Specialist
Executive at Berkshire Medical Center
Agenda
- Key themes and trends within the robotic surgery sector
- Strengths and weaknesses of Intuitive Surgical’s (NASDAQ: ISRG) Da Vinci robotic surgical system vs Medtronic’s (NYSE: MDT) Hugo offering
- Pros and cons of using robotic systems vs legacy procedural options
- Sales force relationships and clinician education efforts
- Surgical robot innovation, simulation software and technological breakthroughs
Questions
1.
What major trends and developments have you been following in the robotic surgery market over the past 12 months or so that might better inform our Interview on Intuitive Surgical’s da Vinci System?
2.
How many of the total da Vinci procedures at your hospital are in the broader gastrointestinal realm vs other areas such as urology, gynaecology, head and neck, cardiac and so on?
3.
How are you viewing relative market growth within the procedures you mentioned? How do you think coronavirus shifted these procedures’ addressable patient populations or growth rates?
4.
Why has there been a dearth of training for urologists and why do you think colorectal has been under-penetrated thus far?
5.
From what you hear from colleagues, how might some of the financial headwinds – either from coronavirus or a potential macroeconomic downturn – impact purchasing on capital equipment for the da Vinci system this sales cycle?
6.
Do you have any purview into the approximate split between owning and leasing robots in your health system?
7.
How much of the Hugo robot placements in outpatient settings would come at the expense of the da Vinci? Is da Vinci primarily an inpatient procedure? How detrimental could the US Hugo approval be to da Vinci’s sales cycle and product placement over the next couple of years?
8.
Could you expound on the instrument replacement cycle for the da Vinci? Does the replacement cycle’s frequency present a material capital headwind to health systems?
9.
How does the da Vinci stack up to the Hugo and other offerings in the markets in terms of the breadth of procedures it can treat?
10.
Are there any patient outcome trade-offs for the da Vinci vs more specialised robot platforms? Do any of the more specialised offerings lead to superior outcomes, or is the difference fairly nominal?
11.
How is reimbursement trending for some of the gastrointestinal and bariatric CBT [Current Procedural Terminology] codes for da-Vinci-treated procedures? Do you anticipate any near-term shifts in the reimbursement landscape?
12.
How would you compare the cost of robotic-assisted surgery – such as the da Vinci – with traditional surgical procedures and laparoscopic? If reimbursement is the same, what does the cost profile look like and how does that affect surgeon decision-making about which method to use?
13.
What justifies the added cost of robotic-assisted surgery?
14.
What are some of the main side effects associated with these procedures and how detrimental are they to a patient’s standard of living, post-surgery? How do the side effects differ for the da Vinci robotic procedures vs legacy or laparoscopic options?
15.
We mentioned staffing shortages and their impact on health system purchasing and overall operations. To what extent could shortages of surgeons and other clinical staff affect demand? The da Vinci can have a pretty substantial lengthening effect on a surgeon’s career due to reduced bodily strain, while you also mentioned robotic surgeries take longer. What’s the net-net impact of those factors on uptake and adoption of robotic systems such as the da Vinci?
16.
How do you assess the quality of Intuitive’s surgical simulation offering, provided by Surgical Science to help clinicians get trained on its equipment?
17.
How penetrated do you think the simulation software is within Intuitive’s installed base and how are you viewing any price sensitivity considerations for health systems or clinicians here?
18.
Do you know how much Intuitive charges customers for a simulation package?
19.
Does the software offering make a material difference in training time? How long does it take to get surgeons trained to use the da Vinci system software vs no software simulation?
20.
How often do you experience glitches with the da Vinci system, if ever? What problems can these pose to surgeries?
21.
Could you compare the da Vinci with Medtronic’s Hugo, CMR’s Versius and other offerings across efficacy, size, flexibility, training time and cost? What are some key differentiators?
22.
Do you foresee your hospital switching over to the Hugo when it receives US approval due to the lower price point? Are the rip-and-replace costs from already owning the da Vinci substantial enough to create stickiness there?
23.
To what extent do you interact with the sales reps from Intuitive Surgical, Medtronic and others? How important is their knowledge and experience to product placements and are any companies ahead of the curve in terms of sales force acumen?
24.
How are you viewing any new offerings coming to market and their disruptive potential, aside from the Hugo? Vicarious Surgical, for example, boasts a robot with nine joints, leading to a much greater range of motion than the da Vinci. Could any new offerings displace da Vinci’s leading position?
