The Promise of Surgical Robotics

Vicarious Surgical is working to realize the promise of surgical robotics. They have been in “stealth mode” since I first invested a few years ago, and so I’m excited to talk about them for the first time publicly. I’ll start with some background on surgical robotics from my own experiences to provide context before sharing more about the team, their company, and their mission.

I’ve been in the healthcare industry for over a decade now (TFW), and first came across “robot-assisted surgery” when I was in medical school. The technology promised an improvement on minimally invasive surgery (MIS also referred to as laparoscopic surgery).

MIS, a “disruption” in the field surgery, replaced the practice of cutting patients wide open with a technique that involved only a few small incisions and complex manual tools. Benefits included a reduction of blood loss, pain, scarring, infections, and average length of stay. Some procedures even moved from in-patient to out-patient. These benefits brought cost-efficiencies for hospitals and eventually lower costs for payers. As a result, MIS has flourished as a technique despite being challenging to learn and often taking longer than open surgery.

Which would you rather have?

The use of robotics in MIS, or MIRS, promised additional benefits. With MIRS, we could theoretically have even fewer and smaller incisions with more precise movements, and thus enjoy even better outcomes. After years of research and development, millions in federal grants, long regulatory battles, and of course some IP litigation, robots were built and purchased and surgeons were trained.

Hospitals made the decision to buy based on some initial data and the fact that MIS had worked out so well. Clinicians trained on the new devices for similar reasons, and contributed to the decision-making to adopt robotics. This combination of investment and expectations led to doctors, hospitals, and robot manufacturers touting the benefits of MIRS in advance of concrete evidence.

Eventually, patients became educated about MIRS and began to demand it as well. Emerging longitudinal data began to show a lack of better outcomes and cost savings vis-à-vis MIS, or at least uncertainty on those measures. What robots did do for sure was drive procedural volume, as surgeons and patients would migrate to whichever hospital provided robots.

After leaving medical school, I joined a consulting firm. Hospitals would ask us to help them decide whether a robot was a good investment. Usually, we had to tell hospitals their choice was between buying the robot and experiencing a negative ROI, because revenue wouldn’t increase enough to justify the multi-million dollar expense, or not buying the robot and experiencing an even more negative ROI as volume shifted to hospitals with robots. So take a loss, or take a bigger loss, and either way your outcomes probably won’t improve. Not something any client wants to hear.

The Continued Pursuit of Better Outcomes

With that history in mind you might be wondering why would anyone invest in a surgical robotics company? Well, the promise of better outcomes is still there. Robots undoubtedly provide more precise movement and a more even application of force. Fewer and smaller incisions are theoretically possible, as are more rapid movement and remote operation. With enough data and programming, MIRS could even be completed autonomously. If provided correctly, MIRS could increase both access and quality while reducing costs, thus breaking the “iron triangle” of healthcare.

Improvement on one or two of the measures necessarily causes worsening of the other(s).

While the triangle is a bit controversial and an imperfect framework, here are some quick examples: If you suddenly provide everyone in America with health insurance, access increases, but costs increase and quality goes down as resources are stretched. A new drug that stops cancer with fewer side effects is higher quality, but the cost will be higher and so access will be low. Telemedicine can be provided at a lower cost and can reach patients in remote areas but is limited in the conditions it can treat and so lower quality to an in person visit.

Flash forward six years to 2015 when I met Adam Sachs and Sammy Khalifa, co-founders of Vicarious Surgical. I was investing at Rothenberg Ventures and looking for great virtual reality founders and companies (a story for another time). Adam and Sammy were simultaneously enthusiastic and serious. Both had worked at Apple after graduating from MIT. They sincerely understood the complexity of the undertaking, and we shared beliefs about the state and potential of MIRS. They also had a clear vision and plan to solve the numerous challenges ahead with a single solution. I realized they considered the problem and the system holistically. Most importantly, I believed they could actually pull it off. So, we became their first investor.

From there, I’ve watched this team grow and build their technology. As they’ve proven their capabilities and made great progress, they are now armed with a $16.75M Series A and the support of Khosla Ventures, Eric Schmidt’s Innovation Endeavors, Bill Gates’ Gates Ventures, Yahoo! co-founder Jerry Yang’s AME Cloud Ventures, and Marc Benioff. I’m excited to be investing again in this team and this mission.

The vision for Vicarious Surgical includes the combination of virtual reality with human-like surgical robotics, enabling surgeons to perform minimally invasive surgery through a single micro-incision. The result is less bleeding, less pain, lower recovery times, less scarring, and fewer opportunities for infection — all of the original promises of MIS and MIRS. In addition, the team aims to provide a truly intuitive experience by “shrinking the surgeon” and putting them inside the patient. With a goal of increasing patient access to minimally invasive surgery, the mission has more at stake than just a new device for the market. Vicarious Surgical intends to fulfill the promise of surgical robotics. Oh, and they’re hiring!

New logo!

Some background reading:

A history and overview of applications from the American Journal of Robotic Surgery.

A detailed literature review on robotic surgery.