The surgical robotics market is segmenting - what do you do?

Once upon a time - a long time ago - there was a surgical robot that stood alone in the world. The da Vinci S. It pointed at the heart - missed and hit the prostate. And as they say…. Well the rest is history.

But for 20 years (give or take a few entrants that tried to muscle in) surgical robotics remained a one horse race as we moved through Si (3 arm - 4 arm), Xi then SP and now da Vinci 5.

Because of the architecture of the da Vinci multi arm robots - and the console concept (ie. Closed console - with a surgeon non sterile at the console away from the table) combined with the size and mass of the robot… we ended up with one main segment for robotics.

Main OR blocks, more complex cases, robotic surgery in a robotic paradigm and all at a perceived much higher cost.

Now before you blow your stack and say “of course we have DVs in ASCs, and they do less complex benign procedures” - I want to state I’m being a little generic here and painting big buckets.

Generally (note the word) there was one choice, in one location, with one way of doing it, in higher end procedures that could justify the time and cost.

But in the past five years - I’d say that has changed. And as new formats of robots (including DV) with very different use profiles, size, cost and target procedures have emerged. What we are seeing is a segmentation of the surgical robotics market.

This is how I think you can start to slice this market:

Slice 1 Technological capability

Surgical robotics Segmentation Slice 1

I’ve probably used a bad term here - but what I’m trying to convey is that you have a spectrum of technological capability and “add ons” to all the different robotic and non robotic systems.

You can start at the low technological end - and basically look at the approach to minimally invasive surgery with basic straight stick laparoscopic tools. Even something as basic as a robotic scope holder. That is one extreme of the spectrum (yes I know a straight stick lap is not technically a robotic tool - but if a robot was to hold it… it would be.)

You then travel left across the diagram until you hit the far end of the sheet. There you will find the big daddy - the da Vinci 5. Technological marvel that has every bell and whistle you need.

It has stapling, advanced energy, data, instruments, smarts, insufflation, advanced imaging etc etc.

It is basically a fully ”technologically” loaded robot.

But this is where you have to start the good ole marketing segmentation. So as you move from left to right on the diagram (don’t take it literally) you start to see bands and clusters of technology.

Those with all the end effectors you need.

Those with high end robotics but limited end effectors, those connected systems, those systems that assist in laparoscopy making it more robotic (Lap 2.0) and all the way to just minor upgrades to lap.

Why is it important to segment this. Well what it does is start to set up a customer segmentation and often a related procedure segmentation where each of these systems is “adequate” or even “best suited”

I know I’m going to explain this badly - where’s Neuralink to just brain dump my head onto the page.

So some customers will absolutely insist in having a certain technology. Let’s say advanced energy. And those customers will insist on having that control of that technology from the console. This may be for a vast number of reasons. So their technologically capable segment is going to be da Vinci. And no matter how you try as a company - you will not convince them that bedside hand held Ligasure or Ultracision or Thunderbeat is a “great alternative.”.

So that segment of customers is just a dead end to you until you get into that technological segment.

But conversely. There are many cases that just do not need advanced energy. A robotic chole has no need for advanced energy. Or there are many surgeons that think that advanced energy is a total waste of money and refuse to use it. There are others that love their current brand of advanced energy and they will have their bedside assistant use it. BUT they insist on a console robot for them.

So now you have another segment by technology - and this opens up a market and even could give advantage against a higher end “wasteful” robot. I’m not going to teach you USP (unique selling propositions) if you want that - buy my time and I’ll segment you out and give you your pitch - “it ain’t hard”.

Then you might have case types (we will come to this) or surgeons that just need damned good laparoscopy. Screw all that complex robotic console stuff for the whole case. I don’t need all those bells and whistles because I’m a God of laparoscopy. So they may drop into the technology group of advanced laparoscopy - they may want “more robotic” for some parts - or “More lap” for others so may sit on the spectrum more of DistalMotion or Moon. Depends. (See what I did there by profiling the user…)

You might have some surgeons that just say - “Screw robots I just want wristed instruments” so again they will drop down to that segment of wristed hand held instruments.

NOTE: Their needs will be fluid as we have a complex matrix of segmentation. And you are going to need to find intersects of the different segmentation matrices. All of that might hold true for a certain group of cases they have - based on acuity, or location (we’re coming to that) - but let’s say in a six hour full pelvic clearance they may want every technological bell and whistle.

