Beyond the Gadgetry: Unlocking Real Value in the Next Generation of Robotics & Digital Surgery | LSI Europe 23

Transcription

Bhavesh Barot  0:05  
Okay, good morning. I think I'll start with asking introduction, Dan, if you want to introduce yourself, please.

Dan Stoyanov  0:15  
First, thank you. So firstly, it's a great pleasure to be here. And thank you so much for the for the invitation. It's such a spectacular venue and event. I'm a professor in computer science at UCL. My research background is in surgical robotics and AI. And I'm also fortunate enough to be Chief Scientist in Digital Technologies, which is part of the Medtronic's surgical operating unit in business. 

Bhavesh Barot  0:44  
And so, Dan, explained to me and I think we were speaking about it last week, as well. Explain the role of academic and the role of somebody in a industry as well and explain how you balance the two and how you made the shift as well from from academia into industry as well.

Dan Stoyanov  0:58  
I think the the right answer is probably that there is no balance, it's full on on both both ends. The exciting part is really seeing technology that we started developing in academia maybe 20 years ago, now transitioning to becoming a product. Firstly, product as a startup in central London, is digital surgery, young spin out in the center of the city. And even more exciting now as part of Medtronic, as a multinational strategic were some of the solutions that we have been developing, now deployed in 15 countries and are being utilized on a on a daily basis. And I think that's really some of the opportunity that we have with digital, that when some of these solutions are deployed at scale, that's when we start really discovering where their true value and their true impact on patients and outcomes is going to be. 

Bhavesh Barot  1:58  
Digital surgery, it's a term used very frequently. How'd you describe it? What does it mean to you? What does it mean to Medtronic? What does it mean to healthcare?

Dan Stoyanov  2:09  
I think the the the meaning and the definition is evolving. But I, I'd like to connect back with some of the opening remarks from Scott, where he said, in the early days of LSI, everything was on paper. And people were traveling with folders and collecting data and organizing everything but very much doing it manually. And today, the operating room is still much more manual than a lot of our lives are outside of the operating room. And I think that's where we have an opportunity to bring digital digitalization. And some of it will be in the form of consumer electronics or systems that we use on a daily basis. For example, the ability to stream information or to record information and then to analyze it. And other parts of digital surgery are going to be really the ability to interrogate information in a way that we've previously not been able to do. So really to bring quantitative systems in surgery that previously haven't existed. So can we understand surgical process in a very quantitative way? Can we see the events the actions taken by the surgeon, again, in a quantitative in a digital way? And hopefully, by being able to do that, I think we will get to the point where we have real time systems that can actually support the surgeon to make the right quantitative decision at the time of care and therefore improve patient outcomes.

Bhavesh Barot  3:41  
Thank you. And how do you monetize that?

Dan Stoyanov  3:45  
An excellent question. I think there's different routes. And I think, dependent on whether you're a startup or whether you're a big strategics, you're a big strategic, you probably have different opportunities to explore how to monetize that opportunity. I think something that is exciting with digital solutions is that they offer the opportunity of software as a service or a model where you pay for the amount of usage that that you use with with the technology. I think that may be that may be something that hasn't existed. And I think it's an it's a new model for surgical operating rooms and also for hospitals. And so I think that needs to be worked through. And I think for a strategic company, there could be monetization routes that are really about creating the next generation of your surgical instrumentation, the next generation of surgical robotics, creating instruments that are smarter that can help you to make the right decision to be more efficient, and of course to link it back to a better outcome.

