Eric Pan | When Robotics meet Data

On December 22, 2022, the Peking University Global Health and Development Forum 2022 was held with the main theme of Digital Transformation and Development Divides. Co-organized by the Beijing Forum, Asian Development Bank and PKU Institute for Global Health and Development, this Forum brought together world leading scholars, policy researchers and industry leaders from both China and international communities to share their insights and recommendations on the thematic topics, attracted over 10 thousands online viewers participated in the event. Eric Pan, Chief Executive Officer of Intuitive Fosun delivered a keynote speech at the session of Health Digitalization and Development Divides.


I will spend my time talking to you about hospitals, how hospitals can leverage the power and purpose of robotics, data and digitalization, especially in surgical care. In the introduction, you probably know Intuitive Surgical is a leader in robotic assisted surgical technologies. And da Vinci Robot is a leading example of such technology. I think we all agree in this room that robotics and digital technology platforms have and will continue to help fundamentally change and improve healthcare globally.

We can also agree that there’s a lot of noise out there. You hear robotics, deep learning, artificial intelligence, data analytics, edge computing, metaverse, cloud computing, machine vision, automation, augmented reality, big data, and machine learning, so on and so forth. A lot of buzzwords and so much hype. But if we are honest, few companies have been able to fully leverage robotics data and digital cohesively to solve real world problems. We believe with our surgeons and hospitals, and we have been laying a foundation for this for the past 25 years. And now, we are at a historical inflection point.

The inflection point is captured on this slide. We all know that healthcare needs to improve and that possibilities ahead of us are vast. It is the intersection of these two things that make today such an exciting time for us to be connecting and collaborating. While we have been at this for the past 25 years, we believe there is a substantial opportunity for improvement of surgery and other interventions.

Looking at us by numbers, physicians used our robotic platforms to perform over 1.5 million procedures last year alone, bringing our cumulative experience with da Vinci to over 10 million procedures. And physicians published more than 3,000 peer reviewed articles. Assessing our products, bring the clinical database to over 29,000 articles. The vast majority of these are conducted entirely independently of Intuitive Surgical.

In 2021, we installed more than 1,300 new da Vinci systems, bringing the total install base of clinically used systems to more than 6,700. I highlight these points because we look to the space of experience as a rich resource from which we can inform our future.

Listening, observing and researching surgeon experiences inside and outside the operating rooms has highlighted for us three trends where we believe the purpose and the power of robotics and digital can be fully leveraged. We see surgeons striving to reduce complications during surgery for their patients and significant variabilities in training, learning curves and total care team performance.

We also see surgeon practices and surgical departments generating vast amounts of data, but struggling to make these data sets actionable. Based on these observations and insights, Intuitive has responded by focusing our efforts and attention on three core pillars. First, focus on outcomes. Second, on the ability to personalize training and the individual's learning journey. And third, on delivering resources that can help optimize efficiencies.

Intuitive Surgical has been working with hospitals and surgeons for 25 years to unify our robotic systems infrastructure, and build learning continuums that incorporate traditional pathways with digital learning technologies. We offer value and services and consultation to help customers use data and digital insights generated from robotic surgery as a guide to maximize practices and hospital service lines.

Intuitive Surgical’s unique advantage is our ecosystem in that we are seamless by design. From the robot, advanced vision, imaging and instrumentation to the new mobile and web applications and the expanding digital learning technologies, we have designed each component to work together for hospitals, care teams, and surgeons. Each of these product offerings generates data so that collectively we can develop insights for hospitals and surgeons to take action.

How can we use all this innovation for positive change? Let me walk you through a few ways we believe we can answer that question. Beyond just surgery in the OR, Intuitive is focusing on activating with our customers in what is known as the virtuous loop. Data generated is high quality, interconnected, secure and accessible. We work together to create insight that is trusted, relevant, accurate, and actionable. And then we support surgeons, hospitals, and care teams to act with recommendations, alerts, notifications, and decision-making empowerment.

One of the simplest examples to start with is clinical decision support in the OR room. Many of you may be familiar with our robotic technology. One of those is a robotic stapler. A SureForm stapler with SmartFire technology. Our system monitors the firing force with kinematics at a rate of 1,000 data points per second. SmartFire algorithms then provide settings for optimal tissue compression and staple formation, depending on the load choice. Automated adjustments to clamping force are made or we suggest a thicker reload. Now this is one way that data from da Vinci is turned into insight that helps surgeons decide on a better course of action.

Another example is how we have been working to personalize learning and surgical education. Simulation is a great example to share. Data from an actual case is analyzed: instrument motion, angles, speed, and distances. Insights from these data sets identify movements that are relevant and beneficial for the case.

In this example, 14 needle driving gestures that are proven to produce maximum case efficiency and minimal tissue damage. These 14 needle poses are then matched and a SimNow training module is created to help a learner improve their performance in real world steps of a given procedure. Imagine how this is helping the training of new learners and residents or fellows.

