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10 reasons your surgical robotic company will fail

Updated: Jul 30

I have been asked more and more about and why companies are struggling to get the installs and market share they promised to their investors and shareholders. This is across a lot of startups and even some of the bigger companies. It is incredibly relevant in the soft tissue surgical robotics market where we see competitor after competitor struggle to hit the install numbers that even keep up with the incredible market growth.



Beware the trap for surgical robots
Beware the trap for surgical robots


That has sparked the question "So what is causing this struggle? Why are so many soft tissue surgical robots (companies) struggling?"

I hope this post will help companies avoid some of the quicksand that is dragging some down.


In this short post I'll give ten on my top reasons that I believe other soft tissue surgical robots are struggling. But before I get to the list I need to first set the baseline of what the biggest obstacle is -- Intuitive and their da Vinci robot.

I've waxed on enough about how great this company is, and how their da Vinci is class leading in nearly every aspect. So I won't repeat it in details, but here are the baselines that robots must measure against to even be competitive.


Baseline set by Intuitive

Incredible build quality and reliability with over 99% uptime

Loaded with every instrument you need - and quality instruments that work for a lot of lives

Loaded with advanced energy and stapling you control from the console

Advanced imaging such as ICG

Full range of procedures - from tongue to toe - approved in most markets

Thousands of proctors and hundreds of training centres

Full connected digital ecosystem

Millions of data points and evidence from a 20 plus year history

Critical mass of installed base - circa 10,000

Huge war chest of cash - and 20 years of investment foundation to stand on

Commercial flexibility - huge commercial team - vast commercial reach


So that is what you are up against if in any way you want to reach parity. But even if you can't reach parity on all aspects you will need to make sure that you don't have huge gaps when compared to this formidable barrier. If so - the market will be extreemly tough on you.


Top 10 reasons failure can happen


1) Your product has inferior features

You can't bring a knife to a gunfight and expect to win. Gone are the days when surgeons are robot naive, and will accept any robot with a basic tool set, basic imaging, no conectivity etc etc. If any company has a huge delta gap on offering of instruments, advanced energy, stapling, advanced imaging, set up help, ecosystem etc etc Then you are likely to be seen as an inferior offering. And unless you can get your cost per surgical case down to 50% less than a da Vinci case - then you will not get the mass adoption you need to get to critical mass.

Get a full set of features as fast as you can.


2) Your quality is not allowing 98% plus uptime

Continue at your peril to place system after system into the market place if you have issues with build quality, reliability, software. Surgeons converting cases, abandoning cases, or cancelling cases because of your system will have a very low tolerance to get through any learning curve. That will mean all that time and effort and money you sunk in to getting that site going will result in a loss as the system inevitably stops being used, or worse, comes back. And every returned system is a black eye in the market place because news travels fast.

And if you think you will "just use service engineers and OR support to get around the issues" you will crush under your own cost structure weight trying to do that. And every system you deploy will just be a black hole for resources and cash.

You will be giving "free" cases to keep up with the complaints, and haemorrhaging even more money.

Get your quality right - test in field and get to 98% uptime - before you expand.


3) Instruments are not the easy part

The lifeblood of your razor - razor blade model are the instruments. This is where you need to get to volumes, longevity, plus low manufacturing costs, if you want any economic business model to work. Think that these are "the last part of the system to get right" and you are doomed. This is where the rubber hits the road for the surgeon - or rather the tip hits the tissue. If you don't have the right end effectors, have instruments that just don't work well enough, or worse, instruments that just break... then you're on that short runway.

If you can't get enough procedures done well, due to a lack of instrument range, or can't complete procedures without instrument replacement, or have way too many instrument failures - then you cannot make any robotic business work commercially. The maths just does not add up. It will be a money pit.

Get a full range of instruments with between 15 and 30 good lives before you expand.


4) Training capacity constraints

If your training requires days away in the lab - you will quickly burn through money. But more so... you will hit staffing, location and availability constraints very fast. As everyone wants the best trainers, everyone wants lab space, everyone wants the best training locations. But beyond that, the training does not stop there - in many places proctors are mandatory and expensive. You will bump up against proctor availabilty and scheduling very fast. If you can't train and proctor, you can't get off the learning curve; and this will cause low usage - and low usage = failure of a program.

Get your training and proctor programs worked out and at a reasonable cost before you expand.


5) Too much reach too quickly

This is an expensive business - and if you are trying to out commercialise Intutive you might be tempted to get to a lot of countries, a lot of cities, and a lot of hospitals to try and cast the net wide enough to get enough of a funnel to land deals. It's a dog that chases its own tail. It is so expensive! And every system needs people and parts and spares. If you don't cluster (which is hard, as you don't get to say where deals come up) and get tempted to spread thin - you are doomed - as the model can never make enough money. You cannot leverage your fixed costs enough; and it is just money on top of money to try and support the growing business that brings no leverage..

Be focused. Cluster your sales - even if it takes longer - don't rush to spread.


