UPDATED: Intuitive daVinci Gen 5 - so what's still expected

IMPORTANT UPDATED 15th March 2024:

Following the release of the DV Information I have made a companion report with details of the system as released.

Check out the companion post - you have access with this report : https://www.howtostartupinmedtech.com/post/intuitve-da-vinci-5-vs-xi-an-early-review

This report still contains more details about the system that have yet to be released

Recently at the Q4 investor update Gary Guthart and the Intuitive management dropped hints to what might be in the upcoming Generation 5 of their multiport robotic system.

Building on the direction that I already see the market going in - knowing what the market is asking for - understanding what hints are out there - and the hints dropped by the team. Here's what I think we could expect from a daVinci Generation 5.

daVinci Gen 5 comes after the Xi

10,000 X computing power on the daVinci Generation 5:

So this was the big first hint as to what upgrade the system will get. But hey... that always sounds impressive - wow 10,000 X more computing power! But let's also get a grip. 10K X more computing power has been the norm in all fields of computing. You have to remember the Xi was launched in 2014 so we are 10 years on just in our computing power in general. Your laptops today boast those kind of improvements in CPU and especially GPU processing power. So okay - we step past the hype - what could they do with that extra computing power is the main question.

Image processing improvements:

In general the entire image chain will have benefitted from a modernisation (I'll come on to that later) but with this increase in processing power they will start to be able to do some cool things with imaging that the Xi cannot do with on board software:

First will be the ability to process very complex scene recognition - determining structures, instruments and tissue structures - such as organs and tissue boundaries. With that they will perhaps be able to give on the fly advisement to the user in real time. They should be able to use that information to also start to beak down procedures "better" and give advice for improved procedure guidance.

Typical surgical scene recognition

Add to that the possible ability to have overlays in real time that could be matched to the moving organs. That would mean - you could load in a 3D scan from an MRI / CT and then overlay that in real time (even on moving organs) to see where vessels or tumours may be. It's an tough one - but they may be able to now do that with enough Nvidia chip sets and GPU computer power.

Better arm management and clash avoidance:

So we should see improvements with computer power to the embedded software of the system that handles kinematics. That means that we mights see some new automation features of the arms - like best setups and positioning to streamline workflow. And we might also see way better clash avoidance by having faster and smarter arm software that is helping with movements in real time. Getting some joints out of the way to avoid the arms banging together. (Later I will discuss the arms more). Arm clash is still a problem for the Xi today. Computing ability is needed for the complex real time calculations.

Better telemetric data:

With more compute power the system can load in a ton more high precision sensors that would be there for possible future additional tech. But it also allow to have an even richer data stream from the sensors that can help with all kinds of insights for the engineers - and for the users. So I think we will see an ever richer data set coming off the system that will be able to be interpreted into very meaningful insights for users and the engineers. (Best approach angles, strain, stress, efficiency). And potentially way better pre-emptive servicing - and maybe even personalised instrument wear out rates. So we move away from fixed lives to actual wear n tear lives on every instrument. In the next decade "the more data the better" as AI will be able to sift through that data and pull out meaningful insights we cannot even think of today. The key is that we have the hardware set up to throw off that data. I think Gen 5 will have that rich hardware architecture.

Connectivity improvements:

With the upping of compute power you can start to do all kinds of things where temporal differences need to be dealt with. It could be possible that some of that extra compute power could be used across 5G networks to allow very high synchronisation between systems. That could allow telesurgical collaboration that could take into account slight differences in lag between the systems and two operators, and sync them better for distance (live) collaborative surgeries. Or even just live distance surgeries (Remote surgeries. Sorry I used that term of live distance... I have something in my head for a much future post.). To get meaningful, smooth remote surgery, and especially collaborative remote surgery takes the right hardware set up. I believe that Intuitive will have nailed that after all their experience of dual consoles.

