Robotics in medicine

Howie ChosetRobotics in healthcare is one of the next big waves of innovation. There are only four public healthcare device companies with a base in robotics: Accuray (CyberKnife® and TomoTherapy® Systems for radiation oncology), Hansen Medical (Sensei® X Robotic Catheter System for cardiology), Intuitive Surgical (da Vinci® Surgical System for minimally invasive surgery), and Mako Surgical (RIO® Robotic Arm Interactive Orthopedic System for orthopedic surgery). But there are early-stage companies that use robotics technologies as a foundation for breakthrough innovations in medicine. One of them is Medrobotics, which is commercializing the first surgical snake robot, invented by Howie Choset, a professor and researcher at the Robotics Institute at CMU, and post-doc, Alon Wolf.

Surgical snake robots are cool; they are also revolutionary because they enable physicians to reach difficult places of the anatomy. Because they are small and super flexible, they can help surgeons perform difficult surgeries more easily, more cheaply, less invasively, and more effectively in terms of outcomes. This is big.

Samuel Straface, President and CEO, tells me a story of seeing the recently released film, Prometheus, and having a revelation about his company’s technology: “The story is set at the end of the century. This gives the writer and director poetic license to be a technology visionary. They give us their vision of what the world, and the things in it, will look like in the future – like a futuristic surgical system that is robotic and manipulative. To the lay person it looks really cool. But I saw something different because they were using the same old toolset. What was wrong was that they are using straight tools, and that’s what the current system uses. Once we [Medrobotics] are out there, there will no longer be straight tools. They will be flexible. That’s night and day different!”Samuel Straface

Howie and Samuel make a great team; each lauds the other. Howie is the visionary technologist; Samuel is the down-to-earth business guy. With perhaps 20 patents to his name by the end of this year, Howie is a genius of invention. He tells me about the evolution of robotics: “In the 1980s, everyone thought that robots would be big. In 1979, a NY Times article predicted robotics would be a $3B industry by 1990. It’s not that big, even now, 30 years later, but it is moving and in a lot of directions. Maybe we’ll never hit the metric of many companies manufacturing many robots. But the industry is marching on; it’s strong and inevitable. Robots are here to stay and we will see them more and more. But, in ways that we can’t predict.” Medrobotics is part of that future!

Beginning.  You can tell that Howie is the creative type as there are toys and creative playthings all around his office at CMU. Howie is all about invention and then wants those inventions to get to the market to help mankind. It’s a bold vision, and Howie is proving it’s achievable. I asked Howie how he came up with the idea for the snake robot. The first snake robot was actually conceived in the 1970s, and then reinvented in the 1990s. Howie’s is the first surgical snake robot and his starts in 2003 with a prototype that he built with Alon Wolf (with whom he co-founded the company). It was one inch in diameter. Howie was not focused on medical applications, but fate intervened when he met Marco Zenati, MD, a cardiac surgeon then at Pitt/UPMC, now at Harvard. Marco immediately recognized the possibility for surgery. With NIH funding, the next generation prototype was 11 millimeters in diameter.

Jim Jordan at the Pittsburgh Life Sciences Greenhouse acted as matchmaker, steering the company towards marketing and recruiting an experienced entrepreneur/CEO. Samuel Straface jumped on board because he recognized that the company could revolutionize surgery by being able to go to difficult to reach places in the body, such as the heart: “I saw Howie’s snake robot as an enabling platform for surgeons to operate with both hands and magnify their vision in difficult areas. We can get the physician to difficult-to-reach anatomy that was once inaccessible. That’s our fundamental value and differentiator.”

Funding.  Like any medical startup, Medrobotics needed funding. We know that raising equity funding is particularly difficult for robotics companies. In 2009, with the strong team, revolutionary technology, solid IP, and a plan for the future, the company secured $11.6M in a Series A angel funding round thanks to the help of Mel Pirchesky of Eagle Ventures. The company raised an additional $5M from the same shareholders at the end of 2009, and in late 2011 closed a Series C of $11.7M for a total of $28.3M – all from angels, small family funds and the Pittsburgh Life Sciences Greenhouse.

