Robotic surgery's innovation boom

Healthcare providers looking to build soft tissue robotic surgery programs saw their options multiply in the past year.

When Medtronic and another deep-pocketed robot developer, CMR Surgical, snagged Food and Drug Administration nods in December 2025, it capped off a steady succession of regulatory clearances and submissions, funding rounds and clinical trial launches for companies advancing new systems for minimally invasive surgery. The momentum continued in the new year as Johnson & Johnson submitted its Ottava robot for FDA authorization.

An ongoing shift to robotic assistance, which enables soft tissue surgery to be performed through small incisions, is expected to help reduce complications, improve outcomes and shorten recovery times for patients. Companies are developing platforms to bring greater precision to an increasingly diverse range of procedures.

What impact the new systems will have on Intuitive Surgical, the robotic surgery market leader for more than two decades, is the subject of much debate.

Here are five trends to follow in surgical robotics in 2026:

1. Startups are going where Intuitive is not

Two tiers of companies are emerging in robotic surgery: large multinationals that will challenge Intuitive head-on in the soft tissue race, and smaller competitors working to differentiate themselves in specialized uses.

Medtronic and J&J fall into the first category, said industry expert Steve Bell, an adviser to medtech startups, but large companies that are less well known in the U.S., such as Shanghai-based MicroPort MedBot and Japan’s Medicaroid — a joint venture of Kawasaki Heavy Industries and Sysmex — are also increasing their global reach. 

In the second category, smaller companies will try to go where Intuitive is not, said Bell. He predicted the biggest area of differentiation in 2026 will be new sites of care. Companies may pursue certain hospitals that have not yet established a robotics program.

New market entrants are also rushing to gain a foothold in ambulatory surgery centers, where more procedures are taking place but robots have historically lacked a presence, Bell said. In the outpatient-focused ASCs, sidestepping Intuitive could mean “the fight will be easier,” said Bell. Distalmotion and Moon Surgical are two robot makers targeting ASCs as part of their strategies, he said, and Virtual Incision and CMR likely will do so as well.

CMR expects its Versius system to find a home in both ASCs and hospitals looking for a smaller, portable robot that can be moved between departments, CEO Massimiliano Colella said.

“There are an increasing number of hospitals that basically are telling us that this modularity will really fit into the idea that they have of a robotic program,” said Colella. “My takeaway — they see it as complementary to whatever they already have in place.”

Intuitive has ASCs in its sights as well. On an earnings call, executives said the company is prioritizing expansion in higher-volume ASCs.

2. Medtronic will gain commercial traction

In December 2025, Medtronic became the first large medtech company positioned to take on Intuitive in the U.S. when it secured FDA clearance for the Hugo robotic assisted surgery system in urology. Medtronic will also seek indications in general surgery and gynecology.

Rajit Kamal, Medtronic vice president and general manager of robotic surgical technologies, said Hugo’s U.S. rollout will be similar to its global introduction.

“We are taking a purposeful approach to launching the Hugo RAS system in the U.S., beginning with select, leading institutions,” Kamal said in an email. “This will allow us to establish a strong foundation of success for customers and their patient care.”

Of the roughly 50 million soft tissue surgeries that will be performed this year, about 30 million will be done as open surgery, the Medtronic executive said, so there is still a significant global need to expand access to minimally invasive surgery.

“Even in the U.S., which has the highest adoption of RAS in the world, hospitals are facing capacity and access challenges as they seek to offer minimally invasive surgical options to more patients,” said Kamal. With Hugo, and through its global scale, strong training partnerships and broad technology offerings, Medtronic can help address those challenges, he said. 

Bell, the startup adviser, expects interest in Hugo to come from loyal Medtronic customers comfortable with its surgical instruments, academic institutions and some surgeons who are not using an Intuitive robot.

“The impact of Medtronic this year, and J&J next year, will be meaningful,” said Bell. “It will be meaningful in a small percentage, but it will be meaningful.”

3. Intuitive is up to the challenge

Jefferies analyst Matthew Taylor said it could be two to three years before the competitive landscape really heats up.

“You do have Medtronic with the U.S. approval now, and they're going to move ahead with a limited launch and have signaled that there really may be some impact next year for them on their growth,” said Taylor. “And then J&J is in the process of getting approval, but they probably won't have a more material impact at least for their growth until 2028.”

As competition rises, Intuitive continues to innovate, adding new features to its robots such as a video replay capability to inform real-time decision-making, a gauge measuring the force applied to tissue and additional surgical tools. “I like our chances,” Intuitive CEO Dave Rosa told investors this month at the J.P. Morgan Healthcare Conference.

