Robotic surgery: who will be the next top dog? - Gadgets Price
Robotic surgery: who will be the next top dog?

Intuitive Surgical, a pioneer of robotic surgery, celebrated a major milestone this week: The number of robotic-assisted procedures performed worldwide using the da Vinci surgical system has surpassed 10 million.

Approved by the FDA in 2000, there are nearly 70 representative clinical applications for da Vinci Systems, intuitively noted, spanning clinical specialties including urology, gynecology, thoracic surgery, general surgery, and transoral surgery.

“Surgeons’ use of da Vinci surgical systems in more than 10 million procedures reflects the benefits that high-quality, minimally invasive surgery provides to patients, families and the healthcare systems that care for them,” said Intuitive CEO Gary Guthart. “While we are proud of this milestone and momentum, this is truly a time to look at what we have learned from these 10 million procedures and ask ourselves how we can apply that to improve the field of surgery in the years to come.”

Intuitive said it plans to continue its deep and broad experience with these procedures and put them to work for customers in the form of personalized surgical training programs, continued innovation in systems, instruments and accessories, and an extensive ecosystem of customer service. , evidence development , and digital support and solutions.

Intuitive’s latest, fourth-generation robotic surgical systems (pictured below), the da Vinci X, Xi, and the single-port system have continued to evolve through technology, as have the addition of instruments, features, and digital support. The company’s innovation in robotic-assisted technology includes the development of the Ion Endoluminal System designed to enable robotic-assisted lung biopsy.

Image Courtesy of Intuitive SurgicalIntuitive surgical gen 4 robotic surgery systems

Competition for robotic surgery

The milestone of 10 million procedures comes as Intuitive faces increasing competition from Medtronic, Johnson & Johnson, Vicarious Surgical, Asensus Surgical and others. Although the bigger challenge for all these companies is not so much to tackle intuitively, but to grow the use of robotic surgery in general. While there has been considerable hype surrounding the technology, the fact remains that only about 2% of procedures performed worldwide are currently performed using robotic-assisted surgery (particularly in the US market, that percentage is closer to 10%) .

“I’m often asked, ‘Well Bob, what do you think about competing in this 2% space?’ And I’m like, ‘You’re missing the point.’ This is about 98%,” said Bob White, president of the medical-surgical portfolio at Medtronic, at a 2018 investor meeting at which the company officially introduced its Hugo robotic-assisted surgery system for the first time. “This is about 98% of the procedures that aren’t done today. That’s about increasing market access and that’s something we’re doing very well.”

According to Verified Market Research, the global robotic surgery market size was estimated at $6.1 billion in 2020 and is expected to reach $22.27 billion by 2028, growing at a compound annual growth rate of 17.60% from 2021 to 2028. numbers represent the entire robotic surgical market, including orthopedic systems such as Stryker’s Mako and Zimmer Biomet’s Rosa. However, this article aims to focus on the opportunities in robotic soft tissue surgery.

Medtronic received CE Mark for its Hugo robotics-assisted surgery system in October and recently obtained a Health Canada license to use Hugo in urologic and gynecological procedures. Hugo is also approved in Australia for urological procedures.

Image Courtesy of MedtronicRobotic Surgery - Medtronic Hugo Robotic Assisted Surgical System

During Medtronic’s Q2 2022 earnings call Tuesday, CEO Geoff Martha revealed that during the limited release phase of the robotics platform, the company has encountered a number of supply chain and initial manufacturing challenges, meaning Hugo’s fiscal year sales fell below target. will come true. Martha said the company is focused on solving those problems and ensuring that initial surgeon experiences with the technology are positive.

“We’re not on schedule, but we’re not off track,” said Martha. “And while we’re disappointed in the revenue growth of this important program, we’re confident we have visibility into the solutions we need to be successful and optimize the customer experience.”

While sales this fiscal year are likely to fall below Medtronic’s $50 million to $100 million target, Martha said the company still expects revenue for fiscal 2022 to be in double digits, with a sharp increase. in fiscal year 2023.

He added that demand for robotic-assisted surgery remains high, surgeons continue to do business, the order pipeline continues to grow and Medtronic is on track to begin a trial of research equipment waiver soon in the United States. The company has also heard from the first surgeons to use Hugo in the clinical setting that they believe the system addresses the costs and barriers to use that have held back the growth of robotic surgery to date, Martha said.

“We remain confident in the success of this program and we believe we are poised to meaningfully expand the soft tissue robotics market and drive growth in the coming years,” said Martha.

Investors following this space are also excited about Johnson & Johnson’s Ottava robotic-assisted surgery system, which the company unveiled in 2020. However, J&J said in October during its third quarter earnings call that the robotic surgery platform has been delayed for about two years.

“We remain committed to developing a general surgery offering with Ottava,” said Joseph Wolk, Chief Financial Officer of Johnson & Johnson. “We posted a partial ongoing R&D charge of $900 million in the third quarter. The accounting for this levy allows for a first-in-human delay of approximately two years from our earlier projections of the second half of 2022, due to technical development challenges and COVID-19-related disruptions, including supply chain constraints that are experienced in all sectors. “

Another strong competitor in robotic surgery is Vicarious Surgical, which recently filed a pre-filing with the FDA for its system. The Waltham, MA-based company is developing surgical robots that combine human-like mechanical arms with virtual-reality technology that, according to the company, essentially serves to “transport surgeons inside the patient when performing minimally invasive surgery.”

Vicarious went public through a merger with D8 Holdings for a special acquisition in a $1.1 billion deal in April.

Nor would it be a fair overview of the robotic surgery market without acknowledging the presence of Asensus Surgical, formerly known as Transenterix. The company markets the Senhance Surgical System, described as a digital laparoscopic platform that goes beyond the typical surgical robotic system to provide surgical assurance through haptic feedback, eye-tracking camera control and 3D visualization. The FDA approved the Senhance system in 2017. Unfortunately, until now, demand for the Senhance Surgical System has been too weak to produce a positive gross profit for Asensus, said Cory Renauer, a long-term healthcare analyst.

Asensus reported plenty of good news on its third-quarter earnings call, the analyst noted, including the introduction of four new Senhance systems (three in Japan, one in Russia), and a 47% year-over-year increase in the number of lawsuits completed. . On the other hand, he also pointed out that the cost of goods sold still exceeds the revenue the company generates.

“This is usually what happens when a company has a product that no one really wants,” Renauer wrote.

Intuitively waits for competitors to substantiate claims

Intuitive expects to experience longer sales cycles and pricing pressures as competition in robotic surgery advances. if Guthart’s comments during the company’s third-quarter earnings call are an indication, but the CEO isn’t really shaking in his boots.

“So far, there’s been quite a few claims about what these new systems will do. And I think reality will tell, only time will tell,” Guthart said. “…I think evidence needs to be generated to back up those claims. And so far we don’t see anything resembling evidence, just a series of claims. So we’ll continue to serve our customers and do what we can to make sure they can achieve the quadruple goal, and we’ll see how other companies do.”

That fourfold goal he mentioned includes: better patient outcomes, better patient experience throughout the process, better healthcare team experience, and lower total treatment cost per patient episode.

Investors can also expect Intuitive to continue to innovate no matter what happens to the competitive landscape from now on.

“I think you can expect continued innovation from us,” Guthart said. “Or we think we need something immediately, we innovate at a pace where we think we can bring things that matter to the fourfold goal, not so much a ‘What’s our retail strategy?’ But more ‘Can we do something that changes the quadruple purpose or otherwise improves the customer experience?’ And that’s what we’re focusing on.”

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