TOKYO -- In a lab at Tokyo Medical and Dental University, a doctor in a control booth is laser-focused on controllers in each hand. A mechanical arm hums as it cuts into and sutures a pig lying a few paces away.
This is to test a surgical robot developed by Riverfield, a medical startup spawned from the Tokyo Institute of Technology. The company aims to finalize its product as early as this month and bring it to market in fiscal 2022 for lung cancer and other patients.
The market for surgical robots was long dominated by the da Vinci surgical system from U.S.-based Intuitive Surgical. But newcomers like Riverfield have recently joined the fray as core patents of Intuitive have begun expiring, triggering cutthroat competition for better and cheaper products.
Riverfield's surgical robot runs on air pressure. "Unlike electric motors, which are more typical, using air pressure allows the doctors to feel subtle textures," Chairman Kenji Kawashima said. Better tactile feedback, combined with endoscope footage, will increase surgical accuracy.
Using air pressure also means a lighter robot with fewer components. Riverfield aims to price its surgical robot at 100 million yen ($912,000) or less -- about half as much as popular da Vincis.
"We are targeting big hospitals that are looking for a second surgical robot," Kawashima said. The startup aims to sell 10 or so units in the first year.
A pioneer in robot-assisted surgery, Intuitive launched da Vinci in 1999. The company holds thousands of patents related to the system, which is still widely used around the world, including at roughly 400 Japanese hospitals.
But recent years have seen the expiration of patents tied to some of da Vinci's most basic features, such as its remote controls, arm joints, and automatic adjustments on the positioning of endoscopes.
"This gave us an opening to enter the field," Kawashima said. Many other companies across the globe also want a piece of the fast-growing surgical robot market, which MarketsandMarkets sees expanding roughly 70% to $11.8 billion from 2020 to 2025.
A-Traction, a startup at the National Cancer Center Hospital East in Chiba Prefecture, has developed a robotic surgical assistant. While a human surgeon takes charge of the operation itself, the robot performs support roles, such as operating the endoscope camera or holding up surrounding tissue during the procedure.
With the robot, surgeries that used to take three doctors can now be done by just one or two.
"It makes endoscopic surgery possible at rural hospitals with few specialist doctors," A-Traction Chief Financial Officer Eiji Shinohara said.
By narrowing the scope of the functions, A-Traction looks to keep the deployment cost down to 30 million to 50 million yen per unit -- a fraction of a da Vinci's price tag. The robot will go on sale in 2022.
Japanese medical device maker Asahi Intecc announced in March that it would spend 2.6 billion yen to purchase A-Traction.
"We'll look to use Asahi Intecc sales channels to sell 100 units in five years," Shinohara said.
Medicaroid won regulatory approval here last August for Hinotori, billed as "the first made-in-Japan robotic-assisted surgery system." The four-armed device can perform a wide range of procedures.
Kobe-based Medicaroid was founded as a joint venture of Kawasaki Heavy Industries and medical electronics manufacturer Sysmex. Hinotori was developed based on Kawasaki technology.
"We'll offer fee plans that can be accessible to medical facilities that were unable to procure robots in the past," a Medicaroid representative said.
The trend will also develop peripheral industries. Yokohama medical startup Anaut is developing a system driven by artificial intelligence that supports doctors using robots and endoscopes. Camera images are analyzed to identify organs and other items on-screen.
Anaut aims to commercialize the system by fiscal 2023.
"With robots becoming more common, we seek to support safe surgeries with AI," said Anaut President Nao Kobayashi, himself a surgeon.
"Overseas, large corporations typically acquire startups that have developed sophisticated medical devices such as robots so that they can commercialize the technology," said Hajime Oshita, president of Tokyo-based venture capital firm MedVenture Partners.
Big names like Johnson & Johnson are major buyers, since they can gain access to technology from universities and the medical front lines. In Japan, startups have been nurtured following this pattern, which is contributing to the practical application of research findings.
Surgical robots are used in endoscopic procedures, which limit the invasiveness of surgery. Instead of the abdomen being opened up, for example, a tiny incision is made for an endoscope. The greater availability of less-expensive surgical robots will be a boon for older adults in need of less-taxing treatment options.