Specialist
Consultant Surgeon at North Bristol NHS Trust
Agenda
- Use case for Intuitive Surgical's (NASDAQ: ISRG) Da Vinci vs key competitors including CMR Surgicals, Johnson & Johnson (NYSE: JNJ) and Medtronic (NYSE: MDT)
- Uptake of robotic surgery vs traditional minimally invasive surgery including discussion on specific fields such as oncology
- Da Vinci vs CMR Surgical's Versius, including usability, training required and Da Vinci’s more immersive nature
- Difference in cost of key surgical robotic incumbents, including likelihood of decreasing costs with increasing adoption
Questions
1.
Could you discuss the key applications for robotic surgery such as the key surgeries where robotic surgery is the dominant choice vs traditional surgery methods?
2.
You mentioned robotic surgery began in cardiac and it didn’t necessarily take off there. What might have slowed the uptake in robotic surgery in certain key indications such as cardiac?
3.
A lot of studies have been published around the successful outcomes of robotic-assisted surgery. What do physicians need or want from these studies, to perhaps be encouraged to use robotic surgery further?
4.
Could you discuss some of the key benefits of robotic-assisted surgery, particularly in the urology arena?
5.
What versions of the Da Vinci have you used, and which key indications do you use the Da Vinci in?
6.
How do the three main integrated subsystems of the Da Vinci surgical system each work, including the surgeon console, the patient sidecar and the electronic car? Within that, what are 1-2 benefits of each of those?
7.
Where you still have to do the pelvic open surgery occasionally, what might be the use case for the open surgery instead of the robotics?
8.
How long might an average procedure take with the Da Vinci compared to traditional surgery?
9.
If you take a typical day of surgery, is there a difference in the number of patients you may be able to operate on with the Da Vinci vs traditional surgery?
10.
Is there a difference in the number of individuals that may be required in the operating room with the robotics vs traditional surgery?
11.
Is there any difference between Da Vinci and CMR Surgical’s Versius in surgery time, or any of the other offerings from J&J and Medtronic, or are they all quite similar?
12.
Could you elaborate on what exactly is involved in training for these robotic surgery systems?
13.
How long might it take to retrain someone if they have been working on the Da Vinci, to then retrain them to be able to perform surgery on CMR Surgical’s unit?
14.
Is the cost of the training potentially included when you purchase a Da Vinci, or is that additional cost funded by, say, the hospital?
15.
Does CMR Surgical offer a similar sort of training programme?
16.
You mentioned the beneficiary results around using robotic surgery, regarding reduced blood loss, shorter recovery time and so on. While we do have these short-term benefits, it does seem that after 12 months there’s not necessarily any major difference between traditional and robotic for urinary control and sexual function. Do you think the short-term benefits outweigh the long-term benefits, which are the same, to justify the large cost that’s associated with the Da Vinci?
17.
We’ve spoken about the risks that are associated with the traditional surgery, but what might be the specific complications related to robotic-assisted surgery?
18.
90% of prostatectomies in the US were done robotically by 2014 over laparoscopic surgery. What are the key benefits of doing this robotically vs the traditional surgery, regarding how has the prostate improved, or how has the hand and wrist flexibility improved and so on?
19.
Could you discuss the immersive nature of the Da Vinci and how beneficial this is?
20.
How does this immersive nature of Da Vinci compare to CMR Surgical’s unit, with the open console? You mentioned this communication point that people sometimes bring up as a potential negative of the Da Vinci. Do you consider the open console to have more of a benefit, as it does maintain the natural communication, even if it’s perhaps not as big of a negative now as it once was?
21.
We have some new incumbents coming into the market. We’ve got the Da Vinci which has four arms, as does the Hugo from Medtronic and CMR’s Versius. J&J’s new option which has been announced boasts six arms to provide more control and flexibility in surgery. How advantageous do you think it will be to have these two extra arms? Do you think they will provide a key competitive advantage to these typical four arms and these other options?
22.
Could you elaborate on the clashing? I know you associated that with the CMR Surgical unit, but also with the Da Vinci. How much of an issue might that be in the operating room?
23.
What might be the advantage of having the arms on the outside with the CMR unit?
24.
What potentially are the key differences between CMR Surgical’s and the Da Vinci? What potentially do you think of as the positives and negatives of CMR’s unit?
25.
If you had any choice, price aside, of which robotic unit to go for, what would you choose and why?
26.
You mentioned pricing, and we all know that Da Vinci is perhaps one of the more expensive options. How is the Da Vinci priced vs competitors such as CMR Surgical’s unit? How important is the price?
27.
If you purchase the Da Vinci or CMR Surgical’s unit, what’s involved in the install bases? Is that a lengthy process, or is that quite simple?
28.
Intuitive has increased the usage of its instruments from 10 to around 12-18 surgical procedures. How much of a benefit is that extended use now regarding instruments?
29.
You mentioned that you think we could even potentially see an increase from the 12-18 surgical procedures that Intuitive has now implemented. In your experience and from your use, what number of uses do you think you could potentially get out of these various different instruments?
30.
You mentioned this extended use now will save you tens of thousands of pounds a year. What might be the cost savings per surgery now, with this extended use?
31.
If you had the budget to purchase another Da Vinci, would there be any other limiting factors to you purchasing that, regarding whether you might be limited by the number of trained staff that you have available, or space or anything like that?
32.
When we spoke yesterday, you alluded that Intuitive have flooded the market since coronavirus. Could you elaborate on the uptake of the Da Vinci in the UK, as we come out of the pandemic?
33.
If CMR Surgical were able to get the robot up to an equal level of the Da Vinci, where you were struggling to notice any kind of differences, how likely would you be able to switch to that different machine, and what might be the reason that you would switch?
