A Search Firm Placing MedTech Pioneers in Transformative Roles to help us live longer healthier lives.

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Cruxx is a search firm that supports the most innovative healthcare companies on the planet. With a global focus and a team of deep sector experts, we are building the search firm for the modern day.

Our vision is a future of life-saving innovation. We help accelerate medical technology to a point that fringes on science fiction. We advocate for a new age of surgery to turn today&rsquo;s MedTech ideas into reality.

Meet the team

Inspire and excite. Avoid fluff. Be clear, direct and transparent. Strip things to the base layer to build intentional, authentic relationships with partners.

We are relentless in our pursuit.

Relentless

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We are purposeful.

We're always on the hunt for talented people who thrive on building committed connections. We are curious, energetic, driven, open-minded, innovative, and lovers of learning, so if that sounds like you, you know just what to do.

Careers

<h2>Be the changemaker</h2>&nbsp;We're always on the hunt for talented people who thrive on building committed connections. We are curious, energetic, driven, open-minded, innovative, and lovers of learning, so if that sounds like you, you know just what to do.&nbsp;<a class="outlineBtn mt-3" href="/submit-your-cv/">Send your CV</a>

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EXPLORE OUR INSIGHTS OR THE SURGIBOTS PODCAST

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MedTech Search at the Cutting Edge

You're Probably Here for 1 of 3 reasons

We place MedTech pioneers in leading companies to solve the world&rsquo;s biggest health problems.

Companies who are addressing the world’s biggest health challenges through innovation.

<h2 class="text--primary">Cruxx are the experts in building and scaling MedTech companies.</h2>

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Cruxx are the experts in building and scaling MedTech companies.

Companies who are addressing the world’s biggest health challenges through innovation.

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We specialise in matching pioneering talent with leading companies in the MedTech sector to address the world’s most pressing health challenges. Cruxx operates globally with a commitment to innovation, placing the aspirations and needs of our clients and candidates at the heart of our approach. We don’t just fill roles; we forge connections, facilitate breakthroughs, and fuel progress in medical technology and healthcare.

Testimonials

At Cruxx we are at the cutting edge of MedTech search. Working with innovators, to hire the talent who are bringing medical innovation to the world.

We're Hiring

At Cruxx, we understand the vast potential and intricate nuances of the MedTech sector. We have our fingers on the pulse of the latest advancements and opportunities worldwide. We pride ourselves on offering a personalised experience. Every person we work with is unique, and we tailor our approach to match their distinct aspirations and needs.The world of medical technology is not just about devices and data; it's about real-world

impact on health outcomes. When you partner with Cruxx, you're aligning with a team that's deeply committed to addressing the world's most pressing health challenges.At Cruxx, we believe in the power of meaningful connections. We're not just filling roles; we're building bridges between pioneering talent and leading companies. Choose Cruxx, and be part of a journey that redefines the future of healthcare.

Take a look at what our clients say...

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Case Studies

Thomas Looby

Dual-Modality Imaging That Rewrites PCI Outcomes with Thomas Looby

Sabine Bois

How to Survive FDA Battles and Boardroom Drama - with Sabine Bois

Adrian Mendes

The AI Solution That Targets Repeat Cancer Surgeries - with Adrian Mendes

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<h1 data-start="484" data-end="593">How Digital Health is Transforming Patient Rehabilitation &mdash; Insights from David Pettigrew of my mhealth</h1>
In a recent episode of The Crux of MedTech podcast, David Pettigrew, CEO of <a class="cursor-pointer" target="_new" rel="noopener" data-start="675" data-end="711">my mhealth</a>, shared his journey from working in what he once called his &ldquo;dream job&rdquo; to leading one of the most innovative digital health companies in the UK. The conversation uncovered how simplicity, patient engagement, and targeted innovation can transform chronic disease management and rehabilitation &mdash; and why so many healthcare systems are still missing the opportunity.
<hr data-start="1080" data-end="1083">
<h2 data-start="1085" data-end="1143">From Industry Leader to Digital Health Entrepreneur</h2>
David&rsquo;s career began in the corporate MedTech world, culminating in a senior position at Sagentia. While he loved the role, he made a pivotal shift into entrepreneurship, driven by the potential to directly improve patient outcomes through digital tools.
That decision led him to my mhealth, a digital platform designed to help patients manage chronic conditions such as asthma, COPD, diabetes, and cardiovascular disease &mdash; with a growing focus on rehabilitation.
<blockquote data-start="1617" data-end="1778">
&ldquo;The more simple the solution for the patient, the more uptake you get,&rdquo; David explained. &ldquo;We&rsquo;ve stripped away complexity so patients actually use the tool.&rdquo;
</blockquote>
<hr data-start="1780" data-end="1783">
<h2 data-start="1785" data-end="1850">The Rehabilitation Gap: Why Only 3% Get the Care They Need</h2>
One of the most striking statistics David shared was that only 3% of Americans eligible for rehabilitation are actually receiving it. The reasons?
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Lack of awareness among patients
</li>
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Limited education for both patients and healthcare professionals
</li>
<li data-start="2111" data-end="2175">
Misaligned healthcare incentives that don&rsquo;t prioritise rehab
</li>
</ul>
This gap is particularly alarming given the proven impact rehabilitation can have on quality of life and long-term outcomes.
<hr data-start="2303" data-end="2306">
<h2 data-start="2308" data-end="2365">How my mhealth Drives Engagement Where Others Fail</h2>
Unlike many digital health apps that struggle to retain users, my mhealth has achieved strong daily engagement by focusing on:
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<li data-start="2496" data-end="2573">
Simplicity: An intuitive interface that encourages daily interaction.
</li>
<li data-start="2574" data-end="2673">
Personalisation: Condition-specific pathways for asthma, COPD, and other chronic illnesses.
</li>
<li data-start="2674" data-end="2778">
Holistic support: Beyond rehab, the platform addresses anxiety, symptom tracking, and education.
</li>
</ul>
The result? Patients stick with it &mdash; and healthcare providers get actionable data that can improve treatment plans.
<hr data-start="2897" data-end="2900">
<h2 data-start="2902" data-end="2937">Who Benefits &mdash; and Who Pays?</h2>
A core challenge for digital health adoption is identifying who has the incentive to implement it. While patients clearly benefit, David pointed out that reimbursement and funding structures in many health systems aren&rsquo;t yet aligned to support widespread rollout.
However, as healthcare increasingly moves toward value-based care, solutions that improve outcomes and reduce hospital readmissions are gaining attention from payers and providers.
<hr data-start="3388" data-end="3391">
<h2 data-start="3393" data-end="3441">Looking Ahead: What&rsquo;s Next for my mhealth</h2>
David closed the discussion by hinting at exciting developments on the horizon &mdash; from expanding into new therapeutic areas to strengthening partnerships with healthcare providers internationally.
<hr data-start="3640" data-end="3643">
<h3 data-start="3645" data-end="3666">Key Takeaways</h3>
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Digital health works best when it&rsquo;s simple, patient-focused, and integrated into care pathways.
</li>
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Rehabilitation remains vastly underutilised, with huge potential for impact.
</li>
<li data-start="3856" data-end="3962">
my mhealth&rsquo;s success shows that designing for engagement is the key to sustained patient outcomes.
</li>
</ul>
<hr data-start="3964" data-end="3967">
📢 Listen to the full conversation with David Pettigrew on The Crux of MedTech podcast to explore the future of digital health and how companies like my mhealth are closing the gap in patient rehabilitation.

David Pettigrew, CEO at my mhealth

Why Digital Health Keeps Failing Patients - with David Pettigrew

Hannah Claridge, Head of Neurotechnology at TTP

What's the Hype with Neuro? A Lesson in the Brain - With Hannah Claridge

Kiko Filipov, Partner at APPARIUS

Why Most Medtech Fundraisers Fail and What to Do Instead - Kiko Filipov, Partner at APPARIUS

Paul Roberts, CEO of Lupin Dental

Clinically Beautiful Smiles, Made with Robots - Paul Roberts, CEO of Lupin Dental

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<h2 data-start="130" data-end="211">Redefine Surgery: The AI Company Transforming Orthopaedics from the Inside Out</h2>
In this episode of The Crux of MedTech, we sat down with Peter, a serial entrepreneur in the orthopaedic space and the founder of Redefine Surgery. With three startups under his belt and a deep history at Stryker, Peter shared what it means to build meaningful AI for real-world surgery&mdash;and why the future of orthopaedics won&rsquo;t look like the past.
<h3 data-start="564" data-end="614">From Basement Prototypes to Multi-Acquisitions</h3>
Peter&rsquo;s journey began as an intern at Stryker, where he fell in love with the tangible, fast-paced nature of orthopaedic surgery. After launching a successful knee implant project, he cofounded his first startup&mdash;funded by a mixture of life savings, a mortgage, and a 401(k) withdrawal. The company was acquired just 15 months in. That deal kicked off a domino effect of acquisitions: from Nexa to Tornier to Wright Medical&mdash;and finally, back to Stryker.
But Peter wasn&rsquo;t done. He built a preoperative planning software company next, enabling 3D-printed, patient-specific surgical instruments. Still, he saw a gap: &ldquo;Once you get into the OR, the plan changes.&rdquo;
<h3 data-start="1277" data-end="1331">The Birth of Redefine Surgery: AI Built for the OR</h3>
That insight seeded Redefine Surgery, a company focused on intraoperative intelligence. Unlike legacy robotics systems that rely on slow, hardware-heavy setups, Redefine uses a robotic vision system powered by AI to track instruments, bones, and surgeon hands&mdash;all in real time, with no need for bone screws or lengthy registration steps.
The result? A radical efficiency boost. Peter predicts that procedures which currently take 45 minutes can drop to just 10.
<h3 data-start="1797" data-end="1831">What Makes Redefine Different?</h3>
<ul data-start="1833" data-end="2350">
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AI That Understands Surgery: Redefine isn&rsquo;t just tracking. It&rsquo;s learning from the best surgeons and building AI models based on their techniques.
</li>
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Vision-Led Robotics: Their system automatically adjusts lighting and positioning while recognising instruments and anatomical structures&mdash;removing the need for traditional fiducial markers.
</li>
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Partnership First: Rather than launching direct-to-market, Redefine partners with implant companies to embed their tech&mdash;like &ldquo;Intel Inside&rdquo; for orthopaedic surgery.
</li>
</ul>
<h3 data-start="2352" data-end="2407">Commercialisation &amp; the Future of Surgical Robotics</h3>
Peter sees the future of orthopaedics as smaller, smarter, and more accessible&mdash;particularly in ambulatory surgical centres (ASCs). By speeding up procedures and reducing cost and complexity, AI-powered tools like Redefine&rsquo;s can enable broader adoption beyond large hospital systems.
He also touched on the evolving role of surgical reps, arguing they are still indispensable&mdash;but need better tools and better treatment, especially around issues like poor-quality disposable scrubs.
<h3 data-start="2892" data-end="2922">Raising Capital for Growth</h3>
Redefine is currently raising a seed round to support further deployment and partner integrations. Peter emphasised that this round will help unlock hundreds of thousands of procedures over the next five years, offering medical device companies new revenue streams and a faster route to market with intelligent navigation.
<h3 data-start="3248" data-end="3282">Lessons in Building for Impact</h3>
Peter&rsquo;s biggest lessons? Timing matters. The wrong investor or partner can slow you down. But the right team&mdash;co-founders you trust, versatile hires, and early customers who believe in the mission&mdash;makes everything possible.
<blockquote data-start="3508" data-end="3676">
&ldquo;We&rsquo;re not just tracking. We&rsquo;re teaching machines to understand what good surgery looks like&mdash;so that knowledge can be shared across the entire orthopaedic ecosystem.&rdquo;
</blockquote>
<h3 data-start="3678" data-end="3696">Final Thoughts</h3>
Redefine Surgery is more than a robotics or AI company. It&rsquo;s a new model for how surgical intelligence is built, delivered, and scaled. If Peter&rsquo;s vision comes true, the next generation of orthopaedic procedures will be faster, more precise, and more widely accessible&mdash;thanks to AI that truly understands what&rsquo;s happening in the OR.

Peter Verrillo, CEO of Redefine Surgery

Artificial Intelligence Feels Like Magic - With Peter Verrillo

David Caumartin, CEO of RebrAIn

“AI is not Taking the Lead, AI is the Enabler” - With David Caumartin

Dimitri Sokolov, CEO of Spiro Robotics

Making Difficult Intubation a Thing of the Past - With Dimitri Sokolov, CEO of Spiro Robotics

Top Mistakes Surgical Robotics Companies Make in Technology Development - Paul Galluzzo - TTP PLC

Flexibility, Accessibility, Simplicity: Dexter’s Approach to Robotics - Greg Roche – Distalmotion

Don’t Believe The Hype – We Need More Clinical Evidence - Mark Slack - CMR Surgical

Pimp My Robot – How Ultrasonics Will Get Better Outcomes - Nico Fenu - Nami Surgical

The World’s First Arthroscopic Robot - Chris Jeffery - Convergence Medical

How to Do Remote Surgery, 2001 to 2024 - Cynthia Perazzo & Yulun Wang

The Biggest Competition for Surgical Robotics Companies - Bjoern von Siemens - Caresyntax

Exploring the Future of Surgical Robotics: Insights from Rajit Kamal of Medtronic

Why Developing Soft Tissue Robots isn't for the Faint of Heart - Rajit Kamal – Medtronic