Intuitive provided a 2026 worldwide da Vinci procedure growth forecast of about 13% to 15%, below 2025’s approximately 18% growth rate, but did not call out U.S. competitive pressures. Instead, executives pointed to potential impacts from changes to Affordable Care Act premium subsidies and Medicaid funding, capital challenges in Europe and Japan, and competition in China.

Taylor said the robot maker typically begins the year with a conservative outlook and will likely outperform its 2026 forecast, supported by continued adoption of da Vinci 5. “Then in 2027, you'll see the rubber start to meet the road with the competition,” he said.

4. Expect cardiac surgery to benefit

Cardiac surgery is shaping up as a key area for investment in the year ahead.

Intuitive recently unveiled a plan to step up its presence in cardiac surgery after receiving FDA clearance for nine new indications in the specialty, including mitral and tricuspid valve repair, mitral valve replacement, and left atrial appendage closure.

The move comes as other robot developers, such as SS Innovations International, Capstan Medical, and Corcym and CardioPrecision, eye large market opportunities in the space. 

Intuitive plans a limited U.S. rollout for the initiative in 2026 as it ramps up training programs for cardiac teams in certain hospitals. The company also intends to develop cardiac-specific instruments.

On an October 2025 earnings call, Rosa said da Vinci 5’s strengths in motion control, advanced imaging and artificial intelligence integration, coupled with new surgical instruments in development, could make a difference for cardiac surgeons and their patients.

“Where those two intersect — our capabilities plus an unmet need — I think that's where some magic can happen,” Rosa said.

5. Specialized applications are growing

Intuitive’s da Vinci robots are commonly used in urologic, gynecologic and general surgery. Companies are now expanding the frontiers of robotics into more surgical categories. Among those to get new FDA clearances in 2025 were Microbot, creator of a robot for peripheral endovascular procedures, and Stereotaxis, whose magnetic navigation technology is used in ablations to treat heart arrhythmias.

Bohdan Pomahac, chief of plastic and reconstructive surgery and director of the face transplant program at Yale Medicine, leads the post-market study for MMI’s Symani system, a robot that enables surgeons to reconnect tiny blood vessels.

Pomahac said new robots are allowing surgeons to perform high-precision movements previously only feasible for the most talented and well-trained specialists. “The technology lowers the bar of who can do very complex procedures, so the learning curve is faster,” said Pomahac. “It also allows us to deploy it in situations that you would not normally be comfortable with.”

In the field of ophthalmology, new robots could help offset a projected decline in the number of eye surgeons in the next decade, said Joseph Nathan, co-founder and chief medical officer of ForSight Robotics, which is developing a platform for cataract surgery. 

“ForSight Robotics will be able to provide the ability for surgeons to do many more procedures, to be more efficient,” Nathan said.

Companies such as ForSight are re-engineering the procedure through robotics, said Nathan, adding that advances in AI, visualization technology and the miniaturization of mechanics will make it possible to elevate the level of care that patients receive.

“We’re seeing more and more specialized robots,” said Nathan. “As a surgeon, I think that patients deserve to have the best technology delivered through healthcare.”

More surgical procedures in the U.S. are migrating to ambulatory surgery centers, where costs are lower, patients go home the same day, and physicians often have an ownership stake.

Hospital systems are prioritizing investments in ASCs as well, eager to expand outpatient capacity and stay competitive. Yet despite their growing popularity, and advances in medical technology that have allowed a wider range of procedures to be performed in ASCs, most do not have a soft tissue surgical robot.

Distalmotion, a Swiss company whose robot is cleared in the U.S. to perform several common same-day procedures, is working to change that. ASCs that want to add a robotics program face barriers such as space limitations and the expense of acquiring and maintaining a traditional robotic platform.

“We solve a lot of those problems,” said Distalmotion CEO Greg Roche.

The company has designed its Dexter robot to provide the clinical benefits of robotic surgery — namely, the dexterity of “wristed” instruments that mimic the human hand but with greater predictability — in a system that more care providers can afford to own. With most general and gynecologic surgeons now trained on robots during their residency and fellowship programs, integrating a robotic system into the workflow “is no longer a luxury” for a provider, said Roche. “It’s a required tool.”

A spinoff from the Swiss Federal Institute of Technology in Lausanne, Switzerland, Distalmotion received Europe’s CE mark in 2020 for use of its robot in urology, gynecology and general surgery.

