Medical Robotics and Computer-Assisted Surgery: The Global Market

• Publication date: January 2013
• Report size: 160 pages

INTRODUCTION STUDY BACKGROUND Information technology plays a key role in an ever-widening range of human activities, including surgery. Computers, working in tandem with a variety of microprocessor-enabled equipment and instruments, support and facilitate the work of the surgeon and have brought a level of safety and precision to surgery that would have been inconceivable just a few years ago. These computers, ...

INTRODUCTION

STUDY BACKGROUND

Information technology plays a key role in an ever-widening range of human activities, including surgery. Computers, working in tandem with a variety of microprocessor-enabled equipment and instruments, support and facilitate the work of the surgeon and have brought a level of safety and precision to surgery that would have been inconceivable just a few years ago.

These computers, electronic equipment and instruments are referred to collectively as medical robotics and computer-assisted surgery (MRCAS) or, more dramatically, “the operating room of the future.” MRCAS is used in a growing number of operating rooms around the world, largely as a result of the growing popularity of minimally invasive surgical (MIS) techniques. Minimally invasive, or “keyhole” surgery is an alternative to traditional open-incision surgery in a growing number of procedures. MIS utilizes special instruments that can be inserted and manipulated through small incisions (sometimes no more than a few millimeters long) under remote optical or video guidance, greatly reducing patient trauma and recovery times.

The need to perform delicate surgical procedures safely in tight spaces where the surgeon cannot directly see has created a growing market for devices that act as extensions of the surgeon’s eyes and hands: remote imaging, data processing and feedback, and robotics. Meanwhile, MRCAS technology has been evolving, as have the medical and economic environments in which it is used. Populations are aging, increasing demand for a wide range of age-related surgical procedures such as heart and orthopedic surgery. Technological advances have expanded the range of surgical procedures that can be performed using minimally invasive techniques, making them accessible to even more people.

The structure of the hospital industry, the main user of MRCAS, is also changing as hospitals consolidate and other health care options such as walk-in surgical clinics become available to consumers. Private and government health insurers around the world are becoming more cost-conscious, forcing hospitals to re-evaluate their capital spending plans but strengthening the case for technologies that can reduce the cost of surgical procedures. Medical malpractice suits continue to be common in markets like the United States, so technologies that increase the precision and accuracy of surgery have obvious appeal.

In such a fast-moving field, there is a pressing need to develop and maintain an up-to-date base of market information in order to better understand the dynamics of the market for MRCAS devices and equipment.

GOALS AND OBJECTIVES

This report is an updated and expanded version of an earlier (2011) BCC Research analysis of U.S. and global markets for MRCAS equipment. The updated report is based on the most recent market information available, and analyzes technological, economic and regulatory developments that may have a long-term impact on the size and structure of the MRCAS market. The new report also contains a more in-depth and detailed analysis of selected foreign markets than its predecessor offered.

More specific objectives of this report are to:

Identify and segment the main types of MRCAS devices that have been commercialized to date.
Analyze the historical and current volume and value of shipments of each of these product segments in specified applications and geographical markets.
Identify and evaluate the impact of demographic, economic and other factors that will drive future demand for MRCAS devices.
Forecast the volume and value of product shipments by equipment type and application and by probabilities that future demand will be higher or lower than the baseline forecast.
Identify promising new surgical procedures and products still in the development and testing stage and assess the probability that they will be commercialized successfully within the next five years.
Forecast the potential market for these developmental procedures and products, taking into account the estimated probability that they will be commercialized.
Identify leading manufacturers of the devices and analyze the structure of the MRCAS industry (e.g., market shares, concentration, and recent M&A activity).
Assess the long-term outlook for MRCAS equipment, taking into account market opportunities as well as technological, financial and economic factors.

INTENDED AUDIENCE

This report has been written for the entire MRCAS interest community, especially those in:

The medical and surgical devices industry.
Medical research institutions.
Investing.
The financial and analyst community.

Although the report is structured around specific technologies, it is largely non-technical in nature. That is, it is concerned less with theory and jargon than with what works, how much of the latter the market is likely to purchase and at what price.

As such, the report’s main audience is executive management and marketing and financial analysts. It is not written specifically for scientists and technologists, although its findings insofar as the markets for their work, including the availability of government and corporate research funding for different technologies and applications, should interest them as well.

SCOPE AND FORMAT

This report is an analytical business tool with the primary purpose of describing the MRCAS equipment industry and the global market for these devices. MRCAS equipment is defined as computer- or microprocessor-enabled devices and accessories that are physically situated in the operating room and directly assist the surgeon in planning and carrying out surgical procedures. Thus, the scope of the study does not include:

Devices that provide images and other information but are not an integral part of the MRCAS system, such as preoperative imaging (e.g., CT, MRI) equipment or laboratory and other analytical devices.
Computerized medical records systems.
Electronic operating room equipment such as heart monitors that enable the surgical team to monitor the patient’s condition but do not assist the surgeon directly in carrying out the operation.
Other nonelectronic operating room equipment.

The format of the study is organized around the following topics:

Major types and applications of MRCAS.
Industry structure.
Market size and segmentation, including historical data on sales by application, product type and geographical market.
Market drivers.
Detailed market projections through 2017.
Competition and market shares.
Observations and conclusions regarding the future of the MRCAS market.

METHODOLOGY AND INFORMATION SOURCES

Both primary and secondary research methodologies were used in preparing this report. The findings and conclusions of this report are based on information gathered from manufacturers and users of MRCAS and other informed sources. Interview data was combined with information gathered through an extensive review of secondary sources such as trade publications, trade associations, company literature and online databases to produce the baseline market estimates contained in this report.

