Versius - The most popular soft tissue surgical robot. After Intuitive.
- Steve Bell
- 2 days ago
- 10 min read
I've held off a very long time to write about Versius - as of course I'm biased. But I'm not going to lie. It's an awesome system in my eyes. But I feel two and half years out I can be a little more impartial and credible about the system. And hopefully you will indulge me as I try to use facts and data to show why it is abosluetly the number two system out there. (Number 1 competitor.)
I cannot stress enough, that comparing the numbers of surgeries, systems, users, clinical studies etc of any system to da Vinci by Intuitive is just borderline stupid. My strongest of suggestions is for us all to look at systems in their own right, as alternatives. And then we can benchmark the alternatives... and maybe have some sense of scale and leadership.
So for this blog I am excluding Intuitive from the discussion (nearly) as all the others together become noise in the signal if we add the da Vinci numbers.
Why now? Well I wanted to follow up on announcements by CMR Surgical at SAGES this year as they signalled their commercial intent in the USA. They announced their latest procedure numbers - and I wanted to dig into this - and do some contrast and compare. I wanted to see if those case numbers kept them at the top of the pile.
Firstly they announced they have passed 45,000 patients treated. So let's take a look how that growth has been happening since launch. How have those numbers evolved over time.
I've taken all of the historic CMR announcements of procedure figures and graphed them against the time frames. This graph is a healthy graph and is going up in the right direction and accelerating. I like it because what it shows is an increasing uptake as installed systems continue to utilise the system and grow cases - because that is the healthy side of a robotics business. The razor blades are important.
The second feature you should focus on is that this is in the OUS market so not with the bigger volumes often asscoiated with the USA. I have always been a firm believer that the right system in any country - in the right hospital will get utilised like in the USA.
But let's now do a bit of crystal ball gazing. Based off current OUS usage only, I've plotted the bear and bull side of projections for CMR. This doesn't truly consider USA as a major "uptick" factor as I feel that Versius does get good utilisation in other countries; so I don't forsee a major US impact on cases per system. I could be wrong. But.
If we look at these modelled forecasts we can see that with little to no trajectory change by 2036 Versius could well do a half million cases. A respectable number. If we do see some tailwinds and a USA impact, more indications, more features (staplers, more advanced energy) we could see 780K procedures.
Conversly if we see even stronger competition with JNJ, Medtronic gaining ground then we still get to a very respectable 280K procedures. In all of these scenarios we do see a significant jump from the 45K today - significant. And importantly all the models show an increasing slope to the graph. Robotics is not going away any time soon.
But what about all the other runners alongside CMR?
One note about this graph. I know that some of the companies have done more cases than reported. But I need to try and be fair and treat published numbers equally. EXCEPT MEDTRONIC - there are no published numbers - so take this one with a massive pinch of salt. That number is derived from guestimate of installed systems - and then case volumes that have been taken from linked in posts - clinical studies - articles - presentations - then averaged out across the guestimated installed base (plus a little magic I've sprinkled in.) So take it for what it is. But this is the best I could find online - and this is how those cases all stack up historically. And yes this is important. As EDGE / SSi Mantra / Toumai are all later comers... so yes they of course are lower numbers. Ahhhhhhh!
Why is this important? Because much of the thing about cummulative case numbers is time dependency. You can't magic installed bases and usage over night - even if you are Medtronic or JNJ. And that is critical for the next part of this post - as we will discuss relative projections. And this is where it gets tricky - because if TIME is a constant.
It is also tricky as SSI, Toumai and EDGE all have so far played "home turf advantage" with most of their cases done in their home countries. CMR interestingly has not. Of course it has a lot of systems in the UK but is in 30 countries! And the bigger contributing countries to procedures are most likely not UK. (This is another impact of time for smaller companies. geographical footprint takes time.)
I've mixed some magic sauce here - and I am not revelaing my methods as it was complex. But here we see how these numbers could play out - and size of your company does not overcome the constraints of time - features - approvals. The lead in time is more important than the company size in surgical robotics. Time is the biggest predictor on cases. "er yeah!! that's a dumb statement Steve." Well no. I still hear projections that do not fully undertsand this. No matter how big you are. no matter how many approvals you have. Selling - installing and growing systems has a finite limit based on time. You cannot sell 1000 robots if there are only 100 being bought in that time period.
Now no matter how I model this - and it is time and time again - the numbers keep coming out in these rough amounts. And part of this is simply that function of time. I did not include JNJ Ottava today as they are starting at zero and no approval - so I'm not just going to speculate those numbers. But if you want to (and it's on you) - follow under the MDT curve most likely. I'll try and come up with another method to do that one. Also no Distal Motion - no Moon (and others) as I wanted Multi-arm robots for this one and had to draw limits for my modelling so went with these. And I left off Hinotori because I ran out time... sorry.
So what do my numbers say:
Well first off today Versius is the second most utilised surgical robot after Intuitive. It doesn't seem to be slowing - in fact it seems to be increasing in case rates.
Then we are followed by Medtronic Hugo.
Senhance - read LUNA for forward pojections - it's the best I can do on a system that is still out there but will transition to a newer model (LUNA) in the future some time. Too many variables. They come in third. (Time on their side historically.)
I said I wouldn't - but I will. Let's sit back again for a minute and look at how this stacks up against Intuitive. (I know I said I wasn't going to do it.) We see a total of about 1.2 million procedures cumulative for all these systems by 2036. Today Intuitive sits at 20 million cummulative. By 2036 expect (at todays 3 million run rate) that number to be over 50 million. As an old US friend of mine always said "You do the math!"
