Abdominal Surgical Robot Market Shares, Strategies, and Forecasts, Worldwide, 2017 to 2023

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1 3 Abdominal Surgical Robot Market Shares, Strategies, and Forecasts, Worldwide, 2017 to 2023 Mountains of Opportunity Picture by Susan Eustis WinterGreen Research, Inc. Lexington, Massachusetts

2 CHECK OUT THESE KEY TOPICS Abdominal Surgical Robotics Support Precision Surgery Abdominal Surgical Robotics Surgical Robots Medical Devices Healthcare Robotics Surgical Enabling Technology Robotic-Assisted Minimally Invasive Surgery Robotic Surgical System Medical / Surgical Delivery Robots Surgical Assistive Technology Hospital Robots Robotic Surgery Equipment Surgical Robot Applications Next Generation Robotic Surgery Flexible Robot Platform, Minimally Invasive Surgery MIS Abdominal Surgical Robot Market Analysis: Abdominal Surgical Robots: Market Strategies and Forecasts, Worldwide, LEXINGTON, Massachusetts (May 25, 2017) WinterGreen Research announces that it has published a new study Abdominal Surgical Robots: Market Shares, Strategy, and Forecasts, Worldwide, 2017 to The 2017 study has 524 pages, 202 tables and figures. Worldwide Abdominal Surgical Robot markets are expected to achieve significant growth as robots replace open surgery in treatment of abdominal disease conditions. Visualization of the surgical site is improving, giving surgeons better insight into the surgical site. The robots permit a more accurate and steadier cutting than is possible with open surgery. Treatment via a robotic approach to abdominal surgery is useful for benign and malignant gynecologic conditions. Urologic and abdominal disease conditions are being treated increasingly with robotic surgery. Challenges still exist at a systems level. Implementation of a robotic program has a long learning curve. Resistance by surgeons on the team who are not adept at using the systems, quality of life, and financial challenges are being addressed in the industry. Challenges arise because of high capital expense, and organizational challenges continue to exist on an ongoing basis.

3 Intuitive Surgical da Vinci System Source: Intuitive Surgical This is being addressed as more surgeons are trained and gain experience in the market. The world market for abdominal surgical robots is at $2.9 billion in The Robotic surgery equipment industry revenue is projected to increase to $12.9 billion by Robotic surgery equipment continues to comprise a fast-growing segment of the medical device industry. Demand for the less invasive procedure is high among patients and doctors. The number of procedures and disposable instruments increases. Existing open surgery is set to be replaced by robotic-assisted surgery. Young surgeons have steady hands, but even the greatest surgeons have off days and they age. As this happens, the advantages of the robot are evident because the hand is steady every time with the robot. During a robot assisted surgical procedure, the patient-side cart is positioned next to the operating table with the electromechanical arms arranged to provide access to the initial ports selected by the surgeon. Technologies for abdominal robotic surgery applications has had growing adoption and commercialization. These technologies work in solving surgical approaches to many gynecology, urology, and general surgical issues. Robotic surgical procedures have reached a level of market acceptance that proves their value. Market saturation is a distance away, the industry is still in its infancy. The technology available is becoming more sophisticated in order to overcome hurdles. The objectives of overcoming the limitations of fixed port access, limited dexterity, and limited visualization remain. The industry leader, the only company with a commercial footprint, within the robotic surgical market is Intuitive Surgical, Inc. (NASDAQ: ISRG), maker of the da Vinci Surgical System.

4 According to Susan Eustis, lead author of the team that prepared the study, Growing acceptance of minimally invasive surgery and robotic surgery is because the robotic surgery provides an improvement over current surgical techniques. Open surgery is a difficult thing. Demand for less invasive procedures is coming as patients realize the benefits of quality of care from robotic surgery. Patients feel better after robotic surgery and the surgeries are more likely to be successful. The worldwide market for abdominal surgical robots at $2.7 billion in 2016 grows to $15.8 billion by The complete report provides a comprehensive analysis of abdominal surgical robots in different categories, illustrating the diversity of uses for devices in surgery. A complete procedure analysis is done, looking at numbers of procedures and doing penetration analysis. WinterGreen Research is an independent research organization funded by the sale of market research studies all over the world and by the implementation of ROI models that are used to calculate the total cost of ownership of equipment, services, and software. The company has 35 distributors worldwide, including Global Information Info Shop, Market Research.com, Research and Markets, electronics.ca, and Thompson Financial. It conducts its business with integrity. The increasingly global nature of science, technology and engineering is a reflection of the implementation of the globally integrated enterprise. Customers trust wintergreen research to work alongside them to ensure the success of the participation in a particular market segment. WinterGreen Research supports various market segment programs; provides trusted technical services to the marketing departments. It carries out accurate market share and forecast analysis services for a range of commercial and government customers globally. These are all vital market research support solutions requiring trust and integrity. Key Words: Abdominal Surgical Robotics, Medical Devices, Healthcare Robotics, Enabling Technology, Robotic-Assisted Minimally Invasive Surgery, Robotic Surgical System, Medical / Surgical Delivery Robots, Surgical Assistive Technology, Hospital Robots, Robotic Surgery Equipment, Surgical Robot Applications, Next Generation Robotic Surgery, Flexible Robot Platform, Minimally Invasive Surgery, MIS. Companies Profiled Market Leaders