Bhavesh Barot  4:55  
Thank you. And when we were speaking last week, I was sharing with you some of the challenges of bringing digital into a hospital. What's your perspective on that and bring it into the hospital? And actually back to the monetizing, but actually trying to even get it into the hospital, get it integrated into the systems, get it through the firewalls through Europe GDPR. What's, what's your perspective there? And what advice would you give to some of the innovators and peers over here,

Dan Stoyanov  5:26  
I think there are many challenges, and some of them are, you know, challenges of proving the value of the technology. So that's a more sort of standard challenge with any new medical device product. And some of the challenges are less tangible. So they are about software IT or having a sales cycle that is slower than you would expect. And but when I say slower, you know, sales cycles of 12 months plus, are not uncommon for a digital product, which can sometimes be frustrating if you're a young innovator, and you know, you can go and deploy the system very, very easily. And there's very minimal risk to the patient. So I think I think we do need to work with hospitals and with with the clinical teams to break down some of those barriers. And to get hospitals to be more comfortable with digital solutions entering the operating room. I think some of the challenges, and it really depends on the on the healthcare system on the type of hospital and it's a very heterogeneous space can be, you know, in the UK, for example, a lot of hospitals are privatizing some of the IT services. So for example, if you want to have a network port opened in your operating room, you have a subcontract a company, which needs to come in and do that port opening. And so if you're reliant on your solution, connecting to the network, even if you filled up all of the papers, and you're good to go, from an administrative point of view, you can get logistical delays, because the third party provider of the port opening is going to delay. So I think there's there are a lot of glitches like that in the system that really needs to be worked through. And also, the sales teams and the deployment teams of digital solutions really need to be specialized in digital solutions. And be aware of all of these holdups and all of these problems, so that they can tackle them in a very smooth and systematic way.

Bhavesh Barot  7:30  
And I think if I could just double click there, having a sales team that's able to actually sell software, and software as a service is very different to having a sales team selling a device. And I know historically is several strategics and abroad in this have typically used the sales teams that are comfortable selling devices, not comfortable selling software. So what what advice, what recommendation would you give them from that perspective,

Dan Stoyanov  7:59  
I think you're 100%, right. So something that I've seen within Medtronic is a greater effort in educating the sales team on how to sell digital digital products. But it's not easy, because if you've got a long and very successful history of selling instrumentation, obviously you've got a culture in the in the sales organization, that that is the important thing. If you're bringing out a new complex piece of capital equipment, for example, a surgical robot, then the sales force is incentivized in a different way to solve selling software as a service. So I think all of these things just require buy in from all parts of the organization, they require a lot of training. And they require, you know, the leadership teams to to work with you to make sure that everyone is incentivized in an appropriate way that the Salesforce have the appropriate training and the appropriate expectation of what they will get out of the sales funnel. So I think it's something that is that is evolving, and we're learning a lot. But I think we're much better today than we were five years ago.

Bhavesh Barot  9:08  
And we talked about the challenges of getting software or digital surgery into hospital. What about from a regulatory standpoint? Where is Medtronic? Going from that standpoint, and talking about software as a medical device and getting regulation there? What's What's your thoughts?

Dan Stoyanov  9:24  
I think it's similar to the to the sales question, you know, the big strategics have regulatory teams that are very experienced in regulating very risky, high class medical devices. But regulating a pacemaker is different to regulating a digital solution. Regulating an instrument or an energy device is different to regulating the digital solution. And so I think, from a logistical perspective, I think again, it's very important to work with your with your colleagues in the RA side of the organization. And to make sure that you get that appropriate experience. And really, I think with with digit developing digital software as a medical device solutions, it's important for the regulatory teams to work very, very closely with the r&d teams. Because these are new products. And so you need to work together in order to really figure out how you create a system that is both safe with the patient, and also is not overly cumbersome. So you're not over complicating your development cycle and therefore delaying it entering the market. So I think from the internal logistic perspective, that's a very important piece. Working with the external regulators is obviously also extremely important. And I think, you know, the FDA and the European bodies are making headway in understanding what sort of metrics they need to use, what sort of guidelines they want on the data that you need to validate your product. So I think everyone is becoming more educated in this area. But there's still more work to do.

Bhavesh Barot  11:01  
And you talked about AI? And I mean, do you want to share with the audience, what Medtronic is doing specifically in AI and how building the capabilities in Medtronic across all the business units? 

