Medicaroid Corp.

上市23年，股价从2美元暴涨184倍至369美元的直觉外科，如今好似也遇到了“中年危机”。7月19日，直觉外科的股价一度拉高到每股358.07美元，市值达1261亿美元。但在7月20日发布第二季度财报后，其股价持续下跌，截至10月27日收盘，该股票已降至每股258.98美元，市值约为912亿美元。从7月19日至10月27日，直觉外科的市值已缩水约349亿美元（人民币2554亿元，11月1日汇率计）。直觉外科近期发布第三季度财报后，有媒体、证券投资咨询机构认为直觉外科实现超预期增长，但其股价却未见较大起色。坐拥独霸全球市场的达芬奇手术机器人，直觉外科的发展遇到瓶颈了吗？手术机器人行业出现了怎样的变动？直觉外科的最新财报揭示了怎样的趋势与变化？畅销20年的达芬奇手术机器人，卖不动了？10月19日，全球手术机器人龙头直觉外科发布2023年第三季度财报。财报显示：2023年第三季度营收17.4亿美元（约127亿元人民币），较去年同期的15.6亿美元增长12%。虽然数据向好，但隐忧已现。按业务划分，直觉外科的营收来源包含系统、耗材（仪器和配件）、服务三部分，即手术机器人+耗材+服务。在系统方面，2023年第三季度，直觉外科的手术机器人（系统）营收略有降低，为3.79 亿美元，低于2022年同期的4.26亿美元和2021年同期的4.15亿美元。不过，直觉外科在该季度安装了312台达芬奇手术机器人系统，高于2022年同期的305台。安装数高而营收低，是因为本报告期内安装的达芬奇手术机器人，有163台是通过租赁的方式安装，而2022年同期是113台为租赁模式安装。在2022年第三季度，以租赁方式安装的达芬奇手术机器人占总安装数的比例为37%，而在2023第三季度，这一比例达到52.2%。由此可见，本季度达芬奇手术机器人的装机量虽在增长，但其主要是租赁模式下的装机量增长，全款采购的装机量反而在减少。因此，直觉外科该季度在手术机器人板块的营收有所降低。雪上加霜的是，美国地区的医院目前面临较大的财务压力，且盈利能力下降。基于此，大部分医院已降低设备投资计划，收紧财务预算。同时，在宏观经济条件充满挑战的情况下，美国医院的财务预算将持续受到影响。直觉外科预计，医院的财务压力将影响其关于达芬奇手术机器人的采购计划，并限制达芬奇手术机器人的装机量增长。另外，各个市场的竞争加剧，将使直觉外科面临更大的定价压力。这也可能影响到达芬奇手术机器人的装机量增长情况。在耗材方面，2023年第三季度，直觉外科的仪器和配件业务营收10.7亿美元，同比增长23%。不过，上一季度，该细分业务营收达10.8亿美元。根据分析，仪器和配件业务的同比增长，主要受益于达芬奇手术机器人的安装数量和手术数量持续增长，以及定价的提高。截止2023年9月30日，直觉外科已累计安装8285台达芬奇手术机器人，较2022年第三季度末的7364台同比增长13%。尽管其中一部分装机为租赁模式，但这些达芬奇手术机器人的每一次开机使用都将为直觉外科贡献收入。另外，装机基数的持续增长，推动了达芬奇手术机器人的手术量不断增加。相较于2022年第三季度，今年第三季度的手术量同比增长19%，且增速与去年几乎持平。根据财报信息，去年同期的高增速是由于2021年第三季度受疫情影响，手术数量减少。今年的更高增速则来自于美国地区的普外科手术和妇科手术数量增长、美国以外市场的普外科手术和泌尿外科手术数量增长。其中，达芬奇手术机器人在日本、德国和英国的手术量增长强劲。作为直觉外科的大本营兼营收主要来源地，美国地区手术量的稳定增长在预料之内。但美国以外地区手术量的加速增长，意味着全球范围内越来越多的医生接受了达芬奇手术机器人相关的培训，并认可了达芬奇手术机器人的价值。更重要的是，达芬奇手术机器人的临床价值与经济价值正取得越来越多的全球性证据，并征服更多的临床医生与医疗支付单位。不过，手术量方面也有负面消息，“减肥神药”司美格鲁肽的爆火似乎影响到了达芬奇手术机器人。与前几个季度相比，达芬奇手术机器人在2023年第二季度和第三季度的减重手术量增速放缓。直觉外科表示：尚不清楚这种增长放缓是患者评估新药物疗法的暂时停顿，还是美国减肥手术的增长将在未来继续放缓。根据司美格鲁肽的临床数据及最新动态，我们预计达芬奇手术机器人的减重手术数量将持续降低。或许是早早预料到如今的情形，直觉外科选择了“系统+耗材+服务”的商业模式。目前，相比前些年，直觉外科的营收支柱已悄然发生变化，耗材（仪器和配件）已成为其最重要的收入来源，且该细分业务随着手术机器人安装数和手术量的增长将越来越突出。例如，直觉外科2023年第三季度耗材板块（仪器和配件）收入占总收入的61.5%，较去年同期的55.7%有一定增长。预计随着达芬奇手术机器人安装基数和手术量的增长，来自于耗材的营收占总收入的比例将越来越高。 装机量隐忧与竞争风险，直觉外科怎么破局？从财报里可以看到，直觉外科遇到麻烦了。随着美敦力、Medicaroid、Meerecompany、威高集团、微创机器人、精锋医疗、思睿哲、术锐等企业的腔镜手术机器人获批，直觉外科旗下的达芬奇手术机器人迅速从蓝海市场陷入红海竞争。不仅如此，直觉外科此前布局的经自然腔道手术机器人也遭遇了诸多企业的围堵，且直觉外科在该细分市场不具备明显的先发优势。在经自然腔道手术机器人市场，直觉外科不仅要面对强生、奥林巴斯等巨头的竞争，还需要应对堃博医疗、微创机器人、精锋医疗、普利医疗、巧捷力医疗机器人等企业的挑战。遭遇激烈竞争的直觉外科急需找到一条道路，以应对日益焦灼的手术机器人市场。根据手术机器人采购价格高、使用周期长、装机后不易更换等特点，直觉外科计划通过增加达芬奇手术机器人的装机量与手术量来提高营收增速，稳定市场份额。