Keynote: Transformative Pathways — Advancing Medtech in Europe | LSI Europe '25

Dirk Barten  0:05  
And thank you LSI for giving you the opportunity to speak about intuitive, transformative pathway over the last three decades, and today, I was asked to speak a bit more about the commercial angle of our business. So let's kick it off here just a few notes about my person. I'm a Medtech engineer. Started 30 years ago and working at the neurosurgical space in the cardiovascular space, and then the early 2000s I joined an organization called surely fiber optics, and in the first couple of days in this engagement, I was contacted by a small startup called Intuitive Surgical at the time, and they were asking, can you make an endoscope? Can you make us a light cable? And that is when my journey started with this organization. The first 15 years, managing a supplier and a partner for intuitive, and over the last 10 years, now working as a European Lead for intuitive directly on the upper right side, you see me proudly presenting DV five at SRS just a couple of weeks ago. So we launched this new product, our fifth generation robotic assisted surgical system, which of course, is defining our future going to the next couple of years, and in the middle here, and that is a picture I have chosen on purpose field, rights for us as an organization are very important. So I'm joined up here with a surgeon from Switzerland, Professor deeds, who is highly focused on hernia surgery with with Da Vinci systems, doing four to six cases a day. And these are the two dynamics we observe right now in our industry. On the one side, we define where the future is going to in terms of technology. On the other side, transformation is happening, replacing many laparoscopic procedures. So that is what I will speak about. But of course, here we are still at the beginning, and there are many barriers out there, and I just put a few buzz words here on that slide. If you think about if a patient is having his first symptoms for lung cancer, he has typically a one year journey until he gets a solid diagnostic one year. And of course, this has to be changed. Healthcare money is less and less. Waiting lines, specifically here in the UK, AI are still increasing. And of course, health workers are getting less and less. We think that with robotic assisted surgery, we can contribute a bit on optimizing that the good news is, when we influence outcomes, patient outcomes, all these parameters move in the right direction. And so we work on that journey since very long, with with a with a strong vision and mission in mind. And this statement has not changed over the last three decades. So we envision a future of care which is less invasive and profoundly better, where diseases are identified earlier, treated quickly, so that patient can get back home to what matters most to them. That is in our heart, and we speak about prioritization later on, that is a core statement which has actual impact in our daily organization. We are an organization with a lot of discipline with strong principles. And one of the principle is that everything we do and everything we we perform inside our organization, outside with customers, is aligned to the quintuple aim, namely, to drive better outcomes. Here as an example, to optimize length of stay, to reduce conversions, to reduce complication rates, to impact the patient experience, but also to impact the care team experience, of course, because those are the ones which apply the technology on the patients and everything should happen at a lower total cost of care. That was for decades the big discussion are our European healthcare systems able to to swallow that investments, but, but they can, and they can very well. So that is the fourth pillar, and the fifth one, and this is where we concentrate today on is, of course, giving more access to patients on those technologies. We are on the journey, as I said, over the last 30 years, many of you know, and there's a lot of competence out here already that we are now in our fifth product generation of multi port systems, starting at the late 90s, with the Da Vinci standard system, which made its journey here through Europe, first in the cardiovascular space. Then the first prostateectomies have been performed here, and this was the kickoff of our organization, and was driving the development