Dan Stoyanov  11:14  
Yeah, we have a, we have a, I'll speak about surgical, in particular, but in surgical, we have a tremendous opportunity, because our devices are in over 50,000 operating rooms. And now with the ability to collect video data, as well as device data. So energy data, we have an opportunity to understand what happens in those operating rooms and to drive our instrumentation to become smarter, not only our surgical robot, but also our energy and stapling businesses as well. And so, we're addressing this by building solutions to all the different procedures that we handle. So as because we're a part of so many different operating rooms, of course, we cover many, many specialties. And that's both an opportunity and also a challenge because it means that we need to build bespoke solutions to each of the different surgical specialties that we provide instruments to. But we're making headway in there. So we're sort of categorizing the important high volume procedures to us. And we're creating a portfolio of solutions that are going to look at how we provide analytics. So the ability to understand what happens in the operating room, during the operation, and also after the operation. So post operative analytics, and then layering in real time systems so that we can detect events that may be surrogate measures of risk so that we can detect critical structures so that we can detect how our instruments interact with the anatomy, and thereby Drive Safer clinical decision making.

Bhavesh Barot  12:53  
Thank you. And how would you assess or rate what is what is value add? There's several companies out there today with AI solutions, how does somebody in Medtronic, or yourself specifically say this is differentiated, this is a value add. And then combined with that, is it all organically inside Medtronic as if you were going to build everything ourselves, or we're welcoming other innovators to come in and integrate those systems within us?

Dan Stoyanov  13:23  
I think we're definitely welcoming other innovators. And there's different strategic initiatives within Medtronic. Some things will be built organically, and others will be built based on open access platforms. So there's a there's a great example and initiative of that in our surgical GI business. I think in terms of value creation, one of mechatronics missions is to improve patients lives, the quality of lives and patient outcomes. And so I think that's the North Star. So value will be created by improving the standard of care and by improving the type of patient outcome that we can achieve by using our instruments and our solutions. And if we can do that, I think there's there's value creation through surgical efficiency, so driving better efficiency in the operating room, making sure that our instruments are more analytical, more quantitative, and are able to really make the smartest decisions possible in all of the procedures that we play in. 

Bhavesh Barot  14:24  
Thank you. And if I go back to LSI, 12 months ago, and my friend and former peer to peer Mei Jiang talked about the AI Gold Rush, right? And she talked about how Medtronic should evolve from actually building the shovels to actually go and help the innovators out there as well. So can I expect Medtronic to be building API's where other systems could connect to them and start talking to them? Does Medtronic start building a Medtronic store? Where's it going?

Dan Stoyanov  14:56  
I think there's there are a lot of opportunities and to be to be part frankly, honest, I don't have the answer to this. I think building API's and working with open source and creating ecosystems is very exciting. But monetizing that can be also a real challenge. And so I don't have a clear line of sight of whether strategics should should do that, or whether or whether it should they should build moats around their data. I think if you if you look at some of the strategic capital, equipment pieces, such as surgical robots, maybe there are opportunities there to provide a plugging, or a sort of interface where other providers, startups might be able to inject information and work within your system. And that's the ecosystem. I think more broadly speaking, from a pure software perspective, I think it may be a little bit more challenging, because there, you don't want to carry the burden of maintaining an ecosystem, while everyone else takes the opportunity of providing their device. So I think that fine balance is something that everyone is still working through. I think the big tech companies, if you if you look at Microsoft, or Nvidia and others, they perhaps have a different opportunity, because their, their core business is the core technology that they provide. But they don't, they haven't yet invested in doing the regulation, or managing the lifecycle, or doing release product engineering. And all of those things carry significant cost. And so I think for the medical device, strategics, we still need to figure out how we balance out that cost versus the potential reward. 

Bhavesh Barot  16:36  
Thank you. I think if we switch gears into robotics, and digital surgery was acquired by the robotics division in Medtronic, where does digital surgery play in robotics? And, you know, if you get what you can share, and maybe even share with your glass ball, how do you see digital surgery coming together with robotics? And what value does it add.

