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The thinnest Cardica stapler is 5mm, as I understand it from their website.
The SPORT barrel is 25mm dia, or at least that's the incision size claimed. Each articulating arm looks to be larger than 5mm dia, maybe as much as 10mm?
I wouldn't know personally, but I suspect laparoscopic procedure staples need to be a bit on the larger size as compared to those for cardiac vessel use, so I think stapling through SPORT could have constraints due to the limitations created by entering via a snakearm channel.
Anyone want to expand on this?
Also noticed the black sleeves on the one SPORT video look like simple electrical shrink wrap. Obviously, that was not meant to showcase a done-design.
I wonder how Titan came up with the 25mm "limitation" on their barrel size. May be that a bit larger will eventually be more useful for introducing larger instruments through larger snakearm channels.
I work with some of the best doctors/surgeons in the country, at an internationally famous hospital.
That doesn't make them businessmen, accountants, or marketing experts. And they almost never sit on the medical devices review board like I do, which makes decisions on what to buy for the hospital, contracts with suppliers, etc.. They are too busy earning money for the hospital and doing their best for their patients.
I'd like to see Titan hire-away some people from ISRG, or a Stryker, or top-hospital management, to fill those positions and sit in with the Titan SAB.
Much of the instrument/assessory story for SPORT will a function of the durability of the articulated arms and their ability to be cleaned and sterilized. I have multiple reasons to think they will not be as durable, or easy to clean/sterilize as straight stick types. They will probably be comparatively expensive to produce and quality test, too.
That could be an initial sticking point for early adoption of SPORT. I hope the company is giving this a lot of thought in their developing strategy for introduction, sales, and support.
Nice find. I reviewed the MAKO site and system operation and this appears to be a solidly though-out product. Its integration with CT (of course, necessary here)and computer 3D modeling appear to be cutting edge. No lack of knee and hip surgeries where it could be applied either. I'm sure some orthopods have valid criticisms but the idea is right on.
Titan Medical better be intensly studying the MAKO experience as discussed in this article. If MAKO is having growing problems, SPORT can be expected to have the same, if they follow the same path.
Just spoke to a general surgeon acquaintance of mine who I told about Titan back in the $0.40 pps days when I first learned about them. This guy thinks the snake arms and camera concept is really cool but says surgeons don't get excited until they see a product or at least a working model. Also said the hand interface is critical, and that any haptics is better than none. Also said ISRG is taking it on the chin because of all the negative press about robotics being oversold. This guy is a MIS proponent and MIS practitioner! Last thing he says to me in the hallway when I made a joke about making enough $$ to retire and why wasn't he invested, was, "Well I haven't heard anything about them in a long time".
It serves as a reminder to the company that they are public, and relying on cash donations, even for their salaries.
I got the same reply. Wrote to them and heard back within the hour.
At least there is someone in the office.
Well, that could certainly support Titan's apparent paranoia for such limited PR.
Well, Titan touts its intended use as General Surgery, so a simulation package from Mimics might be the match.
I am unfamiliar what these simulation packages (software systems) actually look like, but my guess is they need to simulate the surgeon interface and instruments/effectors too. That being the case, simulation of the snake arms would be needed, and then too, the specific surgeon's hand control interface. That is why it must be an expensive committment to develop a Mimic product for "another" system besides daVinci.
Note that Titan has said it is developing its own virtual simulator for SPORT.
I suspect having a company like Mimic develop a full-fledged and continuously-updated simulation product for a company is an enormous, and costly undertaking. If they are working with Titan or hoping to, I am sure they will be very critical when evaluating Titan's chances in the market.
I think any snooping on Mimic that yields clues to its dealings with Titan would be a great source of information for this board. Especially since Titan is so damn quiet.
Great find on the tweet.
Dr. Advincula had written a pro-surgical simulation article (probably company-neutral) for the ob-gyn community. I'm sure Mimic wanted to put out thanks for that by acknowledging his career moves.
http://www.mimicsimulation.com/2014/09/augmented-reality-other-trainers-for-complex-disease/
Go to the ISRG website and see the different types of procedures daVinci is being touted for, whether they are done widely or not. There are 16. SPORT is seeking approval for 1. I have heard nothing from Titan to suggest SPORT is planning to be anything other than an expensive tool for doing gall bladder removals, and maybe an appendectomy that is sometimes more safely performed open. So what will be the selling point to hospitals?
I know I'm being a bit facetious, but I want information about plans and developments from Titan.