6) Run out of money - you will

No matter of you raise vast sums of money - gas fills a void and you will spend whatever you have... and spend it way faster than you can imagine. If you want to commercialise the right way you need at least a billion dollars. (Don't tell me that is way too much) - I said to commercialise the right way for a sustainable business. If you want to "prove your system works" different numbers of 100 to 200 Million dollars. But no matter what - this is now, in 2024, a super cash hungry business. The sales of pure capital to fill the coffers is limited, and you are in the world of fronting systems on rental or lease. That is cash intensive for surgical robots. The system costs you $300K plus - the training costs $50K per team - the headcount costs a fortune .... etc etc etc. It all adds up, and if you are getting about $1800 - $2000 per case (capital, service, instruments, disposables) - at 50 to 100 cases year one - that is an income of $200K max against an outlay of around $500K per system. So you ain't making money back until year 3. And that means the more you expand, the faster you dig your cash hole. Most companies in soft tissue robotics will simply run out of cash from expansion - so exapandthen pull back on activity - lay everyone off - and be forced to look for an IP sales or fire sale.

Watch your burn and don't expand too fast.


7) You went after the wrong procedures

Ignore urology at your peril. "But that's an Intutive strong hold." Yes - and nearly every hopsital worth selling to has a urology robot already. So now you want to go without that ability - so if they need to do a case on your robot... they can't. If they want to upgrade an old system to your robot... they can't. The Robotic User Group (RUG) will ask the urologist "Is this any good?" and they will say "No idea you can't use it for urology... I say don't buy it."

Or you go for the most life threatening procedures before your system is ready. And that is not a pretty place to be.

You go for the most complex procedures without the tools to do it properoy and frustate the hell out of your users.

You go to specialist areas (like TORS) that need specialist end effectors... and you don't have them yet. So results are just not as good as a da Vinci.

Any of these approaches will end up in systems not being used or even worse, coming back. At minimum you will get a bucket load of complaints... or conversions... and you could easily end up in field notifications... or worse - recalls.

Pick the specialities that are politically the right ones, and have the right tools for those procedures.


8) Getting the wrong experts to advise you

There's no simple answer here. You go to a big name lap user as your champion... and the robotic users ask "Who's that?"

You go to the usual robotic suspects and everyone says "Yeah but they try any of the systems."

Some opinion leaders don't actually know what a good robot is... they know a good lap product. Some robotic users are so taken by da Vinci - "everything feels garbage." compared to it.

You need to be very careful who you pick and why you pick them... and what is the end goal. Get this wrong and a bad clinical study, a poor congress podium talk, an over dinner conversation with their peers about "This is what it's really like..." can literally sink your product and hence your company.

Add to that - having inexprienced "robotic" surgeons advise you on what end effectors, what instruments are needed, what a robot needs can be useful to a degree. But you need to look through a lens of "this is a great lap surgeon advising." They may not know what a great robot is really like (if they've never done da Vinci cases.)

What they think is "acceptable" may not be to a hardcore da Vinci user.

Like wise - if you only listen to da Vinci "fan boys" - you'll get a poor da Vinci copy.

Get the right profile of KOL for the right reasons - for the right messaging of your product.


9) Inexperience management in surgical robotics

This is not a place to be learning the absolute pinnacle of medical devices. There is nothing like soft tissue surgical robotics - NOTHING. You need a blended management team of industry experts - vertical experts - but at least 40% must be soft tissue surgical robotics experts. I just cannot stress this enough. The understanding of every aspect of this market and the deep challenges it WILL bring need to have some scar tissue in surgical robotics. Some voices around the table need to say "I've been here - that is not going to work." An entire fresh faced - excited team of medtech experts re-running the playbook of the past 20 years will slam into a brick wall. Novices to the world of medtech regulations will have a rude awakening on what you can and cannot do in robotics. Even the most experience people in consumer robotics will struggle to understand some of the weird nuances of surgical robotics.

A team needs to be balanced with some medtech, some hi-tech, some digital natives... but above all some soft tissue surgical robotics experts to bring balance and experience.

Build a balanced team and then listen to them.


10) Lack of understanding of the capital sales process for soft tissue surgical robotics

There is absolutely no capital sales process like that of a soft tissue surgical robot. It is not selling large capital like MRIs, it's not selling ortho robots on the back of implants, it is not selling lap towers, it is not selling procedures, it's not selling consumables, it is not selling reusables, it is not selling semi reusables, it is not selling digital solutions... etc

No. It is all of the above combined into one of the most complex cross sells to so many stakeholders for a major change in a hopsital program. There is nothing like it - and if you do not work that out quickly - you will collapse under lost deals - and tenders - and process. You will fail against the people that know how to do this in their sleep - Intuitive.

Understand the process and get experts to lead it and build that world class internal process.


I'm not saying every company will do all of these mistakes. But some of these, and certain combinations of these will be fatal for a company. This is just my opinion for educational purposes of course. But I hope it inspires you to dig deeper and go find those experts before it's too late.



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