AI-Enhanced Surgery: A Business Analysis of Intuitive Surgical and Johnson & Johnson’s OTTAVA System

Introduction

The integration of artificial intelligence (AI) into surgical robotics is transforming the operating room, offering unprecedented precision, efficiency, and improved patient outcomes. The global surgical robotics market is projected to reach $765.12 billion by 2035, driven by advancements in AI-driven systems that enhance surgical decision-making and reduce complications. Two key players, Intuitive Surgical with its da Vinci Surgical System and Johnson & Johnson with its OTTAVA Robotic Surgical System (evolved from Verb Surgical), are leading this revolution. This article provides a comprehensive business analysis of their contributions to AI-enhanced surgery, focusing on their software, applications, ethical considerations, and market impact as of June 2025.

The Role of AI in Surgical Robotics

AI-enhanced surgical robotics combine advanced imaging, machine learning, and robotic precision to support surgeons in performing complex, minimally invasive procedures. These systems analyze real-time data, provide predictive insights, and enhance training, leading to reduced recovery times and fewer surgical errors. Applications include urological, gynecological, and general surgeries, where precision is paramount. However, ethical challenges such as transparency in AI-driven decisions, patient safety, data privacy, and equitable access must be addressed to ensure trust and widespread adoption. Intuitive Surgical and Johnson & Johnson are tackling these challenges while pushing the boundaries of surgical innovation.

Intuitive Surgical and the da Vinci Surgical System

Overview and Features

Founded in 1995 and headquartered in Sunnyvale, California, Intuitive Surgical is the global leader in robotic-assisted surgery. Its da Vinci Surgical System is a multi-port robotic platform that integrates advanced robotics, 3D high-definition visualization, and AI enhancements to support minimally invasive procedures. The latest model, da Vinci 5, launched in 2024 with FDA 510(k) clearance, is used in over 1 million procedures annually across 4,400 hospitals worldwide, primarily for prostatectomies, hysterectomies, and colorectal surgeries.

Key features include:

• Case Insights: An AI-powered tool that analyzes surgical data, kinematic movement, and video to provide objective feedback, improving surgeon performance and patient outcomes.
• Force Feedback Technology: Enables surgeons to sense tissue resistance, reducing applied force by up to 43% and minimizing tissue trauma, as shown in studies like Awad et al. (2024).
• Telepresence: Facilitates real-time case observation and mentoring, reducing the learning curve for new surgeons, as evidenced by a SAGES 2024 study.
• SimNow 2: Offers over 65 AI-driven simulation exercises for skill acquisition, improving proficiency, as demonstrated by Raison et al. (2021).
• Computing Power: Boasts 10,000x the computing power of the da Vinci Xi, enabling advanced AI applications.

Applications in Surgery

The da Vinci system’s AI capabilities enhance surgical workflows through:

• Procedure Analysis: Case Insights identifies patterns in surgical data to optimize techniques and reduce complications.
• Predictive Guidance: Real-time data processing highlights critical anatomical structures, improving precision in procedures like tumor resections.
• Training and Simulation: AI-driven simulators reduce learning curves, with trainees showing improved performance metrics on the GEARS Scale.

For example, in urological surgeries, AI-enhanced vision and force feedback enable precise tumor resection, minimizing damage to surrounding tissues. The system’s analytics also support quality improvement initiatives, reducing hospital readmissions.

Ethical Considerations

Intuitive Surgical addresses ethical challenges through:

• Transparency: Case Insights provides explainable AI outputs, ensuring surgeons understand recommendations, fostering trust and accountability.
• Patient Safety: FDA approvals and rigorous testing ensure safety, though critics note the need for long-term outcome studies compared to laparoscopic surgery.
• Data Privacy: Compliance with HIPAA and GDPR protects patient data through secure cloud storage and encryption.
• Equitable Access: High system costs ($1.5–2 million per unit) limit access, particularly in underserved regions. Intuitive Surgical is exploring financing models and refurbished systems to address this.

Challenges include ensuring unbiased AI algorithms across diverse patient populations and addressing criticisms of proprietary software limiting physician customization, as noted in Wikipedia’s da Vinci entry.

Business Analysis

Intuitive Surgical dominates the surgical robotics market, with a forecasted revenue of $2.41 billion in 2025, projected to reach $7.28 billion by 2032. In Q1 2025, the company reported a 19% revenue increase to $2.2 billion and a 21% rise in earnings per share to $1.81, driven by strong da Vinci 5 demand (MD+DI, 2024). The company hired 550 employees in Q2 2024, with half supporting manufacturing to meet demand.

Strategic initiatives include:

• Innovation: The da Vinci 5’s AI and force feedback features maintain a competitive edge.
• Training Programs: Over 70,000 surgeons trained globally enhance adoption.
• Global Expansion: Expansion into Asia-Pacific and other emerging markets drives growth.

However, competition from emerging players like Johnson & Johnson and high costs pose challenges. Intuitive Surgical’s extensive patent portfolio and established ecosystem provide a strong competitive moat.

