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Downside to aquablation is you still have to use a TUR loop at the end for hemostasis. 3 of my partners do them. I got trained up and ready and bailed due to that fact. Once they advance to the point of not needing a mini turp at the end of the case I’ll start doing them. I think it’s a nice technology. They just need a little creativity on the hemostasis issue.
“Especially when it is obvious that they lack any medical background whatsoever. It just makes them look quite foolish.”
To whom exactly are you referencing?
I simply pointed out that he references a procedure that doesn’t exist then you said he’s talking about a lasers. The overwhelming majority of robotic prostate surgeries in this country are for prostate cancer, not BPH. Most BPH patients can undergo a laser or TURP or some other less invasive procedure than a robot. I probably do 10:1 robotic prostates for cancer vs BPH, and e technique is entirely different. I’m glad that guy from the HBO board made money on his investment. I plan on making money on Titan like you do. I’ve been around for several years at this point. I’m not an investment expert by any stretch, but I am a medical expert and feel the need to call out inaccuracies from a medical standpoint when I see them. Nothing more. Nothing less.
There is also no such thing as laser surgery for prostate cancer. I’m a urologist. I do lasers of the prostate for BPH or benign enlargement. There are no laser surgeries for the prostate outside of BPH treatment.
I think Titan is going to go much higher. I’ve been invested here since 2015 and have averaged down to $1.50 during the past 5 years. That has nothing to do with what I said in the previous post. Facts matter.
He lost me at precision radiation surgery. There’s no such thing. And any type of radiation therapy is thousands of more dollars to the healthcare system than surgery.
Some of what he said seems reasonable, but overall he doesn’t know what he’s talking about.
I went and watched a TRXC video again just to make sure I hadn't forgotten anything. For context I'm a robotic surgeon that uses the multi port Intuitive System ~150-200 cases/year. TRXC might have been cool 20 years ago. I used to do lap nephrectomy (kidney removal) cases. TRXC would make that easier. You know what makes it easier than pure lap or TRCX? A real robot which is why I quit doing pure lap kidney removals. Maybe some 60 year old general surgeons that have been doing lap colons and Nissens for 25 years would think TRXC is cool. I don't think a single urology colleague would. Why would we when Intuitive has a MUCH better system currently in the hospitals where we're working everyday, and Titan has something much very impressive on deck.
TRXC is the '97 camry sitting on the lot with a new 911 parked across from it. I can't understand their run. And I don't think it's one of these things where the robotic space is exploding and there is room for everyone. TRXC will NOT generate excitement with surgeons. And without that I don't see hospitals buying it in any real numbers.
Since Medtronic has been involved, has this happened?
Anyone seen SPORT19? He has been very consistent in posting stock prices when the stock was declining. Interesting he isn't doing the same when it's increasing. One would think he would be happy...
It's not like he's the only one here that has lost money. What purpose does it serve to post hundreds and hundreds of negative things day in and day out for months/years? No one is telling him he can't be bitter. I've lost a lot of money in this stock too. Many of us posting here have. His constant berating and general approach to the stock in 2019/2020 is the problem. Why try to make everyone else miserable? Get lost. On top of that he disappeared with the good news of Medtronic. He didn't hang around to say he's happy for his fellow posters who have been here with him in the mud taking grenades for years. No, he put his tail between his legs and disappeared until the stock dropped to 80 cents last week or two weeks ago then he instantly reappeared to say what a crappy stock this is. His approach is the problem, not his hurt feelings over lost money. We can all empathize over lost money. It sucks.
This simply isn't true. Haptic feedback is not necessary to do safe surgery. I think from a sales perspective, it would be great if TItan can use this along with being single port as part of what makes them different. Ask transenterix how banking on haptic feedback has worked out for them. I do robotic surgeries every week without haptic feedback. While I wish I could blame "vessel and nerve" injuries on the robot, it is simply surgeon error. Millions of robotic surgeries have been safely performed without haptic feedback. Tissues dissect predictably when in the right tissue plane. The human brain can fill in with its own haptic feedback when one has 3D vision and coordination of instrument and hand movements with predicted tissue change.
I think it will require a larger than 25mm incision for the gelport. There has to be room to work for the bedside assist. A suction irrigator, laparoscopic scissors, or other lap instrument is essentially an 18" rigid stick. While it may not have to be a handbreadth away like traditional lap instruments, space will be necessary for maneuvering by the bedside assistant.
I am a little disappointed about the lens cleaning system. I thought that feature was a huge selling point. Nothing is more frustrating as a surgeon than to be in the middle of a complex operation and have to stop to clean the camera. It happens almost every case with the DaVinci system and with traditional lap cameras.
Generally speaking, one can't do traditional lap surgery through a gel port. The lap instruments have to be far enough apart (generally a handbreadth or more) to triangulate tissues. For Titan, a gel port could allow the assistant at the bedside to access the abdomen through the gel port erasing the need for an additional assistant port. The DaVinci SP (single port) for example, requires a second incision for an bedside assistant port to be placed for suction, tissue manipulation, etc. For the majority of operations that require bedside assistance, the DaVinci SP is not truly single port. It is single port plus 1 or 2 ports. The gel port for the titan could allow truly single incision surgery. Just my 2 cents...
