After a slow start, the U.K. robotics surgery market is gathering pace — and there are signs that a mixture of established companies and innovative start-ups could help the country emerge as an increasingly important player in this growing sector.

One of the most prominent examples is Renishaw PLC, whose neuromate system has now been used in more than 10,000 neurosurgical procedures around the world. Renishaw acquired the neurorobotic device, which was the first commercial system to be approved by the U.S. Food and Drug Administration, from Integrated Surgical Systems Inc. in Sacramento, Calif.

Neuromate is a stereotactic robot that provides a platform for a wide range of applications, including surgery for the treatment of epilepsy and brain tumors, as well as pediatric shunt and endoscopic surgery and deep brain stimulation.

Gloucestershire, England-based Renishaw currently has four systems installed in the U.K., with others in France, Germany, Italy, Spain, Middle East, Japan and the U.S.

“Due to the potential for reduced procedure times, a robot-assisted approach may offer a less stressful patient experience, a reduction in patient discomfort, as well as improving safety through a reduced risk of infection,” said Stuart Campbell, clinical sales development manager for Renishaw’s Neurological Products Division. “Our robot is designed for minimally invasive surgery, inducing less trauma than open surgery.”

Projects look to keyhole surgery

The U.K. is also the site of some exciting research and development breakthroughs in keyhole surgery, also known laparoscopic, minimally invasive, or “Band-Aid” surgery.

Late last year, a multidisciplinary team of engineers from the Stiffness-Controllable Flexible and Learnable Manipulator for Surgical Operations (STIFF-FLOP) project successfully collaborated with surgeons at King’s College London on the first-ever operation on a human body using a soft surgical robot.

The STIFF-FLOP project has received funding from the EU. Meanwhile, the Royal Surrey County Hospital, which has state-of-the-art equipment for cervical cancer treatment, said it will be the first training center for robotic surgery in the U.K.

“We have been training surgeons informally for over five years on the robots, with doctors choosing to come here from all over the world,” said Simon Butler-Manuel, a consulting gynaecological oncologist.

In addition, NightstaRx Ltd. and Preceyes BV are developing a high-precision robotic device for subretinal delivery of gene therapy drugs. London-based NightstaRx raised $35 million in Series B funding last November.

Preceyes is a spinoff of the Eindhoven University of Technology in the Netherlands. At the University of Oxford, Robert MacLaren’s team will also be starting human clinical trials of the Preceyes Surgical System.

“We are delighted to have approval for a clinical trial in Oxford, which will be the first to assess use of a robotic device for surgery inside the eye,” MacLaren said.

CMR develops light arm prototype

Cambridge Medical Robotics Ltd. (CMR) recently announced the completion of a prototype of a next-generation robotic system for universal minimal-access surgery. The Cambridge, England-based startup’s engineering prototype was successfully demonstrated to a select group of surgeons and investors late last year, and CMR plans to begin cadaveric tests to prove the system’s performance and versatility.

The surgical prototype is designed to be lightweight and modular, with each robotic arm weighing less than 15kg (33 lb.). The arm, which is designed to mimic a human arm, features a fully maneuverable wristed system and 5mm (0.19-in.) surgical tools.

This is smaller than the current standard of 8mm (0.31 in.), which the company claims should ultimately translate to smaller scars for patients.

“The potential market for robotically-assisted, minimal-access procedures is in the range of 10 million to 12 million procedures per year,” explained Martin Frost, CEO of CMR.

However, only 600,000 procedures are currently performed robotically each year because of electromechanical and cost constraints.

“These 600,000 procedures generate annual revenue of $2.3 billion, derived mostly from sales in the U.S. and from ‘uro-gynae’ procedures,” Frost said. “Our system overcomes these constraints, which will ultimately enable those 10 to 12 million people across the world to get the right form of surgery.”

“Robotics expands the number of patients who can receive the benefits of minimal-access surgery which include reduced blood loss, shorter hospital stays, reduced scarring, and better surgical outcomes,” he adds.

Slow but strong growth ahead

Looking ahead, Frost agreed with estimates that the surgical robotics sector will reach more than $20 billion by 2025. Although Frost remained coy about dates for the planned commercial launch of CMR’s system, he revealed that he envisages a potential market of 10 million procedures per year.

“The U.K. has to date been a slower adopter of surgical robotics because the incumbent systems are too expensive for the benefit they deliver,” he said.

“To date, just over 50 systems have been bought in the U.K., mostly by philanthropists and charitable trusts, and not all are operational.”

“However, many leading surgeons would agree that the surgical robotics genie is now out of the bottle and not going back in,” Frost added.

“It’s CMR’s job to ensure that there is a British system which is available on the market at an affordable price, offering the versatility which will ultimately transform the market,” he said. “It would be good to have a U.K. company in the lead pack.”