Intuitive's chief executive told analysts on Tuesday that hospitals want proof before they move more benign general surgery onto the da Vinci. In those procedures, David Rosa said, customers want to see how robotics compares with laparoscopy, which is well entrenched, and sometimes with open surgery. He was answering Wells Fargo analyst Larry Biegelsen, who had asked whether a slowdown was a temporary lull. US da Vinci procedures grew 10% in the third quarter, which Biegelsen said was the slowest rate Intuitive has reported since the pandemic. MedTech Dive reported the call.
Hospitals kept buying systems. Intuitive placed 546 da Vinci systems in the quarter, up from 427 a year earlier, and 315 of them were the da Vinci 5. Revenue rose 22% to $3.05 billion. The slowdown is in procedures, and Rosa placed it in the operations where surgeons already have a minimally invasive tool they trust.
Robot versus laparoscopy is the harder comparison
I've argued for years that a surgical robot should usually be compared with open surgery, because open surgery is what most patients would otherwise get. The da Vinci's value in prostatectomy came from turning an operation that a small group of laparoscopic specialists could do by hand into one that urologists broadly could offer. Benign general surgery doesn't fit that story. Many general surgeons already do these operations laparoscopically and do them well, so the robot is measured against a minimally invasive procedure, on cost as well as outcomes.
Rosa said customers are building clinical and economic dashboards to make that comparison, and that robotics compares favorably on them. The hospitals building those dashboards already own the robot, have trained surgeons and pay for service. Each new procedure still has to justify itself on the hospital's own numbers.
A surgical robotics startup will be measured the same way, without the installed base or the trained surgeons. Before moving a procedure to a new robot, a hospital will compare it with how its surgeons do that operation today. If they already do it laparoscopically and do it well, the startup needs clinical and cost data that beat that operation, and it needs them before the first sales call.
Paying for adoption at the instrument tray
Intuitive is also cutting prices. It expects instrument and accessory revenue per procedure to fall 3% to 5% once the changes are fully in place. CFO Jamie Samath called the cuts a deliberate choice to broaden adoption in high-volume benign procedures, concentrated where cost may be a barrier, particularly outside the US and in ambulatory settings. He said broader adoption creates more long-term value than near-term revenue per procedure.
Intuitive's price cuts land on the part of the business that carries the recurring revenue. The hospital buys the robot once and buys instruments for every case, so the instrument cost per case decides which procedures make financial sense. Intuitive can accept a lower price per case because it collects instrument revenue across its whole installed base. A startup selling the same model has no such cushion. It should know, before launch, which indications its instrument price shuts out, and whether its own economics still close at the price those indications require.
Intuitive is meeting the hospital dashboards and the price barrier in the same quarter because both show up in the same procedures, the ones where laparoscopy already works. A startup can see that coming in its first pricing model. Set the instrument price for each target indication next to what the hospital spends on that operation today, and the indications the price shuts out show up on the founder's spreadsheet before a hospital's value analysis committee points them out.
Dave's take
Intuitive still expects 14% to 15% da Vinci procedure growth for 2026. The company that taught hospitals to buy surgical robots is now answering hospital spreadsheets with a lower instrument price. I'd make that the starting assumption for any new surgical robot aimed at general surgery, and price the first instruments with it in mind.
From Dave’s video library
In today's Robot Roundup, Dave looks at New York's reported results for the ElliQ companion robot and where those numbers come from: a report by the company that makes it.
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Dave Saunders is the founder of Base Reality Group and a Fractional CPO for product companies. He was a founder and operator at Galen Robotics, where the surgical-robotics platform earned FDA De Novo authorization in 2023, and he managed a 35-patent portfolio licensed from Johns Hopkins. He wrote Founders Who Finish and publishes The Build. More about Dave →