Strategies to sell against Intuitive's amazing da Vinci 5

I'm going to start by prefacing this post with a disclaimer.

I love the da Vinci 5 - I think Intuitive has stepped up to the challenge of competition and is absolutely killing it with their marketing / market leadership / and roll out of this product.

Intuitive Da Vinci 5

They have stepped into a new segment - and although not going to directly punch tower systems like Stryker, Olympus, Storz on the nose (I don't believe it's their intention) - the DV5 tower strategy will cause vast collateral damage for those companies.

I'm utterly pro Intuitive at the minute - but in an effort to bring some balance to the world of soft tissue surgical robotics, and minimal access surgery. I'm going to put my hypothetical hat back on, and give you my insights (for what they are worth) into how I would be selling against da Vinci 5 if I was on the road today with an alternative offering.

I'm going to say this one more time - the worst strategy you can have is to rip into a product or company - and that goes 100X more when it is the utter market leader with a class leading product. Don't do it.

Instead as I discussed in my "How to sell against Boom robots" read it here - you need to play a judo move and use the features of that product against them by highlighting your own benefits.

Start with a solid strategy of your own product not bashing da Vinci 5

I cannot stress this enough - sell your own strengths.

If you have a modular robot like a HUGO RAS, or a Versius, or Asensus, or Carina etc then you should be helping laparoscopic surgeons understand the benefits of where your product shines; and helps them to get into robotics via your pathway.

Ronovo Surgical Carina small modular robot

If you are a system like Moon Surgical or Distalmotion - you need to help them understand why your product is differentiated and fits a different need - it's about work flow and enhancing laparoscopy. Not a head to head comparator to DV5. An alternative.

Moon Surgical Maestro

If you are a Vicarious Surgery, or a Virtual Incision - you need to be able to articulate very clearly where you fit into the ecosystem; and the differentiated advantages of your system compared to a da Vinci 5. Admit the limitations but focus on the strengths.

Vicarious Surgical

It starts with - know where you and your product fit into the spectrum of care - into the right site of care - for the right surgeon - with the right robot. If you cannot articulate your space - then just saying "da Vinci is shit" is stupid. I know you think you don't do it - but I've heard it out in the field in one form or another. I've seen it as subtext in presentations.

If you are one of the tower companies - you risk being run over by the bus by accident. You only need to have 1000 less sales across your markets (category) as people decide to use the DV5 tower as a replacement - and your 4% annual growth target will get very hard - very fast.

Ignore this at your utter peril - because Medtronic and JNJ have their own tower strategies coming right behind - I guarantee it. And unless you didn't notice - they really really really do care about manual laparoscopy.

So tower companies and smart OR companies - understand these towers will not only replace towers - they replace the need for a smart connected OR (you got it yet?)

So you all need a strategy as to why a DV5 tower is not adequate for day to day laparoscopy - and your systems are. And that will be around rapid advancements because you don't need to drag a robot along that development path. You will need a very solid rationale as to why you still need a smart OR.

Conmed...(just my opinion) you need to get with Medtronic or JNJ and fast - as Airseal is utterly and totally in the firing line of DV5 with its insufflation add on. You need to act fast and act now. Do not be tempted by the "let's see how it affects our sales."

The one killer app for Airseal is surgical robotics and you need to be in to win. You just lost every single use ever with a DV5.

Whatever product it is - which ever company you are - today is the day to be understanding how you and your product fit into the world of surgical robotics - directly or tangentially.

Your strategy must be simple - clear - solid and be able to be said back to you by everyone in your company. Your marketing materials must scream it - and scream it loud. Your customers must be able to understand where you fit into the ecosystem.

If you do not have a unity of message - you will fragment and confuse the market.

This is where you need to start. Get a message.

Killer application

So now you know where you fit into this complex spectrum of minimal access surgery - you need to really start to refine what your killer app is.

The failing of many companies is to think "We can be all things to everyone because our system is just as capable as da Vinci." - Stupid!

Even da Vinci had (many years ago a Killer app) - as this is the trojan horse that gives your strategy some form of meaning. It allows you to deploy your resources in a sensible way and not over stretch. Focus in on a procedure. Let the surgeons expand you.

