Intuitive Surgical Inc (ISRG)

[was CUIN2]

AMAZING NEW ARTICLE ON SPORT - SOMEONE NEEDS TO MAKE THIS ONE A STICKY ON THE BOARD

http://www.mdtmag.com/articles/2014/04/drawing-board-or-part-i

This article, written mostly from the Ximedica perspective, provides one of the best behind-the-scenes write-ups of the design and tissue testing for SPORT to date. After reading this article, you'll understand how well things have been going on the SPORT buildout. There are also some excellent tidbits in there as to how the tissue testing has been going, and just how long the project has been going on to commercialize IREP into SPORT.

Also included is a picture of the fully configured SPORT OR used in the tissue testing:

[was CUIN2]

Copied from Titan Medical message board:

I just spoke to one of my friends who is a high ranking executive at Stryker. He told me Titan is the real deal and can easily have a $2 Billion valuation in the next year. I would be surprised if this stock is not at least $3 within a month, and $9 by the end of the year.

[was CUIN2]

Excerpt Copied from Seeking Alpha

Intuitive Surgical: The Growth Story That Wasn't
Saturday, April 12, 2:19 AM ET | Bill Maurer

"Suraj Kalia commented, "We ask a fundamental question....What is the da Vinci Xi really trying to solve other than be a "jazz" factor? From a purely engineering perspective, we do not see how the da Vinci Xi is radically different from the Si (we are specifically talking about cost and clinical effectiveness). While some of the features in terms of instrument set-ups and multiquadrant capability in the Xi is good, it does not address the fundamental issues hospitals are facing which is lack of cost-effectiveness. We believe we are entering a cycle wherein Intuitive will have to start offering discounts in order to maintain growth. Either top-line growth gets sacrificed or margins get squeezed ... Field checks on the Firefly continue to be poor, and we cannot figure out the emphasis from Intuitive on this imaging modality."

The second half of that statement is what worries me. Either Intuitive will have to sacrifice top line growth or margins will get squeezed. Neither scenario is very appetizing, especially when you have such a lofty valuation. Obviously, some investors might take this in stride since the firm has a $275 target on ISRG. I don't see Intuitive falling that much anytime soon, but it goes to the issue of the growth story. Intuitive is having a hard time with device sales, and the company has blamed insurance companies and the ACA in recent quarters. Add in some of the legal troubles, and you can see why the company's growth has stalled a bit.

Final thoughts / preferred trade:

Another warning from Intuitive Surgical sent shares lower. A recent spike in the stock has mostly been eliminated, despite a new da Vinci system coming online. This company has hit a rough patch in terms of its growth story, and at a premium valuation, the stock is just too expensive. Going forward, the company may need to sacrifice profits to resume revenue growth. Earnings per share will be helped a little by the buyback, but it won't be enough to offset a sharp decline.

For now, investors should consider Intuitive a short candidate until the growth picture clears up or the stock gets a bit cheaper. An outright short is not a bad idea, but I think hedging this position (via options) a little is the best way to go, just in case. At this point, the market has been beaten down the past few days. I would wait until the next bounce back to short Intuitive, as you might see a bounce to $450 or so at some point. For investors that want to be in right away, maybe short half now and short another half if shares pop.

In the end, Intuitive has had a rocky couple of weeks. A sharp rise has been followed by a fall, and that fall might continue as estimates trickle down. Intuitive is going to have some explaining to do on the call (April 22nd), and growth questions will be asked. As you can see from the chart below, Intuitive was below $420 before the recent run started, and that could be the next pullback level to watch if this name heads lower. Should these revenue and earnings issues continue into Q2 and further, you might see shares fall back into the $350 to $400 range or even lower. A company that trades at such a high valuation needs growth, and right now, Intuitive is severely lacking in that department."

