Medgadget recently reported on the first successful use in patients of the Preceyes system for robotic vitroretinal surgery from Preceyes, a firm from Eindhoven, The Netherlands. We had the opportunity to ask Perry van Rijsingen, CEO of Preceyes some questions about the new technology and how the Preceyes team overcame some of the challenges medtech start-ups face.
Tom Peach, Medgadget: To start, please tell us about the Preceyes system and the team behind it.
Perry van Rijsingen, CEO of Preceyes: The Preceyes system focuses on robotic assistance for vitreoretinal (VR) surgeons. Our system is designed to provide assistance so that the surgeon can work with higher accuracy and precision, while at the same time improving on dexterity. The system is expected to improve treatment outcomes for patients and increase procedural safety, while the higher degree of automation inherent to robotics is also expected to improve clinical workflows and bring down costs.
Preceyes began as early as 2007 as a research collaboration between Marc de Smet, in those days professor and VR surgeon working at the Academic Medical Center in Amsterdam and Maarten Steinbuch, distinguished Robotics professor, at the Eindhoven University of Technology. A lot of our technical development was driven by the unique knowledge base in and around Eindhoven, with its university and some of the world’s leading ultra-fine precision mechatronic instrumentation companies. We incorporated in 2011 and our first sale happened in 2016 to NightstaRx—a British biopharma company working on gene therapy for several retinal diseases.
Medgadget: What is unique about the Preceyes system?
Perry van Rijsingen: The Preceyes robot is unique because of both its ultra-high-precision and ultra-high-dexterity. This is achieved by scaling down movements in the system, which dramatically increases precision by more than a factor of 10, while also filtering out any surgeon hand tremor. The instruments used in VR surgery are so fine that they often bend and deform when inserted into the eye by hand—the level of control in our system means this does not happen. The integration of the system with the conventional operating room is also very sophisticated, and the system can be used with the majority of operating tables.
Medgadget: What benefits does the Preceyes system offer to patients?
Perry van Rijsingen: Firstly there is patient access to surgery. The level of manual control and precision that these VR surgeons have is incredible, but it takes years and years of training to get to that level. Also, a VR surgeon can quickly reach an age where hand tremor and other inaccuracies can become a problem, often long before the normal retirement age. So being able to use robotics to take over some of the precision and dexterity allows us to train surgeons faster and extend the number of years they can work once trained. This is, of course, an even bigger issue in emerging economies, where there is currently a very significant shortage of VR surgeons. But, given that the incidence of VR diseases is expected to double in the next 15 years, there will also soon be a shortage of VR surgeons in developed economies as well.
The other benefit is the improved accuracy and precision of the surgery overall, which is expected to lead to dramatically improved patient safety and health outcomes. This is a pattern that is true for all robotic surgery. The ultra-high precision required in VR surgery would suggest that the gains for patients from robotic assistance could be even greater.
Finally, the technology opens up opportunities for totally new therapies, particularly gene and cell therapies, vein cannulation, and the possibility of sub-retinal implants. With the Preceyes system you can place a needle in the sub-retinal space with a 10 micrometer precision and keep it there for two or three minutes while you carefully inject a fluid—that is something that is just impossible manually.
Medgadget: What was the biggest challenge you faced in developing Preceyes?
Perry van Rijsingen: Looking back, the biggest challenge was also the biggest achievement, and that was talking to so many surgeons and people in the VR field—that is what really shaped the current system. It may not be the biggest technological hurdle that had to be overcome, but if you look at where many start-ups face their biggest challenge, it’s understanding and truly dealing with unmet medical needs, and that is where the end-user’s input is vital.
Medgadget: Preceyes is currently undergoing first-in-human trials, which is a development stage often never reached by device companies. What are the biggest challenges faced by a healthcare start-up in getting to the in-human phase and how are they best overcome?
Perry van Rijsingen: There needs to be real drive to get there from your clinical and industrial partners, and for that to be true, your solution really must be meeting an unmet need. It’s always risky to adopt the technology of a start-up, particularly in the medical space, so if you start a new business, you have to ask yourself—am I really offering a unique value proposition? If you don’t have a radically unique value proposition and the business model to deliver it in a sustainable way, it will be very difficult to get to the in-human stage. In Preceyes we have paid very close attention to fully addressing the unmet need aspect.
Medgadget: Prior to Preceyes you spent 10 years leading the Philips Healthcare Incubator Portfolio; what do you think was the most important lesson you learned in that role?
Perry van Rijsingen: I think the most striking thing was again the need for an offering to be sustainably unique. In reviewing new concept ideas from both within Philips and from external start-ups, I’d say we operated with about a 99% attrition rate. At that early stage of investing in an idea, you have to be extremely critical on a number of parameters, which leads to the second major lesson—and it’s not a nice word—but you have to learn to kill fast. At the end of the day, creating a radically new healthcare business is always very expensive and it becomes progressively more expensive. One needs to decide in an early phase, say within the first 6-12 months, if you want to go “all the way”, i.e. getting that venture to market and make it cash positive. If so, you have to have a very rigorous system of stage-gating during the entire process, and the early stage gates are very important.
Medgadget: You’re a very accomplished business leader who would undoubtedly be successful in many fields; what got you interested in the biomedical and medical devices world specifically?
Perry van Rijsingen: Healthcare has always attracted me: I find it fascinating, and it’s changing enormously all the time. The challenges are huge, and with more people living longer with chronic diseases, the affordability of healthcare in particular is becoming an enormous issue. But that’s the reason why I have always loved this business: because you get to help people and overcome massive challenges.
In Philips I also worked successfully in several other non-healthcare divisions, but, in the end, the fruits of your works in a healthcare business are really helping people to live better and longer lives. To me, that is tremendously satisfying, and I feel like I’ve been able to contribute to improving the lives of others. Many years from now, when I’m sitting with my grandchildren on my lap, and they ask me what I did with my life, that’s what my answer will be.
Product page: Preceyes system…