针对装机量，直觉外科通过租赁模式降低医院的采购门槛，加速提高达芬奇手术机器人在医院的装机量。根据财报，医疗机构交纳8万美元-19万美元/年的培训服务费用之后，就能通过租赁的方式得到达芬奇手术机器人。同时，直觉外科在财报中表示：租赁模式与销售整机的利润率几乎持平。在美国市场，达芬奇手术机器人的渗透率已达到较高水平。2019年，1000张床位以上的医院中，71%都已经安装使用了达芬奇手术机器人系统。这使得直觉外科在美国医院的整机销售变得更加困难。但是，全球其他地区的渗透率还处于极低水平。因此，直觉外科正通过多种策略和方式开辟新市场。例如，达芬奇SP单孔手术机器人在2018年获批FDA后，后续又在韩国、日本获批，并在获批后迅速开展商业化。同时，直觉外科计划将为达芬奇SP单孔手术机器人申请更多适应症，并计划在美国以外市场持续申报注册，以切入更多地区市场。财报显示，截至2023年9月30日，达芬奇SP单孔手术机器人已安装158台，并保持持续增长态势。这是因为该机器人在临床中取得的更好临床效果，且其获批了更多适应症。此外，直觉外科还通过成立合资公司的方式，快速打入各地市场。例如，直觉外科于2017年与中国领先的创新医药企业复星医药联合创立直观复星，由该合资公司负责达芬奇手术机器人在中国大陆的独家经销。 截止目前，直观复星生产的国产达芬奇Xi手术系统已获得国家药监局批准，预计达芬奇手术机器人将凭借“国产”身份加速在中国市场的中标和装机。在直觉外科的努力下，越来越多欧洲、亚洲等美国市场以外的大型医院开始采购、使用达芬奇手术机器人。配合租赁模式，达芬奇手术机器人依靠产品性能、口碑品牌等优势正进驻越来越多的医院。针对手术量，直觉外科在提升装机量的基础上，拓展达芬奇手术机器人的适应症，并培训更多医生，以提高开机率与手术量。具体来说，达芬奇手术机器人的适应症从最早的泌尿外科手术，逐渐拓展至妇科手术、普外科手术、部分经口手术。随着适应症扩展，其手术量也在持续增长。例如，美国越来越多的普外科手术、妇科手术开始通过达芬奇手术机器人完成，美国以外地区越来越多的泌尿外科手术也开始通过达芬奇手术机器人完成。在培训方面，直觉外科已布局20多年。从市场培育到行业发展，直觉外科的培训系统立下了汗马功劳。如今，这些接受过培训的医生将影响更多医生，使其青睐、认可达芬奇手术机器人；这些培训中心、培训基地将为更多医疗专业人士提供达芬奇手术机器人的学习和训练。此外，直觉外科还与大型医院、医学高校合作，推动更多医生、医学生学习和使用达芬奇手术机器人。通过上述举措，直觉外科有望凭借达芬奇手术机器人的临床优势、品牌优势、先发优势、资本优势在市场竞争中占据主动。在中国市场遇阻，依靠国产身份能逆转吗？从直觉外科各季度财报里可以看到，中国手术机器人企业越来越多的出现在其财报里。这也代表着中国手术机器人企业给其的竞争压力越来越大。尤其是2022年以来，诸多国产手术机器人获批，并启动商业化，彻底打破达芬奇手术机器人垄断市场的格局。而且，相比于达芬奇手术机器人，国产手术机器人具有产品满足临床需求、价格低、性价比高、国产身份等优势。例如，相较于2300万元一台的达芬奇手术机器人，精锋医疗、微创机器人等国产腔镜手术机器人的价格在1400万-1700万元。而思睿哲的腔镜手术机器人SR1000的出厂价格为350万元至900万元，在黑龙江中医药大学附属第一医院的中标价格为538万元，约是达芬奇手术机器人均价的1/4。除了价格优势，国产手术机器人还具有国产身份优势。此前，国家明确提出：国产药品和医疗器械能够满足要求的，政府采购项目原则上须采购国产产品，逐步提高公立医疗机构国产设备配置水平。这使得公立医院采购手术机器人设备时，更偏向国产手术机器人。诸多因素影响下，达芬奇手术机器人在中国市场的市占率明显降低。根据“一医械千里”统计的2023上半年手术机器人招投标数据，截止2023年6月，全国各级医院手术机器人招标公告46个，同比增长43%；中标公告39个，同比增长105%。其中，达芬奇手术机器人中标14台，继续统治腔镜手术机器人市场，但相比于2022上半年，其市占率有所降低。除了达芬奇手术机器人，国内的图迈、精锋、康多等国产腔镜手术机器人均已实现中标。另外，天智航在我国骨科手术机器人市场遥遥领先，占据明显先发优势。神经外科手术机器人领域，华科精准、柏惠维康、睿米等国产手术机器人实现批量装机。这两大细分领域，预计将是国产手术机器人的兄弟之争。总的来看，在众多国产手术机器人获批及启动商业化的背景下，直觉外科也不得不认真面对白热化市场竞争。第一，直觉外科让达芬奇手术机器人拥有国产身份。2023年6月，直觉外科与复星医药成立的合资公司直观复星，成功获批胸腹腔内窥镜手术控制系统，即国产的达芬奇Xi手术系统，应用于泌尿、妇科、普外、胸外及小儿外科。第二，直觉外科将生产与研发同时实现本土化。据悉，直观复星的总部及产业化基地也于2022年开工建设，准备研发生产达芬奇Xi手术系统、Ion形状感知支气管镜操作控制系统等医用手术机器人和相关零部件产品。2023年10月，首台国产达芬奇Xi手术系统正式下线，意味着达芬奇手术机器人实现国产化。据《政府采购进口产品管理办法》规定，进口产品是指通过中国海关报关验放进入中国境内且产自关境外的产品。外国械企品牌在国内生产的医疗设备也算国产，享受国产待遇。此前，已有跨国巨头产品通过该规定以国产身份中标。第三，合理合规开展医学培训。直觉外科财报显示，2023年7月我国开展的为期一年的医药领域腐败问题集中整治行动，影响了包括其在内的医疗器械公司在中国市场的招投标（招标过程变长）。在该行动影响下，2023年第三季度达芬奇手术机器人在中国市场的安装数减少。预计该行动将继续影响达芬奇手术机器人在第四季度的安装。对此，直觉外科选择以合理合规开展医学培训方式，推广达芬奇手术机器人。据悉，截止到2023年8月，达芬奇创新中心已为3000多名医生提供达芬奇手术机器人相关培训。同时，直观复星已与大型三甲教学医院深度开展机器人手术技能培训，先后成立了5家基础培训中心，7家学术培训中心。*封面图片来源：123rf近期推荐声明：动脉网所刊载内容之知识产权为动脉网及相关权利人专属所有或持有。未经许可，禁止进行转载、摘编、复制及建立镜像等任何使用。动脉网，未来医疗服务平台