The base year for analysis and projection is 2011. With 2011 as a baseline, market projections were developed for 2012 to 2017. The market projections are “consensus” projections, obtained by averaging market scenarios obtained from industry and other sources or developed independently by BCC. The analytical methodologies BCC used to generate the market estimates are described in detail in the section on detailed market projections.

All dollar projections presented in this report are in 2011 constant dollars.

ANALYST CREDENTIALS

The author of this report is Andrew McWilliams. Mr. McWilliams, a partner in the Boston-based international technology and marketing consulting firm of 43rd Parallel, LLC, is the author of several other BCC Research studies of the surgical and related medical devices markets, including the previous edition of this report; HLC051F ? The Market for Minimally Invasive Medical Devices; HLC066B ? Medical Automation Technologies, Products and Markets; HLC038C ? Patient Monitoring; HLC016D ? Microelectronic Medical Implants: Products, Technologies and Opportunities; HLC072B ? Global Markets and Technologies for Medical Lasers; and HLC082A ? Emerging Markets for Advanced Medical Technologies.

Global Surgical Equipment Industry

TABLE OF CONTENTS

CHAPTER 1 INTRODUCTION 1
STUDY BACKGROUND 1
GOALS AND OBJECTIVES 1
INTENDED AUDIENCE 2
SCOPE AND FORMAT 2
METHODOLOGY AND INFORMATION SOURCES 3
ANALYST CREDENTIALS 3
RELATED BCC RESEARCH 3
BCC ONLINE SERVICES 4
DISCLAIMER 4
CHAPTER 2 EXECUTIVE SUMMARY 6
SUMMARY TABLE GLOBAL SALES OF MRCAS EQUIPMENT, THROUGH 2017 ($ MILLIONS) 6
SUMMARY FIGURE TRENDS IN GLOBAL SALES OF MRCAS EQUIPMENT 2011-2017 ($
MILLIONS) 6
CHAPTER 3 OVERVIEW 9
GENERAL DESCRIPTION AND DEFINITION OF MRCAS 9
FIGURE 1 MEDICAL ROBOTIC AND COMPUTER-ASSISTED SURGICAL SYSTEMS 10
HISTORY OF MEDICAL ROBOTICS AND COMPUTER-ASSISTED SURGERY 10
SURGICAL IMAGING TECHNOLOGIES 10
IMAGE REGISTRATION TECHNIQUES 12
COMPUTER IMAGE PROCESSING 13
SURGICAL ROBOTS 13
"THE INTELLIGENT OPERATING ROOM" 14
SURGICAL SIMULATION 14
TECHNOLOGIES AND PRODUCTS 14
STANDALONE SURGICAL PLANNERS AND SIMULATORS 14
Technology 15
Modeling of Organs and Deformations 15
Simulation of Actions and Force Feedback Reactions 16
Emerging Technologies 17
Web-Based Surgical Simulators 17
Virtual Reality Simulators 18
Recent Patents 18
Advantages of Surgical Planners and Simulators 19
Products 20
TABLE 1 STANDALONE SURGICAL PLANNERS AND SIMULATORS 21
CAE Healthcare 22
Fifth Dimension Technologies 22
Haptica (acquired by CAE Healthcare in 2011) 22
Intuitive Surgical 22
Mentice Medical Simulation 22
Merge Healthcare 23
Simbionix 23
SimQuest 24
SimSurgery 24
Surgical Science 24
VirtaMed 25
VOXEL-MAN 25
VRmagic 25
SURGICAL NAVIGATION SYSTEMS 25
Technologies 25
Imaging Technologies 25
Multimodal Imaging 25
Fluoroscopic Imaging 26
Video-Enhanced Imagery 27
Microscopic Imagery 28
Endoscopic Imagery 28
Dynamic (Interventional) Imaging 29
Compact MRI Scanners 29
Intraoperative CT 30
Intraoperative Ultrasound 30
Tracking Technologies 30
Optical Tracking 31
Electromagnetic Tracking 31
Display Technologies 31
Multiplanar Displays 31
Three-Dimensional Displays 31
Stereoscopic Displays 32
Virtual and Augmented Reality 32
Heads-Up Displays 32
Recent Patents 32
Advantages of Surgical Navigation Systems 34
Products 35
Image-Guided Surgical Navigation Systems 35
TABLE 2 IMAGE-GUIDED SURGICAL NAVIGATION SYSTEMS 35
Boulder Innovation Group 36