In the U.S., the robot gained Food and Drug Administration de novo authorization for inguinal hernia repair in 2024, followed in 2025 by clearances for gallbladder removal and hysterectomy. The company has submitted a request for additional gynecological indications. Next up is a filing for ventral hernia repair, said Roche. The generally low-risk procedures are increasingly moving to ASCs.

“We believe that the cost profile of our robot allows for profitability within these lower-acuity, high-volume surgeries,” Roche said. “What we're trying to accomplish is to really drive these surgeries into the ASC.”

To further its U.S. expansion, Distalmotion in 2025 raised $150 million in a Series G funding round. Johnson & Johnson’s JJDC venture capital arm is a strategic investor. In all, the company has received about $400 million from its backers, according to Roche.

Now, as its robot rolls out in the U.S., the ASC-focused strategy is fueling momentum. After surpassing 3,000 cumulative procedures across Europe and the U.S. in the fourth quarter of 2025, Distalmotion’s first quarter of 2026 was its best yet, Roche said.

“We're being very pragmatic and really picking a sector that we think needs a lot of help,” said Roche. “We fit a need. We’re solving a problem for hospital and physician partners and for patients.”

Cypress Surgery Center in Wichita, Kansas, acquired its first surgical robot, a Dexter system, in March 2026. The ASC was eager to add a robot and had looked at Intuitive Surgical’s da Vinci system in the past but found it too costly. Da Vinci was also too bulky for the center’s operating rooms, explained Cynthia Meaux, market CEO at Cypress parent Surgery Partners.

“Dexter comes around and all of a sudden offers a proposition that is a smaller footprint,” said Meaux. “Our ORs at Cypress are smaller. They are a lot smaller. Fitting a da Vinci is a bit more cumbersome than the Dexter robot. I mean, we just wheel the bad boy around.”

Meaux said having the robot gives the center a competitive advantage in the local marketplace. Distalmotion provided surgeon training and support, helping to make the program feasible. “You have surgeons who know how to use a da Vinci but are willing to toggle between two different robot systems now,” she said.

The number of Medicare-certified ASCs has been climbing steadily, at an average annual rate of 2.2% over five years, to reach more than 6,400 facilities in 2024, a report from the Medicare Payment Advisory Commission, or MedPAC, shows. In contrast, slightly more hospitals closed than opened over a 14-year period through 2023 tracked by health policy researcher KFF.

Advances in minimally invasive surgery have supported a shift in many procedures to ASCs, from cataract removal and colonoscopies to hip and knee replacements. Patients like the convenience and lower out-of-pocket costs, compared to hospital outpatient departments, while physician owners have more control over their work environment and can earn additional income, MedPAC said.

Distalmotion is not the only robotics company pursuing the ASC market. Industry leader Intuitive, which has acknowledged that some customers are more sensitive to capital acquisition costs, in 2025 began selling a refurbished version of its older-model da Vinci Xi system.

Intuitive placed 42 refurbished XiR systems with customers in 2025, and 34 more in the first quarter of 2026. The strategy gives Intuitive a sizable long-term opportunity to expand access to the da Vinci platform in both ASCs and international markets, CEO Dave Rosa said on a January 2026 earnings call.

More recent contenders in robotic surgery, including CMR Surgical and Moon Surgical,  are also targeting ASCs.

Roche maintains that Distalmotion has a combination of advantages that give it an edge over the competition. The former Zimmer Biomet robotics executive, who joined Distalmotion in 2023 after leading German robot developer Avateramedical, said Dexter is designed specifically for the ASC environment, and it's unlikely that any one competitor can match all of its attributes. For starters, he said, the robot requires just 125 square feet to operate and can be moved through a standard door frame, plugged into a standard outlet and set up in four minutes or less.

Unlike Intuitive’s da Vinci, Dexter’s console positions the surgeon in the sterile field with the patient, making it possible to switch between robotic and laparoscopic techniques during a procedure.

The platform is also open architecture, meaning customers can use the visualization, stapling, advanced energy and other technologies that they choose. The system’s single-use instruments require no sterilization, another big plus for ASCs, which often do not have the capacity to process robotic instruments, Roche said.

“With the Dexter, we didn't have to change any of those surrounding complementary services,” said Surgery Partners’ Meaux. “It fit into our system. It fits our instrumentation, our videos, our scopes. So the open system is important, because it didn't require that much more incremental investment into single-branded things like you do with a da Vinci.”

Distalmotion is working on other ways to improve efficiency in the ASC, such as a “flip room” concept to facilitate sharing between operating rooms. Because one room may be used for many types of procedures, a robot must be movable between cases, said Roche, but with most traditional platforms, that is hard to do.

“If you are in an ASC, you cannot have a room beholden to a robot,” he said.