Better "nudge help":

With enough compute power and back history data - technically the DV5 could help users to do some specific things by making slight adjustments based on vision and scene recognition. So say a surgeon wants to cut along the edge of a tissue plane - and they are not say ... as accurate as they could be. With imperceptible movements the arms could nudge and ensure a perfect tissue plane is dissected. It may be imperceptible to the surgeon. Or the space between suture throws could be helped a little and be a little more accurate. These are micro changes during the case that can lead to much better outcomes. BUT this may not come out at launch (if it ever does) as there are some big regulatory implications to this. But I do think the system will be capable of it at launch. It just may be turned off.

Autonomous steps:

The system could start to allow a slow march to autonomous surgery. It is not there yet, but there will potentially be the start of autonomous help to the surgeon. I think that knot tying could come in the system soon, dissection assist along the tissue planes ,and more subtle help that will make a less skilled surgeon more skilled. And that will be a big part to how they access more procedures. Not that they get more types of procedures they can do, but more surgeons will be willing to use the robot for more of their procedures because it makes them better, and outcomes better through assistance. People will just feel more comfortable when using a Gen 5 to do their everyday cases. They might not fully appreciate why it "makes them better." but they will know it.

Rendezvous capability:

Rendezvous is the ability to bring two technologies together from two sides of the patient. So ION could approach from one side of the lung (endolumenal) and daVinci Gen 5 from the other (Thoracic). I suspect that Gen 5 will have embedded ability to track where tips like ION will be, and allow the two systems to communicate so they can find each other with HUD overlays. This will allow coordinated approaches to create super targeted surgical procedures. I think Gen 5 will have that kind of imaging smarts in its capability.

Imaging chain improvements:

One of the sides of the daVinci that is good is the 3D HD vision system with black and white "Firefly" ICG imaging. It's still okay - but a long way off the pace of most modern 3D scopes - cameras - and fluorescence imaging systems. So I predict a big jump in imaging capability.

ICG capability:

Today the black and white Firefly capability is dated. It is clear that Gen 5 will get 4K ICG and potentially colour modal ICG. That means first and foremost I will get white light colour overlay. So you can see the tissue in full white light (so it's natural colours not the B&W night vision) and have the ICG image overlayed on top of the surgical anatomy. I'm speculating that they may have some tricks up their sleeves so that they could have different colours for different fluorophores - so they might be able to show blood vessels in one colour with ICG and nerves with another - ureters with another so they could landscape structures by colour to help with dissection or avoidance. Finally they could bring an "Iridium" style ICG heat map by colour technology that would allow the user to see concentrations of the ICG - all in glorious 4K.

ICG "Heat Mapping" example

4K Imaging chain:

The big upgrade will be the move to a 4K 4 chip imaging chain. This will allow a much higher resolution and brighter imaging. Each eye will get true 4K imaging from camera tip to screen. This will be a critical step in allowing some of the upgraded computer power to be put to work on image analysis. It will also bring an amazing image 3D image to the user. It is the amount of extra data that a 4K imaging chain brings that will be useful in the scene analysis systems. Of course the user will have a glorious image; but the Nvidia GPUs that will have more and better data to analyse and make better decisions and models on.

Flexible steerable scope:

More speculative is the possibility of an optional extra. That optional extra could be a combined straight and flexible scope. There are sometimes a need when instruments could be close together to use a flexible tip of the scope to get better angles on the tissue. They know how to do this from the SP and it would be relatively easy to bring that capability as an optional extra to the Gen 5.

4K screens:

This may be obvious, but there's no point having a 4K camera if you can't project a 4K image. So I imagine that at the console, the screens for the viewer will jump from HD to 4K per eye. And I may be bold here... But something tells me that the world is requesting open consoles on way too many systems - and it may (this is a big maybe) lead to two console variants - one with a periscope viewer and potentially an open console with 4K screen. (Don't hold me to that one).

