"Fortune" draft: within 5 years, 35% of surgical operations will involve surgical robots

Release date: 2017-10-31

Ten years ago, robot-assisted surgery sounded like a concept in science fiction. Today, robot-assisted surgery has become a reality. In hospitals around the world, more and more surgeons treat patients with robot-assisted surgery and get rid of the pain.

In the medical robot industry, the California-based Intuitive Surgical (NASDAQ: ISRG) is undoubtedly a leader. The company's da Vinci Surgical System received the FDA's first medical robot license as early as 2000. However, the Da Vinci robot has only become popular in recent years and has won the recognition of many surgeons. According to surgeons who have experience in using, the Da Vinci surgical robot provides them with a clearer picture to observe the condition of the patient, and its operational performance is also more powerful. Last week, Fortune magazine used a deep manuscript to analyze how the company of intuition surgery developed into a market giant with a market value of more than $40 billion after 17 years of listing. Fortune believes that with the deepening of doctor education, The future of surgical robots will be even more attractive. Most doctors believe that in the next five years, 35% of surgical operations will involve robots.

Currently, Da Vinci Robots has entered all of the top cancer, urology, gynaecology and gastroenterology hospitals in the United States, including the noted New York Sloan Kettering Cancer Center, Mayo Clinic, Johns Hopkins Hospital and Cleveland Clinic. As of June 30 this year, more than 4,100 Da Vinci robots have been installed in hospitals around the world, of which 2,703 are in the US, 698 are in Europe, 538 are in Asia, and the remaining 210 are located in other parts of the world.

However, the price of this medical robot system is not cheap. The fourth-generation Da Vinci robot is priced at $1.9 million (a contract of 12.6 million yuan), which does not cover a variety of surgical accessories worth hundreds of thousands of dollars. Despite the high price, the medical robot system has been selling very well, and more and more surgeons have used the device in surgery.

Gary Guthart, CEO of Intuition Surgery, told Fortune magazine that since 2000, Da Vinci robots have implemented more than four million minimally invasive procedures, meaning that every 42 seconds, there is a place in a corner of the world. The Finch robot operated a minimally invasive procedure. In 2016, the number of operations performed by Da Vinci surgical robots increased by 15% year-on-year. At the same time, the company estimates that the 2017 figure will increase by 14% to 15%. In fact, for some specific complex surgeries, such as radical prostatectomy, nearly 90% of these surgeries are now robot-assisted.

The Da Vinci robot's sales have made Intuition Surgery's global revenue in 2016 reach $2.7 billion, of which more than 70% of revenue comes from old customers. This number is enough to prove that intuitive surgery has become a leader in the rapidly growing industry of medical robots.

Such eye-catching financial data naturally attracted many investors to Intuition Technology. In 2017 alone, the company's market capitalization soared by 70% to nearly $40 billion.

Such soaring performance can not help but doubt whether intuition technology has the ability to continue such performance. However, the long-term follow-up of the company's professionals is very confident in the intuitive technology company, they believe that intuitive technology has a good grasp of the prospects of surgery. At the same time, Intuition Technology is developing new types of medical instruments for people to operate a wider variety of surgical procedures, opening up new areas beyond the field of cancer diagnosis, and expanding rapidly in the Asian market.

Intuition Technology and China's Fosun Pharma have entered into a partnership and established a joint venture to “develop, produce and market innovative products based on robot-assisted catheter technology for the early diagnosis and treatment of lung cancer”. The company is currently developing a flexible robotic catheter for access to spongy lungs. "The main difficulty with lung cancer treatment today is that surgeons don't have good equipment to assist them in making diagnoses. They don't often find tissues that are cancerous in the lungs, because it's difficult for doctors to harm their patients without harming them. The lungs are being observed," said a Morgan Stanley analyst who followed the report on intuition technology for more than a decade.

Intuitive technology developed catheter positioning accuracy is extremely high, it will help surgeons to more easily and more accurately detect diseased tissue. In response, the analyst made the following judgment: "We believe that this device will revolutionize the treatment of lung cancer surgery."

Although many elderly surgeons need to take the time to learn this new technology, robotic assisted surgery has become a routine surgical procedure. Dr. Martin Weiser, a surgeon at the Sloan Kettering Cancer Center in New York, is very optimistic about the prospects of robotic assisted surgery. He said, "Whether the patient's hospital stay is shorter, it is easier for the surgeon to perform the surgery. I only know that something (robot-assisted surgery) is better."

At present, it is not clear whether robotic assisted surgery will definitely lead to better surgical results. But surgeons wielding robotic arms tend to praise this new technology. They were shocked by the patient's postoperative recovery rate. After the traditional open surgery, the patient no longer needs to stay in the hospital for days or even weeks to be discharged. They are also impressed with the clarity of the medical robot camera and the flexibility of the device.