[was CUIN2]

http://www.titanmedicalinc.com/wp-content/uploads/2014/04/TMD-Morning-Star-Research.pdf

[Stockexpertpro]

ISRGMOTHER OF ALL SHORTS!!! LINK ISRG Why Intuitive Surgical Is The Mother Of All Shorts

http://www.thewallstreetfox.com/2014/04/why-intuitive-surgical-is-mother-of-all.html

[was CUIN2]

Interesting article about robotic surgery trends that will create new career options for nurses. ISRG and Titan Medical/SPORT are mentioned as a new option/conduit for hospitals wanting to offer robotic surgical procedures.

http://www.oncologynurseadvisor.com/robotic-surgery-trends-create-new-career-options-for-nurses/article/341748/

[Stockexpertpro]

Sales expected to be down 59%

[was CUIN2]

Possja18 - Several reliable sources on the Titan Medical Message Board have indicated such, as well as the following Brokers : BMO, DISNAT and RBC all confirmed it as well.

Please review the posts on the Titan Medical Board.

Good luck!!

[possja18]

Thanks CUIN2 and yes I was aware of it. Been doing DD for the last 2 days and will be taking a position in the am. Where are you seeing that the offering is already completed?

[was CUIN2]

Possja18,

Did you hear about Titan's overnight financing? It surprised all of us as they just had a very successful financing in February.

Traded at an all time high yesterday, and then a halt to announce an overnight finance which now takes them all the way through commercialization of SPORT, (no more financing needed) The financing sold out last night $25,000,000 raised I believe, and Titan closed only about 5% below yesterday's close with very high volume on the open market as well. Really incredible IMO.

If you are considering taking a position, you may want to fast track your DD. Best of luck to you.

[pointofreturn]

You are correct Chickenlips

Tomorrow morning will be the opportunity to step into Titan as they just announced a financing to be done over-night.

We suspect it will be in the $2.10 to $2.20 range giving you all an opportunity to step in now.

GLTA

[chickenlips]

Once in a lifetime opportunity with Titan(TITXF)! Get in early

[was CUIN2]

Thanks possja18. ISRG is a great company BTW. I missed initial blast-off with it as well and am hoping to catch a ride up with Titan as well.

[possja18]

Thanks for the information CUIN2. I will be doing some very serious DD on Titan in the coming week or 2. I have seen you post here about Titan for some time now. I was late to the party on ISRG for the real monster gains a few years back but did quite well here. I did very well with MAKO also and hopefully Titan will be the same if I take a position. Wish you the best here and will probably see you around!

[was CUIN2]

Possja18 - $6 PPS by Ted Melcher of MarketDigestOnline. Link to article is at the bottom of this page.

SPORT will be around $800,000 versus the cost of the da Vinci around $2.1 million. So not only is the footprint likely to be much smaller but the cost is also projected to be substantially less and the SPORT can also be used for ambulatory and outpatient procedures. The return on investment with the SPORT should be much, much faster for hospitals.

Titan management recently had a meeting with several large Group Purchasing Organizations and their member hospitals within the U.S. Over 300 people were in attendance representing CEOs, CFOs and directors of operating rooms. One of the CEOs involved was quoted as saying that after they purchased a da Vinci and it arrived at their hospital that it became clear that once the unit was placed in an operating room it was going to have to remain stationary.

Quite often equipment is moved from operating room to operating room but that is not the case with the da Vinci. The CEO said to move the da Vinci would be like moving the space shuttle through Los Angeles! This CEO said this is where his story began because up until that time in that specific operating room his hospital was able to complete four “open surgical” operations a day 260 week days a year for 1,040 procedures annually. With the da Vinci that decreased to 160 so they had displaced almost 880 procedures and unfortunately or fortunately for the hospital, they were operating at 94 percent operational efficiency so they didn’t have any place to put the patients.

With respect to reimbursement, surgery performed by with the SPORT will be classified as minimally invasive surgery. The SPORT will be targeted in general procedures and OBGYN procedures.