NEW: Images of the new screen (CORRECT)

da Vinci 5 screen

Hyperspectral imaging upgrade:

I do not think this is coming now, at launch, as hyperspectral is still a little way off. But I believe the hardware will have the capability to process and deal with hyperspectral in the near future. This will allow the Gen 5 to see structures "beyond the human eye"without the need for injecting Fluorophores. It will use different bands of light and sensors to pick out tissue differentials and bring them to the screen to help navigate structures like nerves, see blood flow and ureters etc. It will give high tissue boundary contrasts and more. But I am not convinced it will come at launch as it needs way more clinical data to be fully accepted. Plus the technology to get camera heads size down is still a little way off. But I do believe the Gen 5 at some point in the near future will get this capability.

Hypervision Hyperspectral Imaging

New console & Haptics

Haptics: (CONFIRMED - called Force Feedback)

I will bet money this is in there. The new console will be haptic capable and will give push and pull tissue sensation as instruments grab tissue - but it will potentially also give palpability sensation of tissues so that the surgeon will be able to feel how thick - tough or spongy tissue is. Haptics are hard - but I think after a decade, Intuitive has enough historic data to implement this in a meaningful way - and I do expect haptics to be on the new console. I think this will be one of the key features of this premium system that will be used to set it apart from all of the other robot clones. I also think this is a meaningful add on to get lap surgeons across to the system and get faster adoption and a faster move to proficiency with the robot. This is going to be a big enabler to get adoption of lap surgeons.

Smaller and lighter:

As technology has improved they will be able to do the top screens for viewing with smaller - lighter screens - or they will maybe even move to a smaller viewfinder like Medicaroid. A Sony 4K custom unit that will be lighter and less bulky. Either way the top half of the console will be much smaller and lighter - and that will allow the removal of some weight from the bottom of the console - and potentially some size. This is going to be critical to have lighter - smaller and more compact consoles to be able to move between ORs and be able to store them away a little easier. Every Kg / Lbs of weight loss is critical in mobility. I feel that all of the Gen 5 console will be generally lighter and smaller and more "slim" - bringing a fresh modern look.

Medicaroid 3D viewer

UPDATE: Confirmed the console is like Medicaroid

DV5 console - confirmed

Controls:

Although foot control is a hall mark of daVinci, as more complexity in instrument usage comes - more functionality - more data comes streaming in. I feel that a bigger more capable wing mirror touch display will be added to the console (as with many others). This may be mirrored inside the console view - but navigation of controls - data - pre and peri operative imaging will all come on a touch screen that can then be swiped across to the main surgeon view. Expect to see a much more comprehensive control system that may also integrate into controlling functions such as the OR environment and system set up by user.

Patient data / electronic health records:

I think that integration into hospital health records has already started, but I suspect that Gen 5 will have some capabilities in reading and writing to electronic health records. This will allow much better integration of the robot data into the EHR, but also start to integrate better the patient data into the digital ecosystem of intuitive. This will continue the ability of the daVinci to track outcomes for the user. But I feel that Gen 5 will have some yet unknown capabilities here regarding health data, pre-operative images etc. Perhaps some predictive outcomes, or suggestions based off history for helping peri-operatively.

Boom - lighter and more compact

(WRONG- Boom stayed the same outside)

I think as we see a need for robots to get lighter and tighter - I imagine that the entire boom structure will get a slight make over - but only slightly. I imagine there may be a light sliming down of the arms and joints, as modern technology will have allowed some changes to components (motors and gearboxes - harmonic drives). With that change to more modern components I suspect something may change slightly...

Soft robotics / more cobot: (NOT YET CONFIRMED)

Robotics has moved on and I suspect that one way Gen 5 could allow users to have better flow is to incorporate a more cobot (collaborative robot or soft robotic) style compliance mode for the arms. This would allow easier set up - and better working around the arms for the bedside team - being able to position arms - move arms during operations. They may go for less reliance on mechanical settings and put more of the compliance modes in software. If this is combined with some mechanical changes we could start to see easier set up and strip down - faster docking and just generally better work flow. Potentially even automatically adjusting pivot points. Modification to the above architecture of the joints could allow even better multi quadrant usage. They will have learned a lot from their vast data lake and I think some slight geometry changes will be seen.

