From Local Insights to Global Impact: Advancing Medtech in Asia Pacific | LSI Asia '25

Glenn Vavoso  0:05  
First of all, I want to thank LSI Scott and team for the invitation to to be here. Super delighted for anyone that is visiting from outside Singapore. Welcome to my adopted home here. I hope you're getting a chance to experience Singapore, if you haven't been here before getting out and about. Hopefully today, I could provide some insight to the early startup, early innovators that we have in the audience. It's hard to believe, but 30 years ago, Intuitive Surgical was sitting where you're sitting in terms of early innovation and trying to figure out how robotic assisted surgery would be adopted around the world. So I could provide some insights, and I'll give you a little bit of flavor of how our businesses developed in Asian and perhaps there's some insights there as well. Just to introduce myself, Glenn vivoso, president of Asia Pacific for intuitive. I am in my 20th year at intuitive, and this picture is a way back picture of some sometime in 2006 and I was getting to my first couple months to show off the Da Vinci S, which was second generation. So I've had a chance to support all of our platforms, even since the early Da Vinci system, and have watched the growth and the scale. And it's pleasure to be with you today. You know what gets us excited at intuitive? You know? Why do we get up and do what we do every day? It's really about solving some of the most challenging healthcare problems that we have. And even for intuitive when we look at our product set and what we have been able to accomplish over the last 30 years, there is still dramatic room that can be made in outcomes, even for robotic, assisted surgical procedures. But let's look at three examples. And I think you can take dozens of these types of examples all across the body. But if you look at lung cancer and how well is this diagnosed, from the time that it could be diagnosed with current technology to the time that it's actually diagnosed definitively, is over one year, and we know how important that is in lung cancer, the earlier the diagnosis, the better the five year survivability. About women with endometriosis, they're dealing with pain and symptoms for longer than five years before they get a definitive diagnosis of what's going on, and even the treatment pathway for endometriosis after that is uncertain and even longer, then you have mitral valve repair, 7% mortality. If you look around the globe, there are about 1000 mitral valve repair procedures every day. So that means for 70 people today, they will not make it the full year post their mitral valve repair. And so this is what motivates us. No matter what the past has brought we look forward to trying to solve these larger problems. This is our vision. It's been with us for nearly 30 years now. I won't read it, but what we get after is, can we, with technology, identify disease sooner than it is under the current standards, and can it be treated definitively and early so that patients can get better to what matters most to them, their families and their everyday lives. This vision for us is powered and aligned with what our customers are feeling and thinking and what they're trying to execute on. You may have seen this before. It's the quintuple aim. It's defined, really, for hospital and surgeon or physician operators, what are they trying to solve for? Of course, it starts with improved clinical outcomes. You have to have a product that is truly trying to change the current standard of care. And then, can you enhance the patient experience? Can they recover more quickly? Can they be out of the hospital sooner? And can they avoid an unnecessary conversion, in the case of a. Minimally invasive surgery. How about for the care team experience? You know, every healthcare system is having challenges with staff burnout. How can you make it a better experience for the care team and the surgeon and of course, then lowering the total cost to treat for the patient episode that they're in. And then the fifth pillar of the quintuple aim is, how do you expand best technology access to the broadest base of patients? So we've been at it for 30 years. As I said, you can see the affection that we call it the Da Vinci standard, all the way to the left through Da Vinci five, which is recently launched in the United States and now Korea. But Xi was a platform that really set the bar and the standard for multi port robotic surgery. We now have Da Vinci single port, which is a new, innovative way for surgeons to access the body. Think about different approaches, and relatively early in its adoption, but we think this will be a game changer for many surgeries and patient conditions. We have the ion platform, which is a catheter based robotic platform that can do peripheral lung nodule diagnosis. Getting after that, can we be more successful at treating or diagnosing patients with lung cancer so they can get to that definitive treatment sooner and then Da Vinci five coming to the market. Just some stats for these platforms. In the Da Vinci systems, multi port and single port, 2.7 million patients treated just last year since the first commercialization of the product, 17 million patients now have been treated with Da Vinci technology. And while I on is early in its market introduction, just last year, 95,000 people were successfully diagnosed with this platform. 180,000 since the platform was launched. So you can see there's quite an acceleration with that capability, there are now over 10,000 Da Vinci and ion systems placed throughout the world.