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<h2>Insights on Surgical Robotics and Market Evolution: A Conversation with Sabeen Shaikh</h2>
<h3>Introduction</h3>
The Surgibots Podcast is a premier platform for discussing cutting-edge advancements in surgical robotics. In Season 3, Episode 2, host Henry Norton welcomed Sabeen Shaikh, Partner at Life Sciences Consultants (LSC), to delve into the evolution of surgical robotics, adoption challenges, and future trends shaping the industry. With over 20 years of experience spanning MedTech giants like Stryker and Medtronic, Sabeen offered invaluable insights into the complexities and opportunities in this transformative field.
This episode covered a wide range of topics, from technological advancements to the strategic shifts driving robotics adoption, making it essential reading for professionals in healthcare, MedTech, and investment sectors.
<hr>
<h3>Sabeen Shaikh: A Leader in Life Sciences and MedTech</h3>
Sabeen&rsquo;s career journey is a testament to her expertise in surgical robotics and life sciences. Starting her career at Stryker Navigation, she played a pivotal role in launching the Libere image-guided surgery system in the U.S. market. After moving through leadership roles at Medtronic and contributing to operations in Australia and New Zealand, she transitioned to consulting. At LSC, she co-leads the MedTech practice, advising global corporations, startups, and investment funds on upstream and downstream commercial strategies.
<hr>
<h3>The Evolution of Surgical Robotics</h3>
Having been at the forefront of surgical robotics since its inception, Sabeen highlighted how the field has evolved over two decades. Early systems like Stryker&rsquo;s Libere faced significant hurdles, including:
<ul>
<li>High Costs: Initial systems were expensive, with prices ranging from $500,000 to $2 million.</li>
<li>Workflow Disruption: Integrating robots into surgical workflows often slowed procedures, making surgeons reluctant to adopt the technology.</li>
<li>Uncertain Outcomes: With limited data on improved patient outcomes, early robots struggled to prove their value.</li>
</ul>
Despite these challenges, advancements in preoperative planning, intraoperative execution, and outcome tracking have propelled surgical robotics into the mainstream.
<hr>
<h3>Adoption Challenges in Surgical Robotics</h3>
Today, only 20% of surgeons use robotic systems regularly, a statistic that underscores ongoing barriers to adoption. Sabeen identified key issues:
<ol>
<li>Workflow Disruption: Time-intensive setup and unfamiliarity with robotic systems deter adoption.</li>
<li>Surgeon Skepticism: Many surgeons believe their manual techniques are already optimal, creating resistance to new technologies.</li>
<li>Overengineered Systems: Robots with excessive features often fail to address surgeons&rsquo; core needs, complicating usability.</li>
</ol>
Addressing these challenges requires a nuanced understanding of surgeon behavior and a focus on simplifying systems while retaining essential functionalities.
<hr>
<h3>The Role of Ambulatory Surgery Centers (ASCs)</h3>
ASCs, or day surgery centers, are revolutionizing healthcare delivery by providing efficient, cost-effective environments for outpatient procedures. Sabeen emphasized the growing importance of ASCs in orthopedic, spine, and cardiovascular surgeries. Factors driving this shift include:
<ul>
<li>Efficiency: ASCs offer faster turnaround times compared to hospitals.</li>
<li>Surgeon Ownership: Many ASCs are owned by surgeons, incentivizing their use.</li>
<li>Technology: Smaller robotic footprints tailored for ASCs are emerging, although challenges remain in standardizing platforms and workflows.</li>
</ul>
<hr>
<h3>Business Models in Robotics: Closed vs. Open Platforms</h3>
The debate between closed and open platforms is a pivotal one. Closed platforms, designed to work exclusively within a single company&rsquo;s ecosystem, drive implant sales but limit flexibility. Conversely, open platforms offer compatibility with multiple systems, appealing to ASCs but challenging traditional business models.
Sabeen argued that the future lies in data-driven business models, where insights from preoperative to postoperative phases enable better decision-making and outcome optimization. This shift will redefine profitability in the robotics industry.
<hr>
<h3>The Strategic Role of Mergers and Acquisitions</h3>
Strategic acquisitions play a critical role in the growth of surgical robotics. Sabeen outlined what large players look for in startups:
<ul>
<li>Product-Market Fit: Alignment with market demands is crucial.</li>
<li>Technological Integration: Seamless compatibility with existing ecosystems enhances acquisition potential.</li>
<li>Early Engagement: Building relationships with potential acquirers early ensures alignment with their long-term strategies.</li>
</ul>
Startups that address unmet needs and offer unique value propositions are well-positioned for acquisition.
<hr>
<h3>Predictions for the Future of Surgical Robotics</h3>
Looking ahead, Sabeen shared bold predictions for the next decade:
<ol>
<li>AI and Machine Learning Integration: From predictive analytics to workflow optimization, these technologies will revolutionize surgical robotics.</li>
<li>Advanced Reimbursement Models: Data-driven insights will influence reimbursement structures, holding surgeons and hospitals accountable for outcomes.</li>
<li>Increased Surgeon Ownership: As younger, tech-savvy surgeons gain ownership stakes in ASCs, robotic adoption will accelerate.</li>
</ol>
<hr>
<h3>Sabeen Shaikh&rsquo;s Thought Leadership</h3>
Sabeen&rsquo;s role on the Forbes Business Council underscores her influence in the MedTech ecosystem. Through her Forbes series, she aims to address gaps in innovation, investment, and strategy, drawing from her global experience in healthcare.
<hr>
<h3>Conclusion</h3>
Sabeen Shaikh&rsquo;s insights on The Surgibots Podcast provide a comprehensive look into the past, present, and future of surgical robotics. As the field evolves, addressing adoption challenges, embracing data-driven models, and fostering innovation will be critical to unlocking its full potential.
For professionals in MedTech and healthcare, staying informed about these trends is more than a necessity&mdash;it&rsquo;s an opportunity to shape the future.
</div>

Want to Build a Competitive Robot? Build for the ASC - Sabeen Shaikh - Life Science Consultants

📺 You can now watch the full episode on Youtube&nbsp;
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🎙️ Or Listen on Spotify or Apple Podcasts
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<a href="https://podcasts.apple.com/gb/podcast/the-surgibots-podcast/id1676605171?i=1000671642915" target="_blank" rel="noopener">Apple Podcasts </a>
The medtech space, particularly surgical robotics, is a rapidly changing industry with immense potential for professionals in various roles. In Season 3, Episode 1 of The Surgibots Podcast, I spoke with Nnamdi Njoku, a seasoned leader in the medtech space, about his journey through the industry and his thoughts on the future of surgical robotics. Nnamdi shared his unique perspective on moving into the medtech world, leading robotics initiatives, and the importance of integrating technology with patient care. Here's what he had to say about his experience in the field and the future of surgical innovation:
What was your first experience with surgical robotics, and how did you get involved?
&nbsp;&ldquo;My first experience in robotics was with Medtronic, particularly when I got asked to help move forward the strategy we called at the time &lsquo;Surgical Synergy,&rsquo; which was really all about trying to figure out what enabling technologies would do to improve spine surgery. At that time, I didn&rsquo;t know much about robotics, but what I did know was that we were trying to shape a strategy around these enabling technologies and see how they could be used to make spine surgeries more precise and efficient.
I started by asking a lot of questions and learning from the experts in the field. I was tasked with crystallizing the strategy for robotics in spine surgery, working out what M&amp;A transaction needed to happen, and determining what robotic platform would fit best into our company&rsquo;s strategy. It was exciting to see how robotics could be integrated with our technologies, and that early experience showed me just how much potential robotics has in this space. The decisions we made back then have continued to pay dividends for the company, and it&rsquo;s amazing to see how far the field has come since those early days.&rdquo;
What excited you about joining Zimmer Biomet?
&ldquo;When I first considered joining Zimmer Biomet, a couple of things stood out to me. First, I was really impressed by the company&rsquo;s long-standing history&mdash;they&rsquo;ve been around for almost 100 years, which is pretty incredible. They have this mission-centric focus that has driven their success, and that really resonated with me. Given where I was coming from at Medtronic, I was looking for a company that had a clear purpose and mission, and Zimmer Biomet absolutely fit that bill.
What also caught my attention was where the company was at that point in time and where it could go in the future. They had already gone through a tough period of integrating Zimmer and Biomet, and they were looking toward the future with a strong focus on innovation. They weren&rsquo;t just resting on their laurels&mdash;they were actively thinking about what it would mean to develop new technologies and lead the market. That vision of transformation, combined with the strong leadership and talented team, made it an exciting place to be. I knew I wanted to be part of that journey.&rdquo;
How do you ensure a successful rollout of new robotic technologies?
&ldquo;Rolling out new technologies, especially something as complex as robotics, requires a very intentional approach. You have to be very deliberate about where you place the technology. It&rsquo;s important to make sure you&rsquo;re putting it in locations where it&rsquo;s going to get used, where there&rsquo;s strong surgeon engagement, and where you have the ability to service it effectively. If you place a system somewhere and it&rsquo;s not getting used or if you don&rsquo;t have the resources to support it, you&rsquo;re not going to get the kind of feedback and insights you need to make improvements.
Training is a critical part of this. It&rsquo;s not just about giving a surgeon the technology and expecting them to be an expert right away. You need to provide ongoing training and support, especially in those first few cases. It&rsquo;s a process of learning and adaptation, and you need to be there every step of the way to ensure success. Ultimately, it&rsquo;s about setting the right expectations and being clear about where you are in the launch cycle. You have to have the right metrics in place and be constantly assessing how things are going so that you can make adjustments as needed.&rdquo;
What does the future of surgical robotics look like, particularly in orthopedics?
&nbsp;&ldquo;I think we&rsquo;re going to see a lot of exciting developments in the future of surgical robotics, especially in orthopedics. One of the biggest trends I see is the miniaturization of these robotic platforms. Right now, some of the systems are quite large, which is fine in a hospital setting, but as more surgeries move into ASCs [Ambulatory Surgery Centers], there&rsquo;s a real need for smaller, more efficient systems that can fit into those environments.
I&rsquo;m also really excited about advancements in tissue sensing. Imagine a robotic system that can adapt based on the type of tissue it&rsquo;s interacting with. That&rsquo;s a huge step forward in terms of precision and personalization, and I think we&rsquo;re going to see more of that in the coming years. AI is another area with enormous potential. We&rsquo;re already capturing a lot of data during surgeries, and as we get better at analyzing that data, I think we&rsquo;ll be able to use AI to improve surgical outcomes and even predict potential complications before they happen.
And then, there&rsquo;s the possibility of remote surgical approaches. As someone who comes from the African continent, I think a lot about how remote surgery could increase access to specialized care in parts of the world where there aren&rsquo;t enough surgeons. You could have a surgeon in one country supporting or even performing a surgery in another, which could dramatically improve access to care. The future is incredibly exciting, and I think we&rsquo;re just scratching the surface of what&rsquo;s possible.&rdquo;

Launching Shoulder Robots to the World - Nnamdi Njoku - President Zimmer Biomet

Autonomous surgical robotics are still a thing of the future. However, when I spoke to Nick Damiano, the CEO &amp; Co-Founder at Andromeda Surgical, on Season 2 Episode 9 of The Surgibots Podcast, he explained how he&rsquo;s bringing them closer than ever before. As a third-time founder and veteran of the medical devices space, Nick is perfectly placed to talk us through groundbreaking tech and how to shape the industry and the wider public&rsquo;s perceptions of it. &nbsp;
It seems like autonomous driving and autonomous surgery are quite far away from each other. So how do the same principles translate from self-driving cars to surgery? &nbsp;
It's very interesting to compare and contrast those two spaces. It is fundamentally the same challenge at heart - you're trying to understand the world that you're operating in and make autonomous decisions based on that. At a very basic level, it's the same challenge. &nbsp;
However, there are a lot of differences when you get into the details. One thing with the driving world is a lot more complex than surgery, or at least the procedure we're doing, which is the number of variables. When you think about a car and everything it might encounter as it's driving around, there are so many different edge cases that you wouldn't get in human body surgery. The human body is pretty variable, and you get weird anatomies or unexpected things that come up during the procedure, but it's a much smaller set of things that can happen than in the entire world, which is where automotives exist. &nbsp;
That said, the data you can collect to train models in surgery is a lot smaller than the data set you can get in driving. You can't just drive a surgical robot around people's bodies continuously like you could for a car, so something that balances the lack of complexity is the sparsity of data. &nbsp;
When you bring up autonomous robotics, how do agencies like the FDA react? &nbsp;
AI and autonomy definitely raise some alarm bells with the FDA. There are going to be some safety concerns when they come up. We didn&rsquo;t get into too many details in our initial meeting, but it was a big topic of discussion later on. &nbsp;
However, even without the FDA being there, we're very safety-focused. Even though we're trying to move fast, we want to make sure that we can feel confident that this product is going to be safe and deliver the results that we want it to every time. We had already developed a suite of tests, and we'd deliberately thought about the procedure and the features we were building for this first version of the product and made sure we weren't building anything that was too crazy or risky in the beginning. &nbsp;
As a result, the FDA conversation so far has been really productive. Being transparent and straightforward and showing them that we do care about safety and helping patients was really beneficial. We also want to make sure they're aware of the benefits, not just the risks.  That's something a lot of companies are afraid to bring up, but balancing the conversation in that way seems like it's going really well so far. &nbsp;
Do you think there is a need for a patient education piece when it comes to autonomous surgery?&nbsp;
Yes. We&rsquo;re seeing parallels with the early days of DaVinci and what we've seen with autonomous vehicles. When you compare this to autonomous vehicles, we are taking a similar approach to where Tesla sold these cars initially and started training the autonomous features in the background as people were driving manually, as opposed to the way Moe and Cruz launched their fully autonomous cars. Whether it was deserved or not, the latter have gotten a lot of bad press, and there has been a lot of fear around those products, even if they are beneficial on the whole. People focus on specific incidents where the car got in an accident, and we're going to have to face a lot of the same. &nbsp;
We want to make sure that we are ready for that messaging effort. That means building incrementally in a way that keeps safety at the focus. The fact that we have a skilled human surgeon who's trained on these procedures in the loop is a big help in itself because the result will be a collaboration between the surgeon and the AI. We have a human involved who can prevent some of the bad outcomes from happening. Even though we want to move fast, we have to slow down to make sure that we build every incremental step of autonomy safely. &nbsp;
To find out more about Andromeda Surgical&rsquo;s work and Nick&rsquo;s perspectives on surgical robotics, tune into Season 2 Episode 9 of The Surgibots Podcast here. &nbsp;

