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Inspired by a remarkable journey, a miniature surgical robot aims to revolutionize abdominal surgery

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Bill Gates-backed Vicarious Surgical, which is due to go public in the SPAC deal, hopes to reach $1 billion in revenue by 2027 as it beats out surgical robots Goliath.

Written by Amy Feldman with Ayoshi Pratap

aKid, Adam Sacks, co-founder and CEO of Vicarious Surgical, watch the 1966 sci-fi movie Fantastic trip He was fond of the hypothesis of microsurgeons performing surgery inside the scientist’s brain. “Humans are the mistaken size to operate on humans,” he says. We won’t scale down humans, but we can create avatars for them. We can create miniature robotic versions.”

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That’s exactly what he and his co-founders of surgery – Sami Khalifa, the company’s chief technology officer, and Dr. Barry Green, chief medical officer, has spent the former decade doing. They have developed an itty-bitty robot paired with a VR headset to perform abdominal surgeries that they hope to bring to market in 2023. Its arms and camera are designed to enter a patient’s abdomen through an incision less than an inch and operate in all directions once there. Reducing the size of a surgical robot is very challenging, but by doing so, the Vicarious trio hopes to aid doctors perform abdominal surgeries, starting with hernia operations, faster and safer with fewer complications than current alternatives.

It’s not exactly sci-fi stuff in the movie, where doctors are injected into a patient’s blood, but it’s futuristic enough that Vicarious has attracted A-list investors including Bill Gates, Vinod Khosla, Eric Schmidt and Jerry Yang. It has also received a breakthrough rating from the Food and Drug Administration — a first for a surgical robot — making it eligible for priority review.

“Putting the elbow down into the body cavity and being competent to reach back and work toward the abdominal wall is a lovely big deal,” says Paul Hermes, who directs the robotics program at Medtronic and is now a consultant to Vicarious. “We should expect robotic surgery to improve.”

The company is scheduled to go public through a merger with SPAC, which was set up by Hong Kong investor Donald Tang. The $1.1 billion deal will hoist $115 million and bring in medical technology giant Becton Dickinson, which makes the surgical mesh used to repair hernias, as an investor. It expects annual revenue to reach $1 billion by 2027.

“We’re going following markets where current surgical robots have struggled,” says Sachs, 30. “There are a lot of imitators targeting the incumbent. They have the alike challenges. . . . our architecture is completely distinct.”

The $115 billion (market value) robotic-surgery behemoth Intuitive Surgical, which introduced da Vinci, a big, four-armed robot carrying wand-like tools, two decades ago and has dominated the space ever since. As Intuitive’s patents expire and robotic technology advances, competitors including J&J and Medtronic, both of which have acquired emerging surgical robot companies, are vying to make robotic surgery as popular as laparoscopy. The expected price of the Vicarious robot at around $1.2 million, roughly half the price of existing robots, could be a factor in its favour, as well as the ease with which surgeons can learn how to use it.

Sachs’ education in machine design began at his home in suburban Boston. His father, Eli Sachs, is a professor of mechanical engineering at the Massachusetts Institute of Technology who is considered the biggest statesman in the field of 3D printing. His mother is an architect. He met Khalifa, 31, during his freshman year at MIT, where they both studied engineering. They became rapid friends and spent their spare time in the school’s machine shop making motors, the mechanical components that power the joints of a robot. “We were testing them, and we found out they didn’t work and we’re going to do it over and over again,” Sachs says.

While Sacks and Khalifa were still in college, they began working with Green, a bariatric surgeon and comrade of the Sacks family, on a medical device that became a robot. In 2014, following a short stint at Apple, Sachs officially launched Vicarious with $400,000 in seed funding led by Michael Rothenberg (the VC was later charged with fraud by the Department of Justice in an unrelated case) and in 2015, Khalifa cease his job to join.

The hardest part over the years, Sachs says, has been figuring out the engines. Making it little enough to include nine of them, three times what is typical for surgical robots, was challenging. And also they are separated so that each joint can move separately, with the aid of 28 sensors per arm.

Carnegie Mellon professor of robotics, Howie Choset, compares the technical challenge to jamming a lot of things into a piece of luggage, and then trying to make those things do something. Even worse, the smaller the motors, the weaker they become. “You want to get as much of the run as conceivable in as little a package as conceivable, but you’re really struggling to get as much of the package as conceivable,” he says. “It’s amazing [Sachs] Make this work.”

Hernia repair, the number one market that Vicarious targets, is a massive operation, with over 2 million procedures annually in American abdominal hernias, common along the midline of the abdominal wall, accounting for 500,000 operations and is extremely complicated. Standard repair involves attaching mesh to the abdominal wall, but results in recurrence about 20% of the time, and often requires a more extensive repair. Advanced technology that involves stretching the mesh against the rectus abdominis reduces repetition, but is challenging and can take up to four hours with current robots.

When Vicarious received the FDA breakthrough designation, he could perform this surgery on a cadaver in about half the time, Sachs says, and has since reduced that to less than an hour. In a video demonstration of abdominal hernia repair, the arms of a Vicarious robot shove a mesh into the abdominal cavity and then quickly sew it up. Shorter surgery is less hazardous for patients and more cost-effective for hospitals.

Vicarious’ ambitions extend to other abdominal surgeries, including gallbladder procedures, for a potential whole market of 39 million surgeries (only 3% of these operations are performed using robots). That’s why Sachs, who has a stake in Vicarious $112 million, reports that it only needs a part of the market to create a big company.

“The field has been lovely much stagnant for a lengthy time, and there is an accepted wisdom that is incorrect,” says Tang, an investor in SPAC. “You need to put this in people’s hands to show that it is conceivable and not a distant dream.”

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