In this interview, Surgical Robotics Technology speaks with Dr. Michael Vogele, CEO at Interventional Systems, about the company’s current status and product offering, exciting new developments with the Micromate™ robotic system in 2022, challenges in developing a robotic system for micro-invasive interventions and how Interventional Systems is adapting to stay ahead of its competition.
Could you please begin by providing a background to Interventional Systems?
Dr. Michael Vogele, CEO (MV): Interventional Systems stems from a very cohesive, very creative set of minds that share this particular trait: the ability to look at things they work with on a daily basis and question them. And because most of those minds have a medical, engineering or fairly scientific educational background to them, they just keep fidgeting with that self-imposed problem until they find a new, better way to solve it.
That’s what lied at the core of my very first company, Medical Intelligence, which invented the Hexapod system, the first robotic treatment couch for radiation therapy with six degrees of freedom, which essentially turned the medical table into a steerable piece that precisely aligned patients undergoing radiation therapy to the radiation beam, rendering the workflow much more seamless.
At that time, we were also fascinated with “live” imaging capabilities and in parallel with our activities in radiation therapy we were also looking closely into interventional radiology procedures and thus we started our first developments in that area.
So, we’re coming from image-guided procedures and stereotactic robotics. It was an unconventional, but extremely disruptive field and technical approach to start with.
Robotics was first developed for laparoscopic procedures, and then orthopedics and endoluminal procedures followed. And the state-of-the-art offering on both fields continues to be around large, industrial-arm-based robot technology. We have been the only ones with a miniature robot for percutaneous procedures for nearly 10 years, but recently new compact solutions have appeared, even in those other fields. So we believe that the different technical approaches for robotic surgery will eventually fuse, combining the minimally invasive percutaneous approach with compact solutions, with extremely adaptable, steerable, and highly flexible effectors and instruments to work in narrow spaces.
This is the path we’ve walked so far. Micromate™ is the result of over ten years spent answering the question: “But what if any kind of intervention could be performed by a robot that acted as the physician’s steadiest, most reliable hand?”
How has the pandemic impacted Interventional Systems and what is the outlook for 2022?
MV: Before diving into details regarding the pandemic and how we handled it, let me just make a point on how Interventional Systems’ understanding of Medicine made us look at this medical crisis. We’re a company that supports percutaneous procedures, so our ultimate goal was always to reduce hospital stays, side effects of interventions, cross-contamination and infections rates by doing small punctures.
This lies at the heart of our belief system, so the COVID-19 crisis is not just a commercial setback for us, it is also a living example of the problem we’re trying to conquer.
This being said, as a company, we always strive to see the silver linings in any hardship that comes our way. The pandemic had its fair share of hardship and it stifled us on both ends of our business funnel: on one end, trade shows and demos mostly went online; on the other end, our clients and KOLs were dealing with the most demanding quest of their professional lives, and we obviously knew we had to respect that.
But we also knew that stopping meant dying so what we did instead was realign our priorities: instead of looking for sales growth, we redirected our efforts towards product and market growth.
That is why Micromate™ — the new and improved version of our robot — was rolled out during the pandemic. That is also why we got our FDA approval during the pandemic — enabling us to reach the US market. In fact, from a market reach standpoint, in 2021 we added the US, China, South Korea, the Gulf region and Turkey to our client list, meaning we’re now represented in almost every single continent.
From a business standpoint, there was a clear message to 2021: we know this is not the perfect time for medical teams to buy a robot, there are more pressing problems to address. So we’re going to stand in the back, doing everything we can to improve our offering and our market reach. And now that clinical teams are back to topics other than COVID-19, we have an even better offer with even less friction.
Congratulations on your recent FDA approval for the Micromate™ system. There is a lot of excitement around this offering. Could you please explain some of its features?
MV: Micromate™ is a remotely-controlled miniature, table-mounted medical robotic platform that is designed to fit several different types of percutaneous intervention because it can hold, steer and insert several different types of medical equipment.
Because it fits inside the gantry, it allows the medical team to have live-imaging of the intervention, be it a fluoroscopy or a CBCT, during the alignment – essentially, a user can drive Micromate™ to its final position and align to the surgical plan real-time imaging.
And since there’s a robot inside the gantry taking care of the critical part of the process, the interventional part of surgeries also takes less time, so exposure to radiation is highly decreased both for the patient and the clinical team
Micromate™ can fit any standard table and is equipped with a universal needle guide concept that enables the guidance of any standard instrument. This allows users to maintain 100% of their typical workflow. The only difference is that the robot performs a faster and more accurate alignment to the surgical plan than a physician would, and it keeps that alignment throughout the procedure.
In fact, the system is very adaptable and works synergistically with the user. Instead of tucking it to a corner for telemanipulation, it invites physicians to take control and advance the instrument during the therapeutic steps.
We achieve this by providing a very stable but near frictionless passive needle guidance solution, thus ensuring the inserted instruments are kept within their trajectory during needle insertion, while still providing the much needed, and extremely relied on, needle-transported haptic feedback which is used to feel and differentiate tissue types and lesions.
