With robotics for the sustainability of healthcare
As I outlined in my open letter to regulators, the long-term sustainability of healthcare systems could be solved by automation powered by digital health technologies, such as artificial intelligence, 3D-printing or robotics. The latter could take over monotonous work from healthcare workers, which would allow them to focus more on patients and to have lesser workload.
The way automation cuts out repetitive and monotonous tasks from the human work schedule fits into a decades-long (or even centuries-long) global trend thriving to make people’s lives easier and more comfortable. Experts such as Elon Musk, Tesla-CEO and other believe that technologies and automation through robotics might even push for the introduction of universal basic income. Even if it does not happen any time soon, it is already visible that robotics is skyrocketing. The global medical robotic systems market was worth $5.48 billion in 2011 and is expected to reach $13.6 billion in 2018, growing at a compounded annual growth rate of 12.6% from 2012. Surgical robots are expected to enjoy the largest revenue share.
For this reason, it is of utmost importance to keep an eye on robotics companies and start-ups with the mission to build a more democratic, transparent and efficient healthcare through their technological innovation. Here are the most promising ones!
1) Surgical robotics
One of the fastest-growing field of robotics in healthcare concerns surgeons and their profession at “the top of the medical food chain”. Surgical robots are the prodigies of surgery. According to market analysis, the industry is about to boom. By 2020, surgical robotics sales are expected to almost double to $6.4 billion. The following companies are the most important players on the market.
The most commonly known surgical robot is the da Vinci Surgical System; and believe it or not, it was introduced already 15 years ago! The company, Intuitive Surgical raised $46 million in an initial public offering in 2000 and in the same year, became the first robotic surgical system cleared by the FDA for general laparoscopic surgery. Since then, da Vinci has been used for more than 3 million minimally invasive procedures in various surgical specialties. The product features a magnified 3D high-definition vision system and tiny wristed instruments that bend and rotate far greater than the human hand. The surgeon is 100% in control of the robotic system at all times; and is able to carry out more precise operations than previously thought possible.
However, there are already some concerns regarding the da Vinci, which might also resonate with the general aversion towards robots. Intuitive Surgical recently avoided a class-action lawsuit over the da Vinci robot after plaintiffs claimed that the robot left tiny metallic particles in the body that eventually made their way to the brain. Company officials expect da Vinci system procedures to grow to 9% this year, down from the 15% growth seen in 2016. Also, Intuitive Surgical has a serious competitor as Johnson&Johnson and Google recently teamed up to “build a better robot”.
The medical device company was founded in 2006, and represents the biggest competitor for Intuitive Surgical in the field of urology, gynecology or colorectal surgery. It is pioneering the use of robotics to improve minimally invasive surgery by addressing the clinical and economic challenges associated with current laparoscopic and robotic options.
After the FDA rejected its SurgiBot robotics technology in 2016, the company laid off a third of its staff and had to rethink its strategy. It started to focus on another technology, the ALF-X, which the company rebranded as the Senhance Robotic Surgical System. Transenterix is trying to get it approved for hospital use in the U.S. as soon as possible. The Senhance, which TransEnterix acquired last year for $100 million, is already approved in Europe.
Founded in 2005, Massachusetts-based Medrobotics received FDA clearance for its Flex Robotic System in July 2015. It raised $147.4 million so far to develop a medical robot built on exclusive worldwide licenses for robotics technology from Carnegie Mellon University and the University of Pittsburgh. The stunning result, the Flex Robotic System allows physicians through its snakelike design and its 180º path to access anatomical locations that are traditionally harder to reach, such as the ear, nose or throat. Surgeons now have a magnified, HD view of anatomical structures for minimally invasive procedures.
In December 2015, Google’s Alphabet and Johnson&Johnson announced the formation of Verb Surgical, the offspring of the strategic partnership between Ethicon, a medical devices subsidiary of Johnson&Johnson, and Verily Life Sciences, formerly known as Google Life Sciences. It seems J&J really wants to challenge Intuitive Surgical. The company is building a surgical solutions platform that began several years earlier as a concept built between Ethicon and SRI International. Verb Surgical utilizes the medical instrumentation technology developed by Ethicon, while the “big data” and machine learning expertise comes from Google to develop a so-called “digital surgical platform” that will also include robotics as well. They refer to their surgical system as “digital surgery” and claim it will cost much less than Intuitive Surgical’s da Vinci.
