The Future of Robotic Surgery

In this episode of The Future Of, Caleb Osborne, Director of Product Development at Asensus Surgical, joins Jeff Dance to discuss the future of robotic surgery. They unveil the types of robots involved in surgeries today, the newest developments in surgical robotics, and the surgeries robots are already doing.

Caleb Osborne – 00:00:00:

We’ll pick up the phone when a technology group calls them. These are all early, early, early adopters. And that’s going to be a different challenge. And I don’t think it’s totally just user experience. I think there’s, there’s something about economics, certainly. And something about training and the emotional benefits, the prestige of using AI.


Jeff Dance – 00:00:22:

Welcome to The Future of, a podcast by Fresh Consulting, where we discuss and learn about the future of different industries, markets, and technology verticals. Together, we’ll chat with leaders and experts in the field and discuss how we can shape the future human experience. I’m your host, Jeff Dance. In this episode of The Future of, we’re joined by Caleb Osborne, Director of Product Development at Asensus Surgical to explore The Future of Robotic Surgery. Caleb, we’re grateful to have you on the show.


Caleb Osborne – 00:00:59:

Yeah, absolutely. I appreciate it.


Jeff Dance – 00:01:02:

Awesome. Really excited to dive into Robot Surgery, learn more about Asensus, learn more about your experience, and explore the future. Can you start with telling us a bit more about Asensus?


Caleb Osborne – 00:01:14:

Sure. Asensus is a company that’s been developing Surgical Robotics for nine or 10 years before that had a previous stint focused on mechanical Singapore solutions in the late 2000’s, early tens. And right now we’re focused on two things. We’re focused on the commercialization of the Senhance surgical system, which is on the market in Europe, US, Japan, Taiwan. And we’ve done over 10,000 procedures with that system, which were really proud of. We’ve been able to introduce a lot of additional technology and additional regulatory clearances on that platform. And we’re also focused on the development of what we call the Luna surgical system, which is a next generation system that incorporates even more digital technologies, mechanical technologies, and we’re really excited about it. 


Jeff Dance – 00:02:06:

Great. I know there’s a lot of innovation in this space, but it’s great to have you here and also representing a company that’s been in this space for quite a while now. For the audience, for those who don’t know you, can you tell us more about your experience and also your journey into robotics?


Caleb Osborne – 00:02:23:

Sure. Yeah. I am a North Carolina native. Asensus’s headquartered in research triangle between Raleigh and Durham, Chapel Hill in North Carolina. I’ve grew up here and went to college at NC State in Raleigh and haven’t really gotten out of, out of the state and haven’t really needed to. We have really good family, really good connections and friends in North Carolina. So happy to have found robotics and especially Surgical Robotics in this area. On the way into college, I didn’t really know what I wanted to do. I was really focused, I thought on alternative energy. I really wanted to do wind turbines. I thought that was the coolest and they are, but there was a key moment for me, I think in one of my, this thing is dynamics or control systems or one of my classes. And the professor showed a video of Robotic Surgery that he had consulted on in the early two thousands. And I just thought. I said, that’s what I want to do. That’s I never really looked back. And so coming out of school, I found a different job that was kind of, you know, your first job, you get what you can get. And a few years after that, I pivoted over and started here. And I’ve been here since then. So I started as mechanical engineer. I had a lot of background in die casting and fluid flow, which wasn’t what we did here, but we were interested in some production tooling and that kind of thing, which is how I got my foot in the door and slowly pivoted that towards motor control. And really, I always say, really found some incredible designers and engineers here. And I was a little bit more interested in where marketing and the business and Engineering meet. So I went back and got my MBA a few years after being here. and over that time period was happy to lead. Most of our instruments development, we progressively had more and more instruments released on the robot, as well as what we call the Intelligent Surgical Unit, which is our Machine Learning Computer Vision product. It’s part of Senhance that uses telemetry and elements from Senhance, but it’s primarily a video processing unit. And we’ve really been able to do some new and innovative things with that. So now in this current role, I have four groups. I have product design, product development Engineering, manufacturing Engineering, and the PMO reporting to me. And I like to describe that as the layer around the core Engineering disciplines. So mechanical engineering, electrical, software, robotics. That’s kind of the core technology group. And then I have the next layer out as we get through the product development process at Asensus.


Jeff Dance – 00:04:59:

Awesome. It’s great that you’ve been there for a while. And it’s also the thing you’re passionate about. And we were able to discover that way back in school. That’s pretty neat. All right. What do you do for fun?


Caleb Osborne – 00:05:11:

Yeah, I have two young boys at home. So typically. You know, as it goes outside of work, it’s doing something with them. Okay. We live in kind of North Durham and have a state park and in our backyard. And we get out there most weekends trying to get my older son into some, some STEM principles, a little bit of Engineering, a little bit of electronics. So we’ve been doing a catapult at home and trying to do this. It’s hydroponic garden with some sensors and that kind of thing too. So that’s been fun.


Jeff Dance – 00:05:41:

That that’s amazing. Well, now that we got some of the formalities out of the way, let’s dive into The Future of Robotic Surgery. I wanna start with kind of the current landscape a little bit, help people understand that, and then go deeper into the future as we think about the opportunities and challenges there. Before we get in there, what kind of sets the Asensus apart as we think about the landscape? There’s a lot of players and Robot Surgery. What makes the Asensus unique?