Dan Stoyanov  16:59  
So although we were acquired by the robotics, part of the business, digital surgery, or digital technologies, is now very much working across the surgical portfolio. So working with our advanced surgical technologies, business with our energy and stapling devices, with our lung solutions, as well as with our with our robot, and I think we're going to add value across that ecosystem. So something that exciting that you're going to see in the next few months is we're launching a live stream product. So any operating room that has our digital compute platform is going to be able to connect and live stream to a number of operating rooms or colleagues, KOLs. And that just comes as part of our touch surgery enterprise product. So it's all one connected ecosystem. In the future, our device information, robot is going to connect to the same ecosystem, you will have analytics and an ability to analyze anything that you record in the operating room at an unprecedented level. So in a way that just not available today. So we've released around four procedures today. And I think by the end of next year, there'll be in double figures, where once your surgical video is uploaded, it's automatically segmented into procedural steps, we can detect certain anatomy that is visualized, we can detect which instruments are visualized. So immediately after surgery, you actually have a dashboard of process. So we're turning data from the operating room into information from the operating room. So something that's meaningful and tangible and may have an important role for your practice as a surgeon, but maybe also for the whole clinical unit, or even for the hospital. So I think that's something that's in our near term roadmap, and you'll be seeing these solutions coming out over the next year. And then, of course, we're working on our real time systems. So these are regulated systems that can provide information during a surgical procedure that enhances safety. So the ability to detect ducts or blood vessels or perhaps nerves, and really to allow any surgeon independent of your experience to visualize some of the really important structures that help you to manage your case in a more efficient way. Thank

Bhavesh Barot  19:31  
you. And you talked about the surgeon. How do you see the perspective from the surgeon because I get it from a hospital administrator. I understand that they can measure results see outcomes, but from a surgical standpoint, I see sphere there as well, right that everything is recorded. Everything is there, my department can see what's what's going on. So how do you overcome that and sell the benefits and see the value from that standpoint over that the fear of being watched by Big Brother.

Dan Stoyanov  20:01  
I think it's a great point, I think I think that fear is actually largely beginning to go away. So if we'd spoken about it 10 or 20 years ago, it would have been, I think that would have been a higher barrier. I think today, a lot of surgeons record the cases anyway, they just do it on a USB stick. And whether it's on a USB stick or on the cloud, it's really just a matter of ease. So, you know, if you, if you purposefully delete your information on a USB stick, and there was a problem with the case, you still have some level of responsibility there. So I think a viewer does, we're providing an advanced tool to be able to interrogate your practice, the data is yours, we don't own it, you can delete it, you can, you can do whatever you want with it, we just give you the means to interrogate it in a more meaningful way. And I think there's a lot of excitement from surgeons, surgeons who are educators who see technology like this, help them in their training practice, in educating their fellows, we see a lot of opportunity, and surgeons that just want to understand better how particular cases are managed. I think there's an opportunity also for strategics, internally to understand how some of the devices are used, and also to support their customers in using them better, or to understanding when when certain events are happening, that shouldn't be. And I think that's also going to drive greater efficiency. So I think the opportunity is bigger than the barrier for us today. But of course, we need to work together with, with surgeons and with hospitals, and to make sure that the solutions are what they need, rather than big brother solutions.

Bhavesh Barot  21:40  
And where does the patient fit in this? What will what value is does it add to the patient? And what role does digital surgery play in involvement with the patient, I

Dan Stoyanov  21:50  
think ultimately, the value to the patient should be safer surgery. So better surgery so that surgery is more standardized, so that it matters less whether you go to the top 10 Hospital in the in the world or the top 100. So I think I think that that ambition to make surgery better, I think that's where we want to bring value to patients. We do work with patient groups, we want patients as well as surgeons, to not feel like this is an invasive technology that is monitoring. But this is a technology that's going to add value to the standard of care. And so I think involvement of patients is extremely important. Protecting the data of patients is extremely important. I think it's very difficult to recognize patients from video of their internal anatomy. But nevertheless, it is inflammation of their anatomy. And so it's very important for patients to have the appropriate ethics in place and for the hospitals to to know how to manage that process. And so I think patient and surgeon involvement is both very important because they're the key stakeholders in this. 