FlashPoint 5500 36
Brainlab AG 36
VectorVision 36
Kolibri 37
Curve 37
Med Surgical Services 37
CBYON Suite (CBYON) 37
Medtronic 38
StealthStation 38
Praxim/Orthopaedic Synergy 38
Nano-Station 38
Siemens Healthcare 38
NaviLink 38
NaviVision 38
Smith & Nephew 39
Dash 39
Stryker Corp. 39
Stryker Navigation System 39
Zimmer 39
ORTHOsoft 39
Interventional Navigation Systems 39
TABLE 3 INTERVENTIONAL SURGICAL NAVIGATION SYSTEMS 40
TABLE 4 COMPARISON OF NONFLUOROSCOPIC INTERVENTIONAL IMAGING
TECHNOLOGIES 40
B. Braun Aesculap 41
OrthoPilot 41
Kinamed 42
NaviPro 42
SONOWAND 42
SonoWand Invite 42
Medtronic 42
PoleStar 42
Smith & Nephew 43
PiGalileo 43
Surgical Navigation Accessories and Add-Ons 43
TABLE 5 SURGICAL NAVIGATION ACCESSORIES AND ADD-ONS 44
Ascension Technology 44
Viking Stems 44
3-D-HD Visualization System and Infomatix 44
4navitec 44
Pointers, Trackers, Adapters, and Other Accessories 44
SURGICAL ROBOTS 45
Technology 45
Robotically Assisted Micromanipulation 45
Steady-Hand Systems 46
Robotic "Wrists" and Other Dexterity Enhancements 46
Preprogrammed Robots 47
Constraint Robots 47
Voice Control 48
Other Emerging Technologies 49
New Robotic Arm Designs 49
Remote Surgery 49
Natural-Orifice Surgery 50
Microbots 51
Recent Patents 51
Advantages of Robotics 53
Products 54
TABLE 6 SURGICAL ROBOTICS 54
Biobot Surgical 55
Mona Lisa 55
Corindus 55
CorPath 200 55
Curexo Technology 55
ROBODOC 55
Freehand 55
FreeHand 55
Given Imaging 56
Given Imaging Diagnostic System 56
Hansen Medical 56
Magellan 56
Sensei 56
Hitachi Medical Systems 56
Magnetic Resonance Image-Guided Surgical Robotic System 56
IMRIS 57
NeuroArm 57
Intuitive Surgical Systems 57
da Vinci 57
MAKO Surgical 58
RIO 58
Mazor Surgical Technologies 59
Renaissance 59
MicroDexterity 59
MicroDex 59
Robotic Systems and Technologies 59
Penelope CS 59
Schaerer Mayfield 60
NeuroMate 60
SOFAR 60
ALF-X 60
Titan Medical 60
Amadeus 60
DIGITAL OPERATING ROOMS AND EQUIPMENT 61
Technologies 61
Data Routing 61
User Interface 62
Open System Architectures 62
Recent Patents 63
Advantages 63
Products 64
TABLE 7 INTELLIGENT OPERATING ROOM SOLUTIONS AND COMPONENTS 64
Stryker 64
iSuite Operating Room of the Future 64
SIDNE 65
Karl Storz 65
OR 1 NEO 65
Smith & Nephew 65
Digital Operating Room 65
Intuitive Surgical 66
HERMES 66
Steris Corp. 66
3085 SP Operating Table/Harmony Surgical Lighting System 66
Skytron Surgical 66
Stellar Surgical Lighting Systems (Skytron Surgical) 66
Berchtold 67
CHROMOPHARE Surgical Lighting Systems 67
Covidien 67
Force FX Electrosurgical Generator 67
PRINCIPAL SURGICAL APPLICATIONS OF MRCAS 67
TABLE 8 PRINCIPAL SURGICAL APPLICATIONS OF MRCAS 67
ORTHOPEDIC APPLICATIONS 68
Hip Replacement 68
Knee Replacement 69
Trauma 69
Pedicle Screw Fixation and Other Spinal Procedures 70
NEUROSURGICAL APPLICATIONS 70
Stereotactic Biopsy 71
Craniotomy 71
Shunt 71
Implants 72
Deep Brain Stimulation 72
EAR, NOSE, AND THROAT (ENT) APPLICATIONS 72
Functional Endoscopic Sinus Surgery 72
CARDIAC APPLICATIONS 73
Coronary Bypass Surgery 73
Heart Valve Repair and Replacement 73
Percutaneous Coronary Intervention 73
OTHER ENDOSCOPIC APPLICATIONS 74
CHAPTER 4 THE GLOBAL MARKET FOR MRCAS EQUIPMENT 76
GLOBAL MRCAS MARKET 76
FIGURE 2 TRENDS IN THE GLOBAL MRCAS MARKET, 2011-2017 ($ MILLIONS) 76
MARKET BY COUNTRY/REGION 76
TABLE 9 MAJOR INTERNATIONAL MARKETS FOR MRCAS DEVICES AND EQUIPMENT,
THROUGH 2017 ($ MILLIONS) 77
FIGURE 3 GLOBAL MRCAS MARKET SHARES BY COUNTRY/REGION, 2011 VERSUS 2017