Caleb Osborne – 00:06:07:

Yeah, I think a few things. I think since we’re a smaller group, we have an opportunity to focus in a few areas. And that’s what I love about it. I love being able to bet big on some big beliefs about the market. And especially, I think for us, the major emphasis with Senhance has been on economics, the reusability of the instruments there are very, very high. So the per procedure costs are very low. And we really set the bar for that cost. I think that’s been really meaningful for a lot of markets, especially a lot of European markets where they have a different appreciation, I think, for traditional laparoscopy, and that’s been a really important market for us. Going forward with Luna, we’re working on these five millimeter instruments, which are totally wristed, pitch and yaw, wristed that are really best in class. The things we’re doing there and the innovation have been incredible. Those are many, many years in development compared to most robotic instruments are at seven and a half to eight millimeters. So it really matters in procedures when you’re talking about converting a traditionally laparoscopic procedure to minimally invasive with robotics. That instrument diameter is really important for adoption. And as I mentioned with the ISU, the Intelligent Surgical Unit, are really the first people to do anything with real time, intraoperative video in soft tissue surgery, and we’ve deployed a few Computer Vision, Machine Learning techniques to do that and really allowing surgeons to have access to data that they didn’t have. If you look back at how you take a measurement inside a body, there’s literally sterile measuring tape that you see it in and lay it out and you get as good of a measurement as you can get. And it’s antiquated and it’s obviously time consuming and difficult mechanically and technically to do. So being able to do that with a click of a button instead, we’re starting to scratch the surface of all the clinical opportunities that come with that.


Jeff Dance – 00:08:05:

Well, it’s interesting, it’s kind of what I would imagine that you would combine like the human experience and kind of guidance, but then also being able to have the digital measurement and then the robot and the AI kind of all working together. But having all those pieces truly come together is, and do that seamlessly when lives are at stake is a very complex thing. Tell us more about like all the disciplines that come together on your side in order to something, a robot that can compare with a doctor and perform these surgeries.


Caleb Osborne – 00:08:41:

To me, that’s the best part of the job, especially with the size of our group in our engineering team, we do every, every type of engineering development. Not only, not only do we have the quality and regulatory and operations people to make the products, move it through to the market, but just from an engineering perspective, I’ll go from a meeting on microbiology and sensitization of these materials to a meeting on cybersecurity, to a meeting on. UI, UX design and industrial design. And it just goes on, computer vision, machine learning, what we’re trying to do with some cloud offerings as well. All that material science, all that in addition to the mechanical robotics embedded systems development that are the foundation for what we do. But the capital system and the instruments in the OR really are every type of product. you can have in the OR outside of at least fluid management, which we don’t do. And everything else we’re doing it. And I really enjoy that. The density of the talent with our group is really, really high. And that leads to a lot of respect and trust and at the pace we’re moving. It needs it. It needs that trust, which is great.


Jeff Dance – 00:09:54:

That’s amazing. Amazing to have that many disciplines coming together to do something truly innovative. As a background to Robot Surgery, can you tell us more about all the robot all the different kinds of robots that do surgery today. I know Asensus has a specialization, you’ve talked about your competitive edge, but tell us more about the variety of robots that are out there doing surgery.


Caleb Osborne – 00:10:22:

Yeah, sure. It’s something I love to see because every robot is different. I don’t think that even in the same specialty, you have many robots that look really similar. And. It’s going to be very hard, I think, in the future for a single robot to serve more than one or two segments. You could have maybe a spine and ortho robot or maybe a neuro and spine or something like that. But otherwise all these things are very bespoke for their specialty. So they’re kind of endovascular, Steerable Catheter, Bronchus, B Robots. Like I said, there’s neuro, there’s a lot of spine and ortho. And some of those we would, I think more accurately call image guided surgery as kind of a subset of Robotic Surgery where you’re anchoring to the patient and you’re monitoring the position of a drill relative to the patient anatomy versus what we do with laparoscopic or minimally invasive robotics is really tele manipulation or teleoperation where the surgeon’s directly guiding the instruments from a secondary console. So all of these are Surgical Robotics. It’s, we have to be a little precise with the type of offering and the predominant surgeon control modality.


Jeff Dance – 00:11:36:

Are most of the robots surgeon controlled or are there points where like the robots are kind of going autonomous or they’re running routes based on?


Caleb Osborne – 00:11:45:

The route planning and kind of closing the loop with vision and with images is mostly coming from orthopedic applications. It just, frankly, it just gets harder when things are squishy. And the reproducibility between your knee and my knee and the way that those, the bones lay on top of each other and are all the alignment, that’s pretty standardized and standardizable and not many patients are going to come in with a dramatic difference in that anatomy, in the target anatomy versus in minimally invasive, especially with oncology, cancer, obesity, history of previous surgeries. You’re going in at a very, very different outlook for different procedures. So there really has not been any move towards autonomy yet in soft tissue. I do think that spine and ortho have to lead the way a little bit there just in terms of reproducibility.


Jeff Dance – 00:12:39:

So there can be where things can be reproduced, but otherwise when you say it gets kind of squishy, you’re referring to the human body as well, right?


Caleb Osborne – 00:12:48:

Yeah, exactly. Yeah, exactly.


Jeff Dance – 00:12:49:

Yeah, so it kind of depends on the space about how much autonomy can happen, but otherwise it’s about precision and accuracy for the doctors essentially. So they can be very precise in how they’re doing the surgery and have additional tools. It’s kind of augmenting them in a way to be better.


Caleb Osborne – 00:13:07:

Yeah, totally. I think the two dominant value props from a technical, mechanical dexterity perspective is again, like you said, control and precision, and then also the articulation, you just, you can’t meaningfully use articulation without a robot and have your brain be able to process all of that. So having that ergonomic console that can provide that kind of frame of reference and you can make sense of that motion is super important.


