Professional Documents
Culture Documents
SURGICAL ROBOTICS
Verb Surgical
Surgery in the
Digital Age
KEY POINTS
n Johnson & Johnson and Verily, Googles life
sciences company, have joined together to
create Verb Surgical, which hopes to develop
a new platform in surgical robotics that blends
Ethicons expertise in surgical devices with
Verilys expertise in high-tech capabilities like
advanced analytics and enhanced visualization.
n Verb executives concede that surgical robotics pioneer and leader Intuitive Surgical has
done an excellent job of launching the robotic
revolution but argue at the same time that with
advances in technology, surgeons want more
and that robotics per se are only part of the
value equation.
n Certainly, Ethicons deep background in surgical tools, close relationships with customers,
and a strong presence in the operating room
provide an important base for Verb. But it is the
information technology component that has the
potential to create a truly disruptive technologyone that by incorporating Big Data and data
analytics, can enable better decision-making in
the OR.
n No small part of what Verb is trying to do lies
in democratizing robotics and, by extension,
surgery itself, bringing advanced technology to
ORs around the world with an affordable system.
Verb's platform represents the latest revolution
in surgery, something theyre calling Surgery 4.0.
by
DAVID CASSAK
SURGICAL ROBOTICS
From sensor-based devices and enhanced imaging to advanced analytics and machine learning, the new technology
horizons that companies like Apple, Samsung, and, most of
all, Alphabet/Google have brought forward are being incorporated into products that, in some cases, enhance the therapeutic impact of those devices, and, in others, generate a
whole new category of products.
surgery, democratizing the technology with lower priced options that allow for a wider dissemination around the globe
while incorporating capabilities like advanced analytics and
enhanced imaging that bring surgery into the Digital Age.
(Since Googles recent reorganization and name change,
Google and Verily, which used to be known as Google Life
Sciences, are now divisions of Alphabet.)
Perhaps not coincidentally, the growing role of information technology comes at a time when robotics, the medtech
industrys original futuristic technology, seem to be taking
off. For a lot of different reasons, the uptake on surgical robotics was slow for a long timeonly industry leader Intuitive Surgical Inc. achieved realin fact outstandingsuccess, although as more of an outlier than an exemplar. More
recently, thanks to companies like Blue Belt Technologies
(now part of Smith & Nephew plc), TransEnterix Inc., Titan
Medical Inc. and Corindus Vascular Robotics Inc., to name
just a few, robots are hot again.
Big deals like Stryker Corp.s $1.6 billion acquisition of
Mako Surgical, and Auris Surgical Robotic Inc.s ability to
raise $230 million in early financing from hedge funds attest to the new perceived value around robotics. And with
a market cap that in early May stood just over $23 billion,
any attempt by one of the big multi-national device giants
to take out Intuitive would, factoring in an acquisition premium, likely price the company higher than the $21 billion
Johnson & Johnson paid for Synthes a couple of years ago
and even higher than the $25 billion Abbott Laboratories
has offered for St. Jude Medical.
What would happen if you could marry robotics with the
enhanced capabilities of high tech? Could you, at once, reconcile the twin dynamics of advanced
technology and cost reduction, with
technology that both enhances outcomes and reduces costs through better,
more efficient procedures? Thats the
promise of Verb Surgical Inc., the joint
venture launched last year by surgical
device giant, Johnson & Johnson and tech leader Alphabet
(formerly known as Google). Through their respective operating companies (Ethicon and Verily), J&J and Alphabet
hope not just to develop a better robot, but to transform
11
Online print subscriptions, reprints, and web posting and distribution licenses are available.
Contact Kristy Kennedy at 480.985.9512 k.kennedy@medtechinno.com
12
SURGICAL ROBOTICS
But looking ahead, Huennekens goes on, the time has come
to think of a future in which were moving from large robotic
systems to something entirely different, something Verb is
characterizing as Digitally-enabled Surgery, a technology platform that embraces, at once, small robotic systems and advanced surgical tools, as well as advanced visualization, machine learning, data analytics for performance tracking and
benchmarking, connectivity both inside and outside the OR,
and more. Its a more comprehensive, holistic approach to
surgery, which is why Verb describes itself not as a next-generation robotics company, but as a surgical solutions company. And robotics is only part of that, says Huennekens. I
think Intuitive defines itself as a robotics company. Were not
a robotics company.
