Vice President of Product Management
Intuitive (Jan 2021 – Now)
Jonathan Conta is the Vice President of Product Management for Intuitive’s SP platform. As such, he is the head of all product decisions, product roadmaps, customer voice and user feedback. Intuitive is a global technology leader in minimally invasive care and the pioneer of robotic-assisted surgery.
Section 1: Why is this technology redefining MedTech?
1.1. To what extent has this technology disrupted the way we deliver healthcare?
Surgical robotics played an important role in bringing minimally invasive surgery to a much broader set of patients. You can look procedure by procedure beginning with prostate cancer back in the early 2000s. Robotics enabled more surgeons to provide a minimally invasive option to their patients, and then actually improved upon the results they were getting by not only removing the cancer, but by enabling a shorter length of stay, less complications, less blood loss, shorter times to potency, shorter times to continence and actually higher rates of potency and continence than what was previously possible.
And then it’s been lather, rinse, repeat in multiple other procedures from there. Robotic-assisted surgery brings minimally invasive surgery to a broader base of patients to improve upon the existing outcomes.
I believe where robotics is going to play a major role in the next 10 years is that we have placed a computer between the surgeon and the patient, and this enables the displaying and capturing of information that was never possible before. What the computer can do is bring in other imaging modalities, it can overlay CT scans, it can bring in ultrasound images, it can show you exactly where critical structures are.
If we can improve the safety of the intervention by showing the surgeon important safety information, we can see a step-change in the outcomes for those patients. And that’s what the computer in between the patient and the surgeon can do – show the surgeon all those things.
1.2. Why should healthcare providers use this technology more?
There are certainly many more robots in OR suites now than there were five years ago, and still more than five years before that. There’s more proof both of both the clinical outcomes as well as the economic outcomes.
Robotics keeps proving that when you look at the total cost of care, yes, the instruments and accessories cost a little bit more, but you more than make up for that cost in decreased length of stay, decreased readmissions & decreased complications. It takes cost out of the system.
And that’s why I believe surgeons are going to be using it more is because it’s a cheaper way and better way to perform surgery.
1.2.1. What opportunities could robotics unlock?
Continued development of robotics could lead to increased precision, furthering our ability to bring in other sources of information to display to the surgeon, and eventually use machine learning and technologies like that to be able to create “no-fly” zones. A “no-fly” zone would prevent even a novice surgeon from piercing the aorta, even if they wanted to. The machine knows where the aorta is and will not let it happen. It’ll be able to not only light up the ureter and show a surgeon where that is, but they will not be able to injure it in the process.
1.3. Are there any barriers to successfully implement this technology?
There’s lots of cost perception barriers. Many people assume robotics is the most expensive way to do a surgery. And the robotics companies need to do a good job of showing why that is not the case.
They need to be doing better economic studies, they need to be proving out those financial results because you can arguably always do better by the patient, but at what cost?
If you make an investment into a robotic surgery platform, irrespective of what platform that is, and you simply look at that platform as another piece of technology or another tool that just sits in the operating room then your investment will fail. You must look at robotics as a program, because you must do lots of other things differently with robotics to extract the maximum value of your investment.
We face resistance with robotics from patients and HCPs. I believe it is highly variable on the patient side depending upon the nature of the disease state. Men seem to be on average more excited about robotic surgery than women. Again, depending upon how long robotic surgery has been around in a particular specialty or whatnot, the awareness and acceptance of that trickles down eventually all the way to the patient.
Doctors’ acceptance depends on the training that they went through, in particular how recent that training is: the more the recent the training, the more likely that they have been exposed to robotics. It also depends upon the specialty, for example cardiac surgery will have very little teaching of robotics in the residency program, while urology will be almost exclusively robotics. And then to some degree, the acceptance on the part of the attendings to teach this modality. If you’ve got attendings who are still early in their learning curve or have not yet adopted robotics, chances are their residents are not going to and the inverse also applies.
1.4. How does this technology reshape what the future of healthcare will look like?
I believe robotics will play a very important and crucial role in enabling a step-change in patient outcomes, irrespective of the procedure. How do we do better? How do we lower complication rates in colon and rectal surgery that are still well north of 20%? I imagine robotics is going to play a very important role in an example like that by giving the surgeon more information and providing additional safety.
Robotics programs have also forced hospitals to think a little bit more deeply about how they measure quality and how they think about credentialing, how they think about who should be doing these surgeries and how do we measure outcomes and how do we say this person is in our top 10% and this person’s in our bottom 10%, and maybe they shouldn’t be doing surgery at all irrespective of the modality?