5 Intuitive Surgical Selected Market Participants AdEchoTech / T-MedRobotics / Auris Robotics Avra Robotics Cambridge Medical Robotics Chinese Surgical Robots Fosun Pharma Freehand Freehand 2010 / Prosurgics Google IMRIS Johnson and Johnson / DePuy Synthes Medtronic / Mazor Robotics Medrobotics Medtronic Meerecompany / Eterne OMNI Smith & Nephew Stryker THINK Surgical Titan Medical TransEnterix Verb Surgical Virtual Incision Zimmer Biomet Acquires Medtech SA, Joins Surgical Robotics Selected Surgical Robot Companies Abdominal Surgical Robotics: Market Shares, Strategies, and Forecasts, Worldwide, 2017 to 2023 Report Methodology This is the 705th report in a series of primary market research reports that provide forecasts in communications, telecommunications, the Internet, computer, software, telephone equipment, health equipment, and energy. Automated process and significant growth potential are a priority in topic selection. The project leaders take direct responsibility for writing and preparing each report. They have significant experience preparing industry studies. They are supported by a team, each person with specific research tasks and proprietary automated process database analytics. Forecasts are based on primary research and proprietary data bases. The primary research is conducted by talking to customers, distributors and companies. The survey data is not enough to make accurate assessment of market size, so WinterGreen Research looks at the value of shipments and the average price to achieve market assessments. Our track record in achieving accuracy is unsurpassed in the industry. We are known for being able to develop accurate market shares and projections. This is our specialty.

6 The analyst process is concentrated on getting good market numbers. This process involves looking at the markets from several different perspectives, including vendor shipments. The interview process is an essential aspect as well. We do have a lot of granular analysis of the different shipments by vendor in the study and addenda prepared after the study was published if that is appropriate. Forecasts reflect analysis of the market trends in the segment and related segments. Unit and dollar shipments are analyzed through consideration of dollar volume of each market participant in the segment. Installed base analysis and unit analysis is based on interviews and an information search. Market share analysis includes conversations with key customers of products, industry segment leaders, marketing directors, distributors, leading market participants, opinion leaders, and companies seeking to develop measurable market share. Over 200 in depth interviews are conducted for each report with a broad range of key participants and industry leaders in the market segment. We establish accurate market forecasts based on economic and market conditions as a base. Use input/output ratios, flow charts, and other economic methods to quantify data. Use in-house analysts who meet stringent quality standards. Interviewing key industry participants, experts and end-users is a central part of the study. Our research includes access to large proprietary databases. Literature search includes analysis of trade publications, government reports, and corporate literature. Findings and conclusions of this report are based on information gathered from industry sources, including manufacturers, distributors, partners, opinion leaders, and users. Interview data was combined with information gathered through an extensive review of internet and printed sources such as trade publications, trade associations, company literature, and online databases. The projections contained in this report are checked from top down and bottom up analysis to be sure there is congruence from that perspective. The base year for analysis and projection is With 2011 and several years prior to that as a baseline, market projections were developed for 2012 through These projections are based on a combination of a consensus among the opinion leader contacts interviewed combined with understanding of the key market drivers and their impact from a historical and analytical perspective. The analytical methodologies used to generate the market estimates are based on penetration analyses, similar market analyses, and delta calculations to supplement independent and dependent variable analysis. All analyses are displaying selected descriptions of products and services.

7 This research includes referencde to an ROI model that is part of a series that provides IT systems financial planners access to information that supports analysis of all the numbers that impact management of a product launch or large and complex data center. The methodology used in the models relates to having a sophisticated analytical technique for understanding the impact of workload on processor consumption and cost. WinterGreen Research has looked at the metrics and independent research to develop assumptions that reflect the actual anticipated usage and cost of systems. Comparative analyses reflect the input of these values into models. The variables and assumptions provided in the market research study and the ROI models are based on extensive experience in providing research to large enterprise organizations and data centers. The ROI models are useful for comparing products from different manufacturers, for example servers from different manufacturers, Systems z models from IBM, and labor costs by category around the world. This information has been developed from WinterGreen research proprietary data bases constructed as a result of preparing market research studies that address the software, energy, healthcare, telecommunicatons, and hardware businesses. YOU MUST HAVE THIS STUDY

8 Abdominal Surgical Robotics: Market Shares, Strategy, and Forecasts, 2017 to 2023 Table of Contents Abdominal Surgical Robotics: Executive Summary The study is designed to give a comprehensive overview of the Abdominal Surgical Robotics market segment. Research represents a selection from the mountains of data available of the most relevant and cogent market materials, with selections made by the most senior analysts. Commentary on every aspect of the market from independent analysts creates an independent perspective in the evaluation of the market. In this manner the study presents a comprehensive overview of what is going on in this market, assisting managers with designing market strategies likely to succeed. ABDOMINAL SURGICAL ROBOT EXECUTIVE SUMMARY 28 Abdominal Surgical Robotics Segment: Urology, Gynecology, General Surgery, Thoracic, Structural Heart, And Head/Neck 28 Abdominal Surgical Robotics Market Driving Forces 28 Surgical Robotics Market Driving Forces 31 New Entrants to Open Up Surgical Robotics Market 35 Abdominal Surgical Robot Market Driving Forces 35 Healthcare Abdominal Robotics Enabling Technology 42 Abdominal Robot-Assisted Surgery Market Driving Forces 42 Entrepreneurial Manufacturers with FDA-Approved Products Provide Sourcing To Larger Companies45 Surgical Robot Market Risks 46 Medical Abdominal Surgical Robots: Market Shares 48 Robotic Abdominal Surgery Market Forecasts 51 Abdominal Surgical Robot Systems Forecasts ABDOMINAL SURGICAL ROBOTS MARKET DESCRIPTION AND MARKET DYNAMICS Open surgery Abdominal Robotic Surgery Extends The Benefits of MIS Business Model Abdominal Robotic Surgery Systems Intuitive Surgical Procedure Mix / Products Abdominal Robotic Surgical System Robotic Surgery As The Standard All Surgical Procedures Focus on Key Institutions Focus on Leading Surgeons to Drive Rapid and Broad Adoption Maintain Market Leadership Develop Industry Alliances Increase Patient Awareness Clinical Applications for Abdominal Robotic Surgery Technology ABDOMINAL SURGICAL ROBOT MARKET SHARES AND FORECASTS Abdominal Surgical Robotics Segment: Urology, Gynecology, General Surgery, Thoracic, Structural Heart, And Head/Neck Abdominal Surgical Robotics Market Driving Forces Surgical Robotics Market Driving Forces New Entrants to Open Up Surgical Robotics Market Abdominal Surgical Robot Market Driving Forces Healthcare Abdominal Robotics Enabling Technology 84