A final example is where we are helping hospitals become more efficient and optimize their robotic service lines by improving reliability and our uptime guarantee. Intuitive Surgical’s proactive monitoring captures information from the arm movements. Service algorithms analyze the anonymized data indicating a potential future arm failure before it even occurs. Action is taken with proactive maintenance being scheduled when it is most convenient for the hospital.

Next, I want to show you a few future digital innovations stemming from the data inside action design concepts. These are not available in China or are still under development. And we believe it is Intuitive Surgical’s role to design innovative products that are integrated and connected across the care continuum. We also believe it is our role to give you ways to easily and efficiently access all the data generated from our offerings.

Let me highlight a future example for clinical decision support. This time was Intuitive Surgical’s in development 3D modeling offering, called Iris. CT images are used to create a high-resolution 3D model. The 3D model offers user insights into anatomical relationships and contextual views. These images can then be used to act in pre-op planning process to prep for how you approach the case, to review with the resident or a fellow or maybe even with the patient and the family.

Our vision for Iris is to leverage 3D model not only for pre-op purposes, but bring them into OR for intraoperative guidance and integration into the surgeon console. Intuitive can help customers by entering into agreements to combine our system logs with data sets from either the hospital's own databases or with the third-party data registry in our analytics engine. This can enable a bigger picture view of the variations that are occurring along the learning journey in practice or in the entire service line.

Now, one of these examples will be to develop so-called objective performance indicators to further personalize learning by using the robotic system data to help distinguish between the actions of a senior and a less experienced surgeon in the actual surgery. Here, the different colors indicate the trajectories of the instrument in the surgeon’s dominant hand, this instrument in the other hand and the camera. The top row shows the data from experienced da Vinci surgeons for four different steps of a prostatectomy. The bottom row shows that data from less experienced da Vinci surgeons. It is apparent there is a big difference between these groups.

The goal of this work will be to study and look at differences in OPIs so that we can fine tune learnings through simulations with the exercises that are most likely to improve those metrics correlated to positive patient outcomes. Then we have customized SimNow modules to be relevant to the learner and the procedure. The data coming from the OPI machine learning platform help identify opportunities to improve the relevant tasks. A Sim module is built from clinical data to personalize your learning. Imagine now if you are a novice trying to replicate your master or your mentor.

As we move forward, Intuitive has created two delivery platforms for this intuitive digital experience, so-called Intuitive Hub and My Intuitive. These channels along with Intuitive consulting services will provide ways for customers to access, analyze and use your data, video and digital insights from Intuitive systems learning and services.

Another example of post-operative and analytics is managing the service line using block time analyzers, best demonstrated practice benchmarking, outcome variation analysis, financial and operational performance metrics. Intuitive Hub is one of our newest digital offerings. Hub allows the capture of the information in the OR for post-operative analysis. This case audio, video recording, decision supporting sites and system of analogs.

Hub also provides real-time intraoperative information for decision support. Tele-presence and virtual collaboration, for example, provides case observation and mentoring. Imaging interpretation, for example, with 3D module models and ultrasound. Operational workflow support within care team alerts. What is the approach to bringing data together? Today in a hospital, it is a very complex picture. Intuitive Hub makes this much more seamless and efficient.

Another channel is My Intuitive. It is a mobile and web application that empowers surgeons to manage their practice by giving on-demand access to their data. My Intuitive was designed to solve two needs, to provide real time actionable insights to our customers with the vision of helping them improve performance, reduce variability and improve outcomes. And secondly, to connect our customers more easily to our ecosystem of products and services.

My Intuitive converts data into insights. Through My Intuitive, you will have the ability to view total case count, view instrument utilization, view console times, as well as case characteristics. In the future, you'll be able to see your surgical video from Intuitive Hub overlayed on this for you to scroll to the exact part of the procedure you would Like to watch for extra clinical context. In our first release, you have access to intuitive learning and simulation learning, with future product integrations coming very soon. We are excited that My Intuitive application will be available soon in China.

Now, we have talked a lot about robotics and use of data. Let me start my conclusion with this. I want you to know that from its very start, Intuitive has been transparent with the purposes of our data. Proactive monitoring for service, improving product reliability, and helping customers turn data in insights into actions that matter most to the patients.

And secondly, we do not collect additional data without the right permission and appropriate or in place. We believe that current healthcare environment will demand agility, creativity, and flexibility. If there ever was a time to explore what is possible with robotics, data and digital for positive change, it is now.

We believe we will be able to innovate faster when silos are broken down and we begin to collaborate more. This means sharing data and sharing our insights. Surgery by its very nature, is already highly collaborative. The question is how we will move forward and make progress together.

It will be the intersection of the two spaces I talked about earlier. The challenges in healthcare and new technology that creates a point of possibility where it all connects, which excites us most at Intuitive. And we believe that this will fundamentally shape the way we do surgery moving forward.