Changing Perceptions of Autonomous Surgical Robotics     

Autonomous surgical robotics are still a thing of the future. However, when I spoke to Nick Damiano, the CEO &amp; Co-Founder at Andromeda Surgical, on Season 2 Episode 9 of The Surgibots Podcast, he explained how he&rsquo;s bringing them closer than ever before. As a third-time founder and veteran of the medical devices space, Nick is perfectly placed to talk us through groundbreaking tech and how to shape the industry and the wider public&rsquo;s perceptions of it. 
<blockquote>
It seems like autonomous driving and autonomous surgery are quite far away from each other. So how do the same principles translate from self-driving cars to surgery? 
</blockquote>
It's very interesting to compare and contrast those two spaces. It is fundamentally the same challenge at heart - you're trying to understand the world that you're operating in and make autonomous decisions based on that. At a very basic level, it's the same challenge. 
However, there are a lot of differences when you get into the details. One thing with the driving world is a lot more complex than surgery, or at least the procedure we're doing, which is the number of variables. When you think about a car and everything it might encounter as it's driving around, there are so many different edge cases that you wouldn't get in human body surgery. The human body is pretty variable, and you get weird anatomies or unexpected things that come up during the procedure, but it's a much smaller set of things that can happen than in the entire world, which is where automotives exist. 
That said, the data you can collect to train models in surgery is a lot smaller than the data set you can get in driving. You can't just drive a surgical robot around people's bodies continuously like you could for a car, so something that balances the lack of complexity is the sparsity of data. 
<blockquote>
When you bring up autonomous robotics, how do agencies like the FDA react? 
</blockquote>
AI and autonomy definitely raise some alarm bells with the FDA. There are going to be some safety concerns when they come up. We didn&rsquo;t get into too many details in our initial meeting, but it was a big topic of discussion later on. &nbsp; &nbsp; However, even without the FDA being there, we're very safety-focused. Even though we're trying to move fast, we want to make sure that we can feel confident that this product is going to be safe and deliver the results that we want it to every time. We had already developed a suite of tests, and we'd deliberately thought about the procedure and the features we were building for this first version of the product and made sure we weren't building anything that was too crazy or risky in the beginning. &nbsp; &nbsp; As a result, the FDA conversation so far has been really productive. Being transparent and straightforward and showing them that we do care about safety and helping patients was really beneficial. We also want to make sure they're aware of the benefits, not just the risks.  That's something a lot of companies are afraid to bring up, but balancing the conversation in that way seems like it's going really well so far. 
<blockquote>
Do you think there is a need for a patient education piece when it comes to autonomous surgery?
</blockquote>
Yes. We&rsquo;re seeing parallels with the early days of DaVinci and what we've seen with autonomous vehicles. When you compare this to autonomous vehicles, we are taking a similar approach to where Tesla sold these cars initially and started training the autonomous features in the background as people were driving manually, as opposed to the way Moe and Cruz launched their fully autonomous cars. Whether it was deserved or not, the latter have gotten a lot of bad press, and there has been a lot of fear around those products, even if they are beneficial on the whole. People focus on specific incidents where the car got in an accident, and we're going to have to face a lot of the same. &nbsp; &nbsp; We want to make sure that we are ready for that messaging effort. That means building incrementally in a way that keeps safety at the focus. The fact that we have a skilled human surgeon who's trained on these procedures in the loop is a big help in itself because the result will be a collaboration between the surgeon and the AI. We have a human involved who can prevent some of the bad outcomes from happening. Even though we want to move fast, we have to slow down to make sure that we build every incremental step of autonomy safely. 
<h5>To find out more about Andromeda Surgical&rsquo;s work and Nick&rsquo;s perspectives on surgical robotics, tune into Season 2 Episode 9 of The Surgibots Podcast above, or on Spotify, Apple Podcasts or Amazon Music. </h5>

Surgibots S2 Ep 9 Blog

The Tesla of Surgical Robotics

The surgical robotics industry is an innovative space that regularly produces a number of unique platforms. During Episode 8 of The Surgibots Podcast I spoke with Lucien Goffart, the CEO of Robocath, to talk about his experiences in a first-to-market surgical robotics company. &nbsp;
Can you tell us about Robocath&rsquo;s technology and the problems it solves?&nbsp;
We are developing and manufacturing a robotic platform for vascular interventions. We are making it for the European and Chinese markets. We are bringing precision to intervention. That is a key advantage of any robotic platform because it results in better treatment and therefore better patient outcomes. What really differentiates vascular robotics is that they are the only physician specialities that are exposed to X-rays. So, on top of the precision and ergonomic movements of the physician, we are also bringing protection and better working conditions to the physicians and vascular lab staff. &nbsp;
That is what vascular robotics is bringing today. If we think about tomorrow, though, robotics will be able to solve the problem of no man's land hospital areas and all sorts of other problems. And in some countries that are having lack of positions, some, so this is going to be the next step. Autonomous navigation interventions using AI are something else I can see in our future. We are at the very beginning of our vascular robotic journey today with the key advantages that I just mentioned earlier.&nbsp;
How far away do you think we are from the world of remote surgery? &nbsp;
From a technological standpoint, we have an attribute gap. We have to know how to perform remote procedures, and we did it ten times on animals a couple of years ago, and last year we performed a remote procedure in China from around 2000 miles away on a patient. So we do know how to do it. It is not science fiction. Catching up with certain security aspects, such as cybersecurity, will allow us to move forward and make it a daily practice. It won't be Robocath&rsquo;s job actually to solve that, because it is not where we have our core competencies, but we will have to work with companies who are working in that to ensure that if we use remote procedures, it can happen safely. &nbsp;
Secondly, who will be responsible if something goes wrong? Would it be down to the physician who is operating? Would it be the teams around the patient? The main responsibility lies with cybersecurity and the hospitals involved. They need to decide if it makes sense to use a remote procedure. If the patient is dying because they cannot get into the right hospital quickly enough for the physician to save their life, should you use a remote robotic intervention? For stroke procedures, where every second counts, the remote capability will definitely save lives. Robotic platforms plus remote capabilities make a lot of sense in vascular and neural space. &nbsp;
What are the advantages of being first to market?&nbsp;
There are pros and cons. We had a competitor, which was good because having someone to fight against makes it easier to develop the market you&rsquo;re in. When there are two or three risers, they have the money and power, to diffuse the rights messages. They can also provide big clinical trials to prove that this technology is essential, which paves the way for smaller companies to compete in the market. On the other hand, when you are alone, you know that one day or another, the competition will come. So here's the rule of the game: it's okay to say, &lsquo;We are the first one, and this is this is what we want to achieve&rsquo;, but you have to keep driving towards those goals without the competition, or you won&rsquo;t measure up when it comes. &nbsp;
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Developing Innovative Surgical Robotics Technology     

On Season 2 Episode 7 of The Surgibots Podcast I had the pleasure of getting to know Sudhir Srivastava, the Founder, Chairman &amp; CEO of SS Innovations. During the conversation, he explained the advanced technical features of the SSI Mantra and the impact those features will have on the wider surgical robotics field. &nbsp;
Here are his insights: &nbsp;
&ldquo;If we compare the SSI Mantra with the industry leader, there are several differences, starting with the surgeon console. With the previous model, you're sitting hunched over, and you don't see your hand controls. You have an eight-inch screen, and then you have little windows where you can pull in whatever images - which in my opinion doesn't provide meaningful analysis. Your posture was not very ergonomic, your hands are colliding with each other or hitting the roof of the system, or you&rsquo;re pressing the wrong foot pedal. &nbsp;
What we have designed is an open finish console with a large 32-inch 4k monitor, with the head tracking camera on the top for safety. If you're not watching the stream, your system won't respond - even if you move your hairs. Secondly, we have given a large 2D touch panel monitor that can present these DICOM, CT, MRI, angiogram, echo, etc. images in a meaningful way. Our Maya division can take any of these images and convert them into a 3D model so that you can rotate it and access the entire anatomy of the patient in front of you. That will make the procedure safer and faster.&nbsp;
Next, we have the controls. Ours are ergonomic - designed differently than the currently available options, they rest in your palms. There is no muscle tension compared to when surgeons grip something like rings or a pistol grip. Our design allows the muscles from your hand right up to your neck to loosen. That allows you very free motion so you can do very precise movements. Ours is the only system that is prepared - right from the beginning - for the surgeon to control five arms. &nbsp;
Our vision card is unparalleled. The combination of the high-definition monitor and 3D models gives the entire surgical team the same view. Accidents occur when you&rsquo;ve only got 2D vision - I&rsquo;ve seen them happen - and that's why you got 3D vision in our model. It is very important to have that perception. Accidents won't occur when the nurses are bringing supplies, because they&rsquo;ll know exactly where to go. 3D vision also shortens the learning curve. You have hesitation in 2D. People take things very slowly, being very careful, which adds to the time. If you shorten the learning curve by providing better visibility and therefore more confidence, ultimately that improves the quality. &nbsp;
Our system also has built-in recording and playback capabilities. You can record all your procedures and watch them or broadcast them. This is one of the things I found when I was in practice, and even now, it's not always easy to find people who will mentor others because you have to fly here and there. We've utilised the technology, to the point that our Maya division has advanced far beyond anyone else here now. We&rsquo;ve adopted a holistic approach in the sense that when we were looking at this whole training cycle, the idea was to not only go through the routine curriculum etc but ultimately shorten the learning curve, avoid accidents and improve the outcome. &nbsp;
We have also built in real guidance. You can input the type of surgery you want to perform, and the system will ask &lsquo;Do you know where to place the ports in relation to our system and the target?&rsquo;, which removes the guesswork and makes it more efficient. We are looking at the future and creating a 3D reconstructed operating room we can push the button based on the target anatomy and the surgery and the cars will move on their own and practice. &nbsp;
We&rsquo;re including a lot of futuristic ideas in relation to the robotic arms and cars. Every robotic arm with these attachments is mounted on a separate car, which allows you to place them wherever required. You are not boxed in by the arms attached to one set point. That gives you flexibility based on the target anatomy, body habitus, room setup etc. Since it is modular, you can use any number of arms based on your requirements. Cardiac enabling technology will use the fifth arm, whereas transfer procedures typically use four, and a simple pelvic or gallbladder operation only needs three. &nbsp;
Our system is designed to fit a budget, reduce expenses, and address costs while being incredibly user-friendly. When we talk about some of the technology&rsquo;s attributes, we have developed several cardiac enabling technologies that no one else has, which will become a lifeline for the patient, because it gives bypass surgery a predictable outcome. It&rsquo;s also levelling the playing field regarding the human skill level. We have kept all of these maps in mind to help the surgeons and change the direction across the spectrum.&nbsp;
To find out more about SS Innovations&rsquo; work and how Sudhir Srivastava intends to drive the company forward, listen to Season 2 Episode 7 of The Surgibots Podcast here. &nbsp;
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&nbsp;

Inside SS Innovations’ Mantra System

The surgical robotics space is a richly varied industry that&rsquo;s full of opportunities. Whether you&rsquo;re an engineer, leader or marketer, there&rsquo;s plenty of potential. On Season 2 Episode 5 of The Surgibots Podcast I spoke to Jeff LaConte, the Vice President of Global Marketing and Business Development at Medical Microinstruments, about his personal experience of moving through the surgical robotics space. Here&rsquo;s what he said about his experience of moving into and progressing through the surgical robotics sector so far: &nbsp;
What was your first experience with robotics, and how did you transition into the space?&nbsp;
My first experience with robotics was back in the Ethicon endosurgery days where I led a portion of the business, and we were competing with the early days of Intuitive. I was looking at their trajectory, spending time evaluating what they were doing, and obviously watching how they've gone from those early days to where they are now. Before that, I was spending a little bit of time looking at what J&amp;J was thinking about and wondering how to approach that side of the business. &nbsp;
From an orthopaedic standpoint, with Velis, my first experience was with the prototype. It was an acquisition from a very impressive company - eCential Robotics and Stefan, who I believe you've had on The Surgibots Podcast before - and seeing that prototype and knowing that our great r&amp;d team had plans to accelerate it as quickly as we could to bring it to market was really my first experience of the surgical robotics space. &nbsp;
We had to really look at what was in the market and figure out the advantages of being fourth to market. We were able to see what was working and what was not, and pivot quickly so that we could offer something really unique to the market despite being fourth. I believe that that team really did that, and transformed that space from these big robotic concepts to something that is a little bit smaller and more fit for form. That first experience showed me that there's a lot of impressive technology in that space; I think we&rsquo;ve got some of the most technologically savvy concepts that are on the market. &nbsp;
Talk to me about what it was that you saw in MMI.&nbsp;
With where things were at J&amp;J, I didn't want to leave for just any technology. I didn't want to leave for anything other than really the right opportunity. When I looked at what we have here at MMI with their R&amp;D team, and the incredible leadership from Mark on the executive side, it was really eye opening, and a bit of a no brainer. MMI is a technology where there really is no other technology in this space. It's targeting minimally open procedures, which I saw in some of my early work at Ethicon endosurgery in the laparoscopic space. There's been so much focus on laparoscopy - rightly so - and advancing that through natural orifice surgery, that I haven&rsquo;t seen anybody else develop something like what MMI has. &nbsp;
There is this concept that opened my eyes, which is that there are many procedures that will never be laparoscopic, they will always be open, and a lot of them are in the plastic reconstructive space. Some of the most talented surgeons on the planet are performing a lot of these procedures, and it&rsquo;s a big range of applications for what MMI and the Cemani robot can do. I really saw an opportunity to come into the space and bring our technology to a target audience that has not really had advanced technology like this before. In some ways, the last great technology that they may have had may have been an awesome microscope, but we are offering them something that can do everything from extend careers down to change procedure types and go even more minimally invasive. We can really change lives.&nbsp;
How have you found the transition so far?&nbsp;
It's maybe not exactly what I expected. but there are definitely pieces that I just mentioned that I did expect. I did expect it to be fast. I did expect it to be dynamic. I did expect to wear multiple hats here. When you talk to anybody who is a former big company person, and say, &ldquo;Hey, are you willing to wear many hats? Can you do X, Y, and Z?&rdquo; The answer is yes. Folks in all these big companies do that. I think that sometimes goes unrecognised, or there's this perception from smaller companies that the bigger company, the people and assets and resources, etc. there are, and that's not always true. &nbsp;
The other thing that I would say that is not quite as expected is the opportunity to constantly engage with our customers. I did have a little bit more of an expectation that folks may not necessarily know exactly who we are and what we're doing, but that is not the case at all. This space definitely knows who we are and what we're doing, and the engagement is fantastic. The opportunity to get out, see customers, spend time with them in their facilities and talk to their staff has been fantastic. Sometimes in big companies that isn't something you can do all the time, because of travel restrictions, a different focus, or more internal management that has to take place. At MMI we&rsquo;re absolutely focused on creating our technology, changing a space and ensuring the customers understand exactly what we're talking about, then really continuing that loop.&nbsp;
To learn more about Jeff and his work at Medical Microinstruments, tune into Season 2 Episode 5 of The Surgibots Podcast here. &nbsp;
&nbsp;

