Cover Story: Solving Wicked Problems at the Intersection of Healthcare and Technology - Insights from Intuitive Foundation’s Catherine Mohr, MD

Dr. Catherine Mohr shares her journey with Intuitive Surgical as the surgical robotics leader evolved as a “29-year overnight success,” and offers lessons on how to approach what she calls the wicked problems in healthcare and medtech. Now leading the Intuitive Foundation, she’s focused on solutions that go beyond technology, ensuring innovation meets real-world needs—for example addressing the global surgical training gap in emerging markets to save patient lives.

Dr. Catherine Mohr, President of the Intuitive Foundation and former VP of Strategy for Intuitive Surgical, where she held both research and strategy roles since 2006, brings a rare blend of VC insight and deep medtech product development experience. At LSI Europe ’24 in Sintra, Portugal this past September, she delivered a powerful keynote that spoke to Intuitive Surgical’s meteoric rise to surgical robotics market leadership—and the high-stakes impact of robotics technology on global healthcare and patient lives. 

Her message, based on her two decades at Intuitive, was clear: Medtech must focus on solving “wicked problems.” She challenged the standing-room-only audience of medtech innovators to recognize the current environment, and ask where is the gap between what surgeons want to be able to do for their patients and what they can do? Also, can we fill that gap with technology?

“A lot of the problems at this current intersection of healthcare and technology are fundamentally about trying to address issues in patient care,” she notes. “These are the important problems that we are facing. But a lot of those issues have been consistent for a very long time.” 

Here, we explore Mohr’s compelling ask for transformation-focused industry stakeholders, lessons learned from solving a wicked problem in lung cancer with Intuitive’s Ion Endoluminal System, and her world view on the problems that still need to be solved. Her work at the Intuitive Foundation is an inspiring example of how to deploy AI/ML technology in future-facing ways that help prevent avoidable patient deaths across the globe. 

Intuitive’s Focus on Wicked Problems in Healthcare

Going back to the 1990s at Intuitive, the company was always focused on solving what Mohr calls the wicked problems. 

“We asked, what are the problems that we try to treat?” she says. “It’s not, ‘I have a robot, what do I apply it to?’ It’s ‘I have a really big clinical problem, the gap which I can close with robotic technology. What robot should I make to close that gap?’” Intuitive was trying to solve the wicked problem of how to make minimally invasive surgery better for the patient. “The incision serves no therapeutic purpose,” Mohr says. “If you can make that incision as small as possible and do exactly the same surgery, it will always be better for the patient. That is the wicked problem we need to solve. Then Intuitive asked, can we do it with robotics?” 

Mohr highlighted the long-runway perspective required for groundbreaking advancements in medical robotics. She traced Intuitive Surgical’s long evolution from an uncertain startup to a dominant force in minimally invasive surgery and pioneer of robotic surgery, emphasizing that success in medtech often depends on persistence, problem-solving, and strategic adaptation. And, she discussed the future-focused work going on at the Intuitive Foundation, which she leads as President, to scale surgical training so that surgeons and other healthcare professionals can save lives across the globe, including in emerging markets in Asia and Africa.

Robotics as a “29-Year Overnight Success” 

Mohr began by taking the LSI Europe ’24 audience on a journey through Intuitive Surgical’s product development. The company, founded in 1995 by Frederic Moll and Robert Younge, actually got its start in the 1980s, with the first prototypes developed by Stanford Research Institute (SRI), for military use. Moll and Younge then reworked the surgical telepresence system developed by Phil Green of SRI and developed Intuitive’s first robotic surgical prototype: Lenny, short for Leonardo. Intuitive’s second generation was Mona, in 1997, being their first robotic surgical system to be used in human trials. 

In 1998, Intuitive brought into human use the first system, which is still the most successful robotic surgery platform today: da Vinci. The first da Vinci surgical system was FDA-cleared in 2000 for general laparoscopic procedures, becoming the first operative surgical robot in the U.S. 

At that time, Intuitive was a start-up, with procedures numbering in the hundreds per year, says Mohr. “In 2003, there was a reverse stock split. Intuitive was struggling to keep its stock price over $10,” she says. “Just doesn’t seem possible from where it is now. But understanding where we were in those days, we were building something that a lot of people didn’t understand, and didn’t see the future value of. But this is why I joined Intuitive Surgical. Not all the rest of the robot, the instrument, but because that was the big idea that was solving the big problem. And it’s my job to get that technology to the point where it can solve this beautiful problem. And so, after a few iterations, you arrive at elegant solutions to things. We think about robotics as futuristic, as modern— it’s really a 29-year overnight success.”