Clash avoidance: (COMING LATER)

Still an issue for daVinci is in tight spaces where it struggles with close port positioning as the arms can sometimes clash (ports being very near to each other). By adding an extra joint, or developing more of a cobot style architecture, they could, through a combination of design and software, get to a product that has way less arm clashes, and even clash avoidance (A Holy Grail). If this happens then trocars can be placed in more standard laparoscopic positions and much closer together. This makes it easier to convert lap surgeons - and opens up more users and possibly more procedure volume. All of these subtle changes I feel will be aimed at making adoption from laparoscopic surgeons "easier" and less troublesome.

Specialist arm capability: (WRONG)

Slightly more fanciful here - but I'm thinking we might see specialist terminal joints that could be user fitted or engineer swapped. Technically the boom structure could support terminal joints that build on ION and drive catheters , or hold micro surgery instruments for open cases, or hold needle biopsy systems. The boom could hold all of these and use them to now approach microsurgery, endovascular surgery, or ophthalmics or ENT. This may be fanciful and will no way be out at launch - but I suspect they are thinking of future use cases, and the system architecture may well be built to allow it at a future point. (If ever they want)

Haptic sensors and more drive interfaces: (CONFIRMED)

To be able to use haptic instruments and get sensible information you need to have haptics ready drive packs that can take information from the instruments. So I imagine some changes to the drive packs. And if you're changing that then why not add in another drive wheel and now allow you to drive even more complex instruments such as flexible tip instruments and scopes? You could still use all the old instruments by blanking off the extra wheel - but take advantage of the extra drive wheel when needed.

Lighter, more mobile, smaller: (CONFIRMED LIGHTER CONSOLE)

Much like the console there is a need for lighter - smaller - more mobile components that occupy less space. The battle is going to be in new sites of care. And if Intuitive wants to access the 7 million procedures - they will need to move to where the action is going to be. I imagine that even 10KGs they can shave off the weight will be a huge boost to portability. I am sure the entire system will appear and even be lighter and smaller. I think they will have worked hard to make it so that it can be more easily moved - as the days of dedicated robotic ORs are failing fast. This is their chance to skinny the system down with lighter and modern components. Flexibility and mobility are going to be key to unlocking more procedures. It needs to be able to be used by anyone and anywhere.

Next Gen instruments:

Haptics: (CONFIRMED - FORCE FEEDBACK)

To enable haptics the instruments themselves will need to have some changes. These of course will be premium instruments, and besides the robot arms doing the heavy haptic lifting of "push n pull" - I think that certain instruments will gain sensors in the jaws to be able to feedback the grip strength - tissue resistance - and palpability of the tissues. This will really help novice surgeons to get to grips with robotics much better. (Pun Intended) And will allow lap surgeons to more easily switch as they do not lose all those haptic queues they like. I can imagine Intuitive suggest just using haptics for "getting going," as the surgeon transitions from manual lap to robotic. But I image "once you go hap you never go back." It's just that type of technology. I do think that the learning curves for the robot will shorten dramatically with haptics.

Intuitive haptics in the lab

Sensing:

Add into that a degree of sensing on some specialty instruments. Doppler tips for sensing blood flow in delicate tissues. Cancer margin detection. Or Thermal detection to ensure the system has a feedback loop for thermal spread on electrosurgery instruments. All have been demonstrated in the lab - and maybe not at launch - but I suspect the hardware will be ready to take inputs from instrument sensors should they be needed in the future.

Flexibility:

No strangers to flexible instruments with the SP. I think that a range of straight instruments with flexible ends to the shaft BUT combined with a real endowrist are possible on the Gen 5. Sometimes (especially in tight spaces - or areas with lots of instruments together) - being able to flex an extra elbow inside the patient might be very useful it could allow some interesting angles.

