surgical robotics development

How fast can you bring new Surgical Robotics tech to market? Know the 3Cs to rapid development.

SUMMARY
  • Speed to market has essential benefits for all top Robotic Assisted Surgery (RAS) companies – from maintaining and driving investor confidence to realising the commercial value as quickly as possible. But speed is often associated with risk.
  • Bringing new surgical robotics development tech to market quickly and confidently requires the 3Cs: Capability, Capacity and Culture.
  • A skunkworks approach provides R&D teams with all 3Cs, allowing them to focus on working without interference or interruption.
  • Our RAS leadership team will be speaking at DeviceTalks Boston on April 30, on the 3Cs and showcasing an example of a successful robotic assisted surgery device design and product development for one of our clients.

Companies that build technologies for robotic-assisted surgery (RAS) are under growing pressure to deliver new products quickly. Whether you’re a global corporation or a small startup, you need to show executives and investors that you can rapidly innovate and go to market, and you need to realize the value of investment as quickly as possible. The keys to moving fast, avoiding risks and maximizing the odds of market success? Capability, Capacity and Culture.

If you’re a longtime leader in MedTech, you undoubtedly have capabilities with a large in-house talent pool of experienced engineers, design experts and other specialists. But your development efforts can stumble if teams are stretched thin across multiple projects or are delayed by bureaucratic red tape – which are problems of capacity and culture.

If you’re a startup, on the other hand, you might have launched with a promising concept but lack the breadth and depth of capabilities, and the maturity in all three Cs. Without a broad and deep field of experts – capability and capacity – and a proven culture built on the experience of delivering many other previous projects quickly, you might struggle to meet investors’ expectations of fast results.

What’s the solution to bringing all 3Cs together? A skunkworks approach.

“A skunkworks approach enables R&D teams to focus on projects in a way that’s protected from distraction, such as internal politics,” says James Boonzaier, Deputy Head of RAS and part of Cambridge Design Partnership’s new RAS leadership team. “Too often, what we see is that key people are constantly being pulled onto other projects, or they’re spread too thin, or there are political agendas getting in the way of things. In order to get these programs running fast, you need capability, capacity and culture. Capability means, ‘Do you have the required skills across your individual engineers’ brains?’ Capacity means, ‘Are they available right now?’ And culture is, ‘Are they able to work in the right kind of context for fast, deliberate progress?’”

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“In order to get these programs running fast, you need capability, capacity and culture.”

James Boonzaier | Deputy Head of RAS at Cambridge Design Partnership

A Better Approach to Rapid Surgical Robotics Development & Design

Cambridge Design Partnership’s (CDP) new RAS leadership team is headed up by Tom Brittain, James Boonzaier and Jack Hornsby. Their focus on fast delivery reflects CDP’s ongoing investment and long record of success in surgical robotics

CDP strengthens its clients’ RAS programs by enhancing capability, capacity, and culture. The company’s specialists work closely with client development teams to accelerate innovation and delivery.

“Key to working this way is being able to match highly skilled and technically capable people with the right expertise, experience, personalities, and a passion for RAS, and providing them with the right tools, conditions and working environment within which to do the best possible job,” says Tom Brittain, Head of RAS. “By collaborating closely with our clients’ teams, we’re able to operate as an extension of their own pool of people. And since we’ve been active in this sector, having worked with a number of the big players in surgical robotics, we know this approach works time and time again.”

This way of working, Tom says, enables quick development by providing organizations with turnkey access to deep technical expertise, system-level thinking and user-focused design capabilities. He notes that CDP’s success in the sector relies on a team dedicated and often exclusive to surgical robotics, with bespoke teams of experts often embedding with clients according to the unique requirements of each project.

“We’re passionate about our mission and committed to helping our clients’ RAS projects succeed,” says Tom. “And our approach works, as our track record shows. Since 2019, we’ve built four complete systems, along with multiple subsystems, for clients from the ground up. These have included both blue-sky development and remedial redesign with total system architecture development. Each of these systems has been designed and manufactured in under a year, which represents extraordinary speed in this industry. We have supported several single port trans-umbilical NPD programs, with detailed engineering of capital equipment, disposables and reposables, draping systems and more. This was made possible only by having the right capabilities on site, with the right capacity available as needed, all supported by a culture of innovation.”