Another project is called solo robotics. “We believe we're going to get to a point where a surgeon can do certain procedures by himself, so not even a nurse is in the field,” said Roche.

The CEO predicted that in the future, the robotic surgery market will be segmented, with some companies specializing in platforms suited for the outpatient setting, like Distalmotion, and others battling for a space in the hospital itself, where complex procedures will continue to be performed.

“We could have built a closed-system robot with all the feature sets and all the bells and whistles. We chose not to do that intentionally,” said Roche. “We’ve chosen to say no to a lot.”

Days after being named CEO at CMR Surgical, Massimiliano Colella faced a difficult decision.

CMR was about to launch its Versius surgical robot in the U.S. The robot had just secured Food and Drug Administration authorization for its initial indication in soft tissue surgery, and the company was preparing to line up its first U.S. hospital partners.

The new CEO, however, chose not to go ahead with the rollout.

“It was basically the same week I was appointed CEO of the company,” said Colella. “I actually stopped it, as a first decision that I took, because I didn't want to launch the generation one of Versius. I wanted to wait for Versius Plus.”

Colella, who was named interim CEO in late 2024 before taking over the role permanently in January 2025, needed to be certain the robot’s U.S. debut could meet the market’s high expectations. Looking back, waiting for the more advanced system to be ready was the right thing to do, he said, even though halting the release delayed market entry by a year.

“It’s a market where we cannot afford a single mistake,” said Colella.

Now, with FDA clearance for Versius Plus in hand, CMR will attempt to establish a foothold in the U.S. The company’s arrival comes at a critical juncture for the U.S. market, as a growing number of robot developers, including medtech giants Medtronic and Johnson & Johnson, are poised to give industry leader Intuitive Surgical the first competition on its home turf since it pioneered the da Vinci system in the early 2000s.

Elsewhere, Cambridge, England-based CMR has found success in an increasingly crowded global surgical robotics field. Versius is the second most widely adopted robot outside of the U.S., according to the company. The platform received Europe’s CE mark in 2019 and has been used to perform more than 40,000 procedures in more than 30 countries worldwide.

Investors, confident in CMR’s potential and the future of robotic surgery, have poured almost $1.5 billion into the company to support the development and commercialization of Versius, making CMR the top-funded venture capital-backed surgical device business, according to PitchBook.

Scrapping the first U.S. launch gave CMR more time to fine-tune Versius, learn the market and chart the course for its expansion, said Colella. New surgical instruments and data tracking tools, enhanced visualization technology and greater system efficiencies are among the improvements in the second-generation platform. The robot is now “super performing,” said Colella. Most of the changes can also be transferred to customers with the original Versius system through a software upgrade.

In robotics, getting the best performance from a system is a step by step process, said the CEO. “This is something that nobody can avoid,” Colella said.

CMR’s updated robot won FDA clearance in December 2025 for gallbladder removal surgery, its initial indication. The company is also pursuing 510(k) submissions with the FDA for gastrointestinal surgery, gynecology, urology and general surgery, with clearances expected in 2026.

As it begins a U.S. soft launch for Versius Plus, CMR is choosing its first partners among hospitals and ambulatory surgery centers. A full market rollout will follow as indications for more surgical specialties are received.

“We have, I must say, a very healthy queue of centers that want to work with Versius,” said Colella.

The robot is designed to replicate minimally invasive laparoscopic surgery, where procedures are performed via tiny incisions. The small and modular system is portable, so it can be shared between operating rooms.

Colella said hospitals view Versius as complementary to robotic programs they already have in place.

“Huge hospitals with a high number of ORs, sometimes they have got the first one, the second one, the third one, and then they realize, ‘OK, we cannot keep going this way and having 20 robots, but we could have one which is portable, that we could move,’” he explained.

Departments within the hospital that lack full access to a robotic program because it is dominated by other specialties could work with a portable robot on a rotational basis.

“The reason why we are very optimistic about our chances, in the U.S. market and everywhere in the world, is because we are fully differentiated products, vis-à-vis Intuitive,” said Colella.

Yet while CMR will compete with Intuitive, Colella is quick to emphasize that the company is not coming to the U.S. to challenge the robotic surgery market’s creator. “We are coming because we know that this market is going to become so big around the world that we truly believe that there is space for us based on the features and benefits that we can offer,” he said.

The increased competition in surgical robotics, brought by CMR and others, will accelerate the market’s overall growth and will likely make robotic systems more affordable for many more hospitals globally, said Colella.

“We will — I wouldn't say easily — but we'll find our space to become a big company without challenging anyone, just positioning ourselves for the benefit of customers and patients,” he said.

