10 memes your marketing department will tell you about surgical robots

Your company is either working on a robot or you’ve recently launched a surgical robot. Cash has been sunk (a lot of cash) - and engineers have been busy creating a great product.

Your illustrious leaders have been gung ho to get into this lucrative market - like a gold rush (or in some cases as a haemostatic patch to stop the bleeding from your lap businesses of towers - staplers - Endo cutters and energy devices.) (Tick the box that suits your business.)

It doesn’t matter the reason - as now you’re all in. And design choices will have been made - often a decade ago - and often based on knowledge that is maybe now even upto  15 years out of date.

But it’s hard - very hard to get over those initial internal company memes that marketing and sales folk perpetuated back in the day. Memes that stick within your meetings even today. Often back then it was to try and ridicule the growing threat of Intuitive. Often it was to justify why some business was “transiently” lost. But mostly then, and now, it’s down to ignorance of the real world of surgical robotics. You and your team are stuck rolling out the same old meme after meme.

10 years ago there were still lots of “die hard” laparoscopists from the golden era of Ethicon Endo surgery and USSC camps that reinforced the company lines of “robotics is for the urologists that can’t do laparoscopy.”

That circular robot bashing often created the  baseless memes to justify internal group think combined with surgeon think.

Now - I’m not saying that some of these “thoughts” didn’t have some foundation - the odd rogue and aggressive Intuitive rep - a focus on urology to start - capital models a decade ago etc. But many of these mixed urban marketing myths have been amplified and linger.  But they do not reflect reality as we stand today.

If not already out of date, they are rapidly becoming out of date - the world has moved on! Yet they often remain within detached marketing groups that continue to scramble for a “reason” for their new robotic program to exist / get more funding / give their customers reasons to believe.  Keep going… even if the design choices no longer hold a unique positioning that makes sense.

The issue is - sitting in that internal think bubble is often detached from reality - and then when companies struggle to get traction in “the real world” they can’t understand what went wrong.  “But no one likes Intuitive? I don’t get it?”

So here’s a few of those memes that persist today, and unless eliminated, will cause bad decision making for your robotic company - wild expectations on sales that will not be met. And above all a disconnect between what your say in marketing and what the teams on the ground run into.

No one likes intuitive

Maybe a decade ago when they were a monopoly people resented Intuitive - they assumed the prices were just monopolistic gouging - “Buy the capital at this price or we will go to a competing hospital and destroy your urology business.” Is what gets said back to me time and time again. This is what people think is still happening out in the real world. It is not.

The proverbial gun to the head sales tactic. And yes - in pockets I even heard tales of this happening in the distant past.  But it seems to have morphed from rare aggressive, rogue pockets to “this is how Intuitive practiced !”

No.  Not at all. For every one of these stories (clearly amplified by competing interests) - there were ten tales of advancing urological cancer care in partnership.  Great partnerships that hospitals and surgeons were proud of.

Anyhow - that was then and this is now - 2024.  Some customers may resent the peri-operative high price of robotics at the point of care.  They may well think that’s “Intuitive’s fault” - but that is just a lack of understanding that “there is no such thing as a cheap robot” - period.  I personally have not seen the price of robotics crash by that magic 50% everyone claimed.

Instead of “no one likes them”  in 2024 their NPS (net promoter scores) which say how much people support a company… are off the chart.  They have built a community of users and hospital administrators that are raving about working with them.  They are pushing the boundaries of data and research and building immense data sets that show the value of robotics.

Bottom line - most people like them - some love them - some are annoyed by their cost still - some dislike them - some are paid by competitors to “dislike” them… (you know what I mean - consultancy) - but the data says very different to the meme.

NPS scores apart - they seem to have healthy growth and even with alternatives now on the market - not many people are running to the competition to “escape” Intuitive. They are still outselling everyone. Why?

So… marketing teams - get that off your internal decks because if not… the real world will smack you hard when all those customers “just dying for any alternative to Intuitive” don’t run to your arms.

Surgical Robots cost $2 million

So… historically in many distributor led countries with mark up on mark up the capital could cost north of $2 million.  Yes. That was true.

