
The robot doctor is in.
While surgical robotics have traditionally been the domain of large and well-resourced hospital systems, there is a growing movement bringing robotics into ambulatory surgery centers (ASCs).
As technology evolves, surgical robotics are set to become a staple in outpatient care, offering new opportunities for ASC operators. Yet there are barriers to overcome, including cost constraints and patient-safety concerns.
“Robotics in ASCs is a challenge because of the tight margins,” John Van Valkenburg, executive director of the Upstate Orthopedics Ambulatory Surgery Center, said last year on an industry podcast. “Manufacturers have recognized this migration and gotten creative with financing options to lower the capital outlay. However, robotics only works in high-volume situations, which requires a big commitment from ASCs.”
For reference, the most popular soft tissue robotic surgery platform in the U.S., da Vinci, can cost between $1 million and $2.5 million, depending on the model and configuration.
Intuitive (ISRG), the company that manufactures da Vinci, reported full-year 2024 revenue growth of $8.35 billion in 2024. The company placed 493 da Vinci surgical systems in Q4 2024, of which 174 were the da Vinci 5 system.
“Currently, when I do a navigated case or robotic case, that’s done in a hospital setting because it would be prohibitively expensive for our surgery center to spend, say, a million and a half dollars to buy a robot for a spine procedure that’s not going to be used enough times to make it economically feasible,” Dr. Michael Burdi, an orthopedic spinal surgeon with Community Orthopedic Medical Group and California Specialty Surgery Center, told Ambulatory Surgery Center News.
Yet increasingly, outpatient operators are willing to bet big on robotics.
“We recently established a 16-surgical-suite ambulatory center focused on robotic surgery for cancer patients,” Jeffrey Brand, executive director at global architecture and design firm Perkins Eastman, told ASC News.
Robotic surgery allows outpatient operators to perform more complex procedures that require a bit more recovery time for the body to reset, Brand added.
And large industry players are also bracing for the impact of robotic integration.
“There’s a lot of room for expansion of the range of services that can be offered in the ambulatory surgery setting,” Saum Sutaria, CEO of Tenet Healthcare (NYSE: THC), said during a recent earnings call. “Robotics and other things will increasingly be a part of that.”
ASC News took a look at some of the major players in robotic surgery development to see what changes might be on the horizon.
Soft tissue robotics today
Founded in Switzerland, Distalmotion began as a mechanical device concept and evolved into a robotic system for soft tissue repair, Greg Roche, CEO of Distalmotion, told ASC News.
The company recently received FDA approval in October for its surgical robotic system, Dexter, and conducted its first inguinal hernia procedure at UC San Diego’s outpatient surgical hospital.
“It was a landmark day for us,” Roche said.
Distalmotion plans to expand to cholecystectomy and hysterectomy surgeries next, leveraging its pathway for regulatory approval, he noted.
“Everyone is trying to figure this riddle out,” Roche said.
The broader adoption of robotics in ASCs will not happen overnight, but the trajectory is clear, Roche said.
“We’re in the early stages of this shift,” he said. “But I believe it’s inevitable. Robotics will become a standard part of outpatient care, just as [it has become] in hospitals.”
Certain procedures are particularly well-suited for robotic adoption in ASCs. Common, high-volume procedures like inguinal hernia repairs, hysterectomies and cholecystectomies are leading the charge, Roche said.
“These are surgeries where robotics can make a meaningful difference,” he said. “They’re lower-acuity but still benefit from the precision and efficiency that robotics provide.”
Looking ahead, Roche sees competition and innovation as critical to advancing the adoption of robotics in ASCs. As more companies develop solutions tailored to outpatient care, the industry will benefit from a range of options, he said.
One of the most significant challenges has been the size and complexity of traditional robotic systems. Many existing platforms are too large for ASC operating rooms and require dedicated space that many centers cannot afford.
“The form factor of these robots has historically been a major obstacle,” Roche said. “Operators often find themselves unable to commit an entire room to a robotic system, which limits their ability to adopt the technology.”
Another factor is the cost. Robotics have long been perceived as prohibitively expensive, both in terms of initial investment and per-case operating expenses. This has been a particularly acute issue in ASCs.
“A lot of operators tell me they’re interested in robotics, but the economics just don’t work for them with the systems currently on the market,” said Roche. “This is a challenge we’re all working to address.”
Currently, surgical robotic systems are most commonly leased from manufacturers, although they are sometimes bought outright or refurbished, Deb Yoder, TKTK for Compass Surgical Partners, told ASC News.
“When you’re doing the analytics for robotics, you have to understand the cost difference between purchase versus rent … , lease or placement,” she said.
