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The robotic surgery monopoly is a poor deal

BMJ 2013; 347 doi: (Published 19 December 2013) Cite this as: BMJ 2013;347:f7470
  1. Abhishek Trehan, vice president, Hugh Cairns Surgical Society, Nuffield Department of Surgery, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK,
  2. Tristan J Dunn, graduate researcher, Faculty of Economics, University of Cambridge, Cambridge CB3 9DD, UK
  1. abhishek.trehan{at}

The lack of competition in the surgical robots market may mean that this technology represents a poorer deal than it need do for healthcare buyers—ultimately patients, insurance companies, and taxpayers, write Abhishek Trehan and Tristan J Dunn

The adoption of robotic surgery has been zealous to say the least, especially in the United States. An ever increasing number of cases of surgery from several specialties are being performed with a robotic approach (in urology and gynaecology in particular but by no means exclusively).1 2 3

Despite increasing demand for such procedures, only one device is currently approved for soft tissue surgery by the US Food and Drug Administration—Intuitive Surgical’s da Vinci robot. The latest model of the da Vinci costs about £1.7m (€2m; $2.8m).4

The lack of competition in the market for these devices has likely stemmed from patented technologies, high barriers to entry, and Intuitive Surgical’s acquisition of a key competitor.

Although it is not apparent whether robotic surgery is associated with a superior clinical outcome,5 6 several cost analyses have found robotic surgery to be more expensive than other surgical approaches.1 2 …

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