Over the past 40 years of reform and opening-up, China has continuously promoted its opening-up policy while practicing innovation, which has created opportunities for outbound investment. After joining the World Trade Organization (WTO), China has accelerated its opening-up process and realized the historical turn from "introducing" to "going out" and from following to leading.
As China's economy enters a new phase of steady growth, overseas markets become more attractive than in the past amid intensifying domestic volatility. In addition, the national government and relevant departments have been issuing a series of favorable policies in the field of international expansion. Besides, the increase in the level of openness towards the outside world has further motivated domestic brands to enter overseas markets. Lastly, the increasing improvement of the digital economy infrastructure including supply chain, mobile social commerce, the Internet and the rise of logistics, payment, SaaS/ERP and other tools have directly reduced the cost and significantly increased the convenience of going abroad.
As we enter 2023, EqualOcean is excited to present the "Global 100: Go Global and Co-creating the Future" series, in which our analysts will sit down with frontline industry practitioners and enterprise leaders to gather insight on globalization of Chinese brands. We hope to help brands be seen, recognized and valued through our professionalism and credibility.
The following is the eighth piece in this series, conducted by our analyst Mianmian Wang after her talk with Dr. Kai Xu, Founder and CTO and Founder of Surgerii Robotics (Chinese: 术锐机器人).
Beijing Surgerii Robotics Company Limited, or SHURUI, is a technology company founded by an industry elite active in China's medical equipment in 2016. Relying on the core technology of the new generation of flexible continuum robotic arm, running through the implementation paradigm of many types of clinical minimally invasive surgery, and harnessing the powerful system design and integration capabilities, Surgerii Robotics is committed to becoming China's da Vinci and making its presence in global markets.
EqualOcean: Why does Surgerii mainly focus on the single-port surgical robots?
Surgerii: There are two main reasons we bet big on the single-port surgical robots. First of all, I am convinced of that single-port surgical robots are the future of surgical robots, which is in line with my PhD mentor, Professor Russell Taylor, the father of medical robotics. "In our opinion, single-port surgical robots resolve the fundamental difficulty of the extremely difficult operation during single-port laparoscopic procedures. In the view of many leading surgeons, multi-port surgical robots don't do what they can't. Much of the advantage comes from improved ergonomics. But in single-port surgery, surgeons can use surgical robots to perform operations that were previously difficult to do manually."
For example, in a single-port robotic laparoscopic procedure, only a 2.5cm incision will be made in a patient's abdominal wall, and a 3D high-definition electronic endoscope and three snake-like surgical instruments can be inserted by the robot.
And I also realized early on that it would be very difficult to surpass the da Vinci multi-port laparoscopic surgical robot just by designing a similar one. Therefore, if we really want to make achievements in the field of surgical robots, we have to make changes.
Second, the snake-like robotic instrument can achieve technological breakthroughs and can also promote single-port surgery prevalence. We have achieved the technological breakthrough in terms of the Dual Continuum Mechanism after years of hard work, which enables the snake-like robotic instruments to operate precisely and efficiently in narrow surgical sites.
Different from the da Vinci systems that are composed of joints and rigid links, both the endoscope and the surgical instruments used by the Surgerii endoscopic surgical system are composed of the Dual Continuum Mechanism, allowing to achieve the motions via continuous deformation of the super-elastic nitionl backbones. These backbones can apply both pull and push forces, making the surgical tools adequately strong for surgical operations. What’s more, our Dual Continuum Mechanism helps the surgical tools to realize a 6 degrees of freedom motion, with the robotic arms kept stationary during operation. This feature improves safety in surgery because it eliminates the inherent risks stemmed from collisions between robotic arms in the multi-port robotic surgery, meanwhile not causing the problems of limited movement of instruments and poor visualization, etc.
EqualOcean: How about the application of surgical robots in domestic market?
Surgerii: The increasing market size of surgical robots has attracted much attention in recent years. The global market has basically formed a pattern of endoscopic robots as the main, orthopedic robots as the secondary, and diversified medical robots in other fields. In the field of endoscopic robots, Intuitive Surgical’s da Vinci is currently leading the track and it has grabbed the largest market share of surgical robots.
According to the number of incisions, endoscopic surgical robots can be divided into multi-port surgical robots and single-port surgical robots. However, the da Vinci single-port surgical robot has not entered the Chinese market at this stage, which brings a window for the development of domestic single-port surgical robots.