But in the medical field, if a technology can't bring benefits to patients, even if it is impressive, it's just a small trick. Some patients were initially hesitant to choose robot-assisted surgery, but after watching some surgical videos on Youtube, they dispelled their doubts. 

One patient was discharged from the hospital only four days after the surgery was completed and returned to work within three weeks. His surgical experience is very different from the same surgery his father had experienced 15 years ago. The patient said: "At that time, my father's surgeon opened his stomach for him, cut his sternum to the pubic bone, and then took out his large intestine and put it all back. So my father's recovery time is more than mine. It’s a lot longer, it took him months to recover.”

In the vast majority of cases, their medical insurance reimbursement rates are consistent regardless of whether they choose robot-assisted surgery. The cost of traditional surgery and robotic assisted surgery is still different for both patients and hospitals. “There is a factor that affects cost that has not been taken into account, that is, robotic assisted surgery will reduce the time for patients to recover from hospital stay. In the hospital, if you reduce the average 3.1 days of hospital stay to 2.1 days, you can save a lot of money. ."

However, if we think about how fast intuition technology can increase the sales of DaVinci systems, especially in markets where there is no such high demand for technology, then the system will not sell for nearly $2 million. It’s just an insignificant factor. Although there is still much controversy in the academic community about the advantages and disadvantages of robot-assisted surgery for patients, there is a rough consensus on more complicated surgery such as radical prostatectomy. The conclusion is that robotic assisted surgery is better and more economical for patients.

Intuition Technology has invested a lot of energy and money to communicate this conclusion to potential hospital customers, but more importantly, the company hopes that young surgeons – the next generation of Da Vinci robot users – can understand this conclusion.

Morgan Stanley's analysts presented a detail showing how rapidly the surgical environment is undergoing rapid changes: five years ago, at a cutting-edge meeting for laparoscopic and endoscopic surgeons, he discovered intuitive technology. The reception was extremely rudimentary and almost all of the surgeons at the venue frowned at their use of the Da Vinci robot. Today, five years later, young surgeons have taken over the venue of the same conference, showing their peers the data from the Da Vinci system using intuitive technology.

Last year's survey data from the investment research institute Royal Bank of Canada showed that surgeons in the United States believe that 35% of the operations will involve robots within five years, compared with 15% this year.

With the rapid development of the medical robot market, intuitive technology has naturally ushered in competitors. Medtronic and Webb Surgery (Verb Surgical, a joint venture between Johnson & Johnson and Google's parent company's life sciences division, Verily) are believed to challenge the industry's dominance of intuitive technology. These two companies are not well prepared, and they have a lot of cooperation with hospitals around the world. They may be able to use these long-standing relationships to drive their own medical robots into the operating room.

However, some analysts remain relatively optimistic. “We believe that competition is a process of market validation and is likely to expand this market.”

The industry believes that the future development of Intuition Technology will go through three important stages.

The first phase is ongoing, which is to continue to allow Da Vinci robots to enter more hospitals in the United States, Europe and Asia. “The European market is at least three to five years behind the US medical robot market in many respects,” Lewis said. “So bringing these new technologies to the European market, then new markets like China and Japan will become important. ."

The second phase is the “platform expansion period”, which is also the potential business growth point. At this stage, Intuition Technology will promote new products that are just entering the market or are still in the research and development stage. Among them are the Da Vinci five generations that have just passed the FDA approval, and its price is $600,000 cheaper than the Da Vinci four generations. This new system will attract many financial strengths that are not as strong as those of large cancer centers.

In addition, the Da Vinci SP system, which will be released in 2018, is also highly anticipated by Lewis, which may change the rules of the game in the medical robot industry. "SP" stands for a single port. Unlike the four spider-like robotic arms of Da Vinci's four generations, the Da Vinci SP has only one robotic arm. It can penetrate the robotic arm into the opening of the patient's body and then perform the operation using the four different operating devices above. Since the Da Vinci SP's robotic arm can be inserted into the body through the patient's existing orifice, the surgeon can become more non-invasive by performing certain oral cancer operations. (In contrast, traditional surgery requires a large opening in the patient's neck). According to a May report, by 2025, surgeons will complete up to 170,000 robot-assisted surgeries per year.

The third phase of Intuition Technology will try to integrate all of its cutting-edge technologies into one platform. Medical robots with higher image quality will be able to observe the patient's body in great detail and help the surgeon to instantly identify the various blood vessels and nerve fibers in the patient's body. Perhaps the console of these medical robots will also be able to record the patient's medical record or a video of the surgery that the surgeon will receive before returning to the patient during the procedure.

All of this sounds like science fiction, but we can't forget that robotic surgery was just a concept ten years ago.

Source: health point healthpoint (micro signal caixin-life)