From their website:
"Titan plans to target general surgery (gall bladder and appendix removal) and ear, nose and throat procedures."
OK, so tell me about a procedure where the SPORT effectors are going to be used in ear surgery?
I agree with what you are saying in that they are two very different technologies. I do research work with spinal problems and know the surgeons. The Mazor system, just after a quick look by me, seems to add a fair amount of complexity to the procedure. My take is that the experienced spinal guys will find it cumbersome. As always, if you train a new surgeon with it, they will probably always need it. We don't use it here.
Again, my point is that SPORT may not see the quick adoption (assuming all continues to go well) that many enthusiasts pin their pps expectations to. And it is not a "direct competitor" that will dethrone DaVinci and assume the ISRG stock price. The DaVinci experience is teaching the market to be a lot more conservative. There will always be surgical technology advances, but not revolutions.
Mazor is apparently a success in that it has a unique product, high tech design from Israel, and an unlimited need (scoliosis and spinal surgery). Add to that their move into brain-surgery stereotaxis which is a very important technology.
"Tens of thousands" of implants, granted they are probably counting every pedicle screww.
It's trading at 12 (near where it started), max price ever was 25.
This is my point:
Alhough calling Mazor "robotics" is a bit outside the commonly-conceived idea of robotic surgery, here is a well thought out device with a big market, and a true medical need. If your 12 year old daughter needed a spine fusion for scoliosis you would want the system that helps her surgeon avoid a pedicle screw placement error, right?
Folks, it's pps is the same as when it started. That's why I've seriously had to rethink the irrational exuberance for Titan's launch. After, and along with, the DaVinci experience, surgical robotics will be a long slow ride for the shareholders. Sorry if this blows some of your minds - mine too, unfortunately.
IMO
Best case fast action would be a pop after a buyout. Interesting that the Siemens name has come up again. First as a probable rumor from a boiler room group, now from what I take is a legitimate poster.
Thanks scalpel; I agree with where you are coming from. Robotics aren't going to put traditional surgeons out of work. Not in the primitive state we are in now.
That is what I think the experience of ISRG has and is showing. SPORT will be a next step in a slightly different direction from DaVinci, but subject to the same continuing growing pains. The market is wiser now, and has less money to spend and more constraints.
I want to make money on this stock, bottom line. It sucks, but I've ratcheted down my expectations considerably having gone from thinking Titan will repeat the exuberance of the ISRG pps.
Nice article, in contrast (in a marketing way) to the Columbia scientific review that raises big questions about how fast robotic surgery will be adopted, and develop, if the metrics are not overwhelmingly positive.
Unfortunately, as a scientist and engineer, I have to take the Columbia article a bit more seriously than a press release geared to market a health care system. Note that they say their nwe robotics "may" improve patient care.
As we all know, robotics is here to stay, and will only get better, but conventional manual surgery will be here for a long, long, long time. Simply put, it is an adequate skill that can benefit by small, enhancing technologies, for example staplers and biocompatible implantables like mesh, valves, joints, and the like. SPORT, and DaVinci, do not now address areas like plastic surgery, scoliosis surgery, limb reconstruction, or other surface or large field prodedures. The SPORT mechanism may eventually win out with being able to move into these types of surgery, when and where it makes sense. But other technologies that mimic the overall dexterity of the human hand will also be powerful, especially when haptics can come into play.
I hope, as I've been saying all along, that Titan is being proactive behind the scene (since we never hear anything) and actively developing procedures with the same agressiveness as ISRG.
It really bugs me that the company is so quiet.
Read the print version of the Columbia article in my Wall Street Journal. Third page, I think.
Unfortunately, I think it puts a serious throttle-down on the immediate hopes for quick acceptance and optimism for the DaVinci approach to surgery. The robotics is here to stay, but the drumbeat has been increasing for the negative assessments of the technology in light of effectiveness, outcomes, and cost. Those assessments will not diminish in the foreseeable future, and they shouldn't anyway. Rational use of technology is a good thing.
Hopefully, Titan will be forging a newer, and different path based on the learning experiences that continue with ISRG.
If SPORT was merely an equivalent of DaVinci, Titan would not look so good right now, even on the simple price basis.
I'm hoping they are partnering with a Sony for superior optics, and that the articulation they seem to have is superior to whatever is coming down the pike.
Titan's pps history is unlikely to look like that of ISRG. I think slow pps increases are probably more likely, except for an initial pop if they ever get CE approval and can deploy.