Titan is on track with all their milestones which began in 2013 with the initiation of bench and preclinical testing and completion of technical feasibility and integrated testing. Through Dr. Dennis Fowler, the company will work closely with the FDA on initiation of preclinical and clinical planning. Dr. Fowler is the coinventor of the singleincision technology licensed by Titan from Columbia University and he is a minimally invasive surgery pioneer, performing over 10,000 minimally invasive procedures during his career. Titan expects to initiate outside U.S. approval and initial commercialization in 2015.

Including the raise the company completed on February 19, 2014, there are just under 30 million warrants currently outstanding. The exercise prices vary from a low of $1.25 to a high of $2.00. If warrant holders exercised all outstanding warrants, it would generate an additional $58.5 million for the company. In the last several days approximately 3 million warrants have been exercised. The expiry date of the least expensive warrants is March 2018.

Unless warrant holders play a waiting game to see how high the stock goes prior to expiration of their warrants, this writer cannot phantom any reason why all outstanding warrants will not be exercised. Assuming that none of the outstanding warrants are exercised over the coming twelve months (which is a crazy assumption), the company currently has enough cash on hand to carry them for another 12 to 14 months which would mean they would have to do another financing within the next year. Assuming the stock continues to perform like it has in the past and millions of warrant holders exercise their warrants the company could theoretically have enough cash to take the SPORT Surgical System to market.

During my conference call with Titan management, John Hargrove, CEO was quoted as saying…. “In my 40 plus years within the medical device business this is the biggest opportunity I have ever seen. There’s a perfect storm out there for a robotic company like Titan.”

BOTTOM LINE FROM MDO: After I completed my initial due diligence, the thing that struck me first was the huge price difference between the stock of Intuitive Surgical (ISRG $434.94) and Titan. This is certainly not to suggest that shares of Titan are going to $400. It simply suggests the total potential, particularly when considering Titan’s SPORT appears to have many advantages over ISRG’s da Vinci. Fundamentally, we have a company that has met and is meeting all its milestones. Technically, we have a stock that is setting new 52 week highs.

Simply from a technical perspective, technicals are now indicating a near-term price objective of $6.00. Fundamentally, if Titan is successful at bringing their SPORT to market, we should easily have a stock headed to somewhere in double digits.

While partnerships are a possibility, Titan’s management is prepared to take SPORT to the market themselves. When asked about a potential buyout, the CEO said he didn’t want to speculate.

http://www.titanmedicalinc.com/market-digest-online-inc-newsletter/


Titan Website under Press Room-Media Articles
http://www.titanmedicalinc.com/market-digest-online-inc-newsletter/

[was CUIN2]

http://seekingalpha.com/instablog/1282351-steve-rosenman/2810293-titxf-updated-view-and-pt

I am increasing my buying sentiment on TITXF and taking price target to $15 within 6 months. I believe an full acquisition of the company or a substantial commitment on orders for 2015 will be announced.

[possja18]

Can you provide the names or links to the analysts who predicted $15 per share? TIA

[was CUIN2]

News will be forthcoming soon and a small position in Titan might be the best investment decision you make in 14.

You could sell 10 shares of ISRG at $505.61 = $5,056 and buy 2330 shares of Titan.

In the next few months Titan will at least double or triple in PPS based on anticipated news of clinical tissue testing and SPORT prototype completion (and most likely other news we aren't even privy to yet)

Within 6 months some analysts have predicted $15 PPS.

Think about it, do your DD and you should come to the same conclusion.

[was CUIN2]

10 share of ISRG gets you 2500 shares to Titan....

News will be coming soon and this is the deal of a lifetime.

[was CUIN2]

Titan has raised $3.75 million (minimum) from warrants exercised in the last several days according to the article.

"Including the raise the company completed on February 19, 2014, there are just under 30 million warrants currently outstanding. The exercise prices vary from a low of $1.25 to a high of $2.00. If warrant holders exercised all outstanding warrants, it would generate an additional $58.5 million for the company. In the last several days approximately 3 million warrants have been exercised. The expiry date of the least expensive warrants is March 2018."