In its embrace of Verily as a partner, J&J, too, is acknowledging that robotics is only part of the equation. Even before joining forces with the tech leader, J&J had spent the last three
or four years in a partnership with SRI International (formerly
Stanford Research Institute)interestingly, the organization
that developed the technology that became Intuitives da Vinci
20 years agoto focus on enhancements in the robotics platform itself. SRI has a tremendous capacity in robotics used
in defense, industrial, consumer and medical markets, says
Huennekens. (J&Js work with SRI will become part of Verb.)
At the same time, incorporating an expertise in surgical
technology and the OR is just as critical to Verbs vision.
Huennekens notes that Verb will focus its relationship on
Verily, which will link Verb into areas of Alphabet that work
on Big Data and machine learning initiatives, and other programs in advanced visualization, connectivity, video analytics, and proctoring, as well as more tech-specific capabilities
such as user interfaces and experiences with augmented
reality and decision-making tools.
Theres a whole host of technologies that Verily and Alphabet bring
to the table that we can use in conjunction with the robotic technology J&J has been developing with
SRI, he says.
Direct Patient
Access, HighlyFlexible, Expanded
Reach
Advanced Imaging
Procedure-Enabling
Advanced Tools
Data-Driven Surgery
Transforming the OR
In visualization, for example,
Verb hopes to capitalize on Verilys expertise in imaging to do advanced anatomical and pathological identification of tissue states.
And in an OR with intra- and interoperative connectivity, data and
imaging come together to allow
for experience sharing, remote
guidance, and tele-monitoring.
SURGICAL ROBOTICS
Certainly, Ethicons deep background in surgery, surgical instruments and tools, close relationships with customers, and
strong presence in the operating room provide an important
base for Verb. But it is the high-tech component that has the
potential to create a truly disruptive technology. Huennekens
offers an example of the role that big data and data analytics
can play in better decision-making in the OR. We can envision a world in the future in which we take 10,000 prostate
surgeries and run them through an algorithm that produces
a tremendous amount of learning relative to things like anatomy, task learning, performance, and things like that, he
says. Those things can then be built into the device. Instead
of the conventional model in surgery which emphasizes the
uniqueness or individuality of each procedurethe see-one,
do-one, teach-one modelVerb envisions a platform that incorporates big data and data analytics and, aggregating the
experience of thousands and thousands of procedures, offers a cumulative learning experience that can be part of
the tools the surgeon uses, he goes on.
And just as important as improved clinical outcomes and
surgical techniques, theres also an economic play here.
Positioning itself as a surgical solutions company, Verb executives see themselves not just advancing surgical technology by incorporating digital high tech capabilities, but in
the process also democratizing surgery. That means bringing robotic platforms to surgeons working in hospitals that
cant afford $2 million systems. We want to bring the capability to advance surgical procedures to all geographies
of the world in any economy, says Huennekens. Indeed, in
emerging markets where there are few resources in each
facility and an often smaller clinical base, Verbs platform,
he goes on, can be very effective in helping with training,
proctoring, and market adoption.
In such a vision, the technical and clinical capabilities of
robotics is only a part of the value proposition. During his
days as CEO of Volcano (now part of Philips Healthcare)
Huennekens and his team did extensive research into how
hospitals used expensive capital equipment such as the
IVUS (intravascular ultrasound) systems Volcano manufactures. They found that hospitals want platform technologies that have broad applicability and are constantly
in usetechnology that is connected to everything else in
order to optimize its impact, whether in the cath lab or the
operating suite. Way more often than not, he says, standalone IVUS systems sat in a hall way, waiting to be used.
Nothing that had wheels on it was ever used more than
10% of the time, he says. Once we integrated it and put
multiple apps on it, it was used in 40-50% of the cases.
Huennekens believes Verbs surgical solution platform will
face the same challenge: the equipment has to always be
there, always be on, integrated and serving multiple applications, he says. Robotics is just one of the technologies
well offer in transforming the OR.
13
Online print subscriptions, reprints, and web posting and distribution licenses are available.
Contact Kristy Kennedy at 480.985.9512 k.kennedy@medtechinno.com
14
SURGICAL ROBOTICS
will be both vertically and horizontally applicable, he goes
on, meaning it can embrace procedures in other clinical
spaces as well as those of varying degrees of complexity
(see Figure 2).
