Filenews 2 August 2021
One child, Adam Sachs, co-founder and CEO of Vicarious Surgical, watched the 1966 sci-fi film Fantastic Voyage and was thrilled by the film of tiny surgeons performing surgery inside a scientist's brain. "People are the wrong size to operate on people," he says. "We're not going to shrink people, but we can create avatars from them. We can create small microscopic robotic versions."
He and the co-founders of Vicarious Surgical - Sammy Khalifa, the company's chief technology officer, and Dr Barry Greene, the head of its medical department - have spent the past decade doing just that. They have developed a robotic robot paired with a VR headset for abdominal surgeries that they hope to bring to market in 2023. Both hands and his camera are designed to enter the patient's abdomen through an incision of less than an inch and operate in all directions when they are there. Shrinking a surgical robot is extremely difficult, but in doing so the Vicarious trio hopes to help doctors perform abdominal surgeries, starting with hernia operations, faster, safer and with fewer complications than existing alternatives.
It's not exactly the sci-fi material of the film, in which doctors are injected into the patient's circulatory, but it's pretty futuristic that Vicarious has attracted investors from the top shelf, including Bill Gates, Vinod Khosla, Eric Schmidt and Jerry Yang. It has also received a ground breaking designation from the FDA - the first for a surgical robot - making it eligible for priority review.
"Putting the elbow into the body cavity and being able to get back and work towards the abdominal wall is a big deal," says Paul Hermes, who ran Medtronic's robotics program and is now a vicarious consultant. "We should expect robotic surgery to improve."
The company is set to go public through a merger with a special-purpose company founded by Hong Kong investor Donald Tang. The $1.1 billion deal will raise $115 million and bring in medical technology giant Becton Dickinson, who manufactures the surgical mesh used in hernia repairs. It predicts it will reach $1 billion in annual revenue by 2027.
"We're chasing markets where existing surgical robots have encountered difficulties," says Sachs, 30. "There are a lot of imitators out there targeting the existing ones. They have the same challenges... Our work is completely different."
The megatherium in robotic surgery is the $115 billion company that listens to the name Intuitive Surgical, which introduced da Vinci, a large four-handed robot that holds tools, two decades ago and has dominated the space ever since. As Intuitive's patents expire and robotic technology evolves, competitors such as J&J and Medtronic, which have acquired robotic surgery startups, are vying to make robotic surgery as common as laparoscopy. The expected price of Vicarious's robot at about $1.2 million, being nearly half that of existing frontline robots, could be a factor in its favour, as could the ease with which surgeons can learn how to use it.
Sachs' training with machine design began at his suburban home in Boston. His father, Ely Sachs, is a professor of engineering at MIT, who is considered the oldest personality of 3D printing. His mother is an architect. He met Khalifa, 31, during his first year at MIT, where they both studied engineering. They quickly became friends and spent their free time in the school's machine shop making the mechanical components that feed a robot's joints. "We tried them, we found out they weren't working and we did it over and over again," says Sachs.
While Sachs and Khalifa were still in college, they began working with Greene, a bariatric surgeon and friend of the Sachs family, on a medical device that became the robot. In 2014, after a brief stint at Apple, Sachs officially launched Vicarious with $400,000 in funding led by Michael Rothenberg (VC was later accused of fraud by the Justice Department in an unrelated case). In 2015, Khalifa quit her job to join the project.
The hardest part over the years, says Sachs, has been finding devices for robots. Making them small enough to include nine of them, three times as many as usual for surgical robots, was difficult. So is their disconnection so that each joint can move separately, with the help of 28 sensors per arm.
Carnegie Mellon robotics professor Howie Chooset compares the technical challenge to fit too many things into a luggage, and then try to use all these things to do something. Even worse, he says, the smaller the actuators, the weaker they become. "You want to get as much mobility as possible in as small a package as possible, but you're already struggling to get as much as possible in one package," he says. "It's amazing that [Sachs] did this."
Hernia repair, Vicarious's first target market, is huge, with more than 2 million operations a year in the US. Celiac diseases, common along the middle line of the abdominal wall, represent about 500,000 operations and are extremely complex. Typical repair involves placing a mesh on the abdominal wall, but results in recurrence about 20% of the time, often requiring a more extensive repair. An advanced technique that involves lining the mesh onto the rectal abdominal muscle reduces relapse, but it is difficult and can take up to four hours with existing robots.
When Vicarious received the FDA's pioneering designation, he could perform this surgery on a corpse in about half the time, Sachs says, and has since reduced it to less than an hour. In a video demonstration of a celiac repair, vicarious robot hands push the mesh into the abdominal cavity and then sew it quickly. Smaller surgery is less dangerous for patients and more economical for hospitals.
Vicarious's ambitions extend to other abdominal surgeries, including gallbladder operations, for a total potential purchase of 39 million surgeries (only 3% of these are done with robots). That's why Sachs, whose stake in Vicarious is worth $112 million, reckons it only takes a fraction of the market to create a large company.
Source: Forbes
