Has Ethicon used its reach in sutures to outsmart the other robotics companies?

AITA that DATA trojan horse

Now and again I see a post on Linked In and I think. Hmm that’s smart. Then I dig deeper as things don’t seem to be what they appear. I saw this company AITA do a small post in the corner of linked in… and as a former Ethicon employee I couldn’t help but feel that suture management was a massive unmet need in many hospitals.

I thought… “Finally someone may have brought a smart solution to an age old problem of suture management.”

But then I started to go down the rabbit hole and it wasn’t until I got to the bottom of their page that I saw it. Tucked away. Almost “hidden”

In fact it suddenly hit me when I looked at the branding - the style of the site - was someone trying to hide something? And then it hit me!!!

Tucked down right at the bottom of the page was this small text. Really small.

“© AITA Ethicon. All rights reserved.”

Whoa - hang on!!! I mean yes - it heavily features Ethicon sutures and with 80% plus market share in sutures in the USA (and the Lion’s share around the world). But when I suddenly realised what this is - it blew my mind. And then I dug deeper and saw that this system had been out for a fair while - but with little to no fanfare. It was "odd" to say the least.

AITA is basically an automatic suture and inventory management "robot" - or "system." It pulls custom suture bundles for surgeons according to their surgery cards. (Hold that thought !!)

It then acts like a vending machine - and prepares the sutures needed for that case in a nifty tray.

But it is clearly more than that with “smart shelves” that can handle way more than just sutures. In fact they can handle everything. Even robotic instruments if you please.

See it in action here

AITA is more than sutures

So what? It’s a suture management system by Ethicon?

I’m going to break this into two parts - as if you think that… you’ve most likely not seen what this “really is” and why sutures is a golden key to unlocking what it actually is.

On th face of it - for every case of open, lap and even robotic surgery at least a few sutures will be used. And in the USA it is almost likely that every single surgical case that happens will have an Ethicon suture (or rival suture) used in it.

This system builds the surgeon preference cards and dispenses the sutures. For the hospitals this suture management is a royal pain in the rump when done manually. It takes time and stock management... and then if the sutures are not used or churned properly there are returns and SLOB (slow inventory.) Millions of $$ can be wasted every year.

Hospitals waste a lot of sutures - and duplicate a lot of sutures. In fact I am sure that flows back to the supply chain to Ethicon. This is a very neat system for starting to bring inventory management to sutures in a modern way. Automated ordering - inventory turns, restocking and a lot more.

But keep this in mind - it is basically for every surgeon and every procedure - and that’s important... very important.

https://aitasmartstudio.com

So what we see here is the digitisation of suture management - and the expanded capability to use the system - when you add the smart shelves - to start to digitise the supply of a lot of important consumables. And now you know the operation - surgeon preference for any given procedure.

You got it yet?

And because Ethicon can uniquely do this for sutures - they are tapping into all of the surgical procedures. Becazsue sutures are one of the only supplied ubiquitous across all surgeries.

A great win for the hospitals and procurement - as it has auto replenishment - it has insights into inventory management. And now we start to see where this goes. Insights...

Control the insights - control the suggested products

The first genius thing about this system is that if you have say - competing sutures - in for some surgeons. Right there with the insights - you now have Trojan horse into direct competitive intelligence.

The insight can easily suggest “Hey why not replace these three Covidien codes with these two Ethicon codes - and that will rationalise the sutures in the OR - help with contracts and discounts. Reduce SKUs - simplify etc etc”

If you control every case, and get to generate the insights - you get to own the narrative. Genius in itself.

But now what if this goes to say - staplers - and you can suggest an Echelon for those outlying surgeons that are holding out on Covidien staplers or energy?

Woah - you can see in real time if you are losing an account by market share. You can see if the endocutter business is going to Medtronic. Or…. Or…. Or…

What if you see these things….