If this trend continues, Titan may not need another financing, or a very minimal one. In the last few days 10% of there outstanding warrants have been exercised.

[was CUIN2]

SPORT will be around $800,000 versus the cost of the da Vinci around $2.1 million. So not only is the footprint likely to be much smaller but the cost is also projected to be substantially less and the SPORT can also be used for ambulatory and outpatient procedures. The return on investment with the SPORT should be much, much faster for hospitals.

Titan management recently had a meeting with several large Group Purchasing Organizations and their member hospitals within the U.S. Over 300 people were in attendance representing CEOs, CFOs and directors of operating rooms. One of the CEOs involved was quoted as saying that after they purchased a da Vinci and it arrived at their hospital that it became clear that once the unit was placed in an operating room it was going to have to remain stationary.

Quite often equipment is moved from operating room to operating room but that is not the case with the da Vinci. The CEO said to move the da Vinci would be like moving the space shuttle through Los Angeles! This CEO said this is where his story began because up until that time in that specific operating room his hospital was able to complete four “open surgical” operations a day 260 week days a year for 1,040 procedures annually. With the da Vinci that decreased to 160 so they had displaced almost 880 procedures and unfortunately or fortunately for the hospital, they were operating at 94 percent operational efficiency so they didn’t have any place to put the patients.

With respect to reimbursement, surgery performed by with the SPORT will be classified as minimally invasive surgery. The SPORT will be targeted in general procedures and OBGYN procedures.

Titan is on track with all their milestones which began in 2013 with the initiation of bench and preclinical testing and completion of technical feasibility and integrated testing. Through Dr. Dennis Fowler, the company will work closely with the FDA on initiation of preclinical and clinical planning. Dr. Fowler is the coinventor of the singleincision technology licensed by Titan from Columbia University and he is a minimally invasive surgery pioneer, performing over 10,000 minimally invasive procedures during his career. Titan expects to initiate outside U.S. approval and initial commercialization in 2015.

Including the raise the company completed on February 19, 2014, there are just under 30 million warrants currently outstanding. The exercise prices vary from a low of $1.25 to a high of $2.00. If warrant holders exercised all outstanding warrants, it would generate an additional $58.5 million for the company. In the last several days approximately 3 million warrants have been exercised. The expiry date of the least expensive warrants is March 2018.

Unless warrant holders play a waiting game to see how high the stock goes prior to expiration of their warrants, this writer cannot phantom any reason why all outstanding warrants will not be exercised. Assuming that none of the outstanding warrants are exercised over the coming twelve months (which is a crazy assumption), the company currently has enough cash on hand to carry them for another 12 to 14 months which would mean they would have to do another financing within the next year. Assuming the stock continues to perform like it has in the past and millions of warrant holders exercise their warrants the company could theoretically have enough cash to take the SPORT Surgical System to market.

During my conference call with Titan management, John Hargrove, CEO was quoted as saying…. “In my 40 plus years within the medical device business this is the biggest opportunity I have ever seen. There’s a perfect storm out there for a robotic company like Titan.”

BOTTOM LINE FROM MDO: After I completed my initial due diligence, the thing that struck me first was the huge price difference between the stock of Intuitive Surgical (ISRG $434.94) and Titan. This is certainly not to suggest that shares of Titan are going to $400. It simply suggests the total potential, particularly when considering Titan’s SPORT appears to have many advantages over ISRG’s da Vinci. Fundamentally, we have a company that has met and is meeting all its milestones. Technically, we have a stock that is setting new 52 week highs.

Simply from a technical perspective, technicals are now indicating a near-term price objective of $6.00. Fundamentally, if Titan is successful at bringing their SPORT to market, we should easily have a stock headed to somewhere in double digits.

While partnerships are a possibility, Titan’s management is prepared to take SPORT to the market themselves. When asked about a potential buyout, the CEO said he didn’t want to speculate.

