What should the next generation da Vinci be like?

The da Vinci Xi is the fourth generation of the da Vinci system and we are all waiting for the next generation. At the beginning of the year Gary Guthart, the CEO of Intuitive stated that the fifth generation of the system would not be launched in 2023. It would be interesting to try and speculate what the future might look like.

Perhaps to help  in that thought process a little historical reminder.

The very first da Vinci system launched in Europe in late 1990's in Europe and in early 2000's in the US probably never sold more than one hundred units and lasted for 10 years until 2009. It set the main elements that we know today of the console ,a patient side cart and a vision tower as well as instrumentation with a utilization shelf life. One of the biggest complaints I seem to remember at the time was the cabling between all the units. 

The da Vinci S system was the second generation launched in 2006. Here the main change was to the patient side cart which was reworked and offered new instrumentation. It was easier to set up and use This product was also sold for about 10 years and close to one thousand units were shipped.

The da Viinci Si was launched in 2009 so relatively soon after the S and while the patient side cart stayed the same the changes were to the console and the overall architecture of the system. The main architectural change was the processing power being moved into a central core that exists in the video tower. This simplified cabling and there was a focus on making the user interface easier. Along with the redesign of the console  this allowed for the support of two consoles with the same core unit as well as them functioning as stand alone units when powered by simulators. This was marketed for eleven years and roughly three thousand units were installed.

The da Vinci XI family was launched in 2014 so it is getting close to 10 years since a new product was launched. We could argue about whether the SP and the X fall into the same family but this picture from the intuitive web site would appear to imply they are. They use the same console and video tower. The main differences with the Xi as compared the earlier model was a redesign of the patient side cart which allowed for support of more advanced instrumentation and also included new camera technology which allowed the camera to be placed in any arm. It also continued the journey of ease of use and simplification. The architecture essentially has allowed for the support of multiple patient side carts using very similar control components. If we add all these just over 7,000 of these have been sold in the last 10 years.

The graph below shows the number of units sold per year since launch. I do not have the exact data on the Standard and the S as that was not published by Intutive at the time. The other numbers are taken from the annual reports It is interesting to see that the Si peaked at 600 units a year and the Xi nearly achieved 1200 a year. We will need to wait to the end of the year to see if 2023 is the continuation of a downward trend for the Xi.

So back to the original question what will the next generation bring. To be honest I do not know the answer or have any additional insights. As the console has not been refreshed since 2009 I would not be surprised to see some changes there. Perhaps a modular approach that allows customers to choose an open or enclosed viewer with a smaller foot print and at a lower cost. As the instrumentation changed between the S , Si and Xi the reach became longer and more advanced instrumentation were supported. Clearly one of the themes through the generation has been making the systems easier to use and setup and I am sure this will continue.

I think the overall the market will fragment, as costs come down, and there is a move away from the one multi purpose system to more procedural focused units.  Perhaps the next system will not be a replacement but complementary to open up lower cost markets.

I do believe in the future promise of " Digital Surgery" but I am pretty sure that the digital elements will end up being hardware independent and will not necessarily require new hardware to support it. The advances that real time data being supplied to the surgeon will only grow and have a huge impact.

Only time will tell. Any additional thoughts appreciated.

#roboticsurgery #digitalsurgery