Jeff Dance – 00:13:37:

Yeah. It’s really interesting. I recently bought an electric car and I was like, how it changed your driving almost instantaneously. I’m not saying that happens with a doctor and a Robot Surgery, but imagine that as they adapt, it’s hard to like, go back once you do like one pedal driving and you’re like, wait, I’m going to get in something that’s just as freewheeling, you know, like, and I would imagine by having these controls at their disposal or these measurements and the guidance or the support, the precision helps a lot. Tell us more about some of the other top benefits of, you know, just using Surgical Robots compared to, you know, just traditional manual procedures.


Caleb Osborne – 00:14:16:

Yeah, sure. So robots have been used clinically, at least in soft tissue robots for, for about 20 years, a little over 20 years. And their traditional primary value proposition has been moving a traditionally open procedure, manual, big incision, use your hands procedure and transitioning that to a minimally invasive procedure. When you can do that, there are really, really meaningful benefits for length of postoperative pain, use of narcotics, all these really core patient experience elements that, especially linked to the state side, also have a lot of hospital financial outcomes, which are very positive as we go forward, I think. That value proposition has to change a little bit because, let’s take Prostatectomy for example, which 20 years ago was done almost entirely open and now it’s done almost entirely robotically in the US. I don’t think that there are many procedures with the volume necessary that are really at that high percentage. open or manual state and they’re going to transition to minimally invasive. So, so I think robotics generally us included have to figure out how to convert and add value to laparoscopic procedures and turn those into robotic procedures. So I think the value add has to be a little bit different and the implications on cost are much different because you’re not. necessarily competing over that length of stay as much as you formerly were. So that’s, we’re in kind of a transition. There’s many new entrants into the market right now. And just with the trajectory of the market, the focus is shifting a little bit, which I think is fun to be a part of.


Jeff Dance – 00:15:56:

Yeah. So you mentioned new entrants. What are some of the newer developments happening in Surgical Robotics today?


Caleb Osborne – 00:16:05:

Yeah, I think it’s hard to not start off with data and especially with the last seven months or whenever since ChatGPT came out and talk about AI. I think that these are certainly disruptive and certainly on paper should add a lot of value. I think that, the area that was privacy and cybersecurity are going to be really, really important. And I think it’s really interesting. I’ve been thinking a lot. You read a lot about how AI should be regulated. And I actually think medical devices have a pretty good roadmap here already because. The FDA has come out in two ways. The FDA has come out, they’ve said, for Radiology and Diagnostic Imaging. If you’re going to use a AI algorithm, some kind of computer vision, machine learning algorithm, you need to have your trading set. You need to have your testing set and you have another clinical set as well. And you have to show how your algorithm development is going to output the same results from those different groups. And just the idea that somehow AI is going to come into Medical Devices and not follow some methodical training, testing, reproducibility protocol. It’s not going to be the wild west the way that we’re already kind of seeing it in the consumer space. It’s just not. And I think that Medical Devices, they also, every medical device comes with an intended use statement. It’s how this device is allowed to be used by the doctor. And I think that these algorithms are going to come with their own intended use statement, whether they’re deployed in abdominal procedures or spine or neuro or anything, there’ll be. This algorithm is intended to detect blood flow is intended to detect some other. characteristic and so I don’t think you’re going to have. Again, kind of algorithms run amok and that kind of thing.


Jeff Dance – 00:18:05:

Open AI for open surgery?


Caleb Osborne – 00:18:07:

No, no, yeah. I don’t think it’s gonna happen.


Jeff Dance – 00:18:10:

So very, very kind of small precision datasets around certain use cases. So we’re kind of controlling, you know, we’re controlling what can be done.


Caleb Osborne – 00:18:18:

Yeah, and another distinction that the FDA has made is between closed algorithms versus open. So whether your algorithm will continue to adjust based on new procedures that you’re doing. They’ve offered a little guidance on open, but moving to an open algorithm is, obviously, a much bigger deal than a closed-out. Because if you didn’t have a connected device, the device that was in a secondary market that didn’t have the same internet access that you’d expect to have that algorithm could be different on that device than the algorithm over here on this device. And that’s seems pretty unpalatable by the FDA. 


Jeff Dance – 00:18:55:

Yeah, right. There’s actually a parallel to some of the work we do in industrial robotics where it’s like, when we’ve implemented some autonomy, it’s an industrial application to spend with like a mini brain around a very small use case where you can have a lot of variation. But if you pair that variation with machine teaching, Machine Learning, it’s like, oh, I’ve seen this a thousand times before already and I can train that mini brain around that little particular use case. And then you can react still in change, but it’s all around that particular use case. And I would assume that that sounds very similar to kind of the implementations you’re describing.


Caleb Osborne – 00:19:33:

Yeah, I think, you know, easy example is in a gallbladder cholecystectomy is the number one in million invasive procedure in the US. There’s, I think, 500,000 or more a year. Some small percentage of the time. The anatomy is a little different. There’s the common Bile Duct and then there’s the Cystic Duct and the Cystic Artery. And you want to take these and not this. And this is a pretty common and really life-changing complication for people if the common Bile Duct is injured instead. But sometimes they’re kind of wrapped around each other. And sometimes this has a short leg and it just kind of stubs into the system. And sometimes that’s the other way. And collecting the dataset for all of these variations, as you said, it’s really hard to think about how we gather that dataset and validate it. And then have enough data points to prove a therapy when the implications are so serious.


Jeff Dance – 00:20:33:

Makes sense. You know, this kind of discussion of AI. really kind of brings us into discussing the future. One last question before we kind of get there is, for a end of the future, is like who are the main players in kind of Robot Surgery today? I think a lot of us have heard of Intuitive Surgical with the Da Vinci Robot. Obviously, Asensus has been around. Both these companies are publicly traded, so they’re serious. But what other companies are you aware of that are kind of big players in the space?


