Twenty-five years after creating the first ever da Vinci surgical robot, the Sunnyvale, CA-based industry pioneer continues to innovate and transform health care as we know it.
Intuitive’s fifth generation robot, which is expected to be fully launched mid-year, has already been well received by surgeons, Gary Guthart, CEO of Intuitive Surgical, told investors at the J.P. Morgan Healthcare conference. During 2024, the company placed 362 units, which were used to perform more than 32,000 procedures, he said.
The system, which has been a decade in the making, incorporates multiple upgrades such as Force Feedback technology, which allows surgeons to sense how much force is being applied using the instrument. The company is working on more advancements, including a digital coach, which Guthart told Medtech Insight will “allow surgeons to get better, faster.”
The company, however, has expanded far beyond the da Vinci System. In 2019, it launched the ION endoluminal system, a robotic-assisted bronchoscopy platform for minimally invasive lung biopsy. Guthart said the system, which creates a preoperative personalized map of the patient’s lungs, is like a Google Map that helps the surgeon navigate each case with personalized precision. ION’s installed base grew 51% in 2024 to over 800 systems.
The company also provides a suite of stapling and energy devices, a single-port (SP) robotic system, advanced imaging and visualization, AI-powered digital coaching, case insights and data analytics, instrumentation and accessories. Intuitive also invests in biomolecular contrast agents, new robotic platforms and interoperability efforts.
Intuitive delivered strong financial results in 2024 with revenues of $8.4bn, a 17% increase from 2023, and a 29% rise in net income from the prior year.
The company is facing competition from rival robotic platforms such as Medtronic’s Hugo and Johnson & Johnson’s Ottava, as well as new platforms from Chinese surgical robotic makers KangDuo, Medbot, Ronovo Surgical and Edge Medical, Japanese company Hinotori and Korean-based REVO-i. But while these companies are offering what Oppenheimer & Co managing director Suraj Kalia described as “exciting new options to clinicians” in a 2 March report, Kalia also said that Intuitive’s dominance over the next decade is not in question.
The company’s “growth outlook could be challenged,” but Intuitive remains king with a current 95% market share and more than 10,000 systems placed and over 2.7 million cases performed globally, Kalia wrote.
For 2025, Intuitive plans to focus on expanding adoption of da Vinci 5 in domestic and international markets, integrating innovative digital tools and optimizing manufacturing processes. Its long-term strategy is driven by ongoing innovation and international expansion.
Key Takeaways
- Force Feedback Innovation: da Vinci 5 introduces precise haptic feedback via internal sensors, setting it apart from competitors with coarser haptic technologies.
- AI-Powered Digital Coaching: Machine learning capabilities will enable personalized training and surgical insights, with future potential for real-time intraoperative guidance.
- Future of Automation in Surgery: While AI is evolving, Guthart stresses that human oversight in robotic-assisted surgery will remain essential for the foreseeable future.
Medtech Insight sat down with Guthart during the LSI USA 2025 conference, held from 18-20 March in Dana Point, CA, to discuss how Intuitive is leveraging technological advancements such as AI and machine learning to maintain its leadership position in robotic-assisted surgery as well as his views on health care interoperability, AI regulation, outpatient surgeries, autonomous robots, and how the company is harnessing technology to shape the future of robotic surgery.
The interview with Gary Guthart below has been slightly edited for brevity.
Medtech Insight: What is Intuitive’s strategy for the planned mid-year full launch of the da Vinci 5?
Guthart: We're coming up on the first full year of launch [of the da Vinci 5]. Five stands for the fifth generation of the system. Our first clearance was for a da Vinci in 2000, so we're excited by it. [da Vinci 5] contains some things that are iterative, and it contains some things that are disruptive.
Can you explain the new Force Feedback technology?
Guthart: The way to think about it is, back in the 1800s William Halsted [founding professor at Johns Hopkins Hospital] outlined a set of principles that he thought were important for surgery. Amongst them was understanding the force applied [during] surgery and using the appropriate force. In open surgery, people would use their hands to determine that, so you have some sense of force. But it turns out our hands are not very good force measurement devices. If I handed you that pen and said, ‘Tell me how many grams it is,’ you couldn't tell me how many grams.