Titan Website under Press Room-Media Articles
http://www.titanmedicalinc.com/market-digest-online-inc-newsletter/

[was CUIN2]

Closed at a new 52 week high

[was CUIN2]

Thanks and good for ISRG!!

[Johnny Penstock]

The new robot

[was CUIN2]

Any idea what ISRG Management is revealing at the SAGES conference this week?

[Hereitfirst]

Bullish Analysis on ISRG ! http://hereit1st.com/2014/03/29/analysis-on-isrg/

[posilock]

its like the davinci on steroids with a better brain!

[was CUIN2]

Very true. This rookie is a better built athlete as well.

[posilock]

you know what they say even with football eventually the rookies take over because the veterans get too old but can't handle it anymore. Titan is a rookie thats on its way to MVP...

[chickenlips]

Titan Medicals next leg up will be strong!

[buccaneer1961]

nope...your wrong,it wont disappoint,this one ran its course....that other one will make a 10 bagger long before this makes a double...and this wont make a double without a split

[was CUIN2]

Mayo Clinic designed and built the Surgical Stapler for the SPORT Surgical System.

[was CUIN2]

Columba University/Vanderbuilt built IREP which is the main component of the SPORT Surgical System

[Johnny Penstock]

Titan is and will always be 3 steps behind ISRG. Mark this post. IMHO.

[buccaneer1961]

nope...your wrong,it wont disappoint,this one ran its course....that other one will make a 10 bagger long before this makes a double...and this wont make a double without a split

[pointofreturn]

Hi everyone including many of the familiar names from the Titan board. First time posting here and came to see whats going on.

Anyway, to add to CUIN2's comment yes Titan is completely working around ISRG.

Titan has a far superior product than ISRG however time is now the issue as they must go through all the usual process's.

The main issue now with ISRG is that most of the medical community hates dealing with them and thinks they are arrogant from what I understand. It's not my comment, it's the doctors comments that I am repeating.

Titan was designed by the doctors for the doctors.

Anyway, from a simple stock perspective Titan has substantially more upside than ISRG. I see no less than a double in less than a year where I don't see that with ISRG. That is my personal opinion.

I would not short ISRG at these levels as one person on this board suggested though. That would be reckless and risky unless you know something we don't. Another reason I would not short it is because ISRG appears to be a potential acquirer of Titan (one of many) and if they were to make such a move that could lead to substantial upside at any time to ISRG. It's simply a way of managing risk. My risk tolerance is huge and I have no problem shorting stocks, but not this one.

ISRG has in fact done lots for the surgical robotic industry however Titan is close behind nipping at their heels.

Come on over and take a look at the Titan board too as its very friendly, informative from the medical side as well as from the stock/finance side too. Lots of informative questions and answers. Good content all around.

Lots of healthy discussions going on at all times and I hope you all don't mind us coming by here for a peek now and then.

You will note that we are not trying to promote Titan on that board, rather we are having healthy discussions around the product, various way to own the company (through shares or warrants that trade) etc...

Robotics are the future still.

[was CUIN2]

Listen, I think it's anyone's game at this point so you could be correct. But if what you say is true, COV will take the brunt of ISRG's rath.

TITXF is working around ISRG in other surgical areas and with a totally unique technology. I think it's the smart play.

[Johnny Penstock]

I think you're going to be sad when COV disappoints you by being ISRG first competition. I agree that this is a good short play but long term, Titan is dead in the water. Jmho

[was CUIN2]

Another big day for Titan today, $2.10 US and $2.38 CAD.

Also, after close today a PR was released that Dr. Wolff from Mayo Clinic was appointed to the Titan Medical Board of Directors.

A few shares of ISRG would buy a lot of shares Titan Medical...

[was CUIN2]

Titan is really starting to percolate....news coming soon. Check it out.

