Adam Sachs Presents Vicarious Surgical at LSI USA ‘23

Transcription

Good afternoon, everybody. I'm Adam. I am one of the founders and the CEO of Vicarious Surgical. So I'm going to power through a few things in about eight minutes here and try to get to some video of where our system is today. So just to start the background, I think I've been here a few years, some of you may have seen this, this presentation to some degree before. Obviously, almost everybody here is familiar with open surgery. And you know what exists today. Of course, minimally invasive surgery is that the way a lot of procedures are performed, especially across the US. And the really important thing on this slide is that there are there with minimally invasive surgery, there is a strong correlation between incision size and complication rates from the procedure. And most of the complications actually come from the incision itself. And it's, it has a discontinuity in it, where, if you have incisions that are about about one centimeter or smaller, they end up with a very small excuse me two centimeters or smaller, they end up with very low complication rates down in the 1% territory, and somewhere right around two centimeters, you end up needing to cut through the layers of the abdominal wall. And when you do that, you end up with a much more serious injury to the abdominal wall that doesn't heal properly in about 10% of cases for two and a half centimeter incisions all the way up to about 20% of cases for large, open incisions. So it's incredibly important in minimally invasive surgery to keep your incisions small enough down to about two centimeters or below, where you can actually bluntly dissect your way through the abdominal wall, keeping good minimally invasive technique, avoiding open surgical technique and keeping complications down to about 1%. The second point that's really important on this slide is that it is really challenging to perform minimally invasive technique for multiple incisions. So if you can kind of imagine here, you're triangulating from multiple incisions up to a single point in the abdominal cavity. And what that means for a surgical robot is that the surgeon actually needs to create the kinematic profile of the robot for every case that they want to perform. And that's true because the motion actually works by pivoting about the abdominal wall and about those incisions. So that's incredibly challenging, there is a better way it's single incision, surgical robots, but to date, they've also been really limited in their their total force capability, their total motion capability, and actually the smallest of them is about two and a half centimeters, leading to again, using open surgical technique, and resulting in complication rates of almost 10%. And, and upwards. So all of this has resulted in surprisingly little adoption of surgical robotics. It's why there's a lot of people here working on this problem, and why there's an incredible market opportunity. We're at about 3% penetration of surgical robotics worldwide. And that's just within the addressable procedures, the procedures that are addressable by today's surgical robotics. So this is our system. Our system is a single incision surgical robot focused on two arms and a camera providing the surgeon really unparalleled capability all through a single incision that is at today in our beta to form is at 1.8 centimeters and we are driving that down to 1.5 in the future, getting us down into that normal laparoscopic incision size. Just a little bit. Before we dive into some of the video about how we were able to achieve this. Most surgical robots today have something called coupled motion. So if you look at the light blue cable here, that cable controls the bottom grasper draw jaw Excuse me, but if you imagine if you were to flip the wrist back and forth, that cable actually gets longer and shorter so it moves the grasper jaw as you move the wrist. And the result is that if you pull on this cable to tighten the grasper and hold on to something, you you exert a force pulling the entire wrist over to the left here. And then you need to exert a counteracting force on this dark green table to prevent that motion. And this is what we call coupling and robotics. It's a solvable problem within a few joints. But the challenge is that you actually double the force on the control cables, every joint that you go up the arm. So This is okay with just a few joints. But if you wanted to do say nine degrees of freedom per arm plus motion about the trocar, like we have, all of that quickly becomes impossible with this exponential growth in force. So we invented and spent the last 10 or so years, fully decoupling this motion. This is a scaled up version of our arm. And you can see with all these joints down here, when one of the joints that is moved, none of the cables that pass through that joint change length, and you can watch up on the top there. So when that that shoulder joint is moved, just one set of cables moves at a time. And this is what enables us to not just use plastic parts, plastic control cables, and still exert high forces at the end effector, but also to have so many more joints inside of the body. And this gives us actual wrists, elbows and shoulders with existing single incision solutions. Not only are they larger, and require those two and a half centimeter and above incisions requiring open surgical technique, but they also have either wrists or elbows and we're able to have both. So we've developed this out into our beta two system and are well on our way to our first product. This is a series of categoric procedures that we performed at Tufts Medical Center with Dr. Igor Beljanski. One of our first target procedures will be eventual hernia repair. And this This video has two different types of hernia repair, although, given the time, I think we're going to just see one. So, the surgeon sits at the surgeon console gets an immersive 3d view is able to dock the one incision, the one trocar easily and then the camera is inserted and both arms are inserted through the same trocar. And because of our decoupled motion, you can see as the cameras inserted, it moves up and out of the way. And that is what enables our the robotic arms to come in from underneath, providing all of this capability through the same small incision, again that the view through the surgeons eyes, our camera has two incredible image sensors. And part of this is due to the fact that we have created all of this physical space inside of the body and inside of our robotic tool for additional sensing and additional visualization. By the way, all of these videos this third person video is actually shot with our version 1.0 camera and then the videos that are first person through the surgeon's eyes are shot through our beta two camera. So you can see once it's inside, the surgeon can not only work forward easily but they can work up on the ceiling this here is working almost straight up like this. The surgeon can even flip all the way back and work around the incision site. And the vision for this the whole idea is that by creating a system where the surgeon just creates one small incision and inserts the system and is ready to go, and then once it's inside, it has capability to just work anywhere, regardless of where the incision was created, facing in any direction. So an eventual hernia repair. This is a huge advantage because the surgeon can work straight up on the ceiling. In an inguinal hernia repair the surgeon can work bilaterally easily or in a hysterectomy. They can work all the way around the uterus, giving them incredible visualization and incredible ability to dissect and work. So right now, we're just finishing up the design of our version 1.0 system will be in the clinic early next year and bringing this to the FDA after that. So with that and looking at the clock, I will stop there. Thank you everybody very much.