Intuitive Surgical (NSDQ:ISRG) isn’t resting on its laurels when it comes to the surgical robotics field that it dominates. The Sunnyvale, Calif.­–based company is seeking to stay competitive through technologies including computer-controlled navigated robotic catheters, contrast agents to improve imaging during procedures, and intelligent surgical interfaces.

That was a big message that hundreds of attendees heard during Intuitive Surgical CEO Gary Guthart’s evening keynote discussion on Dec. 11 at DeviceTalks West in Orange County, Calif.

“Payers are constraining total costs per treatment episode, so we have to do all of this innovation and lower the total cost to treat per patient episode,” Guthart said. “There are a bunch of people who think that the way to do that is to make things as cheaply as possible. Product cost matters, but innovation is going to be a lot more important.”

(DeviceTalks returns June 5–6, 2019 in Boston – now co-located with the Robotics Summit & Expo.)

Guthart showed off video and animations of some of Intuitive’s latest work.

For example, there was a computer-controlled navigated robotic catheter that was 3.5 mm in diameter with full sensing all the way down its length. It was shown performing a transbronchial biopsy of the lungs.

“The goal here is, ‘Can we get in there and do early detection?’” Guthart said. He added that the system has gone through clinical trials and is working its way through regulatory clearance. “You can imagine other things to do with it.”

The robotic system appeared to be an answer to 11-year-old Auris Health, formerly Auris Surgical Robotics. Auris already has FDA clearance for its Monarch robotic, endoscopic platform for therapeutic bronchoscopic procedures.

Guthart also touted the da Vinci SP robot-assisted surgery system and the expanded clearance Intuitive would like to achieve for the single-port device. Initially cleared by FDA in April 2014 for urological procedures, the system this year won an additional indication for procedures requiring very narrow access from a single small incision.

“This is a product that will enter the body through either a natural orifice, your mouth, or transanally or transvaginally,” Guthart said.

Its tube is an inch across and delivers fully articulating instruments: three that can manipulate things and one that’s a steerable endoscope. “You can imagine going inside the umbilicus, inside the belly button, and then fully rotating all the way around inside of the body. … If you’re trying to get better outcomes, then what you want to do is avoid making large incisions in people.”

Other work that Guthart showed off included use of contrast agents in tissues to help guide surgeons. For example, he showed how a contrast agent could alert a surgeon to an aberrant bile duct, a duct that branches off the main duct that the surgeon must ligate to avoid leakage.

“You wouldn’t have been able to see it without a contrast agent. And that leak is an extremely serious complication. It’ll re-hospitalize you for weeks, and then it’s a $100,000 event – let alone patient suffering. So the idea here is, ‘Can we show the surgeon more than what they can see with the naked eye?’ And we’re using contrast agents to do it,” Guthart said.

Intuitive is also focused on intelligent interfaces and smart use of data

“We really try to say, ‘How do we take the extraneous information out? How do we keep the noise level down, and highlight those things that really matter?’ … We want intelligent informatics. We are really, really concerned about overwhelming surgeons with data. There’s a lot of us working on data, a lot of us working on algorithms. That stuff’s really important, but pruning is really, really important. And it’s the thing that we really work hard on.”

New companies have emerged in recent years to compete with Intuitive Surgical in the surgical robotics field. But Guthart noted that it’s a tough business, that the level of detail and precision required to deliver surgical robotics products with quality consistency is very difficult.

“New entrants are coming. They’ll try new ideas. I think that folks will be interested in that. Some of them will be natural competitors. Some of them will be natural cooperators with us. We’ll see. We’ll see where they take it.”