Glenn Vavoso  7:33  
Here's a point I'd like to make just when you think of perhaps, how do you think about integrating with intuitive, if there's an interest there in collaboration, I think of it in terms of the ecosystem that is around the Da Vinci and I on platforms for for us at intuitive, in partnership with our customers, it's become clear that it goes well beyond the platform. Now, to be successful, you have to have this ecosystem that, frankly, it's what the customers are requiring of us, but it's a great opportunity for early startups to where they want to integrate or collaborate with the Da Vinci ecosystem. It's advanced technology. These are vision systems, smart instrumentation, software. How do we think about data and insights, informing the program that has to be powered by a world class Professional Education capability, and you got to be able to do that at scale. And then, how does the hospital manage their program to optimize that program most efficiently and delivering the outcomes that are expected? And can you deliver on that promise as you think about bringing your products to market? And I think the commercial infrastructure panel kind of got to this. In that panel, it was a discussion about, you need clinical validation, and it's great if you can get your product peer reviewed and get that published. When we look at Da Vinci, I think it may be one of the most well studied medical device technologies in history, there are 43,000 peer reviewed journal articles that review the efficacy of robotic assisted surgery, 4000 just last year. And I'll say the majority of those 4000 publications last year happened here in Asia. I want to take one of those publications, and it's a recent one was published in the Annals of surgery at the end of last year, and just give you a sense first about the journey and how long it takes for the market for hospital operators. Process for physicians to really evaluate the efficacy of the product, something you want to consider as you're thinking about introducing your technology. So this one publication was a meta analysis that looked at the highest levels of evidence across that 43,000, publications, 230 publications, and it was a cohort, set of nearly 4 million patients, 1.2 million patients in the robotic assisted surgery cohort, another million patients who had undergone laparoscopic procedures, and 1.6 million patients who underwent open surgery. And the in the study looked at these outcomes you see on the right. It covered 12 years of data, 22 countries across these seven cancer procedures, hysterectomy, prostatectomy, partial nephrectomy. Right, colectomy, lower anterior resection and lobectomy. And these are the results. Now, most would say, hey, we get how robotics can help reduce open surgery, well established, but even against laparoscopy, these were the results across six of those outcomes against laparoscopy, lower conversions to open a reduction in blood transfusions, lower complications, lower mortality, readmissions. Only one was comparable to laparoscopy, that was 30 day re operations and one robotic assisted surgery was longer in time by about 18 minutes compared to laparoscopy. So you think about your products, and you go, Okay, what will it take for me to identify and establish the clinical foundation. This is a representative example, at least, for robotic assisted surgery. The panel earlier this morning also talked about, especially in Asia, this is absolutely true. If you enter most the Asia markets are socialized healthcare, and the government wants to know, okay, I get the clinical outcomes. Tell me what is the economic value that you're going to bring to the healthcare system. And so if you take that data that I just showed you, and that study was called the compare study, so I take that compare study, and if I just look at 2023 there was about 2.2 million patients were treated with Da Vinci. And let's say, for example, that robotics did not exist for those patients and they had to have laparoscopy. Taking those probabilities from the compare study and applying it to this it would mean for those patients undergoing laparoscopic surgery one point or 134,000 of them would have had a conversion to open, which then starts a cascade of effect. 270,000 nearly 270,000 excess hospital days, where you're eating up resources, costing the health care system more because of those conversions, excess hospital days, and we would have even seen a readmission rate of 16,000 of those patients having to get readmitted to the hospital within that 30 day period. This is what can then transfer into the economic value, either to the hospitals or the healthcare system at large. And I'll give you an example. This is a US setup, and it shows for the representative procedures along the bottom, where does a robotic assistant surgery compare to laparoscopy or open surgery? Just last year, that robotic assistant surgery line passed laparoscopy because the clinical and economic data was there to drive that conversion of surgery. Now, early days still in Asia, but we think Asia will be on a very similar trajectory. So let's talk about intuitive in Asia, Pacific specifically, and again, in the in the panel this morning, there was a lot of discussion about, how do you go to market? What's your commercial capability. How do you think about doing that? And I think there are a number of different ways to commercialize and go to market. This was our journey for the first 10 or 12 years or so of commercialization for intuitive for Da Vinci in Asia. And intuitive did not represent our products directly. We were growing. It was the early days. How do you still start to go to market with your product? Doing it a cost effective way, knowing we had a focus in US, in Europe, Asia was set up as a distribution region. So all of the countries throughout Asia were country level distributors. So over time, it started in 2012 South Korea moved from a distribution to a direct organization. We understood at the time, Japan being second largest medical device market that we needed to be close to the customer. And in 2013 Japan became a direct organization, followed by India, Taiwan in 2018 and then in 2019 China into A into our joint venture, which, by the way, it's a different way to go to market, and we did that in China. In 2016 we established a joint venture with fosin pharma, who's actually in the room with us today, who's been an outstanding, excellent partner for navigating China as a market for Intuitive Surgical been a great partnership, but that was in a distributor setup before and that moved into our joint venture. So today, the markets that we are representing our products directly today you see in the dark blue here and the rest of Asia is actually managed by a long term partner who's also in the room device technologies, who has been on this journey with us for over 20 years. They know as much about robotic surgery and Da Vinci as we do, and it's been a great partnership with them. So over two decades of growth now, these are the numbers of where we stand. 1700 systems throughout Asia. Just last year, nearly 400,000 patients were treated with Da Vinci technology.

