We recently visited the Canadian health tech startup incubator, the BioMedical Zone, to speak with Canadian entrepreneurs who are developing exciting new medical products and technologies. Robert Brooks is one of those entrepreneurs, and his new medical sensor tech shows us how new technology can make existing surgical instruments even better.
Dr. Robert Brooks of SensOR Medical Laboratories
My company is called SensOR Medical Laboratories and we are developing a virtual sense of touch for minimally invasive and robotic surgery.
Most people are familiar with open surgery. If you are watching any of the medical dramas, someone takes a scalpel, they cut the person open and they stick their hands inside. We don’t do that anymore. It is very rare that it would be required.
I had my gall bladder removed last year. They did something called laparoscopy…
Exactly. Minimally invasive surgery is the default at this point. The only reason they would opt for open surgery is if they need to remove something that is relatively large, or if it is an emergency situation.
The vast majority of procedures are done with laparoscopic instruments. It’s great because you recover a lot faster, there’s less scarring, there’s less risk of infection.
Surgeons are known for their golden hands, but at the same time it used to be a lot easier for surgeons to feel what they were doing when they were in direct contact. When you take that away…
The tactile piece is not there.
They’ve lost the tactile sensation. Even with more and more training that has been added in to become proficient with these laparoscopic procedures, you are still missing a sense.
We have come up with a technology to give that sense back to surgeons.
The way it works is that we have this very thin film that goes on a standard off-the-shelf surgical tool that you can get from many manufacturers. This very thin film is able to measure all the forces that the surgeon applies to the tip of the instrument. There is a small electronics module at the back of the instrument that decodes that information and wirelessly displays it on the monitor the surgeon is already looking at.
What is it actually measuring? Pressure?
Force. It is able to determine all the different forces that the surgeon is applying to the tissue, and then we give them visual and auditory feedback. That way they can look at the screen and see exactly how much force they are applying.
New features we are developing is the ability to see how much force they have applied in the past so they can use that information to be a lot more consistent, because right now, they are remembering how they’ve done it in the past. So you never know – maybe they had an extra coffee that day and they were going a little harder…
It takes a lot of work to co-ordinate two hands in surgery. The other ability our technology has is that the surgeon can set limits. If they are grabbing onto this one piece of tissue and they are really concentrating on their right hand to tie a knot for example, to stitch things together, they can often forget what they are doing with their left hand. They can grip a little too hard, or they can potentially drop it. So our technology has a little auditory cue to let you know if you are grabbing the tissue a little too hard. Organs are quite fragile.
To get an idea what surgeons are doing currently, in a laparoscopic gall bladder procedure for example, what is the surgeon doing? Are they looking through some kind of binocular thing, a video monitor? What are surgeons doing currently?
They would have two instruments like this one, using them like a knife and fork, then there would be an attending surgeon, someone who is a little less experienced, who is working under this veteran surgeon. So the veteran would be operating the two instruments, and the other one would be holding the camera that they are viewing everything through.
They are looking up at a screen and there is a camera in the middle, two tools that they are holding onto at the side, and sometimes that attending surgeon will also have a third instrument that they will use to grab or move things out of the way. It is usually 3 or 4 things, or sometimes even just one instrument and a camera.
With your technology involved in the procedure, how would that look?
It doesn’t change the way they operate, it just gives them that extra bit of feedback. When the surgeon is looking up at that camera view they are also getting some bars on the side showing exactly how much force they’re applying with their left and right instruments.
So this is more relevant data coming in from the operation itself. I can see this being a huge benefit for a surgeon.
It is giving them the information back that they used to have before, and doing it in a digital way, rather than with a tactile sensation.
How long have you been in the BioMedical Zone?
We have been year since May 2017. The company has been around since December of 2015, and I was working on it 6 months before that, when we officially incorporated.
How did you come up with this idea?