Safety and workflow integration are also critical considerations, Roche said. Unlike hospitals, which can support larger surgical teams, ASCs operate leaner.
“In many robotic platforms, the surgeon has to integrate into the workflow of the robot,” Roche said. “That’s a fundamental mismatch for ASCs. The technology needs to adapt to the surgeon, not the other way around.”
Yet beyond logistical and financial challenges, there is a growing demand for robotic systems driven by patient and surgeon preferences.
Many patients are drawn to the idea of minimally invasive surgery, particularly in the outpatient setting where recovery times are shorter, Roche said. And younger surgeons entering the workforce are increasingly trained on robotic systems and expect to use similar technology in their practices.
“A lot of surgeons coming out of residency today have limited laparoscopic experience,” Roche said. “They’ve been trained primarily on robots and are looking for ways to continue using that expertise.”
Developments at home
In Maryland, researchers are developing a Smart Tissue Autonomous Robot, or STAR, which in 2022 performed a fully autonomous laparoscopic procedure to suture bowel tissue.
“The surgical robotic market is really huge and growing,” Axel Krieger, the medical roboticist leading the development of STAR, said during a recent public presentation. “We have over 300 million major surgical procedures performed every year, and of those, just over 1% – 4 million procedures – currently use robotic assistance.”
Some procedures, such as prostate removal, have reached over 90% robotic penetration, Krieger said. Yet there is still untapped potential.
For ASCs, which thrive on efficiency and precision, this marks a pivotal moment, he said.
“There is an upcoming health care crisis, particularly in surgery,” he said. “We have fewer surgeons available. We also have an aging, growing society, and so the caseload is projected to rise more than twofold in the next 10 years.”
Over the past three decades, minimally invasive techniques have transformed surgery, reducing recovery times and complications for patients. But these advances have also made procedures more challenging for surgeons, Krieger said.
“We need more assistance, so robots can play a huge role in enabling that minimally invasive technology,” he said.
The STAR robot consists of two surgical robot arms with a custom suturing tool and an imaging system for tissue tracking and a supervised autonomous control architecture that performs the surgery suturing autonomously with the operating surgeon watching and makes adjustments.
“We compared ourselves to expert surgeons and showed that we can outperform expert surgeons on some key metrics,” Krieger said, noting the robot’s ability to reduce errors like needle misplacement and ensure consistent stitch spacing.
And STAR is just the beginning, Krieger added.
“What we have been really up to in the last couple years is a more scalable, AI-learning-based approach that really can get better and better with more data,” he said.
Krieger envisions a future where surgeons act as supervisors, overseeing robots performing complex procedures with minimal intervention.
“The goal is to reduce complications, democratize access to everyone for expert surgery, and alleviate the shortage of trained surgeons,” he said.
The path to remote telesurgery
Advancements in robotic surgery are also paving the way for the prospect of remote telesurgery, which would likely emerge in the outpatient setting or for less acute procedures.
“We’ve always known telesurgery was possible,” Cynthia Perazzo, CEO of Sovato, said during Medical Device & Outsourcing’s recent industry conference. “In 2001, the first transatlantic surgery was performed, with the patient in France and the surgeon in New York. But the infrastructure and adoption hurdles were significant.”
Founded in 2022, Sovato is developing systems to enable remote robotic-assisted surgeries and procedures.
“During COVID, we got a call from some physicians at the Mayo Clinic who were worried that their patients weren’t coming in for care,” she said.
It was during this period that Perazzo and her team revisited the concept of telesurgery. With advancements in fiber-optic networks, widespread adoption of telemedicine, and an expanding market of robotic platforms, the time seemed ripe for innovation.
And with the development of robotic systems like STAR and Dexter, remote telesurgery in the outpatient setting might be possible.
“One of the most exciting changes is the diversity of robots entering the market,” Perazzo said, adding that it also addresses capacity issues for large health systems.
“Surgeons can now perform procedures in community hospitals while reserving flagship facilities for the most complex cases,” she said.
Co-surgery models, where local surgeons collaborate with remote specialists to perform complex procedures while keeping patients close to home, may emerge.
“It’s a win-win,” she said. “Patients recover better when surrounded by loved ones, and local health systems benefit from retaining cases that would otherwise go to larger centers.”
Yet like Distalmotion’s robotic system, it will take time for remote telesurgery to get approved and implemented in U.S. markets.
“We’re working with stakeholders to develop clinical and operational guidelines, training programs, and risk management protocols,” Perazzo said, adding that the FDA has been receptive so far in conversations, but there will be safety and regulatory hurdles to overcome.
“Our goal is to ensure that every remote surgery is as safe and effective as traditional in-person procedures,” she said.