Developing a Career in Surgical Robotics 

On Season 2 Episode 5 of The Surgibots Podcast I was joined by Eli Shapiro, the Chief Executive Officer and Co-Founder of W Endoluminal Robotics, to talk about the innovative system that the company is creating. We touched on the importance of real-time imaging in bronchoscopy, how their system is enabling surgeons to perform more intricate and complex procedures and why simple concepts are the key to creating effective surgical robotics technology. &nbsp;
What is the W Endoluminal product?&nbsp;
At W Endoluminal Robotics, we&rsquo;ve taken a different approach than other systems. We enhance the capabilities of the physician in the room, and we allow additional degrees of freedom, which is something that physicians don't have in conventional, augmented or even robotically assisted bronchoscopy. We&rsquo;ve designed a system with two lumens inside of it, which, with conventional tools like radial Airbus in the IP room, allows us to visualise the nodule and sample it with real-time imaging. That creates certainty for the physician that they took a biopsy from the right place. From a clinical aspect, that's mind blowing.&nbsp;
What's the challenge with the way these procedures are currently done that real-time imaging is trying to solve?&nbsp;
With lung cancer, it's a problem because all the nodules start from the periphery and propagate toward the centre of the lungs. In the periphery of the lungs, you have a great anatomical challenge, because you're trying to reach the nodules through the airways, which are very tiny. That creates a few challenges. The stiffness of the tool it's crucial there. From one perspective, you want to be very flexible so that you do not harm the anatomy. On the other hand, you want to have a lot of steering force to steer the tools towards the target. It's the longest navigational challenge, because you need to remember all the turns that you have to take during the way. &nbsp;
The biggest challenge is that the procedure today is done blindly. You don't have real-time imaging. In most cases, when you reach the target the airway collapses on top of your bronchoscopes, but you can&rsquo;t see what&rsquo;s happening. Olympus developed a good device that is a rather small ultrasound probe that can reach the target and allow you to see the nodule itself, but the problem is that you need to take out the ultrasound, and then introduce your biopsy tool, which only has a 70% chance of getting to the same place. &nbsp;
We believe that we solve these issues with our system. You might not have a lot of space for fancy technology such as electromagnetic navigation, and we struggled to show the efficacy for the cost that brings. You need simple and clever solutions, which we believe we have developed at W Endoluminal Robotics.&nbsp;
What's the simple and clever solution you mentioned?&nbsp;
On the clinical side, we introduced the ultrasound tool and biopsy tool through different airways, and then allowed them to meet in the middle to show the target by providing real time imaging of the tool in a nodule. On the mechanical side, instead of applying force all along the bronchoscope, we multiply the forces on the end (which is the steering region), which is how we&rsquo;ve created a flexible construction. We combined gastro cardiology to route the wires differently, which allows us to make a simple, capable system that is very affordable for the physician. &nbsp;
Talk to me about how a surgeon actually controls the robot. What does the control panel look like? &nbsp;
There are two approaches on the market today; you have the aisle approach where a controlling console will use one arm for steering and another for advancement, and then you have the approach that Monarch and Galaxy have taken, where there is a control console that is used in both hands like an XBox controller. We have created a controller that a physician can hold with one hand to control the robot, and then use the other hand to do other things throughout the procedure, which reduces the need for additional assistants in the operating theatre. &nbsp;
To learn more about the advancements that Eli and W Endoluminal Robotics are making in the bronchoscopy space, tune into Season 2 Episode 5 of The Surgibots Podcast here. &nbsp;
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&nbsp;

Inside W Endoluminal Robotics 

When adopting a new piece of technology, it can take surgeons time to adapt. On Episode 4 of Season 2 of The Surgibots Podcast I was joined by Edvardas Satkauskas, the CEO and Co-Founder of Inovatyvi Medicina, to talk about the process of developing a seamless clinical workflow through innovative surgical robotic technology. &nbsp;
Here are his insights: &nbsp;
What makes the Sentante platform so ambitious?&nbsp;
There are two key things about Santana. One is that we designed it to perform entire procedures robotically. That is a big contrast from robotically assisted technology, where physicians are still required to be in the room in order to do the procedure. We designed Santana in such a way that you could do an entire procedure using robots. What that means is that you have the ability to use any endovascular devices or instruments during the procedure, and we are compatible with most standard, off the shelf vascular devices, so physicians can use any devices they are used to during the procedure, but now they can manipulate three devices at a time. So we haven&rsquo;t changed devices or the clinical workflow - the same people are responsible for doing the same things, except that we have taken the physician out of the operating theatre. &nbsp;
We haven&rsquo;t even changed how the physician operates on their own. Santana works because the interface between physician and the robot is the same as the methods they are trained to use. Physicians have an interface with the robot that includes the devices, guide, wire catheter and diagnostic. Whatever the physician does in the cockpit, the robot senses all the movements with linear or rotational movement and translates the exact same movement to the patient side. If there's resistance from the patient, the surgeon can actually feel it in the cockpit through real time haptic force feedback. In that sense, the most ambitious part is that the physician has to retain the ability to feel the resistance of the devices in real time, not just rely on X-ray imaging. That feedback is part of information that doctors base their decisions on while doing the procedure. &nbsp;
Given that we have to be compatible with a wide range of devices, the system is very dynamic. We have very thin guide wire, which is very sensitive, whereas if you take a very stiff guide wire, where you would use brutal force to get through calcification, those are very different conditions to work in. The system has to be compatible with both of them. It has to provide that haptic force feedback as well as the ability to manipulate the devices as they would be manipulated during medical procedure. Ours is a system that seamlessly integrates into clinical workflow, because physicians can use their existing skills alongside the system after as little as 10 minutes. They don't lose anything, but they gain so much more.&nbsp;
Is there anything that people haven't liked about Sentante?&nbsp;
Absolutely. There was some feedback that suggested some improvements, which is actually very difficult in our situation, because we are trying to build a system for endovascular interventions. You can do peripheral interventions, coronary interventions, neuro interventions, and each of those would have very different requirements and very different devices, workflows, and people. Technically, the device can be used in any of those interventions, but our first clinical indication is peripheral vascular, because that's got the shortest time to market for us, and we want to demonstrate the system in a real clinical setting. &nbsp;
However, we also work with clinicians to demonstrate the system for clinicians that work with neuro indication. For example, with stroke management or aneurysm closing, there are different requirements. There were some very experienced people who initially said, &lsquo;I would probably need more sensitivity, or extreme accuracy,&rsquo; and technologically that's absolutely possible, we just need to go that development pathway. The funny thing is that many of the clinicians are usually rather sceptical initially because they see so many technologies every day, but after some time passes, if you demonstrate the system, they come back and say, &lsquo;I thought about it, it's great. That would absolutely work,&rsquo; and then we have a great discussion about how we could apply it to their specific field for their specific indication.&nbsp;
Have you ever had to pivot based on feedback, to the point that you&rsquo;ve had to change your route or methods?&nbsp;
We&rsquo;ve never lost our North Star. We constantly work towards the same requirements that we set at the very beginning, but sometimes we may alter them. We did make some changes to create a better usability. From an engineering standpoint, you can adapt the system or tweak it according to your needs. We could have an equaliser system which would adapt to a particular physicians&rsquo; habits for example, but that is a dangerous road to go down, because then you risk making a super complicated system that would need dramatically adjusting to customise it. For some people that would be helpful, but it probably wouldn&rsquo;t work for everyone. Bringing such a sophisticated system to a clinical work has to be as simple as possible, as easy to use as possible and as safe as possible. We have no room for error. The feedback we collected went into the requirements of the system rather than defining what we&rsquo;re trying to build. &nbsp;
To learn more about the Santana system and Edvardas&rsquo;s work, tune into Season 2, Episode 4 of The Surgibots Podcast. &nbsp;
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&nbsp;

Developing Seamless Surgical Robotics Workflows     

As new surgical robotics platforms are released, there is an increasing amount of training that needs to be done in order to bring surgeons up to speed. On Episode 3 of The Surgibots Podcast&rsquo;s second season, I was joined by Dr. Caitlin Houghton, the Assistant Professor Of Surgery at the Keck Medicine of USC, to talk about how we can improve this learning curve as an industry. Here are her insights: &nbsp;
How did you train to use surgical robotics?&nbsp;
I considered myself a laparoscopic surgeon at the time. I had been on the robot and manipulated the console four or five times, I had done some of the training courses and I had a certificate for completing them. Back when I trained there wasn't a rigorous set of rules on how you can access the robots and how much training you had to do first, so my experience was limited, despite the certificate. When I had the opportunity, however, to teach the residents robotics, they wanted me to do inguinal and gall bladders. At the time I thought the robot was for more complex things, and my attitude was that it would be a waste of resources. But that quickly changed. I realised that by getting on the robot for three cases every week and consistently working on those fundamental skills, not only was I able to increase my skills along with it, but I was also able to teach some of those fundamentals to the residents at the same time. I was really going through my learning curve as I was starting to teach residents and fellows.&nbsp;
How are you helping other surgeons become native to robotics?&nbsp;
I love minimally invasive surgery. One of the advantages of robotics is that it's accessible, it's an enabling technology and its tools and  visualisation are better. It's an advancement from laparoscopy. If we can teach more surgeons how to do robotics, then patients get access to more minimally invasive surgery. Some of those open procedures, like transplants, that never took off minimally invasively because of the challenges of laparoscopy, we can now do with robotic technology. There&rsquo;s a lot of potential in the hepatic biliary space, general surgery, abdominal wall reconstructions, and other major surgeries that were really exclusively open. Now we're adapting and are able to do them more easily with robotics. &nbsp;
The great thing is that it's not confined to those surgeons that really dedicated themselves to learning minimally invasive surgery. You still have a learning curve, but the timeline can be shorter because it's easier to adopt. In the long run, more patients are going to be able to have access to minimally invasive surgery if we continue to promote robotics. My role is to speak about it and teach it, not just for the company but also when I'm speaking at societies. I often incorporate videos to highlight what the technology can do so that people can see the quality and then hopefully want to train it.&nbsp;
What barriers have you come up against when you're trying to get people to embrace new technologies?&nbsp;
I think whenever you're trying to change or disrupt a culture there's going to be a range of perspectives on it. There's going to be the people that are excited, because they see it and they want to be the early adopters. Then there's the surgeons who are like, &lsquo;Well, I'm doing laparoscopy very well with my technique, my patients have good outcomes, so I don't need any other technologies to assist with that&rsquo;. Then there's the ones that are just resistant to technology or change. I think most people are in the middle. &nbsp;
Age comes into it too. Some of the trainees that are coming out now have been exposed to this technology the whole time, so their perspective is different and they are more adept at embracing technology because they are used to it. Surgeons who were trained minimally invasively or laparoscopically like me will also have a good perspective, because they've trained to do something well, and they're doing it consistently. It's important to most of them to embrace robotics, because we see how it's changing medicine for future generations. &nbsp;
There is concern about how much we embrace technology versus teaching the basics of open techniques because of access. What if you're in a rural area, or you don't have access to the technology? For the most part, when people are challenging the technology, I try and highlight the things that it is enabling, like the complexity of surgeries. The more complex the procedure, the more technically difficult it is for the surgeon. With robotics however, it's a flatter curve. There's a broad area in the mid-range of complexity of surgical cases where the patients do well, the morbidity and mortality don't go up with the case complexity, and the difficulty for the surgeon stays even. That's a huge benefit of the robotic platforms, so enabling surgeons to adopt it will have better outcomes for patients. &nbsp;
How can we flatten that learning curve out?&nbsp;
There's a lot of companies that are working on that. One of the companies that I really like is Fundamental VR, who are working to make a virtual reality where you don't have to have access to a physical simulator or to the robot itself, but you can have a headset that simulates the robotics training in virtual reality. That's a really cool concept. &nbsp;
Right now we do have simulators in a lot of the training. Most of the time, when a surgeon is going to start training, they start on a simulator -but again, access to that simulator is a bottleneck. There may only be one or two simulators in an institution, or some have none, so you have to travel to get on the simulator. We know that as you're adopting a new skill, the more practice you have, the more muscle memory builds so that it becomes more automated. We need to get surgeons through to that automated point where they're no longer thinking about the technology, but they're thinking about the surgery. &nbsp;
What I like about the idea of a virtual reality setting is that you could go back to it. You could do a training session and then have that training accessible online. If someone does the training, then their first case isn't till three months from now, they can go back to that training in real time the day before or an hour before, and you don't have to travel off campus. You can brush up within your normal workflow, which I think would really change the game as far as the learning curve and access to simulation. &nbsp;
To learn more about training for and adopting surgical robotics, tune into Season 2, Episode 3 of The Surgibots Podcast here. &nbsp;

Increasing Acceptance and Adoption of Surgical Robotics  

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The most important part of a company is the people in it. On Episode 17 of The Surgibots Podcast I was joined by Jorge Presa, the CEO of Cyber Surgery, to talk about the importance of building a great team from day one. Jorge and his team are developing a spinal surgery robotics platform from their base in Spain, and are working together to achieve incredible things. He shared his insights into developing a driven, creative culture in such a dynamic industry. &nbsp;
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What challenges have you faced in creating a collaborative and open team?&nbsp;
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It is a very tall order. That&rsquo;s the real talent challenge, because until now we have hired only local people or people who have moved to this area. People can do hybrid work, but every Monday they have to be in the office. We grab a coffee together and talk about everybody's weekend, how everyone is, their family, friends, whatever is important to them. However, last October was the first time that we were looking for a special profile, so we decided to hire a person remotely. We're going to see how this works, because it is much more difficult to keep up with the culture you mentioned. &nbsp;
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So another challenge is to find the right people for these risky projects. We cannot rely on hiring people from this area, we have to begin to hire people from abroad. We are going to maintain at least three meetings in our office per year to create team building events, and we will try to analyse how it was and because we need them to feel like part of the company. Our secret is that our current team is like a big family. Every company that is in the surgical robotics field will have candidates that are abroad, and people moving from one area to another. That's very attractive for some candidates, but other people don't want to move. We&rsquo;re lucky that we&rsquo;re in an attractive area, but that&rsquo;s not a guarantee that we&rsquo;ll gain the right candidates. &nbsp;
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How do you drive the team forwards?&nbsp;
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Well, it's not easy. The first five years was a research project inside a corporate environment. We were a small team at the beginning, there were three of us. We were pushing quite hard, but we didn't know what was going to happen because it was a research project. After that, in 2018, when we received the first funds, it was totally different. We were creating a product and we were creating a team, which in some cases was more difficult. Now there are 30 of us, and we are creating a culture. We do a lot of meetings analysing how people feel, analysing how we could improve our work, and how to improve communications, because the team is the most important thing in this company. &nbsp;
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Culture is the most important thing. It&rsquo;s everything from how people feel to how we help each other and collaborate with each other. There are different states for the company, and hopefully, after the new fundraising, we are going to begin to grow in the sales or manufacturing area. We are going to keep on growing now we are all together. But in the future, we're going to be distributed around the world. &nbsp;
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What are the biggest challenges you've had to overcome with getting to this point with the team?&nbsp;
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The team is the base for everything. Whether or not you push hard is the difference between success or failure. To find the right people is not easy at all. Another thing regarding the team is that with the current economic situation, salaries have increased dramatically. Sometimes salaries are moving so fast, that in some cases is very difficult even for our startup because we don't know how to manage these situations. You have to be different, you have to promote your company a lot. We need enough funding to attract a good team, and that&rsquo;s a big challenge for a company as small as ours. &nbsp;
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To learn more about building a team in the surgical robotics space, listen to Episode 17 of The Surgibots Podcast here. &nbsp;
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Building an Exceptional Surgical Robotics Team 