Caleb Osborne – 00:21:01:

Yeah, I think the exciting thing here is. There are many, many small companies and also the big guys are involved. So on the orthopedic side, J&J has a robot, Striker has a robot, minimally invasive, J&J has been talking about what they want to do. Medtronic has a unit that’s available in Europe. And obviously Intuitives has a pretty big presence in both Europe and the US and globally, they’ve had a long time to build a good business. And. I think there are a few other. guys our size and the few that are smaller, many more that are smaller. I think it’s exciting to see some of the particular value propositions they’re going after, whether it’s Singapore, natural orifice, hybrid, kind of sterile console, some of these are really not the type of risks that I think big companies would take. So it’s exciting to see a small company go all in on a single element. And yeah, and we, we certainly get excited to see each of those variations and the IP that they can generate out of that. 


Jeff Dance – 00:22:05:

Mm-hmm. Thank you. As we think about the future, I think it was Bain and Company reported that, there’s more than three billion, more than three billion in the Surgical Robotics market and that’s gonna continue to balloon over the next decade with majority of surgeons kind of being interested in embracing these new technologies. So as we look forward to the future, like what do you see Robotic Surgery looking like, let’s say 10 to 20 years from now?


Caleb Osborne – 00:22:31:

It’s a good question because I don’t want to go straight from a technology answer, I think. And I think that the user experience answer is that it’s a much more integrated experience and a much more. continuous or perpetual experience. If you think about a surgeon that maybe they have four or five cases today, they have a clinic day where they’re meeting patients and doing follow-ups, and then they’re back in the OR, their use of the robot is bound by when they come into the OR, when they sit down and when they operate. And I think that that will. bleed out into other areas of interaction with the robot or from the digital side of the digital side of that experience. Meaning that, a surgeon’s going to be able to provide an overview of the robot to the patient and kind of confer some confidence and competence and associate some trust that the patient’s putting into the surgeon and associate that trust with the robot and with the tools that are in there are certainly there’s going to be a lot on the training and privileging credentialing side. We see a lot of medical officers and CEOs of hospitals asking about how this works as a program. I don’t want to just send a few surgeons in and have them operate and then have them be done. I want to see how the company is going to support a training regimen, how we’re going to do ongoing training and how we’re going to expand into additional specialties. So they want to see the economics across the whole platform. They want to make sure that there’s utilization at every touch point. So if we have a simulator for training, if we have a dashboard for analytics, that we’re making sure that we’re driving those touchpoints way beyond just the user experience of sitting down on the console and performing a procedure. And I think the other side of it, as I mentioned, is kind of the integrated side, integrated with the rest of the devices. There’s a standard for communication protocol between OR devices. I don’t know how popular it is. I don’t know how much it’s used, but there are a lot of people with smart, for lack of a better word, smart. OR tables, smart, electrosurgical units, anesthesia, all these different things are going to start to share data with each other. And I do think that the robot. Maybe there’s two, the robot and anesthesia are really the centerpieces of the OR in Lunaway’s anesthesia for how important that is for the patient. And then the robot just for the number of sensors and motors and screens that it offers. So integrating all that without overloading the surgeon from the user experience side is going to be an interesting roadmap for the next 10 years, I think.


Jeff Dance – 00:25:14:

So basically the robot becomes a lot more integrated with what’s around it. It becomes more of a centerpiece of like the surgery versus like, you know, a central maybe OS per se, versus like an ancillary thing that they’re pulling in.


Caleb Osborne – 00:25:28:

I think OS is a good way to think about it. I like that. 


Jeff Dance – 00:25:31:

Mm-hmm. So it takes more center stage essentially. And then you mentioned kind of this notion of like perpetual experience, like just like the usability is gonna be a lot better. Is that kind of what you mean by that? Or? 


Caleb Osborne – 00:25:42:

Yeah, I think that, like you mentioned with your car, not having so much switching costs associated with your other tools. And I think in 10 years, there’s many robots on the market. And I don’t think that anyone thinks that a hospital will only have a certain brand of robot. So even between robots, what are they best suited for? And how does a surgeon take his skills between two different robots? I think we’ll have to answer those things kind of together in a way.


Jeff Dance – 00:26:11:

Hopefully more common standards as you think about, not just data standards, but usability standards where it’s like, oh, I know that this control is gonna do this between robots because they have aligned essentially on a standard. 


Caleb Osborne – 00:26:22:

Yeah. Yeah, exactly.


Jeff Dance – 00:26:24:

That makes sense. What about robots working together? You mentioned a statement earlier that, yeah, there might be this working with that around certain surgeries, but do you envision, let’s say 20 years from now, robots being a lot more collaborative in a surgery sense?


Caleb Osborne – 00:26:38:

Between independent robots?


Jeff Dance – 00:26:40:

Yeah. I mean, we see it in the movies, but I’m just asking for the reality.


Caleb Osborne – 00:26:45:

Certainly, certainly under a single brand umbrella, I think we’ll see more and more awareness of each other. I think we have plans with Luna for how the robots will be aware of each other in the OR and how they’ll accommodate for space. There’s collaborative robotics, which are two things. One is being aware of objects in the room, and then even more important, being aware of people and what the people are trying to do. And we do see a lot of applications, there’s industrial robotic standards around co-bots and working alongside people that I don’t think have really been applied, despite obviously the proximity to many people in the operating room. There are standards for safety and for velocities and these kinds of things, but there’s not a standard for awareness and touch points and some of these, so I do think that those will continue to advance.


Jeff Dance – 00:27:39:

You mentioned AI earlier, like do you envision the robots having any sort of conversational interface as it relates to what’s going on?


