Bruce Lichorowic, Galen Robotics - AMOI Studio Interview | LSI USA ‘23

Galen Robotics is a digital-surgery-as-a-Service (DSaaS) combining the power of a new microsurgery platform with a system of big data analytics and machine learning to provide advanced surgical assistance in performing delicate or intricate procedures.
Bruce Lichorowic
Bruce Lichorowic
President & CEO, Galen Robotics



Ben Glenn  0:10  

Say hello to my guest, Bruce Lichorowic at LSI 2023. Bruce, thanks for coming by the studio.


Bruce Lichorowic  0:17  

Thanks, Benny. It's really a pleasure to be here with you.


Ben Glenn  0:20  

So Galen Robotics, spun out of Johns Hopkins, let's play back that tape. How did it get started?


Bruce Lichorowic  0:26  

Right after our last company. Johns Hopkins Tech Ventures gave me a call. And they said they had this new robot that they were putting together since 2010. Base basically coming out of Dr. Russell Taylor's lab, and if anybody does knows about Russell Taylor, his, his DNA is in the DaVinci. It's in the Mako it's and Think Surgical. So he's very prolific roboticist. And so this particular device was in five years, six years of development just to get to a prototype before they even wanted to license it out to us. So we did our deal in 17. to commercialize it. We were located, as you will know, in Silicon Valley, up until 2020. And then we had a great deal from the state of Maryland to move the company. So we moved to Baltimore, believe it or not, the whole company sold the house, took the dogs, the kids, the cats, and a bunch of vans, and all of us moved to Baltimore.


Ben Glenn  1:29  

So how do you like how do you like the Baltimore ecosystem? I've been following that from afar. A lot of the development that's going on at the Inner Harbor, and Under Armour was going to put a new tech center in there, how do you find Baltimore?


Bruce Lichorowic  1:42  

Actually, it was a great surprise. Beta more, which is part of Under Armour is development team is building a whole system of like, Santana row type of development, next to the water. But the ecosystem of Baltimore has been absolutely incredible to us, the city has embraced us, the state's embraced us. It's been an incredible, of course the university has. So being closer to the university, they're pretty much our r&d arm, for the future development of some of the features for the Galen robot. So this has been a really pleasant surprise. And so my wife told me like nine months ago, you can move back to the Bay Area, but I'm staying.


Ben Glenn  2:27  

We're gonna get gotta get that onto the, you know, come to Maryland, and lose your wife. That's right, whether you have a wife or not, I'm always happy to go back to Hopkins that the ecosystem that they have there and the work they do at CVID, which was it followed the work that went on at Stanford Biodesign.


Bruce Lichorowic  2:45  

That's right. 


Ben Glenn  2:46  

And I was amazed. I always think that, you know, we do a lot of things right at Stanford. But one of the things I loved about being with CVID, is that everybody stays around. And that ecosystem is very dynamic. And they keep coming back, it's like, it's like these boomerangs, they never get really thrown very far away. But they stay, they stay very engaged in what's.


Bruce Lichorowic  3:04  

It's interesting a lot of the graduates out of Russell's lab, they immediately get recruited, I mean, it's 100%. And so every summer, we get to bring in it close to 10 to 15 interns into into Galen, and we spread them out amongst our engineers, and we get them for three months. And we give them projects. And of course, they're already used to the Galen, because we've given Galen to the university for them to do their case studies with and do their capstone some things. So we put them through our own combine, and when they graduate, we offer them you know, full time work, and half the company are all ex Hopkins grads. So obviously, our burn is relatively very low. And these kids are wicked, smart, just wicked smart. And you know, they just do a terrific job building out the robot. I mean, we what we've done in three years is everybody would say would take five to six and some of these bigger companies, because you have that young energy and they're just they just pile on this stuff. 


Ben Glenn  4:15  

And that's even a better form of ecosystem by having those trained engineers come right into the company. So what's the Galen robot for? You're inside of FDA? Now, what's the first clinical approach you're going for?


