ISRG Stock Hammered

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ACOG president announces robotic hysterectomy isn't the best or most cost effective treatment option.

I don't know exactly what he said yet, but those of us in the know, know that the robot is a safe and enabling device. The volitility of the stock is a little disconcerting, as it seems that whenever anyone opens up about it publicly about it swings wildly up and down. A point could be made that it is a more costly procedure that other modalities, but not outrageously so on a per procedure basis. Of course, everyone always glosses over the fact that it significantly reduced the rate of open procedures in gyn cases...
 






Anonymous said:
ACOG president announces robotic hysterectomy isn't the best or most cost effective treatment option.

I don't know exactly what he said yet, but those of us in the know, know that the robot is a safe and enabling device. The volitility of the stock is a little disconcerting, as it seems that whenever anyone opens up about it publicly about it swings wildly up and down. A point could be made that it is a more costly procedure that other modalities, but not outrageously so on a per procedure basis. Of course, everyone always glosses over the fact that it significantly reduced the rate of open procedures in gyn cases...
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Unfortunately you cannot demonstrate any improvement in clinical outcome. With today's technology, a woman can have a TAH in <45 minutes (+/- a few minutes). How long for a robotic hyst? 2 hours? There is a huge benefit to the patient in getting her off the table faster. There is a place for robotic surgery in procedures with limited access or where precise microsurgery is needed (prostate). But Hysterectomy? come on. NO CLINICAL BENEFIT. Do no harm.
 






Anonymous said:
Unfortunately you cannot demonstrate any improvement in clinical outcome. With today's technology, a woman can have a TAH in <45 minutes (+/- a few minutes). How long for a robotic hyst? 2 hours? There is a huge benefit to the patient in getting her off the table faster. There is a place for robotic surgery in procedures with limited access or where precise microsurgery is needed (prostate). But Hysterectomy? come on. NO CLINICAL BENEFIT. Do no harm.
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You're trying to say that a TAH is better than a robotic hyst?! NO WAY! Minimally invasive is always better than a huge open incision. What about the increased infection rates or length of stay w/ an open procedure? What about the patients return no normal activity? Perhaps you meant to say TLH, but even so, an experienced robotic surgeon is faster robotically than they ever where lap. I would be happy to show you the clinical data on that as well.
 






























I can hear the collective sigh of relief from all those 2/month GYNs that you guys have been dogging forever to "capture market share," "become a leader in your market," "differentiate yourself.". They're all just said "thank you mr. President of acog for getting these a-holes off my back."
 






Working for this company makes me nervous. Too risky. Unprecedented micromanagement. No thanks..life is too short to work for these idiots. Over time, this company will wear on you.
 






This ACOG announcement has been a long time coming, and everybody knows it whether they admit it or not. It's been a very impressive run for the daVinci marketing machine, and robotic surgery is here to stay, but the next five years ain't gonna be like the last five. I feel bad for the reps who left solid organizations to join Intuitive over the last 6 months. It's gonna be a rough ride.
 






Anonymous said:
You're trying to say that a TAH is better than a robotic hyst?! NO WAY! Minimally invasive is always better than a huge open incision. What about the increased infection rates or length of stay w/ an open procedure? What about the patients return no normal activity? Perhaps you meant to say TLH, but even so, an experienced robotic surgeon is faster robotically than they ever where lap. I would be happy to show you the clinical data on that as well.
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So you are saying that those surgeons who still do TAH "open" are unethical? FYI-surgeons who have been doing open TAH's for decades are still just as fast.
 






"Patients should be advised that robotic hysterectomy is best used for unusual and complex clinical conditions in which improved outcomes over standard minimally invasive approaches have been demonstrated."

If lap is so equivalent to robotics then why the fuck can't it handle unusual and complex clinical conditions??
 












Anonymous said:
Do you guys know on average how many hysterectomies are considered "unusual or complex", is it around 10%, more? Thanks.
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CDC has about 600,000 annual hysterectomies 90% are estimated as chosen electively by the patient. Of the remaining 60,000 I'd guess 20% are complex. So 12,000 procedures per year as non-elective and complex.
 












Anonymous said:
"Patients should be advised that robotic hysterectomy is best used for unusual and complex clinical conditions in which improved outcomes over standard minimally invasive approaches have been demonstrated."

If lap is so equivalent to robotics then why the fuck can't it handle unusual and complex clinical conditions??
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The issue is cost. For a simple total hyst, a vaginal approach is cheapest and the least invasive method of treatment. Nothing is less invasive than a vag hyst period. Lap and dV are equivalent in terms of invasiveness, but a lap hyst is cheaper. The instruments are cheaper and doing a TLH doesn't require purchasing a $2m piece of capital. If the patient looks like it's going to be a chip shot, the surgeon should start lap and the robot can be docked if needed. The problem is ISI couldn't care less about cost, so they use the guise of patient safety to leverage hospitals and surgeons into doing BSOs with the robot (part of the clinical pathway after all!), which is totally ridiculous. ISI's greed will be their undoing. If they pushed the robot for use in appropriate procedures, I guarantee we wouldn't be having this discussion (look at urology and dVLAR). However, because of their hostile sales tactics that are grounded in a greed driven culture that says the robot should be used in simple procedures like hysts and choles, societies and hospital systems are starting to push back on the exbortitant and unnecessary costs of attempting to do every procedure that way.
 






Go baby GO! Can't tell all you readers/voyuers out there how happy it makes me to see this shit show get exposed.

If I were Ethicon or Covidien, I'd be plastering this ACOG review all over the hospital. Not just the GYN offices.

Wonder how eager those general surgeons will be to tackle single-site lap choles now?
 






Anonymous said:
The issue is cost. For a simple total hyst, a vaginal approach is cheapest and the least invasive method of treatment. Nothing is less invasive than a vag hyst period. Lap and dV are equivalent in terms of invasiveness, but a lap hyst is cheaper. The instruments are cheaper and doing a TLH doesn't require purchasing a $2m piece of capital. If the patient looks like it's going to be a chip shot, the surgeon should start lap and the robot can be docked if needed. The problem is ISI couldn't care less about cost, so they use the guise of patient safety to leverage hospitals and surgeons into doing BSOs with the robot (part of the clinical pathway after all!), which is totally ridiculous. ISI's greed will be their undoing. If they pushed the robot for use in appropriate procedures, I guarantee we wouldn't be having this discussion (look at urology and dVLAR). However, because of their hostile sales tactics that are grounded in a greed driven culture that says the robot should be used in simple procedures like hysts and choles, societies and hospital systems are starting to push back on the exbortitant and unnecessary costs of attempting to do every procedure that way.
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...pretty much spot-on.
 






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