Business Strategy
Our goal is to fundamentally improve surgery and maximize the number of patients who can derive the benefits of MIS. Through the use of computer-aided robotic technologies our objective is to create value for patients, surgeons, and hospitals as summarized below:
1. Patient Value. We believe that the value of a surgical procedure to a patient can be defined as: Patient Value = Procedure Efficacy/Invasiveness. We define procedure efficacy as a measure of the success of the surgery in resolving the underlying disease and invasiveness as how disruptive and painful the treatment is itself. When the patient value of a da Vinci procedure is deemed higher than alternate treatment options, patients may seek out surgeons and hospitals that offer that specific da Vinci procedure, potentially resulting in a local market share shift for the specific treatment. da Vinci procedure
adoption occurs procedure by procedure, and is driven by the relative patient value and total treatment costs of da Vinciprocedures compared to alternative treatment options for the same disease state. We believe most patients will place higher value on procedures that are not only more efficacious, but also less invasive than alternative treatments. Our goal is to provide products to surgeons who in turn provide patients with procedure options that are both highly effective and less invasive than other surgical options.
2. Surgeon Value. We train surgeons on the use of our da Vinci Surgical System and assist them in building their practices by their delivery of high patient value. We provide an ergonomic platform for surgeons to perform their procedures. We seek to provide surgeons with reliable and easy to use products.
3. Hospital Value. We assist hospitals in building value by offering patient value using da Vinci products,thereby increasing surgical revenue and reducing costs through lower complication rates and reduced length of patient stay. We believe da Vinci Surgery is a cost effective approach to many surgeries as compared to alternative treatment options, as recognized in many published studies.
Clinical Applications
We are the beneficiaries of productive collaborations with leading surgeons in exploring and developing new techniques and applications for da VinciSurgery—an important part of our creative process. We primarily focus our development efforts on those procedures in which we believe our products bring the highest patient value, surgeon value, and hospital value. We currently focus
on five surgical specialties: gynecologic surgery, urologic surgery, generalsurgery, cardiothoracic surgery, and head and neck
surgery. Key procedures which we are focused on include da VinciProstatectomy (“dVP”), da Vinci Hysterectomy (“dVH”), hernia repair, da Vinci Cholecystectomy, da Vinci Colon and Rectal procedures, da Vinci Partial Nephrectomy, da Vinci Sacrocolpopexy, da Vinci Mitral Valve Repair, da Vinci Lobectomy, and da Vinci Transoral Robotic Surgery. In 2016, total U.S. procedure volume was approximately 563,000, of which 44% was in gynecology, 33% was in general surgery, and 19% was in urology. Procedure volume from our market outside of the U.S. was approximately 190,000 in 2016, of which most procedures were in urology.
Representative surgical applications are described below.
Gynecologic Surgery
Hysterectomy. Removal of the uterus is one of the most commonly performed surgeries in gynecology and is performed
for a variety of underlying benign and cancerous conditions. Hysterectomies can be performed using open surgery
(laparotomy), or MIS techniques, which include vaginal, laparoscopic, and robotic approaches. Prior to the clearance of da
Vinci surgery for use in gynecological procedures in 2005, the majority of hysterectomies performed were open surgeries.
We believe that da VinciSurgery provides a large number of women the opportunity to receive a minimally invasive treatment
as an alternative to an open hysterectomy, as we estimate that nearly 80% of hysterectomies are performed with a MIS
technique. Hysterectomies for benign conditions can be performed using either multi-port or Single-Site technology and
we believe a majority of da Vinci surgery is performed using multi-port techniques. Single-Site instruments enable surgeons
to perform surgery through a single port via the patient’s belly button, allowing for virtually scarless results.
Sacrocolpopexy. The abdominal (open) sacrocolpopexy is one of the most successful operations for vaginal vault prolapse.
Sacrocolpopexy involves suturing a synthetic mesh that connects and supports the vagina to the sacrum (tailbone). A
sacrocolpopexy can be performed using a conventional laparoscopic technique; however, it is generally described as difficult and cumbersome to perform. Surgeons have reported that the da Vinci Surgical System’s capabilities may enable a large
number of these procedures to be performed through a minimally invasive technique, conferring the benefits of MIS to a broader range of sacrocolpopexy patients.
Urologic Surgery
Prostatectomy. Radical prostatectomy is the removal of the prostate gland in patients diagnosed with clinically localized
prostate cancer. The standard approach to removal of the prostate has been via an open surgical procedure. The conventional
laparoscopic approach is an option, but is difficult and poses challenges to even the most skilled urologist. The da Vinci
Surgical System has enabled a large number of surgeons to convert from using an open surgical technique to a minimally
invasive technique.
