CompetitorsNarrow moat

Intuitive Surgical (ISRG) — moat facet

Twenty-five years without a serious rival, and then two arrived in eight months — plus one that is a drug.

For a quarter of a century Intuitive had no comparable competitor in American soft-tissue surgery. That ended twice inside eight months.

Twenty-five years, then eight monthsda Vincicleared 2000No largerival to 2025Hugo clearedDec 2025OttavaauthorisedJul 2026ASP $1.50Mto $1.60MFourteen competitors are named in the 10-K; two of them are among the largest device makers on earth.
Neither rival has taken share, and neither had to. What changed is that a hospital can now ask for a second quote.

On 3 December 2025 the FDA cleared Medtronic's Hugo system for urologic procedures — making Medtronic, in the trade press's phrase, "the first large medtech company to introduce a robotic system for soft tissue surgery in the U.S. since Intuitive's arrival more than two decades ago"1. On 22 July 2026 Johnson & Johnson received De Novo authorisation for Ottava, cleared for a list of general-surgery procedures including gastric bypass, gastrectomy, cholecystectomy, small bowel resection and hiatal hernia repair, and described as the world's first table-integrated soft-tissue robotic system2.

Neither has placed a meaningful number of machines and neither will displace much volume soon, for the reasons set out under the moat: clearances are per-procedure and per-country, evidence takes years, and surgeons are trained one console at a time. But the structure of the market has changed. A hospital building a robotics programme now has a choice, and a hospital that already has one has an alternative to mention in a negotiation.

The 10-K names fourteen competitors in total3, and the other twelve fall into two groups. Eight are Chinese or Asian and are dealt with under the China threat rather than here, because their significance is a policy question rather than a commercial one. The rest are niche or single-market players.

The two rivals that matter most, though, are not on the list at all.

The first is laparoscopy — the incumbent minimally-invasive technique, cheap, universal, and good enough in exactly the high-volume categories where Intuitive's growth now comes from. Intuitive concedes the point in its own filing.

The second is a drug. United States da Vinci bariatric procedures declined in the high single digits in 20254, and management attributes the pressure to GLP-1 obesity medicines5. That is a competitor that does not need an operating room, a surgeon or a clearance — it removes the patient.

Average selling price is what tests this facet, approximately $1.60 million in 2025 against $1.50 million in 20246. Rising means nobody is competing on price yet. A sustained fall would be the first hard evidence that twenty-five years of pricing freedom has ended.

Moat trajectory: Narrowing

Twenty-five years without a serious rival, then Hugo cleared in December 2025 and Ottava took a De Novo in July 2026. Neither has taken share, and neither had to: the fact that a hospital can now ask for a second quote is itself the change.

The number that tests this moat
Reported
Da Vinci systems placed, latest quarter
468 in Q2 2026, against 395

Neither rival has taken share yet, and placements are where they would take it first. Fewer placements while procedures keep growing would show hospitals buying a second robot from somebody else.

Source: Intuitive Surgical Q2 2026 results release ↗
Dig deeper
DIG DEEPER 01
Medtronic: The First Rival in Twenty-Five Years
Hugo's clearance did not take share; it ended the conversation in which Intuitive did not have to quote a price.
DIG DEEPER 02
Johnson & Johnson: The Rival That Already Sells the Instruments
Intuitive spent a decade moving onto Ethicon's ground, and Ethicon's owner has now moved onto Intuitive's.
DIG DEEPER 03
Laparoscopy: The Competitor Intuitive Concedes To
The rival that needs no capital, no training and no clearance — and that Intuitive's own filing admits it may not displace.
DIG DEEPER 04
The Drug That Removes the Operation
A GLP-1 competitor does not take the case to another hospital; it removes the case.
References
  1. Reportedsince Intuitive's arrival more than two decades ago".
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 1 Business: competition, intellectual property and government regulation (the fourteen named competitors, more than 5,600 patents in force and 2,500 pending, Class II devices cleared under section 510(k) on substantial equivalence, special controls, field actions and recalls) — FY2025 · publ. February 3, 2026 · source ↗
  2. ReportedOn 22 July 2026 Johnson & Johnson received De Novo authorisation for Ottava, cleared for a list of general-surgery procedures including gastric bypass, gastrectomy, cholecystectomy, small bowel resection and hiatal hernia repair, and...
    MedTech Dive, 'J&J gets FDA authorization for Ottava robot, teeing up competition with Intuitive' - De Novo authorization for multiple general-surgery procedures granted about six months after submission, on a system with four arms integrated into the operating table — July 2026 · publ. July 22, 2026 · source ↗
  3. ReportedThe 10-K names fourteen competitors in total, and the other twelve fall into two groups.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 1 Business: competition, intellectual property and government regulation (the fourteen named competitors, more than 5,600 patents in force and 2,500 pending, Class II devices cleared under section 510(k) on substantial equivalence, special controls, field actions and recalls) — FY2025 · publ. February 3, 2026 · source ↗
  4. ReportedUnited States da Vinci bariatric procedures declined in the high single digits in 2025, and management attributes the pressure to GLP-1 obesity medicines.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 7 MD&A, business and operating highlights (3,153,000 da Vinci procedures up 18%, 1,721 placements, an installed base of 11,106, utilisation up about 3%, 870 da Vinci 5 placements, Ion procedures and placements, procedures by region and category, and revenue denominated in foreign currencies) — FY2025 · publ. February 3, 2026 · source ↗
  5. ReportedUnited States da Vinci bariatric procedures declined in the high single digits in 2025, and management attributes the pressure to GLP-1 obesity medicines.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 7 MD&A, business and operating highlights (3,153,000 da Vinci procedures up 18%, 1,721 placements, an installed base of 11,106, utilisation up about 3%, 870 da Vinci 5 placements, Ion procedures and placements, procedures by region and category, and revenue denominated in foreign currencies) — FY2025 · publ. February 3, 2026 · source ↗
  6. ReportedThe number that tests this facet is average selling price, approximately $1.60 million in 2025 against $1.50 million in 2024.
    Intuitive Surgical Form 10-K, fiscal year ended December 31, 2025 - Item 7 MD&A, results of operations (instruments and accessories $6,018.9M, systems $2,473.7M, service $1,572.1M, recurring revenue $8,465.3M, gross margin 66.0%, operating income $2,945.5M, average selling price, lease revenue recognition, and the discussion of procedure categories) — FY2025 · publ. February 3, 2026 · source ↗
Sources
Generated September 23, 2026