Why Now?
Twenty years ago, it seemed as if large surgical device
companies like Ethicon and US Surgical were little interested
in the robotic revolution that Intuitive was launching. Perhaps that was because they were skeptical of the reach and
attraction of the new technology; perhaps it was because the
business model was so different. To companies with a strategy built around selling high volumes of disposable instruments, multi-million dollar pieces of capital equipment were
hard to wrap their minds around.
But those days are over and both Ethicon and Covidien
(which embraces the former US Surgical business) are now
making aggressive pushes into advanced robotics. Michael
Del Prado, Group Chairman for Ethicon, notes that Ethicon
has had a long history of shaping the future of surgery with
the goal of improving the standard of care in surgery globally. Key to that, he goes on, has been developing new tools
that drive the adoption and penetration of minimally-invasive
surgery (MIS). In surgical sub-segments like bariatrics and
others, he says, penetration of minimally-invasive surgery is
more than 90% today, much of that due to better instrumentation that enables surgeons to perform more complex proFigure 2
*Laparoscopy
cedures, such as, but not limited to, tools that allow for better
articulation and powered motion in endo-cutters and energy
devicesin the process overcoming early opposition to MIS
on the part of many if not most surgeons. We now make
[our instruments] smaller in order to access difficult anatomies and address intraoperative complications, he notes.
Weve been able to build a number of fairly large and successful platforms in surgery.
Ethicons recent embrace of robotics is, in that context, yet
another stage in the companys efforts to build on technology
that enables and enhances MIS. I think its been proven that
robotics will play a key role in further driving the adoption
of minimally-invasive surgery, especially in procedures where
the anatomy is difficult to access, Del Prado goes on.
As noted, J&Js first steps in developing a robot began well
before the collaboration with Alphabet was announced, and
the decision to launch Verb reflects in many respects a maturation of both robotics technology generally speaking and
J&Js innovation efforts more specifically. Asked why Ethicon is jumping on the robotics band wagon now, Del Prado
notes, Over the past few years, weve engaged a number
of stakeholders and customersrobotic users, robotic rejecters, and even economic decision-makersin order to
understand the unmet need as far as robotic surgery is concerned. I believe weve gained a lot of insights and knowledge
in this space. We think this is the right time to take robotic
surgery to the next level.
J&Js early research focused on
what Del Prado calls gaps in the current robotics offerings and aspirations about where robotics should
go, and led the company to SRI, the
Palo Alto-based research firm that
has done extensive and pioneering
work in robotics in a number of industries. Says Del Prado, A few years
ago, we started working with SRI to
firm up the concept, validating the
unmet need in robotic surgery and
the technical feasibility of the work
that were trying to do, and together with SRI I think we were able to
build not only a concept but a good
prototype that we could bring into
product development with some enhancements.
In turn, Ethicons work with SRI
led to the joint venture with Verily.
Ethicons discussions with doctors
suggested that physicians, on the
whole, are eager and excited to
SURGICAL ROBOTICS
hear about our collaboration with Verily and Verb, says Del
Prado. The partnership has drawn a lot of kudos and enthusiasm across the board, an excitement that stems, he says,
from the vision of taking robotic surgery to something different, a transformative platform. Del Prado notes that there
are lots of companies with the capabilities to develop surgical
robots and a number of companies already in that space. The
partnership of Ethicon, Verily, and Verb, however, represents
something different, as the joint effort capitalizes on the capabilities of each.
In Ethicons case, says Del Prado, that means offering insights into advanced surgical devices and instruments as
well as into what goes on in the OR. Del Prado points to
Ethicons global footprint in both technology and surgeon education and notes, about the former, that the advances Ethicon has introduced over the years lend themselves to expanding [the companys offering] into robotic
surgery. That expertise, combined with the tech capabilities of Verily, especially around data aggregation and analysis to better inform surgeon decision-making, will create
a platform thats truly distinguished from incumbent technologies in terms of advanced imaging, machine learning,
and augmented reality, he says.
15
Verilys contribution is critical because it will help Verb deliver something that, in J&Js thinking, redefines robotics. Del
Prado says that as Ethicon executives discussed the direction of their robotics effort, they came to the conclusion that
the best approach to truly deliver a
transformative technology lay not
in simply delivering a robot that is
Figure 3
an extension of the surgeons hands.
