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CUIN2, thanks.
Daktari, right with you. Wrote my post before I saw yours.
Suckitup, honestly I would be happy with a M/A for $15. Save me a lot of gray hair and give me a return on investment better than most people ever can dream of. My buy in averages to $1.76/sh. For me, Titan needs to liven things up by giving me some hints of what they see in the future. I'm not looking for propaganda to raise the pps, just something to let me know they have a strong and continuing vision. So far I'm underwhelmed.
Until then, I'm not putting any more money in the game.
The SPORT can move like a snake in that can bend and "twist". The Choset devive can extend/retract along its own path. SPORT does not and does not need to do that for its intended function at this time.
I seem to recall however something in the SPORT IP that suggests they could potentially do the expand/retract path thing. You need to control actuators between every link, not just exert differential tension in the snake from the tail actuators.
That is where there may be IP friction.
I'm also sure neither group were the first to think about it. Many mechanical engineers and robotics groups have thought about this idea and probably have patents of sorts. Think devices to inspect pipes and sewers. Think the cellar scene in the Tom Cruise "War of the Worlds" movie.
Nice video about the Carnegie Mellon snake technology. It confirms what I said about the difference between what procedures Medrobotics and SPORT will target. SPORT will be useful where large surgical fields are required, which is by far the more common case. Even in the video, you have to ask yoursef, how many things can be performed by threading in a snake with only working tools at the face of it. You aren't going to be able to do CABG or replace a valve (I realize that catheter guided valve replacement is possible in some circumstances). The working field for most surgery, especially the classic open-incision types like chole, will still require a stand-off, large field approach.
A lot of times a surgeon also wants to look around in the general vicinity too, like if doing a dissection for lymph nodes.
I think Medrobotics will have its own niche, like in many ENT procedures. I said months ago on this board that the power of SPORT will depend on Titan developing the applications and specialized tool options for where it can be used. ISRG daVinci pushes those boundaries for itself, even where it is a bit of a stretch. But I give them credit for trying and advancing the technology. Titan better be doing the same, and I'd like to get a little hint about it from time to time, but they are too quiet.
For those posters who say one form factor is "superior" to another that is based on ignorance of the intended and potential applications. I'm an engineer and have done animal surgery and work with surgeons.
My guess here, based on the stated applications of trans-oral surgery "down to the voice box", is that the system is "micro surgical", ie. very small instruments at the business end. You still need room in (or around) the snake to ventilate the airway (unless a tracheostomy is done), and for 3D vision, which requires some physical standoff from the working field, and I think stereoscopic separation. Look at the SPORT camera, for example.
Sounds like this was developed to extend and make oral access procedures easier. Of course, it also opens up the possibility of trans-rectal, trans-vaginal, trans-gastric, approaches to sites I would guess primarily for tumor removal. As such, it may not be all that useful for the larger field, single incision laproscopic procedures like chole, where they essentially blow up the surgical field with gas.
Anyway, I'm willing to bet the Medrobotics form/function has a big place in surgery. It may be a long time, like is true for daVinci and prostatectomy, to show effacacy over traditional methods. Titan will face the same hurdles.
I am worried about the posssibility of patent issues between the "snake" companies.
All in all, this Medrobotics system has taken a bit of wind out of my sails for SPORT. I've got 13k shares in, but I have got to hear some good news before I will buy more. They don't have to be so GD quiet.
Maybe not similar in the overall form factor, but certainly able to be directed to similar procedures as SPORT. My guess is for smaller field procedures, and certainly via less direct access to that field than SPORT.
This is a contender to some of the market SPORT sees itself in or developing for.
Good for medical technology, but not going to make it any easier for TITAN.
The only odd thing is that their website has almost zero detail about the device, unless I missed something.
Just an opinion here, but the articulated snake arms on SPORT will be an expensive component themselves, and "difficult" to clean/sterilize compared to straight stick components. That is irrespective of them being shielded since guaranteeing and testing for sterility behind shielding is itself difficult. I trust Titan knows this and is designing for it, but there may not be economic advantages over daVinci in terms of reusables because of that.
