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A surgeon utilizing the Moon Surgical Maestro surgical robotics system. | Source: Moon Surgical
The Moon Surgical Maestro robotic surgical procedure system faces some stiff competitors — and the machine developer plans to make use of that to its benefit.
In an interview with Medical Design & Outsourcing, Moon Surgical CEO Anne Osdoit, and Chief Technology Officer David Noonan mentioned the know-how behind what they described as their system’s key profit: the power to collaborate with surgeons.
“We’ve built a collaborative robot, which is not necessarily what you typically see out there in the market,” Noonan mentioned. “[Most] robot arms are extremely stiff. If you want to try and grab a hold of that and use it to manipulate it, you can’t because the payload and the stiffness are what’s needed to execute the task.”
But Maestro is designed to let surgeons straight transfer the laparoscopic devices connected to its robotic arms and maintain them in place. That reduces pressure on surgeons and frees up assistants, growing process effectivity and effectiveness.
“When a user attaches an instrument to our system, they still manipulate the instrument in the way that they used to before, via its handle if it’s a grasper or via the camera head if it’s a laparoscope,” Noonan mentioned.
The know-how satisfied Dr. Fred Moll — co-founder of surgical robotics chief Intuitive Surgical — to hitch Moon Surgical first as an advisor and now as board chair.
Moon Surgical CEO Anne Osdoit. | Source: Moon Surgical
“His first reaction was somewhat skeptical, and until we really had something to show him and put into his hands, it was hard for him to picture what we would be doing,” Osdoit mentioned. “That’s something we’re also experiencing with surgeons that we have to solve. Until they can touch and feel it, what we’re doing is so different from the other surgical robotic approaches that people have a hard time even understanding how it’s possible and representing it in their minds.”
Landing Moll is only one of Moon Surgical’s accomplishments this 12 months. After successful its first FDA clearance for Maestro in December 2022, the machine developer adopted up with European Union CE mark approval in April 2023. Then got here a $55.4 million funding spherical in May and the addition of Chief Financial Officer Anne Renevot and Commercial Strategy VP Lisa Jacobs to the management crew.
Moon Surgical closed that Series B funding spherical lower than a 12 months after its $31.3 million Series A spherical — and a couple of 12 months and a half prior to Osdoit beforehand anticipated.
“Since we announced the A round we’ve had constant inbound interest from investors, and at the end of last year we realized there might be people out there willing to give us some money and in the current environment it would be foolish not to take it,” she mentioned. “We had also reached a number of significant milestones that justified a new round with new pricing and new terms. Otherwise, I’m not sure our historical investors would have been supportive.”
The newest spherical will fund growth and commercialization with a restricted market launch deliberate for 2024 and a full business launch in 2025.
Moon Surgical is bettering Maestro’s design from the primary model that received FDA and EU approval.
“It’s not a version of the device that we felt we could scale from,” Osdoit mentioned. “We have basically translated all our learnings into a commercial embodiment that not only looks a lot nicer — it looks amazing — but has the same core architecture and functionalities and incorporates some of the learnings from our initial feasibility study where we’ve treated 50 patients.”
To scale for manufacturing, Moon Surgical is working to stabilize the design and assemble the required infrastructure and sources, notably elements for the arms that set Maestro aside.
Maestro’s mild contact within the surgical robotics arms race
Moon Surgical’s Maestro surgical robotics system has two arms that may maintain the identical laparoscopic devices that surgeons already use. | Source: Moon Surgical
Intuitive Surgical’s da Vinci system stays the chief to beat in gentle tissue surgical robotics. But Osdoit thinks one cause surgical robotics hasn’t snatched a bigger share of complete process quantity — moreover the price — is that surgeons aren’t snug working on a affected person from a surgical system console within the nook of the room.
“What we wanted to do when we started Moon was provide a solution that would deliver the benefits of robotic surgery — the things that surgeons love — maybe not with the complete degree of sophistication that you could have in a da Vinci system, but something that would be appropriate to cover the vast majority of surgical procedures, maybe even 70%, 80% of what you would do with the da Vinci,” she mentioned.
Maestro’s disposable couplers enable surgeons to make use of the identical laparoscopic instruments as they did earlier than, besides they will do the identical procedures with one fewer particular person within the room.