over over the years. In the meantime, two years ago, we received the CE mark approval for the Da Vinci single port system. At the same time for the ion and aluminum cathyra based robotics. System, and just a couple of weeks ago, the Da Vinci five. So this is what happened in terms of product development over the last decades. But of course, a product is a product, and it requires more than just this. And we speak about our ecosystem here. We can go more in depth later on, but if you think of everything which is built around it. This really differentiates us and makes it valuable for our customers, namely, for example, the technology we provide, the instruments, the vision, technologies, the software, the applications which delivers the data and insights to take the right decisions. Then, if you take the stream of professional education, our work with the societies, training each surgeon on the proper use of this technology, and then all these resources which make sure that the investment of the hospitals are being used in a way that these programs are successful. May it be, operationally, economically, strategically, there are a lot of support resources ensuring that this will work out and everything happens with a very strong patient first mindset. Again, that is one of our additional principles. We have patient is always in focus, and we know that these products are used to save lives, and that requires a lot of trust into our organization, and we are here to deliver on that promise. And we have, over the last decades, around 17 million patients have been treated with Da Vinci platforms just in the last year, 2.7 million the ion system, just as a comparator. Here we are in the 200,000 procedure space, and just in the in the last year, nearly 1800 Da Vinci systems have been delivered to the market, adding up to nearly 11,000 of those working day to day, between two and three times in average. So these are numbers. What about evidence? Over years, we have been asked to deliver more evidence clinically at the beginning, then later. It was more economically in the meantime, and Da Vinci is probably one of the most studied med tech product out in our industry. 43,000 peer reviewed publications has been created on the proper use of that technology, because data are important. Just the last year, 4000 have been added. The question here again you might raise is, how solid is this evidence, and how high is the level of evidence? And here I just brought with me one of those impactful studies from the last year here, researchers have looked into those 43,000 peer reviewed publications, and they just pulled out those with high level of evidence. So I'm speaking about randomized control trials, prospective cohort studies and large database studies. These have been pulled out. These are about 230 of those 43,000 and these researchers looked into the following outcome measures, conversions, blood transfusions, complication rates, length of stay, mortality rates, re operations and the operative time on those procedures which are listed up here on that slide, and three cohorts have been compared, open robotics, Da Vinci procedures and laparoscopy or vets. And interesting is that here from Europe, a third of the high level of evidence studies were delivered from European researchers, 78 and by looking at the results, many of you might say it is not really surprising that against open surgery, this is why we came on the plate, there are high numbers of improvements. Look at blood transfusion, 75% less likely compared to open surgery. Length of stay in average, two days shorter, 30 day mortality rate, 46% less. Readmission rates lower, etc. That is not a surprise, even though the time of the surgery might be a bit longer. But if you look at these numbers compared to laparoscopy or vets, that is a surprise, still, conversion rates went down by 56% 10% less likely of complications. Again, another half day length of stay, shorter and, and, and if you add these numbers up and do the calculation, what does that mean for for patients? It's interesting when you compare the 2.2 million patients treated robotically in 23 just take this number and put those evidence factors against it. It means that approximately 133,000, conversions to open surgery could be avoided by performing robotics. Surgical procedures. This is translatable in 260,000