9 2.1.6 Abdominal Robot-Assisted Surgery Market Driving Forces Entrepreneurial Manufacturers with FDA-Approved Products Provide Sourcing To Larger Companies Surgical Robot Market Risks Medical Abdominal Surgical Robots: Market Shares Intuitive Surgical Dominates The Abdominal Surgical Robot Market Intuitive Surgical Market Opportunity and Revenue Intuitive Surgical davinci Installed Base and Product Shipments, By Product Type, Si Systems, Si-e, Xi, Single and Dual Console, Units and Dollars, Worldwide, Intuitive Surgical Shipments by Model Intuitive Surgical Unit Shipments Intuitive Robotic Surgery Competitors Intuitive Surgical Competitive Advantages Intuitive Surgical Imaging Technologies Intuitive Surgical Profitability Intuitive Surgical Robotics da Vinci System Intuitive Surgical and the Competition Overcome Market Saturation Intuitive Surgical Recurring Revenue Intuitive Surgical Robotic Surgery Strategic Positioning Transenterix TransEnterix Google and Johnson & Johnson Medtronic Johnson & Johnson / Verb Surgical Titan Robot Titan Robot Partners Titan Prospectus Medicaroid Robotic Abdominal Surgery Market Forecasts Abdominal Surgical Robot Systems Forecasts Segment Abdominal Surgical Robots Forecast Analysis: Systems, Instruments, and Services Dollars Abdominal Surgical Robots Segment Analysis Products, Services, And Instruments And Accessories Abdominal Surgical Robots Segment Analysis Gynecological, General Surgery, Urological, Cardio, and Head/Neck Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological, Dollars and Units Medical Robotic Surgery Challenges Robotic Surgery: Risks vs. Rewards Abdominal Surgical Robot Disposable Instruments Forecasts Surgical Robot Systems vs. Disposable Instruments Forecasts Robotic Surgery Market Challenges Cancer Robotic Surgery Learning Curves Abdominal Robotic Remote Surgery Medicare and Medicaid Impact Installed Abdominal Surgical Robot Systems Abdominal Surgery Installed Systems Geographical Analysis Intuitive Surgical Robotic Surgery Installed Systems, Number, Regional Analysis By Country, Surgical Robot Regional Installations Procedure Volumes Abdominal Surgical Robots Systems, Instruments, and Services by Segment and by Country Abdominal Surgical Worldwide Procedures Abdominal Surgical U.S. Procedures Abdominal Surgical Procedures Outside of the U.S Intuitive Surgical Gynecological Procedures Gynecology Robotic Surgery Procedures By Country Intuitive Surgical Benign Gynecology Procedure Adoption Trends Abdominal Surgical Robot Procedure Analysis Intuitive Surgical Sacrocolpopexy Urologic Procedure Volumes Intuitive Surgical Robotic Urology Surgery Procedures Urology Robotic Surgery Procedures by Country Urologic Prostatectomy Surgery 219

10 2.7.4 Intuitive Surgical da Vinci Prostatectomy (dvp) Urology Robotic Surgery Partial Nephrectomy Robotic Urologic Prostatectomy Surgery General Surgery Robotic Procedures Intuitive Surgical Robotic General Surgery Procedures Robotic General Surgery Procedure Volumes General Surgery Cholecystectomy Intuitive Surgical da Vinci Prostatectomy Cholecystectomy Intuitive Surgical Procedure Mix Head and Neck Surgery Head and Neck Transoral Surgery Cardiac Abdominal Surgical Robot Abdominal General Surgery, Gynecology, and Urology Surgical Robot Procedure Category Discussion Abdominal General Surgery, Gynecological, And Urological Robotic Surgery Procedures By Country Intuitive Surgical Procedure Mix Robotic Myomectomy Intuitive Surgical Investments to Improve Surgery Open and Robotic Surgery Procedure Detail Forecasts, US and Worldwide Small Hospitals Lack the Procedure Volume To Justify The Upfront Investment In A Robotic Surgery System Robotic Surgery Equipment Prices Intuitive Surgical da Vinci Surgical System Prices Abdominal Robotic Surgery Equipment Regional Market Segments Intuitive Surgical Regional Revenue Intuitive Surgical European Demand U.S. Robotic Surgical Procedures Chinese Imported Surgical Robots Chinese Development of Surgical Robots Chinese and Taiwanese Markets for Minimally Invasive Spinal Devices BRIC (Brazil, Russia, India, China) countries Aging Taiwanese Population Korea Focusing On Creating A Growth Engine In Research & Development Korea Brazil Surgical Care In Emerging Markets Shifting to a Needs-Driven Equipment Purchase Method Presents Challenges In Emerging Markets Regional Analysis by Country SURGICAL ROBOTS PRODUCT DESCRIPTION Intuitive Surgical da Vinci Xi da Vinci X Surgical System Provides Lower-Cost, Robotic-Assisted Surgical Option For Hospitals, Surgeons Intuitive Surgical da Vinci Si-e, A Lower Price System Intuitive Surgical da Vinci Xi Integrated Table Motion Intuitive Surgical da Vinci X System Intuitive Surgical da Vinci Xi Surgical System Intuitive Surgical da Vinci Surgical System Intuitive Surgical HeroSurg Robotic Platform Offers Tactile Response Intuitive Surgical da Vinci Surgical System Components Intuitive Surgical Patient-Side Cart and Electromechanical Surgical Arms Intuitive Surgical 3-D Vision System Intuitive Surgical Firefly Fluorescence Imaging Intuitive Surgical da Vinci Skills Simulator Intuitive Surgical Instruments and Accessories Intuitive Surgical da Vinci Single-Site Intuitive Surgical EndoWrist One Vessel Sealer Intuitive Surgical, Inc. (NASDAQ:ISRG) and Shanghai Fosun Pharmaceutical (Group) Co., Ltd Intuitive Surgical Accessory Products Intuitive Surgical Da Vinci Minimally Invasive Surgical Product Intuitive Surgical Cardiac Surgery Intuitive Surgical da Vinci Mitral Valve Repair Surgery 302

