Breaking news: Intuitive and Medtronic

Rumours that came out at SRS are now gaining support from in-field intelligence.

Regarding Intuitive - perhaps I spoke too soon on towers.

For Medtronic - the mystery of why HUGO is not in Germany may be confirmed.

If you came here thinking they were merging... no it's not that news.

Breaking news Intuitive and Medtronic

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So what's the scoop. I'm going to say this very loud - none of this is 100% confirmed but it now makes complete sense on two things. Don't hold me to these until I can get more confirmation from more customers.

INTUITIVE

You know how I kept saying that tower companies may be just collateral damage - and Intutive won't directly target them. Well they may be doing that in a stronger way than I had imagined.

da Vinci 5 tower

So at SRS the scoop was that Intuitive have sold to some hospital systems multiple DV5s (Da Vinci 5s) On the back of that they have delivered extra towers - lap towers.

The news is that to move the robot from room to room you now just move the boom and the console. Towers stay fixed. BUT and this is the huge kicker - should you use the tower for lap surgery... then you don't get charged the pay per click for the tower. Just the consumables such as insufflation tubing sets.

I told you that hand held camera was ICG ready !!

This is big. Because it basically spells the end of new towers in many hopsitals (ahem Stryker). Free tower usage when you want. All that lovely data scooped up into the My Intutive ecosystem. So now we have insights on robotic and laparoscopic.

Boom - immediate comparators within users - within systems. Is a robot better that a lap case - well this will tell you.

It also tells Intuitive all about your usage of lap - procedures - times - insifflation pressure - and I am convinced the compute power in the vision system is looking at staplers - instruments - and advanced energy devices.

Oh wow - they now have your entire future procedures they are after mapped out in front of them.

It's unclear if this is an experiment - or this is an already rolling out strategy across systems. If it is - it is beyond cute. Smart ORs in every OR and towers with advanced insufflation a go-go. Scooping up all that info.

MEDTRONIC

During SRS a slide went up and they talked about progress in countries - and well what caught my eye was that there was no GERMANY on the slide. One of the biggest markets in Europe and no talk of it - what wait?

It confirmed what I had heard... they were not selling in Germany (I heard 2 weeks ago) and I thought it was around poor feedback - which was the rumour.

But at SRS someone said a single word to me - Instruments. Immediately I understood the issue and today it was confirmed to me by someone in a hospital.

Medtronic Hugo Instruments

You see in Germany the rules on sterilisation are very much stricter than anywhere else. And you have to have proven by a third party lab that you can remove to less than 10 micrograms of residual bio-burden.

These are long tubular instruments and it is very hard to flush - clean - and get all the gunk out that gets forced up the shaft under pneumoperitoneum pressure.

The manual or automatic cleaning cycles that fly in most of Europe do not fly in Germany. I know - I have lived this and gone through it and come out of the other side.

If anyone needs help with this the world expert is Stuart White. Contact him.

So confirmed at SRS that one of the centres said - we couldn't get them sterilised. And a second source today has confirmed that they had an issue at early sites in Germany.

This is important - as more and more countries are potentially going to adopt this standard - and France is one opf the possible ones. The challenge for any company that has this issue is that it is an entire internal redesign of every instrument. The bipolars will be the hardest due to extra electrical wires inside - but they are all hard. It may require new flush channles - new seals - larger diameter and many things. But that is a show stopper for Medtronic in Germany.

Experts in this field say more European countries will potentially come across and there is potential that FDA might be looking at residue levels in the near future.

When a company is hard core trying to validate staplers - Ligasure and keep the system updates - the last thing they will need is an entire team redesigning the instruments - and then getting them validated! But this is a potential show stopper in some countries - like Germany.

[UPDATE 3/6/2024 - New is that Medtronic had a field action to remove their instruments from Germany last year - read here - https://www.bfarm.de/SharedDocs/Kundeninfos/EN/12/2023/13394-23_kundeninfo_en.pdf?__blob=publicationFile

This caused an issue where they had to revalidate the instruments to be used in Germany as "single use" where they are delivered - the sterilisation department preps them - sterilises them and then they dispose of them.

This may explain why Germany was not put up as a focus on their SRS chart. It will be very expensive and they may not wish to drive that market until this issue is resolved fully.]

These are opinions of the author for educational purposes only.

The above is speculation from field information, and no official source has confirmed the information so far.

Do not rely on this information for investment purposes.