Dirk Barten  10:06  
days in the hospital saved. And of course, the 100 at the 15,000 readmissions could have been avoided. And here, by looking at these numbers, we believe that we deliver on the promise. So that's a bit on the facts. Where we are today in terms of evidence. And of course, when we look at the adoption of these technologies going into into the global markets, we see that Da Vinci surgery has grown in the procedures we address. You can see those in the small prints. Here we are right now at 44% market adoption having overtaken open surgery already years ago and just last year even a laparoscopy. Question might be, what about Europe? We did the same analytics for Europe week. You can just zoom us five to seven years earlier in the adoption curve. But interesting wise, we follow exactly the same pattern here. So which is interesting. First of all, it's in front of us, this transformation. And secondly, it's predictable, so we know what we are doing. And this is probably one of the reasons why so many market entrants are coming to this market right now. So finishing on global data, few information about Europe here. This is our European map. You see here two colors. The light blue is where we still are distributing through distributors, so where we are not directly present. And many companies, when they start their early journey into the Medtech space, cannot invest in their own commercial organization. So these distributors are with us since many, many years, many decades, and they are highly respected and highly competent, and in the dark blue area is where we are right now, directly acting with our own commercial teams. And just this year, we found an agreement to to onboard one of the distributors working in Italy and Spain. So this picture is changing over the time. So that is investment in our markets. Another factor I wanted to call out is investment in infrastructure. You see these pink dots there? This is where we have facility locations, partially commercial centers, partially production sites. So we are producing all the Endoscopes, all the vision equipment already here in Europe, in Germany, as well as just recently announced in Bulgaria, and we produce more. And we know that we are living in a global, unpredictable environment. These are investments which help us to protect the fact that we are transforming healthcare. And these procedures go into standard of care. The blue dots here are commercial education center where we train surgeons in all these countries every day. So there are more than 20 of those right now. So that is a machine which is running every day to bring new surgeons on those systems. Again, also here from a European perspective, some numbers, two and a half million patients treated 1500 15,000 surgeons already being trained. 1800 Da Vinci systems running every day in Europe in average two to three cases, and just last year, around 400,000 procedures performed in those procedures I'm listing here. Still, you see urology as the dominant procedure here in Europe, but you see that the growth of visceral surgery so general surgery is steepest. Then there is gynae, then there is thoracic and more. If you add those up, they are even bigger than Urology. So the picture is changing. Interesting. On that picture is in our home market in the United States, these curves have happened sequentially more or less. Here it's all happening at the same time. This is this excitement we are currently experiencing here in Europe, as the mind has just shifted after the covid times, okay, coming to the end of numbers and where we are today. We are, as I said, currently managing through unpredictable global environments here in our social influenced healthcare systems. It is partly tougher to to to market and to sell than, for example, in the United States. Here, clinical economic data are key. We have to prove. We have to work with evidences as they are influencing our reimbursement structures. And of course, the question to have a proper infrastructure to enable the delivery of products every day is another thing we are currently heavily looking into. While we are here, we are working with many organizations together already. We want to reach out. To the broader Medtech space to continue to cooperate successfully. One of the question to us is always, how do you decide to bring other companies and other technologies on board? Here are a few principles. They should be aligned to our mission. They should support our quintuple aim, namely, mostly to drive patient outcomes that we are together clearly better and also economically better for all parties. This is just common sense. And over the last three years, together with many external players, we have focused on growing in general surgery. We have invested in lung cancer diagnostics with the ion system. We are growing everything besides urology right now, heavily. The introduction of SP was one of those key initiators. We have kicked off supply chain optimization I've mentioned already. And of course, everything related to big data and AI is currently heavily looked into. How do we approach and how do we cooperate and engage the relations with some of you which these are typically two teams. One is you can call them business development. These are organizations which have ready made technologies or products, we onboard relatively easy. But on the other side, we have the intuitive ventures organization which is investing in early startups, in early innovations. That is what we do in the business development side. Over the last couple of years, many companies, and I've listed here, a couple of those have been onboarded. I was personally one of them. You see this name surely on the upper left side. So we acquired this business Peck, which is now a key piece of our production here in Europe. You see kind heart, the organization with which we have received additional know how to create artificial organs and how to use them in our trainings, in touch health for our digital space, Orpheus as well, Nova deck helping us to optimize the fire flight technologies and and and all of these organizations either have, have handed over a part of their organization to us, or a product or a technology. It differs, but very successful onboardings over the time when we invest in earlier seed funding into startups here, the intuitive venture organization is is very active, and we have one of my colleagues here. I don't know if she is in the room. Murielle Thinard McLane, she will speak here tomorrow, going deeper into how we are doing this. But in principle, we are focusing on three areas on the left side, improving access to minimal invasive surgery and and the integration of those technologies in the middle one is precision diagnostics and interventions where we heavily look into it. And then, of course, everything related to big data enablement. And here you can see a few of those startups where we are currently investing around two, 50 million of assets. And of course, we are not alone in that space. At the lower level here, there are other companies, of course, investing in those organizations coming to an end. Here I gave you an insight on a little bit on our history, where we are right now in Europe. So our organic growth has been commercially driven strongly, and we have the chance now to speak in a couple of minutes about this commercial journey, but it has to be balanced out with everything we do strategically in terms of business development and venture funding. With this, I'm closing my my keynote this morning, happy to be on a discussion with you, and I'm asking Bryan Davis to come on stage with me here. Thank you.