(PERCENT OF TOTAL SALES) 77
MARKET BY TYPE OF EQUIPMENT 78
TABLE 10 GLOBAL MRCAS MARKET BY TYPE OF EQUIPMENT, THROUGH 2017 ($ MILLIONS) 78
FIGURE 4 GLOBAL MRCAS MARKET SHARES BY EQUIPMENT SEGMENT, 2011 VERSUS 2017
(PERCENT OF TOTAL SALES) 78
MARKET BY TYPE OF APPLICATION 79
TABLE 11 GLOBAL MRCAS MARKET BY TYPE OF APPLICATION THROUGH 2017 ($ MILLIONS) 80
FIGURE 5 GLOBAL MRCAS MARKET SHARES BY APPLICATION SEGMENT 2011 VERSUS 2017
(PERCENT OF TOTAL SALES) 80
INDUSTRY STRUCTURE AND COMPETITION 81
OVERALL MARKET LEADERS 81
TABLE 12 MAJOR MRCAS VENDORS' MARKET SHARES, 2010 ($ MILLIONS) 81
FIGURE 6 U.S. OVERALL MRCAS MARKET LEADERS, 2011 (PERCENT OF TOTAL SALES) 81
SURGICAL PLANNERS AND SIMULATORS 82
FIGURE 7 GLOBAL SURGICAL PLANNER AND SIMULATOR MARKET LEADERS, 2011
(PERCENT OF TOTAL SALES) 82
SURGICAL NAVIGATION SYSTEMS 83
FIGURE 8 GLOBAL SURGICAL NAVIGATION SYSTEM MARKET LEADERS, 2011 (PERCENT OF
TOTAL SALES) 83
SURGICAL ROBOTS 84
FIGURE 9 GLOBAL SURGICAL ROBOT MARKET SHARES, 2011 (PERCENT OF TOTAL SALES) 84
INTELLIGENT OPERATING ROOM SOLUTIONS 84
FIGURE 10 GLOBAL INTEGRATED OPERATING ROOM SOLUTIONS MARKET LEADERS, 2011
(PERCENT OF TOTAL SALES) 84
CHAPTER 5 THE U.S. MARKET FOR MRCAS EQUIPMENT 87
MARKET ENVIRONMENT 87
DEMOGRAPHIC TRENDS 87
TABLE 13 TRENDS IN NUMBER OF AMERICANS AGE 55 AND OLDER THROUGH 2017
(MILLIONS) 87
TRENDS IN THE INCIDENCE OF CERTAIN DISEASES OR CONDITIONS 87
Trends in Cardiac Disease 87
Trends in Hip and Knee Replacement 88
TABLE 14 PROJECTED TRENDS IN MINIMALLY INVASIVE HIP AND KNEE REPLACEMENT
PROCEDURES, THROUGH 2017 (NUMBER OF PROCEDURES) 88
ECONOMIC TRENDS 88
TECHNOLOGICAL DEVELOPMENTS 89
Adaptation of Minimally Invasive Techniques to New Types of Surgical Procedures 89
New Products and Technologies 89
Development of Lower-Cost Systems 90
Increasing Patient Access to Minimally Invasive Surgery 90
Facilitating Surgeon Awareness and Training in Minimally Invasive Procedures 90
Offsetting Manpower Constraints and Reducing Hospital Labor Costs 90
CHANGING STRUCTURE OF THE U.S. HEALTH CARE INDUSTRY 91
Hospital Consolidation 91
Developments in Health Insurance 91
Distribution Channels 92
FIGURE 11 U.S. DISTRIBUTION CHANNELS FOR MRCAS EQUIPMENT (PERCENT OF TOTAL
SALES MADE THROUGH EACH CHANNEL) 93
LAWS AND REGULATIONS 93
FDA Regulations 93
Patient Protection and Affordable Care Act 96
CONCLUSIONS 96
MARKET SIZE AND SEGMENTATION 96
OVERALL MARKET 96
FIGURE 12 U.S. SALES OF MRCAS EQUIPMENT, 2011-2017 ($ MILLIONS) 96
MARKET BY EQUIPMENT SEGMENT 97
TABLE 15 U.S. MRCAS MARKET BY TYPE OF EQUIPMENT, THROUGH 2017 ($ MILLIONS) 97
FIGURE 13 U.S. MRCAS MARKET SHARES BY TYPE OF EQUIPMENT 2011 VERSUS 2017
(PERCENT OF TOTAL SALES) 98
MARKET BY APPLICATION SEGMENT 98
TABLE 16 U.S. MRCAS MARKET BY TYPE OF APPLICATION THROUGH 2017 ($ MILLIONS) 99
FIGURE 14 MAJOR MRCAS APPLICATION SEGMENTS 2011 VERSUS 2017 (PERCENT OF
TOTAL SALES) 99
DETAILED MARKET ANALYSIS AND PROJECTIONS 100
SURGICAL PLANNERS AND SIMULATORS 101
Historical Sales 101
TABLE 17 U.S. SALES OF SURGICAL PLANNERS AND SIMULATORS THROUGH 2011 ($
MILLIONS) 101
FIGURE 15 U.S. SALES OF SURGICAL PLANNERS AND SIMULATORS 2000-2011 ($ MILLIONS) 101
Projected Sales 101
TABLE 18 PROJECTED U.S. SALES OF PLANNERS AND SIMULATORS THROUGH 2017 ($
MILLIONS) 102
Risk Factors 102
SURGICAL NAVIGATION SYSTEMS 103
Historical Sales 103
TABLE 19 U.S. SALES OF SURGICAL NAVIGATION SYSTEMS, THROUGH 2011 ($ MILLIONS) 103