Endocutter cartridges are being swapped out for Sureform by Intuitive. You can see in real time the switch from Ethicon and lap procedures to Intuitive and robotic procedures. You can see that change in any account in real time and possibly react.

You can see in real time the preference cards that show a move from “Lap hernia” to “Robotic hernia.” And that is so powerful for any company. Especially one that is launching a robot.

So on the surface it helps suggest suture rationalisation which hopsitals need. But that is not what you are doing here in reality. Instead you are getting a global overview of prefernce .cards. And it is ONLY if you own global dominance in sutures can you have such a wide overview of all types of procedures. All procedures - like no one else.

AITA is about DATA - oh look a rhyme !!!!

Ethicon has not built a suture vending machine. They have built the ultimate surgical preference card insights machine - that could basically have oversight of every single procedure in every OR. In real time.

AITA massive data insights

Forget the really nice vending machine (and it is super nice). Look at the smart shelves... and then look at the data sheet system in the digital ecosystem.

The battle in the future for open - lap - robotic will not be just hardware - but it will also be the data. And what I see here is a genius move by Ethicon - hidden so far down on the page - and even in branding so far from Ethicon it sticks out.

If you happen to own one of the greatest franchises across all of surgery - sutures ! - How do you leverage that utter golden key to massive hospital insights. You use the suture management pain point to get hospitals to willingly give up some of the most valuable data in the industry.

You get to defend your sutures - and have a trojan horse into product suggestions - and see trends all in one.

You get an “eye in the sky” across all surgeries. And with some smart analysis you will start to also see some of the extra info that an Ottava or a Velys doesn’t collect about the operational side of the OR. But data that is valuable.

You start to get insights into competing products - order patterns - and changes in surgery. All under the guise of suture management. And only Ethicon has the suture reach to make this happen.

I’m often critical of how this suture business has been left to be a low innovation cash cow. Well I eat my hat - this is a technology leading approach to take a low tech product (well not really sutures are very high tech in what they are) and bring it into the future. The architecture of the vending systems, the cart dispensers, the smart shelves - and the connected management system is light years ahead of anyone else.

Talk about value adds for a customer to make them willing to give up that valuable data. Savings on sutures in terms of inventory - SLOB and nursing room efficiency are a massive pull for any hospital. Almost irristable.. And if it genuinely helps as a primary benefit - great.

But ohhhh - when you start to pull that rich data that no one else will have across so many procedures. You even dare to imagine pairing that up with Polyphonic (here). Well now you are starting to talk about unique - rich and diversified data sets that can be combined and acted upon.

Ottava could have insights into every robotic case

So as the US moves across to Intuitive and robotic surgery. AITA could potentially have all those insights flooding in via the surgeon preference card data. Which surgeons do which procedures when and with what products.

Imagine a sales force armed with those kind of case insights to be able to go and target their potential surgeons. Knowing what is still open - what is still lap - what is robotic. Where - how many and who. When they do it - how they do it.

Boom - that is market intelligence you just cannot buy. And no one else - not Intuitive nor Medtronic nor Stryker can get into this level of details. Because they don’t own the key - the sutures.

If it was me - I would be dropping these AITA systems in at an alarming rate to start to ensure I get enough critical mass of data ahead of the Ottava launch. I'd be encouraging ortho implant management to give me an edge with Velys. I would be pushing this to consolidate that suture stronghold - whilst maybe getting the best data set in the industry.

Is this why this product is hidden away in a dark corner of the internet with little to no Ethicon branding at all? With very little launch and fanfare.

Is this why they have made little to no noise about it as part of their digital armamentarium?

Is this their stealth weapon in the fight for the robotic space? The endo mechanical space? The suture space?

Bravo to the management - no one was watching this. A small piece of genius via a completely lateral approach. High tech to the low tech product where no one was watching.

I’ll be watching with attention as this system rolls out - now I’ve seen it !

These are just opinions of the author for educational puposes. All trademarks beong to their respective companies.