An Exclusive Interview with Mandeep Singh Kumar, Vice President and GM, Intuitive Surgical India

Advances in technologies including Artificial Intelligence, Big Data, Cloud Computing and more have driven businesses across diverse sectors to the next level. Healthcare industry is one of the leading adopters of these disruptive technologies. The industry now has moved to robotics that enables surgeons to effectively perform complex surgery, also known as robotic-assisted minimally invasive surgery. A company which pioneers in offering innovative, robotic-assisted systems that help empower doctors and hospitals to make surgery less invasive than an open approach is Intuitive Surgical.

In an interview with Analytics Insight, Mandeep Singh Kumar, Vice President and GM, Intuitive Surgical India shares how the company is bringing innovation to the healthcare industry and leading the country in "Intelligent Surgery" to enable better outcomes.

Kindly brief us about Intuitive, its specialization and the services and products that you offer.

Intuitive, based in Silicon Valley, is a global technology leader in minimally invasive care and the pioneer of robotic-assisted surgery. We bring more than 25 years of leadership in robotic-assisted surgical technology and solutions to help make surgery less invasive and easier on patients. Intuitive develops, manufactures and markets the da Vinci® robotic-assisted surgical system and the Ion™ endoluminal system. Currently, there are over 5,500 da Vinci systems installed in 67 countries, and more than 7.2 million da Vinci procedures have been performed globally.

Tell us about your company's technological contribution in the industry and how the company is benefiting the customers.

Since the da Vinci surgical system became one of the first robotic-assisted systems cleared by the FDA in 2000, we've taken robotic-assisted surgery from "science fiction" to reality. Since then, the da Vinci surgical system has been widely adopted by surgeons and benefited millions of patients – over 52,000 surgeons globally have trained on the da Vinci system, and more than 7.2 million robotic-assisted procedures have taken place worldwide, with 1.2 million taking place in 2019 alone. Roughly, every 26 seconds, a surgeon somewhere in the world starts a da Vinci procedure.

Robotic-assisted surgery allows surgeons to perform many types of complex procedures with more precision, flexibility and control that is possible with more traditional techniques, such as open or laparoscopic surgery. The da Vinci system is designed for complex surgery using a minimally invasive approach – in other words, procedures performed through very small incisions.

The da Vinci surgical system includes an ergonomic surgeon console or consoles, a patient-side cart with three or four interactive arms with a high-performance vision system and wristed instrumentation. The surgeon controls the arms while seated at the computer console near the operating table. The console gives the surgeon and OR staff a high-definition, magnified, 3D view of the surgical site, which allows everyone in the OR a clear and unobstructed view of the patient anatomy.

By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, da Vinci surgical systems make it possible for skilled surgeons to perform minimally invasive procedures involving complex dissection or reconstruction.

For patients, da Vinci surgery can offer many potential benefits compared to more traditional methods, such as open surgery and laparoscopy, including less blood loss, less pain, fewer complications, shorter hospital stays, fewer readmissions, faster recovery and smaller incisions.

These benefits can extend to hospitals as well – faster recovery and fewer readmissions can free up hospital beds and take the pressure off the overall healthcare system.

Recently, we also expanded from RAS to lung cancer biopsy by launching Ion. It is an FDA approved system that features an ultra-thin, ultra-maneuverable catheter that allows navigation far into the peripheral lung, and unprecedented stability enables the precision needed for biopsy. It enables the physician to extract a sample to detect the disease without the need for invasive surgery. Currently, Ion is in use in the US, and the initial results are promising. It is not yet available in India

AI is projected to be the next big market. How is AI contributing to the making of your products?

Intuitive has continually refined its technology with input from surgeons, and we invest heavily in R&D with an eye to the future. One of the exciting aspects of robotic-assisted surgery is that you are putting a computer between the surgeon and the patient, which enables new possibilities that are not available with open or laparoscopic surgery.

Much of the work we are doing is figuring out how we, as an industry, can make surgery better for both patients and surgeons. If you use ML and AI to identify patterns, such as optimal approaches to surgery, you can incorporate that into teaching and simulation exercises for surgeons and care teams, identifying ways to increase consistency and precision.

How do you plan to revolutionize the Indian market and what are your plans to tap the market?

India is a long-term, important market for Intuitive, and we are investing in India for the future. Currently, there are over 70 da Vinci systems in use in hospitals throughout the country.

We are building on a strong foundation created by nearly two decades of innovation and success in India. During this time, two key factors have helped to drive the rise of robotic-assisted surgery in India: the skill and pioneering spirit of Indian surgeons, and the impact that robotic-assisted surgery has on their patients. Indian surgeons have made important contributions to the evolution and development of robotic-assisted surgery over the past two decades. Since the first robotic-assisted surgical procedure in India was performed with a da Vinci surgical system in 2002, we have been training and collaborating with pioneering Indian surgeons throughout the company's history. As a result, India now has a pool of committed, skilled and highly passionate RAS surgeons, who have a robust patient flow, manage complex cases and collaborate with their peers around the globe.

This foundation of success and innovation prompted Intuitive to move to a direct business structure in India in mid-2018 to further expand access to the benefits of robotic-assisted surgery to patients, surgeons, hospitals and the healthcare system. We are headquartered in Bengaluru, which is Intuitive's sixth international office.

Intuitive is continuing to build a robust presence in India to meet and support the growing interest and demand surrounding RAS. To strengthen our presence, we are rapidly hiring employees, including teams that work closely with surgeons, to support hospitals for the long run. In addition, we have invested in training centres – we aim to provide the best-in-class training and support to surgeons in India throughout their careers – from initial exposure to the technology, to progressing from basic training through to more advanced training.