Bryn Davies  18:59  
Hi. Good morning.

Dirk Barten  19:03  
Thank you. 

Bryn Davies  19:04  
Thank you Dirk, so much. And really insightful presentation and fascinating. And when we decided to do this together, where he spoke about commercialization, and what was I thrilled with Dirk being able to join us was the fact that we were going to talk about not just a great technology and all of the scale and the success that intuitive have had over this time and the impact on patients, but also, really importantly, commercialization, you know, having grown up in the med tech world for, you know, 10 years and then started to 10 years, I see a little frustration around going to market quite late, With your with the commercialization plan, or thinking about commercialization, quite late. So all we're going to do now for the next 20 minutes or so is talk about the commercialization. What are the practical steps the know how that you could take forward as entrepreneurs, as early stage companies, and principles that you can really think about to enable you to be able to scale your product? Right? So with that in mind, it'd be great to look under the hood a little bit more of 10 years of success in that growth. So, so thinking about that, what are the one of the steps that you take to convince an organization to, you know, spend $2 million on a robot. How would you do that, in terms of a sales process? And, yeah, commercial process,

Dirk Barten  20:18  
of course, and maybe it's, it's sometimes surprising to understand that, that there is a, there's a reason why a one or 2 million device is, at the end, cheaper than a one time use Scalpel. And that is sometimes a shocking discussion, but that is what it's about. We have to prove the value of what we do. We have to? We have to prove that the added value is, at the end, saving the healthcare system a lot of money, and of course, it's good for the patients. And if you are able to do that, we know we name this process, quantify the impact, if you can quantify the impact of your technology well, with the use of evidence, with the use of other means we can speak about then this discussion is obviously pretty successfully being done, and that is, I would say, one of the key pillars of our commercial success, being under control of our data and being able to speak about it.

Bryn Davies  21:18  
And with that in mind, and thinking about some companies who are going to struggle to have that data, struggle to have that health economic argument when you begin, especially if it's in the new sector. So how would you, or what did you do early on, 10 years ago, in this complex, heterogeneous market of Europe, to try and think about that discipline or that sales process, and how early Would you go in terms of applying that principle for

Dirk Barten  21:42  
device, yeah, just speaking about evidence not available. Indeed. Also 10 years ago, there was not too much going on in Europe, specifically economic evidence was not there. But typically also hospitals, yes, they look at research, they look at clinical and economic studies, but at the end, they believe in their own data, and this is where we can kick in commercially. We are, we are training every commercial rep to be able to measure what the surgeon is doing in the or before integration and after. And that's not that difficult. You have to count, you have to speak with the people, you have to put it into a specific format, and then you compare to what happened afterwards. And very often, it's surprising to the surgeons how great they are doing. And by doing this exercise, this quantify the impact exercise, you are enabling them, first of all, to realize and to speak about it. And that is, that is key. And I would urge everybody to look deeply into those processes early on. Evidence is not needed. Evidence often is very expensive to be acquired. Studies are expensive, but this dialog with surgeons is not expensive. It's just a healthy way of interacting with them, and they appreciate it

Bryn Davies  22:59  
very, very much. Yeah, and I've seen, and I get contacted about, you know, from a clinical entrepreneur and an engineer that says, we've built this. We've invested it. We built it. Can we find an extrovert, chest beating sales person just to go sell it, please? And, yeah, normally that's quite late in the in the day where you're saying, well, like, I can't, you know, perform miracles. I can't do that. We need to think about how the product was built. So how do you engage with your R and D teams? Or how early do you sort of think about that commercialization standpoint for either a new product launch or or a first to market?

Dirk Barten  23:30  
Yeah, I think what I just spoke about was how we speak with customers in a very structured and efficient way, but in the same time, we use similar methods by going deep with our commercial teams. As you said, sometimes sales people, I consider myself as such as well, even though I'm an engineer, but everybody has to sell their vision and their and their products in our organizations. But sometimes these functions and roles are considered as artists and as people which know what they're doing, and they have good relations, and they have good networks, and this is how they can eloquently convince to sell their systems. But that is probably not enough to place a disruptive innovation where you have to convince. And here, the increase of likelihood of success is a key tool to really make your business case real. And what I'm speaking about is many of the sales steps can be measured, and a sales rep has all kinds of opportunity. He can go to a surgeon A, or he can go to surgeon B the one who is shouting out loudest he wants to be trained, or the one who is maybe access and has a system in house which is not not heavily used, but is not as loud. So where do you go? So? And here, of course, clear guidance, very simple, dear sales rep, you first go to the surgeon who has access and has probably proceed. To potential. And then secondly, you go to this other one. And if you, if you do these logic steps in each of your commercial process, and put them all together in a good sequence, then you have a solid commercial organization. Sounds simple, but it requires a lot of data collection, a lot of process engagement and a lot of management to ensure that everybody is working in the same way.