Multifunction instruments: (Not yet Confirmed)

A way to get to lower cost per case is to use less instruments. That can be done by combining functions in one instrument. Such as needle holding - grasping - suture . Dissecting - grasping - energy. Etc. this not only reduces costs but massively increases case efficiency. Minimising instrument exchanges will be a key to unlocking some procedures. This will be part of the critical strategy to get more cases through - and reduce costs in low acuity procedures. It also allows some IP to be built up around those instruments.

Digital ecosystem

A critical part of the entire daVinci experience is the growing digital ecosystem. It is certain that Gen 5 will talk to this. But I am sure that it will deliver way more information to the digital ecosystem - and in real time be able to pull more help from the digital ecosystem back to the surgeon.

The Hive:

I strongly suspect that the Gen 5 has been designed with more of the network of robots in mind and better communication - including using 5G. Where robot and user can learn from other robots and users. I imagine that there will be an emphasis on connecting all those millions of past and future cases, and gathering all the learnings, then delivering insights to users to help them and assist them in real time. Offering best practices and help hints from either other users or data bases - or even AI. I think the systems will be designed to pump that information to users in real time in a very effective way.

The hospital:

Intuitive are not just about the surgeon, so their digital ecosystem is also about better robotic program management at the hospital. I am guessing that Gen 5 will deliver even more data and insights to the hospital via more sensors and smarts in the hardware. With enough sensors and data you could move away from programmed servicing to customised servicing based on actual joint wear and tear. Usage and stress based servicing. That could go down to the instrument level and you could foresee with Gen 5 that instruments could in the future be "use based" on real world data for that actual instrument. Gen 5 could be the hardware gateway to those changes, as a sort of byproduct of all the haptic sensors. And throwing off way more insights to help the hospital make better decisions, manage patients better, manage inventory better and reduce overall costs. The closer cases get to the price of a lap case and outcomes get better - the less resistance to using robots will occur.

Premium app:

Intuitive have so far been clear that they won't be charging for their digital ecosystem. But by opening up a premium data app and system that is linked to the better sensors and data coming of the Gen 5 - they could capture that value by encouraging a richer data experience when you upgrade to a Gen 5. A little bit like you get more info like oxygen saturation if you upgrade your Apple Watch. The sensors allow the software to give you more insight so the apps become more "useful" and valuable. I do imagine there will be premium features only in the app (My Intuitive) associated to the Generation 5.

Regulatory challenges : how much at once

CONFIRMED BROAD CLEARANCE

This is where now I reign back in some of my fanciful predictions - not because they can't do it technically - but because regulatory catch up will be difficult. The further they go away from the Xi - the more difficult regulatory becomes. And as Gary clearly said "he hoped for broad approval." That means they cannot stray so far away from their Xi or they will have to provide way more clinical data. And that is always a risk. So, if Gen 5 comes out with a broad clearance - it means that a hospital could technically upgrade from an Xi tomorrow with absolutely no change of service / practice. Trade in your Xi and get the Gen 5 and do the same procedures. However should they miss key procedures in a regulatory clearance, it becomes a very different upgrade strategy. How does a hospital justify a Gen 5 if now they can't do colorectal procedures? Maybe only gyn procedures? The system may have more feature sets but would have less procedure applicability - and that will really complicate things.

That's why I'm assuming that the overall look - shape - feel - Ux etc will be relatively close to an Xi. I don't see a modular system right now or Gary would have been less bullish about general clearances. (Unless they throw a real curve ball in and make a detachable arm system where arms can be taken off the boom and deployed to carts - or used on the boom - or a mix.) Honestly - I'm leaving that for Gen 6 in my head. But technically it could be engineered for the future that way - where the architecture is in place, but regulatory wise it stays close to Xi. And that feature only gets used once they get regulatory clearance.

