# data[].attributes.body
Conn Hastings, PhD with Medgadet

# data[].attributes.body
July 30, 2020

# data[].attributes.body
-Improved technology for laparoscopic procedures
-More cost efficient and time efficient than robotic surgery
-Keeps the surgeon at the bedside rather than at a console away from the patient
-Eliminates the need for a surgical assistant which is cost effective and convenient (assistants may be only available at certain times, reduces scheduling conflicts)
-No need to learn a new way to do surgery as surgeons must do with robotics

# data[].attributes.body
-Has not yet been tested on humans
-As with any technology, potential for technical difficulties

# data[].attributes.body
1. Harmony
2. Developer
3. Discipline
4. Belief
5. Responsibility

# data[].attributes.attachment_link.readable_text
Minimally invasive surgery has played a huge role in improving patient outcomes, and reducing morbidity and recovery times compared with traditional surgical techniques. However, it can be a little tricky for surgeons to operate through tiny incisions and use complicated equipment, meaning that there is often a significant learning curve and training period involved.

Robotics is well suited to aiding surgeons in minimally invasive surgery and surgical robots have made an impact on the field. However, they come with a variety of limitations including their expense, size, and need for additional training, specific consumables and time-consuming setup.

MastOR, a French start up, is attempting to change this with their surgical assistance platform. To date, the system consists of two robotic arms, is modular and space efficient, and aims to integrate with existing laparoscopic equipment rather than form a stand-alone system. The company recently announced that it has attracted substantial funding to develop the system.

Medgagdet had the opportunity to talk to Anne Osdoit, MastOR CEO, about the technology.

Anne Osdoit, MastOR: A wide spectrum of diseases and conditions require surgical therapy. Surgery is invasive, per se, subjecting the human body to significant stress. It has an impact on a variety of systems, the most important of which are the cardiovascular, respiratory, excretory, and immune systems.

During the last 20 years, laparoscopy (also known as "Minimally Invasive Surgery" or MIS) has revolutionized operative medicine. Today, more than 10 million patients a year undergo MIS in urology, gynecology, thoracic, and general surgery. MIS results in shorter hospital stays, faster recovery, and fewer complications (less infection and less bleeding). However, performing MIS using traditional laparoscopy remains difficult, requires several years of training and is often tiring for the surgeon. This has led to the rise of surgical robotics, which aim to make MIS more accessible by improving precision and surgeon ergonomics.

Robotic surgery is one of the fastest growing segments of the medical device industry. The market is currently estimated to exceed $4B and, at its anticipated growth trajectory, the industry will likely reach $10-12B by 2025.

Intuitive Surgical has pioneered and dominates robotics in urology, gynecology, and general surgery ($68B market cap, $3.7B revenue with 30% net margin). The company's Da Vinci robot is a complex, closed system which gives surgeons the ability to control surgical instruments indirectly via a console (so called "tele-manipulation"). The impressive growth in the robotics surgery domain has been accompanied by advances that aim to improve patient outcomes and enable greater operating room efficiency. And this is where MastOR comes in.

Anne Osdoit: Today, more than 10 million patients a year undergo MIS in urology, gynecology, and general (abdominal/gastrointestinal (GI)) surgery, which represents a minority of those surgeries. Only 1 million MIS procedures are performed robotically.

Robotics has answered many of the issues faced in traditional laparoscopy in terms of dexterity, precision and ergonomics. However, these closed, non-modular and expensive systems are still associated with challenges. They provide no haptic feedback, require new workflow and dedicated surgical setups, have little allowance for modularity, take up a lot of space, and require time-consuming setup and reprocessing. Surgeons have to be physically separate from the patient to use them (by design), and therefore are required to perform surgical tasks remotely. There is also a high cost with initial capital equipment, dedicated consumables, and service needs. Moreover, surgeons require specific training, despite an absence of premium reimbursement for robotic surgery over laparoscopic surgery because of a lack of demonstrated improvement in clinical outcomes.

MastOR's ambition is to overcome the challenges of laparoscopy and the complexity of robotics, and to bring together the best of both worlds to create a new laparoscopy co-manipulation platform to assist and augment the surgeon.

We aim to do this by:

- Designing a system that is simple, so that there is no need to re-learn surgery.

- Assisting and augmenting the surgeon where it is clinically useful by clipping onto and interfacing with standard laparoscopic instruments.

- Maintaining and optimizing existing laparoscopy setup and workflow, so that the presence of a surgical assistant is not required merely to hold the camera or act as a "retractor" of the instruments.

- Ensuring the system is an open and modular system, so that it can be used only when and if needed- even within a surgical procedure.

- Reducing the system's footprint.

- Enabling the surgeon to remain by the patient's bedside.

- Continuing to use any third-party instruments (e.g. trocars, graspers, staplers, vessel sealers, ultrasonic) or imaging systems (e.g. 3D, fluorescence).

- Making the system affordable and therefore, more widely accessible.