The California-based company designs and produces medical robotics for positioning and control of catheter-based technologies since 2002. Hansen Medical manufactures two types of catheter technologies for two types of diseases, the Sensei Robotic Catheter System for electrophysiology procedures and the Magellan Robotic System for the treatment of vascular diseases.
For example, if the patient’s heart has arrhythmia, meaning it cannot beat properly and cannot pump blood effectively, one possible treatment is an electrophysiology procedure. It requires delivery of a catheter from the patient’s groin, through the blood vessels, into the chambers of the heart. Physicians then steer the tip of the catheter to problematic areas in order to deliver radiofrequency energy and create a scar in the heart tissue. These scars are intended to block erratic electrical impulses. As the procedure is time-consuming and delicate, physicians need accurate, flexible and effective catheters, such as the ones provided by Hansen Medical.
Founded in 2002 in Montpellier, MEDTECH is a European specialist in the design, development and marketing of innovative robotic appliances to assist surgeons in the OR, first of all during brain and spine surgeries. These require utmost precision and fine-tuned technology.
In 2007, MEDTECH developed ROSA, an innovative technological device devoted to brain surgery procedures. It has been approved in Europe, the US, Canada, China. Since 2011, the French company has extended its platform’s scope of intervention to spine surgery, with the development of ROSA Spine. For the latter, MEDTECH obtained FDA clearance in January, 2016.
The Canadian company also focuses on the design, development and commercialization of new robotic surgical technologies. Currently, its SPORT surgical system for application in minimally invasive surgery is under development, so it has not hit the market yet. Titan Medical plans to introduce it first in Europe, then in the US earliest in mid-2017.
SPORT includes a 3D vision system and interactive instruments for performing minimally invasive procedures; and a surgeon workstation that provides the surgeon with an interface to the robotic platform for controlling the interactive instruments and providing a 3D endoscopic view of inside a patient’s body during procedures.
The US-based medical device company is offering robotic technology smaller than your fingernails! Its current platforms are comprised of two highly advanced micro-robotic technologies. The ViRob, a crawling, tiny micro-robot can navigate in blood vessels, the digestive tract and the respiratory system. Its unique structure gives it the ability to move in tight spaces and curved passages as well as the ability to remain within the human body for prolonged time. For example, surgeons could successfully treat patients suffering from hydrocephalus, also known as “water in the brain”. Microbot Medical’s other innovation, TipCat is a needle-like, self-propelled, flexible and semi-disposable endoscope.
i) Cyberknife System created by Accuray
The CyberKnife System is the first and only dedicated radiosurgery system designed to treat tumors with crisp accuracy anywhere in the body. It provides an option to many patients diagnosed with inoperable or surgically complex tumors, or patients who may be looking for an alternative to surgery. The CyberKnife System is designed to deliver precise targeting accuracy with conformality and dose gradient.
There are 140 medical facilities worldwide, which chose the Cyberknife System, with more than 50 thousand patients treated successfully. The innovative treatment solution is created by the California-based Accuray, which offers a complete portfolio of radiation therapy and radiosurgery platforms for treating multiple forms of cancer.
2) Bringing robotics to pharma and medication management
Automation eases the work of medical professionals throughout the whole healthcare spectrum, but it is especially needed in nursing, where monotonous and repetitive tasks burden even the most enthusiastic workers. When it comes to medication management or other workflow problems, the 21st century solution should be everywhere: robotics.
Aethon, founded in 2004 and based in Pittsburgh, is best known for its TUG autonomous mobile delivery robot which is able to carry around a multitude of racks, carts or bins up to 453 kilograms in the form of medications, laboratory specimens or other sensitive materials. The TUG is sent or requested using a touch screen interface and upon completing its “mission”, it returns to the charging dock for a sip of energy while it is loaded for the next job. The TUG has become commonplace in hospitals and makes over 50,000 deliveries each week in over 140 hospitals throughout the United States.
And why the name, you ask? The company says Aethon (pronounced ā-thon) is taken from one of the four horses of ancient Greek mythology that pulls Helios’ chariot – the sun – across the sky each day, resembling their efforts to set their sights high and work hard to bring results. Great philosophy, I would say.
From South America to the Middle East, Aesynt offers medication management solutions for all medication forms, including health robotics IV automation and workflow solutions for sterile compounding to over 80 customers across the world. They promise to develop solutions to manage shortages, address the safety risks of manual compounding, and provide enterprise-wide connectivity and visibility. The company was named Aesynt in 2013, after private-equity firm Francisco Partners bought McKesson Automation. In 2016, the company was acquired by Omnicell for $275 million.
