Robots Could Replace Surgeons in the Battle Against Cancer

Fred Moll started a RM200b robotics company. Now he has FDA approval for a device a doctor sends into the lungs to detect cancer. His ultimate goal: Get rid of the doctor

By Max Chafkin / BLOOMBERG

Fred Moll was a young surgical resident when he assisted on his first keyhole surgery in 1982.

Moll believes that robots are already capable of performing simple medical procedures

The technique, otherwise known as laparoscopic surgery, requires doctors to use unusually slender, extra-long tools to perform operations through tiny incisions.

Today’s laparoscopic surgeons use high-definition cameras to look inside patients’ bodies, but even the older primitive version Moll used blew his mind.

“Wow,” he recalls thinking. “This has to be a better way of doing things.” He withdrew from his residency and began working on medical devices.

Moll, 66, is best known for the da Vinci Surgical System, a large industrial robot that surgeons operate, using electronic hand controls and a video monitor.

The device, the top-selling surgical robot, is used in laparoscopic surgeries in thousands of hospitals and retails for about US$2 million (RM7.84 million).

Its success has propelled creator Intuitive Surgical Inc, the company Moll founded in 1995, to a market value of about US$50 billion.

Thanks to Moll’s work, robotic surgery is now commonplace, but he argues that it can be improved because it still depends on the precision of a surgeon’s hands.

Moll believes that robots, powered by machine-learning algorithms and operating autonomously, are already capable of performing simple medical procedures.

And after seven years of working in secret to prove it, he’s ready to take the first big step. Moll’s new robot, the Monarch Platform, features a pair of arms with a long, blue tube attached, allowing a doctor to steer a camera and other surgical implements deep inside a person’s body.

This is a new kind of surgical scope, which Moll showed off to a Bloomberg Businessweek reporter earlier this month at the headquarters of Auris Health Inc in Redwood City, California.

The Monarch robotic bronchoscope, peeking out of an Auris-made model lung

On March 22, the US Food and Drug Administration (FDA) told Auris it had cleared the device for use under a doctor’s control in human lungs. The company says it will be used to diagnose and eventually treat lung cancer.

The robot can be operated manually, using a controller modelled on the one used for Microsoft Corp’s Xbox video-game console. That’s what the FDA approved, though Moll thinks the Monarch will also be able to work without human aid.

“It’s not science fiction,” he says. “It’s sort of like self-driving cars. People used to wonder if it was going to be five or 10 years. No, no, no: It’s going to be 18 months.”

Although Auris was spun out of Columbia University research in 2007, much of the Monarch technology comes from an earlier Moll start-up, Hansen Robotics.

Hansen’s ill-fated system aimed to use robotic catheters to eliminate the need for open heart surgery, but it proved too expensive when compared to the cardiac stent, a competing technology that became popular around the same time.

Moll left Hansen in 2010, and the following year became the CEO of Auris, which at the time was working on a robotic approach to eye surgery. The company struggled to win FDA approvals.

“They get touchy when you talk about inserting tools in the eye and controlling them with robots,” Moll says. So, he acquired the ailing Hansen and adapted its probe for lung cancer diagnoses.

The company has raised about US$500 million from such investors as Lux Capital and Mithril Capital Management, controlled by billionaire Peter Thiel.

Investors were impressed by Moll’s willingness to bring Silicon Valley sensibilities to a field in which excellence largely remains a matter of fine motor skills.

“The thing that everyone remembers is the control system,” says Peter Hebert, a partner with Lux and an Auris director, referring to the Xbox-style controller. “It’s totally unique.”

Moll says he focused on lung cancer for two reasons. It’s the deadliest cancer, killing 1.7 million people a year globally, according to the World Health Organisation. (That’s double the next-highest total, for liver cancer.) And it’s the perfect proving ground, he says, for medical robots.

The Auris CEO blames lung cancer mortality rates partly on a current screening method’s reliance on a manual bronchoscope, which has a limited range of motion and looks like something you might use to check your car’s oil level.

The Monarch can navigate nimbly through the lung, which looks a little bit like a network of tunnels, and the procedure doesn’t require much decision-making beyond knowing where to turn.

No medical regulator in the world has approved fully robotic surgery, so for now surgeons who sign up for Auris’ pilot programme will drive the bot.

The doctor guides the scope through the lung, starting in the trachea, with a video screen to help navigate. A camera view is on the screen’s left side, and a CT (computed tomography)- scan-created map and turn-by-turn directions are on the right.

Auris tracks the probe’s precise location, in part, by comparing data from the camera view to the 3D map, and by using an electromagnetic sensor that works a bit like a miniature GPS.

The idea is to collect data after every surgery and feed it back into the navigation software, improving it over time.

Once the doctor reaches the suspect tumour, identified on the screen with a target, a needle can be run through the snake and used to take a tissue sample.

Though the stakes were considerably lower, this reporter was able to drive the probe into a plastic lung after a two-minute training session, using the Xbox-style controller and a simulated version of the machine on an iPad.

At Auris, doctors are able to move the Monarch using what resembles a Microsoft Xbox controller

Moll says amateurs won’t be able to safely perform lung biopsies anytime soon, but argues that the robots, operated under the watch of a surgeon, can do the driving for simple diagnostic procedures.

While there are plenty of reasons to be cautious about efforts to automate delicate medical treatment, some surgeons seem receptive.

“I went in a sceptic,” says Alexander Chen, a pulmonologist at Washington University in St Louis who performs about 150 scope procedures in patients’ lungs each year.

But in a test on a cadaver, the Monarch offered more control and reached deeper into the lungs than surgeons’ wrists can, says Chen, now an Auris consultant.

Questions remain, Chen acknowledges, about how well the Monarch will perform. “There are a lot of moving parts,” he says, and more research is needed to truly understand the robot’s impact. But, he adds, “This is one of the most novel things in a while, and that gets me excited.”