Clinician-scientists from Japan and Singapore have set out to test the viability of robotic telesurgery as a treatment option. Last week, a surgical team from the National University Hospital (NUH), the flagship hospital of the National University Health System (NUHS) in Singapore, performed a gastrectomy remotely with Fujita Health University (FHU) in Japan . From a cockpit at the NUH Advanced Surgery Training Centre, the Singaporean surgeons orchestrated the procedure on a simulated stomach in a robotic operation room at FHU in Nagoya, Japan, over 3,107 miles away. Its conduct, which is a first between the two countries, was made possible through a surgical robotic system that is able to replicate the movements of the surgeons from Singapore, which were transmitted via a dedicated international fibre optic network. The FHU team made use of the hinotori surgical robotic system by medical robotics company Medicaroid, which is Japan's first approved and homegrown robotic-assisted surgery system. WHY IT MATTERS In a statement, the NUHS said the preclinical trial of remote surgery between NUH and FHU aims to evaluate, clarify, and address potential issues arising from such a procedure. "Some of the challenges and potential issues arising from telesurgeries include a transmission delay across the network, patient safety, ethical and medical legal aspects, as well as, the various regulatory clearances needed from related authorities," Professor Jimmy So, head and senior consultant of General Surgery at the NUH Department of Surgery, explained to Healthcare IT News . According to a 2022 review of robotic surgeries, a maximum delay of about 300 milliseconds is still acceptable for the safe conduct of robotic surgery. It is said that the delay can be further reduced with 5G internet and asynchronous transfer mode (ATM) fibres. Initial findings from the NUH-FHU trial found about a 100-millisecond delay in the robot's movement, although surgeons were able to adapt to the lag, Professor Ichiro Uyama, co-lead of the FHU surgical team, said in a news report . "The time lag arising from the trial was minimal and within the