What we've done at Intuitive with our Force Feedback has been to put tiny, high-quality sensors inside our instruments that are used inside the body. We can measure tissue forces with these force-sensing instruments inside the body. With those sensors we can then use haptic technology, which means that we can display forces into the surgeon hands.
It works in two different ways simultaneously. When the surgeon touches something, she feels it in her hand. That's the force-feedback. The force-sensing measurement is also being done, and it can be recorded, so we know what's happening during the surgery in terms of force, and the surgeon can feel it in her hands as she's working through it.
Would you say that the new Force Feedback in da Vinci 5 is a differentiator from competitive surgical robots with haptic feedback technology?
Guthart: There are a couple of systems out there from other manufacturers that make claims about haptics and those are quite non-sensitive, coarse and gross. To my knowledge, they are not using sensors inside the body, and I don't think they have the same precision resolution.
You mentioned that additional digital features to enhance the da Vinci 5 further will be rolled out this year. Can you discuss some of them?
Guthart: A lot of the capability in the da Vinci 5 is around our computational engine, which is built on AI chips from NVIDIA. It has given us 10,000 times more processing power compared to the prior generation. We can bring many things to that like augmented reality, using preoperative segmented 3D images overlaid in real time for the surgeon in three dimensions during the case.
We also have our artificial intelligence machine learning system in da Vinci 5. This allows us – with the right data-sharing agreements with hospitals – to look at case insights, which will generate reports automatically for surgeons and for administrators about trends in surgery, about how they're linked or correlate to outcome.
This can be used to create a digital, personalized learning coach for the surgeon and the care team. This is another set of features that will be developed more strongly. The basics are already in this system, but are now being advanced and made more seamless, faster, easier to access the data all through this da Vinci 5 setup.
Where we are today is the surgeon can evaluate techniques and see all the differences. The next thing that we're working on – and it’s quite close – is the digital coach to help surgeons get better, faster. You can imagine in the future that, once you understand digital coaching, that coaching can help surgeons during their surgery, ‘Hey, remember the following things you can do? [That is] guidance intraoperatively.’ It’s not yet cleared. It also takes a long time to validate, but it's a stepwise approach.
We’re beginning to bring out the digital coach for training [not during surgery]. It’s too soon to tell [when digital coaching may be rolled out intraoperatively].
Intuitive invests 13.7 % of its revenue in R&D. Can you elaborate on your key areas of focus and how AI and machine learning are shaping the future of robotic-assisted surgery?
Guthart: Some of your readers will be thinking, the future is digital. And it's true that digital matters, but physical matters too. I don't think all of us are done inventing physical things. We work on better ways mechanically to interact with tissue. We work on new robot designs for new indications and for new environments that would be different.
ION, the flexible robotics program, is an example of that. It’s a very different looking thing than SP, our single-port robotic system; our multi-port is different than ION. And those won't be our last platforms. We think there are other physical platform opportunities to change the way we interact with the body. What I love is, we do software, digital, imaging, optics. We do mechanical things. We do tissue interaction technologies. We’re even doing biomolecules, molecular contrast agents. We look at that whole set of things and say, ‘Can we bring these all together?’
Will the ION robotic platform be used for other indications?
Guthart: Our first physical place has been in the lung, bronchoscopic applications. It has the first cleared indication, which is for biopsy of suspicious lung nodules. We're working on additional clearances in the lung to help pulmonologists do more with what they have. We’re not ready to describe those yet.
Then we’ll also take that kind of technology outside of the lung. People talk about personalized medicine, precision medicine. Today, every single ION case has a preoperative personalized map of the patient's lungs. I think the total number of ION procedures performed today is 180,000 [as of 12/31/2024] and for every single one, we construct a Google Map for their body so that this flexible robot is navigating their personal map.
With the continued shift to outpatient surgeries, how is Intuitive adapting its business and innovation strategy?