Intuitive has unveiled more than 100 updates and user experience improvements planned for its da Vinci 5 surgical robot.

The company will implement the changes in “measured launches” in the U.S. starting in June 2026 before expanding the rollout to overseas markets. 

Updates include improvements to a tool that allows physicians to observe procedures remotely and the option for surgeons to log in to the robot using their phones.

Intuitive began selling da Vinci 5 in 2024. The robot has 10,000 times the computing power of the company’s older Xi system, Iman Jeddi, general manager of da Vinci platforms and product operations at Intuitive, said in a statement. The additional computing power allowed Intuitive to commit to the ongoing integration of new functions, capabilities, indications and instrumentation, Jeddi said.

The company is following through on that commitment with features intended to boost collaboration, connectivity and outcomes. Intuitive is adding a camera that allows remote physicians to see the full operating room. With Intuitive implementing a live cursor and enhancing audio, the company aims to improve communication between remote and on-site surgeons to expand education opportunities.

A mobile phone login feature is intended to simplify access while enhancing security through multifactor authentication. Intuitive’s other near-term updates include six new exercises in its simulation platform.

Other changes are subject to regulatory clearance and scheduled to launch later in 2026 in the U.S. The company wants to add a digital ruler for on-screen intraoperative measurements, implement a feature that allows surgeons to eject tools directly from the console and enable targeting with any number of arms docked. The multi-arm targeting feature is intended to simplify and reduce time for case setup.

Intuitive is continuing to increase the number of uses of its instruments. The company increased the number of uses of five of its force-feedback instruments from six to 15. Intuitive expects to increase the number of uses on some core instruments in 2027, reducing per-procedure costs.

The updates come as Intuitive faces increasing competition on multiple fronts. Medtronic received Food and Drug Administration clearance for its Hugo robot in December 2025, and Johnson & Johnson filed for de novo authorization of its Ottava robot in January 2026. Meanwhile, CMR Surgical formally introduced its Versius robot in March 2026, and Distalmotion is working to increase ambulatory surgery centers’ use of surgical robots.

Intuitive has continued to grow despite the pressure, installing more than 1,400 da Vinci 5 systems as of the first quarter of 2026. More than 12,800 surgeons in 10 countries have used the robots to perform more than 380,000 procedures.

Medtronic said it has filed for 510(k) clearance to expand the use of its Hugo surgical robot to general and gynecological indications.

The Food and Drug Administration cleared the device in urologic procedures in late 2025. Expanding the label would position Medtronic to compete with Intuitive Surgical in more indications.

An “increased contribution from Hugo” helped Medtronic grow U.S. medical surgical sales 8% in the fourth quarter of its financial year, CFO Thierry Piéton said on an earnings call.

Hugo is Medtronic’s challenger to Intuitive’s market-leading da Vinci robots. Six years after Medtronic unveiled the device, the FDA cleared Hugo for use in the U.S. for the first time in December 2025. The initial FDA clearance only covered urological procedures, restricting Medtronic to a subset of the surgeries performed using da Vinci robots.  

Medtronic has filed for FDA clearance in general surgeries, including hernia repair, and in gynecologic specialties. The indications covered by the filings currently account for most surgeries performed in the U.S. using Intuitive’s da Vinci robots. 

U.S. surgeons used da Vinci robots in about 2 million procedures in 2025. General surgery accounted for 1.25 million of the procedures, followed by the 468,000 gynecological surgeries that were enabled by da Vinci robots. Urology was the smallest of the three main areas of da Vinci use, accounting for 201,000 procedures.

Unlocking more indications could support increased use of a device that has begun contributing to Medtronic’s sales growth. Hugo is impacting Medtronic’s medical surgical portfolio, CEO Geoff Martha told analysts on the earnings call. He added that worldwide procedure volume growth is two to three times the market rate. The company is installing more devices in the U.S., Martha said. 

Medtronic has yet to provide a timeline for receiving 510(k) clearance in the new indications. While Medtronic disclosed the 510(k) filings, Martha said on the earnings call that the company applied for clearance in the additional indications in late 2026. 

The push into new indications is part of Medtronic’s broader effort to expand its robotic capabilities. Medtronic also submitted a 510(k) filing for a vessel-sealing technology that works with Hugo and received clearance for a mesh used in robotic-assisted ventral hernia repair.

Johnson & Johnson said it has submitted its Ottava soft tissue robotic surgery system to the Food and Drug Administration for de novo classification in general surgery. The company has applied for marketing authorization in multiple procedures within the upper abdomen.

