Is an App Store for Surgery the Next Big Thing?

Scott Huennekens, CEO of the joint Verb Surgical venture between Verily (formerly Google Life Sciences) and Johnson & Johnson, aims to bringing digital thinking into the surgical suite.

Arundhati Parmar 

Verb Surgical

For the past two decades, Intuitive Surgical has set the terms of surgical robotics, being the only game in town. That hegemony is slowly being challenged with the expected approval any day now of TransEnterix's SurgiBot.

But Alphabet (formerly Google) has had its eye on this market as well. And that means that a wholesale rethinking of robot-assisted surgery is likely in order. The entity that is attempting this is Verb Surgical, formed late last year as a joint venture between Verily (formerly Google Life Sciences) and Johnson & Johnson. The executive leading this Mountain View, CA, startup is Scott Huennekens, the former CEO of Volcano Corp. and a medtech veteran.

Qmed's sister publication MD+DI did an exclusive interview with Huennekens recently. Here is an excerpt:

MD+DI: We've heard a lot of buzzwords about Verb Surgical--machine learning, analytics and advanced imaging. If I am a surgeon, what can I get from a Verb Surgical robot in the future that I am not getting today?

HuennekensFirst of all, we think of us not as a robotics company but as a surgical platform company. If you think of open surgery as Surgery 1.0, minimally invasive surgery and laparoscopic surgery as Surgery 2.0, robotics surgery as 3.0, we really think that the next era is 4.0. We call it digital surgery and physicians call it digital surgery as well.

Instead of having robotics ... used in just 5% of procedures and it's like a mainframe computer, we're thinking of robotics like it's a PC. It's always there, it's always on.

So, it's lower cost, it's more accessible to you. And then in combination with that, there is advanced visualization and next generation technologies that start to give you differentiation of tissue. It could be the anatomy of the tissue, the tissue state or tissue type and surgeons start having information to inform their decision-making.

Learn more about cutting-edge medical devices at BIOMEDevice Boston, April 13-14, 2016.

They can also have that co-registered with current live imaging--whether its ultrasound, x-rays, or pre-operative imaging--and can start thinking about planning surgeries and executing them based upon this information.

Surgeons will also have advanced tools and instrumentation. So what you would have is all that information but not in its individual silos where Medtronic/Covidien has these instruments and Karl Storze has this visualization and somebody else has a table and somebody else has robotics arms.

We want to eliminate silos and bring all these together in a seamless solution and then also have algorithms for decision-making.

I don't want to get into too many of the details that we are working on for competitive reasons, but the integration of all those components together and the solutions around procedures is what we are looking to do.

You've heard of Moneyball, and you may have even seen the movie. There's moneyball for baseball players. You may think of us as developing algorithms and information, so it's moneyball for surgeons.

In surgery, it's been a cottage industry so to speak where you had an apprentice who learned from a master and that's the way things evolved. So there is a lot of disparity of performance in surgeons. There's a lot of disparity in the way procedures are done. What we believe is you can use information and more standardized processes in surgery, just like any manufacturing process, to increase quality, lower cost and make the outcomes more uniform.

It's a long-winded answer but it kind of gives you the context of what we are looking to accomplish at Verb. 

MD+DI: Can you give an example of what kind of decision-making is possible with your advanced imaging and visualization capabilities when surgeons are using your robot?

Huennekens: It doesn't have to be with a robot. It can be an open surgery case, it can be a minimally-invasive surgery case with laparoscopic instruments or it can be robotic. You are going to be able to just look at an anatomy and it will tell you what the anatomy is.

You could tell perfusion versus non-perfusion. You can tell cancer cells versus non-cancer cells. Those are the things that we are working on and moving forward with, whether it's just the visualization techniques or injectables that enhance the image as well. I don't want to get into too much detail in what we are doing there, but it's where things are headed.

MD+DI: You said these techniques can be used in open or minimally-invasive surgery, so are you saying that Verb could offer up a solution where hospitals might not need to buy a robot to get some of these other advantages?

Huennekens: I am saying it is a surgical platform, so if you have advanced imaging capability, you don't have to use robotic arms. The robotic arms are just tools. You can stick your endoscope in there and get visualization. You may want to do these things with laparoscopic instruments that are cheaper.

There are reasons you use robotics--dexterity and reach are among some. You may want to use them in an open case, where you have a deep region that you want to suture for which you want to use robotic arms than to reach in there and do by hand. We are saying, "Why not?"

Today robotics is a defined destination. It's not a tool. In our world, there are no robotic cases. There's open cases and minimally-invasive cases. You use what you need to do surgeries most effectively. Robotic instruments should be used in open cases or minimally-invasive cases.

MD+DI: I wanted to draw this distinction because so far, whenever people have talked about robotic surgery, it's always been minimally-invasive robotic surgery. You are broadening that term a little bit because you are saying robotic assistance can be easily used in open procedures too. Correct?

Huennekens: That's why we call it digital surgery. It's going to the future where all these procedures are digitized and computer-assisted. I think of it as computer-assisted surgery versus robotic. Robotics is one element of computer-assisted surgery or digital surgery.

MD+DI: But if a surgeon wanted to use a robot, Verb Surgical will have a robotic system in addition to all these other capabilities?

Huennekens: Absolutely. It's one of the key pillars. The pillars are: robotics, always there, always on; advanced imaging; machine learning, Big Data; and advanced instrumentation.

Ethicon Endo Surgery is a big leader in instrumentation and has a $6 to $7 billion sales franchise. Google is a world leader in Big Data and machine learning. They are also a world leader in optics, video and data analytics, and then you have robotics, which is something that Verb is working on separately, but in a different form so that it's always available.

And then put an umbrella over all of that and we are saying we will be open platform. Intuitive Surgical's systems are closed. You have to buy the instruments from them. You have to buy the visualization.

We are saying if you pick up your cell phone and download an app, and you can use your app on your phone, we're willing to give people access to our platform under the right circumstances obviously. We have to respect regulatory requirements and such, but if someone has a set of pediatric instruments that would work, we'd be willing to grant them access under the right business relationship to our platform, as an example.

MD+DI: Maybe this is stretching it a little, but it's like you are building an App store for surgery like what Apple did with iPhone where other people can sort of plug and play?

Huennekens: That's right. It's not a stretch at all. What we are saying is that we want to have a broad open platform with multiple apps.

You asked, what's the physician going to have? Well, the physician will have choice. As long as there's an instrument that they want to use and that company is willing to work with us, they're going to be able to use it on our platform.

For the complete interview, go to MD+DI

Learn more about cutting-edge medical devices at BIOMEDevice Boston, April 13-14, 2016.

Arundhati Parmar is a senior editor at MD+DI.

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