Jbuffett, you appear to have experience in robotic surgery. What is your background? In general terms, of course...
A few points of clarification... In the past, Titan has indicated their intended price point as being substantially lower than any available ISRG system. They initially were targeting a sub-million dollar price point but once Mr. McNally took the helm, he indicated that he couldn't realistically meet that target and be reasonably profitable, so they were then targeting the $1.2M range plus substantial discounts (up to 50%) in service contracts compared to ISRG.
I have never seen a third footprint in any Titan presentation; they always indicated they have the surgeon console and the patient cart. The processing power appears to be shared between the two units; note the extra space behind the foot pedals. I do not believe they have an additional processing tower.
They have the patent for the camera wash system but they did state that it will not be deployed in the initial release; they seem to be relying on the 2D camera for visualization during the 3D camera cleaning.
They originally touted their disposable end effectors with no indication that some may be re-usable. It has been very recent that they indicated some re-usable end effectors. I am still hoping to hear some clarification, as they were saying surgeons would always have a fresh, new cutting edge for every case. I think it was as recent as the Medtronic relationship when they said anything about reusable end effectors (design completion declared via PR on July 30 and testing was to commence immediately thereafter). This PR was the first mention of re-processing that I have seen, although they did not draw any distinction here regarding end effectors vs. other instrumentation such as snake arm assemblies, cameras, the deployed camera insertion tube, etc. any or all of which could be generically referred to as instrumentation. I'm hoping they stick to their original plan of at least doing one-time only cutting surfaces but the rest can be reprocessed for economy's sake. And I really don't know what percentage of "cutting" is done with sharps/scissors as opposed to ESU/RF energy devices. And I assume lasers are still too futuristic for robotic surgery, but who knows what the future holds. Heck, Boston Sci fibers for kidney stone ablations start at what, 200 microns? Should be easy to adapt laser fibers to snake armed hardware in the future, if they don't deem lasers too dangerous for non-open procedures.
The surgeon videos are quite dated, some being three years old at this point, and all the hardware was relatively rudimentary at that time. Certainly better than basic proof of concept hardware (that was the "chicken-in-a-bottle" stuff) but nowhere near ready for prime time back then. Various reports over the years indicated they were working on arm strength (especially at full extension), range of motion, range of vision and camera mobility, etc. Any human-operated robotic system will now have motion damping features for hand tremors or other non-standard inputs. I'm quite sure the past 3 to 4 years of development have been more than just implementation of redundancies for failsafe operations; it surely is a much more polished surgeon experience than in the 2017 videos. Without these enhancements, Medtronic may have had no interest at all in little old Titan!
A lot of work presumably remains... but not relative to other development programs. Titan was way further along than any other development hardware platform we have seen, when considering their earlier plans for regulatory submissions which were only abandoned due to finances at the time. I would surmise the additional development work now is mostly at the request of Medtronic to meet certain goals they have. Keep in mind they (MDT) have been working on their own platform for some time so they may have had a few ideas and a stack of independent research which can be applied to Enos to make it an even stronger contender.
Message in reply to:
Thanks for the reply. I got your point and like I said before. I am a long investor of tmdi and I hope tmdi does get bought out. But I think it's important to have realistic expectations from a new technology like the titan sport. Like I mentioned before titan is definitely in line and has positioned itself well to be BO by either J&J and MDT. We are very fortunate that these large companies are having a difficult time in coming up with their in-house robot.
Obviously, as you mention there are many different benefits of the sport compared to ISRG and newer addition. My definition of ground breaking is from laparoscoy to robotics. No matter how bad the tech was abck in the early 2000s. It was ground breaking. I did see the original DaVinci standard robot in the early 2000s and definitely a monstrosity in terms of foot print, but other than CMR versius system the foot print in the or seems pretty similar. One console, one robot and one tower. Same with sport, one console for the surgeon, the robot itself and the tower system (which may incorporate the hospital imaging system), which I don't think we know yet if they are compatable with other imaging systems.
In terms of cost? Tmdi has not mentioned price of the robot and they can't do so until fda approval. So as far as I know it could cost the same or more than intuitive. My guess is that they will price it lower, but by a nonimal amount. Just like trxc, they didn't lower their price point significantly compared to ISRG. For the amount of money it takes to build a robot, it's almost impossible to sell at a much lower price point and try to be a profitable company. Also, the cost of the device for the hospital is usually is the inital cost or the robot and service agreement. Yes, instrumentation does make a difference, but not by much. (by the way ISRG instruments have 10 lives). By increasing the number use of the instruments maybe beneficial for cost, but there is a reason why intuitive recommends 10 uses. I hope tmdi comes up with a better option, but my best estimate is that these instruments need to be changed for safety reasons and they do wear out due to the size of the instrumentation.
The videos of surgeons operating on tmdi, does seem reasonably function, but it's not ground breaking. The movements are not refined and out of this world. It accomplishes what it's supposed to accomplish. A 25 mm incision is nice to only have one, but it can increase chances of developing hernias. ISRG has a 3rd arm in the same size which can help with self retraction and more important for single port surgery, but tmdi does not. I hope that the next Gen may have a forth arm. The 2d camera helps to localize the instrument ao that. I'm not sure If the self cleaning camera is included in the mcnally version since the recent rehash and update. I hope they kept the function in, but I wouldn't be surprised if it was removed due to the new upgrades to the camera system.
I believe if titan really pushes the Enos idea, and to be placed in surgery centers, it can be a benefit and possibly profitable. There is still a lot of work to be done by mcnally and his team. I hope they can get there with MDT's help and guidance of what they want so they can get BO. There are definite goals and metrics they have to meet with MDT, and if they don't we are screwed and done for.
I am just calling out what I see and wish the best of luck for every long tmdi investor, because I'm one of them.