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“Since 2019, CDP has played a substantial role in four notable product development programs in robotic-assisted surgery, delivering system-level prototypes from the ground up. Each of these has been designed and manufactured in under a year, which represents extraordinary speed in this industry.”

Tom Brittain | Head of RAS at Cambridge Design Partnership

You need a strong foundation from which to build any RAS system

The development of any RAS system requires a strong foundation of strategy and system architecture between hardware and software, all aligned to the clinical user’s needs.

James states, “To ensure strong system architecture for our clients, we really focus on conducting structured clinical needs gathering to generate solid initial hypotheses on key requirements and constraints. Once a strong foundation for the platform architecture is created, we shift our focus to the high-risk areas.”

Risk management is vital throughout the entire process. Jack calls the approach CDP takes “targeted derisking,” adding, “we know from experience what the concept killers are and what we need to do to gain confidence that we’ve solved or avoided them. That is a key element of moving quickly. Not only that, the way in which we derisk is targeted in such a way that we’re not adding more complexity or unknowns. This enables us to iterate designs quickly, learn from each step what works and what doesn’t, and develop working prototypes at speed.”

Putting this approach into practice, CDP developed a single-port RAS prototype platform, moving from an early-stage concept to an alpha system prototype for pre-clinical trials in just seven months. Jack makes the further point that “In addition to speed, the client gets to retain all knowledge and intellectual property rights for any technologies developed for them.”

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“The way in which we derisk is targeted in such a way that we’re not adding more complexity or unknowns. This enables us to iterate designs quickly, learn from each step what works and what doesn’t, and develop working prototypes at speed.”

Jack Hornsby | Deputy Head of RAS at Cambridge Design Partnership

Meet the RAS Team at DeviceTalks Boston

Building a surgical robot takes true teamwork. Success demands rapid development while meeting strict clinical and regulatory requirements. Cambridge Design Partnership continues to invest in the expertise and processes that help clients bring advanced surgical robotics to market.

The result is a comprehensive offering with unmatched expertise. Clients gain immediate access to deep knowledge in kinematics, human factors, cart design, optics, systems engineering, and disposables development. And our 26,000-square-foot Pilot Production Center quickly takes a client’s project from concept to prototype build to transfer to manufacturing.

Tom, James and Jack will be speaking at DeviceTalks Boston on April 30 about the importance of the 3Cs (“How Fast Are You? Accelerating Next-Generation Surgical Robotics”). They’ll also be showcasing a platform we developed that demonstrates our approach, going from early concept to Alpha prototype for preclinical studies in under seven months. They will be on hand at stand 735 to talk about CDP’s approach to rapid development in RAS. You can also reach out in advance and chat, or book in some time to meet them in Boston.

Connect with CDP

If you would like to discuss the content of this article, please get in touch with our RAS leadership team; Tom Brittain,  James Boonzaier and Jack Hornsby

Tom Brittain, Head of RAS
tom.brittain@cambridge-design.com

James Boonzaier, Deputy Head of RAS
james.boonzaier@cambridge-design.com

Jack Hornsby, Deputy Head of RAS
jack.hornsby@cambridge-design.com

Surgical robotics
By Cambridge Design Partnership

Where’s the value in surgical robotics?

The first robot-assisted surgical procedure was performed in 1985. In the 35 years since, the field of surgical robotics has exploded, with both surgeons and patients demanding access to the technology. This boom has brought with it plenty of vocal advocates, and just as many critics, debating the risks and rewards of robotic technology over traditional open and laparoscopic techniques.

The main criticism of robot-assisted surgery comes down to the fact that, despite the lofty initial and recurring costs associated with robotic equipment, patient outcomes of robotic-assisted procedures seem to be no better than conventional laparoscopic procedures. Some may see this as evidence that investing in surgical robotics is nonsensical, but it is worth considering the future potential of the technologies. For while the tools and techniques used in conventional laparoscopy may see slow incremental improvements over coming decades, each new generation of surgical robots will likely continue to bring radical step-change improvements in procedural precision, patient safety and surgeon control and comfort.

Current benefits of robot-assisted surgery

The current generation of surgical robots offer a few significant advantages over traditional laparoscopy.

