China's quest for the cutting edge in surgical robotics
For one 43-year-old Beijing patient, relief had seemed an impossible dream.
His arm had been numb for 14 months and every hospital he went to gave him the same answer to his questions about a remedy.
Surgeons told him that the risks of mass bleeding, stroke or even paralysis were too great with the delicate operation needed to fix the abnormalities in his spine and skull that were causing the condition.
Then three years ago the patient met Tian Wei, a top spinal surgeon at Beijing's Jishuitan Hospital and an advocate of using robotics in medical operations.
Tian and his team used a technology called the TiRobot system to create a 3D scan of the patient's torso and plot a surgical path to the affected area. The robot was also deployed to drill precise holes and apply just enough pressure to secure screws in place in the spine and skull.
The plan is meant to help close the China's technology gap with Western hi-tech prowess and reduce its dependency on imported technology in a range of sectors, including medical robots.
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But while some insiders say China has the potential to make great strides in medical robotics, others caution that developing such technology on its own is still well out of reach.
For Tian, robots have "changed the outlook for surgery" and revolutionised medicine by overcoming the physical limits of the surgeon's sight and steadiness of hand.
Tian said that often the choice of treatment for spinal patients was conventional medicine or none at all, but with robots, "difficult and risky surgeries have become safer".
"Routine procedures have become minimally invasive with very small incisions," he said.
The runaway leader in the field is the da Vinci Surgical System, a robotic apparatus made by Intuitive Surgical of Sunnyvale, California. The system was first used in China at the PLA General Hospital in the Chinese capital in 2006 and has been used in more than 60,000 procedures throughout the country since then.
Controlled by a surgeon from a console, the system allows complex operations to be performed through a minimally invasive approach. It is now distributed in China through a joint venture between Intuitive Surgical and giant Fosun Pharmaceutical.
To break the foreign dominance of the sector, Beijing has poured funds into start-ups with the hope of transforming China into a global robotic powerhouse.
At least 30 companies are dedicated to developing medical robots, drawing on the strong technical background of the country's top engineering universities, according to mainland media.
But there is still a gulf in the technology.
Domestically produced medical robots were "still in the early stage of exploration and cannot be compared with foreign ones", said Xin Guobin, vice-minister of the Ministry of Industry and Information Technology. "But they have big potential for development, driven by huge demand and strong innovation."
TiRobot is one of the devices that the authorities hope will help narrow that gap.
It started out as part of the 863 Programme, also known as the State Hi-Tech Development Plan, and was granted a medical equipment licence from the China Food and Drug Administration in 2016. Its manufacturer, Tinavi, a Shenzhen-listed company, has had 400 million yuan (US$58.2 million) of investment from Beijing.
The system has been sold in 41 hospitals and used in more than 4,000 operations across the country. It can also be used for procedures throughout the body, including extremities, pelvic fractures and the spinal segment, while its foreign competitors specialise in certain parts of the body.
However, some of the TiRobot's core components are made overseas and cannot be replaced with domestic equivalents, at least not in the short term, according to the company.
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For instance, an electro-optical system that allows precise surgical positioning on bones is from Canada and a scanning arm used to produce three-dimensional images is made in Germany.
Tianvi board secretary Xing Yuzhu said foreign suppliers were sometimes the only sources of components.
"Domestic brands can be used for two-dimensional imaging, but for three-dimensional imaging we have to use the foreign brand," Xing said.
The National Health Commission and China's ministries of health and industry and information technology are trying to overcome this by encouraging hospitals to team up with makers of orthopaedic surgical robots.
The da Vinci SI Surgical System is the market leader in China. Photo: Alamy
But Hu Jie, chairman of Jiangsu Klude Intelligence Tech, which makes robots to improve the accuracy of and cut the time needed for biopsies, cautioned against overconfidence in China's prospects for immediate success in the robotic development field.
"I seriously doubt there will be a domestic medical robot that can compete with da Vinci in China within 10 years," Hu said.
"We have a favourable government policy. We are not short of investment and the market is huge. But it is way too optimistic to think China can lead in the field of medical robots.
"China's industrial base is weak, and there is a big gap with foreign countries in manufacturing core components in the field of precision machining and materials science.
"We are trying to catch up but it is just not that easy."
Attempts to advance through foreign acquisitions could also be thwarted by governments in other parts of the world, he said.
Li Xuewei, general manager of Medical Healthcare Robot BU, a unit of Shenyang Siasun Robot and Automation, is more optimistic about China's ability to produce high-quality medical robots.
Siasun, the leading domestic maker of industrial robots, designed and made a robot for microwave tumour surgery with components the company produced itself.
"It is a process of accumulation," Li said. "Naturally, China's manufacturing ability will not catch up within one day, but the gap is closing.
"Just look at how the domestic automation industry has developed from 10 years ago."
He pointed to Remebot, a neurosurgical robot co-developed by China's PLA Navy General Hospital and Beihang University, which was awarded a licence in April.
"I am confident there will be domestic products that can match da Vinci in technique within five or six years," Li said.
This article originally appeared on the South China Morning Post (SCMP).
Copyright (c) 2018. South China Morning Post Publishers Ltd. All rights reserved.