In fact, the market for single-port surgical robots is at least as large as the market for multi-port surgical robots, because more patients undergoing simpler surgeries and fewer patients undergoing complex diseases. If we can show in the future that most of surgeries can be done using a single-port surgical robot, cheaply and with minimized trauma, more patients will choose the single-port surgery.
And I have to make it clear that single-port and multi-port surgical robots are not replacing each other. For complex diseases, the clinical efficiency of using multi-port surgical robots is higher.
EqualOcean: Compared to other surgical robots, how about the operation complexity of Surgerii’s products?
Surgerii: The learning curve our single-port surgical robot is not that steep, especially for surgeons familiar with the da Vinci Surgical Systems.
EqualOcean: How do you expect Surgerii’s improvement in terms of materials, precision, or other aspects in the future?
Surgerii: In the future, we will develop other new instruments for robotic single-port surgery that reduces the incision to 1.5 cm. We want to minimize patients’ surgical trauma using minimal and smallest incision, as well as providing the most suitable treatment solution according to a patient’s condition. From my perspective, many surgical treatments do not need three incisions; one incision for a single-port surgical robot via the umbilicus is often enough.
EqualOcean: Do you have plans to develop other types of surgical robots in the future?
Surgerii: Currently, our products can be applied in multiple clinical fields including urology, gynecology, general surgery, and thoracic surgery. But we are always aiming high.
In fact, we are undertaking China's National Key R&D Programs, partnering with top medical institutions such as Fuwai Hospital (Chinese: 阜外医院) to develop the new-generation cardiac single-port surgical robots. And based on our single-port surgical robot technology platform, we are also exploring more solutions and products, such as robots for Natural Orifice Transluminal Endoscopic Surgery (NOTES).
EqualOcean: Compared with leading players, in what areas do domestic products lag behind? And what efforts are needed to enhance the competitiveness?
Surgerii: At present, there are obvious gaps between domestic surgical robots and foreign top-level surgical robots such as the da Vinci systems in terms of branding power and technology matureness. Product iteration and polishing are still needed. The development of surgical robot industry needs cooperation from all aspects, for example, government policy support, technology research and development, local industrial supply chain and clinical recognitions.
EqualOcean: How about Surgerii’s commercialization process?
Surgerii: We believes that the key to commercialization is the value created when products are applied in clinical practice. Thus, our key commercialization logic is focused on the realization and enhancement of product value.
From the perspective of business value, single-port surgical robots create critical values for hospitals, surgeons, and patients. For patients, the prominent advantages include less pain, faster recovery, and less scar. For surgeons, surgical robot can lead clinical and scientific innovation, and help them explore novel surgical approaches. More innovative research results will be achieved based on this new single-port surgical robotic system, the brand-new technology platform. For hospitals, introducing single-port surgical robots can reduce procurement and usage costs. So, we are optimistic about the market potential of single-port surgical robots which delivers value for many stakeholders.
Surgerii now is continually promoting technological and clinical innovation through cooperating with top hospitals, known as Industry-Academia R&D Collaboration. Meanwhile, we will jointly build training centers with provincial head hospitals to promote standardized applications and benefit more patients. Currently, several training centers have started to operate and we will continue to invest in the training center establishment next year to lay the foundation for future commercialization.
EqualOcean: Will you place more emphasis on domestic business or overseas markets?
Surgerii: Both markets are important to us for sure. When putting emphasis on domestic market, we also speed up the explore of overseas market.
The development of our surgical robot is completely complied with European or American standards, and at present, we are promoting the registration in both markest respectively. However, it’s still a long way for us to go completely global. We hope to overcome multiple challenges including the global registration and approval, the disrupted global supply chain, and foreign clinical trials.
EqualOcean: In addition to minimally invasive single-port surgery robots, do you find any other trends or potentials in surgical robot area?
Surgerii: Robotics in NOTES is one of the important directions in this field, which is also where we are heading to. The development from ‘multi-port’ to ‘single-port’ has greatly reduced surgical trauma in patients, but still requires incisions on the patient's skin. However, surgical robots in NOTES can complete the operation without visible incisions, which places a higher demand to technology advancement.
The surgical robot-centered intelligent operation room is another direction. We hope to build the robot-centered intelligent operation rooms, to facilitate the cooperation between surgeons and other surgical equipment through integrated functions, and to improve the convenience and efficiency of surgeons by providing intelligent solutions for surgical operations.
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