The Pransky interview: Professor Moshe Shoham, Founder of Mazor Robotics and Microbot Medical

Pransky: How did you first come up with the concept of SpineAssist?

Professor Shoham: I have been in the field of robotics for about three decades. About 15 years ago, I focused on medical applications, as I saw a need and the potential to apply robotics in this field. Applying new robot structures to medical applications resulted in a new concept of a small bone-attached robot that is affixed to the patient’s vertebra which thereby enables the high accuracy needed in these spine complex cases.

Pransky: What was your position when you decided to set up Mazor Robotics (M.A.S.O.R.) and how easy was it to get the necessary funding? Were there any problems with the transfer of Intellectual Property (IP)?

Professor Shoham: I am a faculty member of the Department of Mechanical Engineering at the Technion-Israel Institute of Technology, and I head the robotic laboratory. Once we completed the concept and built the prototype, I founded Mazor under the Technion’s incubator, and transferred the IP. The Technion incubator helped me to establish the company and get acquainted with investors. I was lucky in raising the needed funds for the first round.

Pransky: How many people worked at Mazor initially and how has it grown?

Professor Shoham: At the beginning (2001), there were two/three very talented people working in Mazor; now there are about 130 people.

Pransky: How many systems are sold each year, and where are they manufactured?

Professor Shoham: They are manufactured in different locations, with approximately 70 installed in more than ten countries. Mazor Robotics systems have been successfully used in the placement of over 7,000 cases implanting more than 50,000 implants worldwide.

Pransky: In terms of man-hours of effort, how would you apportion the split between software and mechanical design?

Professor Shoham: As I came from the mechanical engineering robotics field, I planned to acquire the software part on the medical imaging, since I learned in many conferences that this problem is already solved. I learned the hard way that this is not true, and that there is a long way to have a mature, working product. We then established a software group which today has about the same, if not more weight, as the R&D group in Mazor.

Pransky: Do you use rapid prototyping?

Professor Shoham: We use it for prototyping; not for actually the innards of the device, but it helps us in actually designing new things.

Pransky: If you could wave a magic wand to solve one technical problem, what would it be?

Professor Shoham: Actually, we are working right now on four different levels because there are some projects that are fully commercialized, like Mazor; and there are ones in the start-up companies. There are some which are at the R&D level and still in the laboratory. And there are several of them that are near science fiction and perhaps will never materialize, but we try to address these as well. In all these projects, I would love to have a magic wand for constructing miniature devices without compromising strength, with a production process that is able to produce miniature constructs.

Pransky: Tell us about the Mazor Renaissance Brain Surgery and any other future applications Mazor may be exploring.

Professor Shoham: Mazor has entered into brain surgery, adding this application to the spine. The Renaissance system directs surgical tools in image-based brain surgery to accurately position biopsy needles inside the brain or to place electrodes for deep brain stimulation purposes.

Pransky: You are not only the Founder of Mazor but Microbot Medical. Please tell us how and when you came up with the pioneering ViRob and TipCat and their evolution from concept to prototype to commercialization.

Professor Shoham: Those technologies came from our Dan Kahn Medical Robotic Laboratory at the Technion, an academic institution. We came up with different kinds of medical robotics technologies, but only the ones in which the technology is mature enough actually leave the laboratory. We then create companies to take the technologies into further development. If you really would like to commercialize a product, then it should go at some point out of the laboratory. In an academic environment, the best ideas come from graduate students. I am extremely proud that many of my graduate students chose to pursue a career in medical robotics, and they are doing extremely well. All are in medical applications, developing key components for the world’s top medical device and robotics companies: Prof Nabil Simaan at Vanderbilt University; Prof Alon Wolf at the Technion; Dr Gabor Kosa at Tel Aviv University; Dr Nir Shvalb at Ariel University; and, Dr David Zarrouk at Ben-Gurion University. Dr. Daniel Glozman, Noam Hassidov Oded Salomon, and Or Samoocha, key figures in the Virob and TipCat projects, are also founders, CEOs and employees of medical device companies.

Pransky: How long did it take the concept of ViRob and TipCat to develop from prototype to commercialization?

Professor Shoham: There are several steps involved. The first is the idea, which usually comes from my graduate students. Then we decide to go and take a look at it within the laboratory, which may take a couple of years. At some point, we may decide to take it out of the laboratory for commercialization. Once we do that step, it can take several additional years: first, to find the investors who can invest in this technology. Then, setting up a company can take several more years to develop it into an actual product.

Pransky: How long did ViRob take from the idea stage to where it is now?

Professor Shoham: Five years.

Pransky: And who owns the IP to these? Is it Technion? or is it Microbot? or, do they partner with Technion?

Professor Shoham: Once we have the idea, develop it and decide to commercialize it, we then set an agreement between Technion and the company that brings it to market. At the beginning, the IP belongs to Technion. Technion then licenses it to the company. There are then negotiations and agreements made in terms of equity or royalties.

Pransky: Has Microbot found investors at this point?

Professor Shoham: Yes. Microbot has found investors. The company is about three years old. There are investors that continue to participate in the program. Our small device that can go inside the human body and try to either monitor or fix it from the inside achieves the dream of minimally invasive technology. There is a lot of research along this line in many academic institutions all over the world; however, to date, it’s very difficult to do, and there are no commercialized robotic technologies that are actually working autonomously inside the human body. There is a lot of research, but almost none of it has actually made it all the way across the laboratory path, clinical trials and regulatory path because it is quite new and technologically difficult.

