Are you claiming that it wasn't peer reviewed? This was a study published in the "Journal of Minimally Invasive Gynecology". I would encourage you write them if you have evidence of fraud. Be sure to cc Intuitive and Dr. Martino.
A nod to streetsense on another board for finding a blurb about Firefly being used in robotic surgery to treat endometriosis at Kingwood Medical Center. It’s a good look-at-what-we-can-do-now/case-study piece.
I wasn't aware hospitals were informing the public about this application yet.
Indeed the 80% figure was for the US machines. My point was really about the percentage and the desirability of SPY technology as evidenced by the steep ramp in general procedures, where Firefly shines, not the absolute numbers of Firefly systems sold. With capacity overhang and ACA issues still playing out with da Vinci system sales, the numbers might not jibe with procedure growth for a couple of quarters.
Also, shorter hospital stays, less blood loss.
Comments, Herb Greenberg?
No link, see yahoo company news for ISRG (2-5-2014).
Just poking around I found a 2011 study on cost comparison of staplers in gastric bypass by J. K. Champion MD and Mike Williams MD. The staplers compared were the USSC Endo-GIA Universal six row stapler and the Ethicon ETS-Flex six row stapler. The table from the study doesn’t breakdown the individual handle and cartridge costs but lumps them together. So the per patient cost was $1544.32 for the Endo-GIA and $1225.32 for the ETS-Flex.
From the study:
Endo-GIA (n=50) ETS-Flex (n=50)
Total # cartridges 442 448
Total # handles 50 81
Total Cost($US) $77,215.78 $61,266.22
Verification via eSutures prices -- for Ethicon ETS FLEX (45mm)
Cartridges ($1140 / Box of 12) $95 ea.
81 X $290 = $23,490
448 X $95 = $42,560
Total = $66,050
Close enough at today's prices.
I previously noted that during the RBC talk Arun mentioned that one selling point of PINPOINT was that it serves as a replacement endoscopic system and not just another added piece of equipment. Listening to the BarcIays webcast, it became clear that he really was referring to the new PINPOINT which will be unveiled at SAGES. Based on feedback gained in the field, beyond fluorescence and quantification of perfusion, the new PINPOINT will be aimed at replacing all the functions that surgeons are used to using with their old endoscopes: gas insufflation, data capture, and different sizes and shapes of scopes.
These greater capabilities should speed adoption in the OR and increase unit ASP.
Another item presented that I found interesting was that a second generation PINPOINT device will be revealed at SAGES (April 2-5). Arun intimated that their market strategy included introduction of upgraded versions of current products thus allowing higher pricing power.
A small study - released in the past week - entitled Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery, used Novadaq's PINPOINT in surgery on 30 consecutive patients. The mantra continues - no leaks. Go PILLAR.
2015? Do you have a time machine, endo?
I'm not so sure they they can't present data. I could be wrong, but I think two journals have accepted and made the article available online and rendered it able to cited. Near Infra-red (NIR) laparoscopic assessment of the adequacy of blood perfusion of intestinal anastomosis. In colorectal disease or surgical endoscopy. A seach for NIR, Cahill, Ris should get you there.
(posted on IV)
Not gained from any other source than by by looking at closeups of the following system photos and press releases, it looks like the da Vinci Xi is probably incompatible with the old Firefly endoscope. (1) The mounts are not the same. (2) The new Xi regular scope is much less bulky than the old Si endoscopes(regular and Firefly). An adapter for the old Si Firefly scope might be possible but weight, moment, size and clearance could be problematic. (3) The Si Firefly scope appears to use a dedicated arm whereas the Xi’s endoscope is moveable among the arms. (4) The Xi’s new regular endoscope has improved vision over the Si components.
My guess is that a new Firefly for the Xi is in existence and awaiting FDA approval. The question is whether it incorporates Novadaq's new technology, though I doubt if Intuitive would hitch their new machine to old technology. I'm not sure where this would leave us with regard to the particulars of the current Intuitive/Novadaq manufacturing agreement (we’re halfway through the ten year commitment) but an updated one would no doubt be more beneficial to Novadaq. An announcement of a new agreement MIGHT follow FDA approval.
Photos on company site in media images.
Links on IV-
Photo of Si without Firefly:
Photo Si with Firefly:
Photo of Xi without Firefly:
You are correct that the Exchange 30 was only approved for appendix and intestinal procedures. But, like any other FDA approved device, once approved there is nothing to prevent a surgeon from using it "off-label"(other than liability issues, perhaps). Doctors do this with drugs all the time.
However, Cardica cannot advertize or promote any off-label use.
Arun mentioned that one selling point of PINPOINT was that it serves as a replacement endoscopic system and not just another added piece of equipment. I hadn’t heard that mentioned before.
The key to isrg not being taken out was that isrg's price was always just ahead of an acquiring company's comfort zone. It was easier for a buyer to take a pass on potential future profits than be second guessed by current shareholders and analysts due to a perceived overpayment.
I'm hoping the same thing will happen with nvdq. Nvdq's management knows what they have, I don't think they will sell cheaply.
Arun said that the average 40% growth rate was likely to result from less than 40% for partnered agreements (Intuitive/FIREFLY and Lifecell/SPY) and greater than 40% for self-vended products (LUNA and PINPOINT). Given the enhancements, better color image presentation, and perfusion quantification, my question is when will renegotiation of the Novadaq/Inutitive licensing and equipment sales agreement (ten year, signed 2009) occur? I don't think Intuitive will wait for expiration to get improved equipment.
Both Pinpoints are endoscopic devices. During at the RBC talk, at about the 12 minute mark, Arun described Pinpoint's capabilities both as an endoscope and a perfusion measuring system. He did mention that Pinpoint could replace other endoscopic systems in complex cases. This probably means Pinpoint is overkill for general use, but in cases where perfusion measurement is desired, an additional endoscope will not be required.
However, he made no reference to Pinpoint II until near the end of the talk and declined to reveal its features, saying these will discussed at SAGES when it will be officially unveiled.
Pardon me if I'm wrong but I don't believe the paper you mention has much to do with Pillar II. Pillar II concerns cases of laparoscopic colon resection surgery utilizing PINPOINT and not robotic gall bladder surgery. Nonetheless, I'm still looking forward to SAGES!
It's okay by me. Added another 5% to my portfolio today. Looking forward:
(1) The official Pillar II results have yet to be released. (2) Pressure will be on ISRG to upgrade Firefly visual definition and perfusion quantification. (3) No official announcement of the new Pinpoint has been made.