Previously, Credit Suisse Medical's product functions focused on preoperative diagnosis and surgical planning of cardiovascular diseases; CT-FFR is a noninvasive method to evaluate coronary artery blood supply function in patients with coronary heart disease by AI combined with hydrodynamic calculation. Dr Ma Jun, CTO of Credit Suisse, was interviewed by 36Kr when the vascular interventional robot was released.
Ma Jun once served as an executive in Siemens, GE and Intuitive Surgery (Da Vinci Surgical Robot Company), and developed Da Vinci Ion (lung cancer biopsy robot) as the core personnel. Ma Jun returned to China on 20 17, and started a business together with Zheng, CEO of Credit Suisse Medical, and Lan Hongzhi, chief scientist. All three founders have professional backgrounds such as medical imaging, AI, mechanical mechanics, and biological simulation.
There are three main application scenarios of vascular interventional surgery robot: coronary intervention, nerve intervention and peripheral vascular intervention. For Credit Suisse Medical, it is more feasible to combine surgical robot with coronary PCI because of the basis of CT-FFR detection.
China is a big country with coronary heart disease. In 20 19, China completed1020,000 cases of PCI. 202 1 with the popularization of centralized collection of coronary stents, the number of PCI operations has further increased.
"We interviewed many doctors, including senior academicians, faculty and young people, and learned that there are still many pain points in vascular interventional surgery." Ma Jun told 36Kr that, first of all, vascular interventional surgery is still not accurate and safe enough. For example, when people operate guide wires and catheters, they will shake, shift and rotate excessively. For complicated cases such as multi-vessel disease and diffuse disease, the operation is difficult and time-consuming.
Furthermore, interventional surgery needs to take X-rays at the same time, and the radiation generated will cause harm to the doctor's body. In order to reduce radiation, doctors need to wear lead clothes weighing 20 to 30 kilograms during the operation, and standing for a long time after several operations is easy to produce fatigue, which is not conducive to maintaining concentration.
With the help of the vascular interventional robot, the doctor can control the main terminal outside the catheter without radiation, and can concentrate on the core link of the operation. In addition, for China's huge primary medical service system, surgical robots can shorten the learning curve of doctors, help young doctors to operate more stably, and reduce the variance of surgical effect among doctors with different qualifications.
In clinical use, which dimensions should be used to measure the performance of vascular interventional robots? In this regard, Ma Jun summed up three points: accuracy, flexibility and intelligence.
The accuracy is reflected in the fineness of the robot's manipulation of guide wires and catheters. For example, the Corpath robot of Corindus can operate the guide wire with the position accuracy of 1mm at a time.
Flexibility refers to whether you can rotate while moving forward, and whether you can achieve multi-instrument cooperation. And whether the robot can be operated as easily as a human hand.
Intelligent, you can refer to the automatic driving of the car. If the surgical robot integrates the preoperative surgical plan, with the support of intraoperative AI and image navigation, it will effectively empower doctors by intelligently pushing, rotating and placing stents.
Before talking about Rui's cardiovascular interventional robot, Ma Jun made an analogy with the mature Da Vinci ion surgery robot and explained the core technologies involved in the process. Leonardo da Vinci is a hose robot, which enters from the human mouth, passes through the lung trachea, enters the pulmonary nodule, then carries out puncture and then carries out postoperative analysis.
"Da Vinci's success is because from preoperative surgery planning to intraoperative image navigation, from AI algorithm to surgical robot hardware, a complete closed loop has been formed, which has solved clinical pain points."
In Ma Jun's view, similar to Leonardo da Vinci's Ion, the vascular interventional surgery robot is a systematic project combining software and hardware. "It needs not only the hardware of the robot, but also the support of algorithms and software. Only by closely combining robots with accurate diagnosis, surgical planning, real-time navigation and artificial intelligence can we truly achieve the goal of' surpassing human hands'. "
From the mechanical design point of view, the overall architecture of Rui cardiovascular intervention robot is dominated by slave control mode. Specifically, the main terminal is the operation terminal of the doctor, who can operate the push rod and the remote control lever switch outside the operating room to control the action of the driven mechanism; The device is clamped from the end mechanism to realize propulsion, retraction and rotation.
Under the design of master-slave isomorphism, the propulsion and rotation of the manipulator can imitate the human hand and optimize the learning curve of doctors. "The slave end has a clamping mechanism, a rotary transmission device that can move forward and rotate at the same time, and an axial force measuring mechanism that can sense the force and transmit it to the master end."
The mechanical arm at the slave end senses the force on the guide wire and feeds it back to the doctor at the master end, which is called "force feedback" and is very important in the use of surgical robots. Because the doctor's "feeling" is very important in many operations such as coronary PCI, accurate force feedback can make the doctor better control the surgical robot. Of course, this is also a technical difficulty that still needs to be broken through.
In this regard, Credit Suisse Medical is cooperating with Shenzhen Advanced Institute to develop "two-way force feedback" technology, which is expected to achieve a breakthrough.
Next, Credit Suisse hopes to give full play to its ability in AI and image algorithm, and guide DSA (Digital Subtraction Angiography) to reach the correct position and angle by comparing preoperative surgical planning with intraoperative real-time image navigation, prompt the lesion position, and calculate the real-time position of stent or balloon and the distance from the planned position to assist the advancement of guide wire and machinery.
20 19, Siemens acquired Corindus; Involved in the robot company, cash 1 1 billion dollars; June 5438 +20201October, minimally invasive medical robot signed an agreement with Robocath of France to establish a joint venture company to jointly produce R-One, a vascular interventional robot; Domestic Weimai and Ao Peng are also joining the R&D ranks. "Vascular interventional robot has become a new growth point and a huge trend for surgical robots," Ma Jun said.
It is understood that CorPath of Corindus is a mature vascular interventional robot. CorPath GRX robot system costs $650,000; In the European and American markets, the disposable surgical box costs about 670 dollars (about 4,000 yuan). Ma Jun said that the future pricing of Swiss cardiovascular interventional robots will be based on in-depth research and combined with the specific situation of China market.
In addition, how to develop supporting parts and control the cost of biomaterials, micro-devices and consumables involved in vascular interventional robots is also a problem that enterprises must face.
In this regard, Ma Jun said that when designing products, Ruixin has taken into account the problem of technology and materials "sticking neck" and the problem of cost performance. So "all the core components we use now, mechanical design, motor selection and consumables processing are made in China. Located in Shenzhen, the global intelligent manufacturing center, almost all materials, parts and consumables to be used can find partners within the range of Fiona Fang 100 km. "
At present, the global market of vascular interventional robots is mainly concentrated in North America, Europe and other places. Because this kind of products have just begun to popularize, the penetration rate of robotic surgery in the field of vascular intervention in the United States is only about 0.5%, and the market has sufficient room for expansion.
Facing the competition at home and abroad, Ma Jun believes that compared with endoscopic surgery robots, the gap between China and the international first-class level in vascular intervention robots is not so big; Credit Suisse's advantages of integrated diagnosis and treatment can also help the company gain a firm foothold in this segment.