Urology Marketing 2006 Ryan Rhodes Sr. Director of Marketing Intuitive Surgical Internal Use Only

Urology Marketing Agenda 2005 –2006 Procedure Update 2006 Procedure Focus 2006 Marketing Strategy 2006 Urology Meetings & Events

Urology Marketing da Vinci ® Prostatectomy

Urology Marketing 20% 0.7% 79.3%

Urology Marketing 41.5% 0.5% 58.5% 60.5% 39.5% 0.5%

Urology Marketing da Vinci ® Prostatectomy Clinical Validation Why is dVP Better?

Urology Marketing da Vinci ® Prostatectomy – Clinical Outcomes “The Big 3” 1.Cancer Control – Margins 2. Urinary Control – Continence 3. Sexual Function – Potency

Urology Marketing da Vinci ® Prostatectomy – Clinical Outcomes 1. Cancer Control - Margins

Urology Marketing Radical Prostatectomy Series% Positive margins Guillonneau 1 (Laparoscopic)7.7% Scardino 2 (Open)5.9% Tewari 3 (Robotic)4.3% Lee 4 (Robotic)6.0% Locke 5 (Robotic)6.2% Menon 6 (Robotic)6% Ahlering 7 (Robotic)4.5% Patel 8 (Robotic)5.7% Positive Margins (T2) 1. Touijer K, Kuroiwa K, Saranchuk JW, Hassen WA, Trabulsi EJ, Reuter VE, Guillonneau B. Quality improvement in laparoscopic radical prostatectomy for pT2 prostate cancer: impact of video documentation review on positive surgical margin. J Urol Mar;173(3): p. 766 (Results) 2. Scardino PT. Open Radical Retropubic Prostatectomy. Presented at the American Urological Association’s Carcinoma of the Prostate Course, San Francisco, California, Sept. 30 – Oct Tewari A, El-Hakim A, Leung RA. Robotic prostatectomy: a pooled analysis of published literature. Expert Rev Anticancer Ther Jan;6(1): Lee DI. Margin Risk With Experience. Presented at UC Irivine’s 2006 ART (Advanced Robotic Techniques) of Prostatectomy Symposium, January 5, 2006, Anaheim, California 5. Locke DR, Klimberg IW, Sessions RP. Robotic Radical Prostatectomy With Continence And Potency Sparing Technique: An Analysis Of The First 250 Cases. Submitted To Journal Of Urology, Publication Date TBD. p. 4 Table Menon M, Tewari A, Peabody JO, Shrivastava A, Kaul S, Bhandari A, Hemal AK. Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin North Am Nov;31(4): Review. 7. Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes. Urology May;63(5): p. 821 table III. 8. Patel VR, Tully AS, Holmes R, Lindsay J. Robotic radical prostatectomy in the community setting--the learning curve and beyond: initial 200 cases. J Urol Jul;174(1): p. 270 table 4.

Urology Marketing Radical Prostatectomy Series % Positive margins Guillonneau 1 (Laparoscopic)7.7% Scardino 2 (Open)5.9% Ahlering (last 83 patients) 3 (Robotic)2.7% Patel (last 500 patients) 4 (Robotic)2-4% Positive Margins (T2) 1. Touijer K, Kuroiwa K, Saranchuk JW, Hassen WA, Trabulsi EJ, Reuter VE, Guillonneau B. Quality improvement in laparoscopic radical prostatectomy for pT2 prostate cancer: impact of video documentation review on positive surgical margin. J Urol Mar;173(3): p. 766 (Results) 2. Scardino PT. Open Radical Prostatectomy. Presented at the American Urological Association’s Carcinoma of the Prostate Course, San Francisco, California, Sept. 30, T Ahlering. 3.0% positive margin for last 83 patients. Unpublished 2006 UCI Internal Data. Submitted to JOU for publication. 4. VR Patel. Urology Centers, Vestavia Hills, USA. Histopathologic Outcomes and Short Term PSA Data after Robotic Radical Prostatectomy. 500 Patients. Moderated Poster Session MP27, Wednesday, August 24, rd World Congress on Endourology and SWL 21 st Basic Research Symposium August 23-26, 2005, Amsterdam, The Netherlands. J Endourol Aug.; 19, Supplement 1: A135.

Urology Marketing da Vinci ® Prostatectomy – Clinical Outcomes 1. Oncologic Outcomes – Cancer Control X

Urology Marketing da Vinci ® Prostatectomy – Clinical Outcomes 2. Urinary Control - Continence