From the article:
MEDICAL DEVICES: Canada has a strong medical-device market that is anchored by companies like Nordion, Titan Medical, Abbott Point of Care, Baxter, Covidien, Hologic, Johnson & Johnson, Medtronic, Roche, Smith & Nephew, Sorin Group, and Zimmer.
-October 7, 2014
Interesting Titan being mentioned in Manufacturing along with the likes of old and established companies. I'd be really surprised if Titan is having parts manufactured yet, for anything. Does this relate to Amadeus (was there actually past production)?
We have heard of their intention (milestones) to deal early with the FDA, but we don't have any information on what/if anything has been done, at least to my knowledge.
SPORT roughly half the cost, but with much, much less than half the current procedural uses of DaVinci.
The challenge will be to present 'soon to be' procedural capability to potential buyers who can only compare to DaVinci.
That is why Titan should be seeding the field very early in the approval game with information pointing to uses beyond chole. It would be nice if they could be seeking CE with at least one other procedure. IMO
No, I don't.
There are no human trials yet. Beyond that, sure there may be holdups. That's the nature of the game here. Nothing ever comes in on time, or without unexpected problems, in reseach/device development,product launch.
This is not petty stuff, IMO. It helps shows investors and potential investors that the GD company is alive and real.
I don't care as much about the stock price now, except for the needs of uplisting; I'm not selling now anyway.
But Jeezus, keep your f*ing website up-to-date. It's sloppy and irresponsible, and inconsiderate of the people who have there money parked here for this company.
Get the freaking PR firm to spend 2 minutes, zero-cost, to keep it up to date.
That's why they need to issue information, even if it is only suggestive, and as long as it is true. How about a new video showing improved control, or a new effector. They are off the radar, except for a handfull of people (like ourselves) that understand the potential.
They need an article or some analyst to put something positive out on the airwaves. How about a press announcement from their NYC company?
I may just try to keep from reading this board until my phone alerts me to a Titan announcement - god knows when.
More BS from the salaried government bureaucrats to impede innovation, waste time, and suck money from companies.
"Prove to us in this 1000 page form how your surgery machine won't give away a patient's name or medical record number". "Please be aware that you will need to resubmit paperwork 14 times, on average, as we will lose, misplace, or downright forget about it."
"Please also submit in the following 27 languages so our staff can read it."
Very good article; thanks!
So, is Titan progressive enough to be working with groups that are developing a miniature suturing device that can be mounted on, or utilize either or both of the snake arms in Sport? Since the arms do appear to allow great freedom of motion, and appositional ability, that would be a great advanyage os Sport over straight-stick mechanisms.
Sport suturing can be done in a "more naturally manual" way (as shown in their video), but still appears "clumsy" to me given the manual dexterity of a surgeon.
Can the suturing motions of the snake arms be remembered/repeated automatically with a button press after the needle is passed?
They should call me for ideas.
I will predict that surgeon-trainability will become the greatest hurdle for Sport, in any form it first appears. If the arms are capable of great dexterity, but the human controlling them has large hurdles to overcome to use them well, that will be a problem.
I'd love to see a video showing the hand interface.
ANY potential for haptic feedback, either realistic, or just "shaker-stick" hopefully is being seriously looked into.
Let's face it, what we truly know about Sport's capabilities at this time is a joke. I've seen a primitive Bovie and a needle driver. Arm-control demonstrations are "impressive" but only in a rudimentary way. I haven't even seen suction. I think it is high time the company "hints" at what will be available to surgeons at the front end.
The other piece of information sorely missing to us is information about the manual control system of the arms and effectors. What and how the hand actually controls the articulation that everyone raves about. I have no idea whether that is a simple, or natural feeling process; I don't know what the learning curve is like. I don't know if there are critical deficiencies that will limit acceptance.
In other words, everything right know is a big secret with Titan.
My question is: Should it be?
Titan is simply off the radar. Speculative investors would rather dump money into the next worthless social media IPO or asinine smartphone game company. Medical devices are so far beyond the intellectual abilities of the average moran as to be like investing in some esoteric solid state advancement in chips. Being only on a Canadian exchange compounds the issue immensely.
If Titan WANTS to move the price they need to issue information that people can understand. If they want to play things close to the chest then that is their business. But I honestly don't see more than a dollar or two increase anytime within 6 months. And we are never going to see the 100's of ISRG. That load has been shot.
