U.S. Surgical Robotics Market

Intuitive’s U.S. da Vinci procedures rose 15% to about 2,012,000 in 2025, with general surgery up 18%, according to its full-year results of 14 January 2026; by the third quarter of 2026 U.S. growth had slowed to 10% while overseas procedures still grew 20%, MassDevice reported from the company’s results of 20 October 2026. America’s robotic surgery boom is maturing just as Medtronic and Johnson & Johnson bring the first serious rivals to market. The U.S. surgical robotics market covers the robotic systems, instruments and accessories, and service contracts that U.S. hospitals and ambulatory surgery centres (ASCs) buy for soft-tissue multiport, single-port, orthopaedic, neurosurgical and spine, endoluminal and bronchoscopy, and hair restoration robots. Douglas Insights sizes it at USD 8.12 billion in 2025, from 2.65 million robotic procedures at an average USD 3,064 of revenue a procedure, and at USD 18.6 billion in 2035, a revenue CAGR (compound annual growth rate) of 8.61%. The study sits in our surgical instruments coverage, and every figure follows the Douglas Insights research methodology.

Which U.S. surgical robot categories carry the value: multiport, orthopaedic or single-port?

Soft-tissue multiport robots carry 77.1% of U.S. surgical robotics value, USD 6.26 billion in 2025, because da Vinci runs most robotic prostatectomies, hysterectomies and hernia repairs. Single-port robots grow fastest, 17.0% a year to USD 1.44 billion.

Soft-tissue multiport leads at USD 6.26 billion because the da Vinci Xi and da Vinci 5 fleet is the installed base U.S. surgeons trained on, and each case pulls through instruments and accessories worth about USD 1,810, Intuitive’s 2025 results show. It grows 7.15% a year, below the market, because urology is already about 80% robotic in the U.S., Medtronic said on 17 February 2026, and because a second vendor puts pressure on instrument prices. Orthopaedic robots, USD 830 million, grow 10.6% a year as Stryker’s Mako, Zimmer Biomet’s ROSA and Smith+Nephew’s CORI follow knee and hip replacements into ASCs.

Endoluminal and bronchoscopy robots, USD 330 million, grow 15.5% a year because lung nodule biopsy with Intuitive’s Ion and J&J’s Monarch is still early in adoption; Ion procedures rose about 31% in the third quarter of 2026, Intuitive’s release states. Neurosurgical and spine robots, USD 330 million, grow 11.0% on Medtronic’s Mazor and Globus Medical’s ExcelsiusGPS. Single-port robots, USD 300 million, grow fastest, 17.0% a year, because one incision suits outpatient urology, colorectal and transoral cases and the da Vinci SP has no cleared U.S. rival. System-type values for 2035 sum to USD 18.7 billion, 0.58% above the headline. The worldwide picture is in our Surgical Robotics Market report.

What drives U.S. surgical robotics procedures up 9.60% a year to 2035?

U.S. robotic procedures grow 9.60% a year, from 2.65 million in 2025 to about 6.63 million in 2035, because general surgery conversion, outpatient joint replacement, rival platforms, lung biopsy and single-port cases add 11.0 points before restraints.

Revenue per procedure slips 0.90% a year, so all growth comes from more cases. Five drivers make up the gross volume leg.

General surgery conversion: 4.20 points

General surgery adds 4.20 points. U.S. general surgery procedures on da Vinci rose 18% in 2025, faster than the 15% total, Intuitive’s full-year release shows; cholecystectomy, hernia repair, colorectal and bariatric cases still run partly by open or laparoscopic surgery, which leaves room to convert.

Joint replacement moving to ASCs: 2.40 points

Orthopaedic and outpatient shift adds 2.40 points. The Centers for Medicare & Medicaid Services (CMS) will phase out the inpatient-only list over three years, removing 285 musculoskeletal procedures in 2026, and added 289 procedures to the ASC covered procedures list in its final rule of 21 November 2025, Ankura summarised. Surgery centres that win joint cases buy Mako, ROSA or CORI robots to compete.

Second and third soft-tissue vendors: 1.60 points

Competitive entry adds 1.60 points. The FDA cleared Medtronic’s Hugo for urologic procedures on 3 December 2025, Medtronic announced, and Cleveland Clinic performed the first U.S. commercial case on 17 February 2026. J&J announced De Novo authorization of OTTAVA for 10 general surgery procedures on 22 July 2026, MassDevice reported. Hospitals that held off for a second bid now buy.

Robotic bronchoscopy for lung nodules: 1.40 points

Lung biopsy adds 1.40 points. Intuitive’s Ion fleet reached 1,152 systems at 30 September 2026, up 21%, its third-quarter release states, most of them in the U.S., and every lung cancer screening programme that finds nodules sends patients to them.

Single-port and outpatient urology: 1.40 points

Single-port adds 1.40 points. Next-day discharge after one-incision prostatectomy and kidney surgery lets hospitals move cases to outpatient status, a Douglas Insights estimate. The five contributions, 4.20 + 2.40 + 1.60 + 1.40 + 1.40, give 11.0 points.