Glenn Vavoso  17:12  
For those that are working in different quadrants of the body, just to give you a sense of how procedures are being adopted in Asia, from head and neck all the way through pelvic surgery and gynecology and Urology. You can see urology is the top predominant, but every other specialty is growing and inflecting, which is a little bit different than the way the US adopted, which was, I would say, more sequential. But with that data you saw with publications like The compare study, we're seeing simultaneous adoption across multiple specialties in Asia now, in an unpredictable environment, global environment that we're in in this is especially true in Asia that as you're coming to market, you have many stakeholders that you have to engage. In our case, surgical societies, regulators, government, policy makers. Key aspects that you have to be ready for are clinical and economic data. As I said, many are in a model of socialized healthcare reimbursed directly from the government. If you want your products fairly reimbursed, you need to do the work and work with those government stakeholders and even shape policy over time. And for us, I would describe where we're at as an industrial scale our customers expect that, as we are very much a part of their operation, that we can supply our products when they want them, and that they're reliable 100% of the time. So we think deeply about our supply chain continuity as we go. How about the broader med tech ecosystem that you all represent and how we think about the opportunity. First of all, just in my discussions and conversations today, you know what you are all doing is outstanding. It's inspirational, and I encourage you to stay on that journey. And if there is areas that you think we could be better together, we should have a conversation. But how do we think about it? Is it aligned with our mission, our vision and our mission and our focus on the Quadruple Aim is what you're doing in combination with us? Could we really substantially affect the quant the quintuple aim, are we clearly better in combination? Should be a part of that evaluation. And of course, is there a path to healthy economics for us, for customers and special. For healthcare across Asia, where our areas of focus, because this is where we can align well, in partnership. For us, it's the move into general surgery clearly happened in the last few years. In the US, we will see this move happen. It's starting to happen throughout Asia. We've started four or five years ago, a move into the lung cancer diagnosis, because we looked at that and said, the standard of care is unacceptable. That was the motivation behind the ion platform, and that will continue to grow as a platform in Asia and Europe. It was growing beyond urology, and we started to make that move, as I showed you, in the the adoption of those other specialties. And SP is a new platform for narrow access, single port extraction surgery that will take us into other parts of the body that we may not be in today, as I said, we focus very carefully and in sternly on the supply chain optimization, and we're thinking deeply about AI applications, machine learning capability in our robotic assisted surgery platforms. Give you a sense of companies in the last 15 years that have become part of the intuitive family. As you look at these sets, I think you can see these were particularly supportive of the ecosystem, around the plan, around the platforms that we have, and then our intuitive, intuitive Ventures is really focused on three areas, improving access and integration, precision, diagnostics and ultimately interventions, and then Big Data enablement. And how can we do that to inform programs and inform outcomes so we can make improvement and do better than we are today. For us, it's always a balance between how much is organic or inorganic innovation, but we're always ready to sit down and have a conversation and listen to that. So with that setting the stage, I'd like to invite Scott Pantel up and let's have a conversation. Thank you.