acceptable industry benchmarks," Prof So also noted. The trial also set out to prove that long-distance telesurgeries can be safely done leveraging a robotic system connected by high-speed fibre optic communication. "The trial proceeded smoothly with safe outcomes and proved that such robotic telesurgeries across borders and large distances are indeed feasible," Prof So said. Also through the trial, the research teams see the potential of remote surgeries becoming a more accessible option for patients in the near future. Cost easily comes on top of mind when considering the implementation of robotics in surgery. A single robotic surgical system can cost around $1.3 million while the cost per procedure ranges between $3,000-$5,000. Despite this, its perceived benefits, including prevention of unnecessary postoperative deaths and disability and protection from personal and social losses from dealing with surgical complications, can potentially "outweigh the high up-front setup, training, and maintenance costs of robotics programs," especially for low-middle income nations, argued a recent article published in the American Medical Association Journal of Ethics. Prof So hopes that with improved accessibility of surgical robotic systems and an enhanced telecommunications network, the cost of doing telesurgery will go down in the future. Other potential benefits of remote telesurgery per Prof So include: enhanced global access to specialised care; reduced travel and wait times for patients; minimised health risks during emergencies and pandemics ; training and collaboration among medical professionals worldwide; and contribution to surgical expertise for complex cases. THE LARGER CONTEXT The execution of remote surgical experiments is part of ongoing activities agreed upon in a memorandum of understanding between FHU and the National University of Singapore Yong Loo Lin School of Medicine (NUS Medicine) that was signed in August. The NUH is the principal teaching hospital for NUS Medicine. The first recorded transnational robotic operation was done in 2001 between France and the United States. An uncomplicated cholecystectomy was performed on a patient in Strasbourg by remote surgeons in New York City. An ATM fibre optic network with a bandwidth of 10 megabits per second facilitated the transmission of movements from a console in the US to the robotic arms in France.