I believe Innovation Associates is one of the oldest company on my list. It was established by Harry Boyer in 1972 as an engineering/technical services manufacturing company, but after more than two decades it completely shifted the focus to pharmacy automation. Nowadays, it is a leading provider of pharmacy automation technologies to the retail, hospital, government and other pharmacy markets.
From workflow management until innovative counting technologies and beyond, Innovation Associates provides 21st century technology for pharmacies aiming to be always on the top of their game. Moreover, they offer the PharmASSIST ROBOTx, a robotic medical dispenser system, with a built-in dispensing capacity range, which helps any given facility “right-size” its system for its volume. It is also designed with robust data mining capabilities, so the pharmacy can gain valuable insights about its efficiency all the time.
Exoskeletons are robotic structures that can help a human being move around and lift huge weights. They can also let paralyzed people walk again. For example, a gait-training exoskeleton, suit helped Matt Ficarra, paralyzed from the chest down, walk down the aisle on his wedding day! How amazing is that?
a) Ekso Bionics
In November 2013, I attended an event organized by the Singularity University in Budapest at the amazing venue of the Franz Liszt Academy of Music. We listened to Amanda Boxtel, who got paralyzed from a spinal cord injury in a ski accident in Aspen, Colorado in 1992. She told us how she felt after getting the diagnosis of never being able to walk again and how she refused to stop dreaming. Since then, she has established adaptive ski programs, carried the Olympic torch, organized disabled rafting expeditions, and even conducted research in the Antarctica. She has also become one of the ambassadors of Ekso Bionics.
Their exoskeletons are used by individuals with various degrees of paralysis and stemming by a variety of causes. Ekso Bionics have helped individuals take more than 70 million steps since its establishment that would not have been possible otherwise. Currently, it is utilized in over 130 rehabilitation centers across the world.
As a fresh spin-off from the Artificial Intelligence Laboratory at MIT in 1990, Barrett Technologies started to work on the first haptic robot arm, named the WAM arm. It proved to be so ground-breaking that it got listed in the special Millennium Edition of the Guinness Book of Records as being the world’s most advanced robotic arm. It is able to interact directly with humans through subtle force interactions. Last year, the Smithsonian Air and Space Museum launched a major exhibit highlighting two physically interactive WAM arms and BarrettHands. Currently, Barrett is excitedly preparing to launch a completely new product line in the field of robotic stroke rehabilitation.
The Japanese firm, Cyberdyne was established by Dr. Yoshiyuki Sankai, University of Tsukuba, Japan, in order to materialize his idea to utilize Robot Suit HAL “for the benefits of humankind in the field of medicine, caregiving, welfare, labour, heavy works or entertainment”. Cyberdyne, established in 2004, developed its HAL robot suit to be able to augment human capabilities – in support of care-giving as well as working with heavy loads in factories. So the company has nothing to do with the fictitious company from the Terminator movie series Cyberdyne Systems, nor has the product anything in common with Space Odyssey’s HAL 9000 artificial intelligence program, which had not exactly the welfare of humanity in its artificial mind.
The Swiss company, established in 1996, develops and manufactures robotic and sensor-based devices for functional movement therapy. It has hubs in the US, Singapore, Slovenia and Chile, and almost 50 partners worldwide. Hocoma’s therapy solutions support the treatment of neurological patients with movement disorders caused by stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, cerebral palsy or other neurological diseases and injuries as well as low back pain patients. Products include medical devices used for robotic treadmill training of neurological patients and exoskeleton for the rehabilitation of upper extremities after stroke or traumatic brain injury.
Behind every inspiring company, there is a human story. Dr. Amit Goffer founded ReWalk Robotics in 2001, following a life-altering accident that rendered him a quadriplegic. He pioneered the invention and development of the ReWalk Robotics wearable exoskeleton, enabling individuals with lower limb paralysis to walk again. Even though the technology does not currently enable him to walk again due to the extent of his injuries, his tenacity to develop a wearable exoskeleton so that others could walk paved the way for the ReWalk Rehabilitation and Personal systems to be used by more than 1,000 people around the world today.
The Swiss company designs and manufactures robotic-assisted devices, e.g. robotic gait trainers for the rehabilitation of neurological movement disorders. Its G-EO System Evolution is used by various medical facilities for example in Switzerland, Germany or the Czech Republic. The G-EO System robotic gait trainer allows the patient to move their legs through a range of normal walking patterns that encourage repetitive learning in the brain cells, said a stroke patient about the device.