What holds back U.S. surgical robotics after da Vinci growth slowed to 10%?

Three headwinds remove 1.40 points from U.S. surgical robotics volume growth, leaving 9.60% a year: saturation in urology and gynaecology takes 0.60 points, capital budgets and tariffs 0.50 points, and training and operating room time 0.30 points.

Saturation is the largest brake. U.S. da Vinci procedure growth fell from 14% at the start of 2026 to 12% in the second quarter and 10% in the third, while overseas growth held at 20%, MassDevice reported; with about 80% of urologic abdominal surgery already robotic, the large specialties have little left to convert, so Douglas Insights removes 0.60 points.

Capital costs remove 0.50 points. Intuitive expected tariff costs of about 1.2% of 2026 revenue, Nasdaq reported on 24 March 2026, and hospital capital committees weigh a multimillion-dollar robot against imaging and beds; usage-based leases soften this, as 160 of 291 lease placements in the third quarter of 2026 were usage-based. Training removes 0.30 points: each new platform needs credentialed surgeons, trained scrub teams and operating room blocks long enough for a robotic case.

Where in the U.S. is surgical robotics money spent, and which region grows fastest?

The South spends the most on U.S. surgical robotics, USD 3.13 billion or 38.5% of 2025, Douglas Insights estimates, and also grows fastest, 9.00% a year to USD 7.40 billion by 2035, on population growth and new ASCs.

The South leads because Texas, Florida, Georgia and the Carolinas hold the largest share of U.S. hospital beds and the fastest-growing populations, and because large systems there, from Atrium Health to Duke University Hospital, were among the first to install Hugo, Medtronic’s release shows. The West, USD 1.83 billion, grows 8.80% a year as California and Arizona systems add outpatient orthopaedic robots. The Midwest, USD 1.71 billion, grows 8.20%; the Cleveland Clinic and Mayo Clinic run large robotic programmes, but population growth is slow. The Northeast, USD 1.46 billion, grows 8.00% from the most saturated base, where academic centres in Boston, New York and Philadelphia converted early. Regional values for 2035 sum to the USD 18.6 billion headline. Our worldwide Surgical Robotics Market report puts all of North America at USD 8.00 billion in 2025; this U.S. build, which starts from Intuitive’s 68% domestic revenue share, comes out 1.5% above that row, and the next edition of the worldwide model will be reconciled to it.

Which suppliers dominate U.S. surgical robotics now that Hugo and OTTAVA are cleared?

Intuitive dominates U.S. surgical robotics with about 84.3% of 2025 value, USD 6.84 billion, a Douglas Insights estimate from its 68% domestic revenue share. The top three, Intuitive, Stryker and Medtronic, hold about 92.9%.

All shares are Douglas Insights estimates because only Intuitive reports surgical robot revenue by geography. Intuitive’s figure applies the 68% domestic share in its 2025 Form 10-K to USD 10.06 billion of revenue. Stryker does not split Mako revenue; its 10-K cites more than 2 million Mako knee and hip procedures and a full U.S. launch of Mako Shoulder in the first quarter of 2026. Globus booked USD 141.0 million of enabling technologies sales worldwide in 2025, its results of 24 February 2026 show. The moat is the installed base: a hospital with trained surgeons and instrument contracts rarely switches, which is why Hugo and OTTAVA start with new accounts and second robots. The consumable stream behind these shares is sized in our Surgical Robotics Instrument Consumables Market report.

How much does a U.S. hospital pay per robotic case, and why is it falling?

A U.S. hospital paid an average USD 3,064 of surgical robotics revenue per procedure in 2025, Douglas Insights estimates: about USD 1,810 of instruments and accessories, plus system and service charges spread across cases. It falls 0.90% a year.

The bands are Douglas Insights estimates from company filings and hospital capital budgets. Instruments and accessories per case stayed flat at USD 1,810 in 2025, Intuitive’s results show, because new instruments offset discounts. Revenue per case still slips 0.90% a year to about USD 2,799 by 2035: busy systems spread their cost over more cases, orthopaedic and bronchoscopy cases earn less than a da Vinci case, and Hugo and OTTAVA give purchasing departments a second quote. Intuitive placed 291 systems under operating leases in the third quarter of 2026, 160 of them usage-based, its release shows, which turns a capital purchase into a per-case fee.

Which rules shape U.S. surgical robotics: FDA De Novo, 510(k) and CMS outpatient policy?

Two rule sets shape U.S. surgical robotics most: FDA clearance, through 510(k) for Hugo in December 2025 and De Novo for OTTAVA in July 2026, and the CMS 2026 outpatient rule that moves 285 joint and spine procedures off the inpatient-only list.

The FDA decides how fast rivals arrive and for which procedures. Hugo was cleared for prostatectomy, nephrectomy and cystectomy only, and Medtronic plans gynaecology and hernia repair next, its release states. OTTAVA’s De Novo authorization lists gastric bypass, gastrectomy, cholecystectomy, sleeve gastrectomy, hiatal hernia repair and five other procedures, and an inguinal hernia trial is under way, MassDevice reported. Each new indication opens a block of cases to a second vendor.