Caleb Osborne – 00:27:46:

Yeah. I think definitely. I think that, you know, we’ve all been treating Google’s AI with the little captures of, pick all the buses in this screen or whatever. I don’t think that that’s quite been deployed to the level, right, on detecting anatomy. But I do think that there’s a surgeon and author or speaker, Atul Gawande, that’s written a lot about the need for a coach and just the need for even the greats, even Tiger Woods, LeBron James, they have coaches and they continue to get feedback. And the surgeons really, they walk into the OR and they’re the, they’re the lead and the OR. And. The hospitals surely can’t deploy senior surgeons, additional surgeons, additional attending surgeons to be that coach and to say 10 years ago this, 20 years ago that, this is how this has changed and to provide that context. So how we digitize that and how we deploy that, I don’t know. I’m sure from a technology standpoint, the models. are there from Generative AI and being able to tag and annotate all of the surgical video. That’s all there. It’s really how do you turn that into value. And how do you define that use case to the regulatory body? We’re not at the point where we’re saying, go here, cut that. I think we’re quite a ways from that, from a legal liability regulatory standpoint. But it’s then if we’re saying something simple like, totally generic statement. Have you looked at this from another angle?


Jeff Dance – 00:29:18:

Tell us what you see based on your large LLM of like a thousand of these before.


Caleb Osborne – 00:29:25:

And so I think that that will come. I think that it’s difficult. to decide what all the individual hurdles are along the way.


Jeff Dance – 00:29:33:

Yeah. It’s interesting that you can just provide these large datasets, you can basically add the AI and then you can have a conversational stream. So I would imagine that that could have a role in the future if you give it the data. It’s not a stretch. But then what we’re seeing with generative AI and robotics is they have not only the the language models, but they have visual models and then control models. And so, you know, fresh, we’ve been playing around with interfaces and then giving the robot commands where the robot then, you can have a conversation, but then you’re actually giving it a command. And in this space, it’s like, like you said, there’s precision is everything, accuracy is everything, liability is also everything. And so just unleashing the black box on someone doesn’t seem like a near term use case, even the next 10 to 20 years, but a sharing of knowledge, right? Based on what they’re seeing and analyzing could be really interesting as we think about augmenting the doctors that have the responsibility and also the liability of the surgery they’re doing.


Caleb Osborne – 00:30:39:

Yeah, and I think the other temptation here is to imagine, you and me on the technology side, and some of the surgeons that will pick up the phone when a technology group calls them. These are all early, early, early adopters. And I think some of these things will definitely be deployed in the next 10 years to the early adopter group. But how do we make that such a nice user experience that you get into the early majority? That’s going to be a different challenge. And I don’t think it’s totally just user experience. I think there’s something about economics, certainly, and something about training and the emotional benefits, the prestige of using AI. Some of these things have to kind of migrate past their early adopter stage. And I think that will be probably, from where the technology is today, that will probably be a bigger challenge than just getting your first cohort to start using these tools.


Jeff Dance – 00:31:34:

Yeah. And in some of these technology spaces, we see rapid advancement with Generative AI where it’s like we might understate what’s going to happen this year. But there’s other things like AR, VR where it’s like VR never really took off to the extent that everyone predicted it to be. And so technology definitely has a life of its own and it evolves quicker or sometimes slower than we anticipate. But it seems to be one of those spaces where people are going to be careful in its progression.


Caleb Osborne – 00:32:00:

Yeah. Definitely.


Jeff Dance – 00:32:02:

So. What other trends are happening that will increase the need for more Robot Surgery? It seems like this is still a, we’re still kind of at the early stage, even though companies like yours have been around for 10 plus years.


Caleb Osborne – 00:32:14:

Yeah. Yeah. I think of you, a few things that come to mind. Certainly there’s a big demographic shift in two different ways. One is surgeons are getting older as a cohort. Fewer people are entering. medical school and residency. I think obviously we know a lot of hours. It’s, a lot of weird hours. and the stakes are obviously very high. So I think we have two jobs here. One is to, augment the skills of that coworker as they do get older. They’ve built up 20, 30 years of. experience and knowledge they’ve seen a lot, they probably don’t benefit that much from the-


Jeff Dance – 00:32:57:

They already have their own LLM. 


Caleb Osborne – 00:32:59:

Yeah, exactly. 


Jeff Dance – 00:33:00:

They already have their large language model. It’s in their brain and they have it embedded there, right?


Caleb Osborne – 00:33:03:

Yeah. So they don’t need that as much, they do need the dexterity, they do need the control. Motor skills do decline. And so continuing to add in that space is going to be important. And then, you know, the flip side of that, the younger generation, I think it’s really great and incredible that at this point, I think most or general surgery residents, incoming general surgery residents are about 50% male, 50% female. I think this is not an industry that’s been designed with all body sizes and hand sizes, especially hand sizes in mind. You look at Laparoscopic Instruments and they’re not ergonomic. They’re built to be sterilized. They’re made out of stainless steel. There’s no very little contouring, very little ergonomic adjustments, opportunities to sit in your chair a different way, adjust your seat. And most surgeons, of course, you’re standing most of the time unless they’re doing robotics. So how do we design for that? Incoming cohort, especially when that cohort has had a very digital upbringing and they’re used to sharing clips from the internet. They’re used to social media, of course. They’re used to doing pretty advanced things on their computer just as part of their coursework, especially those that went through medical school during COVID. And those people have a very high expectation for the digital experience. So how do we harness that? They’re still going to sit down and use a very large, heavy, expensive piece of equipment. But how do we make that feel like a very digitally native experience? I think we have to solve. And that does also work against this older generation that wants they just want the control. They don’t want to be throwing all the data sources and all the integrations and Spotify and everything else. They just want to continue to do the good surgery that they’ve been doing. So answering those two in a single project is going to be tough. And I think that we spend a lot of time thinking about that challenge.