Regulatory is also where I think the limits on what features will be released at launch will be determined. I am going to assume that the Gen 5 will be way way more capable than it first appears at launch. And a lot of features will unlock by "over the air" software updates and add on hardware features as regulatory allows. I think Intuitive have understood deeply that the "platform" is now a minimum 10 year change cycle - so it needs to be future proof and "upgradeable" during that decade, to keep up with (rather stay ahead of) new systems coming out. How those upgrades and unlocks come - and if they will be able to be charged for will be the interesting dynamic.

I honestly feel that if they get broad clearance there will be a very very different adoption / upgrade rate to if they get narrow clearances. (Obvious I know) but this is a bigger barrier than maybe most people outside of the industry realise. No hospital can afford to buy systems that cannot be used all day, every day, by everybody, for all procedures. The economics does not stack up. So if they get a narrow clearance, then we need to ask "What's the 510K pathway to unlock other procedures and features?" This will determine the success of Gen 5 and in what time frame.

What this means for the daVinci range

Gary was, and the team were clear on the call that the Gen 5 announcement means some people will hold off upgrading to an Xi this year; and they expect a slower placement number than 2023. They also expect way more leases with upgrades built in. But I think upgrades will only be actioned in some places if the procedure capability matches 1:1 for Gen 5 vs Xi. And the accessories are 1:1 - ie. energy and stapling available day one on Gen 5 to keep it as capable as Xi.

I think the announcement on Gen 5 coming also impacts every other robotic company that gets FDA this year. And I think this is a pretty smart blow against Medtronic HUGO if they get cleared. "Do I buy a Hugo or wait and see what Gen 5 offers?" - I know where people will go. Especially those that already have a few daVincis in their hospital.

(CONFIRMED BROAD PLACEMENT)

So X, Xi will see slower placements, and those placements will have a higher number of "buy back" options on leases. On another point, CE mark - has not been really mentioned - but following SP it is clear they favour protecting USA first and then later getting CE. If this is a premium product then US has the buying power above many other places. But note that Korea and Japan are in their market size, pricing and usage profile helping to drive their decision to also go for those markets next. The drive for South Korea is one of the elements that makes me wonder if reduced scarring / single port replication? - so flexible instruments is maybe real. (Hmmm)

All this then clearly makes me believe Gen 5 will be the flagship - feature loaded premium product. Xi will be the daily workload and mid range pricing - and X the budget entry model. Clear and obvious. Sell the Xi against the new comers where it still stacks up - and you can price very aggressively low. But then premium price the top of range Gen 5 and keep the premium market the Xi occupied so far: premium capital, premium instruments, premium servicing and premium app. And use the X at the low end to deter switches to the budget robotic systems (SSI, Moon, Distalmotion.)

Of course, supply chain and manufacture will be an issue initially so again I think that as many of the parts for Xi and Gen 5 that can be the same will remain the same under the skin - but I suspect that some of the Gen 5 differentiated components will be so unique. However I feel they will have backwards compatibility - so that as the old Xi components sell out (old consoles finish) you would be able to drop in the new console of the Gen 5 to be backwards compatible with the Xi / X - but it just would not be as feature rich on this systems. Same could be true for imaging / camera systems etc - that they can drop to the Xi when all the old Xi cameras are finally exhausted in a few years. This also allows them to keep the mid range fresh as markets evolve. Nice little bump for the Xi to a 4k system mid life of the Gen 5.

Pricing: I'm gonna guess it will be the upper end of the Xi pricing - at about $1.5 - $1.8 million - with little to no discounts until supply chain eases in the future. This will allow the that premium price slot. Justifiably if it is as feature loaded as I suspect.

Procedure access / user access: (CONFIRMED)

So the question on everyone's lips is "So how will that allow them to access more procedures?"