Metric Details

Technology da Vinci 5: AI-driven Case Insights, force feedback, telepresence

Healthcare Application: Over 1M procedures/year in urology, gynecology, general surgery

Business Model: System sales, instruments, services; $2.2B revenue in Q1 2025

Market Impact: Dominates surgical robotics, contributes to $765.12B market by 2035

Johnson & Johnson and the OTTAVA Robotic Surgical System

Overview and Features

Verb Surgical, a joint venture between Google’s Verily Life Sciences and Johnson & Johnson’s Ethicon, was established in 2015 to develop a next-generation robotic surgery platform. Acquired fully by Johnson & Johnson in 2020, its technology evolved into the OTTAVA Robotic Surgical System, designed to transform the surgical experience with innovative architecture, clinically relevant features, and trusted Ethicon instrumentation. As of June 2025, OTTAVA is in clinical trials, with first cases completed for gastric bypass surgery.

Key features include:

• Data Analytics: Integrates with J&J’s surgical data for AI-driven predictive analytics and planning.
• Advanced Visualization: Likely incorporates AI-enhanced imaging for clearer intraoperative views.
• Cloud Connectivity: Enables real-time data processing and remote collaboration.
• Modular Design: Supports laparoscopic and open soft-tissue surgeries, offering flexibility.

Applications in Surgery

OTTAVA’s AI capabilities are expected to include:

• Real-Time Decision Support: AI analyzes intraoperative data to provide predictive insights, such as identifying critical structures.
• Surgical Analytics: Post-operative analysis optimizes future procedures.
• Remote Collaboration: Cloud-based AI enables remote surgical assistance, potentially expanding access to expertise.

While specific applications are limited due to its pre-market status, OTTAVA targets general surgery procedures like gastric bypass and hiatal hernia repairs, aiming to address scheduling and access barriers.

Ethical Considerations

Johnson & Johnson addresses ethical challenges through:

• Transparency: Emphasizes explainable AI to ensure surgeons understand recommendations.
• Patient Safety: Collaborates with Ethicon’s expertise to meet FDA standards, with IDE approval in 2024.
• Data Privacy: Complies with HIPAA and GDPR, leveraging Google’s cloud security for data protection.
• Equitable Access: Aims to reduce costs compared to da Vinci, though affordability details are pending.

Challenges include managing privacy risks associated with cloud-based AI and ensuring unbiased algorithms, given the reliance on large-scale data.

Business Analysis

Johnson & Johnson’s MedTech division, which includes OTTAVA, reported $85.2 billion in overall company revenue in 2024, with surgical robotics as a growing segment. The OTTAVA system, still pre-revenue, benefits from J&J’s extensive resources and Verily’s $3.5 billion in funding. The 2020 acquisition of Verb Surgical strengthened J&J’s position in surgical robotics, positioning OTTAVA to challenge Intuitive Surgical upon market entry, expected post-2026.

Strategic initiatives include:

• Partnership Synergy: Combines Google’s AI expertise with J&J’s surgical legacy.
• Market Entry: Targets a 2025–2026 launch with FDA de novo clearance.
• Ecosystem Development: Builds a digital surgery ecosystem with integrated analytics and training.

Challenges include overcoming Intuitive Surgical’s dominance, navigating FDA approvals, and addressing privacy concerns related to Google’s involvement.

Metric Details

Technology OTTAVA: AI-driven analytics, cloud-connected, modular design

Healthcare Application General surgery (gastric bypass, hernia repairs) in clinical trials

Business Model Pre-revenue, backed by J&J and Verily

Market Impact Poised to contribute to $765.12B surgical robotics market by 2035

Comparative Analysis

• Market Presence: Intuitive Surgical dominates with over 1 million annual procedures and 4,400 installed systems, while OTTAVA is in clinical trials, targeting market entry.
• Technological Focus: da Vinci 5 offers mature AI features like Case Insights, while OTTAVA’s AI capabilities are promising but less defined.
• Business Strategy: Intuitive Surgical emphasizes innovation and training, while J&J leverages its medical device portfolio and Google’s AI expertise.
• Ethical Approach: Both prioritize transparency and safety, but OTTAVA’s cloud-based AI raises additional privacy concerns.

Challenges and Future Prospects

AI-enhanced surgery faces challenges like high costs, regulatory hurdles, and ensuring unbiased algorithms. Both companies address these through compliance and transparency, but equitable access remains a concern. Intuitive Surgical is poised to maintain leadership with da Vinci 5, while OTTAVA’s market entry could disrupt the landscape. Future advancements may include autonomous surgical tasks and enhanced augmented reality.

Conclusion

Intuitive Surgical’s da Vinci Surgical System and Johnson & Johnson’s OTTAVA system are driving the evolution of AI-enhanced surgery. Intuitive Surgical’s established dominance, with mature AI features and strong financial performance, contrasts with OTTAVA’s emerging potential as a flexible, cloud-connected platform. As the surgical robotics market grows toward $765.12 billion by 2035, both companies’ focus on ethical AI will shape a future of precise, efficient, and equitable surgical care.

Key Citations

• Intuitive Surgical da Vinci 5 Product Page
• Intuitive Surgical da Vinci Surgical System Overview
• Johnson & Johnson MedTech Surgical Robotics
• Johnson & Johnson MedTech OTTAVA System Details 2023
• Johnson & Johnson OTTAVA FDA Exemption 2024
• Intuitive Surgical da Vinci System Revolutionizing Surgery
• da Vinci Surgical System Wikipedia Entry
• Intuitive Surgical da Vinci 5 Launch Performance 2024
• Intuitive Surgical CEO on da Vinci 5 and Future Robotics