Robotics: Self-proclaimed Twitter ‘King’ takes Intuitive Surgical to task

Updated April 9, 2014, at 1 p.m. EST with comments from Intuitive Surgical.

Intuitive Surgical (NSDQ:ISRG) got a lot of love from Wall Street after revealing the latest model in its line of da Vinci surgical robots, but at least one doctor isn’t a fan of the direction the company is going.

In a blunt editorial published today, Pennsylvania urologist Dr. Benjamin Davies chided Intuitive for moves that he said alienated doctors and hospitals. The self-proclaimed "King of the Urology twitter world" also took to social media today, calling sales reps "useless," and saying that Intuitive "has blown the rollout of the new bots."

Davies took issue with Intuitive’s "secrecy" in launching the new technology, which he says isn’t compatible with existing da Vinci systems. His hospital isn’t lining up to the buy the new da Vinci Xi system, he added, citing steep declines in procedure volumes amid a slew of bad press for the robots.

"I am in no position whatsoever to beg my hospital for another robot," he wrote for TheStreet.com. "They do not care and they shouldn’t."

Intuitive Surgical ceded that its Xi instruments aren’t plug-and-play compatible with the older Si model, but maintained that the new technology isn’t meant to replace Si, but to complement it.

"The new da Vinci Xi System represents a broadening of the da Vinci platform portfolio, not a replacement for the da Vinci Si System," a spokesperson told MassDevice.com. "Our goal is to align our da Vinci System technologies with case complexity and unique clinical requirements."

Davies has defended Intuitive in the past, saying that the flurry of negative headlines regarding the safety and efficacy of the da Vinci systems is "likely smoke and mirrors." In his latest editorial, Davies continued to characterize the technology as an important one for patients, saying lawsuits against Intuitive are "asinine" and that declines in procedure volumes are "unjust."

He nevertheless took issue with Intuitive’s handling of the new launch, saying that hospitals and doctors are strained to justify the purchase of the new machine.

"While Wall Street hails Intuitive’s da Vinci Xi surgical robot as the shiny delivery vehicle for new sales, those of us expected to pay for and use the new machines are pissed off," he wrote. "I do not see the economics or medical need lining up to justify Intuitive’s recently surging stock price."

Davies primarily took issue with incompatibility between the new da Vinci Xi and the older Si model. The new Si features a single overhead arm that carries all 4 of the robot’s arms, allowing the instruments to rotate and move across the patient’s body without having to shift the entire system. The Xi also features redesigned instruments that are longer, thinner and easily rearranged.

"My ‘old’ $2 million machine became last week completely incompatible with all the goodies that this new sexy, flashy techno-elitist robot is supposed to deliver," Davies wrote. "It’s like owning a great razor but having no blades."

He was also put off by what he called "secrecy" in launching the new system, saying that Intuitive should have been more upfront with hospitals to give them time to budget and prepare. He cited a colleague, California urologist Dr. Marc D’allera, who just purchased the older da Vinci Si without knowing that there was a brand new system on the way in just a few weeks.

Intuitive told MassDevice.com that it simply launched the new Xi system when it received FDA clearance to do so. The da Vinci Xi 510(k) clearance does not yet appear in the FDA’s online database, but Intuitive announced the news on April 1.

For hospitals already outfitted with da Vinci systems, they may be hard-pressed to pony up the cost of a new robot, especially as procedure volumes decline, Davies said.

"The administrators at my hospital email me with my total number of robotic surgery cases per month. The number of these cases have fallen by at least 50% over the past year," he wrote. "I could argue beautifully why that is unjust, but it’s a financial reality that both high volume procedures (prostates and uteruses) have fallen precipitously and will continue to do so."

Intuitive did not comment on Davies’ characterization of dramatic declines in procedure volume, but in early Q1 earnings the company revealed a 2% drop in instruments and accessories revenue as well as a 59% drop in da Vinci suite sales.

The company added that it will continue to provide support for the older da Vinci systems. Intuitive is also offering an upgrade program to help customers who want to shift to the new Xi suite. Intuitive Surgical announced in its 1st-quarter preliminary earning that it would set aside $26 million for a "trade-out program" to incentivize customers to shift to the new Xi system.