Bryn Davies  25:26  
Yeah, yeah. I grew up in more on the orthopedic side of the business. It was very entrepreneurial. You know, you'd get your kid, you go out to the bike, and you'd spray and pray and hope someone to come through. So is that? Is that discipline of execution, that understanding of of of who is going to give you the best return, and having then worked on the startup side of things, I started thinking when what's, what's an early stage customer versus an ideal customer, and one of the challenges was the access, and you need to go quickly to get your first customer, even though you know that customer might not be ideal later on. So how have you found that transition from those early customers to ideal or when you're upgrading from a, you know, the third version, second version, first vision through to Da Vinci five. How do you how do you manage to work that is a similar process?

Dirk Barten  26:12  
Or, yeah, I think it's a, it's a similar process. You say the word upselling? Yes, of course, for us, going from one generation to the other. It is a great progress, because these surgeons, of course, they want to enjoy the latest innovation, which gives them additional value, but it typically comes with a price increase, or a premium, as we call it, and this premium has to be justified, and if you're not able to do that. It's hard. And of course, for every feature, for every new bit in our offering, we have to show that it makes sense, that it's, I'm coming back to the Queen to blame, that it is driving the better outcomes, that it's driving patient care team experience, and at the end, it's lowering total cost of care, even though there it might be price premium at the beginning, and if you master that, you can be successful. And the discipline at intuitive is really something which surprised me when I entered that organization, that there is a strong will and desire to follow those principles.

Bryn Davies  27:18  
Yeah, and I think that's would like to talk a little bit about competition and new entrance in the market, but it's it's really interesting where people have a perception of a of a great new product, and it'll sell itself when you go out, and obviously the discipline that you say. So what happens when you know competition comes in, and you know that we had Marc slack from CMA yesterday speak about a five millimeter instrument versus a seven and eight. And how have you found that in in more recent times, as the growth of that robotic market is, as we saw at SRS, it was just incredible the number of different robots and devices that are from all over the world. So how have you found that? How have you seen that today? Yeah, so

Dirk Barten  27:54  
same impression for me, for those which have been at SRS, great event, great show, and it was shocking to see all these robotic vendors out there now shocking, but positively shocking, because when you are more or less alone on that journey, it's hard to argue not that we have not competed at the time as well. Our competition was open surgery. Our competition was laparoscopy, and now other robotic players are coming into that space, and we are using the same kind of methods. We have to compare outcomes, we have to compare patients and surgeons experience, and we have to compare economics. And one factor I have not mentioned is that these investments have to be used every day, and they have to be up and running every day. I don't know if you have the word heard this number of 99.6% uptime guarantee we are giving with such a system. So what we say with that is, if you invest in such a technology, it has to run, it has to run every day. Seemingness, and this is stuff where we can call it the ecosystem, so everything which is around a product, and in my mind, that is where the real challenge is, because commercial competences, logistics, uptime, service organizations, all of the bits And pieces around make really such a program successful. And in my mind, speaking about other players coming on, we appreciate that a lot, because working in public tenders as a as a one off is always challenging, since these organizations and some big names are part of that, everything got more more interesting because there's no more discussion that these technologies make sense for patients and healthcare systems. Now it's about letting customers choose and decide and compare.

