Why JNJ's OTTAVA Will Win
Y'all are going to hate me for this... and honestly I don't care... I still think OTTAVA has a legitimate shot at taking the soft tissue robotics market by storm.
It all boils down to two words:
Nostalgia & Novelty
I think the vast majority of medTech folks are still at a loss concerning what the hell JNJ's been doing for the last decade progressing their platform OTTAVA... still without a commercialized solution available, or even disclosing promotional images or videos that are "helpful".
For 10 years... JNJ has "Kept Surgeons Waiting"... and they've kept remarkably quiet...
...and while the prevailing sentiment from our industry is "too little too late"...
I intend to argue that OTTAVA is well "Worth the Wait"
A Quick "Hey":
Context:
For those of you who don't know me...
I dedicated a decade of my life progressing surgical robotics at Johnson & Johnson MedTech... before a messy exit into all-in entrepreneurship in 2024.
During my time at JNJ I was the 16th Engineer in a massive build-to-buy nightmare between Johnson and Johnson [via Ethicon LLC] & Google [via newly "built" Verb Surgical]. I worked as both a design engineer and robotics controls engineer taking an undisclosed instrument from pre-concept selection to design verification ready in four years...
... and then the unthinkable happened...
JNJ acquired Auris Health, Inc. for $3.4 Billion and we burned the boats to go all in on a six-armed table-mounted robot.
I supported as a systems engineer owning all risks and requirement cascades across a portfolio of wristed instruments. So I've danced across every FMEA you could imagine [design, software, usability, system, etc]... and I've worked across every robotic architecture that JNJ has ever taken a shot on.
... then more unthinkable happened...
"Technical development Challenges" [all I can disclose] caused a pivot back to the original Verb four-arm table-mounted architecture... and in January 2026 the team "finally" submitted the OTTAVA system to the FDA for de novo classification.
On the back end of OTTAVA's development I ended up navigating 12 relocations over the course of one year to get to Tokyo where I Directed Front End Innovation Japan.
This was a Global Strategic Marketing & Engineering hybrid role to bridge downstream commercial insights into upstream Business Dev & R&D front end pipeline.
I traveled the region extensively, immersed in 40+ procedures, completed post operative interviews with top tier KOLs to discover clinical unmet needs... and most importantly looked for soft spots in Japan/APAC for OTTAVA.
So when I consider the future potential of a medTech innovation I view it through the lens of the Innovation Trifecta... triangulating:
- Clinical Unmet Need
- Technical Feasibility
- Commercial Viability
This trifecta [triangle] is then encircled in "Brand Presence" which gives an innovation the perception of quality w/ [pricing premium]... more on this to come.
So as I go deeper on why I think OTTAVA will "win" it is through the lens of the innovation trifecta that judge the platform's future success.
Semantics:
To all you bean counters... yes I'm aware that:
- Intuitive has 11,000 installed Da Vinci Systems [Xi. SP. & DV5] and has completed 20,000,000+ procedures [source: Steve BellHow to Startup in Medtech]
- CMR Surgical's Versius is the second most globally available platform having completed 45,000+ procedures which is a remarkable success
- Medtronic's Hugo RAS beat JNJ out of the gate and has a nice head start as a large medtech strategic to commercialize globally
- MicroPort MedBot's Toumai robot is on it's 11th revision and Medicaroid is expanding globally with Hinotori as well
- Moon Surgical's Maestro, Distalmotion's Dexter, and CMR Surgical's Versius are all well positioned to find soft spots in the growing ASC market
So how can I make a claim that JNJ's OTTAVA will "win"?
It's all how you measure success and over what time horizon.
I genuinely think there is a place in the market for many of the systems I touched on... but in the 10-20 year horizon [not 1-3]... I think OTTAVA could become a dominate player in Traditional ORs and ASCs globally without tiptoeing around Intuitive... taking on the 1000lb gorilla head on.
So I'm defining "winning" as bringing legitimate value to patients, clinicians, and shareholders over a sustain period of time... not achieving most systems positioned or total volume of procedures.
Staying Power... that's winning... and OTTAVA has a better shot than most.
Innovation Trifecta [Clinical Unmet Need]:
I recently had the privilege of attend SAGES2026 on behalf of Moon Surgical to continue their Unscripted series... sitting down with elite surgeons and curating candid dialogues of the real challenges they navigate everyday in the OR.
One of my favorite aspects of interacting with the incredible team at Moon... was their Glass OR exhibit that they co-curated with Inovus Medical and KARL STORZ.
Honestly I think this was the most immersive and provocative marketing plays I saw at SAGES... as it allowed clinicians to experience an 8ft x 8ft [2.5m x 2.5m] OR with the whole world watching.
Beautiful positioning for Maestro which comes along side clinicians and empowers them with greater control... through ai augmented scope positioning and robotic assisted retraction... a brilliant platform for high volume, low complexity cases such as cholecystectomies.
While the Glass OR provided a beautiful immersion in US ASCs... it was quite similar to some of the smaller ORs I've attended cases in during my time in Japan. Particularly in more rural regions such as Nagano and Okayama.
