"The future of surgery is not about blood and guts; the future of surgery is about bits and bytes.”
/Dr. Richard Satava/

Monday, October 24, 2016

Updates on Verb Surgical

MIT Technology Review and Mass Device covered the recent announcements of Verb Surgical.

"When executives from Verb Surgical, a secretive joint venture between Alphabet and Johnson & Johnson, presented at the robotics industry conference RoboBusiness late last month, they made the da Vinci sound lame.
Intuitive’s machine, with an average selling price of $1.54 million, is too expensive and bulky, they grumbled. Pablo Garcia Kilroy, Verb’s vice president of research and technology, complained that while da Vinci is an impressive tool, it’s a dumb one that hasn’t widely transformed surgery. He said that while it enables surgeons to perform very delicate movements, it doesn’t assist with the cognitive skills that set the best surgeons apart.
Verb claims to be developing a product that will make robotic surgery much more powerful and widely used than the da Vinci has. Garcia didn’t describe that product, and the company has said that a working prototype to be completed this year won’t be publicly unveiled. But Garcia laid out the key features Verb thinks a next-generation robotic surgeon needs. Patents that list him as a co-inventor offer further clues.
One of Verb’s priorities is to use artificial intelligence to help surgeons interpret what they see inside a patient. Existing robots just leave surgeons to look at a video feed. Garcia said that artificial neural networks like those Google uses for image search could annotate a feed with anatomical data and guidance such as information about the boundaries of a tumor. That could give any surgeon a level of expertise usually obtainable only after experience with thousands of cases.
Verb has said its robot will be significantly cheaper than a da Vinci. Garcia said that he also wants to make it much smaller, and that connecting surgical robots over the Internet would make it possible to quickly improve their skills and the guidance they can offer surgeons.
Google researchers recently got robotics software to learn complex skills more quickly by having multiple robot arms share their experiences (see “Google Builds a Robotic Hive-Mind Kindergarten”). “We see a similar dynamic happening in surgery,” said Garcia.
Verb’s robotics technology has been in development for almost four years, though the company only incorporated in August 2015. The joint venture was created by combining a project from Verily, previously known as Google Life Sciences, and Ethicon, a medical-device company owned by Johnson & Johnson. Ethicon had been working on surgical robotics with nonprofit research lab SRI International, and Verb licensed that technology.
Some Verb employees, including Garcia and the company’s director of research, Karen Shakespear Koenig, previously worked at SRI. The pair are among the authors on patents originating in 2013 that describe a “hyperdexterous surgical system” and a “compact robotic wrist.”
The documents detail systems with more mobile joints than surgical robots on the market, saying that would allow for smaller, more capable robots. They claim this would avoid one problem with existing robots: they can’t reach certain “dead zones” in a patient, because their bulky arms limit maneuverability. SRI declined to elaborate what technologies it has licensed to Verb.
Robotic systems that augment a surgeon’s thinking as well as motor control have a better prospect of being used for a wider range of operations and improving the results, says Duvvuri. “This is the kind of approach we need if we are to figure out how to make a good surgeon into a great surgeon and provide better care for the patient,” he says.
Garcia of Verb also envisions being able to significantly increase the productivity of surgery by making surgical robots with a degree of automation. One surgeon might be able to supervise multiple theaters, staffed by robots and less-skilled personnel, he said."

"Verb Surgical will look to implement a “transformative agenda’ in the field of robotics,” with the goal of “democratizing surgery,” according to Pruden.
In Pruden’s words, that means improving surgical outcomes through the use of advanced robotics and informatics that puts the skill of the top 5% of surgeons in hospitals worldwide.
“The top 5% of surgeons can do things that the other 95% just can’t do, in terms of improving outcomes and procedures. If you travel around the world, it gets worse.
“We want to take it to the next level, and if we manage to deliver a system which is built on making better decisions based on advanced analytics, analyzing every decision that was taken by every machine as it’s done,” Fitchet explained, “we bring the opportunity to bring the level of outcomes up as well, meaning every surgeon can get the results of those high operators in say the top 5% of their field."

Image credit: US20150157410, US20150209965

Friday, October 21, 2016


UW's surgical cockpit concept. More of the Raven in the news.