Bryn Davies  29:53  
It is it's an interesting one. When you're supposed to mark in a new category, you're trying to convince against. Apathy or history or a lack of understanding in that. So as there's more competition than the ecosystem, the ocean rises and everyone can do well, I think there's a there's a case around a vending machine of a Coke can. If there's one, you're deciding if I'm going to buy a drink or not, and if there's a coke and a Pepsi, I'm going to decide which drink I'm going to have. So everyone, everyone benefits in that way. And how do you work? You mentioned some of the partners as well, online, working with ion, maybe with Siemens, if I'm right. So what are the places where you could, you know, work with competition or work with those around you. Do you foresee more of that? In terms of coming forward?

Dirk Barten  30:35  
You mean joining up force? 

Bryn Davies  30:36  
Yes, yes. 

Dirk Barten  30:38  
So when we, for example, speak of the regulatory environment policymaker engagement here, we have great cooperations with other players in our soft tissue field, but also with robotic players in the orthopedic side or wherever, because at the end, it is about enabling our healthcare systems to really bring these opportunities earlier to our healthcare systems, because patients do benefit from them. And here sometimes our our healthcare spaces are a bit slow and out of certain reasons, but here we are cooperating a lot,

Bryn Davies  31:19  
yes indeed, and we'll open it up if people have questions momentarily. Please. Would love to do so. And but one of the ones thinking about that, you know, the complexity of the European market and the uncertainty in the world, and thinking about that sales or launch, and we've all got choices between UK, go to Europe or different markets. How? How? How do you see those different markets in terms of attractiveness to go to for a new technology. Do you see a difference between the sort of accessibility of those markets in terms of where you would go, or a differentiator you spoke about, obviously, bringing on board the Italian and Spanish distributor as well? So do you see sort of some growing quicker than others, or a change in sort of attitude that's addressing to innovation?

Dirk Barten  32:00  
I mean, when you look at our journey, we kicked our business off around 25 to 30 years in France, here in Europe, this is where, typically US companies are lending, probably because of Paris attractiveness or the nice people there. And of course, the size of the market. Second priority was then Germany, then followed by UK. I think it's all size and healthcare size driven. And then you make your tour from one region to the other. And we are still in that process, and there are still markets out there in the world which are not served. And yes, you can't do everything at once, so you go where the biggest opportunity is first.

Bryn Davies  32:43  
Yeah, it's, it's that discipline of focus, and we get the opportunity cost. You're always looking over and thinking, I could go, maybe I should go in that the grass is green. I'll go and try. And then you spread.

Dirk Barten  32:53  
And all these services I spoke about have to be set up in parallel. So it's not just sending a bunch of commercial people in the country, all the support functions need to be available. Otherwise it won't make sense. Yes, and so these are wise decision and it takes time.

Bryn Davies  33:09  
Yes, indeed, indeed. Thank you. If there's we've got some quick fire questions the next few minutes. But if there's questions from the audience that you'd like to ask, Dirk, we would happely Open it up. If there's any that come to mind? Any volunteers to go first? We have two on the side.

Audience Question  33:30  
Hi, Derek. Hey. My name is Mike White with HSBC innovation banking here in Levin, but I'm from the United States. I'm just curious how your commercial strategy is affected by the changes that are happening. The United States, with hospital systems have been struggling the last few years post covid. Years, post covid, hospital systems have been transitioning or fighting the competition of ASC is these ambulatory service centers, so they're scaling down in these lighter footprints. And you know, recognizing, you know, healthcare in the US kind of casts a shadow upon Europe and and strategies and decisions in Europe. How does that impact the way that you know intuitive has this incredible growth story, and you continue to grow and innovate. So I'm just curious how you think about that, yeah.

Dirk Barten  34:08  
Let me try to answer yes. So we typically follow, as you have seen, that curve, the path of our US friends, and it's really shocking how how equal it is. Just a couple of years later, you mentioned covid Clearly. After covid Here in Europe, the growth has kicked off heavily because the understanding why it's important to send patient home earlier was clear to everybody. Before that it has been seen as a as a nice, luxury moment to stay a bit longer in hospital after surgery. But since then, it's clear we have to send them out very fast. This is then overtaken. You mentioned the ACS in the United States, I think here in Europe. Same, same dynamic procedures, simple procedures, are pushed into ambulatory centers with the goal to save cost again. And so same thing is. Happening here. My answer to that is we have the biggest growth dynamic in those procedures, even though it's happening here as well. But the understanding is that compared to a average use of a Da Vinci system 10 years ago, which was two to three a week, today, we see two to three a day, and we have hospitals performing up to eight cases a day. And if you do the economics, it makes sense even in ambulatory centers. And then there's, of course, a portfolio of products. Probably you don't shoot with a DV five to a cholecystectomy first, but there are other choices. And so this is more an accelerator as a threat right now. That makes sense.

