Surgery

 Minimally invasive surgery for the masses: under the skin of CMR Surgical

CMR Surgical was founded in 2014, with the ambitious goal of transforming the nature of surgery for good. Five years on, the company has gone from strength to strength, and was recently named Britain’s sixth-fastest growing business. The milestones reached a crescendo in May 2019 in a 30-person clinical study, which has yielded promising results for this rising star of UK medtech. Chloe Kent finds out more.

T

he term minimal access surgery (MAS) - also known as laparoscopic or keyhole surgery - refers to abdominal operations conducted via small incisions of 1cm - 1.5 cm in length. MAS has been proven to reduce the length of hospital stays, minimise post-surgical pain, scarring and infection and speed-up patient recovery times – after all, it removes the physical trauma of large, invasive incisions.

This quicker recovery allows patients to be discharged earlier and in turn means hospitals can treat more patients.

During MAS, gas is pumped into the abdomen to provide a clear view for the surgeon, after which a special tool called a laparoscope is inserted. The laparoscope streams images of the surgical site to a television monitor in the operating theatre and the operation is then carried out using tiny surgical tools which fit through the incisions.

It’s a procedure which can take surgeons years of training to perfect – those that lack the required dexterity, may never master it – and one which is both mentally and physically demanding to perform.

For one thing, a surgeon must use what CMR Surgical chief executive Martin Frost describes as “a blade of grass at the end of a long knitting needle” to make incisions within the patient. They’re doing all of this while looking at a screen instead of looking directly at the surgical site. This requires them to reverse the left/right processing within their brain, as when they move the tip of an instrument one way the part which is actually inside the patient will move the in the opposite direction.

Alongside the mental pressure, some keyhole surgeries can take three or four hours to complete, which can put significant physical strain upon the surgeon as they stand and lean over the patient with difficult to manipulate surgical tools.

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 An easier way to perform keyhole surgery

CMR Surgical aims to bypass these keyhole surgery drawbacks through its Versius robotic system.

The Versius system consists of individual, cart-mounted arms controlled by the surgeon, who sits or stands at its 3D, HD vision open console. Rather than operating using directly handheld tools, Versius’ robotic arms are controlled through a handset, which resembles a video game controller.

The screen in front of the surgeon projects a 3D image of what’s going on inside of the patient, and offers much more intuitive operating.

Plus, by giving surgeons the choice to sit or stand at the console, physical strain is minimised during longer procedures. The open console facilitates the natural communication between the surgeon and the surgical team as experienced in manual laparoscopy.

The open console facilitates the natural communication between the surgeon and the surgical team.

Versius is also much easier to train to use – surgeons have learned to complete MAS procedures, such as suturing, in only half an hour using Versius, shortening the overall learning curve from two or three years to a matter of weeks.

CMR’s robotic system is designed to turbo-charge the use of MAS and help patients across the world receive its benefits. By helping more surgeons become eligible to conduct keyhole procedures, CMR Surgical hopes to drastically increase their uptake in hospital wards.

The MAS market is a promising one to be part of. Global annual revenues for robot-assisted MAS are currently estimated to be around $4bn and are anticipated to reach $20bn by 2025, and CMR has certainly benefitted from being part of such a rapidly developing area.

 One of Britain’s fastest-growing businesses

Frost says: “In the past five years CMR has experienced astronomic growth. We have gone from five founders to over three hundred employees with active business presence across four continents.”

This growth has been supported by a record-breaking round of Series B funding completed in June 2018 which raised a total of $150m, the biggest ever funding round for a European med tech business. Investor confidence in the Versius vision is clear, and the money has enabled CMR to continue its global expansion plans.

We have gone from five founders to over three hundred employees.

The funding been used to support the company’s pre-clinical studies and in-human clinical trials, and CMR claims it has significantly invested in the research and development of Versius to ensure the product is brought to market in a clinically responsible way. It has also paid for CMR’s new global headquarters on the outskirts of Cambridge, which was opened by NHS England chair Lord David Prior in May 2019.

The remainder of the Series B funding is now being used to support the commercialisation of Versius, seeking regulatory approval and commercial scale-up in key target markets.

Syndicate Room’s list of Britain’s Top 100 Fastest-Growing Businesses in the UK in 2018 has now ranked CMR Surgical sixth.

 Expanding the reach of MAS

CMR estimates that every year six million people around the world have open surgery when they could instead have undergone MAS. Its uptake has been limited by a number of factors, such as cost containment and short-term planning.

As highlighted in a recent report by the Office of Health Economics, only 24% of hysterectomies in the UK are performed using MAS, despite this being a procedure perfectly suited to laparoscopic surgery.

“CMR has worked closely with surgeons to understand the barriers to the adoption of surgical robotics and has allowed us to develop a tool that has the potential to bring the benefits of MAS to everyone who needs it,” says Frost.

We want to see minimal access surgery available to everyone who needs it.

All those years of hard work are paying off, as the company has now completed its first set of robotically assisted procedures in humans.

A series of 30 minor, intermediate and major gynaecological and upper gastrointestinal (GI) procedures were completed during the trial at Deenanath Mangeshkar Hospital & Research Center in Pune, India. All 30 of the procedures were successful, with no adverse events reported as a result of the Versius system after a 30-day follow up with each patient.

The promising clinical trial is still ongoing, with the researchers involved collecting data on secondary outcomes such as operative time, estimated blood loss and transfusion rate, intra-operative complications and the length of hospital stay, plus 90-day mortality statistics.

It’s safe to say the coming months will be hugely exciting for CMR Surgical. The company expects to see Versius launch in the UK and continental Europe shortly, followed by wider international expansion as completes various regulatory milestones.

“Ultimately, we want to see minimal access surgery available to everyone who needs it,” says Frost. “We believe CMR Surgical has an important role to play in that story.”