Well over 10k shares myself and hoping to add 5k more soon. I am on a medical devices approval commitee for a world-renowned hospital. I don't say world-renowned lightly,either. Reuse-performance liability and disinfection liability are MAJOR concerns that Titan will need to address in a administrative buyer's mind, even if the surgeons are gung-ho. Unfortunate, but true.
I'd like to change the conversation here a bit to something I think is important to all of us.
All systems seem a go for Titan, but the pps sits idle and the company is quiet with PR which might be wise or not depending on your point of view.
Because of the upside potential we've all got high hopes and probably large investmants made in Titan. I'd like to ask the members on this board what would be subtle warning signs of something that would mean this company or product would be in danger of going under. I'm not talking about not getting CE or FDA approval; that's obvious. I mean what would indicate time to pull out with just modest gain or break-even.
Agreed. Should have realized that.
Very curious that the study's surgeries were performed in 2010 and the paper finally makes it out in 2014. I could believe a 2 year delay in it seeing print, but 4 years tells me it likely either got a lot of rejections/criticisms initially, or the authors delayed for some political reason involving the company. Typically, academic doctors always want to see their work published sooner rather than later.
Finally, there is the possibility the surgeons were typically bogged down with work.
I agree with Honey... how can $2.30 make sense, given just about all positive indicators for Titan? Maybe Robotic Surgery in general is just suffering through a gray zone now. WSJ article today doesn't exactly make the technology look like a near-term win for investors.
Don't get me wrong, robotic surgery is here to stay. It takes a fairly sophisticated investor (medically/scientifically speaking) to understand where the technology will shine for healthcare as time goes on.
If we see $7, my daughter's Ivy League grad school is debt free. $11 adds a fully decked out Indian motorcycle. $16 all the sailboat I'll ever need.
Go Titan!
Or, paranoid about ideas getting stolen, or tipping their hand. That, I could deal with.
You sound a bit insecure.
What the hell is a "Respect Bra"? Is that something like a "Man Bra"?
I don't find their SPORT videos to look much more than amateurish, and there are only a few anyway. I'll agree they do display the essential concepts.
How about some clips from the recent animal surgery? I have yet to hear whether it was a live animal, and if so, whether or not the animal was recovered.
Also, how about some mention of the SPORT instrumentation used to do the chole, and where in the procedure SPORT was deployed and removed.
If the decision to not mention these is because they are better kept under wraps, I can understand. Otherwise, I'd say average PR material at best, if you WANT to engage the medical-device investment community.
I'm hoping that the real work is so impressive that splashy PR is of little consequence.
Proposed human trials studies would easily take 1+ years to design and obtain approvals. That's even before recruitment. In the US, at least.
If Titan is going for CE approval first, I suspect designing a human trial study in Europe will come first. Hopefully the groundwork is already being laid.
It would take a year to get trial study approval in the US for a new flavored aspirin, let alone a device like SPORT.
The subject of retaliatory "shareholder lawsuits" often comes up in boards regarding startup companies that "seem to shaft" investors. In my experience, however, I don't think that threat is usually valid at all. As long as the company isn't violating any laws, "shareholder value" really doesn't mean anything in the board room. That's why every statement a startup company makes has a disclaimer.
I'd like to believe management is looking out for my tiny slice of the pie, but in the end, that's a pipe dream. If they sell, they will negotiate what is best for themselves, not honor your long long term commitment.
Pretty much, we are just riding the roulette wheel with a bit of rational observation thrown in to help decide to buy or sell.
Who is ready to organize and pay to make this 'threat of lawsuits' a valid operating parameter for management? No one.
Excellent recent posts from the surgeons and OR people. That is great feedback. So what I'm hearing is likely (or absolutely) a second (but small) port will be required for SPORT surgeries for assistant suction/retraction. Maybe not during chole, but probably with other possible early procedures, or just for safety.
There are a few considerations to ponder if the above is correct:
SPORT is named "single port". Are there plans for insufflation/suction/retraction to be passed through that port?
If not, SPORT is a bit of a misnomer. Will this invite criticism in the investment community, ISRG reps, the regulatory process?
If so, is this an innovation? If innovation, is it being properly protected? Is this fair information to disclose publicly at this time - would it increase pps, improve perception of the potential product to potential customers?
Will a next version of SPORT provide a same-port channel for assistant operated suction/retraction? Via a snake arm?