Bryn Davies  35:43  
Yeah, there's a question just next to

Audience Question 2  35:50  
her. Catherine from meadows, Derek, thank you. I was wondering about the AI use cases, because intuitive has been an extremely data forward and extremely big data company since forever, and specifically AI use cases. Now for for you, what are you looking at?

Dirk Barten  36:10  
Yeah, I mean, speaking about AI, we can probably speak forever, but we see that this way, that AI first needs a proper baseline on good data, and we have the beauty to collect data since more than 20 years. We sometimes call the Da Vinci's The first internet of things, because, at the time, the decision to connect all these devices to a central station to collect data with the intention to increase uptime. Was very wisely chosen because that enabled us to really measure and to improve the systems over time. Now we have all this data. Clinical information has been added, healthcare information has been added. Surgeon information is added. It's a complex environment, so a lot of data, and here, of course, AI can help a lot in prior to prioritizing the the advice to surgeons and healthcare systems, I would say that is a big piece of of the advice giving, also in managing our commercial teams, because also they have a huge amount of information, and it's hard for them to prioritize. So there's a lot going on in that space. But on the other side, of course, and that's probably where you are pointing on, the surgical space will benefit from from this information as well. So yeah, so both of those are heavily driven right now. Good.

Bryn Davies  37:38  
We're coming to the close that time just maybe put was one more.

Audience Question 3  37:43  
Thanks, Nila. I lead a pre clinical lab in Paris, and we actually got to work with intuitive in 9899 so it really goes way back on animals. My question regards so I see that the clinical benefit is very obvious, and I see how this definitely helped the the progression of your company to to where it is today. But I see a lot of other companies working robotics, and namely in Endovascular and my question is, what is your take now? I see that you can have partnerships, but what is your take on Endovascular robotics, where the benefit for me is mostly that of the of the physician, of not being exposed to X rays, I don't clearly see the benefit for patients. And so surely we can imagine that at one point it will be more precise. So we'll have, you know, AI driven catheters, etc, but at present, I don't really see the benefit for patients personally. I'd like to know what you think of that.

Dirk Barten  38:51  
Not sure if I'm the right one to answer that. But in the cardiovascular space, not necessarily the Endovascular but cardiovascular space, there is a relaunch of this technology right now. There was a ban, there was a an uplift of regulatory expectations years ago, which avoided the use of these systems in the cardiovascular space. Now this has been changed. We are going back into that market, because we see that there is great value in cardiovascular space in the Endovascular speaking more about flexible catheters, yes, we have developed the ion system, the ion platform, which is currently used in the lung space to to take, early on, biopsies, very efficiently. Eventually, this technology will will help going into that space more I cannot answer right now.

Bryn Davies  39:43  
Yeah. Thank you. Thank you Dirk. So we're just about to wrap up. But if there's Yeah, any final So, thank you. If there's any, any final messages, any one key skill or one thing to entrepreneurs out there that you would, you would urge them to do or think about doing, or any Yeah, final messages, yeah, maybe just.

Dirk Barten  40:00  
Just quick comment. And this is a discussion I very often have with startups. Me as a as more a technical thinker for my education, but in the course of my, of my journey in the business, I have always worked in the commercial space. Don't forget the commercial strategies to involve into your business cases early on, because in my mind, that is at least as important as the core product itself. If the commercial setup and the strategy is not set up, well, these ideas will will die.

Bryn Davies  40:33  
Thank you. Thank you very much for all the insights. Really appreciate it. Thank you.