And folks - that is why I firmly believe there will be multiple platforms in a hospital depending on the day - the surgeon the location - the case. And surgeons will choose their weapon based on acuity, where they are doing the case, their skill set and Hopsital management cost constraints.

Slice 2 - procedure acuity

Procedure segmentation surgical robotics

So let’s dig into this segmentation. Left you have the highest complexity - most difficult cases that will need every bit of assistance of the robots capability. FOR SOME SURGEONS.

Your job it to do some hard fucking graft and find out who they are and profile them.

Gripe and rant time: I am so sick of seeing so many companies just throw shit against the wall and see what sticks. Lazy lazy lazy. If you do not do deep market segmentation - customer profiling - targeting and defined messaging by sub sector - then get out of the business.

“Hey doc I’ve got a robot!!!” Is the road to failure.

Rant over… don’t let me catch your sales teams out there thinking every customer is your target!!!! (Do you all know how much espresso I drink before setting off on these posts!)

But we need to map onto that procedural acuity - because it actually cuts both way at the end of this spectrum - with super low acuity procedures over on the right of the graph. Simple procedures.

Now to be CLEAR. I am not saying that systems “Can’t do” the procedures. I’m saying that you must segment on BEST SUITED FOR. And that is in terms of surgeon capability, technological needs (not availability), time and money.

Let me give some clear examples. A DV 5 absolutely could do a gynae diagnostics case. It has the scope - the port for a grasper - the grasper. But anyone reading this should understand that using the full on DV5 for that is utter and total overkill on all fronts. It can do it. But should it do it?

On the other end of the spectrum - a Distal motion can absolutely do a full massive Whipples. You’d end up with hand held energy, staplers, and use the system for suturing. It will work and work well.

But if the surgeon wants everything from the console and is not skilled enough laparoscopically manually do that type of half and half procedure… the acuity for that surgeon may require a DV5.

Again can Distal do a Whipples - yes. In the hands of that particular surgeon is it the best tool? Maybe not.

So you need the right tool for the right surgeon at THEIR right case acuity level.

Now you see why just blanket “I’ve got a robot” does not work. Cannot work. Will not work.

Acuity is a complex balance of case complexity matched with surgeon capability and desire.

It will absolutely also match up with cost per case. A low acuity appendix in many countries just will not have headroom in the reimbursement to even consider a DV5. But a Moon Surgical may be perfect. And the “solo” surgery may then make the economics absolutely right by eliminating the need of a second assistant. (Economics is a massive subject I need to tackle. It is soooo misunderstood and gets dragged down to price.)

It’s very complex - but if you get this segmentation right - then you start to be able to target the right procedures for the right surgeons that matches their technological needs. But this takes a lot of up front work. If I called your marketing department today - would they be able to present me their segmentation and messaging by segment y user profile? Or would it be a blanket message of all “we are cheaper than a daVinci!”

Slice 3 - Site of care and workflow

surgical robotics segmentation site of care

Different sites of care bring very different dynamics that need to be respected - or amplified.

The different sites of care bring differences in location - support services - OR size - staffing - workflow - time constraints - reimbursement - management focus - acuity of procedures etc etc.

If you have not fully mapped out the characteristics of different sites of care in different countries and healthcare systems. What is your marketing team doing?

You should be able to list all sites of care and have a matrix of key characteristics that impact the use / choice of your robot.

So you should have the “hot characteristics” of your offering and where it shines. Where your USP makes so much sense it’s embarrassing. And you need to match that to the right sites of care.

Examples. If we have a tiny private clinic in Rome (where I live) that has low ceilings - weak floors - tiny OR space. A da Vinci is not fitting in there - period. In fact many systems may not fit. So it may be super suitable to a smaller Lap 2.0 system or a small modular robot like Versius.

It may be the ONLY options they have without rebuilding their ORs.

On the far end of that spectrum you may have a huge - massive hybrid OR in a major teaching hospital that wants to have the biggest most loaded technological glory - so wants. DV5.

But you need to know that. Because again - spending your time and $$ on the wrong segment is going to get you nowhere. If they want a da Vinci they want a da Vinci in that location - and they can have a DV. You’re smaller footprint you keep banging on about is meaningless in that environment. Go talk footprint where it counts.

