Today we move to the second in our three-part interview series with Dr. Hannah Teichmann. Hannah is the Vice President of Clinical Development at Medical Microinstruments (MMI), a Robotic Surgery Start-up company based in Italy’s Pisa region. In our first interview we learnt a bit about the co-founders and their efforts to move from concept to prototype. The result of their efforts is a novel robotic microsurgery device and their company, MMI.
MMI a sharp new kid on the block!
Paul: As the Economist article mentioned, there are a number of big, established players like Johnson & Johnson, Google, Medtronic and Intuitive Surgical already operating in this field or seeking to enter it. What differentiates MMI’s approach from what these firms are doing? Why do you think that your idea and firm can be successful in the face of these major competitors?
Dr. Hannah Teichmann, VP Clinical Development
Medical Microinstruments: That’s a great question and one that we get a lot. The companies you named are obviously very strong in their domains and have demonstrated their potential to provide elegant and powerful products. We differentiate ourselves in that we have identified and sized the microsurgery market. In addition, we believe it is large enough to make a company our size profitable. It also appears over the years to have been seen as too small to be of interest to the bigger companies you named. For example, it represents just a fraction of the laparoscopy market that Intuitive Surgical currently dominates.
We also have the agility of an early stage start-up where everyone on the team feels strong ownership of their domain. Internal communication and teamwork is easy, allowing rapid, iterative prototyping to perfect the product. Finally, we have the advantage that we are located in an area that has a lot of local talent. Pisa has three universities with a solid tradition of math, physics and engineering (the University of Pisa, the Scuola Superiore Sant’Anna which has a strong robotics program and the Scuola Normale). Piss is home to a local automotive industry, the Piaggio company that produces the Vespa and other vehicles. So we have been able to grow successfully without the hiring bottleneck that Silicon Valley companies are facing.
Plenty of room for MMI to grow
Paul: On your website you use the phrase “There’s plenty of room at the bottom”, to refer to the possibilities that microsurgery offers for improving surgical outcomes. This phrase reminded me of C. K. Pralahad’s book, “The fortune at the bottom of the pyramid”. Pralahad popularized the idea that through high volume, low margin strategies, huge profits could be made by offering products and services to the 4 billion or so most impoverished persons. Similar ideas have also been expressed by other persons like Peter Diamandis.
What role do you see medical robots and more specifically robotic surgery playing in addressing healthcare needs in the developing world? How feasible are high volume, low margin strategies for bringing healthcare involving robotic surgery to such countries? What specific breakthroughs or business models could make universal access to new health technologies a reality for more people?
Medical Microinstruments: I love your interpretation of the quote, which is originally from Richard Feynman. The question that you bring up is very close to our hearts. When you develop a new technology you want it to be available to as many people as possible. Specifically in this surgical specialty there is a strong need in developing countries. In such countries trauma in industry or agriculture is frequent and the stigma associated with malformations can be ostracizing. So providing quality reconstructions is also paramount in these contexts.
Sustainably generating social and economic value
The concept of teleoperation over long distances, either to train local surgeons or to be able to provide a surgeon in remote locations is obviously intriguing and our platform could have that potential in the future. Currently there may be legal constraints on this type of intervention. But the concept of “where there is no doctor”… “there is a robot”, may in the future be an important contribution. When it comes to trauma surgery there are sometimes constraints in getting treatment, such as with amputations. By the time someone has driven from a remote location that does not have a microsurgery center to a city with a tertiary care hospital that has a microsurgeon, the chances of an optimal outcome may have diminished substantially. So having a robot in a primary care center locally could have huge implications. It could be the difference between being able to replant an amputated thumb or hand and not being able to.
One of the fundamental issues you bring up is the question of margins. Developing a new technology of this type and bringing it to market requires considerable investment. The price point has to reflect this and respond to the expectations of investors, be it private or VC. The investors have placed their trust in the team and their product vision to enable the development of a new technology. The investors need to have a return on their investment.
Complementary roles of public & private funding
The idea of the process of technological innovation being supported by public funding is nice in that it could have the potential to reduce prices. Also, there would be an immediate benefit to patients and healthcare systems both at the national and international level. However, right now, it appears hard for public grant programs to identify technologies with groundbreaking potential. Private funding sources may be more specialized and agile in their decision-making process. Granting broader access to technology innovations like you suggested would require this reality to change. The SME program of the European Horizon2020 Program may be read as an attempt to address this challenge.
Paul: How far is MMI from being able to start shipping your own surgical robots?
Medical Microinstruments: We plan to ship our first commercial platform in 2019 – we can’t wait to pop that cork!
Coming next week, part 3 of our 3-part interview series
We will continue our discussion with Dr. Hannah Teichmann about MMI next week when we will be looking at technology, innovation and society.
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