Intuitive Surgical: Europe Capital Equipment & Instrument Sales

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They want to feel like it's their idea. How does that affect the two scenarios of procedure growth you would see, say, in the first or second year if you go top-down or bottom-up?

If this was a surgeon-driven and care team-driven project, you could see the commitment and a significant increase in procedures. You would start urology first, two or three weeks later, start general, then gynecology. Within two to three months, the system would run four to five days per week, and you could easily see 150 cases in the first year, almost one case per day. If it goes the other way around, with the C-level dictating how things go, you have to reverse engineer the whole project. Surgeons are usually hesitant to start. They need convincing, case observations, and technology demonstrations. A date of installation is set, but teams are not ready yet. Plus, the energy and a chief surgeon who can't sell it as their own project can be annoyed. It complicates things significantly when it's sold from top to bottom, from C-level to surgeons, and not vice versa.

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How would you describe who has the power in a typical German hospital?

It can go both ways. Usually, if you're trying to sell a robot today, I would say, in the end, the surgeons hold the power. You can educate surgeons to present powerful arguments to the C-level, saying, "We need this now." You have to equip them to become more influential. If they aren't powerful enough with just surgical arguments, we can provide them with a set of arguments to present to their C-level.

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