“The surgeon is his or her own assistant using our system,” Osdoit mentioned. “The concept is it’s the robot that adapts to the surgeon and not the surgeon who adapts to the robots. For patients, we are hoping to increase throughput, reduce anesthesia time and give the surgeon better control and confidence over what’s done during the procedure, which ultimately should turn into better care for patients.”
To do this, Maestro permits surgeons to make use of their very own fingers to control devices however holds them completely nonetheless when the surgeon releases them.
“Our architecture is very different to that more traditional serial manipulator with stiff joints all the way along the degrees of freedom,” Noonan mentioned. “Our design actually started as a haptic interface, in this case, an impedance control device which is mechanically transparent.”
While conventional robots are mechanically inflexible, a surgeon can seize Maestro’s arms and transfer them round, with the robotic arms making themselves really feel mild by compensating for their very own mass and the mass of the connected instrument.
And whereas a extra conventional robotic has a motor and a gearbox to offer torque amplification, Maestro’s system has no gearboxes.
“Our torque amplification comes from the combination of a capstan with a pre-tensioned tendon that wraps around and then goes to a larger capstan, so we get a gear ratio by taking a capstan wrapped around a smaller diameter pulley to a larger diameter pulley,” Noonan mentioned. “And that approach allows you to basically amplify the torque while having very little backlash and no friction between gear teeth, which is what you get on a more traditional gearbox.”
The system senses motor present on the motor facet to deduce the pressure being utilized to a joint, detecting when a surgeon is making an attempt to maneuver the arm in an effort to help that motion.
“We’ve got multiple modes,” Noonan mentioned. “The arm can act as a robot and it can move our laparoscope in order to track the surgeon’s tools to be able to reposition in a hands-free manner but also can guide the surgeon to a certain place, it can hold perfectly still, or provide feedback to the surgeon regarding what sort of force it’s experiencing elsewhere.”
The tendons are product of chrome steel, and the system additionally has a collection of springs for passive compensation. While the majority of the system’s weight is in its base, the crew is making an attempt to drive down the mass and inertia of the linkages and transmission mechanisms that reach to the distal joints.
Chief Technology Officer David Noonan. | Source: Moon Surgical
“You can algorithmically compensate for a lot of stuff, but there are some things you can’t,” Noonan mentioned. “We’re trying to minimize that perceived mass because ultimately transparency of the system is really what we’re fighting for: it’s easy for the surgeon to move it, he or she doesn’t feel like it’s there, and it becomes the best possible assistant for that surgeon as opposed to a clunky or complicated tool they have to adapt to.”
What’s subsequent for Moon Surgical
As Moon Surgical builds extra Maestro methods, it should clear up shortages of essential sensors like encoders.
“That’s been a real pain point,” Noonan mentioned, with lead occasions of as much as 40 weeks.
The Maestro system makes use of at the least two encoders to measure joint angles at every motorized axis. All of the encoders are redundant, and the system compares the sensors on every joint to ensure every joint is working as wanted — and that each one the sensors are working as properly.
“In surgical robotics, one of the things from a design perspective you’re always looking for is to make sure you never can have uncontrolled motion. That’s the big no-no,” Noonan mentioned. “All our joints have redundant encoders, and you’re constantly looking to
detect a failure of one of those by constantly measuring the two of them.”
Moon Surgical is consistently scouring the web for out there encoders, and for early prototypes even resorted to purchasing merchandise containing encoders solely for the encoders.
“In that case, you need to only have two of everything or, you know, 2X of everything. And then as we go through our verification and validation cycle and now we’ve got six units, we need to make sure you’ve got 6X of everything,” Noonan mentioned. “As we go toward commercialization and what the build plan is for next year, you’re actually often making decisions based on what’s available as opposed to what you might prefer.”
Moon Surgical is at the moment assembling nearly every little thing within the Maestro system apart from the arms, with plans for closing testing of the arms within the subsequent few months earlier than internalizing manufacturing. The firm’s arm provider is predicated in France, so internalization of the arm is to be accomplished there whereas the remainder of the work is going on in San Carlos, California.
“Our overall strategy is to keep a relatively lean and efficient manufacturing team,” Osdoit mentioned, “which means that as the sub-components of our system get really stable over time, we would be able to outsource them to OEM partners and then just keep the final assembly and testing in-house and leverage our infrastructure and team more and more to get more throughput. … We’re at the beginning.”