Most of those "facts" are really old news and/or taken out of context and have been proven to have no merit. As an example. ISRG is not responsible for credentialing surgeons and the lack of standards for robotic surgeons is not their problem to fix. Individual hospitals certify their own surgeons just as they do for other modes of surgery. To imply otherwise is dishonest. This has been true for ISRG's entire 10 year history. ISRG is in favor and has been supportive of credentialing standards but they do not have the power to do that. It would be kind of absurd to have a product manufacturer telling surgeons when they are qualified to operate. They couldn't do anything about that if they wanted to.
Yes there is a learning curve for robotic surgery, just as there is for open or lap surgery. The truth is that hospitals don't want ANYONE thinking about the first 20 or 30 surgeries by ANY surgeon using ANY mode of surgery. Robotic is no different and is in fact easier to learn and do than standard lap. In fact now that they have their hands-on simulator it is easier and surgeons are more likely to log more hours of practice on robotic procedures than on lap and definitely on open.
As absurd as it seems the studies that show no benefit ignore less pain, less scarring and shorter hospitals stays as though those things are inconsequential, BUT PATIENTS DON"T.
There was no mention of the Citron report nor any lawsuits on the earnings call. Neither ISRG nor any of the analysts brought it up during the Q&A. It's just a non-issue other than the stir it caused by those jumping on the momentum of the price swing it created.
It is all about finding a reference point. Last week I was researching AMS's MiniArc incontinence sling for a friend. In the MAUDE database I found at least one lawsuit, not just complaints, but lawsuits file per day. AMS is a tiny company and they are doing ok (I have friend's that work there) and they install far fewer MiniArcs per day than DaVincis do surgery. The one to two complaints that come in about the DaVinci per week are pale by comparison to the number of complaints received for heart stents and catheters used to insert them and even simple devices like the MiniArc sling.