In 2024 most Xi deals around the world - even if sold -  are actually sub $1.8 million.  Many at $900k (go see the public tender reports.)

But it’s irrelevant in 2024, as most go in as structured rental - long term lease - pay per click - deals - where there is no up front capital.

I have not seen that many tenders in the last year where intuitive was the most expensive.  Yes - go look them up. In most cases - even in lease deals - Intuitive is often number 2 or 3 down the list of capital pricing.

Oh and pre owned systems drops that price even more - oh and the X is there for a budget of $600k…. Etc etc

So however you slice that pie - it’s just wrong.

Add into that the complexity of capital vs non capital and different budget sources - and 3rd party financing etc etc. And they are not $2 million … not even close for the capital part of any deal.

So marketing teams - dust off your 10 year out of date spreadsheets - drop your capital lines to $600k - $800k - and then delete that as cash up front for most deals - and then re-run your numbers. Oh dear - how’s that P&L looking ?

If in anyway your P&L relies on cash up front deals of about $1.5 million. Think again.

We will bring the cost of surgical robotics down

No you won’t - except in a few rare markets like India or Pakistan etc etc where labor is abundant - labor costs are low.  Where expectations are lower of performance.

For the rest of it - stop looking at the capital and look at unit cost to serve a case averaged over a seven year program. (And if you don’t know what that is then get educated or call me.)

The capital is less than a third of the weighted cost factor. Way less. Instrument cost and number of lives.  Cost of sales and marketing per system.  Cost of training and proctors and training and retraining and training further procedure expansion.  Cost of spares - servicing teams - replacements.  Cost of data storage….. etc etc.

Look at the real unit costs - and you will either be more expensive than Intuitive (who leverages 2 million plus cases a year so gets breaks) or you will be a loss leader and haemorrhage money like a stuck pig.

There is no such thing as a “cheap” robot.

Marketing.  If your plan is to be “Cheaper” then go work this out before you make that bold claim.  Europe - USA - LatAm - SEA - will all be expensive due to distribution or labor costs - so work it out. Don’t drop your pants on the capital - and use it as a loss leader… as the rest of the cost will bite you in your naked rump.

And no… you won’t be leveraging your suture and stapling sales force … you won’t.  You will be adding costs as you add dedicated heads. And then you won’t hire enough of them. And then you won’t get the sales and the implementation. And you will be in a downwards spiral for the first 5 years of your launch. That is just how it is.

We will democratise robotics

What?!? Because Intuitive have just been slackers that couldn’t be bothered to bring robots to the masses. They are just business elitist that only think robots are for the rich few.

Seriously?!??

No.  They haven’t gone to many places you point out (like Tunisia) because unless they can deliver at 100% - then they will not serve a market. You know why? Because serving a market in a half arsed way is way worse than not serving a market. Badly supported, highly complex robotics programs is a recipe for bad press and bad results. And Intuitive are smart enough to know it. They also carry 25 years of scar tissue - so worth watching where they go and why.

Often if they don’t fit the economy - or the OR space - or reimbursement then they refuse to do business there or just can’t do business there.  But it’s not been a choice to be elite. And that doesn’t leave a big space for you and your heroic solution to finally bring democracy to the galaxy.

It’s been a reality of markets - ability to pay - ability to serve and service.  And many other companies are now finding out why that is as they roll out robots.  And see that in a large part, many markets are just not sustainable or supportable.

It’s this odd concept of “democratising” that is detached from the reality of getting robotic programs up and running.  And then not have those robots come back.   

Marketing teams need to expunge this term. They need instead to say “we will help to make robots available where we can, and where teams will appreciate our differentiated features.”

Saying “you will democratise surgical robotics” is both pompous and  a little delusional.  Hey but go for it and see how that works out.

Set up and docking is too slow - we will speed up work flow

5 minutes draping - 7 minutes docking ready to go on an Xi - 12 minutes total.  In the literature and proven.

So unless you have a Time Machine….

Or you think you are going to do it in 2 minutes…..

That long set up and docking are old studies of the S and Si before teams and training teams had it all worked out.