Bruce Lichorowic  4:26  

Right now we're going after the ENT market. The robot was basically designed to hold the existing instruments the surgeons already own. So we don't do the our own end effectors. It's a basically a platform with a robotic arm, that the surgeon can click in their tool, push the pedal, and it basically offers power steering to their tool. So it's, it's basically the same thing they normally would have done, they would have picked that tool up and operated all and now now you have the robot holding that tool. So the functions is that The the same, the workflow is exactly the same. The reason why we're a de novo versus a 510 K thing, we couldn't find a predicate because we don't own the end effectors. It could be, you know, an Integra or Teleflex, or stores or j&j on Spock drill or minus racks, or whatever. So we hold those instruments. And the program inside the computer inside the robot knows the length and the geometry and the weight. So basically, the robot can help guide guide the instrument, hold it steady, and in the future will give them safety zones, the XY and Z. So for right now, it's basically a very passive, cooperative assistant robot. Now our first indication will be laringology, which is fairly natural opening, fairly simple, we'll move the then we'll go into otology, which is middle ear, but big the big markets will be neuro, obviously being Hopkins is where neural started 100 years ago, with crashing. So neuro will be our next indication followed by soft spine for Landon neck dummies, and followed by cardiac. So we're just holding those instruments, same platform, the only thing that changes it's a software. So we're really a software company that's happening to be selling a robot.


Ben Glenn  6:25  

Wow, that's a that's kind of the medical device of the future. We were talking earlier today with one of the investors that's here saying how you know, if you can move the medical device into the software, and then the data that it generates, it becomes a virtuous circle, you generate the data that then improves the device that improves the software that improves the data that improves the device? Do you see that kind of a future for Galen?


Bruce Lichorowic  6:49  

Well, you remember my co founder, Dave Saunders, he is a, you know, AI, data specialist. So the whole idea of having a closed loop system, where the robot can actually learn the surgeons movements, and then help him in the future is not that far away. So Galen capturing that data of say, 100 or 200 cases of a particular indication, then grinding that data up looking for patterns, and we can then spit that back as a training tool, or an improvement tool, saying you've made 800 movements to do this particular indication or this particular case, you know, you could probably get away with doing 500. And we'll show you where you're wasting movements are things like that, from a training standpoint, the other point is scoring. Now, so just want to be scored. But training hospitals teaching hospitals like Hopkins and Stanford and those places want to have a scoring robot, so for their residents, so they're gonna go in and, you know, one of the one of the interesting tests that Hopkins has is to buy hand carved off the top of a raw egg with a with a drill, take the shell off without breaking the memory of breaking the yolk. Five minute go, no, go test right. And you got to hold that steady. The problem is that bit spinning, as you will know, and it can catch an edge and dive or plunge, which is a problem they have with spine today. And so we can now be able to do that have the robot hold that particular drill, and cut that time in half where they can continue to go. So it's, it's a cool, it's a cool thing, all driven. It's driven by software. I mean, we as you will know, we're software guys, and the future of robotic will be software based. And so if you can establish a platform, like your iPhone, and now add different apps, virtual fixtures, AR, AI, VR, augmented reality that the surgeon can call up and use for that case. Now you got to know you can customize the case by having the options on the robot for what he needs. So very, it's next gen. It's next level stuff.


Ben Glenn  9:15  

So how does the how does the robot accommodate to the surgeons left handed right handed? It's a cutting instrument. It's a drill. How does the robot accommodate? Is it like is there a getting to know you phase or how does it understand how it's being held and what it's being used for?