Partial Nephrectomy. Partial nephrectomy is the removal of a small portion of a kidney (typically, an area of the kidney
containing a tumor). Partial nephrectomies are most commonly performed in patients diagnosed with clinically localized
renal cancer. Excluding da Vinci surgery, there are three common surgical approaches to performing partial nephrectomies:
open surgical technique, laparoscopy, and hand assisted laparoscopy, which is a hybrid of the open and laparoscopic
techniques. Surgeons have reported that the da Vinci Surgical System’s capabilities may enable a large number of these
procedures to be performed through a minimally invasive technique, conferring the benefits of MIS to a broader range of
partial nephrectomy patients. Treatment guidelines for patients with localized renal cancer recommend partial nephrectomy
due to the benefits nephron-sparing surgery has in long-term patient outcomes. Published clinical literature has shown that
the presence of a da Vinci Surgical System is associated with a higher-proportion of patients receiving a guideline-
recommended partial nephrectomy.
General Surgery
Colorectal Surgery. These procedures typically involve benign or cancerous conditions of the lower digestive system, in
particular the rectum or colon. Common procedures in this area include hemicolectomy, sigmoidectomy, low anterior
resection, and abdominoperineal resection. Conventional laparoscopy is not widely employed to treat these types of diseases,
due to their high degree of complexity. Surgeons have reported that the use of the da Vinci Surgery System and our latest
technologies, such as the da Vinci Xi Surgical System, EndoWrist Stapler, and EndoWrist Vessel Sealer, have enabled them
to offer MIS approaches to a broader range of colorectal surgery patients.
Hernia Repair. A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or
connective fascia tissue. During a hernia repair surgery, the weakened abdominal wall tissue is secured and defects are
repaired. Common types of hernia are ventral and inguinal. Ventral, or abdominal hernia, may occur through a scar after
surgery in the abdomen. Inguinal hernia is a bulge in the groin and is more common in men. Hernia repair can be performed
using traditional open surgery or MIS. There is a wide-range of complexity in hernia repair surgeries and varying surgeon
opinion regarding optimal surgical approach. The benefits of minimally invasive and robotic hernia repair surgery vary by
patient.
Cholecystectomy. Cholecystectomy, or the surgical removal of the gall bladder, is a commonly performed general surgery
procedure. Cholecystectomy is the primary method for the treatment of gallstones and other gall bladder diseases. Most
cholecystectomies are performed using multi-port MIS techniques, although some surgeons choose to perform
cholecystectomy using manual single-port instrumentation. Using da Vinci Single-Site instruments, many of the technical
challenges of manual single-port MIS are reduced as surgeons benefit from additional precision, control, and improved
ergonomics. Multi-port da Vinci techniques are also being used for certain cases, and Firefly technology can be used to
visualize biliary anatomy in three dimensions beneath tissue surfaces during Single-Site and multi-port da Vinci
cholecystectomies.
Bariatric Surgery. A body of literature points to the benefit of surgery to treat patients for morbid obesity and its secondary
effects, such as diabetes. Sleeve gastrectomy and roux-en-Y gastric bypass (“RYGB”) are the most commonly performed
surgical procedures for morbid obesity in the U.S. The body habitus of morbidly obese patients can make laparoscopic
surgery physically challenging for the surgeon, and certain surgeons have found value in using the da VinciSurgical System
to improve upon the ergonomics when performing minimally-invasive surgery in morbidly obese patients. In addition,
RYGB can be a technically challenging procedure because of the suturing, stapling, and tissue (bowel) manipulation that
is required. Surgeons using the da Vinci Surgical System have reported a reduction in a critical complication (anastomotic
leaks) relative to laparoscopic RYGB.
Cardiothoracic Surgery
Thoracic Surgery. Conventional approaches to surgical procedures in the thorax include both open and video-assisted
thoracoscopic approaches. Procedures performed via these methods include pulmonary wedge resection, pulmonary
lobectomy, thymectomy, mediastinal mass excision, and esophagectomy. Many thoracic procedures remain open procedures.
Surgeons have reported that the use of the da Vinci Surgery System in thoracic surgery has enabled them to offer MIS approaches to a broader range of thoracic surgery patients and improved clinical outcomes compared to open and video-
assisted thoracic surgery in published single-center, multi-center and national database clinical studies. We believe the
EndoWrist Stapler 30 may have particular utility in thoracic procedures.
Mitral Valve Repair. When patients are diagnosed with mitral valve disease, there are typically two surgical treatment
options from which they can choose: mitral valve replacement or mitral valve repair. Mitral valve repairs are generally
preferred over mitral valve replacement for a number of reasons, which include longevity and durability of the repaired
valve over a replacement valve and the elimination or reduction of the patient’s post-surgical pharmaceutical regimen.
Because mitral valve repairs are considered to be more technically challenging than mitral valve replacements, they are
only performed approximately 50% of the time. Several of our surgeon customers have reported an improvement in their
mitral valve repair rates over mitral valve replacements when using the da Vinci Surgical System.
Intuitive Surgical, Inc. - AnnualReports.com