I remember attending a robotic proctectomy in a room very similar to the glass OR where the separation between sterile/non sterile barrier was slim. I was crammed against the wall with my arms by my sides and the room was literally Table, Tower, Robot, & Console.... no wiggle room
I've heard Japanese clinicians repeatable ask about the weight of our proposed robotic system because a Davinci broke through the floor of an OR in Japan. Seriously.
There's a reason that JNJ's cheeky marketing "reveals" OTTAVA from a ceiling perspective as only a bed with no robotic arms visible... is so appealing...
There is not a single robot on the market that has Zero OR Footprint [less the console and/or tower of course].
It's quite compelling as I anticipate [with a touch of speculation] that the system would empower clinicians to operate within tighter space constraints either fully robotically [4 arms], robotically assisted [2 arms], or Digitally [zero arms] leveraging Polyphonic's ecosystem across handheld lap/open procedures.
This opens up new clinical capabilities that boom [DaVinci] and cart [Hugo RAS & Versius] based architectures lack.
Innovation Trifecta [Technical Feasibility]
Now, there's a reason the majority of surgical robotic systems aren't table mounted... it's because it's hard and opens up different risks that need to be burned down through hardware/software requirements.
NUDS... [New. Unknown. Different]... They're Project & Platform Killers.
Imagine a catastrophic power failure and your arms aren't back drivable... locking the patient inside a death cage. Oh, and inverted pendulums holding a tool payload... that a lot of fun to optimize controls for... vs arms that come down from the sky with a boom architecture.
Why do you think there are so many Da Vinci copy cat architectures... it's because it works!
I'm also sure... there are also plenty of technical challenges to adapt Ethicon LLC's best in class "legacy' instrumentation for robotic applications... just a hunch lol...
... as this is where most of my late nights in the robotic controls lab came from... so much pain for a worthy cause.
It's funny, I have a close "undisclosed" friend from Intuitive and every time JNJ hit a public delay [failure]... the overall sentiment from his colleagues is that "robots are hard" [insert pretentious Intuitive smirk here 🧐]
But assuming that it is in fact technically feasible to commercialize a table mounted robotic surgical system with "legacy" instrumentation... this will be a massive win for clinicians. Especially those who have leveraged Ethicon handhelds for 20+ years.
More on this when we get to branding.
While I've been out of JNJ for the last 2 years...
I am incredibly curious what digital ecosystems are in pipeline bridging Dualto and OTTAVA to better inform clinical decision making. What's beautiful, is that once hardware is deployed in the field and acquiring real-world data... you can start training new ai algorithms to enhance clinician performance... and monetize them through software releases down the road.
The Data... there lies the power to win.
Innovation Trifecta [Commercial Viability]:
I'm going to be honest... JNJ's in for a world of hurt here... particularly in the next 3-5 years. I don't plan on sugar coating this section.
Positioning Capital of this magnitude is not within JNJ's current capabilities from a talent perspective. You can't simply expect a lifelong Ethicon sales rep to become an overnight expert on selling capital across a wide network of hospital decision makers vs serving a surgeon a new device. It's hard enough for them to push a new powered stapler through VACs [Value Analysis Committees]... so try a robot.
To successfully commercialize OTTAVA, new talent needs to be acquired, retooled, and deployed strategically across global markets. Its a huge lift and reorg... and I hope they've made progress since my exit in 2024!
The pain JNJ will experience will be severe and P&L will continue to be damaged as robots are sold, leased... even given away for free to win key accounts... with instrument sales [razor blades] & servicing bringing in the initial revenue.
That said, for every case that converts from traditional lap to robotics... I'm not sure how COGs and Cannibalization equalize on the balance sheet. For the last decade, prioritizing RAD [Robotics & Digital] has hemorrhaged cash eroding Ethicon's Front End's NPD pipeline outside of robotics.
But JNJ has something that many of the new entrants lack... EGO... and I view it as an asset.
Initial Sales Targets will be missed. R&D budgets in other OpCo's and Ethicon's handheld Front End will continue to be pillaged. Layoffs... divestitures... but at the end of the day EGO will push OTTAVA to the market regardless of headwinds and organizational constraints.
Perhaps JNJ is in soooo deep for soooo long... that it has actually become too big to fail.
After all.. they've gone all-in three times across [Verb Surgical... Auris Health... Verb + Auris Combo "OTTAVA"]... so I see them staying the course from a commercial strategy perspective as well.
New talent will be acquired and built out over the next decade. The competitive sales environment will be fierce and won contract by contract. JNJ will play aggressively in ASCs and hospitals pulling on every pricing lever and bulk discounts [handheld + robotic] they can to close larger networks vs Medtronic [and Intuitive].
But eventually a world will exist where there aren't any crumbs that Intuitive has left as scraps for new players. At this point... hospitals would need to decommission existing Da Vinci's to make way for OTTAVA and other new robots.