The Evolution of Surgical Robotics
That wouldnt suffice, he says. Indeed, Ethicon officials believe Intuitive had done that and done it well.
Rather, Del Prado says, the promise of really advancing the standard
of care lies in connecting all of these
capabilities, i.e., Ethicons strong
foot print and advanced instrumentation with the capabilities of Verily.
We believe thats the way to deliver a truly transformative platform,
he says.
Del Prado says that the vision and
goal of Verbs advanced robotics is
really to democratize surgery. That
said, hes far from dismissing out of
hand conventional surgical robotics.
The solution were trying to deliver
needs to incorporate some traditional robotics benefitsthats the
ticket to play and theres an expecta-
Past
Online print subscriptions, reprints, and web posting and distribution licenses are available.
Contact Kristy Kennedy at 480.985.9512 k.kennedy@medtechinno.com
16
SURGICAL ROBOTICS
more insights and more experience in the field, the potential to expand into other areas will be there.
Building on a robust and well-tested product concept,
Del Prado argues that the superior capabilities across the
partners, Ethicon, Verily, and Verb, should make the robotic system that emerges that much more powerful. I think
the team that weve put together in the creation of Verb can
deliver on a very compelling vision, he says.
SURGICAL ROBOTICS
An Open System
Not that Verb is running away from its relationships with
J&J and Alphabet. Says Huennekens, We want to be able to
leverage all of the benefits of Alphabets and Verilys technology and J&Js global footprint and market leadership
but retain the benefits of a start-up. Today, Verbs board
includes two J&J representatives and two Verily representatives and meets quarterly. We run exactly like a VC-funded
start-up, he noteswith all of the funding provided by
Verbs two joint venture partners.
Verb has enough capital to operate for the next four
years, long enough, Huennekens says, for the company to
launch its first robot, and can also draw on non-monetary
resources of its partners, if the need arises. The company
had about 40 employees at the end of last year and expects
to have closer to 100 by the middle of this year, a figure
that doesnt include the teams from SRI, J&J, and Alphabet
who are also working on the project. (Independent of its
relationship with Verb and J&J, SRI, who serves Verb as a
contract vendor doing work in R&D rather than as a joint
venture partner, has recently spun out two other healthcare-oriented robotic systems.)
Adding the resources of SRI, Ethicon, and Verily to its own
100-person staff, Verb has the wherewithal to do much of
its technology development in-house. Even before the official launch of the company, Verbs partners had invested
$50 million in early efforts to explore what a novel robotics
system might look likeand that doesnt include the hundreds of millions of dollars that both Alphabet and J&J have
invested over the years in relevant independent research
that will help drive Verb going forward.
In addition, even with all of the firepower that Verbs
founders bring to the table, Huennekens says the company
is positioning its platform as an open system and is willing
to consider collaborations, either through acquisition or
some kind of licensing arrangement, with other start-ups
developing novel technologies. Those might include surgical tools conventionally-described and apps that enable
some more high tech-oriented capabilities. Huennekens
says he can envision a scenario where, in a narrow market
of, say, 20,000 annual procedures, Verb might not identify
the opportunity as a high priority, but another company
comes along with a tool necessary to do that procedure.
Will we find a way to make sure that tool can work on our
platform? he asks. Absolutely.
Surgery 4.0
Asked if J&J considered any partners other than Alphabet/Verily in launching its robotic program, Michael Del
Prado notes that potential partnerships are something we
look at constantly everywhere. Verily is a terrific partner in
17
Online print subscriptions, reprints, and web posting and distribution licenses are available.
Contact Kristy Kennedy at 480.985.9512 k.kennedy@medtechinno.com
18
SURGICAL ROBOTICS
not all their faultdevice companies share the blame. Its
a common complaint about the evolution of MIS beyond
lap cholecystectomy, and one of the foundational myths
of first-generation robotics. While MIS was popular with
A Proprietary Railroad
There are some obvious areas where Google-ness might
apply in the ORadvanced visualization systems for the
closed spaces of MIS, for example, video analytics in assessing anatomy, and machine learning to improve decisionmaking. Understandably, Verb officials are reluctant to go
into great detail about how such advanced feature sets
might work in surgery or to speak specifically about what
Google-izing surgery really means.
