Intuitive Surgical, Inc. (NASDAQ:ISRG)

chuckbreaux (95.90) Submitted: 9/12/2007 6:19:17 PM : Start Price: $91.04 ISRG Score: +479.08

As a surgeon, I have seen the da Vinci robotic surgical system take urology by storm with regards to prostatectomy. God put the prostate in the deep pelvis, probably with the intention of nobody ever removing it. An open prostatectomy is a pretty big, difficult operation. The da Vinci robot makes it a more precise, minimally invasive procedure, resulting in shorter hospital stay, faster return to usual activities, and probably improved potency and continence rates. If I needed a prostatectomy, the da Vinci procedure is the one I would want. Within 5 years, if a hospital doesn't have a da Vinci robot and a urologist doesn't know how to use one, they won't be in the prostatectomy business. Interestingly, surgeons and hospitals are not directly benefiting financially from the da Vinci. A surgeon has to pay to learn how to use it. Then he/she is reimbursed at the insurance company's, or in many/most cases, Medicare's, allowable payment for a prostatectomy, however he/she takes it out. The hospital cannot easily pass on the increased cost of the da Vinci procedure (in Medicare's case with DRG reimbursements, not at all). Where the surgeons and hospitals benefit are in increased volumes of prostatectomy and related urologic business.

Now as for other procedures, I feel that the da Vinci success is a bit less translatable at this point in time. There are other valid alternatives to open hysterectomy (eg, vaginal with or without laparoscopic assistance). Cardiac surgeons are not yet being won over by the da Vinci. Most general surgeons are doing fine with plain laparoscopic abdominal procedures. And in my field, pediatric surgery, the instrumentation is currently too big to help us in the cases where it might be really helpful (ie, babies & toddlers).

I am long ISRG because I feel that this company is the pioneer in robotic surgery and is way ahead of anyone else.