11 Intuitive Surgical da Vinci Surgery - Coronary Bypass (Revascularization) Surgery MedRobotics Medrobotics Flex Retractor Medrobotics Flexible Robot Platform Medrobotics Snakelike Robots for Oropharynx, Hypopharynx and Larynx Surgery Titan Medical Titan Medical and Ximedica Resume Development of the Sport Surgical System Titan Visualization Viewing Portal Titan Integration Successful Deployments Into Single 25mm Incision in Abdominal Cavity Titan Medical Surgical Robotic System Titan Robotic Single Incision Platform: Titan Medical Amadeus Robotic Surgical System Johnson & Johnson Johnson & Johnson Ethicon Verb Surgical Verb Surgical Digital Surgery Collaboration Partners Medicaroid Corporation Medicaroid Releases SOT-100 Vercia, Operating Table with the Function to Move Patients Medicaroid Corporation Commences Development of Medical Robots Virtual Incision Miniaturized Robot For Human Surgery Olympus Olympus Plasma Hysteroscopic Resection and Vaporization Olympus EndoTherapy Solutions Olympus Acquires Image Stream Medical TransEnterix / SOFAR S.p.A TransEnterix Senhance Expands into Robotic Hernia Repair TransEnterix Senhance Surgical System in Germany and France TransEnterix Brand for Robotic Surgical System TransEnterix Technology Innovations In Laparoscopic Surgery TransEnterix SurgiBot System TransEnterix Flex Instruments TransEnterix SPIDER AVRA Surgical Robotic System AVRA Computer-Driven Automated Drill for Surgical Procedures AVRA Light-Weight Robotic Arms ASRS Surgeon Console ASRS Instruments Centerline Biomedical IOPS Intra-Operative Positioning System (IOPS) ABDOMINAL SURGICAL ROBOT TECHNOLOGY AND RESEARCH General Surgery, Gynecology, Urology Surgical Robotic Clinical Applications Robotic Cardiothoracic Surgery Robotic Internal Thoracic Artery Dissection Robotic Thoracoscopy Cardiothoracic Surgery Cardiothoracic Surgery Mitral Valve Repair Intuitive Surgical Cardiothoracic Surgeries Robotic Coronary Artery Bypass Government Regulation International Regulation European Union and Canada Regulatory Process Third Party Reimbursement SURGICAL ROBOTS COMPANY DESCRIPTION AdEchoTech / T-MedRobotics / T-MedRobotics 402

12 5.2 Avra Robotics Centerline Biomedical Google Google / Boston Dynamics Johnson & Johnson Forms Verb Surgical In Collaboration With Google Verily Google Robotic Division Google Self-Driving Car Google Cars Address Vast Majority Of Vehicle Accidents Due To Human Error Google Business Google Corporate Highlights Google Search Google Revenue Google Third Quarter 2016 Results Google Q Financial Highlights Intuitive Surgical Intuitive Seeks to Replace Open Surgery Intuitive Surgical Products Fall Into Four Broad Categories Intuitive Surgical Procedures Worldwide Procedures Gynecologic Surgery Urologic Surgery General Surgery Cardiothoracic Surgery Head and Neck Surgery Procedure Mix Intuitive Surgical Revenue Intuitive Surgical da Vinci Surgery Stimulates Procedure Growth Intuitive Surgical ISI Investments Intuitive Surgical Competition Intuitive Surgical Market Analysis Intuitive Surgical Procedure Efficiency Intuitive Surgical Business Model Intuitive Surgical Sales and Distribution Organization Intuitive Surgical da Vinci System Leasing Intuitive Surgical Service Revenue Intuitive Surgical Procedures H Intuitive Surgical Increases Share Repurchase Program to $3.0 Billion Intuitive Surgical Robotics da Vinci Surgical System Intuitive Surgical Robotics da Vinci Surgical System Xi Johnson and Johnson / DePuy Synthes Ethicon 510(K) Clearance For Echelon Circular Powered Stapler Ethicon Acquires Megadyne Medical Products Johnson & Johnson Forms Verb Surgical In Collaboration With Verily Johnson & Johnson Business Johnson & Johnson Consumer Segment Johnson & Johnson Pharmaceutical Segment Johnson and Johnson Medical Devices Johnson and Johnson Geographic Areas Johnson & Johnson Competition Johnson & Johnson Management s Discussion Johnson & Johnson Revenue Google Collaborating With Johnson & Johnson To Develop Surgical Robots Johnson and Johnson / DePuy Johnson & Johnson Caring for the World One Person At A Time Johnson & Johnson / Ethicon Medicaroid Medicaroid US Subsidiary Operations in Silicon Valley Medicaroid s Capital Increase 469