Bruce Lichorowic  9:31  

Well, in the setup, the surgeon will then determine his own bias. He wants a heavy feel or Hartfield. He wants to feel a tool. He doesn't want to feel the tool, but the surgeon isn't 100% control. So he can take the robot, he can take his tool every once the robot will follow today, and the future will give him a safety zone. We can't go outside the safety zone. So right hand left hand, if it's right here. It depends how he wants to have the robot whether it's a dominant hand And whereas less dominant hand, maybe his left hand and he wants a right then he brings the robot on this side of the table and does it this way. And and it does it this way. So, so right now it's just a single tool holder, we're looking at, you know, second arms, extended arms, whatever. But right now, it's it's surgeons choice. You know, and this is what they like, you know, they want to be in control, they want something they can use for five minutes, push it away, or they want something to hold an endoscope for five hours, you know, so they have the ability to be versatile with this with this device, not take up a whole room. But they can bring it in use it when they want, and then take it away or use the tools that they want. So that's what we did a lot. We talked to over 200 surgeons on this. So the biggest things for usability and robots, the biggest problem is setup time. Anytime you start getting past five minutes, these guys are gonna hate I'm doing a 90 minute case, I'm like, I spent 12 minutes setting this damn thing up, get it out of here. So that's one issue. The other issue is cost. So we're you we're not going to charge for the robot, replacing the robot. And we're going to charge a usage fee and a disposable fee. And we know right at the $1,000 $1,500 mark, we know that's right, we're reimbursement stops. So we can charge between 1000-1500 on a usage fee. And between 250 and 350 for the disposable because of the RPC codes on that. So we kind of we kind of nailed that pretty good. I mean, so we talked to the hospitals and say, What do you think on a research basis, they pretty much goes, you're sharing the risk with us. We like that, because it's based on usage. So we lose hospital lose if it sits in the hallway. So we'll have a team now to making sure that this is always used and train and we'll see what happens.


Ben Glenn  11:56  

Wow, it sounds like Galen can maybe envision a future where Oh, I remember that I trained on a Galen when I was a medical student, which I think is it's an area where a lot of medical schools are trying to bring sort of that engineering or more heavy science to their medical training. And this seems like a perfect fit.


Bruce Lichorowic  12:16  

It's called drag effect, right? You train out of Globus or train out of, DaVinci train out of Mako you train on whatever in med school you leave. You're gonna either want to go work on that, or have a hospital bring one of those in? So yeah, I mean, you want the SOA start with a teaching hospitals. You know, so our first set of hospitals is Harvard, Stanford, and Hopkins was our first reinstalls this year. Hopefully, we get to get clear by this year. And then we just make our bones there, we you know, we get you know, there's 130 Some surgeons combined, that we can then have access to, we'll put our clinical teams in there to make sure they're trained. And we'll just go to work. And so far, the response has been quite positive. When the VAT committee is like the fact that they don't have to pay a cap x. Course we're not selling this thing yet. But you know, we've had interviews with them and saying, What would you do? How do you feel what would you pay? So obviously, hospitals want to pay nothing. To save time, you know, there are there are reimbursement for usage fees, and things like that, that we can make great living on. So that's and we want, so we'll place a robot, give us 200 cases, guaranteed. Keep it all you want, knock yourself out. And do other cases is a drop in the bucket for these places.


Ben Glenn  13:47  

So the name of your company Galen Robotics it's not the Galen I was thinking of which has sort of a Star Wars. You've got a much better basis for that name, don't you?


Bruce Lichorowic  13:57  

Galen, the Galen project started at Hopkins in 2010 11 12. With the graduate students naming the project Galen project, the word the name Galen came from the surgeon. I don't I can't pronounce this, right. It's really is a Greek surgeon from 128 AD and he was a surgeon for the gladiators. And so when the gladiators would get all messed up, he would then you know he would carve out time to etch, you know, the anatomy into his notes. And those notes have been used for decades for centuries. And so, so every med student that worth his salt first year med student knows about Galen architectures or whatever his name is. And he is a he's a very famous surgeon and he's probably the most famous surgeon on the planet because everybody knows of him, and he's the one that would patch up the gladiators and get them back out there again, and Because of that, he became very familiar with the anatomy and it was his books that were used up to 1950s for anatomy, which is quite interesting. So that's where Galen comes from.


Ben Glenn  15:12  

So forget Gray's you want the Galen? 


That's right. Bruce, thanks for coming by.


Bruce Lichorowic  15:18  

Thank you for having me, Benny. 


Production crew  15:20  

Bruce Lichorowic. Take one marker.

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