Maria Shepherd, President and Founder, Medi-Vantage09.07.18
First, Intuitive Surgical (IS) was developing procedures in laparoscopy, prostatectomy, and hysterectomy. Many of us who had presented other, non-robotic medical devices to the Value Analysis Committee said it couldn’t be done; robots and their accessories could not be sold at the huge premium IS was demanding. Scoff no more. IS has had four years of profitable growth, and analysts1 think this will continue into the foreseeable future (Table 1). Further, IS is planning to expand into other specialties.
Table 1: Global Cumulative Number of Installed da Vinci Systems1,2
Why This Is Important
Let no sector be left untouched. Many are tossing their proverbial hats into the surgical robot ring. The CorPath GRX from Corindus is a robotic system designed for interventional percutaneous coronary interventions. It comes with an operating station that provides protection from fluoroscopy for the interventional cardiologist and allows robotic-assisted controlled placement of guidewires, stents, and balloon catheters. This is significant because reducing the cardiologist’s exposure to radiation, especially during long procedures, has become an issue for the American College of Cardiology.3
Others include the Monarch Platform from Auris Health, a company planning to transform endoscopy, starting with the treatment of lung cancer using therapeutic bronchoscopy procedures. Medrobotics has developed the Flex Robotic System for robot-assisted visualization and surgery in the larynx, oropharynx, and hypopharynx. Many more surgical robots are in the planning phases (Table 2).
Table 2: Estimated Global Sales for Surgical Robotics Systems4
What Is the Value Proposition?
Surgical trends support less invasive approaches. Just as open abdominal procedures were transitioned to laparoscopic procedures in the 1990s, the next surgical evolution will have surgeons operating through the smallest incisions possible to make the procedure less painful and invasive for the patient. Possible improvements in clinical outcomes could come from a reduction in infections, faster surgical patient recovery time (e.g., possibly enabling same day gall bladder surgery), and a decline in hospital length of stay.
Further, as robotics manufacturers invest more in human factors research, easily reproducible surgical outcomes could come about without such a deep learning curve.
The current paradigm of non-robot-assisted surgeries depends entirely upon each individual physician’s manual capabilities. With the advent of robotics, however, surgeons won’t be made obsolete. Instead, converted physicians see the robot as a new tool in their armamentarium, providing them the confidence required to perform difficult procedures. Robotics can remove or minimize repetitive tasks that can transform a surgery into a multi-hour marathon. In the future, autonomous robotic surgery (surgery performed at a distance, not through direct contact between the surgeon and the patient) holds the promise of greater efficacy, safety, and a brave new world of optimized surgical techniques.
For example, the Smart Tissue Autonomous Robot (STAR) may suture with a greater level of consistency than the most experienced surgeon, according to a report published in Science Translational Medicine5 regarding soft tissue surgery. Technologies like STAR, however, cannot function without a surgeon to strategize on the most appropriate surgical plan, make the first incision, remove the bowel, and set up the anastomosis before engaging the robots’ autonomous suturing algorithm. In an article in Wired,6 the analogy to autonomous cars was made, comparing cruise control and automated parallel parking to the STAR system.
Autonomous surgery as the ultimate goal is logically the greatest driver of robotic-based surgery. In a randomized trial in Korea,7 study outcomes suggested that surgical and functional outcomes were improved using robot-assisted surgery as compared to laparoscopic or open surgery when comparing blood loss and urinary continence.
As the surgical robotics systems from TransEnterix and Titan Medical chase the laparoscopy space, IS is depending upon its large global footprint, proving that its value proposition has legs outside of the U.S. In its 2017 annual report, IS cites strong growth (up 23 percent) in countries in Europe, as well as Japan, Korea, and China. At end-of-year 2017, the da Vinci Surgical System had an installed base of 4,409 systems, with 2,862 in the U.S., 579 in Asia, 742 in Europe, and 226 outside of these regions (Table 3).
Table 3: Percentage Breakdown of da Vinci Surgical System’s Installed Worldwide Base.
Robust Price Strategies Are Critical
Bringing new medical devices to market is expensive. A conjoint analysis can help medtech companies compare high-end features and the price premiums they can command.
The Medi-Vantage Perspective
In almost every strategy research project we manage, we start with a review of price, the most difficult of the four P’s of marketing (price, promotion, product, and place). Price is a critical component of a new product strategy to ensure medical device companies earn every penny a new, innovative technology can bring.
References
Maria Shepherd has more than 20 years of leadership experience in medical device/life-science marketing in small startups and top-tier companies. After her industry career, including her role as VP of marketing for Oridion Medical where she boosted the company valuation prior to its acquisition by Covidien/Medtronic, director of marketing for Philips Medical, and senior management roles at Boston Scientific Corp., she founded Medi-Vantage. Medi-Vantage provides marketing and business strategy as well as innovation research for the medical device industry. The firm quantitatively and qualitatively sizes and segments opportunities, evaluates new technologies, provides marketing services, and assesses prospective acquisitions. Shepherd has taught marketing and product development courses and is a member of the Aligo Medtech Investment Committee (www.msbiv.com). She can be reached at 855-343-3100, ext. 102, or at mshepherd@medi-vantage.com. Visit her website at www.medi-vantage.com.
