Intuitive Surgical, Inc. (NASDAQ:ISRG)

CAPS Rating: 4 out of 5

Intuitive Surgical makes and maintains the da Vinci robotic device, an advanced surgical system that lets surgeons perform minimally invasive surgery.

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Player Avatar kachingg (< 20) Submitted: 4/8/2010 1:58:59 AM : Underperform Start Price: $331.26 ISRG Score: +28.28

isrg technology provides no long term medical benefit. it has not shown any improvement in long term outcome. it takes much longer to perform operations so that many specialties give up using it. it does improve recovery but not long term outcome. physicians and hospitals do not receive higher reimbursement for using it. in fact, it expensive and wastes hospital budget and taxpayer money on procedures that can be just as easily performed by laparoscopy. cms would unlikely approve reimbursement. although government waste does occur frequently.

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Member Avatar daodell33 (< 20) Submitted: 4/15/2010 5:59:29 AM
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First, I want to ask what references are you using. Do you have data, a study that shows no "improvement." Because that is not what I am hearing from surgeons.

Second, you say "it does improve recovery," based on your own account that is an improved outcome. The cost of hospital stay, lost work, pain medications, rehab . . . etc are very, very costly to insurance and the system as a whole. If there are improved recoveries as you say, this system could be well worth it. . . .

Member Avatar bridg2 (< 20) Submitted: 4/16/2010 7:46:56 PM
Recs: 4

I just had major surgery by the use of the daVinci System. Fast, efficient and painless. What's more, it saved my life!

What more can I say?

Member Avatar CrankyTexan (98.57) Submitted: 5/6/2010 4:43:40 PM
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"easily performed by laparoscopy"? Wrong. Laparosopic prostatectomy and hysterectomy are NOT performed by most surgeons because they are too challenging. This is precisely why robotic surgery is thriving.

Member Avatar foolishforwine (< 20) Submitted: 5/11/2010 10:26:10 AM
Recs: 14

I am a gynecologic surgeon who performs advanced laparoscopic surgery and who is just finishing my initial surgeries using the da Vinci robot. Non-robotic laparoscopic hysterectomy really is not a difficult procedure to perform. Most gynecologists do not perform them because 1) there is no outside pressure/financial incentive for them to learn the technique - in fact, it is financially more beneficial to perform abdominal hysterectomy and 2) they are too lazy and cheap to put in the time, effort, and investment required to learn the procedure. For a good laparoscopic surgeon, using the da Vinci robot offers no benefit versus traditional laparoscopic surgery in 90% of cases. Where the da Vinci is helpful is for very large uteri and for other types of surgery requiring finer, more detailed dissection and extensive, precise suturing - procedures such as sacrocolpopexy for prolapse, large myomectomy (removal of fibroids), extensive endometriosis surgery and - perhaps its best application for gynecology - gynecologic cancer surgery.

Intuitive Surgical has done a magnificent job marketing the da Vinci system to physicians, hospitals and the public, and they have been able to generate an increased interest in minimally invasive hysterectomy that the AAGL (the gynecology association for minimally invasive surgery) has been unable to do in 20 years of trying. The da Vinci robot is a wonderful instrument. I like using it, and I feel it will be of benefit to me in some of my more complex surgeries; but, its use in my field is predominantly marketing driven and not because of any demonstrated better outcomes.

On the topic of outcomes, there are just so little data available that one cannot truly make any claims as to better, or worse, outcomes. Clearly, pain, hospital stay, and recovery are better with robotic surgery than with open surgery, but there are no good data showing superiority to traditional laparoscopic surgery. And, to date, the claims of better outcomes for radical prostatectomy (less nerve injury, less impotence, less incontinence) are just that - claims. The claims may ultimately prove true, as many da Vinci surgeons assert, but their are no good studies showing that, yet.

Member Avatar billbu (98.85) Submitted: 6/3/2010 5:04:14 PM
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Your post is self contradictory. If physicians and hospitals don't receive higher reimbursement, which is true, then how is it wasting taxpayer money? Hospitals offset the higher direct costs by gaining patients from other hospitals. Having the latest equipment also helps them attract top surgical talent and donors. CMS (Medicare) already reimburses for any procedure that is already done via standard laparoscopy because robotic surgery is actually robotically assisted laparoscopy. The benefits of robotic surgery over traditional open surgery are well documented as far as less pain, shorter recovery, etc. The bulk of the evidence suggests that the other outcomes are at least comparable with top surgeons indicating short term indications that they are achieving superior outcomes. Documenting improvements in long term studies will take time. Most procedures do not take much longer once a surgeon has done 30 or 40 procedures. The same is true for standard lap. It depends on the procedure and of course the surgeon and in some cases robotic is even faster than either for an experienced surgeon. Most patients are happy to be in the OR for an additional 20 or 30 minutes if they can get out of the hospital days earlier and back to normal activities weeks earlier with less pain and little scarring. The benefits of robotic over standard lap are not as pronounced as when compared to traditional open surgery but then again, patients are not traveling long distances to get standard lap surgery so it's kind of a moot point. As another poster pointed out, surgeons are not clamoring to learn the backwards, hard to master laparoscopic techniques but they are increasingly interested in learning robotics which is good and getting more capable with each passing year.

