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ckostas

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  • Avago Technologies: A Long-Term Buy [View article]
    AVGO hit your prediction of 70$. Any future articles on AVGO that pertain to downside or upside opportunities?

    With iPhone 6 on the horizon what does that do for AVGO if its in the 6 or not?

    Thanks.
    May 27, 2014. 01:37 PM | Likes Like |Link to Comment
  • Intuitive Surgical - Don't Hesitate To Short [View article]
    Great regurgitation of available published information.
    Oct 20, 2013. 09:26 PM | 5 Likes Like |Link to Comment
  • Enough On Da Vinci: What About Growth? [View article]
    Sorry to hear about your friends father. However your information is inaccurate or incorrect.

    The da Vinci system is a slave to the surgeon. So it was in fact the surgeon who cut the artery you speak of. Which means your friends father had a crappy surgeon.

    But here, let me have a surgeon tell you............

    Crappy surgeons get crappy outcomes from surgery, whether they're performing procedures with a robot or with their own hands. Post-operative problems (including horrible deaths) happen all the time. That's the fault of the surgeon, NOT the robots. To err is human, to blame the robot is ridiculous. (and stupid)

    http://bit.ly/16dZDUD
    Apr 22, 2013. 07:38 PM | 1 Like Like |Link to Comment
  • Enough On Da Vinci: What About Growth? [View article]
    I would be interested in where you got your information on Procedures / system.

    That is not public information by the company. The company does not comment on procedural data per system.

    The company did sell 164 da Vinci systems in Q113. Half of those system sales were to existing customers. What does a repeat buyer tell you?
    Apr 22, 2013. 07:35 PM | Likes Like |Link to Comment
  • Intuitive Surgical Fighting Off Short Sellers [View article]
    The WSJ commenting on the JAMA article is misleading and leaves out numerous points of data. The author of this article, and many like him, also fail to understand the short comings and misleading data of the JAMA article.

    The study looks at the transition from open to MIS, the cost of robotics vs. other surgical modalities, and the ability for surgeons to offer laparoscopy to a broad base of patients. The paper concludes, “Between 2007 and 2010, the use of robotically assisted hysterectomy for benign gynecologic disorders increased substantially. Robotically assisted and laparoscopically assisted hysterectomy had similar morbidity profiles, but the use of robotic technology resulted in substantially more costs.”

    While the authors focus on the costs of robotic versus laparoscopic surgery, the paper presents data on all modalities, and confirms several very important points:
    • The JAMA article clearly outlines the growth of minimally invasive surgical approaches for the benign hysterectomy from 2007 thought the first quarter of 2010. **This is highly positive for patients.**
    • In all hospitals, the rate of abdominal hysterectomy declines and in those with a robotic surgery system, the rate declines much faster. Again, this is very positive for patients. However, in those hospitals without da Vinci Surgery, the rate of abdominal hysterectomies actually increases in the last few quarters of the time frame examined (2007 through Q1 of 2010). **This is not positive for patients.**
    • The JAMA paper states, “When cost is examined from a societal perspective, including postoperative recovery, robotic assisted hysterectomy is less costly than open but remains more costly than a laparoscopic procedure. Additionally, some studies suggest that adoption of robotically assisted hysterectomy actually reduces hospital costs as the rate of laparotomy declines.” Since the paper also shows an accelerated decrease in open hyst in hospitals who have a daVinci, **this is very positive not only for patients, but also for hospitals.**
    • The JAMA paper clearly shows accelerated adoption of MIS in hospitals that adopt daVinci for benign hysterectomy. The authors point out that "both laparoscopic and vaginal hysterectomy are already widely available and used for hysterectomy." While true, the authors fail to acknowledge that after 20+ years of laparoscopy and decades of vaginal surgery, the vast majority of patients still received a laparotomy in this country until the adoption of da Vinci for benign hysterectomy. It is not access that is the issue; rather, it is the non-reproducible nature of laparoscopic and vaginal hysterectomies that have resulted in this reality.
    • The JAMA authors omitted key data points which indicate that despite a more difficult surgical population, the daVinci cohort still experienced a significantly lower conversion rate than the laparoscopic cohort. It is this applicability across a broad range of patients which has allowed daVinci to materially impact the open hysterectomy rate.
    Apr 22, 2013. 07:24 PM | 1 Like Like |Link to Comment
  • Modeling Intuitive Surgical's Triple Revenue Stream [View article]
    The facts are Dr. Breeden's comments are NOT the view of ACOG. But his opinion. (He just happens to be president)

    The facts are Dr. Breeden is an owner and investor in a surgery center in Carson City, NV. (there is not a da Vinci system in his surgery center)

    The facts are he is not trained on the da Vinci system.

    The facts are numerous ACOG members sharply spoke out against Breeden:

    Minimally Invasive Surgeons Group Responds to ACOG President's View on Robotic Surgery

    “Today, we have sent Dr. Breeden a letter strongly protesting his remarks. We see a failure in ACOG’s ability to embrace the education of Minimally Invasive Surgery. Even at their peak, the combination of vaginal and laparoscopic approaches barely represented one-third of all benign hysterectomies performed, again despite their availability for decades. Robotic Surgery is an enabling technology that has transformed our ability to operate in a more efficient, controlled surgical field and master complex anatomical environments. It has allowed us to extend a level of quality surgical care to our patients that is exceptionally more diverse and complete than was ever possible with traditional methods of surgery.”

    http://bit.ly/15TxEtl
    Apr 22, 2013. 07:10 PM | Likes Like |Link to Comment
  • Modeling Intuitive Surgical's Triple Revenue Stream [View article]
    What is this cloud of uncertainty you speak of?

    And "flood if litigation"? Floods are what Noah built an ark for....