Bro, it's not really "for sale" yet. It's being used at Cleveland Clinic and soon at UTSW in Dallas as well as installations at a couple other big academic sites around the country. I was talking to a regional Intuitive rep recently who is trying to get the administration at a hospital in which I work to buy a 2nd robot. I sit on a robotics committee at this hospital, and we elected to wait an additional year due to all the changes coming in the robotic space. Of course I disclosed my Titan investment, but I hope we will be the first center in my state to use Titan for single port surgery. The rep tells me the Intuitive SP uses the Xi patient cart base, so the hospital will have to own an Xi system to upgrade to SP. If you look at pictures of the two systems you can tell the bases are identical. This will allow all existing Xi owners to upgrade to SP without buying a completely new robot. Price point is nowhere close to the SPORT price point which our hospital administrators were very interested to hear.
I’m not arguing that it’s profitable to do a surgery robotically. I’m saying the cost isn’t enough extra to keep insurers from paying for the surgeries. There are also a lot of robotic “toys” that are expensive. These “toys” aren’t necessary to do quality surgery. For example... I do a robotic radical nephrectomy instead of a laparoscopic radical nephrectomy. I use the same stapler for both instead of the robotic stapler. No cost difference. All the robot ports are reusable metal ports instead of using disposable ports that I would use for the a pure laparoscopic nephrectomy. That’s actually a savings. I also don’t use an expensive ligasure or harmonic scalpel which I would have to use for a pure lap surgery. The working instruments are reusable on the robot as well although they do have a service life. The cords to power these instruments are sometimes single use and sometimes reusable depending on the instrument. The robot also requires a single use drape. There have been multiple people look at this from a cost analysis standpoint (like yourself), and they have all pretty much cake to the same conclusion. Robotic cases are more expensive, but the gap is much much smaller than many believe. It’s also very dependent on what the actual case is eg lap chole vs lap nephrectomy
It's laughable how misinformed you are about the robotic surgery space. My goodness I have been wondering about you for a while, but this post 100% proves you're clueless.
As a robotic surgeon, I can tell you really have no knowledge about what is actually going on in healthcare. There is enormous data to support robotic assisted surgery. Do some pubmed research. Better yet, show me some peer reviewed publications that show "enormous negative data." Please. I'll wait.
And training issues? Titan's interface is very similar to Intuitive's system. Ask any medical student going into OB/GYN or Urology today what is important to them. The overwhelming majority will say robotics training. It's not just the future. It's now. Every good residency program out there has a robust robotic experience. Coming out of residency in 2018 without robotics training is an anomaly, not the norm. There is no issue with training the next generation of robotic surgeons.
And I robotically perform a particular surgery routinely that can be done laparoscopically. Why? The patients want the robot, and robotically is easier on my body with better vision than pure laparoscopy. Does medicare or private insurance ever deny those surgeries? Not once. Why? The massive difference in cost isn't there. Disposables for the robot aren't much more than disposables for a pure laparoscopic surgery. The capital cost of a robot is stretched out over many many years. Again, you simply don't know what you don't know.
"Their SP and articulating arm design leaves them in the abdominal space where there is strong established competition and mature pipelines in place. "
What?? I don't even know where to start here.
Anyone who invested in TRXC should have sold after FDA approval. It's all downhill as the market will never support that system. It's a joke as compared to Titan or even the very first Davinci S system. Maybe if it debuted in the 1990s after straight laparoscopy surgery was taking off, it would have been a substantive advance. In 2017 it offers nothing to the robotic market. Even more crazy is their system cost more than the fully loaded DaVinci Xi. And haptic feedback... If one can't perform robotic surgery with 3D vision, magnification, and precise movements alone, he/she probably shouldn't be performing robotic surgery.
I have a robot prostatectomy tomorrow. The Xi does it fairly well. I haven't used Sport but every video I've seen looks as if it can do it better. Of course I recognize watching a video vs using the system is not the same thing. A final point, the Michael Jordan of robotic prostatectomy, Vip Patel, doesn't touch this system with a 10 foot pole if isn't a viable technology.
I like (sarcasm) the video on the transenterix website showing the surgeon bashing an instrument into tissue, and the video saying "haptic feedback" while panning to the hand controls inferring the controls are saying you're hitting something. I would say in that situation, open your eyes! It's quite apparent you're slamming the instrument into a wall of tissues without the so called haptic feedback telling you so. I guess it could be useful if you like to operate with your eyes closed and solely off feel.
From a surgeon's perspective, I can't see this working as a legitimate defense. Is anyone aware of any judgements won against intuitive for mechanical malfunction? They may be out there. I'm not aware of them but would be interested to read the case if so. Open surgery requires the surgeon's own haptic feedback. Robotic surgery is simply an extension of the surgeon's commands. I can't see how a lawsuit could be won blaming poor haptic feedback especially considering millions of surgeries have been successfully completed by a robot with no haptic feedback. Having said that, judgements against companies for outrageous things do occur in this country all the time.
Haptic feedback... I've been lurking in the shadows on this board for about a year and have been invested for about the same time. As a practicing urologist who does a good bit of robotics, I have to say I'm very underwhelmed with haptic feedback. Tissue planes dissect very predictably when you are in the correct plane. I can't think of a single robotic operation I've done that would have been enhanced by haptic feedback. I'm sure there is a situation out there, but I haven't seen it. I bought into Titan after watching videos in the past and discussing with surgeons who had seen it at SAGES. I bought more after watching the most recent video from Celebration. I readily admit I'm an investment rookie, but as a robotic surgeon, Titan's movements appear (by video) on par with the market monopoly holder trading for 4000x our current value. I personally think TRXC is a joke, and the market for it will correct with time.