Now if your pitch and tailored messaging is “You need to be teaching multiple robots to be a credible training centre and not just a da Vinci centre…” that works. But the size messaging is not applicable. So you need tailored messaging for each segment.

Other things in site of care are just as important - and I will not reel them all off now. But think reimbursement differences between an ASC (ambulatory surgery centre) and a main op block.

Reimbursement is less - they have a list of procedures they WANT to do. They have a squeezed profit margin and time constraints. They have staffing issues and it is all about workflow and efficiency.

So a DV5 may fit physically… But it may be seen as “overkill” for the procedures in those particular ASCs (yes it’s changing). But using Moon or DistalMotion and keeping surgeons bedside - single operator - lap fast setup and workflow may make ASC “robotic” procedures viable.

If they have CSSD constraints then the right answer might be a robot in a box - Virtual Incision?

It allows a marketing claim of the hospital to say “Get your robotic procedure here” but using a lower technology system (not being offensive I’m talking technological features). But that trades off with allowing simplified set up - smaller footprint - lower cost per case etc etc.

There are multiple reason why a certain site of care might have a preference for a certain format of robot - cost of robot (complex one) - ability of a robot.

The marketing team’s job it to work that out. Match the right surgeons and their needs - to the right site of care - to the right profit profile - to the right procedure acuity etc etc.

And carve out a very well crafted targeted market segmentation - focused.

There are multiple ways to cut this cake - but all of these segmentation slices must intersect to have a maximal impact - and a sensible impact.

So what should we do

I cannot stress this enough. The market is already segmenting itself. If you are still going out to “sell a robot” to anyone that will listen. You are doomed in 2025.

(Likewise if you are a surgeon or a hospital administrator. One size does not fit all.. but there are decent new solutions that may support certain segments of your healthcare needs. DSegments in the past that you thought could not be done with the "robot" that existed.)

If you do not have an utterly crack marketing team that are segmenting - and helping with detailed targeting. Then what are they doing.

Ahh that’s right - they are putting up glib linked in posts about “did you know robotics can help surgeons”

Or “You don’t need a robotic stapler.”

Or “Our robot democratises surgery.”

(Just look at my face as I scroll linked in.)

They are building utterly nonsense brochures that are just a horrible list of features that target no one. “We have four arms.” “We have a console” “We have scissors that cut” “We have robot - buy it.”

Get that marketing team building you targeted smart weapons. They need to be segmenting like crazy (for how best works for you) - then building maps of the targets - and looking for the intersections of where the prime targets (for you) are.

They need to be building 360’ targeted marking campaign that targets those locations.

They need to be segmenting customers by profile that fit your robot.

If you have a Lap 2.0 - your target is not a da Vinci urologist that has done 2000 prostates on da Vinci - loves it - and uses it’s firefly for radical prostatectomies in the main block.

If you have a modular robot - don’t target people that love monoblocks and their simple set up.

Target surgeons doing the right acuity procedures in  sites of care  that want a “more lap approach” and “never got on with da Vinci.”

Don’t allow your commercial team to run off where the sun shines and hope they find a customer just looking for a robot that knows nothing about robotics…

With approval after approval (clearances) of more and more robotic systems that have different architectures - capabilities - cost points… the market will now start to segment further.

I’ve not even discussed how it will be Multiarm vs Lap2.0 vs Single site (Single port). That is another sub division and category where the lines are blurred but the market will start to tell us what is suitable where. In that category of single site alone you have Virtual Incision, Vicarious, SP and more coming.

But how should those systems be targeted? Where do they shine? Where do they make sense vs a multi port?

During 2025 we will start to see this sub classification grown - and there will not be a single answer - a single segmentation that fits every business.

There will no longer be a single robot or format anymore.

The key for companies is to build a segmentation that works for you. (I offer just one method above.) But the “shoot everywhere and hope we hit something” is not going to work - I can assure you.

But what you will find is that with the right market segmentation - in the right countries and healthcare markets  - the right institution and surgeon profiling - combined with the right messaging of your USP. Then you will spend less resources and get a way better hit rate.

Segmentation is here and it will only go deeper.

These are just the considerations of the author for education purposes only. All trademarks and images remain the property of the companies.