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Robotics - Endourological Nephrolithiasis And Cardiac Ablation Brief Marketplace Overview

4Q, 2008

Accuracy, ease of use, and maneuverability are crucial elements for minimally invasive ureteroscopy and retrograde intrarenal surgery for patients with ureterolithiasis and nephrolithiasis.  Procedure duration extending to several hours, as well as a lower level of intrinsic instrumental specificity often results in sub-maximal outcomes in the sectioning of a sizeable nephrolith. 

External shock wave lithotripsy (ESWL) for stones up to 2 cm., requires minimal specialized skill on the part of the Urologist, entails significant organ trauma, at times requires general anesthesia, and is accompanied by predisposition to subsequent hypertension and diabetes.  Percutaneous nephrolithotripsy (PCNL) is highly invasive, requiring penetration of the kidney and surrounding tissues, with resultant increased morbidity, including bleeding, organ damage, and infection.

Competitors in remote control/robotic cardiac ablation, a parallel market space on a device design basis, offer various approaches to intervention.  Digital imaging remains a topic of discussion among clinicians, with minimal experiential evidence to date.  Stereotaxis’ Niobe, costing $2 – 3  MM after instrument purchase and facility shielding and reinforcement, offers some increment in procedural accuracy for cardiac ablation, although only partially documented in the literature.  While a low level skill set is said to be required for the cardiac patient, outcomes tend to improve and procedure times decrease with increasing experience and operator skill.  Restricted catheter compatibility is an issue.  Magnetecs will offer a technology similar to that of Stereotaxis, providing both competitors with the capability of entering the endourologic marketplace.

Corindus is projected to enter the marketplace in 2008 utilizing technology similar to Sensei, constituting a direct competitive threat.  
Future endourologic device engineering may encompass several alternative scope configuration strategies, including dedicated camera and light source, as well as additional components.  Various manufacturers compete in the ESWL, PCNL, and urologic scope markets, including Storz, ACMI, Olympus, Boston Scientific, Medtech, Medispec, and others. 

Initial purchase budgeting, accompanying warranties, and ongoing cost allocation parameters on the part of GPO’s, Medicare, HMO’s, and Medical Groups wield significant input as to product choice and eventual endourologic market share.  Urologist interest in performing the procedure in-house vs. outsourcing, need and availability for training, level of reimbursement, duration of preparation, procedure, and post-procedure tasks are each important determinant elements for market opportunity, commercial viability, projected share, and revenue generation potential.

Several partnering opportunities exist, defining potential targets and a dynamic landscape for industry competitors.

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