“Where Intuitive Surgical is now was not obvious, or even predictable from all of the stages that it was in along the way,” she continues. “There were plenty of things that could have killed the company over and over again,” she says. “By enabling robotic, single-port access, you’re putting different tools in the hands of the surgeons, who will teach you about how to use your products. And overall, the common goal has to be improving outcomes.” 

Intuitive continues to create and refine robotic systems that extend the capabilities of surgeons’ eyes and hands, with the fifth-generation da Vinci 5 system FDA-cleared in March 2024. More than 14 million surgical procedures worldwide have been completed using da Vinci systems, spanning clinical specialties including urology, gynecology, thoracic surgery, general surgery, and transoral surgery. 

“Today, almost every 17 seconds, someone has a da Vinci surgery,” says Mohr

Battling the Status Quo

While many view the surgical robotics market today as a battle between industry giants, Mohr pointed out that the real challenge is convincing healthcare providers to move away from traditional procedures. Rather than competing against other robotic systems, Mohr explained that Intuitive focused on improving existing surgical techniques. The goal was to minimize incisions and enhance patient outcomes, making robotic-assisted surgery a superior alternative to traditional methods. 

“Your competition isn’t other companies—it’s the status quo,” she points out. “When you think about your competition, it’s generally not other companies that are trying to enter the space. It’s the established procedures of how that particular pathology is treated today.”

Breakthroughs Happen When Technology Meets the Right Moment: The Ion 

Mohr described how Intuitive solved another wicked problem, that was more than two decades in the making. The company reached a breakthrough moment in 2019 with expansion into a new frontier: minimally invasive lung biopsy, with the introduction of the Ion Endoluminal System, a robotic-assisted platform. 

The wicked problem that Intuitive was trying to solve was a surgical problem, but also a diagnostic one, describes Mohr: the big gap in lung cancer diagnosis. In lung cancer, time to intervention is critical. Collecting lung tissue samples for biopsy minimally invasively, to allow early diagnosis in this difficult-to-reach area of the anatomy, became possible only when precision robotics navigation technology advanced to the necessary level. 

“We had the problem for years—we just had to wait until the technology existed to solve it,” she says. “It’s about iteration, and understanding what was great about the product that you had and then taking it to that next step.” 

She explains that it all started when a new navigation technology was developed: the shape sensor. Fiber optic shape-sensing technology measures the full shape of the endoluminal catheter hundreds of times per second, providing precise location, shape, and orientation information throughout the entire navigation and biopsy process. 

“We already had our problem list, we already knew what we were trying to solve. When this technology came out, we knew what we were going to do with it. And we built a new robot around it to put the tip of the catheter in the right spot.” 

Part of the problem came from difficulties going back decades with lung cancer screening, Mohr explained. In 2010, the National Lung Cancer Screening Trial was trying to do something that no trial had ever shown before, that it was cost effective and reasonable to do lung cancer screening. 

“Every other trial in the past had shown that you harmed more patients than you helped if you did mass lung cancer screening,” Mohr says. “The workup associated with the nodule was so damaging that you actually hurt more people than you helped. In the early stages with lung nodules, nine out of 10 are entirely benign. And it can be very difficult to differentiate which is cancer and which is not. And so lots of people were getting surgeries, for nodules that didn’t have cancer in them about 30% of the time.” 

Mohr explains that the goal of the Ion technology was to reimagine the lung cancer patient pathway, and provide definitive answers to anxious patients who learn they have a suspicious lung nodule in a more expeditious way than what typically occurs. Today, many patients are told to return months later for a follow-up CT scan to see if the nodule has grown. Patients may also require multiple biopsies prior to a lung cancer diagnosis, which can add months to a patient’s journey to care. 

“Don’t underestimate the burden and the psychological burden of the workup,” says Mohr. “This is not just cost. This is real patients suffering associated with this. If the nodule has grown enough, often you’ve halved their life expectancy.”

The chief goal in designing Ion was to help shorten the patient journey by making it possible, for the first time, to biopsy small, difficult-to-reach nodules in the peripheral lung, where more than 70% of cancerous lung nodules may be located. Ion’s ultrathin, ultramaneuverable catheter allows clinicians to reach small lesions in all 18 segments of the lung with more reach, precision, and stability, according to the company. With shape sensing, Ion provides the precision and stability needed to reach and biopsy small nodules in the periphery of the lung. Today, more than 100,000 Ion biopsies have been completed. 

“And so that was a wicked problem that we had, and we had looked at for a while and we had been waiting until the technique showed up that let us get there. And so this, along with machine learning and imaging processing, is the Ion now.” 