In India, over 500 surgeons have been trained on the da Vinci system. Surgeons across India are adopting the technology, adapting to it quickly and looking at it as a tool that provides them with additional capabilities, such as superior visualization, enhanced dexterity, and greater precision, that can help them deliver clinical benefits and economic value.

What are some of the challenges faced by the industry today?

Intuitive's focus is patients first, always, which drives us to continually ask "how can we improve outcomes?". Robotic-assisted surgery has made a positive impact on the lives of millions of patients, and we have consistently worked closely with surgeons and hospital staff over our 25-year history to identify new opportunities for improvement.

To accomplish this, we are continuing to innovate our products, but we are also innovating in terms of what we call our "ecosystem" by enhancing the capabilities that support the technology and long term success of surgeons and hospitals, such as helping to train surgeons and using analytics to help our customers. Going "direct" in India has enabled us to provide better access to these capabilities to surgeons and hospitals throughout the country.

In India, robotic-assisted surgery is still in a nascent stage, but demand and interest are high. We see evidence of this in the growing surgeon community, and in increasing the adoption of RAS by hospitals across the country. This has included prestigious government institutions – recently Dr. Harsh Vardhan, India's Minister for Health and Family Welfare, attended a ribbon cutting ceremony for the robotic-assisted surgery facility at Safdarjung Hospital in New Delhi.

What does your technology and business roadmap look for the rest of the year?

One of our key focus areas is on hiring employees in sales, support, clinical affairs, marketing, training, regulatory and other areas in order to best support our customers and facilitate access to, and expansion of, robotic-assisted surgery to more patients and institutions throughout the country. Intuitive has a very strong, mission-driven global corporate culture, and we are excited to bring that to life here in India, working to build our team in order to develop and deliver the tools, technologies and solutions to help improve the lives of patients.

What is your roadmap for the Robotic-assisted surgery (RAS)market?

The demand for robotic-assisted surgery in India has, in part, been driven by the same factor that has driven adoption globally: a desire to offer a minimally invasive option that can improve patient outcomes. Compared to other more invasive methods, robotic-assisted surgery can provide surgeons with additional capabilities and the ability to operate through small incisions, which can make surgery easier on patients. The benefits to patients from minimally invasive, robotic-assisted surgery can include fewer complications, less pain and scarring, less blood loss and faster recovery – essentially getting patients back to their lives faster.

These benefits can create dividends for hospitals in India – faster recovery can mean shorter hospital stays and fewer readmissions, freeing up a limited supply of hospital beds and helping take pressure off the overall healthcare system.

Today, we see a high incidence of cancer among the general population and based on a recent WHO report, cases of cancer are projected to rise in India. One of our focus areas is procedures tied to critical types of cancer, primarily around the specialties of urology, gynecology, and general surgery, and we see the high utility in that space in the future.

In India, and across the globe, the surgeon community will also continue to play an important role in the future of RAS, as they collaborate, share their personal experience adopting RAS and the positive impact it has had on their patients. The 2019 launch of the Indian Chapter of the Clinical Robotics Society Association (CRSA), a global association dedicated to surgeon training, and now the first Indian robotic surgical society, demonstrates the growing enthusiasm and maturity of the surgeon community, and we look forward to our continued collaboration with surgeons and surgical societies.

Which industry verticals are you currently focusing on? And what is your go to market strategy for the same?

As the global technology leader in minimally invasive care and the pioneer of robotic-assisted surgery, Intuitive essentially helped created and define the robotic-assisted surgical device industry vertical.

The da Vinci was one of the first robotic-assisted surgical systems to be cleared by the FDA in 2000. Since then, da Vinci surgical systems have been adopted by surgeons across the globe used in more than 7.2 million minimally invasive procedures across a number of surgical specialties. Some of our key focus areas include gynecology, surgical oncology and urology.

Could you shed some light on the safety aspects of robotic-assisted surgeries?

At Intuitive, we put the patient first, always. We care about patients and the impact our technology has on them—Intuitive's top priority is patient safety. Patient safety guides the design and evolution of our technology and serves as the basis for our industry-leading technology training pathway. We collaborate closely with surgeons and hospital staff to improve our products, support evidence generation, and facilitate advanced education and training.

Some of the best indicators of safety can be found in clinical literature. To date, there are more than 21,000 peer-reviewed, published studies and reports that examine the da Vinci surgical system and generally support the safety and intended performance of RAS. For patients, da Vinci surgery can offer many potential benefits compared to open surgery, including less blood loss, less pain, fewer complications, shorter hospital stays, fewer readmissions, faster recovery and smaller incisions.

Surgeons who use the robotic-assisted systems find that it can enhance their precision, flexibility and control during the operation and provide superior visualization compared to traditional techniques such as open and laparoscopic surgery. With robotic-assisted surgery, surgeons can perform complex procedures that can be difficult with other methods.

What is your biggest USP that differentiates the company from competitors?

Our focus is not merely introducing the technology by installing a robotic-assisted surgical system, but assuring that we can support our customers in establishing strong robotic-assisted surgery programs through everything that "surrounds" and supports the technology: training, customer service and support. We call this our "ecosystem" and it helps us help our customers by ensuring the long-term success of each robotics program.

This process starts well before the installation of a robotic-assisted surgical system at a hospital or institution. We evaluate to determine if a program will have the right patient flow, a pool of passionate surgeons who have the right skillsets, and the potential to achieve the right clinical outcomes. All of this helps in developing and maintaining a successful robotics program. Our investment in training centers, a clinical sales team that works closely with surgeon's day in and day out, and a capital sales team collectively enable us to maintain the supportive ecosystem for the hospital over the long run.