Liu Da - How to build a surgical robot

Author: Big Health Industry Network

First, the current situation of surgical robot innovation in China

Liu Da:

The development of surgical robots is relatively fast, and it is also an emerging field from the perspective of the world, and we have been developing robot technology for more than 20 years, especially in surgical robots. Surgical robots can be divided into two categories: one is the master-slave operation like Leonardo da Vinci, which is mainly used in the field of laparoscopic general surgery; the other is the navigation and positioning robots like Ruimi robot and Tianzhihang Tianji, which are more widely used for orthopedic surgery and neurosurgery. Both of these robots are now a relatively cutting-edge trend in international and domestic development.

From the domestic application, the approved product registration certificate, including Tianzhihang's Tianji domestic first orthopedic robot, our Ruimishi is the first neurosurgical robot in China, and now in terms of navigation and positioning robots, entrepreneurial teams and startups are also very many. In terms of technical complexity, navigating and positioning robots is simpler than actively operating robots. From the perspective of the amount of surgery, especially like orthopedic surgery, its amount is very large, and the navigation and positioning robot is more objective for doctors, that is, the positioning accuracy from preoperative planning to postoperative examination, the standard is very consistent, at a glance, more convenient for postoperative evaluation. Once the product is formed, the adhesion, activity and usage between the doctor and the doctor are high.

Robots such as Da Vinci have a higher technical complexity, and only this one product is currently widely put on the market, and it has been nearly 20 years.

From a research point of view, like Tianjin University, Harbin Institute of Technology, with the university product conversion, now I know that there are 3-4 types of products to enter the clinical stage, but have not yet obtained a license, it is not possible to talk about sales in the market and large-scale clinical application.

If purely from the technical cost, that is, the cost of hardware, we and the United States should be on a horizontal line, if the robot and the doctor are analogous, divided into brain, eye, hand three parts, that is, the brain, visual system, mechanical arm, domestic and foreign hardware costs are not much gap, unless the mechanical arm is independently developed, but as far as I know, including Leonardo da Vinci, most of the domestic surgical robot manufacturers have been purchased most of the mechanical arms have been purchased, the difference at home and abroad is not particularly large, The added value of a medical device does not refer to the cost of hardware.

Second, the obstacles to the innovation and development of surgical robots in China

Where did Leonardo da Vinci succeed?

One is the business model of its brand, the other is the commercial insurance of the US medical system that has to be mentioned, a considerable part of the number of applications of Da Vinci in the world is in the United States, which is closely related to his medical insurance system, and in China, the cost of Da Vinci surgical robots is completely borne by patients, which is different from the United States. Orthopedics, such as Tianzhihang Robot, has entered the charging directory in some hospitals, and some of the costs of our navigation and positioning robots can also be reimbursed. If the problem of charging is not solved, in China, the breadth of application and the degree of patient acceptance may still be limited to a certain extent, and the cost of da Vinci's surgery is about 40,000-60,000, which is still a relatively large burden on patients. For domestic surgical robots, it is still necessary for the state to give certain preferential policies in terms of fees or medical insurance reimbursement, and it is only my understanding that there can be fewer detours in promotion.

I feel more deeply, that is, from me to research and development to productization and then to the market on this road, the most difficult I think is to obtain a product registration certificate, that is to say, surgical robots as an international should be a relatively emerging industry, including the trend of technology, then first of all, the company to go public to obtain the license of this product, from the previous lack of this product category, first of all, as the country's review teacher of the three types of medical devices, the real reliability and maturity of such devices is very, very difficult to define, He didn't know much about the product and technology, as well as safety and reliability. But with the development of the country, including the trend of artificial intelligence mobile phone robots, in fact, the experience of judging teachers is also constantly enriched, of course, there are the efforts of us pioneers, so this piece is getting better and better.

However, I want to remind everyone, especially entrepreneurs and this startup, on the one hand, innovation and safety and reliability are sometimes a pair of contradictions, many startups say "what do I want to subvert", because I am after 70, in fact, I am quite afraid of subverting the word, in medical devices, in terms of medicine, food and drug safety and reliability is always the first, compared to the innovation of technology safety and reliability is more important, and for the State Food and Drug Administration's review mechanism, whether it is drugs or devices, Whether it is innovative or non-innovative, the first thing is to be safe and reliable, so how to balance the relationship between safety and reliability and innovation is probably what we practitioners and developers have to consider, it is difficult to reflect safety and reliability in the clinical process, and it is difficult to pass the review. This is when we enter the market threshold, we can't talk about market sales without getting a registration certificate, let alone the market, installed capacity, and surgical volume, which can only be a technology research and development, not a product.