Will a next version of SPORT have two SPORT heads, and a dual console, thus making it a bit more like a daVinci-style robot?
What information can/should PR disclose strategically?
Who said dud? I didn't.
I am long on Titan but I am saying their splash is unlikely to be like ISRG. I got in at the recent 50 cent low and was swept up with the cheerleading and excitement. Now I'm thinking a bit more critically.
You just said, "... and different expanded use of technology." Chole (and appendectomy) has been performed effectively for a hundred years (my guess). Please explain what you mean by 'different expanded'. You don't know, do you? Hysterectomy, colon resection, tubal ligation, Whipple procedures, gunshot trauma, lobectomy, esophageal surgery, bladder cancer surgery...? I want to be hearing something about how the TITAN sees the SPORT platform will be used in those. Hence my bringing up the dual SPORT idea, which I'm sure they have been thinking about for a long time.
What we (the investors and medical community) see now with SPORT is a smaller, less expensive surgical robot PLATFORM with two novel articulating arms and a good camera. That might be great technology, but please tell me what are its planned uses for a day-to-day OR.
Each milestone is critical, especially approval for chole, but long before then, Titan would do well to seed the selling field with some information about "in the pipeline" plans and uses. I know they must be working on some. Realize, good and time-tested open exposure and endoscopic methods already exist out there. They are performed by the thousands each day. Will SPORT offer an alternative method?
SPORT will need to show alternative, and improved (whether by outcome or cost) versions on these where its platform can realistically provide alternate, improved methods. Is that hard to understand?
If I were Titan I'd be partnered up with a major large animal experimental surgery facility. I hope they are. Also, mocking up procedural applications on plenty of dead pigs and sheep.
I hope they are.
Not negative; realistic - based on MY perceptions.
daVinci was presented (and accepted) as a revolution for surgery, and it LOOKED the part. Big, expensive, high-tech. Out to improve the ability to do a very difficult and serious surgery, prostatectomy. The pps went ballistic. That will not happen again.
Things have calmed down since then. daVinci is entrenched, but people are no longer wowed by it. It hasn't produced a revolution in robotic surgery; it has good and bad elements like all technology does. It broke the barrier.
Titan NEEDS to develop on UTILITY, not a wow factor; that is over. And that is my point.
Titan will have to have more than one "surgical application" in its pipeline if it is going to take off after any approval. That's all I'm saying. Those "in the pipeline" applications will need to be common knowledge in the robotic surgery investment and medical sphere to maintain any momentum.
It is very, very, very hard to launch and sustain a product like this; high risk, high cost, unproven metrics, additional surgical training, duplication with existing methods, etc., etc.. daVinci was in many ways lucky, but had no competition. Titan has entrenched competition; it's called da Vinci. And ISRG has the resources to change the playing field any way they want to, even pricing. People will not flock to SPORT, FOR ONE PROCEDURE.
Titan needs to be developing, at least in theory, where it will evolve even as it launches. Doing the detail work in secret is fine, but the medical amd investment sphere need to have something to pin a future use(s) onto.
I've seen and been involved with potential medical products developed by the finest doctors, medical centers, tech transfer departments, and universities - only to flounder because the market had no friggin' idea what they would be good for.
Just a warning: Titan needs to promote its purpose, or just wind up as a takeover technology. Fine by me if the price is good.
What I hope Titan is drumming up is potential applications for SPORT-based surgery besides gall bladder removal.
If I were them, I'd be getting surgeons together to brainstorm and debate ideas about where/how SPORT could push development, so they have a SOLID BASE of "in the pipeline" uses for SPORT once they hit the market.
I'm just really wary of the "costs less (but does less)" than daVinci selling point. I'm also wary of the "buy one to market your institution's Robotic Surgery capability (but we know that's bullshit except for gall bladder cases)". In my opinion, those two will not be enough to carry the initial sales hopes for this company.
I'd like to see PR setting the stage for where this thing might be put to good use. I am trusting that these guys know what they are doing because I'm smart enough to know the technology potential, BUT I'M NOT FEELING IT. There are plenty of highly-developed laparoscopic techniques and instruments for certain common operations. SPORT has to be pushing the idea that it is not just a one or two-trick pony (hopefully it isn't).