I can already see some doing that today - take SSi Mantra - they have been one of the few to hit into Cardiac surgery - and that is a space that even Intuitive is not focused on. But it's rich - it's high level - cardiac surgeons have immense purchasing power. It's a differentiated killer app.

SSi Mantra - The Indian Robot

Understand - it doesn't mean that is all that Mantra can do! It is a super capable robot. But they have a beach head that makes sense when they go and talk to hospital administration.

Every system will be capable of all sorts of things - but where does your system excel? Where does it do it better than daVinci 5 or (if not better) does it in a more sensible way than da Vinci 5?

Take Dexter by distal motion. Two arms - sterile operation of the console - that keeps the surgeon at the site of care - the bedside - fully scrubbed in. That is just utterly and totally screaming for Inguinal Hernia (in my opinion). And follow my logic now... Yes a da Vinci 5 can absolutely do Inguinal hernia - and do it well - but it is potentially overkill. It's not that it "can't do it" - but Dexter could say "We can also do it, do it just as well - but in a way that makes more sense - keeps the surgeon at the table so they don't need someone else putting the mesh in - etc etc" (Ohhhhh that looks like cost savings right there on staff.)

Distalmotion - Dexter

It's a position that doesn't "dis" Intuitive - but a logical thread that sets them up into a massive space that genuinely could benefit from their form factor and work flow. It does NOT mean they can ONLY do some inguinal hernias. They can do Whipple's etc!!!! But it is a talk track that can get a bit of logical attention.

Every robot should be looking for their "killer app" as the point of the spear to get a solid reason why the hospital should take that system seriously.

Get a Greenfield Site of care

Two approaches here:

The first is to find hospitals ideally with zero robots - a green field of a hospital. Dig in and find out why in the last 10 years they didn't get a da Vinci Xi.

Not going to go deep here - but once you understand that - it could be that your solution is the ideal way to overcome that barrier.

It is more often that they have an urology (and potentially colorectal) robot already - but some of the other specialties - like GYN, Gen surg, thoracic don't.

Again - is there something about your killer app that screams to those teams - does your system fit into a small OR? Does it have the work flow speed for super low acuity procedures?

There will be a reason that site is Green Field. Find it out - uncover it - and if your solution helps - amplify it.

The second approach for hospitals is to help them go to sites of care on their premises that are currently moving procedures to the main operating block - so they can be done on the robot(s). Lots of lower acuity procedures have moved from clinics, private hospitals, ASCs, OPDs to the main block - because the robot is forced to be there. If your system or killer app can make it work back over at the ASC or private operating theatre, you fit the work flow - solve some massive problems (like staffing) and can fit into the reimbursement profile. Then that is how you sell against DV5.

In some accounts a DV5 will not physically fit - so if you are a small profile - or no profile robot - you may be the only option. Segment them out !

If I could be the king of the ASC - doing just hernia and low acuity Gyn procures - I'd take that all day long !!! Forget the rest for the next ten years. Be that focus.

Killer user segment

There are still a lot of surgeons out there that do little to no robotic surgery. Some it is because they took a position a decade ago that "Robots are stupid for incompetent surgeons that can't do lap.... bah humbug." Others - it just didn't fit their style of surgery. Maybe they love being at the bedside and doing manual lap a lot. Maybe that's "their thing!" That's what they are known for.

I would be segmenting the shit out of the surgical user base - and looking for that profile where my technology could utterly and totally match their needs that da Vinci didn't.

Take Moon Surgical with it's advanced assisted laparoscopy system - for a segment that doesn't want to stop lap - can't deal with the robotic set up - work flow - does a case load of lower acuity procedures where the robot is overkill... but know they want digital assistance for data and for better bedside help... wow - that's my segment. That is who I would be pouring all over - making marketing assets aimed at them - wooing them and building that community of users "Astronauts" to continue their theme.

Whether a modular robot, a mini robot, an advanced assisted laparoscopy, or a smart OR with integrated towers - you need to find that segment of users and latch on to them. Amplify your messaging to them and own that segment. Own that Tribe!!!

Keep away from cost - I beg you

The economics around minimal access surgery are highly complex - and if you think you understand it - it's like quantum mechanics - you don't.