Robotics can be used to support a number of delicate surgeries. On Episode 16 of The Surgibots Podcast I spoke to Christoph Spuhler, the CEO and Co-Founder of AcuSurgical, to talk about the way his company is changing the face of retinal surgeries. Christoph&rsquo;s background is in medical imaging, which has influenced the direction of AcuSurgical&rsquo;s devices. Read on to find out what they&rsquo;re doing. &nbsp;
How much of an improvement does your robot give surgeons compared to the way that retinal surgery has traditionally been done? &nbsp;
There's multiple aspects to this. One is the precision. With our robots, we can augment the precision from about 100 micrometres down to five. That helps the surgeon to feel more at ease and manipulate the tissues with much more precision, which is great. The robot also assists with tremor reduction. If the surgeon does tremble, we can filter it out by putting in place virtual fixtures or virtual bounce so that the surgeon can&rsquo;t touch structures that they shouldn't be touching. For example, if you&rsquo;re doing virtual retinal surgery, if you touch the the lens in the front of the eye, that creates a cataract, so you have to avoid touching the lens. We can put in fixtures for that, so that the researcher won't be able to touch those structures. &nbsp;
There are other applications as well, such as subretinal injection, which is when you have to inject something into the retina. That's becoming more and more frequent. A lot of different companies are developing gene therapies and cell therapies to restore vision or heal patients that are suffering from various diseases on the retina - for example hereditary diseases that cause the retina to lose sight over the years, or AMD, which is age related macular degeneration, which affects one person out of three in the world. Now there's new treatments that are going to be coming on the market to treat those diseases. But the problem is they require the surgeon to inject directly in the retina. And the retina is tiny, right? So you have to inject exactly the right place, making sure not to rip open a huge hole and make it worse than it already is. That's incredibly difficult. There's only a couple surgeons in each country that are able to do that. But, with the robot, we can inject with high precision, which makes those treatments and gene therapies much more viable due to a higher quality delivery. &nbsp;
Do you foresee this robot improving skills for surgeons who are currently already doing retina surgery, or do you see it as a gateway for less skilled surgeons to learn retinal surgeries? &nbsp;
It's a little bit of both. Our goal is not to replace the surgeon, our goal is to augment the surgeon. We always say to the surgeons that we're partnered with &rsquo;you know how to do the surgery, but with the robot, you can do even better. You can have better control and better precision.&rsquo; The second part is that people are getting older, so there are going to be more and more patients in the next 10-20 years, and there's not enough surgeons to treat all of those people. There's already a shortage today, and those surgeons take a long time to be trained, and we're just not able to train enough surgeons at the moment to treat those patients. What the robot is going to do is accelerate the learning curve, and maybe allow surgeons that are not necessarily specialists on the retina to do certain interventions. &nbsp;
There's publications and studies that have been done which show that the first 150 or so patients that are treated by a surgeon when they come out of medical school have suboptimal results compared to what an experienced surgeon can do. That&rsquo;s huge. With the robot, we can accelerate that learning curve and get surgeons up to a high level much faster, which improves patient outcomes. &nbsp;
How quickly do you think the enabling technology can augment the surgeon so that those sub optimal surgeries are not happening?&nbsp;
That's difficult to say, because we don't have studies at the moment. But, what we can see at the moment is that when we have surgeons come in and try the robot, there's almost a light bulb going off in their head, and their eyes start sparkling. When they use the robot, they're like, &lsquo;Wow, it's amazing, I'm much more precise and steady with my hands, it's just a different experience.&rsquo; What helps the surgeons is that once they&rsquo;ve seen the robot, they understand how much better they need to be, whereas if they haven't tried the robot, it's kind of abstract. But when they actually try it, they see right away their amazing potential. That creates a lot of demand. &nbsp;
To learn more about developing retinal procedures through surgical robotics, tune into Episode 16 of The Surgibots Podcast here. &nbsp;
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Developing Retinal Surgical Robotics  

Anybody who&rsquo;s hiring in the surgical robotics sector seems to have a similar set of frustrations. CEOs, hiring managers, talent acquisition teams and human resources professionals are all frustrated with the time it takes to hire, inconsistent results, irrelevant CVs and candidates who don&rsquo;t understand the company. All of that is incredibly frustrating when the priority is engineering a life-saving robot or designing a clinical trial or commercialising cell systems. &nbsp;
Recruitment can distract focus from your mission critical tasks if it&rsquo;s not done well. In this industry, time is one of our most critical assets, so you can't give it away lightly. As more companies are developing and manufacturing surgical robotics, competition for talent is increasing. In today's world, the top level of talent is in high demand. Their experience needs to be world class, from their first interaction with your company through to their first day. &nbsp;
In Episode 15 of The Surgibots Podcast I shared my advice for attracting and hiring top level talent within the surgical robotics industry. This blog is a step-by-step guide to creating an exceptional hiring process, built off the advice that I shared on the podcast. Read on to supercharge your own hiring process.  &nbsp;
Develop Your EVP&nbsp;
Before anything else, you need to figure out what makes you unique and nail down your employee value proposition (EVP). That clearly lays out what makes working for your company exciting and unique. It&rsquo;s a blend of awards, benefits and opportunities that will entice new people into your company. &nbsp;
Developing a robust EVP begins with a lot of internal work, so you need to dig deep. Get stories from the people you work with, ask them why they joined you on your mission and what made them come to you over your competition. It's not good enough to just say &lsquo;we have a great culture&rsquo;, you need to show people evidence to back it up. If you're finding surface level answers to your questions, travel up the &lsquo;why tree&rsquo; until you arrive at the core of what makes you a great place to work, then put those answers all over your hiring process. &nbsp;
Get Stakeholders Involved&nbsp;
When you&rsquo;re defining a role, pull all the stakeholders in the process. Bring in anyone who will interview the potential hires and include the wider team who are going to be working with them on a daily basis to create company-wide alignment. If you're going to use an external provider like RW Search, bring them in as early as possible too. Quality truly is better than quantity with external partners, because a true recruitment partner who knows your business will be able to provide you with valuable insights about what skills are available on the talent market and can help you successfully define a specific role and person that will be attainable. If everyone is aligned at the start of the process, there will be less hiccups along the way.&nbsp;
Define the Role&nbsp;
In your stakeholder meeting, dig deep into the why behind your requirements and set out the purpose of this new hire. Think of your hiring process as a funnel. You need to input as many prospects or individuals as possible, even if they don't absolutely hit the nail on the head, but they do have the right skill set, attitude or a unique value proposition to take the company or project where it needs to go. &nbsp;
Work out your non-negotiables early on, and constantly question &lsquo;Why do we need this? Why is that important? What would that enable us to do? If we can't identify people with that attribute then what else can we look at?&rsquo; At the same time, it&rsquo;s critical to assess the cost. If you get several months down the line and the role hasn&rsquo;t been filled, what bottlenecks will that cause? How costly will it be to you? That will motivate you to make your process as effective as possible. &nbsp;
Build Your Talent Pool &nbsp;
Building a talent pool isn't just a numbers game. It's about understanding and analysing the data, because that will show you what roles in our company are the hardest to fill. You&rsquo;ll also gain insights into where candidates are currently working, what motivates them, where they went to university, etc. By taking a data driven approach, you can craft targeted recruitment strategies that ensure you're reaching the right people in the right places. &nbsp;
And then there's the incredible power of internal recommendations. Referrals are based on a principle, if we have a really talented individual already in our team, then there's a good chance they know others with the same drive or expertise. Lots of early teams are built purely from internal referrals. But how do you get repeatable results from this, but one way is to formalise and incentivize doing so. This usually happens when a company gets to a certain size. But remember, the goal is not just to find bums on seats here, it's about find the right fit the individuals who will drive innovation, have hope, quality, and contribute to the company's mission. &nbsp;
Fine-Tune Your Job Ads&nbsp;
Don't fall into the trap of posting your job description as an advert. You need to speak directly to the aspirations, motivations and passions of your target audience. What challenges will they tackle? What breakthroughs could they be a part of? By crafting resonant messaging, you can appeal to the cream of the crop, including candidates who aren't actively hunting for a new opportunity. &nbsp;
Your job ads should tell stories. Creative Writing is not an easy skill, but by telling your employees&rsquo; stories, you will craft better adverts. You&rsquo;ll stand out against the competition if you can explain how you&rsquo;re innovative through case study stories rather than slapping the phrase &lsquo;innovative company&rsquo; in a job description. Tell candidates the direct impact of the role you&rsquo;re offering on healthcare outcomes. Talk about a particular engineering challenge the team recently overcame. These narratives humanise your company and make it relatable and aspirational. Writing clear, genuine stories will transform your job ads. &nbsp;
Prioritise the Candidate Experience &nbsp;
The interview process isn't a one way street of evaluating candidates skills and fit. It's also your opportunity to showcase yourself beyond the adverts and messages. First impressions in the hiring process is everything. So let's get something straight: a rigorous, detailed interview process is essential. After all, these roles require precise expertise and alignment with your values and the ability to collaborate in a high pressure environment. &nbsp;
However, there's a fine line between being thorough and being unnecessary. A long, unclear or overly complex interview process massively deters candidates. Top talent, especially in surgical robotics, are likely being approached about multiple opportunities at any one time. An interview process that drags on or lacks transparency leads to candidate dropout. &nbsp;
Create Clarity in Your Interviews &nbsp;
So what's the solution? Firstly, it's all about clarity. From the outset, candidates should have a clear roadmap of the interview stages, your expected timelines and the objectives of each phase. This not only sets the expectations but also showcases your efficiency. If you don't communicate with your interviewees, that creates doubt, which will undermine your entire process. &nbsp;
Secondly, streamline your process. While multi-stage interviews are valuable, you must ensure that each stage has a distinct purpose. For instance, if technical skills are assessed in a task-based round, the subsequent stages can focus on soft skills, team dynamics and culture fit to bring together interviewees. You don't need to do seven interviews to assess a candidate. &nbsp;
Feedback is crucial. Keeping candidates in the loop - even if it's just to update them with a slight delay - creates respect and maintains engagement. It's important to understand that for a lot of people, job interviews are one of the most anxiety-inducing experiences that they can go through. We recommend providing feedback within 24 to 48 hours of each interview stage, because you wouldn't believe how much of an impact this can have on securing talent. &nbsp;
Lastly infuse a bit of the company's personality into the process. Whether it's a casual chat with a teammate or a tour of the workspace, these little touches can make the process more personable and memorable. In essence, while the interview process has to be thorough to ensure you make the right hire, it&rsquo;s equally critical to ensure a candidate-friendly experience. After all, the interview journey is often the first glimpse into the company's ethos for potential employees, so make it count. Time kills all deals, so drawing interviews out will stop you from securing the talent you need, and suck up valuable resources from your hiring team. &nbsp;
Make Valuable Offers &nbsp;
Finally, you have to make an offer. Now is not the time to mess things up. If you've done the work at the start, you should be able to put together better, more serious offers. Keeping candidates warm by bridging the communication between the final interviews and offers is vital. It shows respect, reduces anxieties and maintains the momentum you've built up to this point. &nbsp;
In specialised sectors like surgical robotics, where talent is niche and highly sought after, there's a delicate balance to strike when it comes to compensation packages. If your offer is too low, it can come off as undervaluing candidates' expertise, and I've seen this offend people to the point that they won't let you even present a second offer. If you're trying to buy cheap, you're probably going to buy twice, or you won't buy at all. Obviously, you have to work within your resources in cash-strapped startups, but you have to assess how much it would cost you to go through the whole process again. &nbsp;
Here's where external partners can bring even more value, because we possess a wealth of market data from other searches, so we can provide benchmarks for competitive compensation offers. We can also advise you on benefits packages and other non-monetary perks that candidates value. Armed with our industry knowledge, you can craft offers that are competitive and sustainable. &nbsp;
If there are budgetary constraints, being transparent and having a candid conversation with the candidate is crucial. You can discuss the growth trajectories, performance incentives and what else may be on the table. This is another opportunity to showcase your values, your respect for talent and your commitment to fair practices within your organisation. With the right blend of internal strategy and external insights, your offer can mark the beginning of a very fruitful professional journey. &nbsp;
After that, all that&rsquo;s left is the onboarding journey. &nbsp;
To learn more about fine-tuning your hiring process, tune in to Episode 15 of The Surgibots Podcast here. &nbsp;
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How to Hire Top Level Talent   

On Episode 14 of The Surgibots Podcast I was joined by Noam Hassidov, the CEO of Tamar Robotics LTD, to talk about the advancements that the company is making in neuro robotics. He shared the latest updates from Tamar&rsquo;s robotic system, as well as some of the challenges they&rsquo;ve faced while developing it. Read on to find out more about life inside Tamar Robotics!&nbsp;
What are the challenges of developing a robotics platform in the neurosurgery space? &nbsp;
The major difference between laparoscopic robotics and neurosurgery robotics is the amount of space you have to operate in. The abdominal region has a much bigger cavity, so you can build big robots to perform surgery there. In the brain, that&rsquo;s simply impossible. The surgical corridors in the brain are about 25 to 30 millimetres, which is a very narrow working corridor to preserve the brain in. &nbsp;
The second challenge is that you can&rsquo;t move anything in the brain to access the part you&rsquo;re performing surgery on. On top of having a small surgical corridor, you have to be far more precise with how much you take out. If you&rsquo;re operating on, say, colon cancer, you can take five centimetres of extra tissue from each side of the cancer area, just to be safe. That is impossible in the brain, so you have to be very precise. If you take an extra three millimetres in the brain, you're going to have a problem.&nbsp;
When it comes to the robot itself, instead of coming to the patient with the robotic arms on each side, similar to how we eat at a table, you have to hold your hands close together to get through the smallest incision possible. We're keeping it very shallow. Designing a system like that enables us to enter through a very small corridor and then perform surgery deep inside the brain where the tumour is. It&rsquo;s also difficult to give surgeons enough freedom at the tip of the robot to operate on golf ball-sized tumours through such a small corridor. How to open the arms up to allow for that is another challenge. &nbsp;
How are you overcoming those challenges? &nbsp;
 We came up with an innovative solution called &lsquo;Follow the Leader&rsquo;. You can think of it like a vehicle. If you're driving a long truck and you're going in a roundabout, maybe the back wheels will move from the road or hit a little bit of the pavement. But, when you're driving a train, all the train is always keeping itself on track, to the millimetre. The Follow the Leader mechanism is the same. We&rsquo;ve designed it to move like a snake whose whole body follows its initial path. We don't have the issue of elbows in our robotics, so we can avoid touching places which are prohibited in the brain.&nbsp;
When it comes to creating enough space and access for neurosurgeries, that was an interesting path. We understood that you cannot insulate the brain with high pressure CO2 like you do in oral surgery or in abdominal surgery. That&rsquo;s one of the worst things that can happen in neurosurgery - everybody's fighting to reduce intracranial pressure. Then we we thought of mimicking what happens when you dig a tunnel. In the Mountain Railroad, for example, you have a machine that digs for 10 or 20 metres, and then you put concrete over the walls. You do that process again and again until you reach the right depth. We came up with an idea to do something similar. We let the robot and the user dig down to about 10 millimetres, then deploy a scaffold. Now, this scaffold doesn't generate expansion, but it will hold the volume so that you excavate tissue as necessary. That enabled the physician to work and expand the cavity without it collapsing. &nbsp;
What's the differentiator for Tamara robotics compared to other systems in the space?&nbsp;
Robots are impressive. It's an impressive industry, so we have a lot to achieve until we'll be at an industry level. What our competitors are doing is putting the vectors into the brain. So when you want to take a needle and do the biopsy, and you want to do it very accurately, or you want to take an electrical lead to stimulate the brain and you want to place it very accurately, you can put the patient to sleep, create a small hole and align the robot to do this needle insertion. But once you insert the needle, you&rsquo;re in the end game. Those systems can be very precise, but they're not capable of removing a 42 millimetre golf ball sized tumour like ours can. They might be able to burn a 5 or 10 millimetre tumour, but it will be kept inside and then add to the pressure in the brain. They&rsquo;re very good technologies, but they are limited.&nbsp;
To learn more about the work that Noam and the rest of the team are doing at Tamar Robotics, tune into Episode 14 of The Surgibots Podcast. &nbsp;
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Inside a Cutting-Edge Surgical Robotics Company    

