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The Pipeline

Intuitive sets sights on da Vinci for hysterectomies, international market

Intuitive Surgical, the maker of da Vinci Surgical System, reported continued 2009 growth in its fourth quarter earnings call last Thursday, January 21.The new da Vinci Si system, which was launched in April, drove much of Intuitive's 2009 sales. In total, 110 dV surgical systems were sold in the last quarter, including 20 old systems which were credited for Si upgrades. Q4 da Vinci sales bring the global total to 1,395, of which 1,028 are in the United States, 248 in Europe, and 119 in other parts of the word.

Clinically speaking, the number of da Vinci procedures performed rose to an estimated 205,000 in 2009, an increase of 51% compared to 2008. The international market, in particular, is expanding at a rapid pace--procedures done outside of the US grew by 60% over 2009.  As Intuitive moves forward with its recently granted Shonin clearance in Japan, the company seems poised to move its focus to its international markets as the national landscape becomes increasingly saturated.

While da Vinci prostatectomies (dVP) continue to be Intuitive's largest volume market, with 90,000 procedures performed worldwide in the last year, dV for hysterectomies (dVH) grew at a faster pace: from 2008 to 2009, the number of dVP procedures increased by 23%, compared to nearly 50% for dVH. Of note for many hospitals, Intuitive seems to share our expectation that hysterectomy will become the highest volume da Vinci procedure sometime during 2010.Intuitive highlighted studies which provided evidence of significantly shorter LOS for dvH compared to open or laparoscopic hysterectomies. Company spokesmen believe more surgeons will switch from open and/or laparoscopic to robotic hysterectomies, and expect momentum for dvH to only grow in 2010. In particular, the market for benign hysterectomies was projected to develop faster than that of dvH for malignant conditions, which would present a particular challenge for hospitals from a financial standpoint, given that profit margins for benign hysterectomies are often thin even without the added expense of the robotic technology.

Outside of prostatectomies and hysterectomies, Intuitive reported continued use of da Vinci for partial nephrectomies and thyroidectomies, with the latter presenting faster adoption in Asia. Regarding cardiac adoption of da Vinci, Intuitive suggested steady, but not impressive, adoption, and cited the difficulty of working in this anatomic region and the conservative nature of the surgeons in this field as reasons for lagging growth. In general, da Vinci utilization for cardiac procedures, thyroidectomies, and colorectal surgeries remain far behind that of dVP and dVH. 

Perhaps Intuitive's most significant accomplishment in the last quarter is its official entrance into the ENT space when the FDA granted da Vinci 510(k) clearance for TransOral otolaryngologic surgical procedures this past December.  Data for this application is still early: only a few hundred cases and three publications of TransOral procedures done with da Vinci were reported in 2009. Company spokesman repeatedly highlighted the "high patient value" of transoral robotic surgery, and estimated the market from this procedure to be much larger internationally. The market size estimate for the nation was only 10,000 compared to 70,000 for the international market.The small potential volumes render this specialty an unlikely addition for most robotic surgery programs.