FIGURE 16 HISTORICAL GROWTH OF SURGICAL NAVIGATION SYSTEM SALES, 2000-2011 ($
MILLIONS) 103
Sales Projections 103
TABLE 20 PROJECTED U.S. SALES OF SURGICAL NAVIGATION SYSTEMS THROUGH 2017 ($
MILLIONS) 104
Risk Factors 104
SURGICAL ROBOTS 105
Sales 105
TABLE 21 U.S. SALES OF SURGICAL ROBOTS, THROUGH 2011 ($ MILLIONS) 105
FIGURE 17 HISTORICAL GROWTH OF SURGICAL ROBOT SALES, 2000-2011 ($ MILLIONS) 105
Market Penetration 106
TABLE 22 U.S. SURGICAL ROBOT MARKET PENETRATION, 2011 106
Projected Sales 107
TABLE 23 PROJECTED U.S. SALES OF SURGICAL ROBOTS THROUGH 2017 ($ MILLIONS) 107
Risk Factors 108
INTELLIGENT OPERATING ROOM SOLUTIONS 108
Sales 108
TABLE 24 U.S. SALES OF INTELLIGENT OPERATING ROOM SOLUTIONS, THROUGH 2011 108
FIGURE 18 HISTORICAL GROWTH OF INTELLIGENT OPERATING ROOM SALES, 2000-2011 ($
MILLIONS) 108
Market Penetration 109
TABLE 25 U.S. INTELLIGENT OPERATING ROOM MARKET PENETRATION, 2011 109
Projected Sales 109
TABLE 26 PROJECTED U.S. SALES OF INTELLIGENT OPERATING ROOM SOLUTIONS,
THROUGH 2017 ($ MILLIONS) 110
Risk Factors 110
CHAPTER 6 OTHER NORTH AND SOUTH AMERICAN MARKETS FOR MRCAS EQUIPMENT 112
MARKET ENVIRONMENT 112
DEMOGRAPHICS 112
TABLE 27 OTHER NORTH AND SOUTH AMERICAN MARKET DEMOGRAPHIC INDICATORS,
2011 112
ECONOMICS 112
TABLE 28 OTHER NORTH AND SOUTH AMERICAN MARKET ECONOMIC INDICATORS, 2010 113
REGULATORY ENVIRONMENT 113
Canada 113
Brazil 113
Mexico 114
Argentina 114
MARKET SIZE AND SEGMENTATION 114
OVERALL MARKET 114
FIGURE 19 OTHER NORTH AND SOUTH AMERICAN MARKETS FOR MRCAS, 2011-2017 ($
MILLIONS) 114
MARKET BY COUNTRY 115
TABLE 29 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET BY COUNTRY, THROUGH
2017 ($ MILLIONS) 115
FIGURE 20 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET SHARES BY
INDIVIDUAL COUNTRY, 2011 AND 2017 (% OF TOTAL MARKET) 115
MARKET BY EQUIPMENT SEGMENT 117
TABLE 30 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET BY TYPE OF EQUIPMENT,
THROUGH 2017 ($ MILLIONS) 117
FIGURE 21 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET EQUIPMENT SHARES,
2011 AND 2017 (% OF TOTAL MARKET) 117
MARKET BY APPLICATION SEGMENT 118
TABLE 31 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET BY TYPE OF
APPLICATION, THROUGH 2017 ($ MILLIONS) 119
FIGURE 22 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET APPLICATION SHARES,
2011 AND 2017 (% OF TOTAL MARKET) 120
CHAPTER 7 EUROPEAN MARKETS FOR MRCAS EQUIPMENT 122
MARKET ENVIRONMENT 122
DEMOGRAPHICS 122
TABLE 32 EUROPEAN MARKET DEMOGRAPHIC INDICATORS, 2011 (MILLIONS/%) 122
ECONOMICS 122
TABLE 33 EUROPEAN MARKET ECONOMIC INDICATORS, 2010 (%/$) 122
REGULATORY ENVIRONMENT 123
European Union 123
MARKET SIZE AND SEGMENTATION 125
OVERALL MARKET 125
FIGURE 23 EUROPEAN MARKET FOR MRCAS, 2011-2017 ($ MILLIONS) 125
MARKET BY COUNTRY 125
TABLE 34 EUROPEAN MRCAS MARKET BY COUNTRY, THROUGH 2017 ($ MILLIONS) 126
FIGURE 24 EUROPEAN MRCAS MARKET INDIVIDUAL COUNTRY SHARES, 2011 AND 2017
(PERCENT OF TOTAL MARKET) 126
MARKET BY EQUIPMENT SEGMENT 127
TABLE 35 EUROPEAN MRCAS MARKET BY TYPE OF EQUIPMENT THROUGH 2017 ($
MILLIONS) 127
FIGURE 25 EUROPEAN MRCAS MARKET EQUIPMENT SHARES, 2011 AND 2017 (PERCENT
OF TOTAL MARKET) 127
MARKET BY APPLICATION SEGMENT 128
TABLE 36 EUROPEAN MRCAS MARKET BY TYPE OF APPLICATION THROUGH 2017 ($
MILLIONS) 129
FIGURE 26 EUROPEAN MRCAS MARKET APPLICATION SHARES, 2011 AND 2017 (% OF
TOTAL MARKET) 129
CHAPTER 8 ASIA-PACIFIC AND MARKETS FOR MRCAS EQUIPMENT 132
ASIA-PACIFIC 132
MARKET ENVIRONMENT 132