Table 1: Global Cumulative Number of Installed da Vinci Systems1,2
Why This Is Important
Let no sector be left untouched. Many are tossing their proverbial hats into the surgical robot ring. The CorPath GRX from Corindus is a robotic system designed for interventional percutaneous coronary interventions. It comes with an operating station that provides protection from fluoroscopy for the interventional cardiologist and allows robotic-assisted controlled placement of guidewires, stents, and balloon catheters. This is significant because reducing the cardiologist’s exposure to radiation, especially during long procedures, has become an issue for the American College of Cardiology.3
Others include the Monarch Platform from Auris Health, a company planning to transform endoscopy, starting with the treatment of lung cancer using therapeutic bronchoscopy procedures. Medrobotics has developed the Flex Robotic System for robot-assisted visualization and surgery in the larynx, oropharynx, and hypopharynx. Many more surgical robots are in the planning phases (Table 2).
Table 2: Estimated Global Sales for Surgical Robotics Systems4
What Is the Value Proposition?
Surgical trends support less invasive approaches. Just as open abdominal procedures were transitioned to laparoscopic procedures in the 1990s, the next surgical evolution will have surgeons operating through the smallest incisions possible to make the procedure less painful and invasive for the patient. Possible improvements in clinical outcomes could come from a reduction in infections, faster surgical patient recovery time (e.g., possibly enabling same day gall bladder surgery), and a decline in hospital length of stay.
Further, as robotics manufacturers invest more in human factors research, easily reproducible surgical outcomes could come about without such a deep learning curve.
The current paradigm of non-robot-assisted surgeries depends entirely upon each individual physician’s manual capabilities. With the advent of robotics, however, surgeons won’t be made obsolete. Instead, converted physicians see the robot as a new tool in their armamentarium, providing them the confidence required to perform difficult procedures. Robotics can remove or minimize repetitive tasks that can transform a surgery into a multi-hour marathon. In the future, autonomous robotic surgery (surgery performed at a distance, not through direct contact between the surgeon and the patient) holds the promise of greater efficacy, safety, and a brave new world of optimized surgical techniques.
For example, the Smart Tissue Autonomous Robot (STAR) may suture with a greater level of consistency than the most experienced surgeon, according to a report published in Science Translational Medicine5 regarding soft tissue surgery. Technologies like STAR, however, cannot function without a surgeon to strategize on the most appropriate surgical plan, make the first incision, remove the bowel, and set up the anastomosis before engaging the robots’ autonomous suturing algorithm. In an article in Wired,6 the analogy to autonomous cars was made, comparing cruise control and automated parallel parking to the STAR system.
Autonomous surgery as the ultimate goal is logically the greatest driver of robotic-based surgery. In a randomized trial in Korea,7 study outcomes suggested that surgical and functional outcomes were improved using robot-assisted surgery as compared to laparoscopic or open surgery when comparing blood loss and urinary continence.
As the surgical robotics systems from TransEnterix and Titan Medical chase the laparoscopy space, IS is depending upon its large global footprint, proving that its value proposition has legs outside of the U.S. In its 2017 annual report, IS cites strong growth (up 23 percent) in countries in Europe, as well as Japan, Korea, and China. At end-of-year 2017, the da Vinci Surgical System had an installed base of 4,409 systems, with 2,862 in the U.S., 579 in Asia, 742 in Europe, and 226 outside of these regions (Table 3).
Table 3: Percentage Breakdown of da Vinci Surgical System’s Installed Worldwide Base.
Robust Price Strategies Are Critical
Bringing new medical devices to market is expensive. A conjoint analysis can help medtech companies compare high-end features and the price premiums they can command.
The Medi-Vantage Perspective
In almost every strategy research project we manage, we start with a review of price, the most difficult of the four P’s of marketing (price, promotion, product, and place). Price is a critical component of a new product strategy to ensure medical device companies earn every penny a new, innovative technology can bring.
References
- Levy, T., Sun, N. (Analysts). Intuitive Surgical: da Vinci SP—Why Clinical Adoption Initially Could Be Slow? Wedbush Company Report. Sept. 24, 2017.
- Intuitive Surgical Investor Presentation Q3 2018.
- http://bit.ly/mpo180902
- http://bit.ly/mpo180906
- http://bit.ly/mpo180903
- http://bit.ly/mpo180904
- http://bit.ly/mpo180905
Maria Shepherd has more than 20 years of leadership experience in medical device/life-science marketing in small startups and top-tier companies. After her industry career, including her role as VP of marketing for Oridion Medical where she boosted the company valuation prior to its acquisition by Covidien/Medtronic, director of marketing for Philips Medical, and senior management roles at Boston Scientific Corp., she founded Medi-Vantage. Medi-Vantage provides marketing and business strategy as well as innovation research for the medical device industry. The firm quantitatively and qualitatively sizes and segments opportunities, evaluates new technologies, provides marketing services, and assesses prospective acquisitions. Shepherd has taught marketing and product development courses and is a member of the Aligo Medtech Investment Committee (www.msbiv.com). She can be reached at 855-343-3100, ext. 102, or at mshepherd@medi-vantage.com. Visit her website at www.medi-vantage.com.