Samuel recognizes that this is a fraction of what many healthcare technology companies need to raise and that their strategy of raising funds from angels is also unusual. In Pittsburgh, only Cohera Medical and Knopp Neurosciences has achieved higher dollar amounts raised from angels (I did a story on Knopp earlier this year). Samuel also allows that they have raised a fraction of what other medical robotics companies have raised to get to commercialization. The other robot companies all did successful IPOs after their launch, which remains an option for Medrobotics in the next couple of years (if the markets are stable enough).

Medrobotics Flex Robotic System in useCommercialization path.  Getting a medical robotics technology into the hands of surgeons is not easy. There is first the regulatory pathway, the FDA. Medrobotics started out as Cardiorobotics because cardiac surgery was the first targeted application, consistent with Dr. Zenati’s vision and his expertise. The company completed a feasibility trial in Europe on cardiac patients. They demonstrated the potential of a snake robot being used via a single key-hole opening around a beating heart. And, just as the company was approved to do a limited clinical trial in Europe, the FDA changed its guidance so that the regulatory pathway had to be a Premarket Approval (PMA), instead of the simpler, cheaper, shorter 510(k). As Samuel recalls, “The PMA is an additional $40M and four years and there is no guarantee of the desired outcome. That’s too much risk. We had to change.”

Today, Medrobotics’ first application is not the heart but the oropharynx – the throat: “We enable the ENT (the head and neck) surgeon to access and operate with both hands in the difficult-to-reach anatomy of the oropharynx and larynx (voice box).” The shorter time to market was critical. Samuel calculates that there is approximately a three-year life cycle that applies to new categories of technologies: “We will see mammoth changes in robots every three years. We know what we can do now and what we will do in 12 to 18 months. Add the regulatory process on top and that’s how you get to three years. We’ll continue to push the envelope of flexible robotics every three years.”

Medrobotics should achieve FDA approval some time in 2013. Samuel believes that they are about two to three years ahead of any direct competition in surgical flexible robots. Medrobotics plans to continually innovate and iterate the robot to expand commercial applications. From the throat, they could move down into the chest and into the abdomen: “There are a myriad of hard-to-reach places in the body where a flexible robot will become the preferred surgical tool.”

Samuel has built up the team so that Medrobotics is 44 people now. All focused on getting that snake robot to market just as fast as possible. The company is headquartered in the Boston area but has strong ties to CMU and to its loyal Pittsburgh shareholders.

Lessons learned.

  • Howie knows that the only way that his robot will ever get used is a result of his letting go of his baby: “The riskiest thing to do for me was to retain control. The scariest thing to do was letting go. It was actually a thousand letting gos.”
  • Samuel is focused on the business of commercialization: “Our shift in strategic direction (from cardiac to ENT focus) resulted in a  few sharp arrows in my back, but it’s the lowest risk commercialization path for the company and the fastest way to showcase the product and de-risk the market opportunity – a major inflection point that could lead to a liquidity event or if needed, to less expensive capital for market expansion. We survived as a consequence. We are not a tech company but a business. Robots just happen to be our core competency.”

Thoughts about robotics in entrepreneurship.  I am finding that most robotics entrepreneurs are not using the term in their descriptions of their companies. It’s too hard to raise money they tell me.

Robots are changing rapidly as the market needs become more specialized – like for snake robots. Howie regales me with a story about the historical expectation of robots: “In the 1950s everyone envisioned “people-like” robots performing daily functions in places such as the kitchen. But instead what we got was a dishwasher – one specialized machine that does a damn good job of cleaning pots and pans!” It’s true. I often use the idea of the GPS in my car. If you had told me when I was in college that I would have a map in my car that spoke to me I would have thought you were crazy!

Clearly the use of robots as a tool in medicine is nascent. What will come, will come!

This post is sponsored by Innovation Accelerator, the private side of a public-private partnership with the National Science Foundation to make America more competitive through innovation. This post is part of a series on robotics and entrepreneurship being published in New Venturist Summer, 2012.

From research to marketplace: the NSF challenges scientists to think entrepreneurially
Jeff Arnold and Waseem Daher: Ksplice
Innovation @ U Pitt