Original userfield deployment investment2022-06-02
As MicroPort Medical Robots prepares to return to the A-share Science and Technology Innovation Board, I would like to talk about my views and opinions on medical robots.
1. Minimally invasive medical robot
MicroPort Robot, as the head enterprise of innovative medical devices, will land on the Hong Kong stock market at the end of 2021, and in early 2022, it was approved to list the Tumai laparoscopic robot known as the domestic Da Vinci. However, in the bear market environment of Hong Kong stocks, it is still unavoidable that the stock price will fall sharply. Now the market value has almost returned to the 22.5 billion valuation level of the pre-IPO in August 2020.
2. Features of medical robot products
Doctor-beneficial products: Whether medical robots improve image quality, more precise positioning, and improve control stability, they are all pain points for doctors during surgery. In the manufacturer-doctor-patient disease treatment link, it is the doctor who directly faces the patient, not the manufacturer, so the doctor’s right to choose is very important. The medical robot directly benefits the doctor and the patient indirectly. The doctor can see the lesion more clearly, and perform the operation more accurately, reducing the possible mistakes in the operation, and the wound is small and the bleeding is less. It is a win-win product for all parties in the medical process. .
Consumables business model : DaVinci’s ten-fold increase in stock price in ten years, the main logic is the “tool holder-blade” consumables business model, which is typically “sell equipment, consumables to make money”, the DaVinci robot needs to be replaced after 10 uses Consumables, $2000 for a new robotic arm. Therefore, Da Vinci’s consumables revenue now accounts for the highest proportion of the overall revenue.
Advantages of medical robot products: In the era of medical robots, it can solve more problems. On the one hand, it is the stability and accuracy of surgery. Even the best trained doctors are not as accurate as robots. A good helper to reduce the intensity of the doctor’s surgery. On the other hand, surgical imaging has evolved to three-dimensional high-definition images, which are more realistic and clearer than two-dimensional images in the minimally invasive era.
2. The field of medical robotic surgery
Since the beginning of 2000, the Da Vinci robot has been approved by the FDA, and medical robots have expanded from endoscopic robots to the field. Surgical robots for other surgical procedures began to emerge rapidly in the 2010s, such as surgical robots for spine, joint replacement and pan-vascular surgery.
In the future, we will find that medical robots will appear in various operations that require precise positioning, high surgical stability, and are not easy to operate in traditional operations.
Endoscopic surgery robot. Laparoscopic surgical robots can perform a wide range of surgeries such as urology, gynecology, thoracic and general surgery. The endoscope allows the surgeon’s line of sight to extend into the patient’s body, while the robotic arm mimics his hands to hold and direct the endoscope and surgical instruments. The most famous is the Da Vinci endoscopic robot of Intuitive Surgery. In the future, the endoscopic surgical robot will also be the largest medical robot field in the market. Taking prostatectomy for prostate cancer during endoscopic surgery as an example, since the operation is performed in a very deep and narrow area, the peripheral nerves may be injured. The precise operation and high flexibility of medical robots are just suitable for this type of surgery. .
Orthopedic surgery robot . Orthopedic surgical robots are used to assist orthopedic surgeries such as joint replacement surgery and spine surgery. The first medical robot seen in the domestic capital market is Tianzhihang’s Tianji orthopaedic robot. Tianzhihang’s first-generation products are mainly for orthopedic trauma surgery such as fractures, and the minimally invasive orthopedic robot is more aimed at knee joint replacement. In fact, orthopedic surgery is also very suitable for the type of medical robots. After all, bones are hard organs, and precise positioning is required during surgery. In addition, orthopedic surgery relies on X-rays to see images. It is very obvious that doctors eat rays. High-definition imaging reduces radiation exposure.
Pan-vascular surgical robot . Pan-vascular surgical robots are used to treat diseases of the vascular system or organs related to the heart, brain or peripheral vascular system.
Robot for natural orifice surgery . The natural orifice surgical robot refers to a robot that delivers relevant surgical instruments through the natural orifice of the human body to the surgical area, and can control it for diagnosis or surgery.