Wednesday, October 19, 2016

Monday, October 17, 2016

Cambridge Robotics news

A nice article appeared recently, telling a little more about the daily business of Cambridge Robotics.
"Fast-growing tech firm Cambridge Medical Robotics isn't afraid to think big. Matthew Gooding went to meet chief executive Martin Frost and learn more about the company's modular robotic system that could transform surgery.
Describing a company's office as a pig-sty isn't usually the best way to make friends, but Cambridge Medical Robotics probably wouldn't take offence. "Our building is where they used to keep the pigs," explains chief executive Martin Frost, as we take a walk around the firm's premises at Crome Lea Business Park, a converted farm off Madingley Road which overlooks the rolling fields of south Cambridgeshire.
"When we got here it was just an empty shed with a concrete slab for a floor, so we've had to build it almost from the ground up. It's a brilliant space, though, and we love the view."
ARM famously started life in a Swaffham Bulbeck barn, so CMR is in good company. The firm, which was founded two years ago by Frost and a group of pals, is developing a modular robotic system which it believes can make minimal access surgery more, er, accessible to patients around the world.
"For surgeons, keyhole surgery is like trying to perform a difficult procedure using a knitting needle with a fine instrument attached to the end of it," says Martin, as he demonstrates one of these instruments, a terrifying-looking thing that's about a foot long. "You can only achieve movements of 180 degrees, and the process is very strenuous for the surgeon involved as they have to stand over a patient for hours at a time."
As someone who still bears the scars of having my gall bladder removed 18 months ago, it's enough to make me wince. But I should probably be grateful I live within hobbling distance of one of the country's most prestigious hospitals, otherwise those scars would be a lot larger.
"Obviously it's a lot better for you to have your gall bladder out using keyhole," Martin says. "But hospitals can't always find experienced keyhole surgeons, there might not be any in the area at all. There are 12 million procedures a year carried out which should be done by keyhole surgery, but only half of them are.
"Why use a robot? Well, it's more flexible and can be more precise and less invasive, meaning patients can recover quicker, have a shorter stay in hospital and health care providers can save money."
Surgical robots already exist, but their scope is limited, meaning they spend a lot of time gathering dust. CMR believes its system will be able to carry out 90 per cent of minimal access procedures, making it much more cost-effective.
Frost has form when it comes to device development, having spent 11 years with Sagentia, as CFO and CEO. His co-founders also worked at the Harston business, but he insists CMR is not a spin-out.
"We all share common DNA," he says. "Dr Mark Slack is chairman of our medical advisory board and head of pelvic reconstructive surgery at Addenbrooke's. He's a fantastic surgeon and would love to be able to use robotics as part of what he does, but he can't make the argument when the robot is expensive and won't be very busy.
"We want our system to be something that you can put in the hands of great surgeons and extend their capabilities.
"It's very different to everything else on the market. The control system is similar to that of a games console so it's much easier to learn and we think surgeons will be able to be trained on it in a matter of weeks."
Martin isn't keen to go into much other detail about the robot, with various patents pending (the company has already filed 50), but CMR has attracted plenty of interest from investors. It raised £4 million in seed funding in 2014, and earlier this year closed a £15 million Series A round. But more cash will be needed, lots more.
"When you're developing devices everything you do is big," says Martin. "We're a rare company in Cambridge in that we're actually making something, and realistically that means we need £35-£40 million.
"It can be a challenge because investors perceive devices as much riskier than biotech. I think it's because you have to build something then get it into the market before you get the return.
"We plan to double in size in the next 18 months, so we'll be up to 100 people by the end of 2017. That needs serious commitment and serious shareholders. It's a bit scary, but that's what you need to do to be successful with devices."
Indeed, speed is of the essence for CMR, not least because some industry big names are planning surgical robots of their own, with Google and Johnson & Johnson among those to have announced they plan to try to grab a slice of a worldwide market which is already worth $3 billion. The company has reported success in trials on human cadavers, and now plans to ramp up testing.
Dr Slack believes surgical robots will become a standard feature in operating theatres over the next decade, and Martin is confident CMR will be in prime position to take advantage of this growing trend. "Most predictions suggest the market for these robots will grow fivefold in the next decade," he says.
"The last revolution in surgery was when keyhole techniques were developed in the 1970s and 1980s, and beyond that you have to go back to the introduction of anaesthesia. Robotics has the potential to completely transform surgery, almost like when the first PCs were put into offices.
"I do believe we'll be ahead of the competition and be able to build a large market for our products. We want to be Cambridge's next billion dollar company, and we're not shy of saying it."

Sunday, October 16, 2016


The audience at this year's CRAS2016.
Image source: VESPA