[was CUIN2]

Much like computers, automobiles, etc. the da Vinci Systems that ISRG has placed in the last 7-10 years will have to be replaced. There is an ongoing need and pressure to continually provide patients with the latest and greatest innovations in the market. I do not see Robotics as a won and done deal. Plus, once the facility/hospital/outpatient surgery center has fully depreciated the equipment it's basically worth $0. Who wants a 7-10 year old outdated piece of equipment? This is where I see Titan eventually encroaching on ISRG's turf...

[was CUIN2]

Appreciate the feedback, and I wasn't suggesting that they could/would go toe to toe with ISRG initially (later perhaps). However, I think they are capable of more than a few procedures or it wouldn't make sense that so many Surgeons/Doctors/Medical Experts would be behind it.

[Johnny Penstock]

Titan has made a big move in the last 2 weeks and there's definitely money to be made but unfortunately, their system is only ideal for few procedures, none of which can't be duplicated by the da Vinci Robot. And with over 2000 systems already placed and clinical data beginning to present itself, Intuitive is poised to defeat any potential competition coming to the US market.

But I agree that Titan could be a 10-20 bagger

[was CUIN2]

With so much uncertainty, perhaps the time to take a position in Titan Medical/TITXF is now. Check out our board. Some great conversations taking place...

[was CUIN2]

http://video.foxbusiness.com/v/2980510044001/how-will-robots-improve-the-medical-industry/

[was CUIN2]

http://www.medgadget.com/2013/09/titan-medical-presents-new-surgical-robotic-system-new-worry-for-intuitive-surgical.html

[buccaneer1961]

Lower -cost , more -effective si ngle -port solutio n suggests
moderate advantage for TransEnterix
As of Sept. 30, 2013, Intuitive Surgical had a worldwide installed base of 2,871 da
Vinci systems, 2,042 of which were installed in the U.S. Our research indicates over
60% of hospitals in the U.S. with more than 200 beds own at least one da Vinci system,
and over 70% of U.S. hospitals with 300 or more beds own a da Vinci.
As mentioned in our previous reports, we believe Intuitive has encountered resistence
in selling $2 million da Vinci systems to small hospitals with fewer than 200
beds, and it has also been difficult for the company to sell a second or third system
to larger hospitals. While we do not think hospitals will likely replace an existing da
Vinci system with a competing solution, we believe less-costly options could make
their way into hospitals that already own at least one da Vinci. As shown in Table 3,
TransEnterix's SurgiBot will likely have a distinct cost advantage compared to Intuitive
Surgical's da Vinci.
With the growth of robotic prostatectomies and non-malignant hysterectomies slowing
in the U.S., we believe cholecystectomies will be the next large opportunity for
Intuitive. However, we are not certain whether this opportunity will drive system sales
or merely Single-Site instrument kit sales. Further, based on our conversations with
hospital administrators, we believe many would opt for a single-port-specific robotic
system at a fraction of the cost of a da Vinci system as long as the efficacy and
safety rates were comparable.
With an estimated 900,000 cholecystectomies being performed in the U.S. in 2013,
we believe there is ample room for at least two single-port surgical robotics vendors.
TAB LE 3
Cost Profile: Intuitive Surgical's da Vinci vs. TransEnterix's SurgiBot
Intuitive Surgical da Vinci TransEnterix SurgiBot*
Capital Cost
Low end $1,500,000 $500,000
High end $2,000,000 N/A
Single-Site kit** $80,000 N/A
Cost per procedure
Single-port $1,500 $1,500
Multi-port $1,850 N/A
Annual service agreement $175,000 $50,000
Source: Intuitive Surgical, TransEnterix, First Analysis estimates

[OGSPECULATOR]

Wow glad I DUMPED, looks like 35$

[was CUIN2]

Good point and I agree

[Johnny Penstock]

In my opinion, ISRG will benefit as it means more feet on the streets talking to the benefits of robotic surgery. There's still a HUGE piece of the pie out there and a ton of procedures that are still being done open and not minimally invasive. I think Titan AND ISRG can thrive. There's room for more than one robot company.