So I was doing my PhD, building medical devices over at the Hospital for Sick Children, as part of my PhD at University of Toronto. I did my PhD in mechanical engineering, and I was building new types of surgical instrument mechanisms to enable the next generation of surgical instruments.
One thing I found, because I was one of the older PhD students in the lab and good at manufacturing things, I often helped on a lot of other projects. I spent a lot of time making very complicated instruments. They were very difficult for surgeons to learn and to use, and the instrument was always for a specific procedure. We were making more instruments for narrow use cases that require more education and I don’t think that is sustainable.
“I think the way we move surgery forward is to make the generic instruments more widely applicable and more useful.”
I think that the way we move surgery forward is to make the generic instruments more widely applicable and more useful. That’s why I think that giving surgeons their sense of touch back will make it a lot more accessible, a lot easier for surgeons to use, and expand what it can be used for.
Kind of like if you looked at the end of the industrial revolution we had a specialized machine for everything, to perform just about every task in manufacturing. These would all be custom made and machined. We moved from specialized machines to having a standard pick and place robot and an arm being flexible enough to do just about everything on the manufacturing line.
I think we need to follow a similar path in surgery, where we have a few general use instruments that can be used broadly.
So you are developing the medical sensor tech for instruments, but not the instruments themselves. Your technology then can apply to any number of surgical instruments, giving them more functionality. This is brilliant.
Taking all the basic instruments that every manufacture makes, and making them far more valuable. The manufacturers make the basics, but they also make increasingly complicated versions of instruments for specific areas. We want to take the standard surgical instruments that everybody has already trained on, that everyone already knows, and broaden what they are capable of.
Are you having trouble dealing with surgical instrument manufacturers, with their intellectual property, their design patents and the like? Are they exercising any control of what you are doing as you approach them with designs for this new sensor technology?
We’ve approached them and for the most part they are quite open to it, because they still get to sell their devices. In fact if they bought our technology they could probably sell a lot more of their basic devices at more of a markup.
Right now these instruments are quite commoditized. They don’t make a heck of a lot of money on each. That’s why they are going to these more complex instruments because that’s where the new markets are. So if you could take a product that they already have and create an add-on to it, then they would be able to produce the exact same instrument, get higher margins for it, and even have a bigger market for it.
“We want to take the standard surgical instruments that everybody has already trained on, that everyone already knows, and broaden what they are capable of.”
Just from an overall economy point of view, that’s incredibly efficient.
For sure. How are you getting your medical sensor tech into the hands of surgeons? I imagine the BioMedical Zone is helping out with that…
The BioMedical Zone is incredibly helpful with that, we don’t have our Health Canada of FDA approval yet, so what we’ve been looking at doing is getting this into research and surgical education.
There’s a lot that still hasn’t been measured in surgery. Nobody has actually gone through each procedure to determine what the correct forces are in each procedure. That is still a new area that has to be explored.
From a training perspective, if you think this is hard for a veteran surgeon, imagine how difficult it is for a new surgeon. There is a large use case in those two markets and we are going after those first. St. Michaels Hospital is the first site we want to do, because we are so close to it, and we are preparing to do a study here.
Reaching out and talking to surgeons, we found a few who really want to try this early on for research and for their training programs. We are actually going up to Ottawa next Wednesday to talk with one of the surgeons there about incorporating this into their training program.
Since your product is collecting data in real time from procedures, you could probably store that data and then build databases of the forces used in various operations. I can even see your technology used to model the skills of the top surgeons in the world and use that data for training new surgeons at a later time, for example.
There is likely an incredible amount of value there. Short term, the issue is raising capital. VCs, especially in the medical device space, are very pragmatic. I don’t know what that data is worth, but I imagine it would have quite a bit of value, but nobody has actually paid for force data in surgery yet.
Just selling the technology for the immediate utility and value it provides the surgeon – even just selling it for that, we estimate that there is a $2.6 billion market globally.
That would be a good upper medium size business for us if we can get there.