Martin Frost, Cambridge Medical Robotics

25 January 2018

How a British start-up aims to take on industry giants with its surgical robot

The NHS is under pressure. Surgical complications and prolonged recovery times are sapping already stretched resources. But British start-up Cambridge Medical Robotics (CMR) believes that need not be the case – and it’s embarking on a David and Goliath battle to make a difference.

The idea of robots in operating theatres is nothing new – they've been around for nearly two decades – but the current technology is “not as versatile and not as affordable as it needs to be”, according to CMR’s founder and chief executive Martin Frost. And although it typically takes 10 years in development to get a medical device to market, CMR is getting ready to launch Versius as the first surgical robot designed to perform most laparoscopic (or keyhole) procedures after just four.

Minimal access surgery accounts for about 40 per cent of operations between the chest and the pelvis. Its benefits include less pain, blood loss and nerve damage, fewer infections and shorter recovery times. But only 6 or 7 per cent of these operations are currently aided by robotics globally, despite the opportunities for greater accuracy and precision.

In this context, Frost describes Versius as “game changing”. The robot is small enough and comes with separate arms so it can be set up and moved around easily, meaning it can be used to perform a broader range of operations on a patient. It can also be pushed aside or transported between theatres and hospitals – rather than exist as a permanent set-up that renders valuable operating space off-limits for all non-robotic procedures. 

It has also been designed to replicate the human wrist as closely as possible (albeit with an extra joint for enhanced flexibility), so surgeons can use it more intuitively and with less training than is needed for existing robots.

These factors alone should keep Versius busy – and the more a hospital uses it, the more cost effective the technology becomes, Frost explains.

Competing with giants

But while CMR aims to be the first to market to take on the incumbent, it’s not the only company in the race. Last year, Johnson & Johnson and Google’s life science division Verily announced a joint venture to combine advanced robotics and artificial intelligence to the same end. And medical device giant Medtronic looks set to launch its own surgical robot in India this year.

CMR's Versius robot
CMR's Versius robot could be in operating theatres this year

But that doesn’t phase Frost. If anything, he thinks it validates the market. “In this David and Goliath struggle, David has a number of things going for him. First off, we’re based in Cambridge. Although there’s no big medical device company here, Cambridge does lots and lots of breakthrough work in medical devices for other companies.

“Secondly, in the 18 years since the first robot was introduced, there has been very little innovation in this space. All the big companies haven’t done anything. While we formed CMR in January 2014, they’ve taken a little while to wake up.”

“Frankly there are also advantages to not being American, to being British, and to having our first product used in the NHS. We think there’s no better place in the world to launch a medical device than in the UK.”

Indeed, Frost believes the NHS’ international reputation can be a springboard for its own overseas ambitions – and although its board could have taken the decision to sell CMR two years ago, he is adamant that there is more to gain by waving the flag for British innovation.

“The ambition here is to build a sustainable and significant British medical devices company. There’s just two companies in the UK in the top 50 medical devices companies worldwide, which is ridiculous.”

Funding from scratch

It was initially a challenge to find the funding for such a plan. “It took about a year to get seed capital in place, because unlike most companies in Cambridge we didn’t start with a really clever piece of technology. We started with a really hard problem to solve.”

Unlike most companies in Cambridge we didn't start with a really clever piece of technology. We started with a really hard problem to solve

Nevertheless, even without a prototype, Escala Capital came on board – and CMR has found it “progressively easier” to secure backing since. By the end of last year, CMR had raised $46m in Series A funding, from investors including Cambridge Innovation Capital, LGT Global Invest and ABB Technology Ventures.

Frost also praises the research and development tax credits it has received – and calls for the scheme to be safeguarded and promoted more effectively. “They have enabled us to avoid going down what can be quite a painful and long-winded route of getting grants to do what we do,” he says. “People don’t talk about them enough.”

Clearing hurdles

Frost is open about other challenges the start-up has faced too. “Simultaneously tackling questions about where the business will be in six years’ time, how close we’ll be to the market in six months’ time and what are the technical problems we have to solve in the next six weeks” is like spinning plates, he says. But he adds that doing so is fundamentally necessary for a business that wants to be around for the long term.

And although Cambridge has been a good source for talent, recruiting – and integrating – 150 people in four years has been hard work, he adds.

For a company where functions outside engineering – such as training and servicing – will be of equal importance, its also having to recruit from overseas to find those with medical devices experience. Its head of clinical affairs is from the Netherlands; its commercial director is from Italy.

So does he see Brexit as a threat to finding the right talent? As the “innovation capital of Europe”, Frost believes Cambridge will be relatively insulated from the effects of Brexit. But he adds: “If our competitors in Silicon Valley can have their pick of people from around the world – which is the whole basis on which Silicon Valley has grown to be such an economic phenomenon – why do we think it’s a good thing for us to deny ourselves the same ability?”

He is also concerned about regulation around medical devices and how any divergence, or lack of influence, could affect the business, considering Frost expects CMR expects to export up to 80 per cent of its products.

Creating a brand of the future

But for all Frost’s confidence, he’s also rather humble about what the company is trying to achieve. In fact, “humility” is a company value.    

“Humility comes from the need to listen. We’re not trying to replace the job of a surgeon; we’re trying to enhance what they do. We’re only going to do that if we listen to them,” he explains.

Humility comes from the need to listen. We're not trying to replace the job of a surgeon; we're trying to enhance what they do.

He is therefore realistic about taking commercialisation slowly – emphasising the need to “juggle supply and demand and customer expectations” and initially just working with “half a dozen” early adopters to prove the technology.

And with many different types of sensors on each of the robotic arms, gathering data thousands of times a second, Frost is clear artificial intelligence and machine learning will have a role to play in what CMR is doing. “But the interesting question, that nobody yet knows the answer to, is how best to use that data to better improve surgical performance,” he says.

So CMR has its sights firmly set on the future and the opportunities to develop Versius – and other products – further. Within seven years, Frost wants CMR to have “many thousands of robots worldwide”. But rather than talking in commercial terms, he wants his legacy to be more about creating a British success story, “employing fantastic people to deliver a product that is changing people’s lives all around the world”.

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