13 5.8 Medtronic / Mazor Robotics Medrobotics Raises $25M to Back FDA-Cleared Transoral Surgical Robotics System Medrobotics Closes On $10 Million Financing Medrobotics Several Generations Of Snake Robot Platforms Medrobotics Advances Clinical Development of Snake Robot for Surgery Medrobotics Positioning Medrobotics Cardiac Surgery Gold Standard Medrobotics Snake Robot Technologies For Use In A Wide Range Of Surgical And Interventional Applications Medrobotics Technology & Research Center Titan Medical Titan Medical General Surgery Robot Market Opportunities Titan Medical Robotic Surgery Target Opportunity TransEnterix TransEnterix Acquires SOFAR Surgical Robotics Unit in $100M Deal TransEnterix Radical Hysterectomy with Senhance Surgical Robot TransEnterix Strategic Positioning TransEnterix TransEnterix / Sofar Verb Surgical Verb Corporate Culture Virtual Incision Selected Surgical Robot Companies 511 WINTERGREEN RESEARCH, 520 WinterGreen Research Methodology 521 Figure 1. Abdominal Surgical Robotics Positioning for Appeal to Surgeons 30 Figure 2. Abdominal Surgical Robot Benefits 31 Figure 3. Abdominal Surgical Robotics Market Driving Forces 32 Figure 4. Surgical Robot Key Factors Driving Market Growth 33 Figure 5. Surgical Robot Key Market Challenges 34 Figure 6. Abdominal Surgery Robotics Market Driving Factors 34 Figure 7. Abdominal Surgical Robot Medical Specialties Addressed 37 Figure 8. Surgical Robot General Surgery Gynecology, and Urology Conditions Treated 39 Figure 9. Innovative Surgical Robot Features 40 Figure 10. Surgical Robot Market Positioning 40 Figure 11. Healthcare Abdominal Robotics Enabling Technologies 42 Figure 12. Robotic-Assisted Minimally Invasive Abdominal Surgery Market Driving Forces 43 Figure 13. Abdominal Surgical Robots Market Shares, Shipments, Dollars, Worldwide Figure 14. Abdominal Surgical Robot Forecasts, Combined General Surgery, Gynecological, Head and Neck, and Urological Forecasts Dollars, Worldwide, Figure 15. Medical Multi Articulating Arms 61 Figure 16. Instruments That Support Multiple Approach Paths To A Surgical Target 62 Figure 17. Robotic Surgery Improved Visualization Features 63 Figure 18. Robotic Surgical Specialties Procedure Marketing Efforts Focus 65 Figure 19. Abdominal Surgical Robotics Positioning for Appeal to Surgeons 71 Figure 20. Abdominal Surgical Robot Benefits 72 Figure 21. Abdominal Surgical Robotics Market Driving Forces 74 Figure 22. Surgical Robot Key Factors Driving Market Growth 75 Figure 23. Surgical Robot Key Market Challenges 76 Figure 24. Abdominal Surgery Robotics Market Driving Factors 76 Figure 25. Abdominal Surgical Robot Medical Specialties Addressed 79

14 Figure 26. Surgical Robot General Surgery Gynecology, and Urology Conditions Treated 81 Figure 27. Innovative Surgical Robot Features 82 Figure 28. Surgical Robot Market Positioning 82 Figure 29. Healthcare Abdominal Robotics Enabling Technologies 84 Figure 30. Robotic-Assisted Minimally Invasive Abdominal Surgery Market Driving Forces 85 Figure 31. Abdominal Surgical Robots Market Shares, Shipments, Dollars, Worldwide Figure 32. Abdominal Surgical Robots Market Shares, Worldwide 2016, Table Format 92 Figure 33. Abdominal Surgical Robots Market Shares by Segment, Systems, Services, and Instruments / Accessories, Units and Dollars, Worldwide, Figure 34. Intuitive Surgical Systems and Instruments and Accessories Revenue by Segment 2016, 2015, Figure 35. Intuitive Surgical da Vinci Installed Base and Product Shipments for Surgical Systems Segment Analysis by Model 98 Figure 36. Intuitive Surgical Revenue, Segment Growth, and Regional Analysis Q and Q Figure 37. Intuitive Surgical Product Shipments, By Model Type, Si Systems, Si-e, Xi, Single and Dual Console (in Number of Units), 2014, 2015, and Figure 38. Intuitive Surgical Shipments by Model, Si, Si-e, and Xi, Q Figure 39. Intuitive Surgical Shipments by Model, Si, Si-e, and Xi, Figure 40. Intuitive Surgical Unit Shipments 105 Figure 41. Intuitive Surgical 2016 Objectives 107 Figure 42. Abdominal Surgical Robot Systems Hospital Market Trends 108 Figure 43. Surgical Robot Systems Hospital Return on Investment (ROI) 109 Figure 44. Intuitive Surgical da Vinci Sp 115 Figure 45. Intuitive Surgical Technology Market Positioning 116 Figure 46. Intuitive Surgical Benefits 117 Figure 47. How Intuitive Surgical Gained Dominant Position in Robotic Surgery 124 Figure 48. Intuitive Surgical Robotic Surgery Strategic Positioning 125 Figure 49. Intuitive Surgical Challenges 126 Figure 50. Titan Surgical Robot 131 Figure 51. Titan Medical Novel Robotic Platform for Single Port Access Surgery 132 Figure 52. Titan Medical Amadeus Composer Surgical System 133 Figure 53. Titan Medical Prospectus Timeline for SPORTTM Surgical System 136 Figure 54. Abdominal Surgical Robot Forecasts, Combined General Surgery, Gynecological, Head and Neck, and Urological Forecasts Dollars, Worldwide, Figure 55. Abdominal Surgical Robot Forecasts Dollars, Worldwide, Figure 56. Abdominal Surgical Robots Market Shares, Dollars, Worldwide, Figure 57. Abdominal Surgical Robot Market Segment Forecasts, Products, Services, and Instruments / Accessories Dollars, Worldwide, Figure 58. Abdominal Surgical Robot Market Segment Forecasts, Products, Services, and Instruments / Accessories Percent of Total, Worldwide, Figure 59. Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological, Dollars and Units, Worldwide, Figure 60. Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological, Cardio, Cardio Thoracic, and Head and Neck Dollars, Worldwide, Figure 61. Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery. And Urological Products, Services, and Instruments / Accessories Dollars, Worldwide, Figure 62. Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery. And Urological, Cardio, and Head/Neck, Products, Services, and Instruments / Accessories Percent, Worldwide, Figure 63. Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological, Cardio, Cardio Thoracic, and Head and Neck Dollars, Worldwide, Figure 64. Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological Dollars and Units, Worldwide, Figure 65. Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery. And Urological Products, Services, and Instruments / Accessories Dollars, Worldwide,