  • Ergonomics & surgeon comfort: the ergonomics of laparoscopy are not ideal and can take a toll on a surgeon’s body. During robot-assisted procedures, the surgeon sits at a workstation and controls his surgical tools using ergonomic master controllers. If the surgeon needs to take a break at any point in time, they can let go of the controllers, and the robotic instruments will maintain their current positions.
  • Precision: a robotic system translates the inputs from the surgeon’s controllers to output motion of the surgical instruments. This allows for motion scaling (for example, 3mm of movement by the surgeon results in only 1mm of movement of the surgical tool), providing unprecedented surgical precision.
  • Stability: while providing some haptic feedback to the surgeon is desirable, a robotic system can handle all the stresses and loads associated with a procedure without translating them all back to the surgeon’s hands. Along with surgeon comfort, this allows for improved stability.
  • Better visibility: the steerable robotic endoscopes provide a high-definition 3D visibility of the surgical site, allowing the surgeon to better see what they are doing, compared to 2D endoscopes used in laparoscopy.

More hands: while we humans are tragically limited to typically having only two hands, robots are not subject to such limitations. The da Vinci Xi, for example, has four robotic arms. The surgeon toggles back and forth between controlling different combinations of these arms using foot petals.
Fast learning curve: learning how to safely and effectively perform robot-assisted procedures tends to be faster than training to perform laparoscopic procedures.

Current limitations of robot-assisted surgery

Advocates of surgical robotic technologies tend to focus on the various benefits without mentioning some noteworthy risks and challenges:

  • Setup time: nurses and surgical assistants often complain about the long time it takes to prepare a robotic system for a procedure, including wipe-downs, draping and loading of surgical tools.
  • Lack of haptic feedback: current robotic systems provide very limited feedback of applied forces to the surgeon. Instead the surgeon is required to use the visual feedback from the 3D endoscope to judge what amount of force he is applying to patient tissue. Some studies suggest that surgeons apply significantly higher forces and stresses to tissue using robotic systems than using laparoscopic tools, potentially resulting in more damage to the tissue.
  • High cost: a daVinci Xi system costs about $2M USD. Each da Vinci surgery may cost $3,000 USD more to the patient / insurance company than a traditional laparoscopic operation.

The future

Many of the criticisms above are valid and must be taken seriously. Effectiveness and safety of robotic technologies must continue to be proven, and limitations should be assessed and accounted for. However, these should be seen as criticisms of current robotic systems on the market today, not as criticisms of robotic surgery in general. If anything, these criticisms hint at where surgical robotics is headed next. While Intuitive Surgical continue to innovate, the field of players is also getting wider, with companies like Johnson & Johnson, Medtronic and Stryker investing billions into research and development. Future generations of robotic systems will bring a range of short-term and long-term improvements and will redefine what is possible in surgery.

Increased haptic feedback is expected to be a key feature in some future systems. This will allow the surgeon to truly feel the motions and gestures they are executing with the robotic instruments.

The cost of robotic systems and tools is expected to decrease as the volume of robotic systems and tools sold continues to grow and with increased competition, as new companies bring their robotic systems to market in the coming years.

There may be potential benefits in surgeons being able to carry out procedures remotely. Already today, the surgeon workstation does not necessarily have to be in the same room as the patient. Taking this to the next level, future systems may allow an expert cardiovascular surgeon to perform specialist surgeries all around the world from the comfort of his own office.

The Big Question

All of these features still depend on a human being (the surgeon) having control of every movement of the robot. The big question is: at what point will we be comfortable giving up some of this control to a robot? Crossing this line will increase the productivity of the scarcest of resources, highly trained surgeons, and start to significantly improve the cost-benefit equation for these systems.

Leveraging image recognition and artificial intelligence, it is fathomable that, in the quite near future, we could have a robotic system capable of making decisions and performing certain tasks independently. Especially with repetitive tasks like suturing, a robot could be trained to become increasingly efficient and effective.

However, as we’ve seen with self-driving cars, we humans have very little tolerance for injury and death caused by robotic systems. Despite worryingly high death tolls caused by inebriated and distracted drivers, it is not enough for new technology to reduce injury and death. Even a single death caused by a self-driving car convinces some that the technology is not ready. This may be the same psychological and regulatory hurdle that surgical robotics must overcome to realise its potential.

Connect with CDP

For more on how to accelerate innovation in surgical robotics, from device design to clinical value, contact Cambridge Design Partnership.