CMS decides where the cases happen. The calendar 2026 Outpatient Prospective Payment System (OPPS) and ASC final rule, released on 21 November 2025, raises payment rates by 2.6% and phases out the inpatient-only list over three years, Ankura summarised. As Medicare joint and spine cases move to outpatient departments and ASCs, robots follow them into smaller sites.

What if U.S. procedure growth keeps slowing: where does surgical robotics revenue land in 2035?

The U.S. surgical robotics market ends 2035 between USD 14.4 billion and USD 23.1 billion across our three cases, around a base of USD 18.6 billion. The pace of U.S. da Vinci procedure growth and rival pricing set the spread.

In the slower case U.S. da Vinci growth falls below 8% as urology and gynaecology saturate, and Hugo and OTTAVA win business mainly by discounting. In the faster case general surgery converts at its 2025 pace, the CMS outpatient shift pulls robots into hundreds of ASCs, and Ion lung biopsy becomes routine. One extra point of yearly procedure growth adds USD 1.76 billion to 2035 U.S. surgical robotics value; one point less removes USD 1.62 billion.

The 8.61% base rate sits below the 10.06% we use for worldwide surgical robotics because the U.S. is the most penetrated market and China and Europe convert from lower bases.

Douglas Exclusive: the U.S. Robotic Case Ledger

The U.S. Robotic Case Ledger is a Douglas Insights model, an estimate rather than an official register, built from 9 published sources: 6 company filings and releases and 3 regulator decisions of 2025 and 2026, tracking how U.S. robotic case growth is slowing.

The finding, a Douglas Insights estimate: the U.S. did 63.8% of the world’s da Vinci procedures in 2025 but took only 57.4% of new systems, and its procedure growth has fallen 5 points in nine months. The U.S. is moving from buying robots to using them more. We therefore set the U.S. procedure leg at 9.60% a year, below the 10% of the third quarter of 2026, and put more of the decade’s growth into orthopaedic, bronchoscopy and single-port cases than into da Vinci multiport.

How does the methodology turn 2.65 million U.S. robotic cases into USD 8.12 billion?

Our methodology multiplies 2.65 million U.S. robotic procedures in 2025 by an average USD 3,064 of revenue a procedure to reach USD 8.12 billion. Procedures come from six platform builds anchored on Intuitive’s U.S. count.

The model covers 6 system types, 4 Census regions, 3 revenue streams and 2 end users, and uses 86 data points, 19 sourced and 67 modelled. Arithmetic: 2.65 million procedures x USD 3,064 = USD 8.12 billion; USD 8.12 billion x (1.0960 x 0.9910)^10 = USD 18.6 billion. Procedures reach 2.90 million in 2026 and 6.63 million in 2035; revenue per procedure reaches USD 3,037 in 2026.

Two cross-checks agree. First, 68% of Intuitive’s USD 10.06 billion of 2025 revenue is USD 6.84 billion, 84.3% of our total, leaving USD 1.28 billion for orthopaedic, spine and other robots, consistent with Stryker’s and Globus’s disclosures. Second, about 2.01 million U.S. da Vinci cases at USD 1,810 of instruments each give USD 3.64 billion, about 53% of Intuitive’s U.S. revenue, in line with the 59.8% instruments share of its worldwide revenue once systems are added. AI tools help draft the text and automated checks test the arithmetic and links; the Douglas Insights research desk chooses the sources, builds the model and approves publication, as our editorial standards explain. Robots outside the operating room are sized in our Healthcare Robotics Market report.

Sources

1. Intuitive Surgical Intuitive announces fourth quarter and full year 2025 results (2026)
2. SEC EDGAR Intuitive third quarter 2026 earnings release (Form 8-K exhibit) (2026)
3. SEC EDGAR Intuitive Surgical Form 10-K, fiscal 2025 (2026)
4. Medtronic Medtronic announces FDA clearance of Hugo RAS for urologic procedures (2025)
5. Medtronic First U.S. surgery with Hugo RAS at Cleveland Clinic (2026)
6. SEC EDGAR Stryker Form 10-K, fiscal 2025 (2026)
7. Globus Medical Globus Medical fourth quarter and full year 2025 results (2026)

What counts in the U.S. surgical robotics market, and what is excluded?

The U.S. surgical robotics market counts what U.S. hospitals and ASCs spend on surgical robot systems, instruments and accessories, and service. Implants, navigation-only systems without robotic arms, catheter robots for angiography and training simulators are excluded.

The by-system-type split covers soft-tissue multiport, single-port, orthopaedic, neurosurgical and spine, endoluminal and bronchoscopy, and hair restoration and other robots; the by-revenue-stream split covers systems and leases, instruments and accessories, and service; the by-end-user split covers hospitals and ambulatory surgery centres; the by-region split covers the South, West, Midwest and Northeast. Catheter-steering robots are sized in our Robotic Angiography System Market report.