[iancmceachern]

Yes.

Da Vinci is famously not better. There isn't a single study showing its better. It's also not less expensive, and doesn't reduce staffing needs in the OR.

What is it? A marketing tool. Surgery centers and hospitals can drive increases in patients and patient throughput, improving their bottom line. It's marketing and throughout.

They have a classic razor razor blade model. The surgical instrument are proprietary and locked in with eeprom chips in the disposables. They only last a handful if cases and then must be replaces. Intuitive made something like 80 billion last year and has had no real competition in their market for decades. As a result they've been able to pretty much write their own checks, choosing how much stuff costs and achieving huge margins on lots of very expensive equipment and supplies.

Source- I've worked on and lead the design teams for surgical robots for several companies in the field.

[robotresearcher]

> There isn't a single study showing its better.

The link you provide below says

"When it comes to prostatectomies, urologists have found the outcomes for da Vinci robotic surgery to be much better than for laparoscopic surgery and use this method in more than 90% of these procedures [...] Robotic surgery also appears to provide clinical benefits for some, but not all, types of head and neck surgery."

It also reports negative value overall for gynecological surgeries.

The evidence you provided suggests it's better for some things and not others, which seems like the expected case.

[robotresearcher]

> Da Vinci is famously not better.

Not better than surgeons with competing devices, or not better than surgeons without these tools?

[iancmceachern]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4941968/

https://www.nytimes.com/2021/08/16/well/live/robotic-surgery...

[pav345678]

For the kidney surgery seems to be significantly better then non robotic

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9741158/

[iancmceachern]

That's a single surgeon study, far from compelling evidence

[pav345678]

Actually, it is compelling. All things being equal you give an experienced surgeon an advanced tool and get 30% reduction in hospital stay along with less damage to your kidney function

From a patient point of view it is a big difference. Hospital stay is really expensive even if you have insurance. Hospitals charge like 10000$ per day and copayment foe hospital stay is usually hundreds of dollars.

Of course, it means that hospitals can process more patients and generate more profit, but it also reduces surgery wait times, which is critical for a patient with a tumor, because the longer your wait, the more likely for the tumor to spread

[iancmceachern]

That's the thing, they're aren't any studies that have true statistical significance that show the claims you state here.

That's the rub, what I'm highlighting. We all just automatically assume the robot is better because it's a robot. The proof is in the pudding.

[coldtea]

>Actually, it is compelling. All things being equal you give an experienced surgeon an advanced tool and get 30% reduction in hospital stay along with less damage to your kidney function

First you have to trust the surgeon not to be shilling in his report.

[richk449]

Thanks for the informative reply. Your comment rings true to me, since I am aware of other medical systems that are marketing tools.

I have questions though.

Is the davinci amazing? I have heard that it is.

Why doesn’t someone else make a similar product? Is there technology that is hard to replicate?

[iancmceachern]

It's totally amazing. It's like a space shuttle. It's the culmination of decades if investment and decades of some of the smartest people in robotics working tirelessly. It's a modern marvel.

Others have been trying for years. The latest big player is J&J who faces an existential threat due to robotic surgery overtaking conventional surgery, and therefore one of J&J/Ethicons core business. They bought Verb and Auris and a few other smaller companies in the space and smashed them together. There are others in the space trying to do the same.

Ultimately Intuitive has a pretty big moat. They have a lot on the technical/IP side, but also just business wise. These hospitals and surgery centers pay millions for a robot, then need to keep it busy doing cases for several years to pay it off. There is a lot of risk and not really any clear advantages to changing to a new challenger. That new challenger would need to demonstrate some key advantage, which they have yet to do.

It's hard, its akin to trying to compete with space x or similar, starting now.