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Building a strong team can make or break a company. In the surgical robotics space there are plenty of opportunities for talented individuals, but how can companies choose the right candidates? On Episode 13 of The Surgibots Podcast I sat down with Aleksandar Nacev, the Chief Technology Officer at Promaxo Inc, who shared his insights on life as an engineer in the industry. He defined key characteristics that he looks for in his engineers, shared his advice for attracting and retaining a world class engineering team and offered advice for engineers themselves who are working in the industry. Here&rsquo;s what he had to say: &nbsp;
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What makes a successful engineer in your experience?&nbsp;
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Because we've always run lean compared to a lot of companies in the space, what is critical is the hires that we have. If you're hiring somebody who has a specific skill set, they should be able to bring their expertise to the problem at hand. But, at the same time, because there's only a few of us, it's important for those individuals to be able to branch out and understand the rest of the ecosystem. They don't live in a vacuum. So, although not everyone needs to understand system engineering in terms of overall inner interfaces and integration, it's important for them to at least appreciate how their specific discipline interacts with others in different places. &nbsp;
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How do you attract and retain best-in-class talent? &nbsp;
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It's been interesting in terms of attraction in the space. Mainly what&rsquo;s helped is our proven track record. We've been able to work on a project, create a product and move forward. That attracts people, right? Our attitude towards the medical device development space that really helps bring people in is using the way that people think about &lsquo;the next product&rsquo; or whatever else they think will revolutionise the sector. That&rsquo;s when they want to be part of it. If the team looks fantastic, we have a vision and a goal with what we're trying to do, that attracts people to the company too. &nbsp;
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For example, we have individuals who have come from large companies who specifically wanted to come to a startup because they saw that the development cycle was faster. The impact that they had at the larger company was slow, they don't move, they're not nimble. Now they really want to have a direct impact with what they see as their solution. It also allows them to use their intimate knowledge of the medical space. When they looked at us they saw that we were doing some crazy new stuff, and we're able to actually implement it. We met what we said we were going to do. That's been exciting, because they can say they were part of it. &nbsp;
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What advice would you give to an engineer who's looking to join the surgical robotics space? &nbsp;
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As always, have confidence in yourself and know your discipline very well so you can design something that will operate correctly. A bare minimum is also understanding the robotics space. Try to get some experience and understanding of the commercial and critical viability of a product associated in that space. The main goal of engineering is to develop technology that&rsquo;s actually useful, right? You don't want to create a solution without a problem, so you need to understand the space you&rsquo;re working in. That's usually very hard for engineers, but you have to come at it from the other angle. You have to challenge yourself to think about the problem that you have, then design a solution to that. And finally have fun. A lot of this work is challenging, so if you don't enjoy what you're doing, you're not going to want to keep doing it. There's going to always be challenges, so you have to figure out a way to enjoy them. &nbsp;
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&nbsp;To hear more of Aleksandar&rsquo;s insights, listen to Episode 13 of The Surgibots Podcast here. &nbsp;
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Attracting & Retaining Engineers in Surgical Robotics     

The surgical robotics industry can be a lucrative space for investors. On Episode 11 of The Surgibots Podcast I had the pleasure of sitting down with Mercedes Tuin, a Venture Capital Investor at BOM, to discuss her involvement in the space. With a background in biomedical science and a passion for improving patients&rsquo; lives by translating academic research into products and services, Mercedes&rsquo; insights are incredibly valuable. Read on for her advice on assessing companies for potential investment. &nbsp;
What key ingredients are you looking for in surgical robotics companies when you come to invest? &nbsp;
There are three questions I ask. One is &lsquo;Can we improve patient outcomes?&rsquo; The second is &lsquo;Can we reduce the overall costs of surgery?&rsquo; And finally &lsquo;Can we extend human capability?&rsquo; For several procedures there are very few people who are qualified to perform them, and it takes years and years of training and special instruments to do so. A lot of the procedures that require super micro surgical skills aren't being done because of the lack of qualified surgeons. Because there are few of these operations being done, there is not a huge amount of clinical evidence for it, but we can see a trend from patients that ther improves outcomes. Extrapolating that, we think that improving microsurgery and making it more widely available will improve patient outcomes. &nbsp;
When it comes to extending the capabilities of humans, that is where robotics come into play. Robots can make something easier or more accessible. That is what we think the strength of robotic surgery is and that is where we see the most gain. With microsurgery the limitation is in the surgeon's hands. If you can expand that capability with a robot and enable more surgeons to do more complex procedures, that would benefit patient outcomes because their procedure becomes more widely available. &nbsp;
When we think about reducing operating times, you need to consider the time it takes to set up the robot, to perform the surgery, then take the robot out again. Usually operating times go up. But, we think that is because it's part of the innovation and adoption rate. That is going to decrease. We're still at the early stages of surgical robotics innovation and adoption. Making procedures possible that aren't possible now accessible or making complex, difficult operations easier - that is where the win is. &nbsp;
That is how we assess our companies. We accept that there is a higher investment in the beginning, because we need a longer time for adoption and we're working with difficult technology. VCs are always a bit worried about capital equipment and long sales cycles, but in the end, this is where surgery has a lot to gain.&nbsp;
When you're assessing these investments, are there any common red flags that come up that instantly kill deals?&nbsp;
 Nothing instantly kills the deal. We are typically of the mindset that something can be approached differently, so our question is &lsquo;How can we do it?&rsquo; instead of &lsquo;We're not touching ther&rsquo;. If we see a red flag, the first question is always, &lsquo;Can we mitigate ther?&rsquo; For example, if there's a red flag on the IP, we will talk to the IP people, maybe get a second opinion, and figure out if we can strengthen the portfolio. We really dive into considerations like &lsquo;Are we willing to invest in the CEO?&rsquo; There are a few signs of crisis that would worry us, like a high turnover, inconsistency in the reporting, etc. If we see that, then we say &lsquo;Okay, what is the root cause of this?&rsquo; Very often it's that the CEO and the founders who are not on the same page. We would talk to them, say, this is what we see. Do you agree? And if you agree, what can we do to fix it?&rsquo; If they don't agree, then that's where we start to think &lsquo;Maybe this is not for us.&rsquo; &nbsp;
Deal breakers are when people start being rigid in a negotiation. Then it's also a deal breaker for the other side, not just for us. Valuation can be a deal breaker for us, because we're a sovereign fund. But this doesn't happen very often. If there are investors involved who have a bad reputation, then we would rather walk away as well. If it's a lack of transparency, that&rsquo;s a deal breaker for us too. We do a lot of diligence and negotiation before we move to the term sheet, so once we're in that phase there's not a lot of drop-out.&nbsp;
To learn more about investing in the surgical robotics industry, listen to Episode 11 of The Surgibots Podcast here. &nbsp;
&nbsp;

Investing in the Surgical Robotics Industry 

On Episode 10 of The Surgibots Podcast I was joined by the CEO of Robeaut&eacute;, Bertrand Duplat, to discuss how micro robotics are the future of how we treat hard to reach cancers and diseases in the brain. We discussed the incredibly personal story behind the creation of Robeaut&eacute; and Bertrand&rsquo;s personal connection with the topic as well as the vision for where this technology can go. Read on to learn more about this fascinating space!&nbsp;
Your robots are very different to others in the space - they&rsquo;re the size of a grain of rice. How did you decide to create that technology?&nbsp;
What's very important here is that medical micro robots come from the need to perform surgery in the brain. The brain is a very well-protected organ. It's protected by the skull and the blood brain barrier, which makes it very hard to reach with systemic medication. It's also very sensitive. The way that the brain is addressed in surgery is with tools that move in one direction - they are very linear tools. The protection around the brain makes it very difficult to access areas of interest or pathological areas, making it very difficult to get the right information about what's going on in the patient and what's going on during a therapy. &nbsp;
Our micro robots are a tiny size that enables us to be minimally invasive, and move in the brain in 3D. We can move in the brain parenchyma and the extracellular matrix, but not in the bloodstream or vascular system. We are able to navigate into previously inaccessible locations within the brain using 2D and 3D curves, then gather data that we couldn&rsquo;t have before. &nbsp;
You&rsquo;re pushing a new frontier with micro robotics. How do you research a new technology like that? &nbsp;
In terms of the technology, there are three very difficult aspects to developing it. One is micro fabrication and creating such small devices that can propel themselves, turn and move in multiple directions safely? There is also physics to consider. We have to think about the forces that are suddenly dominant like surface forces and the forces that are not dominant at this scale, like gravity, which has almost no effect on microrobotics. It takes a lot of simulation and experimentation to get it right. We also have to consider the way that the microbiota react to the environment within the medical or neurosurgical context, because that&rsquo;s another challenge for the technology.&nbsp;
When it came to deciding which direction to take with the technology, we used several angles to come to a conclusion. One is very strong intuition. When we started, micro robotics were just passive probes - usually a magnet with a coating around and an external engine. If you think about how those robots would operate in the body (especially in the brain), the micro robot would be a magnet with a coating, and there will be a huge coil around the patient&rsquo;s head, and that coil has to be screwed very precisely. The robot is this passive element that does applications. &nbsp;
We decided not to go down that path because we wanted a micro robot that was able to work without huge equipment, which would restrict it mostly to the OCR. We wanted to be able to monitor the patient over a certain amount of days to make sure that everything in the therapy was going well. We also wanted the micro robots to have native sensors that could gather important information about the state of the patient, the evolution of the therapy and whether the doctors need to change something. We decided to have a micro robot that contains an engine and would be completely independent. We also developed a calibration and tracking system that&rsquo;s based on ultrasound, in order to know what the micro robot is. We had this huge intuition to go against the trend, but we couldn't be sure it was achievable. It has been a huge challenge to achieve it, but we succeeded. &nbsp;
Another direction that we took in terms of microfabrication is not to use existing technology.  At the time, the technology was very slow, the iterations were taking several months, and it was very expensive. We wanted to iterate rapidly because I knew that that was a key factor to being successful due to the fact that at this scale the physics that's dominant is different, so you need to spend months or years experimenting. Going in a different direction to the rest of the industry was a huge risk, but we found as a team we were ready to take that bet. We proceeded with a lot of help from a fantastic network of doctors, neurosurgeons, neuroscientists, roboticists, macro roboticists and other specialty practitioners, and we checked every step of the way that we were making solid building blocks. So there were a lot of skills, a lot of intuition and a lot of faith that went into making this robot. Along that way we shifted on our choice of technology, but we were set up for that journey to go all the way.&nbsp;
Interested in hearing more? &nbsp;
Tune into The Surgibots Podcast Podcast &nbsp;
<a href="https://open.spotify.com/episode/65P8S3f1o3il2jqJHsi13w?si=c5146785ed7b4896">https://open.spotify.com/episode/65P8S3f1o3il2jqJHsi13w?si=c5146785ed7b4896&nbsp;</a>
<a href="https://podcasts.apple.com/gb/podcast/the-surgibots-podcast/id1676605171?i=1000621484024">https://podcasts.apple.com/gb/podcast/the-surgibots-podcast/id1676605171?i=1000621484024&nbsp;</a>
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Glioblastoma, micro robots to the rescue 

One of the key challenges in the surgical robotics space is getting hospitals and practitioners to start using new technology. On Episode 9 of The Surgibots Podcast I had the opportunity to sit down with Richard Vincent, the CEO &amp; Co-Founder of FundamentalVR, to talk about their innovative training platform. Richard shared his insights on the state of training in the surgical robotics field, as well as giving me inside knowledge about FundamentalVR&rsquo;s immersive haptic technology. &nbsp;
How is the platform set up?&nbsp;
 Our platform has three main parts, which can be used individually or together. The first is haptic VR, which is the gold standard. It's the amalgamation of the situational awareness that comes with being in virtual reality alongside the sense of touch, weight, resistance and force feedback. All of those elements are what we call kinesthetic haptics. That provides surgeons with knowledge of what it feels like to reset the bone, the weight of a liver as I'm moving it out of the way within the abdominal space, and so on and so forth. What we're trying to do within the haptic system is give you the sense of being in that space and help you learn the physical cues, which allows you to recognise when things are going right and when they're going wrong. Most surgeons and physicians will tell you that the sense of touch is vital to their precision. &nbsp;
The second part of our platform is a slightly downgraded version of that. So it's a standalone VR system which is great for scale. This is a relatively standard headset that gives you situational awareness in a variety of scenarios and procedural walkthroughs. It doesn&rsquo;t give you the same experience of feeling what you&rsquo;re doing of course, but this is more applicable to early stages of training within medical school or residencies. &nbsp;
The third and final piece is something we call Collaboration VR. That's a multi user piece that lets us carry out training as a team. If I'm going into a Cath Lab, I'm probably going in with three or four other people, or if I'm going into an operating room there might be a team of fifteen. You could do that within a simulation to learn the team dynamics. And really importantly, even without the lead physician there, the rest of the team can still practise and rehearse. It allows you to do all of that without physically coming together. All three of those modules stitch together and enable people to collaborate together across the platform.&nbsp;
How do you ensure that your simulations and scenarios are accurate to real life?&nbsp;
Within the business we have a fantastic team of medical doctors and educators who are trying to break down different procedures and understand where the key educational needs are within that procedure. We&rsquo;re focussing on how to bring that to life within the simulation, whether that&rsquo;s physically, virtually or by applying some basic educational learning theory. We&rsquo;ve also worked with key opinion leaders from medical device companies and pharma companies to figure out what really matters to them for their training and development. &nbsp;
If your audience is a set of surgeons that have been doing a procedure for 20 years and you need to get them to understand a new technique, device or implant that&rsquo;s going to change the way they do that procedure, you don't need to teach them the approach. Your training should focus on the area that really matters to them. That&rsquo;s where our partnerships come in, because they help us understand which bits of training are applicable at each stage. We take our medical panel, plug in our customers' KOLs within hospital groups and figure out what matters to them, then code that into our program and bring it to life.&nbsp;
What will the surgical training and education space look like in the future?&nbsp;
What we're going to see is a much wider palette of capabilities available to healthcare practitioners with more joined up outcome data. We need to get a place where true health economic outcomes are a priority. The only way we can get there is to keep integrating our tech into the full delivery system so that we can show the outcomes of somebody taught using an immersive system and determine whether the health economic outcome is improved as a result of it. That's when people will start understanding what this technology can do. The true human and economic benefits include less error, costs and time in hospital for patients. &nbsp;
The other thing we will see improve is access to skills. The World Health Authority says that 5 billion people worldwide don't have access to good surgical skills, and that has a real impact on their lives. We can change that paradigm through immersive technology, and we're doing it already with one of our partners. Our system goes everywhere, but particularly it goes to lots of third world locations where it's teaching really basic cataract procedures that are life changing for the individuals who are involved in it. Our tech is going to improve basic training in developing countries, improve patient outcomes and give the health professionals a better career and working environment. &nbsp;
To learn more about training and development within the surgical robotics industry, tune in to Episode 9 of The Surgibots Podcast here. &nbsp;
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Inside Surgical Robotics Training & Development     