15 Figure 66. Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery, and Urological, Dollars and Units, Worldwide, Figure 67. Abdominal Surgical Robot Market Segment Forecasts, Gynecological, General Surgery. And Urological, Percent Dollars, Worldwide, Figure 68. Abdominal Surgical Robot Market Segment Forecasts, Head and Neck, Cardiac and Cardio Thoracic, Dollars and Units, Worldwide, Figure 69. Intuitive Surgical Revenue by Segment, 2015 and Figure 70. Intuitive Surgical Revenue by Segment, 2014 and Figure 71. Challenges of Open Surgery and Minimally Invasive Surgery 162 Figure 72. Challenges of Developing Medical Robotic Surgery Systems 163 Figure 73. Surgical Robotic Product Development Challenges 164 Figure 74. Minimally Invasive Procedure Market Penetration 167 Figure 75. Abdominal Surgical Robots Instrument and Accessory Market Forecasts, Dollars, Worldwide, Figure 76. Abdominal Surgical Robot Market Segment Forecasts, Instruments / Accessories Dollars, Worldwide, Figure 77. Surgical Robot Instrument Types 171 Figure 78. Surgical Robot Systems vs. Disposable Instruments Forecasts, Dollars, Worldwide, Figure 79. Surgical Robot Market Challenges 173 Figure 80. Intuitive Surgical Issues Addressed Successfully 174 Figure 81. Benefits of Robotic Surgery For The Surgeon 175 Figure 82. Benefits of Robotic Surgery For The Patient 175 Figure 83. Benefits of Robotic Surgery For The Hospital 176 Figure 84. US Robotic Surgery Treatment Penetration Rate by Procedure, Percent, Figure 85. US Robotic Surgery Treatment Penetration Rate by Procedure, Percent, Figure 86. Penetration of Open Surgery Market Opportunity 181 Figure 87. Intuitive Surgical da Vinci System installed base Figure 88. Number Intuitive Surgical Robotic Shipped and Installed Systems, US, Europe, Asia, and Worldwide, 2014-Q Figure 89. Intuitive Surgical Robotic Surgery Installed Systems, Number Regional Analysis by Country, 2014, 2015, and Figure 90. Number Intuitive Surgical Robotic Surgery Installed Systems, Total, US, International 2012-Q Figure 91. Intuitive Surgical da Vinci System Installed Base by Region 191 Figure 92. Intuitive Surgical davinci Target Procedures, Gynecology, General Surgery, Urology, Cardio-Thoracic, Head and Neck, Number of Procedures and Percent, US, International, and Worldwide, Figure 93. Intuitive Surgical davinci Target Procedures Number of Procedures, Worldwide, Figure 94. Over 4 Million da Vinci Procedures Have Been Performed To Date 197 Figure 95. Intuitive Surgical Robotic Surgery Gynecological Procedures, Number Regional Analysis by Country, Figure 96. Intuitive Surgical Procedures 208 Figure 97. Intuitive Surgical Robotic Urology Surgery Procedures, Number Regional Analysis by Country, Figure 98. Intuitive Surgical Urology Procedures 219 Figure 99. Intuitive Surgical da Vinci Surgical System Improved Visualization Of The Gross Anatomy222 Figure 100. Intuitive Surgical Robotic General Surgery Procedures, Number Regional Analysis by Country, Figure 101. General Surgery Colorectal Procedures 230 Figure 102. Abdominal Surgical Robot Market Segment Forecasts, Head and Neck, Cardiac and Cardio Thoracic, Dollars and Units, Worldwide, Figure 103. Definition of Abdominal Surgical Robot Categories 237 Figure 104. Intuitive Surgical Procedure Aspects 241 Figure 105. Reported Clinical Benefits of da Vinci Hysterectomy Procedures for Benign Conditions 242 Figure 106. Intuitive Surgical da Vinci Xi Product 244 Figure 107. Intuitive Surgical Average Cost to Hospital by Procedure Type 251 Figure 108. Surgical Robot Regional Market Segments, Dollars,