Demographics 132
TABLE 37 ASIA-PACIFIC MARKET DEMOGRAPHIC INDICATORS, 2011 (MILLIONS/%) 132
Economics 133
TABLE 38 ASIA-PACIFIC MARKET ECONOMIC INDICATORS, 2010* 133
Regulatory Environment 134
Japan 134
China 134
India 135
Australia 135
New Zealand 136
MARKET SIZE AND SEGMENTATION 136
Overall Market 136
FIGURE 27 ASIA-PACIFIC REGION SALES OF MRCAS EQUIPMENT, 2011-2017 ($ MILLIONS) 136
Market by Country 136
TABLE 39 ASIA-PACIFIC MRCAS MARKET BY COUNTRY, THROUGH 2017 ($ MILLIONS) 137
FIGURE 28 ASIA-PACIFIC MRCAS MARKET SHARES BY COUNTRY, 2011 AND 2017 (PERCENT
OF TOTAL SALES) 137
Market by Equipment Segment 138
TABLE 40 ASIA-PACIFIC MRCAS MARKET BY TYPE OF EQUIPMENT THROUGH 2017 ($
MILLIONS) 138
FIGURE 29 ASIA-PACIFIC MRCAS MARKET SHARES BY EQUIPMENT SEGMENT, 2011 AND
2017 (PERCENT OF TOTAL SALES) 138
Market by Application Segment 139
TABLE 41 ASIA-PACIFIC MRCAS MARKET BY TYPE OF APPLICATION THROUGH 2017 ($
MILLIONS) 140
FIGURE 30 ASIA-PACIFIC MRCAS MARKET SHARES BY APPLICATION SEGMENT, 2011 AND
2017 (PERCENT OF TOTAL SALES) 140
CHAPTER 9 MIDDLE EASTERN AND MISCELLANEOUS OTHER COUNTRY MARKETS FOR
MRCAS EQUIPMENT 143
MARKET ENVIRONMENT 143
DEMOGRAPHICS 143
TABLE 42 MIDDLE EASTERN AND AFRICAN MARKET DEMOGRAPHIC INDICATORS, 2011 143
ECONOMICS 143
TABLE 43 MIDDLE EASTERN AND AFRICAN MARKET ECONOMIC INDICATORS, 2010 144
REGULATORY ENVIRONMENT 144
Turkey 144
Saudi Arabia 144
MARKET SIZE AND SEGMENTATION 144
OVERALL MARKET 144
FIGURE 31 MIDDLE EASTERN AND OTHER COUNTRIES MARKET FOR MRCAS EQUIPMENT,
2011-2017 ($ MILLIONS) 145
MARKET BY COUNTRY 145
TABLE 44 MIDDLE EASTERN AND OTHER MRCAS MARKETS BY COUNTRY THROUGH 2017 ($
MILLIONS) 145
FIGURE 32 MIDDLE EASTERN AND OTHER COUNTRIES MRCAS MARKET COUNTRY SHARES,
2011 AND 2017 (PERCENT OF TOTAL SALES) 145
MARKET BY EQUIPMENT SEGMENT 146
TABLE 45 MIDDLE EASTERN AND AFRICAN MRCAS MARKET BY TYPE OF EQUIPMENT,
THROUGH 2017 ($ MILLIONS) 147
FIGURE 33 MIDDLE EASTERN AND AFRICAN MRCAS MARKET EQUIPMENT SHARES, 2011
AND 2017 (PERCENT OF TOTAL SALES) 147
MARKET BY APPLICATION SEGMENT 148
TABLE 46 MIDDLE EASTERN AND OTHER COUNTRIES MRCAS MARKET BY TYPE OF
APPLICATION, THROUGH 2017 ($ MILLIONS) 148
FIGURE 34 MIDDLE EASTERN AND AFRICAN MRCAS MARKET APPLICATION SHARES, 2011
AND 2017 (PERCENT OF TOTAL SALES) 148
CHAPTER 10 VENDOR PROFILES 151
ANAMEDIC 151
BERCHTOLD GMBH 151
BOULDER INNOVATION GROUP 151
BRAINLAB AG 152
B. BRAUN AESCULAP 153
CAE HEALTHCARE 153
CONMED CORP. 153
CUREXO TECHNOLOGY CORP. 154
FIFTH DIMENSION TECHNOLOGIES 154
4NAVITEC GMBH 154
GE HEALTHCARE 155
GIVEN IMAGING, LTD. 155
HANSEN MEDICAL (ROBOTICS) 156
HAPTICA LTD, 156
HITACHI MEDICAL CORP. 156
INTEGRA RADIONICS, INC. 157
INTUITIVE SURGICAL, INC. 157
TABLE 47 INTUITIVE SURGICAL, INC., FINANCIAL PERFORMANCE THROUGH 2011 ($
MILLIONS) 158
KINAMED, INC. 158
MAKO SURGICAL CORP. 158
MAZOR SURGICAL TECHNOLOGIES, LTD. 159
MED-SURGICAL SERVICES INC. 159
MEDTRONIC, INC. 160
MENTICE MEDICAL SIMULATION AB 160
MERGE HEALTHCARE 160
MICRODEXTERITY SYSTEMS, INC./STRYKER 161
MUSCULOGRAPHICS, INC. 161
PRAXIM MEDIVISION 161
ROBOTIC SURGICAL TECH, INC. 162
SCHAERER MAYFIELD NEUROMATE AG/RENISHAW 162
SIEMENS HEALTHCARE 163
SIMBIONIX USA CORP. 163
SIMQUEST LLC 163
SIMSURGERY 164
SMITH & NEPHEW PLC 164
SONOWAND AS 165
STERIS CORP. 165
KARL STORZ GMBH 165
STRYKER CORP. 166
SURGICAL SCIENCE AB 166
TITAN MEDICAL INC. 167
VIKING SYSTEMS, INC. 167
VIRTAMED AG 167
VOXEL-MAN 168
VRMAGIC HOLDING AG 168
ZIMMER, INC. 168