Percutaneous surgical robot. Percutaneous surgical robots are used in percutaneous surgical procedures, which are primarily procedures for collecting tissue samples for diagnostic purposes, such as the detection of early-stage lung, breast, and prostate cancer.
3. Thinking: Big Surgical Robot Vs Orthopedic Robot
The major surgical robot can better solve all the problems encountered in surgery (tumor exposure, separation of adhesions, ligation of blood vessels, tumor resection, and anastomosis of organs and blood vessels). , the operation is more convenient.
Orthopedic surgical robots mainly plan the surgical path and accurately position them through image data, but they can only assist in key steps and cannot complete the entire surgical process (spine surgical robots mainly assist in the placement of pedicle screws and other screws, but for Spine exposure, decompression, fusion and other operations have no guiding role).
4. Review: Policy-driven orthopaedic surgery robot
In May 2017, the Ministry of Industry and Information Technology and the National Health and Medical Commission issued the “Notice on Organizing the Creation of an Orthopedic Surgery Robot Application Center”, and decided to organize the establishment of an orthopedic surgery robot application center. In principle, the creation period should not exceed two years. In November 2017, the Ministry of Industry and Information Technology and the National Health Commission issued the “Notice on Approving the Establishment of Orthopedic Surgery Robot Application Centers by 21 Leading Hospitals including Beijing Jishuitan Hospital”. In the actual promotion process of the application center, Tianzhihang was the only selected manufacturer. Most of the sales revenue of orthopedic surgery navigation and positioning robots comes from this policy support.
However, in November 2019, the policy of creating an orthopaedic surgery robot application center has expired, and the trend of Tianzhihang’s A shares has also verified the decline of business development after the policy driving force has weakened.
5. Policy is the core element
We took orthopedic robots as an example to illustrate the driving effect of policies on the product of medical robots. However, in order to develop medical robots in an all-round way, the state also needs full support from the state in terms of configuration planning and reimbursement policies.
Under the background that the country is still promoting medical popularization rather than medical upgrading, it may be promoted from medical insurance areas such as Beijing and Shanghai, which are more accepting of new technologies.
1) In October 2021, robot-assisted orthopedic surgery will be included in the Beijing Class A medical insurance payment catalog
2) In April 2021, artificial intelligence-assisted treatment technology, namely laparoscopic surgical robots, will be included in Shanghai Medical Insurance.
But at the same time, we also see that the country also wants to formulate policies at the national level to reduce the cost of medical robots.
In 2022, the “Guidelines on Improving the Prices and Related Policies of Orthopedic ‘Surgical Robots’ and ‘3D Printing’ and Other Auxiliary Operations (Draft for Comment)” will be released. The maximum proportion is not more than 40%. For core surgical procedures that cost more than 5,000 yuan per case, the additional charge will be capped at 2,000 yuan each time. If the surgical robot completes or participates in the completion of some surgical operations under the control of medical staff, the additional charge does not exceed 80%. “- This kind of price system is much lower than the current price. I don’t know whether the domestic medical robot will be reduced in price like PD-1 drugs in the future, and the final price will be much lower than similar foreign products.
6. Involution is the status quo
Laparoscopic robots such as Weigao Miaoshou and MicroPort Tumai have been approved for sale in China, and medical robot companies such as Yida Health and Jingfeng Medical are preparing for IPO in Hong Kong stocks. .
Each company emphasizes its own technical advantages, but in the eyes of doctors, all kinds of domestic endoscopic robots are Da Vinci robots that can learn a little like it, and the homogeneity of everyone is relatively serious.
And it is impossible for the same hospital to purchase multiple robots of the same type, so whoever has the first-mover advantage and who can iterate more quickly may stand out from many similar companies. In the next few years, the possible situation is that in different medical robot fields, a variety of products will emerge all at once, and competition is looming.
Summarize
The advantages of medical robots, such as improving the accuracy of surgery and reducing the learning curve of doctors, have become indispensable equipment in the future surgery field.
While medical robots are entering a period of rapid development, we also see that the country’s high-priced equipment planning and medical insurance prices are important boosters for the development of medical robots, and the R&D and listing of many medical robots will inevitably lead to a sales war, first-mover advantage+ Iteration speed can be the winning formula.
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