Jeff Dance – 00:35:02:

What type of procedures and kind of markets do you predict we’re gonna grow rapidly in the future?


Caleb Osborne – 00:35:09:

Yeah, I think that one thing is going to be the continued journey towards really high bandwidth data traffic is in and out of the OR. This is obviously being led not necessarily by surgery and we’ll have a lot of opportunity to piggyback on the other needs, whether it’s Diagnostic Imaging or just the electronic health record itself, the amount of data and controlling where it goes and how it flows and what’s done in The Cloud and what’s done in The Cloud. But in Germany, what’s done in The Cloud, but in Italy and all the privacy laws associated with that. I know that we won’t have to solve those problems because I know that companies big and small are figuring out how to manage that privacy and create these plugins and it’s part of AWS now. It’s part of Google Cloud now navigating those. But then how do we, again, regulatory bodies have to be okay with this part of the clinical experience that’s going to happen in The Cloud and then come back to the device because of computing requirements and that kind of thing. And I think that’ll be another advancement is when regulatory bodies continue to address the technology trends. They’ve done a really good job of this in cybersecurity of acting quickly and being pretty clear with their guidance and working with industry and their guidance. They’ll need to do the same thing with privacy and with AI as well. So look forward to those advancements.


Jeff Dance – 00:36:39:

Any other thoughts on other procedures that are gonna come about? We read that the first robotic liver transplant in the us was recently performed. Curious if you have any other insights on other procedures that might come live with robots.


Caleb Osborne – 00:36:52:

I think that there’s kind of three categories. One is certainly bariatric procedures are set to grow. And I think that robotics, just truly because you’re dealing with moving a lot of mass with your hands, robots are well suited to do those procedures. And I do think that especially there’s this weird and a bimodal shape to the distribution of BMI. So for people that are increasingly in that second curve on this distribution, I think that non-surgical options are going to become less and less viable for them. And so they’re going to have to, weight loss surgery is going to continue to be really important for that group. I also think emerging markets. Again, I don’t know if they think that every country has the capital, the hospital systems, the credentialing, much less maybe even the power and internet access that robots are going to require, but that’s going to happen. I think that’s a pretty plain thing to see. And so being able to take part in those markets. I think I want to focus though on what we talk about a lot of this is variability and there are procedures that are very high volume that are still experiencing eight to 15, even 20% complication rates. A lot of these complications are not. a huge deal, but they extend the procedure time by a little bit, or there’s a little bit more post-op imaging or something like that. But obviously sometimes they’re really important. And one thing we’ll have to break down with surgeons to kind of get into this next market and next tranche of the cohort is, it’s called the Lake Wobegon effect. It’s the all the children are above average comment. Every surgeon we talk to, and we talk to great surgeons, right? Because they’re the ones that are early adopters and they’re willing to talk to technology companies, but everyone says they’re above average. And it obviously can’t be that way. My dad. was a doctor and he would always say, what do you call the guy who graduated last in medical school? a doctor and you’re like, oh, great. So I don’t, I don’t think I’m going to say that I know better than. Surgeons in a lot of these areas, but there is a skill gap and there is some distribution there and there is variability as some surgeons do have worse outcomes than others, and even on a risk and cost adjusted basis. So how do we educate that group? How do we eat? bring the evidence and also bring a solution and also not have it be a lot of finger pointing and that kind of thing. I do think that that’s going to. make a rise in a lot of different specialties. And I think there’s trends in healthcare as well or surgeons are having to do more. They have to do more documentation. They have to, most of them are now on, in the US, they’re now on hospital payroll instead of being independent. And they just they have to do more step. And so they might have fewer operating days or their operating days might be stacked up on top of each other. And these can all really create different dynamics for them to perform well. So how do we kind of meet them there and move procedures to robotics that make sense for robotics, where the cost makes sense. How can we get our costs to where it’s a no brainer for them to use our robot and take advantage of that.


Jeff Dance – 00:40:19:

Thank you. You and Asensus are sort of the forefront of innovation in this space. Anything you can share with us on some of your current research that or some of the things you guys are working on that could present some real innovation in the future.


Caleb Osborne – 00:40:34:

I think our big focus when we talk about AI and Computer Vision is intraoperative. A lot of people that do what they called digital surgery that are really recording elements of the procedure, whether that’s putting a sensor on something or using some advanced imaging and then piping all of that to The Cloud and doing some processing. And that’s all great. And that’s part of what we do as well. But offering a real-time experience, again, we take measurements with a click of a button and expanding on that roadmap, to take a measurement implies that you know every. XYZ depth. point on this whole endoscopic scene that you’re looking at. And when you pair that with the telemetry of the robot, so knowing where the robot is in space, and now you can start to build, now I know where the patient is, now with some additional cameras, now I can know where the OR staff is, you can really start to build out a lot of awareness and understanding. And so that’s, that’s a big part of what we focus on is how do we double down on our intraoperative specialty, because we want that to be really the mode that we create if we want to have some barriers to entry from an IP perspective and from a technology deployment and how rapidly we can deploy technology there. So again, I won’t get into super specifics of our roadmap, but what we’re doing to submit our intraoperative leadership is really important to us.


Jeff Dance – 00:42:05:

But what role does VR play in the future? It seems like the devices keep getting better. We saw Apple’s device come out recently that had some unique features, maybe not according to Meta because they’ve been really on the front end and doing some incredible research. Apple has done a good job of bringing things together in an experience, but what do you envision as far as VR playing a role, or AR?


