consumables sales and maintenance services, thereby facilitating entry into the international market.

Regarding the potential future development trends of surgical robots, Wang Tianmiao proposed four key considerations.

First, there is the choice between specialized and general-purpose systems; whether to adopt specialized or general-purpose surgical robots in the future is a direction worthy of attention and discussion.Currently, multiple medical departments are attempting to explore the research and development of surgical robots, leading many to question: Should we develop specialty-specific robots or general-purpose ones? “Logically speaking, it is not feasible to have ten different robots for ten different departments. However, specialized robots are indeed the most efficient when performing specific surgeries. So, is it possible to integrate specialized and general-purpose surgical robots? In other words, the underlying artificial intelligence software and robot control systems could be universal, while the dexterous operation control and end-effectors remain specialized. This issue is still under exploration, but it undoubtedly holds great potential and value,” said Wang Tianmiao.

Second, "explainability" is a key direction for the application of large AI models in hospitals.Currently, artificial intelligence has essentially achieved image recognition and segmentation. With the advancement of large models, there is an expectation that they will be able to identify, reason, and diagnose based solely on lesion points in biological tissues, and even provide underlying explanations and conclusions. “This involves the issue of ‘interpretability.’ Traditional AI can only recognize and distinguish images, but it does not explain why differences exist or what may be present within the tissue. Therefore, many people hope that large AI models can assist doctors in interpreting diagnostic images. ‘Interpretation’ is the most critical function and demand for large AI models in hospital application scenarios; otherwise, no matter how high the recognition accuracy is, its diagnostic value for physicians would be significantly diminished.”

Third, in the past, the functionality of most surgical robots was limited to positioning; now, can this capability be expanded from positioning to interaction and manipulation?For instance, during the bone grinding step in spinal surgery, surgeons typically spend 1–2 hours. Could this tedious task be assisted by surgical robots, allowing surgeons to focus more on the most critical procedural steps? Clinically, not all surgeries require extremely high positioning accuracy. If surgical robots are limited solely to positioning functions, their potential as tools will be constrained, and their value cannot be fully realized.

Fourth, can surgical robots become intelligent tools capable of human-machine interaction?, an intelligent assistant capable of understanding the attending physician’s intent? Today, artificial intelligence, visual perception, and large language models have brought new opportunities to this field.

Finally, regarding the surgical robotics sector, Wang Tianmiao shared three profound insights: First, the integration of AI and robotics represents a critical nexus in the intersection of medicine and engineering. For innovative enterprises, this presents a historic opportunity and a strategic chance for China to ascend to global leadership in this industry; therefore, innovative companies must seize this moment. Second, medical surgical robots should be regarded as intelligent assistants or tools rather than fully automated surgical machines. We must return to the core principles of safety, accountability to patients, improvement of surgical quality, and meeting the public’s demand for cost-effectiveness. By leveraging the distinct clinical advantages of Chinese medical experts, we can develop unique software capabilities. Third, at an appropriate time, the state should adopt a more open approach. It is advisable to implement tiered pricing for innovative medical devices, establish industry standards for surgical robots, and introduce corresponding commercial insurance coverage. These measures would incentivize hospitals and universities to engage in the research and development of more innovative medical devices, thereby sustaining our momentum for continuous innovation in this field.