LIST OF TABLES
SUMMARY TABLE GLOBAL SALES OF MRCAS EQUIPMENT, THROUGH 2017 ($ MILLIONS) 6
TABLE 1 STANDALONE SURGICAL PLANNERS AND SIMULATORS 21
TABLE 2 IMAGE-GUIDED SURGICAL NAVIGATION SYSTEMS 35
TABLE 3 INTERVENTIONAL SURGICAL NAVIGATION SYSTEMS 40
TABLE 4 COMPARISON OF NONFLUOROSCOPIC INTERVENTIONAL IMAGING TECHNOLOGIES 40
TABLE 5 SURGICAL NAVIGATION ACCESSORIES AND ADD-ONS 44
TABLE 6 SURGICAL ROBOTICS 54
TABLE 7 INTELLIGENT OPERATING ROOM SOLUTIONS AND COMPONENTS 64
TABLE 8 PRINCIPAL SURGICAL APPLICATIONS OF MRCAS 67
TABLE 9 MAJOR INTERNATIONAL MARKETS FOR MRCAS DEVICES AND EQUIPMENT,
THROUGH 2017 ($ MILLIONS) 77
TABLE 10 GLOBAL MRCAS MARKET BY TYPE OF EQUIPMENT, THROUGH 2017 ($ MILLIONS) 78
TABLE 11 GLOBAL MRCAS MARKET BY TYPE OF APPLICATION THROUGH 2017 ($ MILLIONS) 80
TABLE 12 MAJOR MRCAS VENDORS' MARKET SHARES, 2010 ($ MILLIONS) 81
TABLE 13 TRENDS IN NUMBER OF AMERICANS AGE 55 AND OLDER THROUGH 2017
(MILLIONS) 87
TABLE 14 PROJECTED TRENDS IN MINIMALLY INVASIVE HIP AND KNEE REPLACEMENT
PROCEDURES, THROUGH 2017 (NUMBER OF PROCEDURES) 88
TABLE 15 U.S. MRCAS MARKET BY TYPE OF EQUIPMENT, THROUGH 2017 ($ MILLIONS) 97
TABLE 16 U.S. MRCAS MARKET BY TYPE OF APPLICATION THROUGH 2017 ($ MILLIONS) 99
TABLE 17 U.S. SALES OF SURGICAL PLANNERS AND SIMULATORS THROUGH 2011 ($
MILLIONS) 101
TABLE 18 PROJECTED U.S. SALES OF PLANNERS AND SIMULATORS THROUGH 2017 ($
MILLIONS) 102
TABLE 19 U.S. SALES OF SURGICAL NAVIGATION SYSTEMS, THROUGH 2011 ($ MILLIONS) 103
TABLE 20 PROJECTED U.S. SALES OF SURGICAL NAVIGATION SYSTEMS THROUGH 2017 ($
MILLIONS) 104
TABLE 21 U.S. SALES OF SURGICAL ROBOTS, THROUGH 2011 ($ MILLIONS) 105
TABLE 22 U.S. SURGICAL ROBOT MARKET PENETRATION, 2011 106
TABLE 23 PROJECTED U.S. SALES OF SURGICAL ROBOTS THROUGH 2017 ($ MILLIONS) 107
TABLE 24 U.S. SALES OF INTELLIGENT OPERATING ROOM SOLUTIONS, THROUGH 2011 108
TABLE 25 U.S. INTELLIGENT OPERATING ROOM MARKET PENETRATION, 2011 109
TABLE 26 PROJECTED U.S. SALES OF INTELLIGENT OPERATING ROOM SOLUTIONS,
THROUGH 2017 ($ MILLIONS) 110
TABLE 27 OTHER NORTH AND SOUTH AMERICAN MARKET DEMOGRAPHIC INDICATORS,
2011 112
TABLE 28 OTHER NORTH AND SOUTH AMERICAN MARKET ECONOMIC INDICATORS, 2010 113
TABLE 29 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET BY COUNTRY, THROUGH
2017 ($ MILLIONS) 115
TABLE 30 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET BY TYPE OF EQUIPMENT,
THROUGH 2017 ($ MILLIONS) 117
TABLE 31 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET BY TYPE OF APPLICATION,
THROUGH 2017 ($ MILLIONS) 119
TABLE 32 EUROPEAN MARKET DEMOGRAPHIC INDICATORS, 2011 (MILLIONS/%) 122
TABLE 33 EUROPEAN MARKET ECONOMIC INDICATORS, 2010 (%/$) 122
TABLE 34 EUROPEAN MRCAS MARKET BY COUNTRY, THROUGH 2017 ($ MILLIONS) 126
TABLE 35 EUROPEAN MRCAS MARKET BY TYPE OF EQUIPMENT THROUGH 2017 ($ MILLIONS) 127
TABLE 36 EUROPEAN MRCAS MARKET BY TYPE OF APPLICATION THROUGH 2017 ($
MILLIONS) 129
TABLE 37 ASIA-PACIFIC MARKET DEMOGRAPHIC INDICATORS, 2011 (MILLIONS/%) 132
TABLE 38 ASIA-PACIFIC MARKET ECONOMIC INDICATORS, 2010* 133
TABLE 39 ASIA-PACIFIC MRCAS MARKET BY COUNTRY, THROUGH 2017 ($ MILLIONS) 137
TABLE 40 ASIA-PACIFIC MRCAS MARKET BY TYPE OF EQUIPMENT THROUGH 2017 ($
MILLIONS) 138
TABLE 41 ASIA-PACIFIC MRCAS MARKET BY TYPE OF APPLICATION THROUGH 2017 ($
MILLIONS) 140
TABLE 42 MIDDLE EASTERN AND AFRICAN MARKET DEMOGRAPHIC INDICATORS, 2011 143
TABLE 43 MIDDLE EASTERN AND AFRICAN MARKET ECONOMIC INDICATORS, 2010 144
TABLE 44 MIDDLE EASTERN AND OTHER MRCAS MARKETS BY COUNTRY THROUGH 2017 ($
MILLIONS) 145
TABLE 45 MIDDLE EASTERN AND AFRICAN MRCAS MARKET BY TYPE OF EQUIPMENT,
THROUGH 2017 ($ MILLIONS) 147
TABLE 46 MIDDLE EASTERN AND OTHER COUNTRIES MRCAS MARKET BY TYPE OF
APPLICATION, THROUGH 2017 ($ MILLIONS) 148
TABLE 47 INTUITIVE SURGICAL, INC., FINANCIAL PERFORMANCE THROUGH 2011 ($
MILLIONS) 158