The application is supported by data from the company’s investigational device exemption study in Roux-en-Y gastric bypass, a type of weight-loss surgery that creates a small pouch from the stomach to reroute food to the small intestine.

J&J said it also received IDE approval in late 2025 to begin a U.S. clinical trial to study Ottava in inguinal hernia procedures, one of the most common surgeries in the U.S.

The FDA submission for Ottava follows Medtronic’s U.S. clearance in December 2025 for its Hugo robotic surgery system in urologic procedures. The two leaders in surgical instrument manufacturing will challenge Intuitive Surgical’s decades-long dominance in the robot-assisted soft tissue surgery market.

“We have taken learnings from Johnson & Johnson’s 140 years in surgery, our decades of leadership in minimally invasive surgery, and the experiences robotic surgeons and hospitals have had over the past 20 years to design a soft tissue robotic system built for the future of surgery,” Hani Abouhalka, company group chair for surgery at J&J MedTech, said in a statement.

Smaller companies, too, such as CMR Surgical and Stereotaxis, have recently gained FDA clearance for new robotic platforms and are working to launch those systems in the U.S. In December 2025, SS Innovations International filed an FDA submission seeking authorization for its SSi Mantra robot in multiple soft tissue procedure types.

J&J said its de novo classification request is targeting an indication covering multiple procedures in general surgery within the upper abdomen, such as gastric bypass, gastric sleeve, small bowel resection and hiatal hernia repair.

Ottava’s differentiated architecture, surgical instrumentation and technological capabilities are designed to address unmet needs for clinical teams across a range of procedures, including the most complex surgeries that require a multi-quadrant approach, the company said.

Stifel analyst Rick Wise noted J&J’s approach to Ottava, with integrated table motion, is unique within the surgical robotics space. The timing of the submission announcement, just days into the first-half 2026 window the company targeted, shows J&J’s confidence in Ottava’s development, Wise wrote to clients. 

“For Intuitive Surgical, this announcement highlights the well-known, well-understood fact that the US robotic market competitive environment is going to become more-crowded,” said Wise. “That said, Intuitive's broad and deep ecosystem, multiple robots, including the highly-differentiated DV5, indicates that the company is well-positioned to address competitive challenges.”

Stryker shared an update on its handheld surgical robot and other new technologies at the American Academy of Orthopaedic Surgeons meeting. The handheld robot, called Mako RPS, was cleared by the Food and Drug Administration in 2025.

After the robot was used in its first cases in January 2026, Mako RPS is in a limited market release. Keith Evans, general manager of Stryker’s Mako and Enabling Technologies business, said the limited release is expected to continue through the first half of the year, with Stryker adding additional users in the second half of 2026. 

Evans said the new robot is targeted at surgeons who do manual procedures and don’t use Stryker’s traditional Mako robotic system. The handheld robot is designed to feel similar to the saw or cutting tools surgeons use, and Evans hopes it will help convert more customers to its Triathlon knee system.

“We've been having these conversations for more than a decade, directly within Stryker, since the acquisition of Mako,” Evans said. 

The traditional Mako system, which offers pre-operative planning using CT scans, has seen “tremendous growth,” he added, “but there is a portion of customers that say ‘we want consistency in the way we do things.’”

Some surgeons might prefer holding an instrument in their hand, or making decisions during a procedure instead of in advance.

Evans said Stryker has seen a lot of interest in Mako RPS from outpatient facilities, such as ambulatory surgery centers, but the device is not limited to those settings. He added that Stryker is interested in pursuing additional global markets with Mako RPS.

Stryker has been building out its robotics segment since acquiring Mako in 2013. The latest iteration of the original system, Mako 4, which uses a robotic arm to guide procedures, is indicated for knee, hip and spine procedures. Stryker also plans to bring a shoulder feature to the system in 2026, Evans said.

Stryker debuts knee component for metal sensitivities

Stryker also showcased a new femoral component for its knee replacement system at AAOS. The implant, called Triathlon Gold, has a titanium nitride coating and is intended for patients with metal sensitivities. 

Lisa Kloes, general manager of Stryker’s knee business, said by 3D printing the component, Stryker is able to offer cemented or cementless options. Because Stryker wanted the base of the implant to be titanium, not chrome, the company needed to invest in new technology to be able to print the devices. 

The component is in a limited market release, after receiving FDA clearance in October 2025.

MMI built its microsurgery robot to perform intricate procedures with greater precision than the human hand can provide.

The robot helps surgeons reconnect and repair tiny structures such as blood and lymphatic vessels that can be less than a millimeter in diameter.