One reason I sometimes make provocative statements like "chicken in a bottle" is in hopes that they read this board and realize that all these fantastic posters here have insight from the masses and even surgeon in the trenches that they probably have lost sight of long ago.
And I've had too much to drink.
It will take substantial and definitive news about moving the hardware forward in development, partnering, production, deployment, or regulatory progress.
$10 by year's end? Why?
1st half of 2015 is next milestone "initiation of outside US approval process". Supposed to have been doing FDA pre-approval clinical planning in 2014. You hear anything? I haven't.
I've seen a video of a piece of chicken getting singed in a bottle that looks like a high school science experiment. And the suture tying looked like it took 47 takes, and it was done by a 7 year old kid trying to pluck a stuffed toy out of an arcade machine.
Sorry, but I'm not feeling the excitement yet.
I'm a believer for the long term, but we are still a long way out. Don't think you are in ISRG land yet.
Will stay off the radar until company issues some sort of information that points to a concrete step towards pre-marketing, beta-deployment, initial-production, or engineering progress.
Another thing that would blow it up would be a buy-in from a device manufacturer planning to supply components or surgical tools.
Exchange uplists and bigwig surgeon advisors mean a lot to us, but not much to the investment community at large.
People are blowing their horns and we ended at 2.20 . Unfortunately, this is still going to be a long haul before lap dances in Vegas.
IMO, the PR company stinks.
We are simply 'under the radar' for the investment comunity at large. We need to get listed on an exchange that has exposure, if the pps is not just going to twist in the wind.
$2.15 is ridiculous at this stage in the game. I know everyone says buying opportunity, but I'd be a lot more willing to buy even at higher prices if I could start sensing there is interest and momentum forming.
I know it has all been discussed before, but IMO the PR for this company sucks ass.
Are you ex-CIA?
Agree.
IMO, minimum of 12 months from now before 1st units even available outside US in a sales-ready form.
Last quarter of 2014 still to go, 1st half of 2015 (milestone listed on website) is as always a minimum optimistic estimate, and add at least another half year of delays due to Murphy's Law. Unless the company issues information to the contrary showing some suprise 'great leap forward', like being acquired, no one will be making money off this stock for at least a year+ .
Just needed to remind myself.
Which brings up the question: what has changed then since 9/13. For all intents and purposes it sounded like it could have been a recent article. I thought it hinted at a recent design freeze. I was getting psyched up. Just goes to show the glacial pace of any information coming from this company.
Look at Figure 19 of the Patent Application. I would take that drawing as being the articulated arm and end-effector of a SPORT system.
That does NOT look like a mechanical assembly that will be cheap to produce, be easy to disinfect, or be mechanically stable for repeated uses. That being said, and being no expert on the state of miniature robotic effectors, I'm glad to see them trying to produce intellectual property.
Interesting is that some of the cable/pulley tracts are called out to be conductive, thereby allowing for downstream current (as in Bovie or auxiliary powered devices), and hopefully for further future sensors and possibly digital control/feedback for devices/haptics. In any case, again, a hell of a complicated part to mass produce, that articulated arm is, for function beyond that of a simple grasper or scissors. IMO
Sales? How about training too. DaVinci users can train DaVinci users now. There is an incredibly steep hill to climb to launch a product like SPORT after approval for sale, and the more buyers, ironically, make it more labor intensive, expensive, and time-consuming.
TITAN may get the approval, but be far behind the curve to launch effectively. That is why a company with deeper pockets and an established infrastructure will have to buy them.
I agree in the sense that the SPORT single port approach will not enable them to capitalize on what are by necessity mult-port approach surgical procedures.
However, a successful market for SPORT will bring about a multiple-port SPORT system, as hinted at in the recently discussed patent application for an armature that can support multiple SPORT heads.
If the SPORT articulation and manual control console are well-suited to surgery/surgeons (this is far from being a fact, but it is a common assumption among TITAN believers), then I think the future looks good.
So far, demonstration of the arms articulation by the company are fairly trivial videos; what is actually required of the surgeon for hand control has not been demonstrated to shareholders. The learning curve for surgical dexterity may be steep; much will depend on that. No facts about the "successful animal chole" have come out to my knowledge, even to whether the animal was live, recovered, species, tools employed, etc.. Someone please correct me if I'm wrong about that.
I'd like to see a buyout because as I've said before, I have been underwhelmed by released information, and consequently my feeling of risk is higher.
Is giving a PR about a "design freeze" typically made by device development companies? I wouldn't think so - just announcements about regulatory submissions and approvals I would guess.