Intuitive can train teams to set up fast now, and the newer systems are way easier to set up. In fact the DV5 is pretty much top of the class with so many set up features automated.

2024 folks… nearly 2025. We are not still in 2003

Get up to date.

People are salivating for our staplers and energy devices

Lots of surgeons will love your products. But they will not judge your robot on accessories.  They will judge how well it works as a robot.

If it doesn’t - they will happily get a daVinci and use Sureform and Synchroseal - period.

If you’re Medtronic or JnJ - you need the staplers and energy on the system for sure.  But do not delude yourself that is why people are not buying a Davinci 5 !!

Do not delude yourself that lack of performance of the robot will be excused by the staplers and energy devices. Your robot must be the ultimate suturing machine as good as an Xi.

Your robot needs to be awesome to hang your tools on.  End of story.

You can’t move a da Vinci

You can - you can.

It’s not about that - it’s about wanting to move it. Pain in the backside of moving it.

And now many hospitals have multiple robots.  And it’s less and less of an issue every day.

And is your robot really small - compact - and truly mobile?

It is true there are plenty of robots out there that are “easier” to move around (if the hospitall needs to and wants to.)

And sure I’ll give you that a daVinci is not the easiest robot to move around (and between floors) … but it can.

And the DV5 just made that a whole lot easier.

If in marketing your big claim is easier to move - then you need to also show the back up that hospitals are doing more cases than the average fixed DV because of that movement.

Which… just by case load numbers.. they don’t seem to be really doing that. So don’t claim something, especially if the one that “doesn’t move” is doing more procedures  when being fixed in place. It blows your whole argument out of the water.

On the other hand if you can show that your mobility gives more cases per day than the Xi… go for it. And show the data.

There’s no room around the bed with that big boom

When I hear this I start wondering if people have been in an OR much, and seen many Xi cases. There is no doubt that on one side of the bed there is a big boom for boom robots. And it occupies much of that side of the bed. But the head, feet and opposite side of the bed are totally free. Most other systems occupy way more floor space when you add up all the pieces.  And those components are spread around the OR occupying utility space for the OR staff in many locations.

It’s not so much about the floor footprint - that is not what actually counts. It took me a while to fully understand that it is the airspace above the patient - and the space occupancy of the robot arms where the bedside staff need to get access. Virtual Incision has no footprint and low airspace. That is a genuine example of space saving and ease of access.

Marketing teams need to be really careful when they say there’s no room - as it will become evident that the boom is occupying just one side. However, that may be better than the arms occupying all sides. I’d much rather see claims of “we occupy less space” or “We give more air space” than the classic meme that will be hard to show and harder to actually put into practice.

Think simple…. If there’s no space around a daVinci - how have they done 14 million procedures? Psyche.

We are at 3% market penetrated our robot will grow this market

I am not repeating myself here - as I bore myself with this one. Read my article here for a super in depth explanation.

Marketing teams - just stop saying it to justify why there’s room for a lot of robots…. Just say “There’s lots of room for lots of robots.”

Our users are just waiting for our robot - they love us

No they are not. If I could give a free daVinci to your users - they would take it with open arms. No one is denying their patients care because they are waiting for your robot.

It will be multi factorial as to why they don’t have a robot so far (and there are now lots to choose from) - and if they don’t have one - it is not their undying love for you as a company.

They may like your other  products, have a great relationship, like your team (big factor). But honestly if you drop your robot in and it sucks… they will send it back, and they will get a daVinci. Note: once you open that box - your robot better work.

Robot - robot - robot - is all that will count. Now if you deliver a robot and it fits their needs better than anything on the market today - great. Because if it’s just because they “love” you as a company - that “love” can evaporate quickly with a bad robot - and actually kill the love fest and drag the rest of your business down.

So focus on the robot - deliver great service - and build on the relationship - but know that they did not wait for your robot because of that.

And once they get a robot in - if it doesn’t deliver… you will know fast and open the door to a competitor. You only get one chance with your robot - so make it count.

We can do more procedure types

This one bugs me. No you can’t. Technically and regulatory wise. The DVXi is utterly capable from top to toe - and is cleared for more procedures than any other soft robot in its class.