Cost of the capital is a stupid hill to fight on - especially now as Intuitive are moving to a SAAS model (see my post on this here) - you will get hammered in that fight. Just look at their balance sheet for God's sake.

So people will default to "Cost per procedure" - and that again is a no brainer for me of a battle you will lose day in and day out if you are going head to head with a da Vinci 5.

(Forget force feedback instruments - that is premium - for another day. All current Xi instruments work on a DV5 and that's your problem!)

Let me break that down for you. If you have wristed instruments your cost of goods will be horrendous! I absolutely guarantee it. WRISTED !!!!!!!!

There are two levers you pull to get that cost per case down on wristed instruments:

First - you drop the cost of goods - so drop the price - and that means increased volume of instruments. If you have 100 systems in the field doing 150 cases per year using and average of 3 instruments...

Or you have 9000 systems doing 200 cases per year using 3 instruments - who has the largest manufacturing number?

So who gets economies of scale - and who has the cheaper cost of goods?

So you are not going to win on cost of goods if you are going like for like with wristed instruments.

And yes I hear you're screaming at the screen "But we don't have fully wristed instruments. We put the wrists in the arms. We use articulated. we use flexible...." Then you cannot do what a DV5 does. You can delude yourself that you can... but... you can't. You can mimic some parts of what they do in some procedures. But you can't do everything they do.

"But we have data that we can do the same procedures." Yes - but not like a DV5 - period.

Second - the instrument factor that crashes the cost per case is number of lives. And Intuitive have up to 20 lives on some instruments - and I am 100% certain they could get to 30 or even 40 for some instruments. They just turn that on when they want and volumes vs price works for them.

How many lives do you have out of the gate? 10 --- don't make me laugh. You have 1 or 2 or 3 at best. Then you'll get the instruments way better and you'll get to 10. And if you do some magic and get to 20 or 30 lives - then I guarantee you have the same quality components as Intuitive - so why would your instruments be cheaper to build?

(The "we can put reusable straight stick end effectors on our robot" is the most dumb way to pretend you can make robotics as cheap as lap I have ever seem.)

So forget that dream of chasing down the reduction in procedure costs. And above all it is irrelevant if it is not in context of the overall patient episode costs and reimbursement. Go find the screen shots of Intuitive Connect 2024 and understand where the arguments have moved to on cost.

If you win by price, you will lose by price because surgical robotics is horrendously expensive - and if you try to go cheap - you will run out of margin - run out of money and go bankrupt. Yes you'll get your first 50 systems in and then... you're out of money.

Instead compete on value.

"We use less instruments"

"We have way less time"

"We have less components to service"

"Our economics combined with form factor allow..."

etc etc.

Show the clinical / work flow value and how that converts into $$ value. But If I hear one more banal claim of "we will cut the cost of robotic surgery and democratise it!" I'm going to literally puke.

Empower the tower

So for the tower companies that will fall under the bus as it passes over you - I would be building strategies.

Kudos for Storz for taking Asensus - they have seen the writing on the wall and that is smart to buy into robotics.

And for all those saying "$95 million what a bargain!!!" - you're reading the numbers wrong in my book. It's $95 plus the operating costs for the next 5 to 10 years. That is not a profitable business today and Luna development and launch will cost them $300 ,million plus (and they will be taking on all that cost.). That deal will cost Storz anywhere between $500 million to $1Billion over 8 to 10 years. But it's that or die a slow death. They did the right thing.

For the others - Stryker needs a Moon Surgical or a Dexter to build on their vision systems - instruments - and sort of positioning in the general surgery market.

Olympus - go talk to Medicaroid - or pick up one of the other robots like Dexter. But do something and don't sit there contemplating forever. You have a killer imaging system - great tower components - brilliant advanced energy in Thunderbeat and Powerseal - so get them on a robot or throw them in the trash.

Right - that's off mychest.

What is a strategy for selling against DV5. Well...

I'd first be ensuring I'm out there as fast as possible ramping up sales ans - marketing teams around my towers and integrated ORs. Big investment now - as there is a short window that will take Intuitive time to get to volumes in the USA - and they still have to get regulatory in Japan, china, Europe etc.

So I'd be out trying to get ahead of the curve and amp up my sales and marketing efforts to stay first mover and "fill the shelves" with my latest technology.

