"Is next week's robot slot open?"—The end of musical chairs as presented by J&J Ottava

"The robot is the table"

Monday afternoon in the doctors' office.

There, even before confirming surgical procedures, a more desperate and political "battle" is unfolding.

"I want to do this case with the robot, but there are no slots open..."
"Can you give me one urology slot? I have an emergency rectal cancer case."
"The OB/GYN department is occupying the robot room this week, so we have no choice but to use laparoscopy..."
"Our robot slot for the week after next is opening up; do you have a suitable case?"

Originally, surgical procedures should be chosen based on what is "best for the patient."

However, in many hospitals today, the final factor determining the surgical method is the "robot operating room reservation status," a logistics issue unrelated to medicine that is currently exhausting Japanese surgeons the most.

Even for cases where one is convinced that "a robot would allow for a safer, minimally invasive procedure," if there is no "robot slot" available in the hospital, one is forced to choose a conventional method.

Alternatively, after scrambling to compete with other departments for slots, staff are left running around in the finally secured robot room just to set up the massive machine.

We want to perform "better surgeries," not compete for "robot slots."

This indescribable sense of stagnation in the field is the true challenge currently facing the surgical world.

MD+DI's provocative essay: "Does J&J really need a robot?"

Amidst this, an article published on April 17, 2026, by Amanda Pedersen, a senior editor at the US medical device media outlet MD+DI, was excellent.

It posed the provocative question: "Does Johnson & Johnson (J&J) really need a surgical robot in the first place?"

J&J subsidiary Ethicon already dominates the world in the field of surgical instruments (staplers and energy devices).

They asked, "Why enter the robot market now, taking such risks," when they are already masters of the operating room without owning a robot?

The robot market until now has been a performance competition of, so to speak, "independent, high-function machines."

However, J&J is not going down that path.

What they aimed for with Ottava was not to sell robots, but to reset the current situation where robots dominate the operating room.

To reclaim the operating room from the inconveniences brought in by other companies' robots, and to make their own battlefield—the surgery itself—free once again.

That is the true reason they entered the market as a latecomer.

The true nature of the "structural friction" plaguing the clinical floor

Hani Abouhalka of J&J MedTech described the challenges currently facing robotic surgery as "Tension and Friction" in an interview with MD+DI.

The true nature of this "friction" binds the clinical floor across the following three layers.

・"Physical limitations" of building codes
Many existing robotic systems weigh approximately one ton.
Supporting this weight requires floor reinforcement work, and due to building codes and load-bearing issues, the "places where they can be installed" are physically limited.
This is the biggest factor forcing robots to be fixed in specific rooms.

・Operational rigidity created by "dedicated rooms"
As long as installation locations are limited, those rooms become sanctuaries known as "robot-dedicated rooms."
Once they become sanctuaries, staff movement is dictated by the massive base units, arms, and cables crawling across the floor, forcing anesthesiologists and nurses to move in unnatural ways.
This physical "obstruction" increases setup and teardown times.

・The despair of scheduling:
And the phenomenon occurring downstream of these structural constraints is the surgeons' "scramble for robot slots."
A game of musical chairs where surgery, urology, and obstetrics/gynecology fight over limited rooms. The true nature of the "access and scheduling barriers" cited by 69% of surgeons in J&J's survey is their exhaustion with the fact that robots are "tied to rooms by building constraints, excluding other surgical procedures."

A paradigm shift where "the operating table itself is the robot"

The "Unified Architecture" presented by Ottava is a highly logical answer from J&J to this structural "friction."

They redefined the robot not as a "machine brought into the room," but as "operating room furniture (infrastructure)."

Overcoming the load-bearing wall:
By integrating the four arms into the operating table, the independent, massive patient cart is eliminated.
This aims to liberate the operating room from the constraints of "specific rooms" that have undergone special reinforcement.

Restoration of movement paths:
Since the arms can be stored under the table when not in use, the bundles of cables disappear from the floor, allowing staff to regain their natural movement paths.

Twin Motion:
The table and arms work in tandem, automatically following patient positioning changes during surgery.
This eliminates the burden of interruption followed by re-docking caused by physical constraints.

The logic to dismantle Japan's unique "sectionalism"

In Japan, robots have been treated as "expensive treasures."
Because of this, "sanctuaries" known as robot-dedicated rooms were created, and the game of musical chairs between departments intensified.

From the perspective of hospital management, especially after the fiscal year 2026 medical fee revision, increasing the utilization rate of robot-equipped operating rooms is a top priority.

To achieve this, a paradoxical situation has emerged where "cases that don't necessarily require a robot" are being forced into the robot room, or "cases that do require a robot" are being turned away due to scheduling conflicts.

The "robotic operation in general-purpose ORs" that Ottava aims for has the potential to physically dismantle this sectionalism.

If the concept of a "dedicated robot room" disappears, each department can enjoy the benefits of the robot only when needed, within their usual operating room.

Department heads will no longer need to worry about adjusting schedules for the following week every weekend.
This is the vision of the robot as a "strategic infrastructure" that J&J is targeting.

To return the lead role to "surgeon judgment"

What J&J is aiming for with Ottava is not merely a victory in robotic functionality.

By integrating the robot into the infrastructure, they are attempting to dismantle the extraterritoriality of "room monopoly" that da Vinci created.

From the perspective of hospital management, Ottava is poised to become a tool that restores "room versatility" and maximizes turnover rates.

From the surgeon's perspective, it is a tool that restores the freedom to choose surgical procedures based solely on "patient condition" rather than "booking status."

The final answer to the question posed by MD+DI, "Does J&J need a robot?"

Perhaps it is that "to return the operating room to the surgeon's control, it was necessary to make the robot's presence disappear and turn it into infrastructure."

The era where the robot sits in the middle of the operating room as the protagonist is coming to an end.

What Ottava is trying to sell may be
the very design of freedom—a state where we are "not pushed around by the robot's convenience," which is something obvious yet something we have long lost.

Author Profile | Surgical Field Insider

Gastrointestinal surgeon / I specialize in robot-assisted surgery and have made it my life's work to bridge the gap between Japan's medical field and technological innovation.
I will be writing about the "realities" that cannot be discussed under my real name here on note.

References and Sources

• MD+DI: "Does Johnson & Johnson Even Need a Surgical Robot?" (April 17, 2026)