“When you think about surgery that's small, the limitations of the human body are pretty real,” said CEO Mark Toland. “The robot comes in and what we call ‘democratizes’ vessel size.”

MMI’s initial Food and Drug Administration authorization, a de novo classification in 2024, made the Symani system the first surgical robot available in the U.S. for reconstructive microsurgery. An additional FDA clearance in December 2025 expanded the system’s capabilities to include soft tissue dissection.

The Symani system has been used to transplant skin, bone and tissue from one part of the body to another after traumatic injury. Procedures to treat lymphedema, an abnormal buildup of lymphatic fluid that can occur after cancer treatments, are a primary focus for the robot's specialized technology.

“We're doing breast reconstruction. We’re doing lymphatic repair across the body. We're doing transplants for patients who have suffered from extremity trauma, typically from manufacturing accidents,” said Toland. “We've even done wounded warriors who are coming back from battle. So it's a pretty rewarding technology, because it's enabling physicians to reconstruct the body in a way that they may not have been able to do with their human hands before.”

Microsurgery is a technique that is performed under an operating microscope during open surgery. With miniaturized instruments — the world’s smallest, according to the company — MMI’s robot addresses the physical challenges of procedures that require the steadiest touch. As the surgeon manipulates handheld controllers, the system filters out tremors and translates the intentional hand and wrist motions into scaled-down robotic movement of the instruments. The surgeon selects the motion scaling factor, from 7x to 20x.

The motion scaling feature differentiates Symani from Intuitive’s da Vinci robot and other soft tissue surgical platforms coming to market, said Bohdan Pomahac, a surgeon who leads MMI’s PRECISE post-market trial.

“What's very unique about this technology is the scaling,” said Pomahac, chief of plastic and reconstructive surgery and director of the face transplant program at Yale Medicine. “The advantage of the system and technology is that it's intended to be a high precision tool.”

That level of control enables surgeons to perform procedures that otherwise might not be feasible, Pomahac said. The PRECISE study will follow up to 455 patients to evaluate the robot’s performance in reconstructive and lymphatic repair procedures.

With Symani designed for open surgery across multiple specialties, Toland sees the robot’s market opportunity as vast. Forty million open surgical procedures are performed yearly in the U.S., four times the number of laparoscopic procedures, he said.

Most da Vinci procedures are in the abdomen and pelvis, typically focusing on large organs like the prostate, gallbladder and colon. The Symani system, by contrast, is used in microsurgery throughout the body, Toland said. 

“Laparoscopic stuff is in the belly,” said Toland, a medtech industry veteran who joined MMI in 2021. “We’re kind of doing all the other stuff, which is a great situation to be in, because you're really not ever competing against the 800-pound gorilla, being Intuitive.”

Microsurgery, he added, “includes a lot of different applications associated with putting the body back together.”

Reconstructive head and neck procedures for cancer patients are a more recent area of expansion for MMI in the U.S. The Symani robot has also supported cochlear implants, ophthalmic procedures, intracranial brain surgery, liver transplantation and spine tumor removal.

“We're trying to move the line of complexity for all physicians who want to do microsurgery, or supermicrosurgery,” Toland said. Surgeons have used the robot in about 3,000 procedures to date.

Alzheimer’s initiative

In May 2026, the company announced that Symani was used to treat a patient with Alzheimer’s disease in the REMIND study. The trial will evaluate whether restoring lymphatic drainage pathways in deep cervical lymph nodes can help clear neurotoxins that researchers believe contribute to the progression of the disease.

The multi-center, FDA-approved investigational device exemption study will enroll 15 patients who will be followed for 12 months after the procedure.

“This isn’t just surgery,” said Toland. “This is pushing the boundaries of medicine.” 

MMI has six clinical trials that are enrolling patients in 2026. “We have clinical trials for all of our applications, to show that the robot is better than the human hand,” Toland said.

MMI is backed by prominent investors that include Fidelity Management and Research, Andera Partners, Deerfield Management, RA Capital and Wellington Partners. All told, the company has raised $270 million to support Symani’s development, said Toland, who is a managing director at BioStar Capital, another MMI investor.

The company has offices in Jacksonville, Florida, and Pisa, Italy, where it was founded in 2015 and where it manufactures the Symani systems.

For now, MMI remains the only company with a commercially available robot in the U.S. designed specifically for microsurgery, though a potential competitor, Microsure, could be on the horizon with its MUSA-3 system, which recently received the CE mark in Europe.

“We’re the only crazy ones out there right now,” said Toland.