Next, I'd be working on fast iteration cycles of product. The components for a vision tower are not locked to the robot - so iterations can come faster. Speed could be the enemy of DV5. I'd be working to ensure my vision is 3 generations ahead of DV5 (They have 4K ICG white light lined up and ready) - so that if you want the latest in "lap" you need my stack. I would be pouring money into this - now is the time for R&D.

I'd be buying up all the companies with imaging technology. Anything interesting for IP or functionality - Hyperspectral - Microscopic - injectable free tissue differentiation - I would be making land grabs to be able to keep saying....

"Intuitive are the masters of the robot - but for the purist vision in lap... you need Gen 100 of the imaging system we have."

For the connected ORs - I'd strip out the cost of a total build and make the tech modular and accessible to any OR any way they want. Smart towers are the future that turn any OR into a smart OR. And boy would it be with connected apps - encouraging open source for instrument manufactures and other suppliers to have open access APIs to be able to share their data and give it back to the surgeons. If the tower companies only have their tower data - that will con compete with My Intuitive and Intuitive hub.

Towers are mobile - convert your smart OR tech tower tech.

And if every one of your components does not talk to each other and optimise each other during a case... get on it. And ensure you have the best of the best of the best insufflation that talks to your energy chain and vision chain to ensure "always optimal clear field of view."

I'd be all about choice

Yes Intuitive have been the monopoly for 20 something years.

Yes the meme is out there that people "don't like them" - wrong - they love them.

Yes they have the best system and most complete system etc etc.

So in that case you need to go to "We are a logical alternative."

This is very hard for JNJ and MDT (as they are just as big and seen by the market as overlords) - they need to sell heritage - faith in their stapling - energy - training - trust trust trust.

But then have a robot that has all those features and functions - and doesn't have software meltdowns and connection between component issues every few months - or that trust drops quickly and your systems are coming back in crates.

But for the smaller companies - be the alternative in your niche. Be the upstart - be the choice some surgeons want. The rebel - the cool alternative.

Some surgeons will want that because they have backed themselves into an anti Xi corner and you are the off ramp that "now makes sense."

Some surgeons will just want to be at the cutting edge of what's new.

Whatever it is - be the anti leader and take that position and use it to your advantage.

Acknowledge the leader but be the alternative that sits along side them in healthcare. Segment that market and go after it with marketing finesse.

Highlight the system and why you're different

I won't go feature by feature - benefit by benefit - because that's why you have a marketing department.

But unless you have spent a few weeks analysing every feature - benefit - screw - wire - cable and screen - and the positioning statement of the DV5 - go check out my video on Youtube

If you don't have a positioning of where you are an alternative or better solution to some of those key features - you don't deserve market share.

Just spouting "We are a big reliable company and we have world class training and a heritage in XYZ - and we will finally democratise surgical robotics from the 5%... blah blah blah." You deserve to see your market cap crash.

You need to be able to articulate very well generically, and specifically about your product your company - your team and your commercial approach. And how they are complimentary alternatives.

In Japan - "we are the Japanese robot" is a differentiator. And it's undeniable.

DV5 is still that massive architecture - we have no footprint at all.

Having an integrated tower allows no choice for rapid upgrades as technology shifts quickly - it is tied to the robot. It's a closed system.

What about if you want a different type of high flow insufflation - now you need to buy two?

They have a boom - we are modular and that means ....

They have 8000 users we are new and that means ......

They have multiple incisions - we do it from one.... and that means ......

They have four arms and we have only two ....

You need to be non sterile for their console and we have a sterile console so.....

They don't fit in this space.... we do.

It can be moved but not as easy as ours.... and that means

Yes you get a lap tower... but if the robot is being used in one room - you still need other towers... or do they not do any more lap? etc etc

Don't attack them - show your better alternative in your killer app to your killer segment.

And I know you're going to say "we've already done it..."

Have you? Have you? Is your entire company 100% aligned behind the messages and able to tell me (if I called them right now; and said - you have 2 minutes - Go!)

I want you all to succeed - and it is a tough fight because DV5 is simply awesome - but it has multiple weak spots where other solutions are "Just a more logical answer in practical terms."

But it will take effort - and it will take focus. And above all humility.

These are all just the opinions of the author for educational purposes and debate.