Lonnie M. Smith - Intuitive Surgical

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  • 1947 William Shockley (Stanford) successfully tested a point-contact transistor setting off the semiconductor revolution. 1953 Jay Forrester(MIT) installed a magnetic core memory on a computer. 1955 TRADIC was the 1 st fully transistorized computer Followed in 1956 by Magnetic Disk Memory 1 st Integrated Circuits in 1958 Microprocessors emerged in the late 60’s and early 70’s Leading to “Super Computers”, Mini-Computers, Personal Computers, routers, and servers.
  • Suggested script: The next generation da Vinci System was the da Vinci S system, introduced in 2006. The ‘S’ offered the surgeon HD vision for the first time in robotic surgery. Furthermore, many of the information sources such as patient vitals that a surgeon was accustomed to seeing in open or laparoscopic surgery on a monitor were integrated into the surgeon console viewer through the advent of our TilePro feature. In addition, by increasing the instrument reach and arm movement, the da Vinci ‘S’ offered the surgeon the ability to have multi-quadrant access. Previously on the Standard System, the device would have to be undocked, moved, and then re-docked. Finally, the da Vinci S system significantly streamlined the OR set-up and turnover process by offering a simplified set-up, less pieces to coordinate. Now, we have introduced the da Vinci Si system. With the Standard and ‘S’ systems, the surgeon worked in an independent fashion, even on complex cases where two surgeons would normally collaborate in open or even laparoscopic surgery. Now, with the dual console capability of da Vinci Si, two surgeons can work collaboratively in a robotic MIS fashion! (More on this in just a moment). The ‘Si’ also has significantly enhanced vision, refined master controllers, a simplified and enhanced energy control footswitch panel, additional ergonomic setting, and several enhancements to increase the surgeons control of the operative field and the OR. Enhanced HD Vision (1080i) Refined Masters Enhanced Energy Control Superior Ergonomics Increased Surgeon Control Scalable architecture
  • Robotics are at the beginning of the adoption curve and after about 10 years we are about the same place as the internet.
  • If you place the two value drives on a matrix, it looks like this. With the patients comfort zone in this area. The most attract zone is in the upper left hand corner.
  • Alternative conventional treatments for prostate cancer might look something like this. Open Radical being the most effective, but also the most invasive with significant potential side effects. Seeds being perceived as less invasive, but arguably less effective - the cancer is not removed. Hormonal treatment less invasive and less effective than the others And watchful waiting clearly the least invasive.
  • daVinci Prostatectomy has in general effected both value drives: Increasing efficacy with better margins, better continence, and reduced sexual dysfunction. And at the same time reducing the invasiveness of the procedure, allowing the patient to return to normal life actives more quickly. And as a result gaining widespread patient acceptance.
  • Over the last five years the installed base of da Vinci Surgical Systems has grown significantly.
  • Over the last five years the installed base of da Vinci Surgical Systems has grown significantly.
  • Over the last five years the installed base of da Vinci Surgical Systems has grown significantly.