Despite the importance of Big Data and advanced analytics to Verbs vision, company officials insist the collection of
SURGICAL ROBOTICS
accounts where they already have relationships and offer
economic solutions to implement their robotic platforms,
he says, leveraging off of their instrument and broader J&J
businesses. Intuitive, he notes, doesnt have that capabilityat least not yet.
And though Verb executives are already thinking of the
competitive landscape ahead, they say that in the first few
years, most of the companys revenues will come from market expansion, increasing current robotic procedure penetration from the current 5% or so to something closer to
50%, rather than taking market share from Intuitive or displacing its installed base. Comparing the anticipated Verb
platform to current robotic technologies, Huennekens says,
Its like moving from mainframes to PCs, from land-based
rotary phones to mobile phones. The current robots are
useful and have done some incredible things. But there are
limitations to the current technology. Will we be able to do
prostatectomies? Yes. But well do so much more.
KOL or No KOL?
Of course, Verb executives expect that Intuitive will step
up its game as wellthe companys recent growth spurt
indicates an expansion of indications beyond prostatectomies. But Huennekens argues that Verband by extension,
Covidienwont have the burden of an established leader
like Intuitive as it faces obsoleting its current successful system. Every company that is a leader and has a legacy faces
the same challenge, he says. As Patton said, you dont
want to pay for the same dirt twice. New entrants dont
face that.
Given his time at Ethicon, Dave Herrmann has spent the
better part of the last decade talking with surgeons about
surgical instruments and technology. I think were now
seeing a groundswell of support [behind the notion of nextgeneration robotics], he says. Intuitive has made surgeons
aware of what technology can do to complement their skills
and help them achieve certain goals and accomplish certain
tasks in the OR, he goes on. Even if they arent necessarily
using da Vinci for all of their cases or arent even adopters
of robots at all, at least they see the potential. In turn, as
surgeons find out more about what Verb is doing, he says,
Theres a lot of appetite for them to partner with us to create Surgery 4.0.
And, in fact, Verb officials note that they had over 100
surgeon visits to either SRI, Ethicon or Verily over the past
two years, before the official launch of Verb, to get an early insight into what the company is doing. The feedback
has been extremely positive, says Huennekens. Central to
bringing surgeons on board has been the participation of
Ethicon, which seems to have leveraged its footprint in the
OR in these early discussions and will be critical to the eventual launch of Verbs platform. Theres so much interest in
19
what were doing and in partnering with us, says Dave Herrmann. And obviously Ethicons done most of the legwork
in developing those relationships.
Verb found that many surgeons cited key attributes such
as precision and control, visualization, and the ability to
dissect in tight places, as imperative in robotic systems
attributes all currently available on just about every system.
Well have those and more, says Scott Huennekens. At the
same time, those surgeons cited other capabilities they'd
like to have, like mobility, expanded reach, multi-quadrant
surgery, greater flexibility in the use or application of the
systemi.e., the ability of the hospital to optimize the use
of the system once theyve made the investment in itand
advanced instrumentation such as harmonics, clip appliers,
and staplers.
Dave Herrmann notes that Verb is developing a set of
clinical priorities and assembling a roster of KOLs to advise company officials as they go forward. More, implicit
in the companys vision of Surgery 4.0 is a new kind of role
for surgeons in improving surgical techniques. Given the
data analytics and advanced learning available on Verbs
platform, using the companys robot will almost be like
having the collective knowledge of top leaders in the field
as part of the tools available to [surgeons] in the OR, says
Scott Huennekens, who believes that Verbs platform will
enhance the ability of highly skilled, high-volume surgeons, but will especially benefit those who do relatively
few procedures a year.
The role of KOLs in Verbs development, however, raises
another question about the marriage of medtech and high
tech. Some digital health investors note that a critical difference between conventional medtech development and digital tech development is that for many digital technologies,
conventional KOLs working at academic medical centers
arent the best people to turn to for insight and guidance in
launching new products. Those academic centers tend to be
conservative and highly sophisticated in their take on new
technology; better, say digital investors, to start in smaller,
community hospitals where pedigrees are less impressive
but doctors are often more open to new ideas.