On Episode 8 of The Surgibots Podcast I had the pleasure of sitting down with Lucien Blondel, the Co-Founder and CTO of Quantum Surgical. Lucien has built an impressive personal brand, making him one of the most popular voices in the surgical robotics sector. On the podcast he gave us an inside look at his personal branding process, as well as the inside scoop on his professional history, business plans and the challenges he&rsquo;s facing at Quantum: &nbsp;
How did you get into this space?&nbsp;
I started in engineering school, but I was not very attracted to heavy industries such as automotive or anything in automotive. I picked a nine month internship in a research lab that was developing a surgical robot for laparoscopy. At the time, it was aiming to compete with the computer motion system and Intuitive Surgical&rsquo;s da Vinci. It was a very big research project. That's where I discovered the medical and surgical robotics fields, which were in the early stages at the time. I researched what was happening in this field and worked on this on this project. After that I applied for a position in a startup that was called MedTech in the south of France, and that's where I started my journey in surgical robotics.&nbsp;
Why did you start building a brand and sharing your knowledge with the community?&nbsp;
That's something I've been doing since the beginning, it&rsquo;s just scaled into another dimension with social media. I started on LinkedIn in 2011, but I never had a plan for it. When this all started, you put your experience, background etc on your profile and every now and then you connected with people. During the COVID I figured that I could share what I already shared internally to more people so that it could benefit the whole community and help surgical robotics technology as a whole to develop faster. I could also raise awareness on what we were doing to commercialise in the coming years. There are a lot of teams who are doing great things and putting a lot of effort into building those products. They deserve some awareness and recognition for that.&nbsp;
Has it created any opportunities for you at all?&nbsp;
The side effect of sharing content is that a lot of people will ask questions, for advice or offer opportunities. Everybody's saying that when you network properly, opportunities come to you. It's more about selecting which opportunities you want to pursue at that point. So yes, I've been contacted about a lot of opportunities, but I&rsquo;ve remained focused on building the Quantum Surgical startup.&nbsp;
Should more people be doing Personal Branding in the sector? &nbsp;
It's not easy. It requires some exposure and effort to bring value to the community. It is not something that you just do in five minutes. You have to be thoughtful of what you do. You have to have a North Star that drives your content strategy if you want to be consistent and relevant. Personal branding is an investment, but obviously that investment is paying off. I would recommend that everybody does some level of sharing and networking, because especially since COVID we've become a more global world. Opportunities are popping up to do remote work for companies in the US, China or Europe. To get those opportunities, people need to know who you are, what you do, and your value. Personal branding is a great way to demonstrate those things. &nbsp;
What advice would you give to anyone who wants to start building their following and their personal brand?&nbsp;
Just start. Do not over complicate things. You can build a long term strategy, you can change, you can iterate, you can adapt, but you need to have a clear purpose. Why are you doing it? It's gonna cost you effort. If it's just to get something in return, that will not work. You need to have something that really drives you to create content online. &nbsp;
Once you are clear on what your North Star is, you just have to take the first step. You&rsquo;ll learn along the way and adjust and connect to people. Try something and connect to people or follow people who do the same thing. The good thing about social media is that there are already a lot of people doing stuff on there. They&rsquo;ll have already laid out the playbook for how to do it, so sometimes it's just a matter of finding inspiration and finding your own way.&nbsp;
To learn more about Lucien&rsquo;s background and professional experience, tune into The Surgibots Podcast here. &nbsp;
&nbsp;

Personal Branding in the Surgical Robotics Space 

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Building a robot which can go into an MR is a big challenge, you cannot use the conventional components as putting a big projectile inside a magnet is never a good idea. Plus with other electronics, you can get image distortion. It is not as simple as  across the surgical robotics industry. On Episode 7 of The Surgibots Podcast I sat down with Gregory Fischer, the CEO &amp; Founder of AiM Medical Robotics, to discuss the MRI compatible robotics that they are developing. We dove into the details of making a surgical robotics system with MRI compatible components and the unique challenges that poses. &nbsp;
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What does the AiM Medical Robotics system do? &nbsp;
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 The idea is to put robots inside of an MRI scanner. That allows you to place an instrument or tool in exactly the right spot. A lot of the ways they do this in an operating room is using a microelectrode recording. They put these electrodes in and they'll essentially listen for buzzing sounds to make sure that they are getting the right amount of electrical activity, then they pull that out and stick another, more permanent probe inside. You can't get the accuracy you need or guarantee that you're going to be in the target based purely on what's available in the operating room. 
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By taking this procedure and putting it inside an MRI scanner we can use iterative intraoperative MRI to look at shifts in the brain. For example, if you want to put something in the brain, you drill a hole, which causes the cerebral spinal fluid to drip out. Similarly, if you start poking at the&nbsp;brain you're gonna get tissue swelling, so things move and change during the procedure and those probe readings are no longer accurate. Working on the images you took before the procedure may be great for targeting relative to the skull, but that system cannot give you perfect targeting relative to the soft tissue anatomy inside your brain. The same thing applies to abdominal anatomy and other parts of the body as well. The idea is to take these probes and get the applicator in exactly the right spot relative to the anatomical structures of the brain. That's where our robot can really help.&nbsp;
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Why is it such a challenge to make a robot that is MRI compatible?&nbsp;
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 An electric motor is the heart of most robots. It's about a steel can, a coil of wire and a magnet, which are probably the three worst things you could put inside an MRI scanner. It&rsquo;s really exciting to think about how we can create new and innovative technologies that let us put robots inside an MRI scanner and not have them affect the imaging. Safety is a given, so we want to make sure we don't put anything that's going to be ferrous and have a projectile effect that could hurt a patient inside the scanner. &nbsp;
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There's other factors like resonance within the wires that can cause heating, which is a challenge as well. That's why you would usually take off jewellery when you're doing the MRI procedure, because you don't want anything heating up on the patient. On top of that, we want to find ways to build a robot that doesn&rsquo;t distort the images or create electrical noise. If you were to take any standard electronics and throw them in an MRI room, you get static, streaking or other issues. &nbsp;
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My research over the last 15 years has focussed on how to put ceramic actuators inside an MRI scanner, getting really high precision motion in a very compact form factor without affecting electrical activity. My PhD dissertation was on using air powered pneumatic robots inside MRI. I spent many years of my life doing that, but I've since pivoted into the electric space, and there's huge advantages to going in that direction. We've tried dielectric elastomer actuators which are essentially really high voltages that you put across pieces of rubber to make them move. They're really cool technologies that are MRI-compatible. However, for surgical level patients, we feel very strongly that the electric approach is the way to go.&nbsp;
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To learn more about making an MRI-compatible surgical robot, tune into Episode 7 of The Surgibots Podcast here. &nbsp;
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Developing an MRI-Compatible Surgical Robot    

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What did you learn from previous acquisitions?&nbsp;
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&nbsp;Listen to the companies that can potentially acquire your startup. It's very important to have information on what their vision is, where they want to go, what you need to target, etc. Big companies will usually make acquisitions because they have long term plans, so you need to focus on something which is in their vision, not not totally outside their scope. The more information you can have on their partnerships, the better your relationship will be. &nbsp;
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Focus. You have to be very careful when establishing a startup to do one thing. If you&rsquo;re only doing one thing you need to be the best in the world at doing it. I see startups saying &lsquo;We are going to create a global solution from scratch&rsquo;. If you want to be acquired, that&rsquo;s not a reasonable goal. &nbsp;
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&nbsp;Build partnerships with key opinion leaders. Surgeons have a big voice, so you have to listen to them very carefully. Their recommendations, including on your technology, will really matter. They have a clear vision of the surgical implications and clinical issues. Have a good discussion about &lsquo;Do you like this technology? Do you prefer that technology?&rsquo; It&rsquo;s really important to create a product that&rsquo;s based on clinical needs, inspired by the key opinion leaders. &nbsp;
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What lessons could you share with other entrepreneurs? &nbsp;
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&nbsp;Never give up. It happens so often in the life of a startup -  things get hard and you are discouraged. Things don&rsquo;t work. You might have a problem with the technology, the competition or the IP. You might have no money so you cannot pay the salaries at the end of the month. Sometimes you're really in a hole. There is always a moment where you are discouraged and you want to stop. This is where you need to resist all those pressures and stay alive. It's a question of finding solutions. Don't let the company die, don't give up. It's impossible to have a 100% success rate. Whether you change something significant, you restructure, whatever it is, just continue. It&rsquo;s that simple.&nbsp;
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To learn more about start-up acquisitions in the surgical robotics space, tune into Episode 6 of The Surgibots Podcast here. &nbsp;
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The Role of Acquisitions in Surgical Robotics 

On Episode 5 of The Surgibots Podcast I spoke with Matt Curran, who took the role of CEO of university spinout Nanoflex Robotics after 24 years at Medtronic. He shared some of his biggest lessons from the transition and gave us a deep-dive into the technology that convinced him to join a new research and development company when he wasn&rsquo;t even searching for it. &nbsp;
How did NanoFlex get into the neurovascular space? &nbsp;
We started by looking at the different market opportunities. We had a core technology, which has the ability to move electromagnetic fields. Within that, we realised that if you have medical devices with tiny magnets incorporated, you could move them super accurately in three dimensional space, so we started looking at different markets to go after, as well as funding. We applied for and received sponsorship and funding from Wyss Zurich, which is a business incubator between the University of Zurich and ETH Zurich. After about six or eight months of discussions with them, we ended up being accepted as a project. A few months later we formed the company with the support of the university incubator. &nbsp;
We have facilities and infrastructure from the Swiss Federal Institute behind us in terms of payroll and HR, which works really well, but it's also a pretty heavy administrative burden for a startup. We started the project in May 2021 and we expanded the team to scope which clinical areas have the biggest benefits for our tech and decided to go into neurovascular surgery. That was based on a couple of factors, such as navigability and access to clinicians who are interested in innovative new technology and new approaches. It&rsquo;s also a market that has grown pretty quickly so we saw potential there.&nbsp;
Why is NanoFlex&rsquo;s technology so important? &nbsp;
What we're able to do is move devices very accurately in three dimensional space inside patients. We can do that with a technology that allows the physicians to be removed from the patients for stroke treatment. Because of how we make the catheters with magnetic rings embedded in them, our devices are softer than other comparable devices in the market. Because of the magnetic control, we can move the tip of the device in three dimensions. There is a translocation problem, where in a standard robotic or manual procedure the doctor is trying to twist and turn a wire from a metre away. With the magnetic field manipulation, you're actually moving the tip of the device in three dimensional space at the exact location, giving you an accuracy benefit. &nbsp;
Because the device is softer you have a safety benefit as well, because it puts less pressure on the walls of the vessels. When you're steering the device, you're going through the centre of the vessels rather than banging off the walls as you do with the traditional wires and catheters. Because you can steer the device remotely you can start to move the patient and the physician apart from each other as well. &nbsp;
The other big benefit that we're working towards is remote stroke treatment. Stroke is one of the procedures which is extremely time sensitive. The majority of patients should be treated within six hours of a stroke onset, but if you're living in a medium-sized town, you probably don't have the facilities in the local hospital to perform interventional procedures. There are probably the facilities in that hospital for peripheral vascular procedures or for cardiology procedures, and we can use the same infrastructure and with remote capability to connect a physician in the university hospital to drive the catheters. That will save the patients up to two hours of transfer time after diagnosis to get to a University Hospital for intervention. &nbsp;
How is this technology unique from Stereotaxis&rsquo; magnetically driven catheters?&nbsp;
Stereotaxis are the other biggest player in the market currently using magnetically controlled devices. They operate in the EP field, steering catheters in the atrium to ablate malignant rhythms. We have a similar approach but a fundamentally different core technology, because  Stereotaxis use very large permanent magnets on big rotating arms inside the operating room. Because they have such large magnets, it makes it hard to use the room for anything other than the dedicated EP procedures. &nbsp;
The way that we've approached it is a little bit different. Our magnet is a portable system, with a 350 kilo portable electromagnet. The electromagnet is the big difference. We can turn our magnetic system off or on very easily because we don't generate as large a magnetic field as the Stereotaxis system does. Our electromagnetic fields are sufficient to move the wires and catheters within an operating distance of approximately half a metre from the head of the magnet, which means you don't need to rebuild your operating room or change the workflow. You can use standard metal instruments without a complicated, complex or cumbersome way of introducing the system into the cath labs. That's really the biggest distinction - size and usability. &nbsp;
Our system allows you to move the devices in the same way the doctor does. Because we can change the shape of devices, and we have the ability to stay with magnets, that means we can change the shape of the tip and get into locations that it's not possible to reach with a fixed catheter. We were more efficient and flexible. Our system should be safer because we use softer devices rather than the standard tips.&nbsp;
Sound interesting? Listen to the full episode below. &nbsp;
<a href="https://open.spotify.com/episode/3wxIKs8bdpDzc3bFTyIySG?si=eaaa17169a1d40da">https://open.spotify.com/episode/3wxIKs8bdpDzc3bFTyIySG?si=eaaa17169a1d40da&nbsp;</a>
<a href="https://podcasts.apple.com/gb/podcast/the-surgibots-podcast/id1676605171?i=1000612286027">https://podcasts.apple.com/gb/podcast/the-surgibots-podcast/id1676605171?i=1000612286027&nbsp;</a>