I agree with the concern about the website. They can be updated, edited, and modified... immediately. There is never a reason to have incorrect or outdated info once it is recognized a change is in order and the change cleared by those in charge.
In my opinion that is the first place a new PR firm should place their attention.
I'd like to see that porcine chole video. I have not seen any details about that experiment either, even that it was porcine, in fact. Is there a good description from Titan about it, evcept to say it was successful? I suspect the video will show other ports and cameras since they mentioned several angles of view. It may not be something they will ever release since it probably not as direct as a normal surgery would be, given it was a chance to experiment.
I agree with you as I opined in the past. Two SPORT units, as currently designed may be needed to eventually do what daVinci does, or to even perform "single port" procedures beyond "relatively simple" ones like chole. There will be a long period of technique development and risk analysis before a SPORT surgeon at a robotic console away from the patient is going to be working without a surgeon assistant who has ready access to the surgery site, via another port, or the ability to do a quick exposure for manual access. One significant bleeding vessel is all it takes.
I am long on Titan, but a lot of posters here have never seen or performed surgery (I've done some large and small animal surgery, including, bowel resection/anastamosis, lobectomy), as a biomedical researcher. I have to trust Titan has all this thought out; but to the non-medical posters out there: just one surgeon, two articulating arms, and a camera in a little hole is not going to go far surgically.
Sure sounds like it.
Sounds like Talarico's move was strategic for both companies.
Ear, nose, and throat?
Titan plans to target general surgery (gall bladder and appendix removal) and ear, nose and throat procedures.
That's a quote taken from the investorshub Titan description. I seem to remember that someone mentioned ear, nose, and throat procedures was an error and not correct.
How about if the new PR firm gets that cleared up for starters?
Scalpel and other surgeons, glad to hear that your experience has been a bit different than mine concerning the "wow factor" when seeing the current PR videos available.
I am hoping that the surgeons on this board who are Titan technology favorable start voicing opinions on where and how the platform may present advantages over manual, and even DaVinci methods. I'm speaking more about procedure-specific ideas, not the standard line about smaller incision, less blood loss, etc.. Also worth discussing what can't be performed with it (at this time, anyway).
Does anyone know if the most recently mentioned testing (cholecystectomy?) was done in a live animal. If so, was the procedure closed and the animal recovered?
I still think that two simultaneous Sport units may provide the biggest bang for the buck for procedures where more "hands" and instruments are needed. The surgeons have to drive these procedure development ideas, not the engineers.
I'm an engineer and have spent enough time around top surgeons and ORs to bet Titan will need to partner (or be bought) by someone really big within the next 1.5 years.
Reason: Too risky and expensive to get a product like this through FDA approval, and fight lawsuits. If they hope to entrench into the US market, they will need a brand name and deep pockets to lean on. ISRG had the "revolutionary" card to play, because they were first. Cost compared to DaVinci counts, but not so much as you might think in large hospital environments that set the stage for new surgeons. Outcomes are the metric, and even DaVinci is not in the clear with proving its outcomes are better.
So far in looking at the few videos by Titan, no surgeon I have told about Titan has said "wow". That bothers me because a lot of posters here think this thing is automatically the second coming.
I am long on Titan with 10k shares, but I hope they've got a lot more that we haven't seen yet, if they think they are going to go it alone.
Thanks for that informative post. We know Titan management is reading these posts. A lot of what is discussed here is important for them to see.
Only seeing upside for Titan at this time but I'd like to hear some news from the company, or experts on this board, concerning:
1) Development of additional tools. Ie., plans for suction/lavage, retractors, insufflation, laser ablation, injection, micro-stapling, etc.. Single port is a bit of a misnomer at this time if additional ports will be required to introduce additional instruments.
2) Development of additional surgical indications where "snake arms" may be more useful than conventional laproscopic instruments. After all, the Titan snake arms are the expected standout technology for the present. Lower-price alone will be less of an advantage if surgical indications are more limited than DaVinci.
3)Dual SPORT unit surgeries where two SPORTS are used with different instruments. Can two SPORTS be better than one DaVinci?
4)Haptic feedback. How important could it be?
These are just things I'm throwing out for discussion.