Scott Pantel  22:20  
Thank you, Glenn. So we are just so everybody knows the format. Here you can get your questions locked and loaded. We're going to have a chat for a couple couple minutes here, and then we'll open it up to Q and A great to get it started. Intuitive has had quite a journey, and you have had quite a journey. And I think one of the things that a lot of people like to know a little bit is about the people that are behind the companies and the build outs. And so I have to read this because you had quite a quite a background. So University of Buffalo, seven years as a US Navy nuclear submarine officer, we're going to come back to that Duke MBA, 10 years of Boston Scientific, and as he just shared, 20 years at intuitive and now running the APAC division. So the the high level question, how did you how did you end up in Medtech? How did you get here?

Glenn Vavoso  23:17  
Yeah, it's a, it's a long, Shaggy Dog tail. But in many ways, I got lucky. A friend of mine, actually, from my navy days, got into med tech, selling pacemakers and defibrillators and, well, we call it Boston Scientific. It was really guidance, if anybody knows the company, guidance. It was back in 1996 97 time frame, which was, you know, an interesting story unto itself. I spent 10 years at guidance, but a friend of mine had joined that company, and I was at an aerospace company coming out of the Navy, and he was convincing me that, hey, this med tech was the place to be and, and at the time I was at that aerospace company, we're working on strategy, where the company I was at was getting really excited about two and 3% year on year growth rates for the the aerospace business. And I was looking at that, made the made the choice to jump into Medtech. And, you know, have not looked back and been a great journey. 

Scott Pantel  24:26  
Tell us any, because I know it's been an easy ride the entire way, right? We all, we all look in and we see intuitive and what they're doing, we know is a just a smooth journey along the way. And I say that obviously joking. We had a conversation about it at the table. And there are the good days, there are the rough days. Any any defining moments along the way? Or maybe you thought about leaving the industry, or defining moments where you said, I have to stay?

Glenn Vavoso  24:57  
Well, I think there are many. I. There's sort of many defining moments along the way. I'll almost never forget my first month coming to intuitive. And it was in the US field based roles as a sales manager, and somebody at the time told me, Hey, we're at about 25% adoption of Da Vinci in prostatectomy, and they said, in three years, we're going to be at 75% and I was like, No way. Now, you know, I can't, can't go that fast. And sure enough, three years later, it was at 75% and didn't have the experience set to have ever gone through that kind of growth before. But when you go through that kind of scale, and we've done it a number of times now, it's it's not one sort of moment in time per se, but it's what you have to do in each of those scale moments. And for us, it was urology first, then it was gynecology, then it was general surgery, and each one of those adoption curves brought us into a new phase of scale. And while I think maybe an outsider's point of view might see, hey, what we're doing at intuitive it may look easy. I think sometimes where that, where that duck on the water looks, look, look smooth, but underneath, there's a ton of work activity that goes on for you to be ready for those scale increases. And I would say overall, that has been a challenge, but it was also the opportunity for us talk,

Scott Pantel  26:42  
talk a little bit about how you became the basically became the a pack guy. Was it? This was our big strategy put in place? Was it something that just was incremental? Or how did you end up here?