    Education and the facts are what investors need.....
    Apr 22, 2013. 07:05 PM | Likes Like |Link to Comment
  • Modeling Intuitive Surgical's Triple Revenue Stream [View article]
    A detailed review of Citron’s report reveals discrepancies between claims and their underlying source documentation. They cite an article in the Seattle Times, quoting “some surgeons and hospital officials say it's being overused, employed for procedures where it offers no advantage.” They did not cite this: “Lenihan and many other surgeons say the surgical robot, the da Vinci, gives them powerful new abilities in the operating room, shortens recovery time for their patients, and decreases their risk of complications." Seems quite damning when taken out of context.

    Elsewhere: "At Wentworth-Douglass, however, the robot has been used in several surgeries where injuries occurred. One patient was so badly injured that she required four more procedures to repair the damage."

    Several sentences further in the cited WSJ article: "There's no evidence to suggest the injuries at Wentworth-Douglass were caused by technical malfunctions. Surgeons who use the da Vinci regularly say the robot is technologically sound and an asset in the hands of well-trained doctors."

    This type of reporting by cintron is at best manipulation of the stock and should be investigated by the SEC.
    Apr 22, 2013. 06:59 PM | Likes Like |Link to Comment
  • Intuitive Surgical May Soon Face Headwinds Due To Non-Intuitive Data [View article]
    I am curious on anyone's opinion specifically tchap1 being a doc.

    ISRG is not training a surgeon to perform surgery, merely training them to use their equipment, the da Vinci system.

    If an MD or DO has completed med school and then their residency, and been given a license to practice and credentialed at their hospital to perform surgery, why should ISRG say no to a surgeon who wants to train on the technology?

    Does the responsibility not fall to the hospital whether to grant or deny that surgeon robotic privileges after the surgeon has completed the training process?

    Additionally for anyone that's ever been in sales, ISRG is no different than any other company. At the end of every month, QTR,and year there is enormous pressure to "make your number". Period.
    Mar 27, 2013. 01:37 PM | 1 Like Like |Link to Comment
  • Intuitive Surgical May Soon Face Headwinds Due To Non-Intuitive Data [View article]
    @tchap1

    Looks like your fellow Urologist don't agree. I'm going to guess you're not the director of a Urologic Oncology fellowship program or A Cheif of Urology.

    Crappy surgeons get crappy outcomes from surgery, whether they're performing procedures with a robot or with their own hands. Post-operative problems (including horrible deaths) happen all the time. That's the fault of the surgeon, not the robots. To err is human, to blame the robot is ridiculous.

    http://bit.ly/16e185i
    Mar 25, 2013. 10:22 PM | Likes Like |Link to Comment
  • Intuitive Surgical May Soon Face Headwinds Due To Non-Intuitive Data [View article]
    This may be the best article I've ever read.

    Crappy surgeons get crappy outcomes from surgery, whether they're performing procedures with a robot or with their own hands. Post-operative problems (including horrible deaths) happen all the time. That's the fault of the surgeon, not the robots. To err is human, to blame the robot is ridiculous.

    http://bit.ly/16dZDUD
    Mar 25, 2013. 10:03 PM | Likes Like |Link to Comment
  • Intuitive Surgical: The Perfect Time To Buy - A Doctor's Perspective [View article]
    And another doctor. I feel like more of these will continue to come out.

    Crappy surgeons get crappy outcomes from surgery, whether they're performing procedures with a robot or with their own hands.

    This Surgeon Isn't Falling Out of Love With Intuitive Surgical Or Its Robots

    From thestreet.com

    http://tinyurl.com/ceo...
    Mar 25, 2013. 09:03 PM | 1 Like Like |Link to Comment
  • Intuitive Surgical: Short-Term Turbulence, Long-Term Growth [View article]
    Defending Side:

    Crappy surgeons get crappy outcomes from surgery, whether they're performing procedures with a robot or with their own hands.

    This Surgeon Isn't Falling Out of Love With Intuitive Surgical Or Its Robots

    From thestreet.com

    http://tinyurl.com/ceo...
    Mar 25, 2013. 08:58 PM | 1 Like Like |Link to Comment
  • American Capital Agency Catalyst For Capital Appreciation [View article]
    Any thoughts to the number of shares that would be added to indices as this progresses?

    What percent of outstanding shares?
    Mar 25, 2013. 11:24 AM | 1 Like Like |Link to Comment
  • Intuitive Surgical: Short-Term Turbulence, Long-Term Growth [View article]
    1. As with any new technology there is certainly a learning curve. I'll agree to that. But as younger surgeons are trained on the system as part of their residency program, this learning curve will no doubt become a non-issue. Many Urologist and Gynecologist graduate residency with robotic hospital privileges. The FDA first approved its use in 2001 for URO and 2005 for GYN. That means there has been at least 6 generations of URO residents and 3 generations of GYN residents.

    2. There are over 600+ publications discussing robotics vs. Lap vs. Open vs. other modalities. I simply went to the companies website, instead of posting a bunch of links to illustrate the multitude of studies and outcomes.

    ISRG obviously highlight studies that are in favor of robotics, but do give the 30,000 foot view of why they are significant.

    http://bit.ly/105E4Aw

    3. I think time will tell whether the recommended changes in PSA testing were valid or not. In my opinion, and after speaking with a handful of Urologist, we will see a sharp rise in the number of men with untreatable prostate cancer. ie, surgery and non surgery treatments will not be available because the cancer will be so advanced (spread to other organs in the body) they have no options. They will have no options bc they failed to get regular PSA testing to see if their was any changes in their PSA.

    Lastly, there are about 80k prostate surgeries a year. 600k Hysterectomies, and 1.2 million gallbladders taken out. I think the companies focus is changing.
    Mar 24, 2013. 03:00 PM | 3 Likes Like |Link to Comment
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