Pransky: Can you describe the technology that separates yours from anywhere else in the world?

Professor Shoham: We are working on this small device like others are, but in our case, we tried to make a very small device that can crawl inside the human body using power either from inside or from the outside. Thus, there is a longer operation time. I think there are many ideas on how to do that, but as I mentioned before, I don’t think there is a single commercially available device.

Pransky: Can you further comment on the power or control, or how you got ViRob to go backwards, how fluids are handled, etc?

Professor Shoham: The micro legs on the device are for gripping, and this helps the device to move. Depending upon the size of the device, it can be maneuvered either from the outside by some kind of electromagnetic alternator field, or from the inside, using batteries. Regarding if whether the ViRob can go backwards, it depends on the application because there are a lot of applications where you would like to have this device go to someplace inside the body and just stay there. For example, in Brachytherapy – where you have to implant small radioactive seeds in specific locations for the treatment of a tumor – you would love this small device to stay in one location, and you don’t have to try to take it out. But, for other applications, there are also ways to move it around, including going backwards.

Pransky: What are some of the challenges that Microbot Medical is facing?

Professor Shoham: Well, several. Technologically, dealing with miniature devices with sub systems of the order of submillimeter in size is always a challenge. We need to pack the mechanical and the electronic sub systems into the smallest pack possible, in order to minimize invasiveness. At the same time, we have to preserve the functionality of the device.

From a marketing point of view, we provide an answer for an unmet need which will make a change in patient treatment and care. Changing mindset and workflow is always difficult, but I prefer to initiate projects that will make a real change even though assimilation of these projects is much more difficult.

Pransky: Do you have to go through clinical studies? Is there something similar in Israel to the USA Food and Drug Administration (FDA)? What is that process?

Professor Shoham: We have to go through animal trials and also human trials. There is something similar to the FDA in Israel. It is called AMAR (the Israeli Ministry of Health’s medical device regulation unit) but in any case, we are trying to follow the FDA regulations before we proceed with AMAR.

Pransky: So you’re just beginning your clinical studies or anything that you can report to us?

Professor Shoham: I don't want to go into too much detail on this. We definitely try to follow the FDA approval guidelines for this device. We also consider it from another point of view; what is needed following regulatory approval to bring this to market. We want to produce a device that will make a real major change to the patient, so in a few years, it will become a standard of care.

Pransky: What are the top application areas where you would expect to see the outcome improved due to Microbot products?

Professor Shoham: I can repeat what CNN reported. We try to go either through the biological lumens, like another kind of blood vessel in the body, or through an artificial lumens, such as implanted shunts. These are the applications we are developing now.

Pransky: What is your prediction of the medical robotics field in, say, 10 years and 20 years?

Professor Shoham: I recently read an article published in the newspaper Japanese Government, in which the Japanese have decided to invest big money to develop a robot-assisted operating theater, for use within ten years. They teamed with major manufacturers such as Panasonic, Hitachi, etc., as well as universities. The aim of this project is to collect the best universities and very big companies to try to compete with the way that the USA is dominating the market today. This is one example that I can see. Also the European Community has undertaken this subject and allocated a large budget to medical robotics.

Pransky: How nano do you think medical robotics will be in the upcoming years?

Professor Shoham: The work that I’m doing is millimetric. We have the robot for Mazor Robotics which is about the size of a human fist, and we have the robot at Microbot Medical which is of millimetric size. This is where I stand. I don’t go to the nanoscale because this is not my strength. Nanoscale is a very different story. There are researchers and companies that pursue this scale for targeted therapy, and I think it is really fascinating and important, but it is on a different level, which means molecular size, and totally different in terms of applications. What I concentrate on is millimetric and submilllimetric size.

Pransky: Can you talk about any other projects you’re working on at Technion?

Professor Shoham: We’re also working on a swimming microbot with Dr Gabor Kosha.

Pransky: You’ve been a Professor at Columbia, Stanford and Technion Universities. How does this career compare with being a Founder of a medical device company?

Professor Shoham: A university professor that founds a company has to understand that as good as he might be, there are positions in the commercial field that other qualified people can do better than he. This is one of the key points for success.

Pransky: What is the biggest mistake you made/the greatest lesson you learned?

Professor Shoham: In this respect, a good and even brilliant idea is not sufficient for bringing a product to market. A good idea is just the beginning, a small piece of a product, and there is a very, very long way to realize an idea. This is one of the lessons I have learned.

Pransky: What do you think PhD and Masters of Engineering students should be doing while in school to prepare them best for the commercial side of robotics?

Professor Shoham: A PhD or Master student has to study and complete his research the best academic way possible. If it happens that his thesis can be commercialized, then he can then take it further. In parallel, he can take courses of entrepreneurship, but I am not sure that directing one’s thesis just along the commercialization route is the best for advancing science and technology.

How confident can we be that the human body will not ‘reject’ robots as invading organisms and either seek to destroy them or cause undesired side effects in their efforts to do so?

Professor Shoham: The material the robot is made of should be biocompatible; similar to the material that implants, stents or shunts are made of. They stay in the body for years without being ‘rejected’ by the body.