But the additional information that robotics provides is objective evidence for hospitals to make better decisions on who should be doing surgery based on, again, tying what happened in the operating room to what happened to the patient and the outcomes. I suggest robotics is going to play a very important role in that, again, by providing that additional level of objectivity and information.
Section 2: The Future of Digital Disruption in MedTech
2.1. What other MedTech innovations are you most excited about?
There’s so many. AI, I believe is going to take a while. I’m excited about it, but I assume before that will be an expansion of machine learning. Machine learning is already playing a role and is going to play an even bigger role with each subsequent year here as we go on through the rest of this decade.
I believe that we are also scratching the surface on some level of precision medicine. I believe for better or worse, this pandemic has showed us that when an enormous percentage of the medical community all focuses on one problem at the same time, we can do some amazing things because we have so much energy applied to it and we’ve got enormous data sets to work from. We’re learning what COVID is doing or not doing, or how to treat it literally on a weekly basis. Find me any other disease in any part of humanity at any time where that’s happened. We’re learning at a pace that’s never been matched before, because again, we have these huge data sets and we’ve got a huge percentage of the medical population all focused on the same thing. That will subside at some point. But the learnings from that will then start to permeate the rest of medicine in lots of different places that I’m incredibly excited about.
2.2. In which area do you expect the biggest breakthrough/ innovation in the next 5-10 years?
I believe that throughout the rest of this decade, the machine learning side, which is the precursor to AI, is going to rapidly accelerate. I believe we’re going to get some amazing stuff going on there. I also believe that by the end of the decade, we’re going to get some really interesting interactions between devices and molecules, in the sense of I can inject a molecule into the patient and then see things the naked eye cannot see using the robotic endoscope.
Utilizing that basic technology, I can light up cancer: I can show you exactly where cancerous cells are so that you take all the tissue that you need to take and none that you don’t, which reduces surgical margin error significantly. That’s going to be incredibly exciting. And I assume we’ll see some of that stuff really starting to come into the mainstream by the end of the decade.
2.3. If MedTech is set to grow significantly, how do you think MedTech providers can create a competitive advantage?
In my view, it all starts and ends with the patient. If you are creating durable, unique clinical value through your technology that can be proven and at a reasonable cost, you’ll win. It’s as simple as that.
The superior patient outcomes over the long run will always win out. If you’re just taking out 10% of the cost out of the system, but are doing nothing to improve patient outcomes, the switching costs for these robotic systems is too high, you won’t get any traction.
You’ve got to move the ball forward, you’ve got to demonstrate that you are creating incremental clinical value for the patient by improving outcomes or safety in some way. That’s the secret sauce and it’s a lot harder to do but that’s how you create long term durable value: doing better by the patient.
2.4. Overall, what role will MedTech play in the healthcare industry in the next 10-15 years?
I believe it will continue to play a larger and larger role. It’s already a large role now and I imagine it will continue to play a larger role as its acceptance grows, as the outcomes that it’s able to achieve are proven and published and more widespread, and that how and where to use it is better understood. I imagine the manufacturers certainly play a role in that, but I assume the healthcare systems play a role in that, the professional societies play a role in that. Everybody has a duty to look at this and say, “Let’s just make sure we’re not using technology for technology’s sake,” Just because it’s a shiny, sexy widget, and we spend a whole bunch of money on it, that doesn’t mean it’s going to do better for the patient.
Where we’ve proven those kinds of things, where we’ve proven a step change in safety or a step change in efficacy, that’s where we’re going to get the exciting stuff. And that’s where I believe everybody’s got to focus their time and energy is, how are we employing this technology to do better for the patient? If you lose focus of that, you hopefully will lose all your market share because you’re not doing this for the right reasons.
2.4.1. Is surgical robotics an area that is well funded or supported by the government?
I’d say in most Western nations it’s generally not supported by the government other than through obviously nationalized healthcare systems being the purchasers. I believe you’ll see in the East, there are some governments who have decided they want to be a player in surgical robotics, and they will help subsidize local competition for robotics. I believe it will certainly make its way too less developed economies because the billion person markets of China and India will adopt, they’re already adopting, and they will start to create different looking machines. Either those countries will start to create them, or others will create them.
But I believe it’s extremely well-funded in the venture capital world and in the private equity world. You look at the valuations and the amount of money that some of these startups have been able to get over the past few years, there’s clearly opportunity out there, there’s clearly hunger and thirst for more of this technology, because the number of companies who stated that they’re pursuing robotics and have been able to secure tens, even hundreds of millions of dollars in funding is dramatically different from what it was just five years ago.