Inside NanoFlex’s Technology 

Who are Interventional Systems and what do you do?&nbsp;
Interventional Systems is a medical device manufacturer of miniature robotic devices. Our guided imagery system is in the minimally invasive surgical space. We believe that we can more or less standardise the workflow of any kind of image guidance solution. Our focus is on supporting percutaneous procedures, and we are starting our first steps on the commercialization journey. Even though we are a 10 year old company, we have always focused on innovation and r&amp;d before commercialising our products in our core markets, which currently are interventional radiology, radiology and oncology. We&rsquo;re expanding through strategic partnerships, such as the one we have with Accelus for spine surgery, or the one we filed with Medtronic for the Grinnell project.&nbsp;
What are your partnerships like, and how do they benefit the company?&nbsp;
I'll start with Accelus. In 2019, we identified that the spine market was in need of not only economical innovation, but something that would address the constraints related to practicality and costs of having a robot similar to other fields. Large robots have large footprints that force you to work contralateral to the system and do not allow you to use live imaging. Currently there are very expensive units that are not really suited to the AC market. We realised it was the right time to work in this field, because ACs were ramping up and nobody had a strategy to penetrate the global AC market. We had the right footprint, the right price point and a great technology, so we partnered with very seasoned individuals in the spine markets. We gathered big names and good technology to develop this fusion robotic system. That was a true partnership between our two entities. We also teamed up with a company in Florida called Integrity Implants to form Accelus. &nbsp;
In China, things are a little bit different. Most Western robotics companies have taken the opportunity to partner with Chinese companies, because the market in China has its own dynamics. Usually what happens is that you team up with an implant company, and you'll develop the product locally for these markets. We partnered with an interventional spine and sports medicine company called Ningbo Hicren, which allows us to tackle more markets under one registration. Together we created a company called Sino-European MicroRobotics, which has allowed us to go to market in China. &nbsp;
What's the big benefits of going down the partnership route?&nbsp;
Well, implants run the business. A robot is nothing but an enabling technology that allows you to target the body in a more accurate way. Even before we started working there, there had been a consolidation in the spine market where any company that has robotics also has implants, and the implants are what makes the business. However, we are not an implant company, so for us, it was obvious that we needed to partner with someone who is. When it comes to developing the robotic system and the navigation system, you really need seasoned professionals that know how to run the business. If those people sign up with us, that shows that it's good technology, because they're putting their seal of approval on it. It was obvious that if we wanted to really make an impact upfront, we couldn&rsquo;t spend a decade trying to get in, so this was the way to go. If you don't partner, you will always spend much more time and money trying to build everything in house. We like to partner because we want our system to be used by as many people as possible. &nbsp;
With these partnerships, what opportunities do you see in the future, and why should more people look to do the partnership route?&nbsp;
For a small company that is in a scale up phase like us, there's not really a choice. Either you really specialise in a field and you raise a bunch of money, to build products and use brute force to make your product penetrate the market, or you find a good partner. Specialisation will limit the amount of things you can do, but it also gives you an advantage because you&rsquo;re really good at what you do. We are specialists in robotics, that's what we do. We believe that all companies should be open to partnership, because that will allow them to access new fields that they wouldn't explore otherwise. It offers possibilities, minimises risks and exposes you to different markets. That allows you to differentiate yourselves. We owe that to our shareholders, and ultimately to the patients. That's why we decided to do this. &nbsp;
Robotic companies are starting to realise that cross pollination between fields and companies is beneficial. I do expect that we'll see more of these partnerships in the future. Ultimately, big corporate companies will want the technology that innovators like us are creating. For us, the more differentiated you are, the better you are positioned for the future. If you are in seven or eight different fields, and these fields overlap in a strategic way, you&rsquo;re a much better target for potential exit or acquisition opportunities. Partnerships are about creating good opportunities for patients and the people in your company. &nbsp;
To learn more about partnerships in the Surgical Robotics industry, tune in to The Surgibots Podcast here. &nbsp;
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 Partnerships in Surgical Robotics     

Surgical robotics are providing innovative healthcare for the future, but what does the future look like for the industry? On The Surgibots Podcast we spoke to Michael Schmid-Santek, the CEO of BHS Technologies. With a background in mechanical engineering, he&rsquo;s worked in medical devices for around 17 years, with a specialism in heart catheters. We talked about the developments that BHS Technologies have made to advance the surgical robotics industry, as well as his predictions for the sector as a whole. &nbsp;
You&rsquo;ve created collaborative plug-ins, how is that going to affect the market? &nbsp;
MMI has adopted our technology, or as they call it &lsquo;also included our device&rsquo;, for their solutions. We&rsquo;re able to demonstrate how their system could be used with ours. We are also part of their solutions, which makes us pretty proud. It's also the other way around - we do have distributors and doctors who are asking about installations because they also want to see that setup. Other companies probably don't want to lock into one microscope vendor, because it doesn't make any sense for them. If a surgeon has already bought a brand new extra scope and doesn't need the robotics club anymore, then he should not have to buy robotics. It&rsquo;s all about the options we can provide. &nbsp;
How do you see funding happening in the future?&nbsp;
The ideal case for our company would be that we will get revenue through what we are making and selling. We know that we have to speed up here and there, especially when we need a second series. That's the plan for now, just to raise another round of growth capital, then stay ahead of the others. We're playing with similar technologies. We're getting to a point where - fingers crossed - our revenue supports our growth.&nbsp;
What do you see as the challenges that you're going to have to overcome in the next couple of years?&nbsp;
Implementing disruptive technology is always going to be a challenge. So is finding a new company and developing something innovative. We are still in the niche, and need to expand that niche day by day. Fundraising will be a challenge with the current situation in the economy. The Ukraine / Russia war is challenging too, but we don't worry about supply chains, because that's something we set up very well. So yeah, there are challenges, but we&rsquo;re not worried about getting through them. &nbsp;
What do you see as future trends in the surgical robotics industry? &nbsp;
We&rsquo;re seeing lots of projects that focus on invasive systems. That's one general trend that you can ignore. On the other hand, what I think is super exciting, is the intuitive system. I think that having more specific robots for specific procedures is going to be the future of the industry. That's a more interesting trend in my opinion. We&rsquo;re seeing devices in laparoscopic surgical robots for example, that insert a Cochlear electrode, and improve patients&rsquo; residual hearing and stuff like that. Interventional Systems are also building one tiny robot for interventional surgical procedures and biopsies, which allows us to analyse the data it collects too. AI will keep getting stronger to support doctors and surgical robots too.&nbsp;
What advice would you give to people who come into the industry in the future?&nbsp;
Don't just do it. Know the use cases for what you&rsquo;re doing. Don't be afraid of going down that path and plan for not just one extra mile, plan for lots more extra extra miles. It's getting more and more competitive in the field, so be prepared for that. If you want to move in a specific direction, you have to know the weaknesses of the other devices in that niche to build something remarkable. That's true for every product you develop. When you decide to develop one super specific robot for one super specific procedure, then you've got to involve as many surgeons as soon as possible to evaluate if the idea really makes sense, and if it has a large enough audience. Who's willing to pay the bills for it? The industry is a lot of fun, but a lot of pain too. &nbsp;
What do you think are the three top technologies that we're going to see in the surgical robotics sector in the future?&nbsp;
What's going to support various robots and functionalities is AI. That's going to support part of or the whole device within augmented reality. Having augmented reality allows you to get more information to the microsurgical cockpit, so that the surgeon has all the information needed - maybe a bit more. Connected devices are also something with potential. In the future we could see a standard interface that you're able to connect various devices to. The devices will be able to collaborate more if they are connected and communicating with each other, controlling functions, and stuff like that. There&rsquo;s so much potential. &nbsp;
To learn more about where the surgical robotics industry is heading, tune into The Surgibots Podcast here. &nbsp;
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Surgical Robotics of the Future

On Episode 2 of The Surgibots Podcast we spoke to David Fischel, the Chairman and CEO of Stereotaxis, about the benefits of surgical robotics for patients and surgeons. David joined Sterotaxis after a successful career in the financial industry, where he specialised in medical device venture capital and healthcare hedge fund investments. After seeing Stereotaxis&rsquo; innovation and potential, David transitioned into a business management role to help the company take their surgical robot for minimally invasive heart surgery to the next stage. &nbsp;
What's the effect on the patient when surgery is performed mechanically compared to when it's done robotically?&nbsp;
The vast majority of our clinical experience has been in one specific type of endovascular surgery called cardiac ablation, which is a procedure used to treat arrhythmias. In the procedure, if the heart is not beating regularly, catheters are navigated into the heart chambers. There are a subset of interventional cardiologists focused on arrhythmia and heart rhythm disorders, and they're able to use electrogrammes, mapping systems and other diagnostic tools to determine where the misbehaving heart muscles are that are causing this irregularity. They can then use an ablation catheter, typically with an RF energy, to ablate that tissue and isolate the misbehaving heart muscle cells. &nbsp;
That's a very common procedure - there are about 1.2 million of those a year around the world. You have to control the tip in a very precise way and get your blade in the right spot to treat the arrhythmia. If you put the blade in the wrong spot you can cause significant damage to the patient, so you have to take direct control of the tip and hold the catheter in a very steady position against the tissue. With the robots, you can do all of that with a very soft and gentle catheter, which has a much lower risk of mechanically harming the patient. In addition, the physician is now doing this entire procedure from a computer cockpit, so they're not exposed to radiation from the X ray system. All of those factors provide value. &nbsp;
One of our physicians uses the system predominantly in paediatric and complex congenital patients. People who had a congenital heart disease had many surgeries over their childhood, and because of that, they often develop an arrhythmia as they become older. In those patients, it's often difficult to navigate the abnormal anatomy, because the tissue is thicker where it&rsquo;s been adjusted through several surgeries. Surgeons often have difficulty reaching where they need to, but the robotic catheter can be steered through the twists and turns with great precision, reaching areas that would otherwise be unreachable. This technology is allowing surgeons to treat patients that otherwise would have no other options. &nbsp;
What other benefits are there for using the Genesis system?&nbsp;
 I'd say the two biggest benefits are the reduction of risk and to the ability to treat patients that otherwise have no options. With the reduction of risk, there is a reduction in major adverse events for patients because of the very soft, gentle catheter that is being navigated through the blood vessels into the heart. That creates a much lower risk of complications than with rigid catheter, where if the physician makes one sudden move it could perforate the heart or dissect the vessel. The reduction of major adverse events leads to significant saving overall for the health system. &nbsp;
For physicians, it allows them to keep operating as they get older. If their hands are less stable due to age or illness, our system allows them to minimise the risks that that poses to their patients. The loss of a physician is a significant burden on society, so being able to reduce the risk for both patients and physicians provides widespread societal savings. &nbsp;
The overall burden on the health system of a patient with a severe arrhythmia is relatively high. They'll be hospitalised multiple times, they'll be on various drug therapies that have relatively poor efficacy etc, so when you can do an ablation procedure that treats them definitively, that is highly beneficial for everyone. When you can provide therapy to patients that otherwise wouldn't be able to be treated, that provides a huge benefit as well.&nbsp;
To hear more about the work of Stereotaxis&rsquo; surgical robots, tune into The Surgibots Podcast here. &nbsp;
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The Benefits of Surgical Robotics 

One of the biggest challenges facing the surgical robotics industry is securing funding. On the first episode of The Surgibots Podcast I spoke to Benjamin Sexson, the CEO and Co-Founder of Monogram Orthopaedics, about a radical alternative funding route that his company has recently taken. &nbsp;
Why did you decide to go down the crowdfunding route?&nbsp;
I'm gonna be honest, crowdfunding wasn't our first choice, but we struggled to get the capital from a traditional finance route. Doug and I were a two-man-band with a really good idea, some patent filings and a prototype. We had this vision, but we didn&rsquo;t have a team or a way to execute it. Investors were saying &lsquo;Come back when you have FDA approval&rsquo; or &lsquo;It's going to take too much money to get it off the ground&rsquo;. It was the scale of what needed to be done to build a team that was our struggle, and we just weren't able to raise the capital. &nbsp;
I suggested crowdfunding. The first portal that we reached out to is a group called Seed Invest. We basically presented the opportunity to the community we got through their investment committee, and to the general public and said &lsquo;Hey, do you want to help support it?&rsquo; It turned into one of the most successful crowdfunded orthopaedic raises I'm aware of. Once you're in the crowdfunding jetstream, it becomes a blessing and a curse, because it's a challenge to get out of it and go back to conventional funding. We've kept this channel and it's been really successful. &nbsp;
What's next for us is a planned listing on NASDAQ. We have a series D round that's just gone live, which is effectively going to be the capital that takes us public, and then will be publicly listed. That's going to put us in a position where we can access institutional capital and push this across the finish line. &nbsp;
What are the pros and cons of going down the crowdfunding route?&nbsp;
I dislike the way the system operates. It's almost like a popularity contest with Silicon Valley. There are certain things that these VCs are looking for, and a lot of them are arbitrary. They&rsquo;re not good markers of whether or not a company is going to be successful, or whether or not an entrepreneur has the hunger to make it happen. What I like about crowdfunding is that you're dealing with real people. If you're genuine, and you explain what you're trying to do, there&rsquo;s a pool of people who either want to be a part of it or don&rsquo;t. They&rsquo;ll decide to invest without intangibles about your business idea. It&rsquo;s more real and organic. You present your idea, and people either like it, or they don't. &nbsp;
The challenge with it is that crowdfunding is pretty new. When you go to these funding portals, people are negotiating on behalf of their investors, and they're trying to do what they think is in their best interest. These investors now have voting rights though. As a company we have to manage a cap table with a lot of people. If somebody gave us $200.03 a few years ago there, they might be following the story, but they might not open every email. When you need them to vote on something, it becomes difficult for companies to really manage that process. &nbsp;
There's a lot of capital available through crowdfunding portals, but you do hit limits, so it&rsquo;s hard to scale when you need institutional capital. For Monogram to be successful, we're going to need really serious capital, because it's a serious undertaking. That&rsquo;s when it becomes challenging to get that capital outside a corporate structure. Big investors might need a certain amount of shares, but because of how we&rsquo;re structured with crowdfunding, we might not be able to offer it to them. That makes it extremely difficult for institutional investors to come alongside and help build your company. &nbsp;
A big part of going public for us is that it's going to convert all of the preferred share classes that we have into common shares. Everybody will be on the same playing field, and then we'll look like any other company to an institutional investor. I would caution anybody thinking about crowdfunding to be really careful, because it can become an impediment to growth at a later stage.&nbsp;
Are you worried about the changing market conditions? &nbsp;
I frequently don't sleep thinking about that. There are no guarantees you'll have access to capital. The economy certainly concerns us, so we've tried to be as conservative as we can with hiring. It's really hard to find the right balance between keeping your team lean, and getting things done that need to get done. But yes, that's a major concern. Our economy, the stock market and people&rsquo;s appetite for risk is rapidly changing, so all we can do is put one foot in front of the other, and try to build a solution that will make a difference for patients.  That is all we focus on; how is this system or concept going to make a surgeon's life easier, or improve outcomes for a patient? That's all we have in our control. &nbsp;
If the economy doesn't go where we want it to go, we have to be smart about spending money on people who we don't necessarily need to hire right now. Every dollar goes into r&amp;d or building a product. We're being cautious right now. I certainly think that things will get tight. It's not all negative, though. Hiring has been challenging the past three to six months, because hiring engineers was becoming cost prohibitive. If there was a recession, that would improve the labour pool for companies like Monogram who can&rsquo;t offer the level of salary that we would like to, so there are always ups and downs to every situation. We just have to be smart about how we spend our money. &nbsp;
To learn more about alternative funding and financial strategies in the surgical robotics industry, listen to The Surgibots Podcast here. &nbsp;
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