And thats not just true of digital technology. Recalling the
early days of MIS, Scott Huennekens says that there was a
lot of resistance to the new surgical techniques from KOLs.
It was people like [surgeon] Eddie Joe Reddicks and others
that really pushed for the adoption of minimally-invasive
surgery, he says. Thats why, Huennekens insists, for all
of the advanced technology at its disposal, Verb is developing its platform based on the feedback it is getting from
surgeons, not on the ability to build sophisticated features
into the system. This isnt coming from us, he says. This
is about making their vision a reality.
Online print subscriptions, reprints, and web posting and distribution licenses are available.
Contact Kristy Kennedy at 480.985.9512 k.kennedy@medtechinno.com
20
SURGICAL ROBOTICS
Democratizing Surgery
Huennekens focus on business model disruption, rather than just technological disruption, is about more than
changing the model for robotic and surgical equipment
companies. Its also about changing the healthcare system
overall. Verbs platform will bring down the cost of surgery, he says, and, in the process, democratize it, making
it available across the globe, not just in first-world places
that can afford [expensive systems].
Verbs openness to working with other companies, noted
earlier, is also part of its business model disruption. Other
systems are closed platforms, says Huennekens. Were
open to partnering with other companies and having the
platform be as versatile as possible. Were willing to have
discussions around using other companies tools, which can
change the cost-effectiveness equation as well.
Even as they seek to lower the cost of surgery and bring
a greater cost-effectiveness to new parts of the globe, Verb
executives understand the scope of their effort. Creating
a new surgical solutions platform will, says Huennekens,
wind up costing a quarter of a billion dollars by the time
we get to commercialization, an effort that will require the
deep pockets of corporate giants like J&J and Alphabet. Although Fred Molls Auris Surgical Robotics was funded by
SURGICAL ROBOTICS
PE investors, few venture investors would likely fund such
a project. Moreover, he argues, companies like J&J and Covidien have to make those kinds of investments to protect
and grow their businesses. Ten years from now, Huennekens says, I think well see three successful companies in
this surgical solutions space: Verb, Covidien, and Intuitive.
But could the competitive landscape be even broader?
Verb executives believe that the current $2 billion robotics market could eventually be five, perhaps even ten times
that size. In just eight key surgical procedures they predict
that, given the current low penetration rates, just addressing unmet clinical needs has the potential to expand robotic
procedures within several years of Verbs launch, more than
doubling the market by 2025. Late last year, Toyota announced that it was committing $1 billion to open a robotics center in Silicon Valley, with broad industrial and commercial applications that will include healthcare. Are Apple
and Microsoft looking into this as well? Im sure they are,
Huennekens goes on. Anytime you get into markets that
are $10-20 billion in size, it attracts the attention of companies like Apple and Samsung and Alphabet.
Huennekens notes that there are five basic risks that any
start-up faces: financing risk, development or technical risk,
clinical risk, regulatory risk, and market risk. When I left
Volcano, I promised myself Id never do another start-up
because I didnt want to deal with the different risks, he
says. But Verb, he argues, is immune in a lot of ways from
each of those risks. With deep-pocketed partners like J&J
and Alphabet, Verb appears to have little risk of running out
of money. As for technical and development risk, Huennekens notes that were adapting [robotic] technology that
already exists. There is a time element, he acknowledges,
but the development risk is mitigated as much as we could
have hoped.
In a similar vein, regulatory risk is lower because robotic
systems are 510(k) devicestheyre tools in the hands of
surgeons, rather than enablers of completely new procedures. And theres little clinical or market risk because, as
Huennekens says, We know surgery works, were just trying to develop ways to do it better.
A Culture Clash?
As the robotic race heats up, so does the cost to play.
As the stakes get higher, are Verbs partners committed to
what could be an expensive project? Michael Del Prado
stops short of an explicit commitment, but he does say, I
think the partnership is very strong.
Intriguing as that partnership between medtech giant J&J
and tech giant Alphabet is on paper, and as compelling as
the technology vision, could obstacles arise precisely because of the different backgrounds and cultures of each
21
partner? Two decades ago, many medtech companies, particularly those developing coronary stents, enthusiastically
embraced the notion of drug/device convergence, which
held the promise to greatly enhance the clinical value of
medical devices.
Online print subscriptions, reprints, and web posting and distribution licenses are available.