Olympus, with the world’s largest installed base of endoscopy systems, is making a push into robotic gastrointestinal surgery as part of a broader transformation initiative under new CEO Bob White.

The Tokyo-based endoscopy giant co-founded Swan EndoSurgical in 2025 to develop an endoluminal robot to treat lesions and cancers in the GI tract and recently formed a partnership to distribute EndoRobotics’ endoscopic robotic devices for gastroenterology.

Keith Boettiger, executive officer and head of the gastrointestinal solutions division, delved into the company’s robotics strategy in an interview with MedTech Dive. 

This interview has been edited for length and clarity. 

MEDTECH DIVE: With the Swan EndoSurgical initiative and EndoRobotics distribution deal, what is Olympus building in surgical robotics?

KEITH BOETTIGER: We're really taking a two-pronged approach when it comes to endoluminal robotics. These two things are definitely related and connected, but we see one as longer term.

With Swan EndoSurgical, we're investing in platform innovation that has the potential to fundamentally change how endoscopic procedures are performed. Then, in parallel, the partnership with EndoRobotics allows us to bring a more immediate solution to the market that helps physicians perform more complex therapies.

If you follow the disease trends around colorectal cancer, you'll see that it's the second leading cause of cancer globally today — close to 900,000 deaths per year — and importantly, the incidence is increasing with the younger population.

Procedures like endoscopic submucosal dissection, or ESD, are growing globally as well, with about 200,000 cases done per year. The vast majority of those are concentrated in Asia, so the gap is really evident in the U.S., where adoption rates for ESD are limited. It's a very technically demanding procedure. It takes probably 200 to 300 procedures to achieve proficiency, which creates a pretty big barrier to scale.

That's where we see robotics coming in, enabling technologies that help to democratize those procedures and really improve access to care for patients. Robotics will make the learning curve easier. It'll make these complex procedures more repeatable, and then we'll be able to expand significantly around the globe.

How will Swan’s platform compare to other robots in endoscopic procedures?

There's a number of companies that are doing interesting work in this space, and it's a positive sign that there's real momentum building around endoluminal robotics. That said, it’s still really early, and when we survey the landscape, most approaches are focused on addressing specific procedural challenges. I'd say our perspective is slightly broader.

We're focused on building a platform that integrates into the overall endoscopy ecosystem and can scale against multiple indications over time. The solution that we're working on will be a scalable platform and slightly broader than what we see in the market today.

What indications are the initial focus for your robot?

We're prioritizing high volume, high impact GI interventions first. I mentioned ESD earlier. That's our initial focus. We continue to do research and work to identify what would be our next indications after that.

If you look at the soft tissue procedures that are done around gastric surgery today, we think over time, with an endoluminal robot, we'll be able to shift more and more of those procedures to less invasive, less painful procedures for patients, where you can use an endoscope to see and identify and diagnose issues, reach those issues with that endoluminal robot, and then treat.

We're moving toward a model where physicians can detect, diagnose and treat disease in a single setting. Given the rise of diseases like colorectal cancer and the push toward earlier, less invasive intervention, this has the potential to fundamentally change outcomes and reduce the need for surgery in the long term.

How will patients benefit if more care shifts to endoscopic procedures enabled by the endoluminal robot?

There's millions of colon and gastric surgeries performed annually worldwide. Advanced endoscopic procedures, ESD, are just a small fraction of that volume. Our focus is to close that gap by improving maneuverability and enabling more precise, repeatable interventions. Then we can start to reduce the dependence on operator skill and start to expand access.

When I think about innovation, and about bringing new products in medtech, I always think about how we can improve care for the patient and improve access to care for patients. There’s endoscopists doing amazing things around the globe, but a lot of that skill set is unique to those individuals. When you start to bring endoluminal robots into the market, you really start to democratize the ability to do those procedures, and ultimately that's best for patients. 

We think more procedures over time will be done with an endoluminal robot, and that'll start to reduce the number of laparoscopic and open surgical procedures that are happening in the world.

Olympus has been working to resolve three warning letters from the Food and Drug Administration and an FDA import ban on some devices manufactured in Japan. Where do those efforts stand?

We continue to work openly with the FDA to have our warning letters and the import alerts lifted as soon as we possibly can. We continue to build our quality transformation work, and we have a strong focus on further strengthening the systems and processes within Olympus, including critical areas like endoscopic reprocessing.

Ultimately, we see that foundation as essential for maintaining safety, consistency and trust across all of our business. Overall, we have a really strong focus on patient safety and making sure that our systems and processes are in place to meet the regulatory requirements. We openly and transparently work with all the regulators to ensure that we're compliant.