But if any feature should be highlighted about Micromate™, it’s its submillimeter accuracy. Some body parts are especially critical on this end, especially if we’re talking about soft tissues that are prone to movement, or bony tissues, whose treatment requires substantial forces. Having submillimeter accuracy is something unmatched in the medical robotics field and the quality we believe really distinguishes Micromate™ from the rest. This is only possible with live-imaging, as you can identify and compensate for any potential deviation in real-time.
What are the main clinical applications for the Micromate™ system?
MV: As a surgical platform, Micromate™ is used for several different applications in several different fields of medicine, either those in which robotics are most widely used, or bringing some innovations in niche applications. We are very active in spine surgery: spinal fusion, for instance, is being performed using Micromate™ in the US and will soon start being performed in China too.
On the other end, such a platform makes it possible to turn previously challenging and lengthy procedures into a simple percutaneous puncture. For instance, post-AEVAR endoleak embolisations, which are performed using Micromate™ in Innsbruck, right in our backyard. This procedure was previously performed in an endovascular fashion, but Micromate™ enables the targeting of an aortic aneurysm sac through the dorsal muscles in a very simple, but extremely accurate way.
Currently, we’re focusing our scope of action in Interventional Oncology, from the diagnostic phase (we have Micromate™ performing biopsies in several different parts of the body, some of which are particularly delicate, like the paraaortic region) to the treatment phase (ablations of all types are also being performed resorting to Micromate™, even in anatomies as challenging as the lung or liver).
What are the challenges in developing a robotic system for these types of application?
MV: Developing a robotic system that holds accuracy as close as ours comes with its challenges. Some challenges stem from the product itself — how to keep enhancing it; other challenges deal with the fact that we work with a diverse range of clients, so we have to adapt to their needs.
A product challenge we faced concerned the soft tissues vs. hard tissues question. It is not extremely difficult to be accurate when targeting bones, especially long bones or the lumbar and sacral spine. These are large, barely-moving structures and, even if they move, there are well-established means to recalibrate the systems. But if we are going to perform interventions on soft tissues, we need to deal with all kinds of things, like organ movement due to breathing or instrument-induced displacements, or the importance of intraoperative imaging as the inner organs don’t always have the same disposition and shape.
As for the hospital and client constraints, they are fairly easy to explain: every hospital, every department, every OR has different setups and preferences for patient positioning, different tables and instruments, even different opinions regarding what’s the best type of imaging modality.
Everything must be disposable: interventional departments are not so keen on having to resterilize instruments because it is costly and they have a relatively high daily patient turnover which would require them to invest in multiple, very expensive sets of instruments. This forced us to create from scratch an entire sterile concept that maintained the performance without compromising on hygiene.
This means our robot must be extremely adaptable to accommodate every single possible setup, positioning preference, table, instrument, imaging modality, because we all know that changing the medical team’s workflow is not an option. And all this must be performed extremely fast. A typical biopsy procedure takes around 30 minutes of room time (we are cutting this down to around 20 minutes, in some cases close to 10!), and nobody is willing to use a system that requires substantial time to set up, no matter how sophisticated it is.
With the increase in new medical robotics manufacturers entering the market, how are you adapting your product offering to stay ahead of your competition?
MV: As pioneers in miniature robotics for percutaneous interventions, we have been paving the way all by ourselves for many years, so it’s always interesting to see new players joining the field. And these competitors don’t just come up with robots, some of them actually come up with robots with a small footprint, which validates our initial judgment. But the best part about having competition is it gives us further reason to stay on our toes.
This being said, we must note that there has been a tectonic shift to how robotics is handled; especially in radiology, there’s no stomach for capital expenses. Competitors still struggle with very high price points, whilst our business strategy and years of expertise on the field give us the leverage to not only build better robots, but also to offer them as an extremely cost-effective solution that is built from the get-go to adapt to our clients’ needs.
There’s another thing no competition can replace: the constant internal hunger for novelty. And this is something that for me, as the company’s CEO, is especially rewarding: I am surrounded by a group of people who are always itching to try new things and to take our current products further.
We try to foster this healthy synergy in two ways: we hire talent that has a creative, spirited quality to it and we then give them space to showcase anything they find makes sense — no strings attached, but no judgment either; it can be a screw or an entire new appliance, we’re equally open because we know either can make a huge difference in the long run. We end up with several ideas in the garbage bin, but the ideas that do make the cut are winners.
The most recent form of this series of iterations and changes will appear in 2022, when we will be launching our planning and navigation station, which will make Micromate™ the first all-in-one medical robotics platform for percutaneous procedures. It will support fluoroscopy, spiral CT and ultrasound guidance, as well as a navigation workflow. From then onwards, our developments will be focused on exploring the integration into new imaging modalities and equipping our software with features that will allow better planning, execution, and confirmation of the technical success of the procedures.
The long-term vision is to shift the “control panel” of an interventional suite from the imaging device (where currently everything is done) to the robot, as it is an enabling technology by definition, interfacing both the imaging device and the instruments.