Urology Marketing Surgeon3 mo6 mo12 mo Walsh 1 (Open)54 %80%93% Guillonneau(Laparoscopic)N/A 89.2 % 2 Rassweiler 3 (Laparoscopic)N/A74%97% Menon 4 (Robotic)N/A96%N/A Locke 5 (Robotic)92.9%94.9%97.4% Ahlering 6 (Robotic)75%N/A%95% Patel 7 (Robotic)82%89%98% Urinary Continence Outcomes 1. Walsh PC. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. J Urol Jul;164(1):242. p. 59 table Vallancien G, Guillonneau B, Cathelineau X, Baumert H, Doublet JD. [Localized prostatic cancer: treatment with laparoscopic radical prostatectomy: study with 841 cases] Bull Acad Natl Med. 2002;186(1):117-23; discussion French. 3. Rassweiler J, Sentker L, Seemann O, Hatzinger M, Rumpelt HJ. Laparoscopic radical prostatectomy with the Heilbronn technique: an analysis of the first 180 cases. J Urol Dec;166(6): Menon M, Tewari A; Vattikuti Institute Prostatectomy Team. Robotic radical prostatectomy and the Vattikuti Urology Institute technique: an interim analysis of results and technical points. Urology Apr;61(4 Suppl 1): p.15 (abstract) 5. Locke, DR, Klimberg IW and Sessions RP. Robotic Radical Prostatectomy With Continence And Potency Sparing Technique: An Analysis Of The First 250 Cases. Submitted To Journal Of Urology, Publication Date TBD. p. 5 table T Ahlering. Continence: The UC Irvine Experience. Presented at UC Irivine’s 2006 ART (Advanced Robotic Techniques) of Prostatectomy Symposium, January 5, 2006, Anaheim, California 7. Patel VR, Tully AS, Holmes R, Lindsay J. Robotic radical prostatectomy in the community setting--the learning curve and beyond: initial 200 cases. J Urol Jul;174(1): p. 270 table 3.

Urology Marketing da Vinci ® Prostatectomy – Clinical Outcomes 2. Functional Outcomes – Urinary Continence X

Urology Marketing da Vinci ® Prostatectomy – Clinical Outcomes 3. Sexual Function - Potency

Urology Marketing Sexual Potency Outcomes Best Potency OutcomesWalsh (2004) 1 N=25 UCI (2005) 2 N=27 Pre-op IIEF-5 >21All Average Age Follow-up12 mos. Coitus71 %74 % BNS100%14/18 (78%) UNSNA6/9 (67%) Post Radical Prostatectomy Average IIEF-5 Potent men score Parsons JK, Marschke P, Maples P, Walsh PC. Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy. Urology Nov;64(5): Ahlering T. The UC Irvine Experience: Potency Preservation. Presented at UC Irivine’s 2006 ART (Advanced Robotic Techniques) of Prostatectomy Symposium, January 5, 2006, Anaheim, Calif. X

Urology Marketing Sexual Potency Outcomes Best Potency OutcomesWalsh (2004) 1 N=25 Menon (2005) 2 N=35 Pre-op IIEF-5 >21All Average Age Follow-up12 mos. Coitus71 %86 % BNS100% Post Radical Prostatectomy Average IIEF-5 Potent men score Parsons JK, Marschke P, Maples P, Walsh PC. Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy. Urology Nov;64(5): Menon M, Kaul S, Bhandari A, Shrivastava A, Tewari A, Hemal A. Potency following robotic radical prostatectomy: a questionnaire based analysis of outcomes after conventional nerve sparing and prostatic fascia sparing techniques. J Urol Dec;174(6):2291-6, discussion p fig. 2. X

Urology Marketing da Vinci ® Prostatectomy – Clinical Outcomes 3. Functional Outcomes – Sexual Potency X

Urology Marketing da Vinci ® Pyeloplasty

Urology Marketing 35% 13% 52% 35% 13%52%

Urology Marketing 7% 40% 53% 7% 40% 53%

Urology Marketing 2006 Meetings / Events

Urology Marketing 2006 Urology Meetings & Events ART Symposium / PacRim Robotics Conference - Anaheim 1/5-1/7 WRUS (World Robotic Urology Symposium) – Columbus, OH 4/7-8 EAU (European Association of Urology) Meeting – Paris 4/5-8 AUA (American Urological Ass.) Meeting – Atlanta, GA 5/20-5/25 AUA Section Meetings: Southeast Section – 3/1-5 Puerto Rico Northeast Section – 9/5-10 Ottawa, Canada North Central Section – 9/11-16 Coronado, CA New England Section – 9/27-30 Providence, R.I. South Central Section – 10/4-8 Santa Fe, NM Mid Atlantic Section – 10/12-14 Washington, D.C. Western Section – 10/22-27 Maui, HI ART (Advanced Robotic Techniques) Symposium – New York, NY June TBA WCE (World Congress of Endourology) – Cleveland, OH 8/17-20 ERUS (European Robotic Urology Symposium) – Stockholm, Sweden 9/7-9 IRUS (International Robotic Urology Symposium) – October TBA AUA Advanced Laparoscopy Course – Baltimore, MD, 11/17-19

Urology Marketing 2006 World Robotic Urology Symposium Ohio State University, April 7-8 Faculty: 20 Experienced da Vinci ® Surgeons Detailed Review of Techniques / Outcomes “Live” da Vinci Surgery Presentations: dVP, Pyeloplasty, Cystectomy Hands-on da Vinci Training 17 CME Category 1 AMA Credits

Thank you! As with any surgery, these benefits cannot be guaranteed, as surgery is patient- and procedure-specific. © 2006 Intuitive Surgical. All rights reserved. Intuitive, Intuitive Surgical, da Vinci, da Vinci S, TilePro and EndoWrist are trademarks or registered trademarks of Intuitive Surgical. All other product names are trademarks or registered trademarks of their respective holders. PN Rev. A 1/06