And no you cannot just say “well in one specific country…” the Xi can’t do it. It just may not be the weapon of choice for that procedure.

I cannot tell you how many times I’ve seen this claim and it is really based on nothing.

If you think you can do “MORE” procedures then list out your procedure capability and clearance - and I’ll list out the Xi. We can then do a count, and I know I’m winning that one.

We will be used every day not sitting in a corner - we will finally get utility up

Nope.

There may be the odd account where your robot is doing a good lick of procedures - but it’s the odd account. Take any robot and look at the number of procedures done - over a time period - by the number of robots - DV is about 2.6 to 3 per week average across 10K robots.

My calculation of the closest competitors  are about 0.5 to 1;.5 per week (or maybe just over depending on the system). But that is based on low - hyper curated installs.

Also, if any company has a few mega users - that means others are doing zero cases because it’s all on averages.

You also just have to look with logic to a few things - the busiest Xi is doing 600 plus cases per year = 10 plus cases a week or 2 per day.

It’s almost impossible to do more cases average a day - every day. Hopsital logistics stop it in most places. Patient load doesn’t allow it. Operating time doesn’t allow it. (AVERAGE!!!)

If the Xi is “sitting in the corner and not being used” - why is the average number of daVinci’s in hospitals right across the USA 1.7 - and tending to 2 by the end of 2024?

Are people buying more daVincis to put them next to the one’s sitting in the corner?

Why are some hospitals getting 10 plus daVincis? To have an army of coat hangers in the corridor?

Come on - wake up. There are some old cases of charity bought DVs that sat in the wrong hospital (Paediatrics etc) - but that is not the norm in 2024.

Most DVs are doing 1 or 2 cases per day - every day. So unless you are doing better than that… stop saying it. And no - one system in one hospital doing 4 cases per day is not representative of use cases and a good marketing claim. I know one daVinci did 8 cases in one day - so have at it!

Marketing folks - people work it out. That’s not a good plan - especially when hospital administrators scratch their heads saying - “our robots are too busy and we need more.”

It also does not help your cause - saying “robots are a waste of money and not used.” That is not bright for the market as a whole. A rising tide and all that.

Instead focus on how you get your utilisation up… what tools can you build to help hospitals use your robot more (if it’s launched.) And think about which customers get your robot first (if it’s not launched.) to make sure you get high volumes from day one. Focus on your care teams to get utilisation up not saying bland terms of “we will get utilisation up.”

And if you have got good daily usage - great - talk that up… not others down.

We know how to sell and have big reach

Do you? Do you really? Ah yes in consumable products with low value simple capital in  few specialties.

But do you know how to commercialise a soft tissue surgical robot? It’s way harder than most think… and few have done it.

And “reach” does not mean success. Size does not mean success.

If you are thinking of using an existing salesforce (MDT / JNJ) - ask if that is the right team to sell ultra complex capital and then initiate and sustain complex robotic programs.

Are those people the right ones to support robotic cases? MDT maybe knows the answer already.

Selling surgical robots is a skill like I’ve never known - implementing programs is a skill for the best - keeping a programs going is a bigger skill and even harder.

Just because you are a JNJ or a Medtronic or a Microport or a Stryker  - you don’t get an immediate free pass. You need to build the best and earn that right.

This meme of “we will succeed because we are strong in lap surgery” is a false promise - and in fact could be a curse for the company. Sell and inservice this like a stapler at your peril.

And no… having cross hospital commercial teams at the “corporate” level will not help you. You might do a great bundled deal - but that isn’t building a robotics program. Two very different things.

My bottom line advice - stop any of these memes. And senior management - dig deep and push back  if you hear any of these tropes get wheeled out in internal meeting - abstracts - podium talks - congress booths - sales pitches - demos etc etc. There’s no need for them… and they are just wrong.

Instead focus hard on your unique selling proposition - and sell your REAL benefits hard. Let surgeons and hospitals come to you for genuine reasons. Plan based on fact - not internal group think. And do some deep and current market research to get the Zeitgeist of the market. We’ve moved on folks.