The scene of surgery will change however. Medical specialists that operate with the robot will need constant practice. This is the same for normal surgery. If operations are not continuously performed the surgeon will loose agility and risks will increase. The change from normal surgery to robot-assisted surgery therefor of a high impact because of this: it does not only mean a new equipment, but the organization and organizational procedures and protocols will change. In addition to the reduced continuity of the business: surgeons with different backgrounds (robot or traditional experience) become incompatible which means an increased specialization of the surgery profession.

For the organization as a whole the investment for the da Vinci robot will have to be analyzed in context of the complete business.

The da Vinci Robot is highly innovative and will increase the image of the hospital (“Da Vinci Inside”) but a reasonable question is: how innovative is the hospital in other areas? Is the hospital leading in offering surgical operations, for example specialized in prostate operations and is it able to continuously keep up with these innovations and be able to support the maintenance costs involved? The improved client satisfaction after using the robot does not directly justify the purchase of the robot for it is able to serve a limited number of operations. New operations (treatments) will be available in the near future but not without additional investments.

For most surgeons the purchase will increase their motivation. The da Vinci robot is a symbol of innovation (status) and medical specialist are sensitive to such tools. But what will the purchase mean for the other specialists in the hospital who have a limited budget assigned and are not able to select the most innovative equipment?

This — and much, much more — is all part of the complete picture. A normal cost benefit analysis is not sufficient to determine whether a hospital should invest or not.

What hospitals have to take into account is that the intuitive approach is no longer competitive. The company bought its sole competitor (Computer Motion Inc) in 2003 and left the sector without any significant competition. This will mean a risk for hospitals who will be more dependent of this single supplier and their strategy.

The med term strategy is to support the equipment of their previous competitor – with equipment like ZEUS and AESOP robots, but “We are no longer promoting the AESOP, HERMES, ZEUS and SOCRATES products; however, we continue to support systems that are installed at customer Prostate Protocol sites. We have discontinued pursuing any further regulatory approvals for these four products.”(1)

The merger between the two companies has eliminated “costly patent disputes” but also it has diminished the innovation process. (see the previous article on the dialysis market).

Melcher argues that the company’s patents, user base, unique regulatory status, and the training required to learn these machines have given the company an unbeatable competitive position… Intuitive has a “quintuple walled monopoly in the robotic surgery industry.” … “any competitors in robotic surgery can’t compete the way Advanced Micro Devices (AMD) competes with Intel (INTC).” (2)

He cautioned me that Intuitive’s systems are not being bought primarily for their capabilities… their capabilities have awesome potential, but are still a little too limited in the number of procedures they can do to justify their cost, except perhaps in one hospital per city… the systems are being purchased to show that the hospital is state of the art… Once one hospital gets the system, the other hospitals have to get it or they look like they are definitely not the leader in town.

Like Intel-Inside, the da-Vinci-Inside is a proof of quality. But before getting there an hospital has to do its homework, even if they appear not to be “the leader in town.” There is a lot more than merely the “Sticker” on the outside…

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