Contact Kristy Kennedy at 480.985.9512 k.kennedy@medtechinno.com
22
SURGICAL ROBOTICS
software upgrades and new instruments. In medtech, you
have markets like large, non-invasive imaging with longer
development cycles, and other markets, like catheter and
instruments with faster innovation cycles that are often incremental in nature, he goes on. Well have both.
Verily encounters not just with its partners, but internally as well, as the company brings together teams
of people with diverse areas of expertise. Alphabet/
Verily works hard, he says, to create a culture that
spans and imports the best elements of all of the
product development paradigms, whether rooted
in high tech, medtech, or biopharmaceuticals.
Bajaj notes that within Verily, there are projects,
such as those in nanotechnology, that are still at
the basic discovery stage and ten years away from
any application. At the same time, there are also
projects that are closer to a typical medical device
development timeline, and others still that, as Bajaj
puts it, operate on a software development scale.
One of the things that Verily does well, he goes on
is to reconcile all of these different world views,
which in turn, he believes, gives Verily an advantage
that no other tech company has in approaching
the industry in an integrated manner. One of the
things that our partners enjoy most about working
with us is that we have reconciled these perspectives and dont consider them to be at odds, he
says. (For more on Verily, see the sidebar, Verily:
Googling Surgical Robotics.)
Ethicons Michael Del Prado, too, believes that
concerns about culture clashes and/or simply different approaches to the project are misplaced. I
think all of the parties are very unified around the
vision of democratizing surgery and making sure
that our technologies are brought to bear to deliver a transformative solutionand I think its very
complementary, he says. Weve been in the [medical] device space for so long, the culture around delivering in a regulated device environment is very
strong. Google has always been very inventive, very
creative. But importantly as well, Verb is creating its
own culture; its very aspirational and yet also very
collaborative and very focused on executing against
a clear plan. I think its working very well.
Twenty years ago, at the dawn of the MIS revolution and fresh out of Harvard Business School, Scott
Huennekens found himself working for a small surgical device company in Orange County, CA, Birtcher
Medical Systems, teaching surgeons how to do a
then-novel procedure: the laparoscopic cholecystectomy. Its very interesting coming back to surgery 20 years later, seeing the advances that have
been made, he says. It really isnt all that different. If Verb has its way, Huennekens wont be able
to say that much longer.
SURGICAL ROBOTICS
23
A High-Tech
Healthcare Company
In defining Verilys mission this
way, Bajaj implicitly rejects the notion that Verilys role in the joint venture is limited to bringing high-tech
capabilities to the partnership and
more explicitly rejects as well the
characterization of Verily as simply a
high tech company. We are a healthcare company, a very unique healthcare company, he says. We have
brought together people from many
different disciplines, ranging from
biology to electrical engineering to
quantum optics to software engineering and even to more traditional
clinical disciplines. Moreover, Verily
has created an environment where
all of these different disciplines work
together to solve problems in healthcare. And we take a very long perspective, says Bajaj.
In that context, Verilys contribution
to the J&J collaboration represents
what Bajaj calls the fusion of several
disciplines, including advanced optics
to foster a detailed understanding of
the operating environment, as well as
tools to resolve anatomical function
in greater detail, including biological
and molecular motifs. He goes on,
We combine all of that with a tremendous capability in information and image analysis. And in so doing, we really hope to give the surgeon a kind of
situational awareness that hes never
had before.
Surveying the current offering
in surgical robotics, Alphabet executives are rumored to have commented that what they saw passing
We are a healthcare
company, a very
unique healthcare
company, Bajaj says.
We have brought
together people
from many different
disciplines, ranging
from biology to
electrical engineering
to quantum optics to
software engineering
and even to more
traditional clinical
disciplines.
the dexterity of the surgeon to systems in which advanced imaging is
increasingly a necessary component
of the procedure, he says. The next
step is to bring situational awareness and intelligence to the surgical
robot. Doing so means developing
visualization tools and decision-making systems to process a lot of imaging information and present it to the
surgeon at the best possible moment
during the procedure, Bajaj goes on.
Thats the evolution we see.
Online print subscriptions, reprints, and web posting and distribution licenses are available.
Contact Kristy Kennedy at 480.985.9512 k.kennedy@medtechinno.com
24
SURGICAL ROBOTICS