LIST OF FIGURES
SUMMARY FIGURE TRENDS IN GLOBAL SALES OF MRCAS EQUIPMENT 2011-2017 ($
MILLIONS) 6
FIGURE 1 MEDICAL ROBOTIC AND COMPUTER-ASSISTED SURGICAL SYSTEMS 10
FIGURE 2 TRENDS IN THE GLOBAL MRCAS MARKET, 2011-2017 ($ MILLIONS) 76
FIGURE 3 GLOBAL MRCAS MARKET SHARES BY COUNTRY/REGION, 2011 VERSUS 2017
(PERCENT OF TOTAL SALES) 77
FIGURE 4 GLOBAL MRCAS MARKET SHARES BY EQUIPMENT SEGMENT, 2011 VERSUS 2017
(PERCENT OF TOTAL SALES) 78
FIGURE 5 GLOBAL MRCAS MARKET SHARES BY APPLICATION SEGMENT 2011 VERSUS 2017
(PERCENT OF TOTAL SALES) 80
FIGURE 6 U.S. OVERALL MRCAS MARKET LEADERS, 2011 (PERCENT OF TOTAL SALES) 81
FIGURE 7 GLOBAL SURGICAL PLANNER AND SIMULATOR MARKET LEADERS, 2011 (PERCENT
OF TOTAL SALES) 82
FIGURE 8 GLOBAL SURGICAL NAVIGATION SYSTEM MARKET LEADERS, 2011 (PERCENT OF
TOTAL SALES) 83
FIGURE 9 GLOBAL SURGICAL ROBOT MARKET SHARES, 2011 (PERCENT OF TOTAL SALES) 84
FIGURE 10 GLOBAL INTEGRATED OPERATING ROOM SOLUTIONS MARKET LEADERS, 2011
(PERCENT OF TOTAL SALES) 84
FIGURE 11 U.S. DISTRIBUTION CHANNELS FOR MRCAS EQUIPMENT (PERCENT OF TOTAL
SALES MADE THROUGH EACH CHANNEL) 93
FIGURE 12 U.S. SALES OF MRCAS EQUIPMENT, 2011-2017 ($ MILLIONS) 96
FIGURE 13 U.S. MRCAS MARKET SHARES BY TYPE OF EQUIPMENT 2011 VERSUS 2017
(PERCENT OF TOTAL SALES) 98
FIGURE 14 MAJOR MRCAS APPLICATION SEGMENTS 2011 VERSUS 2017 (PERCENT OF TOTAL
SALES) 99
FIGURE 15 U.S. SALES OF SURGICAL PLANNERS AND SIMULATORS 2000-2011 ($ MILLIONS) 101
FIGURE 16 HISTORICAL GROWTH OF SURGICAL NAVIGATION SYSTEM SALES, 2000-2011 ($
MILLIONS) 103
FIGURE 17 HISTORICAL GROWTH OF SURGICAL ROBOT SALES, 2000-2011 ($ MILLIONS) 105
FIGURE 18 HISTORICAL GROWTH OF INTELLIGENT OPERATING ROOM SALES, 2000-2011 ($
MILLIONS) 108
FIGURE 19 OTHER NORTH AND SOUTH AMERICAN MARKETS FOR MRCAS, 2011-2017 ($
MILLIONS) 114
FIGURE 20 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET SHARES BY INDIVIDUAL
COUNTRY, 2011 AND 2017 (% OF TOTAL MARKET) 115
FIGURE 21 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET EQUIPMENT SHARES,
2011 AND 2017 (% OF TOTAL MARKET) 117
FIGURE 22 OTHER NORTH AND SOUTH AMERICAN MRCAS MARKET APPLICATION SHARES,
2011 AND 2017 (% OF TOTAL MARKET) 120
FIGURE 23 EUROPEAN MARKET FOR MRCAS, 2011-2017 ($ MILLIONS) 125
FIGURE 24 EUROPEAN MRCAS MARKET INDIVIDUAL COUNTRY SHARES, 2011 AND 2017
(PERCENT OF TOTAL MARKET) 126
FIGURE 25 EUROPEAN MRCAS MARKET EQUIPMENT SHARES, 2011 AND 2017 (PERCENT OF
TOTAL MARKET) 127
FIGURE 26 EUROPEAN MRCAS MARKET APPLICATION SHARES, 2011 AND 2017 (% OF TOTAL
MARKET) 129
FIGURE 27 ASIA-PACIFIC REGION SALES OF MRCAS EQUIPMENT, 2011-2017 ($ MILLIONS) 136
FIGURE 28 ASIA-PACIFIC MRCAS MARKET SHARES BY COUNTRY, 2011 AND 2017 (PERCENT
OF TOTAL SALES) 137
FIGURE 29 ASIA-PACIFIC MRCAS MARKET SHARES BY EQUIPMENT SEGMENT, 2011 AND
2017 (PERCENT OF TOTAL SALES) 138
FIGURE 30 ASIA-PACIFIC MRCAS MARKET SHARES BY APPLICATION SEGMENT, 2011 AND
2017 (PERCENT OF TOTAL SALES) 140
FIGURE 31 MIDDLE EASTERN AND OTHER COUNTRIES MARKET FOR MRCAS EQUIPMENT,
2011-2017 ($ MILLIONS) 145
FIGURE 32 MIDDLE EASTERN AND OTHER COUNTRIES MRCAS MARKET COUNTRY SHARES,
2011 AND 2017 (PERCENT OF TOTAL SALES) 145
FIGURE 33 MIDDLE EASTERN AND AFRICAN MRCAS MARKET EQUIPMENT SHARES, 2011
AND 2017 (PERCENT OF TOTAL SALES) 147
FIGURE 34 MIDDLE EASTERN AND AFRICAN MRCAS MARKET APPLICATION SHARES, 2011
AND 2017 (PERCENT OF TOTAL SALES) 148