Then there is the volume of cost of input, because the time is not four or five years is completely unable to complete a process from research and development to listing, and to go through many clinical trials, expert evaluation, in principle, it is a hundred million to start. In the process, there is no good investor, no good industrial support, no capital support, then you can't stick to it, you may not survive the day when the product gets the registration certificate, and the enterprise will not survive.

If you get the registration certificate, can you sell it? I think the road ahead is longer, from the hospital's inspection, project establishment to bidding, and then to procurement, there is no year that can not be done, so it is really widely accepted by doctors and cultivated doctors' surgical habits, which is actually a very, very long process.

My research and development experience is to consider this problem from three aspects, the first is for patients, replaced by surgical robots, the value is still minimally invasive, the second point is for the doctor,whether it is the director, deputy director or general doctor, what can the surgical robot bring to the doctor, I think the first important thing is precision and safety, that is, the reason why the surgical robot is meaningful is that it is more accurate and stable than the human hand. The third point is the hospital side, this China has Chinese characteristics, for example, our Rimi robot to improve the efficiency of doctor surgery, for example, the traditional surgery takes an hour, with the robot to do it becomes 15 minutes, a day doctor can do two surgeries, with the robot can do ten operations, especially the top three hospitals, and then there is, because minimally invasive, after the robot surgery, the patient's hospitalization time is greatly shortened, only need 2-3 days, and the traditional neurosurgery brain surgery to more than ten days to two weeks, then this for the hospital The patient turnover rate has increased significantly. If the surgical robot products reach these three points at the same time, there will be no problem that the hospital does not buy or the patient does not accept, that is to say, it has obvious significance for the hospital, the doctor, and the patient, and its commercial logic and the technical logic of the product are established.

Third, surgical robot investment and innovation suggestions

Some of my personal suggestions, now the surgical robot is very hot, including the research and development team and the startup company are many, the development of surgical robots to now, in fact, has been from my personal metaphor, That is, the 1.0 era has reached the 2.0 era, the so-called 1.0 era, I personally think that is to say, it can be said to be copied, whether it is imitation da Vinci or to put some mature firmware together, and then do some application improvements in software, I think this 1.0 era, through the review test, to give doctors to patients to create value to the hospital, and then the key is to get the registration certificate, which is what the 1.0 era does.

So now I think that in the 2.0 era, what is the 2.0 era, that is, the review is no longer a problem, then we feel that it is now a refinement, that is, if others also have it. What if we have it too? That is to say, we have to control the cost, and then to experience this new driving performance, for example, the original mechanical arm is to buy, but I now do it myself, and I must do it myself better than his, dedicated, and the cost is still low, I don't know how Zheng thinks, the entrepreneurial team has not developed the experience, I think to see its real power, because the brand degree you can not become the leader, will be from the subdivision field ah, then this may be the future to talk about the doctor's habits, heat, in fact, enough, But it depends on the entrepreneurial team who can create more value for investors in terms of cost performance, so I think it has entered the 2.0 era, not very extensive, or simply than speed, efficiency, than the review can not be successful, so it has entered a refined era, that is, you simply imitate, simply to say whether you can let the doctor use, can you get the certificate? I think this period can be said to be over. Of course, how to do this, each entrepreneurial team has its own method, or whether it can create more value for this patient, for the doctor, for this hospital, including investors, these values are really meaningful values that are not very empty, and are sustainable, this is including what we are doing, everyone's final real competition is a thing, this is indeed to see the content, can not look at some of the superficial hilarity, this is my point of view.

Interactive Q&A session

1. Under the trend of anti-globalization, will the supply chain of foreign mechanical arms or core components be stuck in the neck?

What is the state of the supply chain in The country?

2. How to view the 5G remote surgery of surgical robots, and what are the main problems that need to be solved in the actual remote application?

3. Can you predict the time when the surgical robot project will enter the medical insurance on a larger scale?

Or what kind of cost or market conditions need to be met for surgical robots to fully enter medical insurance?

4. What are the domestic surgical robot enterprises or subdivision directions worth investing in.

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