An eight-year-old girl lies in an operating room in Children's Hospital Boston, propped up on one side, ready for surgery. She had been complaining of pains in her side, and a scan revealed a blockage in her left kidney.

In most hospitals, she'd get a six-inch slice down her abdominal wall, giving surgeons access to her kidney during open surgery, and would then spend four to five days recovering in the hospital. But this Monday morning she is about to undergo a robotic surgical procedure. In about three hours, she'll leave the operating room with a one-inch incision covered by a regular Band-Aid. She'll most likely return home the next day.

Surgeon Hiep Nguyen, a specialist in pediatric urology and robotic surgery, says the da Vinci robot has greatly expanded the complexity of the minimally invasive surgeries he can perform. It offers three-dimensional vision and articulated tips on the surgical tools that go inside the patient, which allows for smaller, finer movements than traditional laparoscopy. At a recent talk in Boston, Nguyen described complex reconstructive surgeries--fashioning a urethra from an appendix, for example--that just a few years ago would have required open surgery.

But after the talk, rather than expressing wonder or hope over these new surgical possibilities, many of the surgeons, scientists, and engineers in the audience focused on their frustration with the technology. The group had varying concerns--if and when the robot will outperform traditional laparoscopy; the learning curve associated with the technology; whether it allows less experienced surgeons to perform more complex surgeries. But everyone agreed on two points. The technology isn't advancing fast enough or dropping in price quickly enough. "The system is very expensive because only one company makes it now," says Nguyen. "We need more competition to drive down price."

The da Vinci robot is made by California-based Intuitive Surgical, the only big player in the robotic surgery arena (some other companies make robotic systems for eye and brain surgery). The company, founded in 1995, adapted technology originally developed for long-distance surgery--an application quickly abandoned--and created a broad patent portfolio around robotic surgery. It bought up early competitors, garnering Food and Drug Administration approval for its surgical system in 2000. And that's largely where things have stood for the last decade.

"People have been disappointed in how slowly the robot is evolving," says Jon Einarsson, a gynecological surgeon at Brigham and Women's hospital in Boston. "There hasn't been a lot of evolution or improvement in the articulation at the tip of the instrument." Some innovations that Einersson would like to see are haptics--a sense of touch that can be translated from the robotic instruments to the surgeon--and a way to incorporate data from magnetic resonance imaging.

Some surgeons and engineers argue that a much smaller and cheaper device could provide the same visual advantages and flexibility, but that no one has been able to move this forward. "The da Vinci robot looks like it was designed to make automobiles--it's great big clunky gear," says Kirby Vosburgh, an engineer with the Center for Integration of Medicine and Innovative Technology (CIMIT), in Boston, who previously designed medical technology for General Electric.