Guthart: Think of the environments in three ways: There’s the main hospital, hospital-owned outpatient department (HOPD) and ambulatory surgery environments [ASC], which are partially owned by surgeons. We do enormous amounts of procedures with our customers in all three environments. HOPDs are a huge part of the business today. ASC is just another version of an outpatient environment. We are happy to satisfy customers in all three.
The biggest difference in ambulatory surgery centers is not the operating room or the procedure. The biggest difference is economics. We will provide solutions for each and tune our offerings to each and so the answer is yes. If that's where our customers want to send their patients, we will support them in those environments. And we do already.
Do you foresee Intuitive developing an ambulatory surgery center-specific robotic platform?
Guthart: The way I'd ask the question is, ‘Do you care about the ASC? Yes. ‘Have you worked on offerings for them?’ Yes. ‘Will you continue to change and improve those offerings?’ Yes.
What are your thoughts on fully automated surgical robots, and do you foresee a future where robotic-assisted procedures require minimal surgeon supervision or even full automation?
Guthart: That’s a question I think is on a lot of people's minds these days, a next-level question. And the next-level question for me is when you get to Artificial General Intelligence (AGI), really thinking machines, how should we think about those thinking machines?
I think that we will go into that future together. There are some really interesting and promising things. My own experience, having been in the field for decades, has been that the early excitement gets tempered by validation. Before I got into surgical robots, I was working in aviation. I came out in math. I spent time in human factors at NASA, which was great.
We’ve known how to have autonomous flight for years. But every time we get onto a plane – they have very good autopilot systems – but we are very comforted by the two pilots. Not a lot of us would sign up to get in that plane with no pilots, even though the technology is quite mature.
I feel the same way about surgery. The analogy is quite strong. It will be a long time before you don't have a surgeon guiding, even if the technology is very good guiding that procedure. We should be building technologies that enable the person guiding this to be better and better.
At some point, those technologies should be quite sophisticated. Then there's an ethics question of what is the role of the surgeon when that has happened? It’s not for me to opine on that. I think that it comes down to our belief in safety systems and evaluation in third-party validation of these technologies. It will be asked, and it'll be answered through a question of scientific rigor in validation.
Where do you see the biggest challenges in interoperability in the surgical suite?
Guthart: I appreciate that question. Good data in health care has to be shared with people to get better results. There is no one organization that has all the data to make great progress. It's federated by nature. The electronic medical record is maintained by the hospital. We have machine data that comes up through our systems that wants to interact with that electronic medical record data. There's billing data that the insurance companies have. There's imaging data that is coming off the great work of our colleagues and friends at Siemens and Philips. Nobody has all of it, which is the drive for interoperability.
Interoperability, in our technical sense, really comes down to, what are the application programming interfaces? What are the definitions and the standards? What's the governance? What are the economic engines for how data is shared? And I think we're already well into those conversations at Intuitive.
We have data-sharing agreements with hundreds, probably almost a thousand, of our customers that allow us to exchange data from our side to theirs and theirs to ours. We have tight partnerships with our partners in the medtech space. All these devices now are smart devices, and they carry data. Cybersecurity and data privacy are key governance questions, and they should be.
A good data ecosystem allows us to find insights. We can find insights with electronic medical records, plus our data, plus images, that nobody can find with just the images, just the robot data or just the EMR. So that's why we need to share. If we share well, everybody benefits.
What would you like to see in terms of AI regulation?
Guthart: Smart regulation is important. It sets the boundaries and the rules for which we can all interact. The biggest thing for me is, keep it relatively simple and based on first principles. We operate in 71 countries. Harmonization for a multinational [company] is so important. We will respond and follow the law and regulations in Europe. If the US has different regulations, China has different regulations, and Japan has different regulations, it’s an extreme complexity inside a company like ours. And what does that complexity do? It increases costs. Harmonization, simplicity, adaptability. I think we're in the early phases of machine learning, AI. As a result, being an adaptive system, not a rigid system, is important, and then harmonization would be important.