  • Lonnie M. Smith - Intuitive Surgical

    1. 1. Training Class Intuitive Surgical & ab medica 10 th Anniversary of Robotic Surgery in Italy
    2. 2. Disruptive Innovation “ Breakthrough” Technologies are Born Ugly
    3. 3. The Beginning
    4. 4. The Goal <ul><li>Enable surgeons to perform complex surgery through tiny incisions with greater precision than is possible with their natural hands. </li></ul><ul><ul><li>Wristed instruments the size of a small pencil </li></ul></ul><ul><ul><li>Natural “intuitive” instrument movement </li></ul></ul><ul><ul><li>Scaled hand motion </li></ul></ul><ul><ul><li>Tremor elimination </li></ul></ul><ul><ul><li>Magnified 3-D Vision </li></ul></ul>
    5. 5. Hansen Way
    6. 6. Engineering Lab
    7. 7. Surgeon’s Console
    8. 8. Patient Side Arms and Set-up
    9. 9. Gary & Tom doing a Demo
    10. 10. 1 st “System Shipped
    11. 11. Evolution of the da Vinci System Traditional Laparoscopy <ul><li>Introduction of 4 th arm </li></ul><ul><li>Simple instruments </li></ul><ul><li>Eliminates lap compromises </li></ul>da Vinci Standard <ul><li>Dual Console </li></ul><ul><li>Enhanced HD Vision (1080i) </li></ul><ul><li>Superior Ergonomics </li></ul><ul><li>Increased Surgeon Control </li></ul><ul><li>Scalable architecture </li></ul><ul><ul><li>Advanced instruments </li></ul></ul>da Vinci Si <ul><li>3D HD Vision (720p) </li></ul><ul><li>Visual Inputs – TilePro </li></ul><ul><li>Multi-quadrant access </li></ul><ul><li>Streamlined set-up </li></ul><ul><li>Procedure-specific and energy instruments </li></ul>da Vinci S
    12. 12. Peeling a Grape
    13. 13. New Technology Adoption Curve Innovators Early Adopters Early Majority Late Majority Laggards
    14. 14. Adoption is Driven by a Significant Shift in the Value to the Customer That Value Equation for Surgery is Efficacy Patient Value = Invasiveness
    15. 15. Adoption is Driven by a Significant Shift in the Value to the Customer That Value Equation for Surgery is 2 Efficacy Patient Value = Invasiveness
    16. 16. Procedure Value Matrix Invasiveness Efficacy High Low High Most Attractive High
    17. 17. Procedure Value Matrix Prostate Cancer Invasiveness Efficacy High Low High Most Attractive Open Radical Prostatectomy Hormonal Treatment Radioactive Seeds Watchful Waiting Radiation
    18. 18. Prostrate Cancer: Patient Preferences Dr. Menon - Henry Ford Hospital <ul><li>All patients seen over a 1 month period polled </li></ul><ul><li>preoperatively: </li></ul><ul><li>Cancer removal </li></ul><ul><li>Continence </li></ul><ul><li>Potency </li></ul><ul><li>Safety </li></ul><ul><li>Recuperation </li></ul><ul><li>Transfusion </li></ul>
    19. 19. Grading of Operation from the Patients Perspective Dr. Menon - Henry Ford Hospital (524) 87% (373) 62% 600 SCORE 100% 89% No transfusion Blood loss 3 7 Score* Pain 98% 85% No comps Safety 66% 33% Sexual Intcourse Potency (6 mths) 96% 60% No pads Continence (6 mths) 94% 76% Neg Margins Cancer removal Menon VIP HFHS RRP Test
    20. 20. Procedure Value Matrix Invasiveness Efficacy High Low High Open Radical Prostatectomy dVP Radioactive Seeds
    21. 21. daVinci Prostatectomy Patient
    22. 22. daVinci Prostatectomy U.S. Adoption Curve Regression Analysis Quarterly Data 2002-Q4, 2007 dVP / Total Prostatectomies Y = .2611-5.4011 2 R = 0.9833
    23. 23. U.S. Prostatectomy Adoption Curve Quarterly Procedures 100,000 Annually
    24. 24. Robotic Surgery adoption will occur procedure by procedure Robotic Surgery Adoption Curve dVPostatectomy
    25. 25. Hysterectomy Patient
    26. 26. dVH Adoption Curve
    27. 27. dVH Adoption Curve Quarterly Procedures 250,000 Annually
    28. 28. Robotic Surgery adoption will occur procedure by procedure Robotic Surgery Adoption Curve dVPostatectomy dVHysterectomy
    29. 29. Clinical Benefits of da Vinci ® Surgery Coronary Artery Bypass Surgery Avoids a Sternotomy <ul><li>Findings were as follows : </li></ul><ul><li>The daVinci “mini-CABG”hybrid patients had 99% patency at one year vs. 80% with open surgery </li></ul><ul><li>3 to 7 fewer days in the hospital </li></ul><ul><li>85% reduction in MACCE (major adverse cardiac or cerebrovascular event) one year post surgery </li></ul><ul><li>83% reduction in intubation time </li></ul><ul><li>No net increase in cost and a cost savings for patients with major co-morbidities </li></ul>University of Maryland Coronary Artery Bypass Study 100 off-pump consecutive daVinci “mini-CABG” hybrid patients compared to matched group of 100 sternotomy CABG patients
    30. 30. Clinical Benefits of da Vinci ® Surgery - ENT Mayo Clinic: Transoral Robotic Surgery Is Safe and Effective in Treating Some Throat Cancer <ul><li>The average hospital stay was 2.3 days, as compared with 7 to 10 days for traditional surgery </li></ul><ul><li>The removal of feeding tubes in patients undergoing transoral robotic surgery occurred an average of 7 to 10 days after surgery, compared with 2 to 3 months for traditional surgery </li></ul><ul><li>“ The results of this research were even more positive than we expected. We found great advantages to using transoral robotic surgery for tonsil and base of tongue cancers .” - Eric Moore M.D . </li></ul>“ There were no major complications, no tumor recurrence and, when compared to traditional surgeries, patients began swallowing on their own sooner and left the hospital sooner.”