Dr. Mohr’s insights from this definitive time in Intuitive’s history offer valuable lessons for medtech innovators: the path to success is rarely linear, but a relentless focus on solving meaningful clinical problems will ultimately drive industry-changing advancements.

Solving the Wicked Problems of the Future 

Taking Intuitive’s robotics technology a step further, Mohr says that the company sees a future of care that is increasingly technology-enabled and digitally informed. There’s tremendous potential to harness current and future innovations in robotics, artificial intelligence (AI), machine learning (ML), and advanced visualization to address stressors facing surgeons, physicians, care teams, and the institutions where they practice. And importantly, to deploy AI/ML technology in future-facing ways that help prevent avoidable patient deaths across the globe. 

“Training is what I am most excited about using data for,” says Mohr. “Understanding how people go from being a novice to being an expert, how we think about the way of experts do something, so that we can think about best practices. We’ve been able to look at the way surgeons move, the way they optimize surgical paths, and we can think about ways in which we can bring people in that into that expert cycle.” 

In Mohr’s view, training surgeons is a wicked problem that needs to be solved. And by solving this problem you drive adoption in a way that can be scaled worldwide, to help save lives. 

In showing the Europe ’24 audience a 100-year-wide view on global health, she noted that as economies got healthier and wealthier over time, thanks to vaccinations and antibiotics available after World War II, big changes took place in surgery and surgical availability. 

“That’s resulting in about seven to 17 million avoidable deaths if somebody just had access to surgery where they were,” she says. “To put this in perspective, we have 3 million deaths a year from HIV, tuberculosis, and malaria combined. We have 10 million deaths a year globally from cancer. If you don’t think that lack of access to surgery is a global health crisis, then you’re not looking at the same data that I’m looking at.” 

“It was these realizations as VP of Strategy, where I said we need to solve a much bigger problem, we need to start looking at the wicked problem of training this next generation of healthcare providers on da Vinci to meet those really critical needs, for example in Asia and Africa,” Mohr says. “Over the next 30 to 60 years, the focus will be in these rapid growth areas where we don’t have ways to train surgeons. And this is the wicked problem that I want to bring AI and ML into.” 

Mohr says that in order to fully scale this goal, a shift in training philosophy has to take place. “Right now surgical training is ‘see one, do one, teach one, do one under observation,’” she says. “We need to shift it to ‘see one, teach yourself one with skill, observation and guidance, and then do one.”

Session Takeaway: Rethink Healthcare on a Global Scale 

Mohr describes that the economies of Asia and Africa will shape the future of healthcare, yet most training systems are designed for Western surgeon replacement economies, where you’re replacing clinicians with new clinicians that are coming in. Companies must rethink how they scale education and innovation globally. 

“We did not build training programs for the economies of Asia and Africa that are growing. Moving forward the next 70 years, if you look at the economic development models, and the best modeling we’ve got on birth rates, and you don’t have a replacement economy. You’re looking in the wrong place for future customers if you think they’re all in the United States and Europe.” 

As a closing message to the Europe ’24 audience, Mohr goes back to her initial question: what problems am I trying to solve? She urges the audience to think about who their customers are going to be in the future, while always keeping an eye on what it is that you are doing for patients. She also asks them to think globally, recognize how the economies of the world are changing, and think carefully about what technologies they are bringing forward to address these needs and change the practice of surgery. 

Mohr’s message was clear: The future of surgery is not just about building better robots—it’s about rethinking how we train surgeons, use AI intelligently, and ensure that life-saving procedures are accessible around the world. By tackling these wicked problems in healthcare, the medical technology industry can drive meaningful global change.

Dr. Catherine Mohr is President of the Intuitive Foundation and previously the Vice President of Strategy for Intuitive Surgical, where she held both research and strategy roles since 2006. Prior to joining Intuitive Surgical, Dr. Mohr served in engineering project manager and new business development roles at AeroVironment. Holding a B.S. and M.S. in Mechanical Engineering from MIT and an M.D. from Stanford University, Dr. Mohr has a diverse background that covers surgery, medical technology, engineering, product design, healthcare, alternative energy, automotive, aerospace, global entrepreneurship, intellectual property litigation, U.S. Food and Drug Administration compliance, education, and product development. 

About the Intuitive Foundation

The Intuitive Foundation was created in 2018 with the aim of reducing the global burden of disease and suffering through philanthropy, research, and education aimed at better outcomes for patients everywhere. The organization accomplishes this through a combination of research grants, philanthropic giving, and local volunteers worldwide.

The Foundation has committed more than $65 million to causes in support of its mission. In January, Intuitive Surgical gifted $45 million to the Foundation, bringing its total contributions to more than $170 million.