Anne Osdoit: The MastOR technology stems from 10 years of research co-led by ISIR, a renowned robotics lab based at the Sorbonne University in Paris, and Professor Brice Gayet, a pioneer surgeon in MIS, who has pushed the development quite far. The team has already performed some initial in vivo testing in a pig model using a functional "demonstrator."

The hardware (two robotic arms) used to date has been designed and is currently manufactured by longtime ISIR partner Haption, a spinoff of the French Atomic Energy Commission, CEA, which designs, manufactures and sells hardware and software solutions based on haptic feedback for nuclear and industrial applications. The arms have been largely adapted and tailored to the requirements and specifications from the MastOR team.

The software architecture includes the firmware controlling the robotic arm, and features that are embedded in the arm such as haptic feedback or viscosity and a set of new functionalities such as the smart camera positioning (developed by ISIR).

Anne Osdoit: MastOR will initially focus on general (abdominal/GI) surgery, which is a key driver of MIS, and a segment that is largely underserved by robotics today, with about 10% of the most common procedures in this field being performed robotically.

Our initial goal is to improve cholecystectomies, appendectomies and hernia repair in operating rooms in the United States, specifically in community hospitals and ambulatory surgical centers where patient outcomes are expected to be excellent for routine cases, with optimal task allocation and operating room processes. Our platform will be intended for camera (laparoscope) holding, stabilization and guidance, as well as for organ retraction and operating field exposure.

Anne Osdoit: Yes, we definitely have the potential to extend the horizon of applications with this system, and we have already received feedback on the potential value of our system for other procedures in the GI space, so this is in our R&D roadmap for future generations of the device.

However, it is important to note that in the field of surgical robotics, design and validation are very specific to targeted clinical indications and procedures, in order to satisfy the requirements and expectations of the surgeon, operating room staff, and regulatory agencies such as the FDA. Therefore, as indicated above, the plan is to stay razor-focused on achieving our initial objectives before expanding into new procedures.

Anne Osdoit: We have announced a €3M equity round through a seed investment from the Sofinnova Partners MD Start III Fund, as well as an additional €1.9M in non-dilutive funding through the acclaimed i-Nov Innovation Award from BPI France, the French national public investment bank. The seed and grant funding will enable the technology transfer from the academic setting, as well as the creation of a team with surgical robotics expertise. We will then work on the development of internal prototypes along with the associated pre-clinical validation, with a goal of reaching the clinic in the next two or three years.

Link: MastOR homepage...

# data[].attributes.attachment_link.title
A Laparoscopy Assistance Platform to Optimize Minimally Invasive Surgery: Interview with Anne Osdoit, CEO of MastOR

# data[].attributes.attachment_link.description
Minimally invasive surgery has played a huge role in improving patient outcomes, and reducing morbidity and recovery times compared with traditional surgical techniques. However, it can be a little tricky for surgeons to operate through tiny incisions and use complicated equipment, meaning that there is often a significant learning curve and training period involved.

# data[].attributes.body
MastOR is a new surgical technology that is meant to improve minimally invasive (laparoscopic) surgeries. Although robotic surgery is the newest technology in minimally invasive surgery (MIS), due to costs and other factors, only about 10% of MIS are being performed robotically. This means that 90% of these cases continue to be performed by basic laparoscopic technique. MastOR desires to bridge the gap between laparoscopic and robotic technology to allow the greater majority of patients to have an updated and efficient surgical experience. MastOR consists of two robotic arms meant to help retract tissue and organs and help hold laparoscopic cameras to assist the surgeon.

# data[].attributes.body
I think this is a great idea to bridge the gap between laparoscopic and robotic surgery. Robotic surgery is great, but with the expensive costs, necessary re-training for surgeons, not enough robots to meet the demands, and more equipment needed to set up for each case, the majority of cases are still being performed laparoscopically. It is important we do not overlook the necessary improvements that need to be made to these types of cases just because robotic surgery is already on the horizon. This also provides improved healthcare options to those hospitals who will not be able to afford a robotic system. I believe this will be a great and necessary advancement in healthcare.

# data[].attributes.body
Alice/Achiever: She would be hardworking and productive in getting the innovation up and running in our facility.
Chelsea/Command: She would take the lead of the team; she is driven and will make necessary decisions for the implementation of the innovation.
Fernando/Focus: He would be able to stay on track and help others stay on track; he is a goal setter and he follows through with accomplishing the goal.
Rachel/Restorative: She would be the problem solver. If any issues arise during the process of adapting to this new innovation, she would be the one to find a resolution.
Sheila/Strategic: She is a strategic thinker; she has good judgment and can identify any potential risks with the innovation. She plans for the unexpected.

# data[].attributes.body
Hastings, C. (2020, July 30). A laparoscopy assistance platform to optimize minimally invasive surgery: Interview with Anne Osdoit, CEO of MastOR. Medgadget. https://www.medgadget.com/2020/07/a-laparoscopy-assistance-platform-to-optimize-minimally-invasive-surgery-interview-with-anne-osdoit-mastor-ceo.html