Caleb Osborne – 00:42:31:

Yeah, I think we talk about this a lot because obviously we’re in the business of capturing video and processing that, and then putting some overlays on top of that, which is very similar to a lot of AR applications. And I think from the VR side. We certainly value the surgeon being able to look around the OR really easily and be able to hear other things in the OR, hear people talking to them. So we’re not going to be in the headset business for a while. If I have anything to do with it, but. I do think that we can learn a lot from motion tracking. So what we’re doing right now on our console is, it’s really in minimally invasive and in soft tissue is the first digital handle. So we’re tracking the hand positions wirelessly. It’s similar to a VR application, but obviously VR Consumer Electronics, the stakes are non-existent for failing some reliability tests. So we have some proprietary technology there that really ups the reliability of those sensors. But what we think that that’s gonna do is create this total freedom of movement and then enhance the feeling of immersion and the feeling that my hands are the tips of the instrument and I’m looking deep into the patient we’re also targeting. And with Luna having a 3D screen that doesn’t require glasses. So working with some vendors on this and it’s incredible. So now this feeling of immersion is really complete when you’re looking at the monitor. So, being on the front end of trying to be the first people to use these digital handles and digital sensors for hand tracking really takes us off of a mechanical bespoke roadmap and onto this kind of. open source electronics based chips and sensors roadmap. And obviously that’s going to move much faster. I mean, the billions of dollars that have been poured into person tracking, hand tracking, much less, you know, older technologies are amazing. And so we’re going to, we’re piggybacking off a lot of work that’s been done there rather than how many robotic Tele-manipulator Masters Controllers, are there 20? There’s just not that many technologies out there. It’s encoders and cables and motors and gears. And so trying to get onto this kind of digital roadmap is gonna accelerate our time to market and our growth after that.


Jeff Dance – 00:45:00:

It seems like more of a platform that you could leverage across robots, but that sounds pretty exciting. In general, how do patients do Robot Surgery today? Is it positive, is it negative? What’s the overall perception? And then I have another question about the future, but what is it today?


Caleb Osborne – 00:45:19:

Yeah, I think it’s generally quite positive. I think that, and I say that because we see hospitals using their robot to attract patients. This is years ago, when we were driving to the beach and there was a big sign that said Da Vinci surgery, now at whatever Regional Hospital, that was a big part of their marketing. And I do think that surgeons and patients think of a hospital as more cutting edge and more innovative and therefore more specialized and able to take on your case. Hopefully your case is not a high end specialty case and it’s a pretty run of the mill case. A lot of times you see that those marketing campaigns are then used to attract patients. And then the patients are ultimately funneled into laparoscopic surgery or something that’s less costly. Certainly think that the hospitals and the doctors are making the right decision for each patient. But it’s interesting, no one markets their laparoscopic program, I don’t think. They do market their robotic program. So I do think that there’s trust in technology there, especially in the US.


Jeff Dance – 00:46:29:

That’s good to hear. I would say in general, there’s kind of a fear of robots. But I think to your point, and there probably still is, but to your point, it’s a symbol of innovation of probably precision and advancement that kind of bodes well for the hospital. So I could see how that helps alleviate some of that fear. Any other thoughts about how for humans, technology sometimes takes its life of its own, and sometimes we create things that aren’t as beneficial and we don’t design enough with intent around the human experience and how this could shape our own experiences as human beings with automation, with computers, with AI, with robots. A lot can happen quickly and sometimes we’re backtracking to figure out like, oh, what did we just create? And how’s that changing us? Because we don’t change as quickly. Do you have any thoughts as it relates to this space how we can design products with more intent so that they benefit humans and alleviate some of the fears that we generally have?


Caleb Osborne – 00:47:32:

Yeah. It’s a great question because I think that we, typically, in medical devices, we underestimate. Two things, we underestimate one, how many devices? clinicians are dealing with on a daily basis. How many buttons and screens and everything that they deal with. I was at, I don’t remember which hospital it was at. We were watching something. Cases and we all have a past room that was just full of those little spider carts with sensors. Every cart had a different sensor, every cart had a different monitor, and they’re just shoved into this closet basically. And the idea that nurses have to know this is the device I need, this is, you know, is the battery charged on it and now I got to find a cord that works with it. they’re trying to do their job to take care of a person. And so I think that there’s a lot to learn and consistency between different user experiences. A lot of the usability and human factors guidance that the FDA follows had to do with different anesthesia machines, having dials that went different directions. So it was like basically more anesthesia versus less. And the different devices, those were opposite. And I mean, obviously there were some really bad outcomes from that. So how do we design with consistency? Again, I think surgeons in the hospital will have access to more than one robot. So how do we make that experience? I mean, log-in is gonna be different and you gotta, I don’t know, you’re gonna have to remember your password and all these things. But the core experience of reaching out and touching and grabbing tissue needs to feel really similar. And then there’s a question of then how do we compete? I think a lot about 10 years ago, car companies could market based on their backup cameras. The new Corolla or whatever has this backup camera. And now they’re required. Every new car has to have a backup camera. So that leg of competition is gone. There’s no such thing as a leader in backup cameras. So. That’s a good thing though. So somehow from a robotic control standpoint, we have to find some other things to compete on because we need that user experience to be consistent for the good of the surgeons and the nurses and the patients. So I think that’ll be an interesting development. I think also on the PBS about the patient side, I think. There are going to be more opportunities for firms and developers to give the hospital more resources that they can share about robotics, you know, with our digital handles and how simple they are. Could we create a lower cost version of those where the hospital could send those home with, with the patient, with a version of our simulator, like you get to practice the procedure, I don’t know, that you’re going to have, you get to see what it’s like to do a gallbladder removal. And if you can do it, imagine your surgeon with hundreds of cases under his belt and medical residency and fellowship. Imagine how they’re going to be able to take care of you. And so connecting that trust to the patient and to the surgeon through a simple user experience, I think is a big part of what we want to try to do.