Glenn Vavoso  26:54  
Yeah, this is true about our DNA. We say this a lot, small steps quickly. You know it's yes, you want to have the end in mind. But how are you going to get there? Is really small steps quickly, and try to be excellent at each one of those steps. So I wouldn't say that was a, you know, this grand strategy for a pack at the time. And if I roll the clock back to 2013 I was doing a commercial operations role as I, as I think I said earlier, we were taking markets direct. Japan was the next market we were taking direct. We had a distributor in place. None of the employees were going to come over in that, in that transfer. And so it was like, hey, we need help establishing a commercial presence in Japan. How do we build that? We understood how to do it well in Europe and US. How are you going to build this team, kind of from scratch? So I started to get involved just helping to build it, hire a new team. And, you know, subsequently, subsequently did that with places markets like India and Taiwan, and then got involved in China and just sort of over time, and as we build it, then had an opportunity to run that business. When

Scott Pantel  28:06  
you look at the business in terms of size and growth, how does the, how does the APAC business compare to, say, US and Europe, growth size,

Glenn Vavoso  28:17  
if you, if you look at those 10,000 systems are out there. So, you know, lots of different measures of relative size. We have over 1700 systems throughout our Asian markets. So that gives you a sense of relativeness compared to the 10,000 worldwide. You know, penetration, or contribution to the organization from Asia is around 15% but on a percent growth basis, it is the region that is growing the fastest, for sure. And for those that have worked in Asia for some time, half the world's population lives in Asia. It is where the future for intuitive is for sure. Let's

Scott Pantel  29:00  
talk about those 10,000 units. You've had conversation we had earlier. You've had, you know, maybe new, new colleagues join the organization. And, you know, you know, Hey, did I miss the run? Are we going to flatten out? How far can it go? Did they come in at the wrong time? Is it stalling out? Where's the growth?

Glenn Vavoso  29:20  
Yeah, we were talking their growth. We were talking this at lunch. I, you know, often as we hire new, new folks into the organization, one of the questions early in in their career is, Hey, did I miss the boat? Did that, you know, the early days of intuitive, the high growth, and I truly believe this, that our next 10 years will be way greater than the last 30. I mean, that's for sure. You know, if you and this is maybe the wrong crowd to do this kind of mental gymnastics on really back of the envelope. Matt. Yeah, but if you just said soft, how much soft tissue surgery is performed that is applicable to Da Vinci, and you put it on 7 billion population, and there's lots of de crediting factors, healthcare access is not equal across all of that. But if you just said, over the long haul, all of that sort of soft tissue surgery can can gain value from robotic surgery. You know, you're talking a couple 100,000 Da Vinci platforms, or robotic assisted surgery platforms that would need to be in the world to treat those patients that need surgery. And And

Scott Pantel  30:38  
speaking of growth, and on one of your last slides, and you touched on this, you talked about the balance between organic and inorganic, and you made an invitation to this, this audience of largely innovators and investors that are trying to build you should expect a couple people pinging you after the after that invitation. But practically speaking, what does it mean to a group like this when intuitive thinks about some of those growth opportunities, how should we be thinking here?

Glenn Vavoso  31:06  
Yeah, I we're not a company that thinks that, hey, the best ideas are are within the four walls of intuitive. You know, we we have lots of different sort of ears to the ground on what is going on. As I said, we're willing to sit down have conversations where there is joint value that addresses the quintuple aim that you're really trying to either double the things that we're doing or having the bad things that are still out there. That's where our interests lie. I think Gary said this in Southern California, is that when we acquire an organization, if super high retention rate, 97% of those employees retain and it's because they come into that mission and have the ability to fulfill their innovation dreams, even within Intuitive Surgical. Think that's how you can think about

Scott Pantel  32:04  
that. And one of the other things that Gary and I talked about, which you and I had a chat about, as well as, and it's, it's important to us as a as an organization, I think, as an industry, is attracting outside talent, and one of the ways that we can do that is by having great technology and innovation. So let's fast forward three to five years. We're at this meeting. What are some technologies that excite you that we might be talking about in three to five years, just broadly?

