Cost Comparisons Draw Different Conclusions in Review of Robotic-Assisted, Laparoscopic and Open Surgery for Hysterectomy

Cost Comparisons Draw Different Conclusions in Review of Robotic-Assisted,
Laparoscopic and Open Surgery for Hysterectomy

SUNNYVALE, Calif., April 29, 2014 (GLOBE NEWSWIRE) -- Two new studies featured
in the May 2014 issue of Obstetrics & Gynecology studied the costs associated
with minimally invasive robotic-assisted hysterectomy, and compared them with
the costs of other surgical methods. Although the studies shared similar
objectives, they analyzed different data sets and came to different

One study (Wright, et al) found robotic-assisted hysterectomy to be more
costly than laparoscopic hysterectomy, which is a traditional minimally
invasive method. Unlike Wright, the other study (Leitao, et al) also included
an open surgery group for comparison. Leitao found robotic-assisted
hysterectomy to be less expensive than open hysterectomy, but more expensive
than laparoscopic hysterectomy if the costs of acquiring the robotic system
are included. However, Leitao noted that the added cost of robotics could be
neutralized if its usage replaces more costly open surgery. Leitao observed an
overall average savings of $1,666 per case at his institution, Memorial
Sloan-Kettering Cancer Center, excluding the cost of acquiring the robotic
system, and an average savings of $418 when it was included. The authors
attributed the savings to a 63% decline in open surgery rates from 2007 to

The Wright study analyzed data from the Premier Perspective database, which
collects data from multiple institutions. This study included 169,324 women
who had minimally invasive hysterectomies for non-cancerous conditions. It
also looked at 10,906 women who had a minimally invasive hysterectomy for
endometrial cancer. The Wright study cost data reflect a range of accounting
methods, which makes them difficult to compare accurately. The study did not
include detailed clinical outcomes data to compare complication rates. It also
did not include an open surgery group. Therefore, the study could not assess
the effect of robotic-assisted surgery adoption on the rates of open

The Leitao study analyzed data from Memorial Sloan-Kettering Cancer Center. It
evaluated the direct costs of 132 laparoscopic hysterectomies, 262
robotic-assisted hysterectomies and 42 open hysterectomies for newly diagnosed
uterine cancers. The study included a detailed breakdown of costs for each
surgical approach. It used data based on actual costs, providing a more
accurate picture than using billed or estimated costs. The study also included
data from up to six months after patients were discharged. This means the cost
of complications, re-admissions and re-operations related to the initial
surgery were largely included.

"When performing a full economic review comparing surgical approaches to
evaluate the cost-effectiveness of each approach, it is important to consider
clinical outcomes," said Myriam Curet, MD, Senior Vice President and Chief
Medical Officer at Intuitive Surgical. "Without this context, one could
conclude that an approach that is actually associated with expensive
complications is least costly."

Since the introduction of robotic-assisted gynecologic surgery in 2005, the
number of open hysterectomies performed for women with both non-cancerous and
cancerous conditions has decreased dramatically. This decrease has been in
direct proportion to the increase in robotic-assisted procedures. Laparoscopy
has also continued to grow in numbers. These trends strongly indicate that
minimally invasive surgery is replacing open surgery. As of 2013,
approximately 33 percent of hysterectomies for non-cancerous conditions and 76
percent of cancer-related hysterectomies were performed using minimally
invasive robotic-assisted surgery.

Neither Leitao nor Wright conducted randomized, controlled studies. Leitao
notes that another potential limitation of their analysis was that they did
not fully account for possible differences in the patients' disease and
overall health, which could have had an impact on outcomes given the small
number of open surgeries.

The study authors disclosed the following financial interests: Dr. Leitao is a
surgical proctor and consultant for Intuitive Surgical. Dr. Jewell is a
speaker for Covidien and Intuitive Surgical. Drs. Wright and Hershman are
recipients of grants and Dr. Tergas is the recipient of a fellowship from the
National Cancer Institute.

About Intuitive Surgical, Inc.

Intuitive Surgical, Inc.(Nasdaq:ISRG), headquartered inSunnyvale, Calif., is
the global leader in robotic-assisted, minimally invasive surgery.Intuitive
Surgicaldevelops, manufactures and markets thedaVinci^®Surgical
System.Intuitive Surgical'smission is to extend the benefits of minimally
invasive surgery to those patients who can and should benefit from it.

About thedaVinci^Surgical System

ThedaVinciSurgical System is a surgical platform designed to enable complex
surgery using a minimally invasive approach. ThedaVinciSurgical System
consists of an ergonomic surgeon console or consoles, a patient-side cart with
three or four interactive arms, a high-performance vision system and
proprietaryEndoWrist^®instruments. Powered by state-of-the-art technology,
thedaVinciSurgical System is designed to scale, filter and seamlessly
translate the surgeon's hand movements into the more precise movements of
theEndoWristinstruments. The net result is an intuitive interface with
improved surgical capabilities. By providing surgeons with superior
visualization, enhanced dexterity, greater precision and ergonomic comfort,
thedaVinciSurgical System makes it possible for skilled surgeons to perform
more minimally invasive procedures involving complex dissection or
reconstruction. Potential benefits are specific to the procedure as well as
the model da Vinci System referenced in the footnoted publications. For more
information about clinical evidence related todaVinciSurgery, please

Surgical Risks

All surgery presents risk, including da Vinci® Surgery and other minimally
invasive procedures. Serious complications may occur in any surgery, up to and
including death. Examples of serious or life-threatening complications, which
may require prolonged or unexpected hospitalization, include injury to tissues
and/or organs, bleeding, infection and/or internal scarring that can cause
long-lasting dysfunction and/or pain. Risks of surgery also include the
potential for equipment failure and/or human error. Results, including
cosmetic results, may vary.

Risks specific to minimally invasive surgery, including da Vinci Surgery,
include temporary pain and/or nerve injury associated with positioning;
temporary pain and/or discomfort from the presence of air or gas; a longer
operation and time under anesthesia and conversion to another technique. If
your surgeon needs to convert the surgery to another technique, this could
result in a longer operative time, additional time under anesthesia,
additional or larger incisions and/or increased complications.

Patients who bleed easily, who have abnormal blood clotting, are pregnant or
morbidly obese may not be candidates for minimally invasive surgery, including
da Vinci Surgery. Patients should talk to their doctor about his/her surgical
experience and to decide if da Vinci Surgery is right for them. Patients and
physicians should review all available information on non-surgical and
surgical options in order to make an informed decision. For important safety
information, including surgical risks and indications and contraindications
for use, please also refer to

Forward-Looking Statement

This press release contains forward-looking statements within the meaning of
the Private Securities Litigation Reform Act of 1995. These forward-looking
statements are necessarily estimates reflecting the best judgment of our
management and involve a number of risks and uncertainties that could cause
actual results to differ materially from those suggested by the
forward-looking statements. These forward-looking statements should,
therefore, be considered in light of various important factors, including
those under the heading "Risk Factors" in our annual report on Form 10-K for
the year ended December 31, 2013, as updated from time to time by our
quarterly reports on Form 10-Q and our other filings with the Securities and
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"could," "should," "would," "targeted" and similar words and expressions are
intended to identify forward-looking statements. You are cautioned not to
place undue reliance on these forward-looking statements, which speak only as
of the date of this press release. We undertake no obligation to publicly
update or release any revisions to these forward-looking statements, except as
required by law.

CONTACT: Intuitive Surgical Corporate Communications
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