Let me start here. The Xi is super capable and already in nearly every thoracic and abdominal surgery type. Read this - it can "do" almost any procedure today. So a Gen 5 will not technically widen the procedures available to daVinci - per se. However what it might do is allow more users to do more of those procedures. And encourage more lap users on board.

a) The improved experience, haptics, better imaging, anatomical help, procedure suggestions might enable more "lower skilled" users to do more complex robotic procedures. So move adoption of robotics in a procedure category from 25% to 35% or more (let's say.) The main gain in procedure numbers intuitive can make is to have more lap surgeons convert their straight stick lap procedures to robotic. Gen 5 could be the catalyst.

b) Easier work flow and more value from the data. There needs to be a quantum leap that makes it as fast and easy to do a robotic case as fast as a standard low acuity lap case. Work flow, draping, set up, docking, and procedure initiation should and could get faster with a cobot style Gen 5. It may also allow (and this will be heresy for some) but allow a more hybrid ability of the system. Allowing more hand held parts of the procedure to be done until the surgeon is ready to rock with the robot. This will be critical for faster, low acuity cases. Get the initial dissection of a lap hernia done fast manually, and then drop into the robotic part and suturing where needed. (It may be too far from their philosophy - but not impossible if they made the changes I think to the system.) The simplicity and hand held capability of a Moon Surgical - that can become the premium full on robot when you move to the console?

c) Site of care is the other critical move. For the lower acuity procedures that need to be done in the ASCs you need a smaller, lighter more nimble daVinci. It needs to be faster to set up - get the case done - strip down and move next door. I am assuming Gary and the team have read where the puck is moving and have done something to skate there. I think Gen 5 will allow more sites of care to have access to daVinci. If they didn't do it now... I think this will be their Achile's heal. They need to get access to ASCs to realise that 7 million procedure per year that could be addressed by a robot.

d) The price of robotics has less to do with the price of capital than most people think. The more cases per system, the lower the cost. If they can combine easier flow, higher utility with smartly tiered instrument ranges they can win. Maybe capture less revenue per instruments per case - but ramp up case numbers dramatically. They have the budget twenty plus uses basic instruments. They have the medium priced current ten lives more critical instruments. And today have the premium advanced instruments like Sureform and advanced energy. Now add into that mix the premium haptic instruments - and well you have it all covered. And if you get hooked on haptics (which many will) you get auto price upgrade with a bump to premium priced instruments. They will cover the whole spectrum of pricing with haptic instruments.

IF and it is a crazy if - they did work out how to add different end effectors to the terminal arm joints (1% chance - just 1% - so stay with me) then they suddenly access all kinds of new procedures - such as vascular, biopsy, focal therapy, radiation therapy.. etc etc. Dare I even say it could with a 1 in 1,000,000 chance be able to look towards Ortho. (Wild I know but 10 years.... there's something in my head). Okay forget Ortho.. forget it. Forget this end terminal piece - it's too wild.

Summary

Regulatory clearance will determine the "rate" of their march on the market. Broad coverage - faster switch to Gen 5 and faster procedure penetration into those 7 million on target procedures. But remember that is all in current procedures the Xi can do today. But just can't make it easy enough for people to attempt them. Narrow clearance and that will massively slower adoption and that procedure expansion (it will still be a bit healthier than Xi alone) but it will be hard to justify a completely new system with bells and whistles that does way less specialties than the Xi you own.

I feel the system design will be massively upgradeable over time - so the platform will have a lot under the skin that will only be unlocked as regulatory gets ticked off - (Think autonomous manoeuvres in a procedure) - but software upgrades and hardware add ons to the core platform Gen 5 could allow sudden leaps in capability into new surgical areas / interventional areas. All as regulatory allows.

Gen 5 will be the premium product and will allow Intuitive to compete well into the next decade.

Disclaimer: The author has no connection to Intuitive in any form and no share ownership. All information in this report is 100% speculative - based upon publicly available information and knowledge of where the general robotics market is going. Understanding technology leaps in general and interpreting public statements by Intuitive and competing companies. All predictions are hypothetical and should not be used to base any investment actions on. This report is for educational purposes only.