Research Methodology

Research Methodology (continued)

Executive Summary

Mapping the Accelerated Evolution of Robotic Surgery

SRI System Begins to be Noticed

Scientists, Entrepreneurs, and the Human Desire to Perform Surgery Faster and with More Accuracy

The Move to MIS

The Beginnings of a Concept for Robotic Surgery

Invasive Surgery Evolves Slowly

Solving the Paradox of Poor Resolution

The Tipping Point—Surgeons Lose Both Tactile and Direct Visualization to Technology

CAS in the Digital Age

Academic Impetus for Ongoing Change

Laparoscopy—Adapting the Hands of Surgeons

A Historic Convergence of Science and Technology

What Exactly is Robotic Surgery?

Autonomous Surgical Robots—First Generation

Autonomy Gives Way to Assisted and Collaborative Efforts

A Timeline of First and Second-generation Products

Master/Slave System—A Second Generation Takes Shape

Assessing the Early Vendor Landscape

Assessing the Initial Vendor Landscape

Assessing the Initial Vendor Landscape (continued)

Emergence of an Industry Giant—Intuitive Surgical

Intuitive Surgical Stretches FDA Clearance Criteria

Competition Heats Up (2002 to 2003)

And Then There Was One—2003

Three System Components Common for all da Vinci Surgical Robots—US Market

da Vinci Surgical System Sells Itself as a Brand

Intuitive Surgical’s Si-e, Si, and Xi General Purpose Surgical Robots

Key Differences for All US Market da Vinci Surgical Systems

da Vinci Surgical System Models and Attributes for the US Market

Intuitive Surgical Launches a 2-pronged Medical Advertising and Sales Shock and Awe Campaign

Intuitive Surgical Understands Early on that Robotic Surgical Procedure Volume Is the Key to Success

Sales Force Focuses on Driving Robotic Surgical Procedure Volume—Salesmen in the Surgical Suite

The US Market Responds—da Vinci Surgical System Enjoys Double-digit Growth from 2003 to 2008

With the US Market in Hand, the da Vinci Surgical System Sets out to Capture Global Market Share (2008–2016)

Growth Strategy Scrutinized—2012 to 2013

ISRG—Roller Coaster Ride on Wall Street for Investors

Despite the 2013 Challenges, Intuitive Surgical Captures 100% US Market Share (General Purpose Surgical Robots)

da Vinci Surgical System General Purpose Surgical Robots—Percent Sales by Model

da Vinci Surgical System List and Quoted Price

da Vinci Surgical System Service and Support Costs

Intuitive Surgical Global Performance (Q2 2016)

Intuitive Surgical—Recurring Revenue Model

Q2 2016—Highlights

Mixed Claims on the Need for Third-generation Surgical Robotics

Defining a Cost Containment and Quality Outcome-driven Healthcare Ecosystem

Defining a Nexus of Science, MIS, and Improved Quality Outcomes that Reduce Costs

Empowering the Surgeon’s Hands through Scientific Advances in Surgical Techniques and Robotic Assistance

RASD Market Responding to an Accelerated Demand for Specialized Surgical Capabilities

Intuitive Surgical—Strategic Intent Moving Forward

Intuitive Surgical—2016 Priorities and Corporate Assets

Intuitive Surgical Creating New RASD Companies

FDA Clearance—Make-or-break Proposition for RASD

Step 1—Understanding FDA’s Definition of an RASD

Step 2—Understanding the US FDA Medical Devices Classification System

Step 3—Becoming Aware of Key Factors That the FDA Believes

Demonstrating Substantial Equivalence to a Predicate

Moving Beyond Class II Medical Device Classification for RASDs

Types of Value-based Payments (VBP)

Bundled Payments

RASDs in CMS’s Hip and Knee Bundled Payments Program

Impetus for Third-generation RASDs

Surgeries Where da Vinci Challengers May Specialize

Can Anyone Challenge da Vinci?

How Will Intuitive Surgical Competitors Enter the Market?

TransEnterix

TransEnterix (continued)

TransEnterix (continued)

Stryker—Orthopedics (Total Knee and Hip Replacement)

Medtronic

Smith & Nephew

Titan Medical

Medtech

Intuitive Surgical

Verb Surgical

The Way Forward

Three Possible Scenarios for RASD Market Growth

Surgical Robots as the Next Standard of Care—2020

Scientific Evidence (Statistical Significance)—Prostatectomy RASD versus Open Surgery Technique Costs

ROI for da Vinci—To Be Determined

Scenario 1—The General Concept RASD

Scenario 2—Specialized RASDs

Scenario 3—Comprehensive Surgical Solutions Platform (Surgery 4.0)

Key Takeaways

Key Takeaways (continued)

Key Takeaways (continued)

Key Takeaways (continued)

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