4) Xenex Technologies – For absolute hygiene in hospitals
The company, founded by two enthusiastic epidemiologists in Houston, has grown from a small start-up to a sizeable company since its establishment in 2008. Currently, it has a presence in 400 hospitals across the US and constantly growing. Its success lies in its world-class product, the germ-zapping Xenex Robot, which might constitute the next level of hygiene. A hospital even polled its colleagues about how to call the smart machine – and named it Hector.
It allows for fast and effective systematic disinfection of any space within a healthcare facility. This helpful automatic tool destroys deadly microorganisms causing HAIs (hospital acquired infections) by utilizing special UV disinfection methodologies. The Xenex Robot is more effective in causing cellular damage to microorganisms than other devices for disinfection, thus the number of HAIs might be more effectively reduced. Westchester Medical Center reported a 70 per cent drop in Intensive Care Unit C. diff with the use of Xenex Robots.
5) Telepresence Robots
Doctor shortages are global phenomena. The World Health Organization (WHO) estimates that there is a worldwide shortage of around 4.3 million physicians, nurses, and allied health workers. We will never be able to train as many doctors as we need worldwide. Robots with telemedical devices will certainly appear in more and more clinics and it’s going to be a common element of care to see them in practice.
Through its vast network, patients in remote areas or people who are not able to travel have access to high-quality emergency consultations for stroke, cardiovascular, and burn services exactly when they need it. Moreover with telehealth, medical professionals in rural towns and remote areas also have access to specialty services, while patients can be treated in their own communities. The InTouch Telehealth Network supports more than 130,000 annual encounters, 11,000 doctors and clinicians, and 1,250 patient access locations with an annualized growth rate of 25% or one hospital per day. Thus, the California-based company is obviously growing exponentially. It currently employs more than 200 people serving 15 major markets in 30 countries.
The company offering a wide range of video communication solutions, was founded in 2007 by experienced and successful veterans of visual communications and robotics industries. In healthcare, doctors and nurses are using VGo to extend their reach to monitor and consult with patients in the hospital, skilled nursing facility and in the home. Family members are also using VGo to visit loved ones when they can’t be there in person. In 2015, the start-up was acquired by Vecna Technologies, developing automated robotic solutions for material handling, enterprise patient engagement solutions for healthcare.
6) Robotic Companions
In the developed countries, alienation and loneliness causes major problems, health troubles included. Robotics aim to offer solutions in order to enable elderly and other people without the necessary social support to connect with the world. There are various types of robot companions – human or animal shaped, smaller or bigger -, but they all share one thing: their goal is to make life more enjoyable and easier.
a) Luvozo PBC
Founded in 2013, the company has been focusing on developing solutions for improving quality of life for older adults and persons with disabilities. In July 2015, it started testing its flagship product — Sam, the robotic concierge — in a leading senior living community in the Washington D.C. area. The human-sized, smiling robot combines the very best in cutting-edge technology and human touch to provide frequent check-ins and non-medical care for residents in long-term care settings. By doing so, it reduces the costs of care, while raises patient satisfaction index by simply being there for the elderly all the time.
In 1986, Honda engineers set out to create a robot that could walk. Two decades later, they presented ASIMO, a full humanoid robot, able not only to walk but also to run, climb steps and even carry a tray or push a cart. It can also comprehend and respond to simple voice commands. ASIMO has the ability to recognize the face of a select group of individuals. Using its camera eyes, the robot can map its environment and register stationary objects. It is simply amazing! It might be the world’s most advanced humanoid robot at the moment. Honda hopes that someday it will help with such important tasks as assisting the elderly or a person confined to bed or wheelchair.
It is a well-known fact that pets and cute animals help to ease stress; to divert attention from pain and to reduce the feeling of loneliness. Unfortunately, not every hospital or extended care facility allows animals to live next to patients. Leading Japanese industrial automation pioneer, AIST comes into the picture here. It developed PARO, an advanced interactive robot. It allows the documented benefits of animal therapy to be administered to patients in medical environments. For it has the shape of a baby harp seal covered with soft artificial fur to make people feel comfortable, as if they are touching a real animal. This therapeutic robot reduces the stress factor experienced both by patients and by their caregivers.
If you know about other companies disrupting healthcare through robotics, please let us know! And if you are curious about developments and innovations of medical start-ups, subscribe to The Medical Futurist Special Newsletter, where you can receive information about the future first-hand!