This conversion ground game will be even more brutal... and in the 10-20 year horizon I do believe in a world where we will see Intuitive systems rolled out of hospitals to make way for OTTAVA.
This is where the scale of JNJ as a global commercialization monster does make it well positioned to win.
Innovation Trifecta [Brand Presence]
Brand Presence enhances the reason to believe in a given technology. It shapes perspectives, builds trust, and empowers early adopters to become radical "raving" fans.
As an engineer I hate to say it... but Brand is Everything.
It's the reason I can sit down with a top tier "analytical" Colorectal Surgeon in Kita Kyushu... fire off as many questions as I possibly can... and still not gain a clear answer on why they've used Echelon staplers for almost 20 years vs Medtronic's Signia.
It's the perception of quality... the confidence in the brand that has delivered consistent outcomes when they've needed it most... its the "Ethicon Feel" in their hands...
... and this "perception" is not always rational... but it is incredibly powerful.
Do not underestimate the power of both Nostalgia & Novelty... to tip this market.
If you haven't seen Medtronic's trailer for Hugo RAS... watch it right now... it's a Banger.
It starts with a black and white intro recording from Leon Hirsch... the founder of US Surgical.
"All ideas need nurturing. It's easy to say no. It's much harder to say... I can make it work." ~Leon Hirsch
For those of you who don't know the depth of US Surgical's impact on our industry, I highly recommend this episode of State of Medtech by Omar M. Khateeb where he documents the History of Leon's legacy.
I know the flipside of his legacy as Ethicon LLC actively disrupted US Surgical in the 90's before it was acquired by Covidean [which was later acquired by Medtronic].
This trailer's intro montage, anchors the perceptions of surgeons in Nostalgia.
The good old days of surgery.
Where the pace of innovation was accelerating and industry took risks on behalf of the needs of clinicians. To build on themes of the quote... a time when new ideas were nurtured and pursued rather then saying no to something hard. Feels almost blue collar... and that's by design.
Then boom... the video shifts to full color and shows you a side of robotic surgery you've never experienced before.
"Then you feel it... the status quo is shifting... you see how choice redefines what's possible [surgeon glancing from an open console to the surgical assistant]." -> This marks a shift from Nostalgia to Novelty.
A new way of doing robotic surgery more collaboratively with an open consol... one of Hugo RAS's key differentiators.
Brilliant US launch video from the marketing team at Medtronic as it bridges nostalgia to novelty... and in the same why I think this is how OTTAVA will storm the market.
Nostalgia: Ethicon Legacy Handheld brands making their way to robotics [note: I'm remaining nondescript here as to which ones]
Novelty: 4 Arm Table Mounted architecture for enhanced OR efficiency and procedural flow... A radical new way to get more function out of a robotic OR suite.
Nostalgia: Learning laparoscopy on Ethicon Instrumentation in Ethicon Institutes established across the world... thereby trusting you'll be able to navigate OTTAVA's learning curve and be well supported in the journey
Novelty: Digital Ecosystem that connects preoperative planning, intraoperative decision making and post operative outcomes across a portfolio of handheld and robotic instrumentations... guiding surgery like never before.
Nostalgia... something only JNJ, Medtronic, and at this point Intuitive can offer.
Novelty... what Maestro, Versius, Dexter, Hinotori, and Toumai are betting on.
Staying Power...
Winning...
I think you'll need both Nostalgia & Novelty to be around in 10-20 years... or at minimum an exit into a larger strategic for global commercialization.
Only time will tell... but I'm confident OTTAVA is "Worth the Wait"
But anyways... you can sip on that.
Lingering Thoughts:
So hey friends...
There are many topics and side quests I've omitted from this initial dialogue.
There are many things I know... that I purposely omitted for legal & competitive strategy reasons... and its my goal to honor the incredible folks at JNJ who have been pushing OTTAVA forward for the last ten years.... I wouldn't want to spoil the surprise.
Like them, I hope to see OTTAVA achieve success in market and impact the lives of millions globally.
As I've been out of JNJ for 2 years... there are also many things I don't know concerning their latest strategy... and in this piece I blend in some speculation as I try to anticipate where JNJ could be moving in the years to come.
I've held onto many of these thoughts for the last two years... and its a privilege to share what I feel I can in a way that is as honest, independent and candid as possible.
The views expressed in this episode of Sunday Sips are mine alone.
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🍵Sunday Sips Episodes Still Percolating:
There are No Rules [medTech Entrepreneurship] with Omar M. Khateeb from MarketCraft [Estimated Release Sunday 4/5]
Reverence for the Craft [medTech Design] with Ian McEachern from Nerdian Inc. [Estimated Release Sunday 4/12]
From Surgical Unmet Need to MedTech Startup with Eran Shlomovitz and Liam J. Burns from Qaelon Medical [Estimated Release Sunday 4/19]
A Century of MedTech Commercialization Wisdom with Kashif Ikram [MicroPort MedBot], Tetsuya Nakanishi [Medicaroid] & Steve Bell [How to Startup in Medtech] [Estimated Release Sunday 5/3]