    31. 32. Robotic Surgery adoption will occur procedure by procedure
    32. 33. WW Procedures
    33. 34. da Vinci ® Surgical System U.S. Installed Base 1999 – 2009 Alaska Hawaii 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009-through Q3
    34. 35. da Vinci ® European Installed Base 1999 – 2009 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009-through Q3
    35. 36. da Vinci ® Asian Installed Base 1999 – 2009 2002 2003 2004 2005 2006 2007 2008 2009-through Q3
    36. 37. Net Sales Trend - ($MM) 67% CAGR
    37. 38. Dual Console - Fully Integrated OR
    38. 39. da Vinci OnSite <ul><li>System health </li></ul><ul><ul><li>Remote Diagnostics </li></ul></ul><ul><ul><li>Increase system up-time </li></ul></ul><ul><li>Procedure metrics </li></ul><ul><ul><li>Time in following </li></ul></ul><ul><ul><li>Duration of instrument changes </li></ul></ul><ul><ul><li>Trends over time </li></ul></ul><ul><ul><li>Objective measurements of performance </li></ul></ul>Intuitive Surgical Internet
    39. 40. da Vinci Connect
    40. 41. Advanced Instrumentation <ul><li>Future Instruments </li></ul><ul><ul><li>Laser </li></ul></ul><ul><ul><li>Linear Cutters </li></ul></ul><ul><ul><li>Seal and Cut </li></ul></ul><ul><ul><li>Drills/Burrs </li></ul></ul><ul><ul><li>Suction/Irrigation </li></ul></ul><ul><li>Integrated Energy Instruments </li></ul><ul><ul><li>Monopolar Energy </li></ul></ul><ul><ul><li>Bipolar Energy </li></ul></ul><ul><ul><li>Advanced Bipolar </li></ul></ul><ul><ul><li>Harmonic </li></ul></ul><ul><ul><li>Advanced Graspers </li></ul></ul>
    41. 42. Single Port Surgery <ul><li>da Vinci Single Port Surgery </li></ul><ul><li>3D Vision </li></ul><ul><li>Improved Ergonomics </li></ul><ul><li>Stable Endoscope </li></ul><ul><li>Tremor Filtering </li></ul><ul><li>Intuitive Control </li></ul>
    42. 43. Surgeon Control <ul><li>da Vinci allows assignment of each “Master” to a specific instrument arm to maintain intuitiveness </li></ul><ul><ul><li>Left Master – Right Instrument </li></ul></ul><ul><ul><li>Right Master – Left Instrument </li></ul></ul>
    43. 44. Single Port & Natural Body Orifice Surgery
    44. 45. Image Guidance - Fluorescence <ul><li>ICG </li></ul><ul><ul><li>Central venous </li></ul></ul><ul><ul><li>Interstitial </li></ul></ul><ul><li>Specific antibodies plus fluorescing markers </li></ul>Vasculature Lymph Node Mapping
    45. 46. In-Vivo Microscopy <ul><li>Sub-micron in-vivo histology </li></ul><ul><li>Real-time functional and molecular imaging and diagnosis </li></ul><ul><li>Tissue information (cancer, endometriosis, etc) </li></ul>
    46. 47. Future Robotic Capabilities
    47. 48. The Journey “ Taking surgery beyond the limits of the human hand. ™ ”
    48. 49. Training Class Intuitive Surgical & ab medica 10 th Anniversary of Robotic Surgery in Italy

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