Member Avatar Joe2010 (< 20) Submitted: 7/24/2010 8:12:01 AM
Recs: 2

Procedures growth is flattening in the US. Prostatectomies have reached a maximum in the US and is growing slowly in Europe. Hysterectomies growth will flatten soon in the US and will never sky rocket in Europe (not to speak about other regions)
The reasons are the following:
1) the number of cases overall is limited and other treatments other than surgery are being developed
2) the medical advantages of the robot (vision, precision, complication rate, length of stay, blood loss) are true when compared to the standard open surgery but NOT when compared to the modern laparoscopy approach which is a standard in Europe
3) after several years of performing prostatectomies, there is no clinical evidence showing that robotic surgery is superior over laparoscopic surgery (all positive studies compare the robotic approach to the standard open surgery)
4) when including all costs (system, depreciation, instruments), the system is very expensive for hospitals outside the US and a break even is hard to reach
5) competition will enter the market, prices will erode and R&D expenditure will increase
6) health care systems around the world will definitely have a better control on the costs, reimbursement in Europe is getting very tough (there is no reimbursement for the robotic procedure (DRG) and hospitals have to compensate the difference). HTA will have a very negative impact as there is no clinical evidence.
7) ISRG is doing a real good job in marketing, spreading the word among hospital administration (that the robot will increase the number of patients), patients association (that the outcome is better with the robot) and surgeons (that they will be more successful with the robot)

As a conclusion, I believe that DaVinci is a wonderful tool but has a real advantage for complicated cases only and has its place in a niche market. Benefits will fall as procedures growth and new system sales will decrease.

Member Avatar FirePit2010 (< 20) Submitted: 9/2/2010 9:41:28 AM
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FoolishForWine said:

"Intuitive Surgical has done a magnificent job marketing the da Vinci system to physicians, hospitals and the public ... but, its use in my field is predominantly marketing driven and not because of any demonstrated better outcomes."

Joe2010 said:

"7) ISRG is doing a real good job in marketing, spreading the word among hospital administration (that the robot will increase the number of patients), patients association (that the outcome is better with the robot) and surgeons (that they will be more successful with the robot)"

If it's true that hospitals are only buying the machines because of "marketing" how do you account for the huge percentage of hospitals that go on to buy MULTIPLE DaVinci machines? Are hospital administrators so gullible that they can be convinced by ISRG's slick marketing professionals that they need not only one machine but maybe three, four, or more? Seems to me that simply acquiring one machine would be enough to tout/advertise the hospitals' "cutting edge technology".

Member Avatar Joe2010 (< 20) Submitted: 10/4/2010 1:15:50 PM
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I am not saying it does not make sense for a hospital to buy a robot in order to increase their patient adoption. As a matter of fact, the robot does attract patients from other hospitals thanks to their excellent marketing job.
The argument here is about the patient benefit and health care provider long-term sustainability (and consequently the sustainability for Intuitive to keep on penetrating the market with their technology).

Member Avatar schmekel (< 20) Submitted: 5/27/2011 7:09:12 PM
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I'm not a surgeon, and in no position to examine the medical benefits or disadvantages of a particular medical procedure. My reading of all the aforementioned statements is pretty straightforward .

1 - If CMS is already reimbursing hospital stays based on this procedure, then I don't see cost being an issue. Surgeons COST money too; salaries, training, insurance and other related things. Depreciation is part of any technology and if a procedure can help cut costs by any measure, you better believe hospitals will do what they have to to get the equipment. The equipment will essentially be government subsidized.

2 - Other manufacturers will enter the market. Sure. This isn't software though, or some easily built technology that a firm can simply swipe up a ton of investor capital and then compete easily with a system that has been proven effective over time and as stated before - been purchased multiple times by the same buyer. In order for another firm to compete they will have to create something that competes on price and quality, that doesn't sound all too easy. who exactly are Surgical Intuitive's competitors anyway?

3 - Multiple buyer's. Great - a fantastic marketing campaign. So it's all slickly packaged into duping a hospital righht. Said jospital is so dumb, full of fully trained brain surgeons and other such idiots that they keep buying the product. Obviously something abouty it is compelling. If it's getting multiple buys AND has an incredible marketing team - it would take a lot for it to falter.

4 - This company has so much room to grow. Ailing economies or not - one area where countries will spend money - especially in socially subsidized Europe - is medical care and social costs. It's one of the greatest fault lines between the US and Europe. One thing the US, Europe, Asia and pretty much everywhere has in common are aging worker populations who will require absolutely enormous amounts of increased medical care in the years to come and demographic crises. Anything that will help ameliorate that will stand to gain.

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