Jeff Dance – 00:50:53:

Sounds like a. Yeah, the broader ecosystem’s really important here and how you’re connecting and collaborating in that overall experience for not just the doctor, but the patient, knowing that you’re part of an experience, not a silo, essentially. So between Robot Surgeries Companies, but also with all the peripherals, sounds like there’s a lot of opportunity to kind of improve there and make that best for everyone. Awesome, to wrap up, I just have a couple more questions. I really found this enlightening, as I’m understanding deeper the Robot Surgery space and I know our listeners are as well. Any other thoughts on advancements you’re excited about as we think to the future?


Caleb Osborne – 00:51:33:

Yeah, I think that’s a great question because, as I said, there’s so many disciplines that we touch and so many engineering elements, and there’s advancements in sterile processing and plastic packaging and all these different things. Like I said, with some of the other smaller competition, I’m really excited to see some of what they’re trying to do kind of mature, especially when firms are able to put some pressure on cost because cost is really the thing that’s holding robotics back from really mass adoption. The technology is not the state director, it’s just the cost. And so being able to pressure that I think is great. And I appreciate everybody that’s trying to do that. One thing that came to mind when you asked was, my brother had recently sent me this article about. It was two big milestones in aviation history. One was the Wright Brothers Flyer and the other was the Bell Labs jetpack. And you probably only know about one of them. And that’s the thing is that these were two big moments in aviation history, but only one of them advanced past that point. And why was that? And the point of the article is that it had a roadmap from day one. The engine could get lighter, the wings could get larger, the controls could get better. Versus the Bell Labs, I think it used a gallon of fuel every two minutes or something like that. It doesn’t scale. There’s no metric for where this gets better. So I think about that a lot. And at the same time, even though right, brothers. Wayne. At the time, there was not an engine with the power to weight ratio that was needed to do heavier than air swipe. until they made it. So they needed this step function, this one element that needed to experience this big change and then everything could take off from there. So what’s the big thing that we need to advance to where everything just steps forward? And I think it’s easy to say that that would be AI or data processing, image processing, Computer Vision, but something has to address costs. Like the same, it’s the power to weight ratio, it’s the value. Something has to affect that. And so I think that’s going to be more on the electronics and mechanics than it is on the software. So we do have continued to see new semiconductors, new, new motor designs, new motor technologies, like fundamentally new motor technologies. So those are going to have to happen and reach scale to bring the next era of robotics that can really reach the full population.


Jeff Dance – 00:54:14:

So costs are basically a big aspect of widespread adoption. So, you know, as, as the mechanical electrical pieces come down, then that can be a step function for the adoption that, you know, we can. 


Caleb Osborne – 00:54:27:

Yeah, I think. I mean, if you look at some of the robotics platforms, Intrinsic AI, which is this Google spin out, they, they just announced this tool that they kind of call like Squarespace for robotics. It’s kind of drag and drop for industrial robotics, but it’s kind of the drag and drop interface. These frameworks and the simulation tools are all. progressing really rapidly in the same way that you see PyTorch and TensorFlow and OpenCV for Machine Learning and Computer Vision applications. So those frameworks on the robotics side are going to have to continue to decrease time to market because that’s especially Medical Devices with all the burden associated with regulatory filings, these devices just have to be expensive. They have a lot of people’s time that they have to pay for over many, many years. So things that decrease the actual cost of the capital and things that decrease the time to market are going to be really, really important going forward if we’re going to push into the next demographic of the market.


Jeff Dance – 00:55:29:

Thank you. Final question is just around advice. Any advice for someone getting into this space around Robot Surgery? And I mean, you might take that from, there’s the surgeon, there’s those that wanna work in the space, even the consumer that’s entertaining the surgery that has Robot Surgery. But any final advice as we think about this new space? And many of the listeners being, hey, this is their first kind of foray into the depth of Robot Surgery.


Caleb Osborne – 00:55:59:

Yeah, I think if I look back at my own career, despite at this point being obviously. I think a specialist with Robotic Surgery, I personally, my own skillset in engineering, I’m more of a generalist. I know about operations and I know about finance and the business. I know enough technology to work with our team and I know the market and I try to balance all these things. So I think there’s a lot of room to be a generalist and there’s a lot of room to be a specialist. I’ve talked to a lot of younger engineers and we have our group of interns here right now for the summer and talking to them and. A lot of them are really. concerned about getting their first job and is my first job going to set the tone for my career? And I don’t think that it does. I didn’t have that experience. I didn’t have my first job was not in Medical Devices and I was able to make that change. I think that you have three to four years to figure out where do you want to specialize and do you want to specialize or do you want to be more of a generalist? So I think my advice is to take your time with that and you can be really an asset to your team as a generalist and know how to represent regulatory, how to represent quality, how to represent marketing in all of your different conversations. And you can have an equally fulfilling career, obviously as a specialist. Don’t try to mix up the two and understand what you want to be and you can dig in and do that really well.


Jeff Dance – 00:57:36:

I appreciate that advice. I think there’s value in both, right? And having some experiences to discover. where that passion is, like you discovered back in school, can be valuable without feeling like I’m unlocked. 


Caleb Osborne – 00:57:48:

Yeah. Yeah, exactly. 


Jeff Dance – 00:57:51:

Awesome. Caleb, it’s been a pleasure having you on the show. I think we’re grateful for your experience, your depth, the wisdom and insights you’ve shared. So thanks so much for making the time and enlightening us all on the future of Robotic Surgery.


Caleb Osborne – 00:58:05:

Sure. Absolutely, I really enjoyed it. Thanks for having me.


Jeff Dance – 00:58:10:

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