Robotic-assisted surgery has transformed multiple surgical specialties over the past 20 years. The da Vinci system (Intuitive Surgical), with over 10,000 units installed worldwide and 2 million annual procedures, leads the global market. In 2026, the fifth-generation da Vinci (da Vinci 5, launched in 2024) incorporates haptics, high-resolution 3D vision, and real-time AI assistance, while new competitors — Hugo (Medtronic), Versius (CMR Surgical), Senhance (Asensus) — break Intuitive Surgical's historical monopoly.
Robotic radical prostatectomy: the gold standard
Robot-assisted radical prostatectomy (RARP) is currently the reference procedure for intermediate-to-high risk localized prostate cancer, with over 80% of radical prostatectomies performed robotically in European and American reference centers. Well-established advantages over open and conventional laparoscopic surgery include:
- Lower intraoperative blood loss (mean 150-200 mL vs. 800-1,200 mL in open surgery)
- Lower transfusion rate (2-5% vs. 15-30%)
- Less postoperative pain and shorter hospital stay (1-2 days vs. 5-7 days)
- Faster urinary continence recovery: 70% recover complete continence at 3 months with nerve-sparing technique
da Vinci 5: haptics and artificial intelligence
The da Vinci 5, FDA-approved in March 2024, introduces two cardinal innovations. Force Feedback transmits tissue resistance to the surgeon as vibration in the handles, simulating the haptic sensation lost in minimally invasive surgery — preliminary studies show a 30% reduction in unnecessarily applied tissue pressure. Anatomical AI uses computer vision trained on over 100,000 surgical images to identify and label critical anatomical structures in real time, alerting the surgeon before approaching at-risk structures.
New competitors: Hugo, Versius, and the price war
Intuitive Surgical's monopoly is being challenged by three robotic platforms:
- Hugo (Medtronic): modular system with four independent arms. Approved in Europe for urology, gynecology, and general surgery. Acquisition price 30-40% lower than da Vinci Xi.
- Versius (CMR Surgical): compact independent arm system designed for inter-theater transport (mobile trolleys). Approved in UK, India, and several European countries.
- Senhance (Asensus): the only system with haptics since its first generation. Integrates eye tracking to move the camera with the surgeon's gaze.
Telerobotics: surgery at a distance
Telerobotic surgery — remotely controlling a robotic system via low-latency telecommunications networks (5G) — has moved from experiment to clinical reality. Spain's first surgical telemedicine procedure (prostatectomy controlled from Madrid, patient in the Canary Islands) took place in January 2025. 5G latency (<5 ms) is sufficient for most procedures except high-precision microsurgery. Regulatory challenges (liability, licensing, cross-border accreditation) remain the main barrier to systematic implementation.