Even if we added in 200K for Ottava - we are still under 1.5 million vs 50 million. Three years ago at SRS I said that by 2033 we could see 30% of procedures worldwide done by non Intuitive systems. I think I'm going to reduce that prediction somewhat. And say maybe 20% of annual procedures could be done by other systems. It has taken the bigger players a lot longer than expected to get FDA. And challenges have been harder - oh and DV5 popped up.
Market share a brief note:
I will not do this today. But when we talk market share in the future we have to be very very very specific.
Share of all procedures ever done?
Share of installed base to date?
Share of installs that year?
Share of revenues to date?
Share of revenues that year?
Share of complex vs simpler cases?
Share of instrument revenues?
Share of capital revenues? etc etc etc
So we will need to be careful. I think 20% of cases performed in 2036 will be non Intuitive. There I said it.
Why do you like Versius?
If there is one question I get asked more than any other when I meet people it is "Why do you think Versius is so good?"
Indulge me for a while. Because clearly with the graphs above, I don't think that is my opinion alone. To be number 2, and ahead of Medtronic, there must be something.
Well there are many things.
Firstly - TIME. I think Versius is good because it got out of the F'in door. We saw a window and we took it. We went out as the first real contender to Intuitive in history. Yes there was Asensus but it didn't go big enough and hard enough at Intuitive. And it had that weird lap control system and no wristed instruments. It wasn't able to compete head on.
Versius was the first "real" contender out of the door - and that was super super important. Maybe that time advantage was more important (looking back now) than we realised. Every day you lose is harder and harder to make up. Competition takes more shelf space, users get more entrenched...
The second big thing, in my opinion, was that we were so far away from the Intuitive design. Open console - hand only controllers - modular bases - no Z rails - 5mm port capable instruments. Utterly alien architecture to the da Vinci. Oh did I say... no Z-rails. Attitude. I think I cannot say this loud enough. We did what most start up brands must do. We created an underdog fighter attitude. Respecting Intuitive, but not being scared of them. We were rebels and upstarts. And that made us curious to the crowd. We absolutely believed we were bringing a genuine alternative. And from a very very very good place of intention. Transforming surgery. For good. Meant something.
Team. We had an absolutely stunning team that were fast - nimble - resourceful and could deal with issues (and there were some...). We had a team spirit that was unbreakable.
But underlying all of this was the unique Versius design. Still to this day the V-wrist is everything in my humble opinion. If you don't understand that - what it is and how it works - hold a stick like a dagger (Z-rail) - hold a stick like a sword fencer (V-wrist) - and that is the magic. It means that Versius has the smallest bases - yet massive reach inside the abdomen, but with small arm movements outside. Go on - pretend that stick is a lap instrument and see how it works.
The open console - yes... but not the game changer. The hand only controllers - hmmm may have caused more switching resistance than with foot pedals in hindsight. (I love 'em though.)
Still today - there is nothing that comes close to the arms - by moving away from a Z-rail. It is the reason is it so compact and small and you can put the bloody ports where you want - even close to each other. If you have not tried the system try it.
Did we have problems getting out so fast? Yes of course we did. But no more than every other system before or after. And that is where the current announcements of CMR from SAGES warms my heart. You see nothing is perfect at launch - software - instruments - vision. The system got better every month. But CMR has waited for Versius PLUS. And that makes a big big difference. White light ICG, Advanced energy, bigger brighter screen, improved instruments and better and better software. I am so pleased that they waited until the Plus version was ready for the USA. The older model was great - the newer model is a step up. No doubts.
If it's number two... why wouldn't a strategic take CMR?
Go ask the. numpties that have passed on it... (I'm kidding !!!!) - no I'm not.
I am!!! but not really. :)
I can only give you my current thoughts from a theoretical soap box...
As I look at the charts above. It seems obvious to me what the best system to tackle this market would be if you were in anyway involved in surgery as a company. And needed to be in this space.
Think about this. Should any company have acquired Versius - that company would now be the number 2 player in soft tissue surgical robotics - de facto. The clear leader of the competitive systems. They would have 45,000 cases under their belt that could be powering their data systems, AI and autonomy. (see recent work with Nvidia.)
They would have access today (not in 10 years) to a surgical robot that has a serious chance of being a real system that could be perfect for the next battle ground - the ASC. And that is where this battle is moving.
They would have a factory with all the manufacturing kinks worked out. A massive OUS footrint and user base. Clinical data, publications and a registry (the biggest robotic registry.) And experience in all of the major procedures with data to follow up - including paediatrics and TORS.
Such a company would have nearly 7 years of commercial insights - scar tissue - service knowledge - contracting knowledge from 30 countries. And be projected to continue to have the number two system on the market into the future (no internal project of any company has a time machine built in.)
Any company (and there's a few) would absolutely be in the fight now and maybe propping up their sagging current surgical business that is being eaten by Intuitive and the myriad of other robotics companies every day.
But hey - you can take a horse to water...
And anyway. Verisus under CMR as a stand alone looks like it is in good shape.
To me, it is utterly obvious that based on my models - Versius is and will remain the number two system for the next decade. Of course I am biased. I said it from the start. So take me with that little pinch of salt you always do.
But the data is the data: 45,000 is not my number. But it's a good number.
These are just musings, projections, assumptions by the author intended for education purposes only. These projects should not be read as facts but just hypothetical models.