New York, May 12, 2021 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Surgical Robots Market by Product & Service, Application, End User - Analysis and Global Forecasts to 2026" - Growth in this market is primarily driven by the advantages of robotic-assisted surgery, technological advancements in surgical robots, the increasing adoption of surgical robots, and the increase in funding for medical robot research. On the other hand, the high cost of robotic systems is a key factor limiting market growth in the coming years.Recurring purchase of instruments and accessories for robotic systems leads to the largest sharee of this segment in market.Based on product & service, the surgical robots market is segmented into robotic systems, instruments & accessories, and services. The instruments & accessories segment commanded the largest share of 53.8% of the market in 2020. This segment is also expected to grow at the highest CAGR of 18.2% during the forecast period. The large share and high growth rate of this segment are mainly driven by the recurrent purchase of instruments & accessories instead of robotic systems, which are a one-time investment.Hospitals account for the highest share in the marketBased on end users, the market is segmented into hospitals and ambulatory surgery centers. Hospitals commanded the largest share of 85.5% of the market in 2020. The high demand for surgical robots in hospitals is primarily driven by the higher budgets of hospitals as compared to ASCs since robotic systems are high-cost equipment.Improved funding for R&D in surgical robots led to the largest market size of the North American regionNorth America dominated the surgical robots market, with a share of 63.6% in 2019, while the Asia Pacific region is expected to register the highest CAGR of 18.5% during the forecast period. The large share of the North American market can be attributed to the availability of funding for R&D in surgical robots in this region and the increasing adoption of surgical robots for pediatric surgeries in Canada and general surgery procedures in the US.Breakdown of supply-side primary interviews: • By Company Type: Tier 1 – 58%, Tier 2 – 21%, and Tier 3 – 21% • By Designation: C-level – 25%, Director-level – 35%, and Others – 40% • By Region: North America - 30%, Europe – 20%, APAC –35%, Rest of the World –15%Some of the prominent players operating in the Surgical robots market are Intuitive Surgical (US), Stryker Corporation (US), Medtronic (Ireland), Smith & Nephew (UK), Zimmer Biomet (US), Asensus Surgical (Transenterix) (US), Corindus Vascular Robotics (US), Renishaw (UK), Auris Health (US), Medrobotics Corporation (US), Think Surgical (US), Verb Surgical (US), OMNIlife Science (US), CMR Surgical (US), Preceyes BV (Netherlands), China National Scientific Instruments And Materials Corporation (CSIMC) (China), Microsure (Netherlands), Titan Medical (Canada), avateramedicalGmbh (Germany) and Medicaroid Corporation (Japan).Research CoverageThis report studies the Surgical robotsmarket based on products and services, application, end user and region.The report also studies factors (such as drivers, restraints, opportunities, and challenges) affecting market growth.It analyzes the opportunities and challenges in the market and provides details of the competitive landscape for market leaders. Furthermore, the report analyzes micro markets with respect to their individual growth trends and forecasts the revenue of the market segments with respect to four main regions and respective countries.Key Benefits of Buying the ReportThis report focuses on various levels of analysis—industry trends, market share of top players, and company profiles, which together form basic views and analyze the competitive landscape, and high-growth regions and their drivers, restraints, challenges, and opportunities. The report will help both established firms as well as new entrants/smaller firms to gauge the pulse of the market and garner greater market shares.Read the full report: ReportlinkerReportLinker is an award-winning market research solution. Reportlinker finds and organizes the latest industry data so you get all the market research you need - instantly, in one place.__________________________