16 Figure 109. Abdominal Surgical Robot Regional Market Segments, Figure 110. Number Intuitive Robotic Surgical Procedures, Detail of General Surgery, Gynecology, Urology, Head and Neck, Cardiac and Cardio Thoracic, Regional Analysis by Region, Figure 111. Number Intuitive Robotic Surgical Procedures, Detail of Gynecology, Benign Hysterectomy, Malignant Hysterectomy, Sacral Colpopexy, Endirmetrosis Resection, Regional Analysis, Figure 112. Intuitive Surgical Robotic Surgery Installed Systems, Number, Regional Analysis by Country, Asia and Rest of World, 2014, 2015, and Figure 113. da Vinci X Surgical System from Intuitive Surgical 274 Figure 114. Intuitive Surgical da Vinci Xi Surgical System Features 276 Figure 115. Intuitive Surgical da Vinci System 279 Figure 116. Intuitive Surgical da Vinci Surgical System 285 Figure 117. Intuitive Surgical. da Vinci Surgical System EndoWrist Instruments 287 Figure 118. Intuitive Surgical. da Vinci Surgical System Vision System 288 Figure 119. Intuitive Surgical da Vinci Surgical System Features 289 Figure 120. Intuitive Surgical Da Vinci Xi Surgical System Surgeon Console Features 292 Figure 121. Intuitive Surgical. da Vinci Surgical System Surgeon Console 293 Figure 122. Intuitive Surgical. da Vinci Surgical System Patient-Side Cart 294 Figure 123. Intuitive Surgical Da Vinci Surgery 300 Figure 124. Intuitive Surgical Da Vinci Surgical System Components 301 Figure 125. Intuitive Surgical da Vinci Mitral Valve Repair Benefits 303 Figure 126. Minimally Invasive Da Vinci Surgery Benefits To Cardiac Patients 308 Figure 127. Intuitive Surgical da Vinci System State-Of-The-Art Robotic Surgical Platform 309 Figure 128. Intuitive Surgical da Vinci Si Surgical System Core Benefits: 309 Figure 129. Intuitive Surgical da Vinci SI Surgical System Dual Console Used For Training And Collaboration 310 Figure 130. Intuitive Surgical da Vinci Surgical System Patient Side Cart 311 Figure 131. MedRobotics Flex Robotic System 313 Figure 132. Medrobotics Flex Robotic System Target Surgical Sites 314 Figure 133. Medrobotics Technology 315 Figure 134. Medrobotics Flex Retractor 317 Figure 135. Medrobotics Snakelike Robot Tested for Heart Surgery 320 Figure 136. Medrobotics Medical Field Target Markets 321 Figure 137. Titan Single Port Orifice Robotic Technology SPORT Surgical System 322 Figure 138. Titan SPORT Surgical System: 323 Figure 139. Titan MedicalSPORT Surgical System Patient Benefits: 325 Figure 140. Titan MedicalSport Surgical System Surgeon Benefits: 326 Figure 141. Titan MedicalSport Surgical System Patient Benefits: 327 Figure 142. Titan MedicalSport Surgical System 328 Figure 143. Titan MedicalSport Surgical System User Touch Points 329 Figure 144. Titan MedicalSport Surgical System Instruments 330 Figure 145. Titan Medical Next Generation SPORT Surgical System Uses 331 Figure 146. Titan Medical Next Generation SPORT Surgical System Market Opportunity 332 Figure 147. Titan Medical Next Generation SPORT Surgical System Competitive Positioning333 Figure 148. Titan Medical Next Generation SPORT Surgical System Market Business Model334 Figure 149. Titan Medical Next Generation SPORT Surgical System Development Strategy335 Figure 150. Titan Medical Next Generation SPORT Surgical Instruments 336 Figure 151. Titan Medical Next Generation Sport Surgical Instruments 337 Figure 152. Titan Medical Next Generation SPORT Surgical Instruments 338 Figure 153. Titan Medical Next Generation SPORT Surgical Instrument Controllability 339 Figure 154. Titan Medical Next Generation SPORT Surgical Instrument Usability Studies and Data Analysis 340 Figure 155. Titan Medical Next Generation SPORT Surgical Instrument Visualization 341 Figure 156. Titan Medical Next Generation SPORT Surgical Instruments 342 Figure 157. Titan Integration Successful Deployments Into Single 25mm Incision in Abdominal Cavity343 Figure 158. Titan Robotic Surgical System Benefits: 344

