Intuitive Surgical

Intuitive Surgical Inc.

Type	Public (NASDAQ: ISRG)
Industry	Medical Appliances & Equipment
Founded	1995
Headquarters	Sunnyvale, California, USA
Key people	Gary S. Guthart, CEO Lonnie M. Smith, Chairman
Products	da Vinci Surgical System
Revenue	$600.8 million USD (2007)[1]
Operating income	$206.7 million USD (2007) [1]
Net income	$144.5 million USD (2007) [1]
Employees	935
Website	www.intuitivesurgical.com

Intuitive Surgical Inc. (NASDAQ: ISRG) is a corporation that manufactures robotic surgical systems, most notably the da Vinci Surgical System. The da Vinci Surgical System allows surgery to be performed remotely using robotic manipulators. The company is part of the Nasdaq-100 and S&P 500. Intuitive Surgical has installed over 1,242 systems worldwide as of July, 2009.^[2]

History

The research that eventually led to the development of the da Vinci Surgical System was performed in the late 1980s at non-profit research institute SRI International.^[3] In 1990, SRI received funding from the National Institutes of Health. SRI developed a prototype robotic surgical system that caught the interest of the Defense Advanced Research Projects Agency (DARPA), which was interested in the system for its potential to allow surgeons to operate remotely on soldiers wounded on the battlefield.

In 1994, Dr. Frederic Moll became interested in the SRI System, as the device was known at the time. At the time, Moll was employed by Guidant. He tried to interest Guidant in backing it, to no avail. In 1995, Moll was introduced to John Freund, who had recently left Acuson Corporation. Freund negotiated an option to acquire SRI's intellectual property and incorporated a new company that he named Intuitive Surgical Devices, Inc. At that point Freund, Moll, and Robert Younge (also from Acuson) wrote the business plan for the company and raised its initial venture capital. Early investors included the Mayfield Fund, Sierra Ventures, and Morgan Stanley.

The company refined the SRI System into a prototype known originally as "Lenny" (after the young Leonardo da Vinci), which was ready for testing in 1997. As the company's prototypes became more advanced, they were named using da Vinci themes. One was named "Leonardo", and another was "Mona". The final version of the prototype was nicknamed the da Vinci Surgical System, and the name stuck when the system was eventually commercialized. After further testing, Intuitive Surgical began marketing this system in Europe in 1999, while awaiting FDA approval in the United States.

The company raised $46 million in an initial public offering in 2000. That same year, the FDA approved use of the da Vinci Surgical System for general laparoscopic surgery, which can be used to address gallbladder disease and gastroesophageal disease. In 2001, the FDA approved use of the system for prostate surgery. The FDA has subsequently approved the system for thoracoscopic surgery, cardiac procedures performed with adjunctive incisions, and gynecologic procedures.^[4]

Shortly before going public, Intuitive Surgical was sued for patent infringement by Computer Motion, Inc, its chief rival. Computer Motion had actually gotten into the robotic surgery field earlier than Intuitive Surgical, with its own system, the ZEUS Robotic Surgical System. Although the ZEUS system was approved in Europe, the U.S. Food and Drug Administration had not yet approved it for any procedure at the time that the FDA first approved the da Vinci system. The uncertainty created by the litigation between the companies was a drag on each company's growth.

In 2003, Intuitive Surgical and Computer Motion agreed to merge, thus ending the litigation between them.^[5] The ZEUS system was ultimately phased out in favor of the da Vinci system.

da Vinci Surgical System

Da Vinci Surgical System

Manufacturer	Intuitive Surgical
Type	Robotic surgery

The Da Vinci Surgical System is a robotic surgical system. The system is controlled by a surgeon from a console. It is commonly used for prostatectomies and increasingly for cardiac valve repair and gynecologic surgical procedures.^[6][7]

Overview

The da Vinci System has been designed to improve upon conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. The da Vinci System consists of a surgeon’s console that is typically in the same room as the patient and a patient-side cart with four interactive robotic arms controlled from the console. Three of the arms are for tools that hold objects, act as a scalpel, scissors, bovie, or unipolar or dipolar electrocautery instruments. The fourth arm is for an endoscopic camera with two lenses that gives the surgeon full stereoscopic vision from the console. The surgeon sits at the console and looks through two eye holes at a 3-D image of the procedure, meanwhile maneuvering the arms with two foot pedals and two hand controllers. The da Vinci System scales, filters and translates the surgeon's hand movements into more precise micro-movements of the instruments, which operate through small incisions in the body.

By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. For the patient, a da Vinci procedure can offer all the potential benefits of a minimally invasive procedure, including less pain, less blood loss and less need for blood transfusions. Moreover, the da Vinci System can enable a shorter hospital stay, a quicker recovery and faster return to normal daily activities.^[8]

A da Vinci Surgical System costs approximately $1.5 Million dollars.^[9] The new da Vinci SI released in April 2009 cost about $1.75 Million. In addition, there are maintenance contracts plus expenditures for instruments used during surgery. Surgical procedures performed with the robot take longer than traditional ones. Critics have pointed out that hospitals have a hard time recovering the cost and that most clinical data does not support the claim of improved patient outcomes.^[7]

Criticism

While the use of robotic surgery has become an item in the advertisement of medical services, critics point out a lack of studies that indicate long-term results are superior to results following laparoscopic surgery.^[10] On the other hand, there is no question that some procedures that have traditionally been performed with large incisions can be converted to "minimally invasive" endoscopic procedures with the use of the Da Vinci, shortening length-of-stay in the hospital and reducing recovery times. But because of the hefty cost of the robotic system it is not clear that it is cost-effective for hospitals and physicians despite any benefits to patients since there is no additional reimbursement paid by the government or insurance companies when the system is used. Data are absent to show that these increased costs can be justified. Another problem is that in the medical literature very experienced surgeons tend to publish their results. These, however, may not be representative of surgeons with lesser experience.^[10] And there is a steep learning curve for surgeons who adopt use of the system.

References

1. ^ ^{a b c} Intuitive Surgical, Inc. (2008-02-14). "Form 10-K Annual Report for 2007". SEC. http://www.sec.gov/Archives/edgar/data/1342960/000119312508058998/d10k.htm#toc53073_5. Retrieved 2009-01-15. 
2. ^ Intuitive Surgical, Inc. (2008-10-17). "Form 10-Q for Quarter Ending September 30, 2008". SEC. http://idea.sec.gov/Archives/edgar/data/1035267/000119312508212329/d10q.htm. Retrieved 2009-01-15. 
3. ^ "Intuitive Surgical." International Directory of Company Histories. The Gale Group, Inc, 2006. Answers.com 30 Jan. 2009. http://www.answers.com/topic/intuitive-surgical-inc (other facts from History section from same source)
4. ^ http://www.intuitivesurgical.com/corporate/companyprofile/index.aspx
5. ^ http://sec.edgar-online.com/2003/03/07/0000891618-03-001169/Section10.asp Merger information
6. ^ Robots as surgical enablers, MarketWatch, 3 February 2005
7. ^ ^{a b} Prepping Robots to Perform Surgery, The New York Times, 4 May 2008
8. ^ J Minim Invasive Gynecol. 2008 May-Jun;15(3):286-91. Epub 2008 Mar 6. PMID 18439499
9. ^ http://www.jyi.org/news/nb.php?id=1499
10. ^ ^{a b} Gina Kolata (February 13, 2010). "Results Unproven, Robotic Surgery Wins Converts". The New York Times. http://www.nytimes.com/2010/02/14/health/14robot.html. Retrieved March 11, 2010. 

External links

• Official website

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