Glenn Vavoso  32:31  
Well, I can say AI, right? I don't know how many organizations in the room are working on AI, but whether it's machine learning or AI capabilities in our space. You know, thinking about just surgery for a moment. You know, since the early days of surgery, it's been a disconnected environment, very hard to get it the right data. If you compared surgery to a manufacturing line. On the manufacturing line all kinds of innovations. They're all all kinds of KPIs that could be measured. You could do your TQM and say, Hey, I got to fix this process yet to try to get that at. Surgery was really, really difficult. Rbocist surgery platform at the center of that allows you to collect that data, to assess that data in a way that could be fed back to the surgeon and the care teams in a real time fashion, whether that's machine learning or AI technologies. So we think about that as this virtuous loop. You have data, but can you gain insight from that data, and then how, in a very real time way, feed that back so you're that much better in the next procedure or a hospital operator, program operator, can gain insight how to be more efficient with their program in very real Time, to me, that is a fulfillment of a lot of people's dreams of what this could be.

Scott Pantel  34:06  
We're running short on time already, so we're gonna go, we're gonna go to Q and A, and while, I don't know if there's a mic out there, while we're getting the mic up, I'm gonna I this is one I have to ask while they're queuing up. Seven years nuclear submarine off any, things you learned on the nuclear submarine that have transitioned over into Medtech?

Glenn Vavoso  34:27  
I would say, you know, calm in the face of adversity. Yeah, you know, in there's lots of things that can go haywire in a submarine, and when it does, you can't freak out. You have to just work the problem. And I would say that is true, especially in today's geopolitical environment. I think this was also said in one of the earlier panels, you know, you have to keep your head about you and stick to your strategy. Be ready to pivot, but remain calm and committed to to your mission, where you're headed. You.

Scott Pantel  35:00  
All right, let's, let's rapid fire. 

Audience Question  35:02  
Can everybody hear me? Yep, hi, Glenn. My name is Omar Khatib, and the host of state of med tech, and also have a go to market agency. So changing surgeon behavior is very important. Something that was very interesting is that when it came to single port, Korea was the first to have approval for single port. And I believe, to date, the single port utilization is almost equivalent to multi port, which shows that the adoption was really good. There. My question to you is, Were there certain learnings that you saw that the Korean surgeons developed, whether it's like technique or certain ways they use a procedure that is influencing the rest of how you think of your strange strategy in Asia, right? And then, how does that influence your business in China? Because China is your second largest market and also your fastest growing so how do those things play into part when it comes to changing behavior and driving adoption?

Glenn Vavoso  35:56  
Yeah, Korea number one. And many of you may know this, but Korea, Korea surgeons are on the technology curve. They want to be out there. And multi port for us over the years has been well adopted in in Korea. But interestingly enough, Korean surgeons are maybe some of the best laparoscopic surgeons there are in the world. And if you sit down with a Korean surgeon, you ask, Hey, why are you so well? Adopted with multi port robotic surgery with Da Vinci, the first thing they would say is, I'm a great laparoscopic surgeon, by the way. That would be their opening line. I think in Korea, what they saw with single port is that for them, that was the big leap, that was the real improvement for them relative to what they were doing with laparoscopy. And they are very good at laparoscopy, so they saw this as you know, a one port surgery, and capable of doing things that they just cannot do as a laparoscopic surgeon, I think, I think that when we we have SP launched in China, I think it'll be somewhat of a similar dynamic. You know, laparoscopy in China pretty well adopted. There will be many that are you know might still look at multi port and go, Hey, how is that going to improve my practice? How is it going to improve patient outcomes? But SP will give me something I cannot do as a laparoscopic surgeon,

Scott Pantel  37:34  
we will. Let's thank Glenn here for his time, and hope you guys enjoyed the session. I know I did, and have a great rest of your afternoon. Thank you, Glen. 

Glenn Vavoso  37:44  
Thank you.