Intuitive Surgical has had a very successful run converting science-fiction to reality. The company pioneered robotic assistance device for surgery back in 1999 and there has been no looking back. Intuitive’s da Vinci surgical system defied all boundaries holding back surgeons, at the time. The system’s robotic and computer assistance, magnified view and steady grip gave surgeons the confidence to take on challenging procedures. With access to precise dissection and reconstruction deep inside the body, the surgeons could now look forward to better outcomes and fewer complications. The patient’s experience was enhanced many fold as less pain after the surgery, lower blood loss, less risk of infection, a quicker recovery period, less scarring due to smaller incisions were marked benefits of this robotic system.
Intuitive’s debut value proposition was huge and could not be ignored. Intuitive grew exponentially, capturing both market share and mindshare. The company went public with a $46 million initial public offering in 2000. In 2002, Intuitive reported total sales of $72.0 million, up 39% from $51.7 million in 2001. It shipped 60 da Vinci Surgical Systems during fiscal 2002 compared to 49 in the previous year. Today, the company has more than 5,500 da Vinci surgical systems placed in 67 countries around the world and has posted a revenue of $4.5 billion in 2019.
In 2018, Intuitive Surgical begun direct operations in India, following seven years of doing business in the country through a distributor, Vattikuti Technologies. Intuitive had said then that the company wanted to deepen its support and work with health care professionals in their pursuit of the clinical and economic benefits that robotic-assisted surgery offered. Two years down the line Mandeep Singh Kumar – VP & GM, Intuitive India talks to M Neelam Kachhap, Editor IndiaMedToday about why the robotic surgery pioneer is bullish on India Market.
- Kindly share global perspective for the robotic assisted surgery market?
In the last 20 years of our journey, we have had more than 5500 robotic programmes established across the globe and about 7.2 million patients who have benefited from the robotic assisted technology. Our mission has been ‘ a patient first approach’, where we have looked at how a surgery can be made easier for the surgeon to perform and at the same time benefit patients. Intuitive started in the US, Europe and then set up its base in certain Asian countries. Our previous management in India was a national distributor named Vattikutti Foundation. As we saw the market potential, we felt we would be able to benefit many more patients if we were to have a direct presence in India.
It has been exactly two years, since we have had a direct establishment in India. We are focusing on better customer connect and building our team capabilities.
- You said 5500 programmes have been established globally. Could you identify how many among these are Indian and how many are from the South East Asian market?
We have about 70 programmes that are running in India. We started in 2002 at AIIMS and since then we have seen a significant increase in acceptance of robotic assisted surgeries, both in the private and government sectors.
- What is it that excites you as a company being here in India?
Apart from India’s market potential, we also considered the surgeon community in India, which was keen on adopting such procedures. Also, both private and government institutions have senior functionaries whose vision is to have an established robotics programme. India has also seen a rise in incidence of cancer which provides us a way to help patients as they could get maximum benefit out of this surgery. All these factors combined, makes us feel confident that we can bring the value of da Vinci surgery to more and more patients and that completely aligns with our mission.
- Could you give an approximate figure of the market size for robotic assisted surgeries?
Honestly, there is no such syndicated data that estimates the market size of India in an accurate manner. We have been trying to do this for ourselves, but no syndicated body has conducted a research to publish data with utmost accuracy.
- I read a report that said global surgical robots market is USD 6.7 billion in 2020. Can you help me validate this, or give me a yardstick on which one could measure this?
Intuitive global reports talk about the number of procedures we are doing which helps us measure the adoption of new technology. At Intuitive, we take into consideration the number of surgical procedures as our success measurement. We have done 7.2 million procedures and number of surgeries is more important to us than a 4 or 5 billion revenue globally. We want to prioritise our patient’s first. Today, there is no significant data as to how many surgeries of a nature are conducted on a monthly and an annual basis. We are working with certain companies to get an estimated figure based on which we measure our penetration in the Indian market.
- I understand getting information like the number of surgeries is difficult, but as a company, how many procedures have you done since 2002 in India?
We do not report country-wide procedures, but since we have gone direct in India, we are growing our procedures close to 20% year on year. On a country level, we only report growth rates, not individual procedure numbers.
So globally intuitive is growing at about 17- 18 percent. 17 percent within the US, and 20- 22 percent out of the US, so the average is about 18- 19 percent. In India, we are looking at growing the range to 20- 25 percent in terms of procedure penetration year by year.
- Which geographies does the Bangalore office handle?
The office at Bangalore primarily focus on the India operations. The South East Asia and Australian markets are being looked at from a distributor’s standpoint. Also, we have a joint venture in China with a company called Fosun Pharma.
- Do the neighboring countries like Sri Lanka, and Bangladesh also benefit from this sales office in India?
For establishing a robotics programme in any new market, we need an ecosystem with clinical staff and service staff. For the potential we see today, these markets would not warrant that kind of an investment at this stage. Also, Intuitive’s philosophy is to go deep into the market before we expand, so we want to focus on India now as we see great potential here.
- Let’s talk about the economies of robotic surgery in India, could you elaborate on the affordability aspect here?
There are two ways we look at our product value, there is an economic value and a clinical value. Our focus is on the clinical value, also the economic value can only be related to a clinical value.
There are 21,000 globally peer reviewed papers that talk about the benefits of robotic assisted surgery in terms of lesser hospital stay, lesser blood loss, lesser complication. To explain this better I will share an example. The surgery for the prostate if not done well, can lead to two potential side effects, loosing sexual potency and urinary continence. You can’t put economic value against such issues.
So, the focus is on clinical value from a procedure standpoint and to make sure we have the flexibility to make payment plans for customers to be able to invest in such technology.
- Are you launching a low- cost equipment in the X surgical product line?
Both products, Xi and X are fourth generation products, we launched X a couple of years before in India, The Manipal institute, Aditya Birla Pune and the latest is in Ramaiah Hospital Bangalore. We believe that the future of Robotic assisted surgeries in India is extremely bright and we can play a major role in that space.