17 Figure 159. Titan Amadeus Features 346 Figure 160. Johnson & Johnson Ethicon Minimally Invasive Procedures As They Apply To Specific Conditions 348 Figure 161. Medicaroid SOT-100 Vercia 351 Figure 162. Olympus Plasma Hysteroscopic Resection and Vaporization 356 Figure 163. TransEnterix Senhance Surgical Robotic System 361 Figure 164. TransEnterix Rebrands the ALF-X to Senhance 362 Figure 165. TransEnterix Surgical Robot Technology 366 Figure 166. TransEnterix Provide Patients With Less Invasive Surgery 367 Figure 167. TransEnterix Device is Patient-Side 368 Figure 168. TransEnterix Device is Patient-Side 368 Figure 169. TransEnterix SurgiBot System Reduces-Incisions 369 Figure 170. TransEnterix Flex Instruments 370 Figure 171. AVRA Computer-Driven Automated Drill for Surgical Procedures 372 Figure 172. ASRS Instruments AVRA Mobility Intelligent, Independent for Surgeon Control376 Figure 173. Centerline Biomedical Simplifies Endovascular Procedures 378 Figure 174. Endovascular Procedure Limitations 379 Figure 175. Centerline Biomedical IOPS Electromagnetic Tracking Functions 381 Figure 176. Robotic Abdominal Surgery Surgical Specialty Focus 384 Figure 177. Intuitive Surgical Robotic Cardiac Procedures 388 Figure 178. Surgical Robot Cardiothoracic Conditions Treated 391 Figure 179. Google Autonomous Vehicles Technology 409 Figure 180. Intuitive Surgical Recurring Revenue Model 447 Figure 181. Intuitive Surgical Pricing by System Model 448 Figure 182. Intuitive Surgical Tip of the Iceberg ROI Cost Factors 448 Figure 183. Intuitive Surgical da Vinci Ecosystem 449 Figure 184. Intuitive Surgical 2016 Objectives 450 Figure 185. Intuitive Surgical Platform, davinci Xi 452 Figure 186. Johnson and Johnson Family of Companies Comprises: 464 Figure 187. Medrobotics Positioning Figure 188. Medrobotics Cardiac Surgery Improvements 480 Figure 189. Medrobotics Snake Robot Technologies For Use In A Wide Range Of Surgical And Interventional Applications 481 Figure 190. Medrobotics Snake Robot Technologies Specialist Areas Served 482 Figure 191. Titan Medical Investment Summary 486 Figure 192. Titan Medical Business Goals and Timetable 487 Figure 193. Titan Medical Describes Robotic General Surgery Market Potential 492 Figure 194. Titan Medical Robotic Surgery Target Opportunity 493 Figure 195. Titan Medical Robotic Surgery Target Opportunity 494 Figure 196. TransEnterix Strategic Positioning 499 Figure 197. TELELAP Robotic Surgical Unit 502 Figure 198. TransEnterix ALF-X Robotic Surgery 503 Figure 199. TransEnterix ALF-X Breaking Barriers Supporting Precision 505 Figure 200. Verb Surgical Digital Platform Elements: 509 Figure 201. Key Players In The Abdominal Global Medical Robots Market 518 Figure 202. Key Players In The Global Medical Robots Market 519 ALF-X Breaking Barriers Supporting Precision 521

18 ABOUT THE COMPANY WinterGreen Research, research strategy relates to identifying market trends through reading and interviewing opinion leaders. By using analysis of published materials, interview material, private research, detailed research, social network materials, blogs, and electronic analytics, the market size, shares, and trends are identified. Analysis of the published materials and interviews permits WinterGreen Research senior analysts to learn a lot more about markets. Discovering, tracking, and thinking about market trends is a high priority at WinterGreen Research. As with all research, the value proposition for competitive analysis comes from intellectual input. WinterGreen Research, founded in 1985, provides strategic market assessments in telecommunications, communications equipment, health care, Software, Internet, Energy Generation, Energy Storage, Renewable energy, and advanced computer technology. Industry reports focus on opportunities that expand existing markets or develop major new markets. The reports access new product and service positioning strategies, new and evolving technologies, and technological impact on products, services, and markets. Innovation that drives markets is explored. Market shares are provided. Leading market participants are profiled, and their marketing strategies, acquisitions, and strategic alliances are discussed. The principals of WinterGreen Research have been involved in analysis and forecasting of international business opportunities in telecommunications and advanced computer technology markets for over 30 years. The studies provide primary analytical insight about the market participants. By publishing material relevant to the positioning of each company, readers can look at the basis for analysis. By providing descriptions of each major participant in the market, the reader is not dependent on analyst assumptions, the information backing the assumptions is provided, permitting readers to examine the basis for the conclusions. WinterGreen Research is positioned to help customers facing challenges that define the modern enterprises. The increasingly global nature of science, technology and engineering is a reflection of the implementation of the globally integrated enterprise. Customers trust wintergreen research to work alongside them to ensure the success of the participation in a particular market segment. WinterGreen Research supports various market segment programs; provides trusted technical services to the marketing departments. It carries out accurate market share and forecast analysis services for a range of commercial and government customers globally. These are all vital market research support solutions requiring trust and integrity.

19 ABOUT THE PRINCIPAL AUTHOR Susan Eustis, President, co-founder of WinterGreen Research is a senior analyst. She has done research in communications and computer markets and applications. She holds several patents in microcomputing and parallel processing. She has the original patents in electronic voting machines. She has new patent applications in format varying, mulitprocessing, and electronic voting. She is the author of recent studies of the Solar Renewable Energy, Wind Energy, Thin Film Batteries, Business Process Management marketing strategies, Internet equipment, biometrics, a study of Internet Equipment, Worldwide Telecommunications Equipment, Top Ten Telecommunications, Digital Loop Carrier, Web Hosting, Web Services, and Application Integration markets. Ms. Eustis is a graduate of Barnard College. Worldwide Who s Who named her Top Female CEO of 2012, 2013, 2014, 2015,2016. About the WinterGreen Research Team: The WinterGreen Research Team is comprised of senior analysts that prepare the market research and analysis that is offered to the client and developed using an iterative process to achieve a final study. Typical projects include providing market/viability research. The team can look at how drones can be applied to critical infrastructures safety, including: type of market existing, Barriers, Forecast demand and competitors, SWOT and competitive advantages, Price Analysis, product design recommendations (marketing orientation). Research is typically for many different regions or localities, for example EU countries including Spain, UK, Nordic, Germany, and France. Typical projects profile the United States and areas of Asia. It is common to three representative countries from South America, Brazil, Argentina, Chile, and Mexico. Representative countries from Asia APAC typically include Japan, China, India, and Australia. Critical infrastructure safety, including: type of market existing, barriers to entry and to faithful execution of product provision, forecast of demand, market share, SWOT, competitive advantage of major competitors, identification of new technologies and new companies, price performance analysis, product design recommendations, and marketing considerations are typical topics covered.