Bhavesh Barot  23:05  
And, I think one more question. And then I will open up to the audience as well to give them an opportunity to ask any questions. But what advice would you give to an innovative we've got, you know, hundreds of innovators here today that have already developed great solutions and ideas that that will maybe want it to be to a company like Medtronic, what advice would you give to the innovators? What advice would you give to the investors that are coming in investing in these great solutions out there?

Dan Stoyanov  23:31  
Specific to digital, I would say that focus is really important. So focus on the exact solution that you're developing. I think with software, there's always a, there's always a an opportunity, but also the danger to spread too thin and to tackle too much. But actually developing these solutions and getting them through regulatory bodies is extremely difficult and takes a long time. And we already talked about life cycles. And so I think focus is really, really important. And from investors, I think it's it's important to, to, to look at the team, as well as the long term roadmap and sustainability of the technology because I think digital products are going to have a different release product engineering burden on them to conventional instruments, where once you develop the instrument, perhaps the maintenance isn't isn't as high. So I think in digital and also of course, in robotics, I think that team aspect and how the team is going to maintain the product over its lifecycle is really important.

Bhavesh Barot  24:36  
Any questions from the audience? Sorry, there's a question up at the front.

Audience Question  24:41  
I was curious, what do you see about the the integration with robotics from a dedicated devices like DaVinci for example, with third party products and and there may be 5-10, whatever products that are presenting here today or tomorrow, that want to meet to integrate with you see, from a vision standpoint, but how do you keep up with the breadth of rapidly changing products in your world? Are you forcing the young companies to try to keep up without standards?

Dan Stoyanov  25:15  
It's a really good question. So I think you mentioned DaVinci. And I think something something that DaVinciintuitive and did with with DaVinci, that I think was very clever, was to provide Tau Pro. So it's essentially a viewer that allows a third party to connect any type of system to it. So you could connect ultrasound or an advanced and at some advanced imaging modality or some analytics product in there. And I think that's a that's a clever way to allow third parties to work with your system without creating a very cumbersome integration process or even potentially creating a regulatory hurdle where you need to reregulate either one of the products. So I think that's a that's a really good way to think about these these integration points, with systems that are complicated, because in the end, building a surgical robot is complicated. And so I think it's important to, to have a strategy where you're not going to create the regulatory burden for your robot, by by requiring the integration, I think if there is the regulatory burden, then the value of that integration has to be really, really high for you to invest in it.

Bhavesh Barot  26:34  
There's one more question.

Richard Vincent  26:37  
Dad, great, great to hear your insights, Richard Vincent from FundamentalVR, I wondered on your perspective on immersive technology, it's been a lot of talk about that recently, I wonder how you view that across the different stages of the areas that you're focused on at Medtronic?

Dan Stoyanov  26:56  
I think there's a great opportunity for immersive technologies in training, training and education, of course, I think as, as systems get deployed in the operating room, there's also an opportunity in helping teams get started, and get familiarized with, for example, setup of armed guards, the logistics of managing an operating room with a router with a very complex system. So I think, great opportunities there. And then I think there's a there's an opportunity to visualize patient data in a way that perhaps is not utilized sufficiently today. So for example, surgeons may be able to visualize patient anatomy just before a case or the night before the case. But I think for that to become really valuable, I think the the workflow between getting the data to the surgeon in that type of format, the the medium of immersive visualization, I think the workflow really needs to be very, very smooth so that there isn't a barrier because you're adding too much time to people who are already extremely busy. So I think I think there are opportunities there. I think maybe some of the some of the barriers are around managing that workflow. So how do you get from PAX, to the appropriate visualization for the end customer in a really smooth way? But I think those are the immediate opportunities that I think that I think could be really great.

Bhavesh Barot  28:21  
All right, Dan, thank you again, and, 

Dan Stoyanov  28:25  
Thank you so much

Bhavesh Barot  28:26  
Close off this session. Thank you have a good day.