Vikas Karade, CEO and Founder of AlgoSurg tells us about how they develop Algorithms for 3D Simulation of Orthopedic Surgeries.
First of all, how are you and your family doing in these COVID-19 times?
Vikas Karade: Thanks for asking. I am doing great. It started with difficult times last year but now moving forward with more strength. The family is also doing great. Fortunately, they live in a place that is less Covid affected zone.
Tell us about you, your career, how you founded AlgoSurg.
Vikas Karade: I studied Mechanical Engineering for 15 years, including my B.Tech, M.Tech, and Ph.D., all from IIT-Bombay, India, one of the top technology institutes in Asia. I found great opportunities for technology in healthcare, especially surgeries when I worked on my Master’s Thesis, which was based on designing surgical instruments for bone resection. This made me continue the work as a Ph.D. research. My Master’s and Ph.D. supervisor, Prof. B. Ravi, supported my interest and connected me to some great orthopaedic surgeons. With the surgeons, I started learning a lot about bone surgeries and realized that there is a great need to apply technologies to make surgeries accurate, cost-effective, and faster. During my Ph.D., I invented XrayTo3D- An algorithm to convert two plain X-ray images into 3D bone models. This technology was very helpful for surgeons to visualize a patient’s bone anatomy in 3D and plan the surgery pre-operatively, without a need for CT or MRI, at a low cost and using easily available imaging equipment (X-ray machine).
The innovation was well recognized by the media that I met the president and prime minister of my country. Many organizations connected me to big decision-makers and innovation supporters across the country and the world, which motivated me to choose to work on the same innovation after my Ph.D. After I finished my Ph.D. in 2015, for two years from 2016-2018, I partnered with Amit Maurya (my co-founder now). I started making the innovation more practical by doing more research funded by the Government of India. Later in 2018, I pitched the idea and related product plans, business plans to Y-combinator. YC selected and funded us, and we started AlgoSurg Inc. in the US while keeping all the development and team in India. Our goal was to develop Algorithms and Software like XrayTo3D to make surgeries better.
How does AlgoSurg innovate?
Vikas Karade: We innovate by using high-end technologies like simulation algorithms, AI/ML, 3D/AR/VR to solve surgical problems, which we learn with surgeons. We spend a lot of time with surgeons, understanding surgeries, attending surgeries, discussing problems, and then inventing solutions. Since we are in the medical device field and our technologies are directly used in patient’s surgeries, testing and evaluating the technology is time-consuming compared to making it. So the journey of innovation in medical device startups is usually slower compared to any other technology startup. Hence in this initial stage, we work on multiple aspects of surgeries like Surgical Training, Surgical Planning, Surgical Device design, and Surgical Methods, using similar technologies, with a strategy of not getting defocused.
How the coronavirus pandemic affects your business, and how are you coping?
Vikas Karade: Well, it affected our earlier strategies and plans a lot but resulted in the new and much better strategies. During 2018-2019, we made an initial version of Tabplan3D, a cloud software based on XrayTo3D technology, to simulate lower-limb surgeries in 3D and auto-design 3D printable patient-specific instruments (PSI), to improve surgical outcomes in a very efficient way. After about 50 pre-clinical tests/trials, we planned to perform a big clinical trial in 2020, following which we planned to take FDA and head towards commercialization. We were also getting some funding and partnership support for this. Due to COVID-19, however, our plans failed. We could not do anything in clinics, and so the support was also lost. By March 2020, we had no funds, and we could not implement our strategies due to the lockdown. Although we are pre-revenue stage, it was a very stressful situation because the COVID affected our startup growth, and then survival was the highest priority. We started rethinking strategies, and two great things happened after that.
First thing, one of our industry contact, which is one of the biggest implant manufacturing companies in India, wanted to collaborate with us to develop a novel cloud software (SIXAFIX) which was an integral part of their newly launched medical device. This project was very helpful in three ways. One, it brought some revenue to us for survival; Two, we learned and worked on its FDA clearance (and got one) which will be useful for our products as well; Three, we demonstrated our capability of bringing a medical device idea to market (with FDA) successfully, gaining traction and support in the medical device industry.
Second, we started thinking of additional ways/products to bring our technology (3D surgery simulation) to the market much faster and efficiently. This led us to work on OpenSurgiSim, which is the world’s first low-cost AR-enabled cloud-based software to up-skill orthopaedic surgeons without the need of an expert trainer surgeon. OpenSurgiSim will use our 3D simulation technology, 3D printing, and AR and will be made in two versions. An open-source version for low-resource settings and a commercial version for any orthopaedic facility/surgeon/industry. The idea came from surgeons themselves who wanted to use our surgery planning software for training their fellows. We got confirmation on our new idea when Intuitive Foundation (from Intuitive Surgicals) launched a global competition, “Global Surgical Training Challenge,” along the same theme. We actually won the competition and got funding support for our open-source module. Following this, we are getting great chances for partnership/funding from the industry as well.
Did you have to make difficult choices, and what are the lessons learned?
Vikas Karade: Pivoting to OpenSurgiSim was a difficult choice. It was an untested new idea on which we worked for months without any funds and guidance. Thanks to the Intuitive Foundation and its global competition, which strengthened our belief in the idea.
We also learned to keep up with the market and focus on top priority ideas. Some of our ideas, like 3D printable patient-specific instruments (PSI), on which we worked for a while, will most probably not work in the market for surgeries like knee replacement, where robotics and automation seem to be the future. Hence, using all our previous efforts, technologies, and learnings to build for the future became the new strategy. Now we are focusing on using our 3D simulation technology for AR-based surgical training and intra-operative surgical guidance. For any other application like 3D printable PSI or custom implants, we planned to license our technology.
Who are your competitors? And how do you plan to stay in the game?
Vikas Karade: Since we work on very new and futuristic surgical technologies, there are very few players. Some companies like Materialize Inc. have been working on 3D surgical planning with CT and MRI, manual engineering work, and 3D printable PSIs. We innovate AI-based algorithms to use low-resources (like plain X-ray) and focus on automation. Our PSI was automatically generated by the software and used only plain X-ray.
Now we are focusing on Augmented Reality based surgical-training and surgical guidance. There are a few startups using AR for training or surgical guidance as well; however, I think we are hitting the right problem. We do not rely on 3D virtual simulation-based surgical training only, but we emphasize psychomotor skills. For the AR-based surgical guidance, we are using our XrayTo3D technology instead of CT/MRI.
We believe that in the near future, there will be two categories of surgeries. First, where the surgeons will adopt technology to improve their skills, and second where surgeons will rely on robots to perform some critical tasks of the surgery itself. All these will ultimately lead to completely automated surgeries. The 3D surgery simulation will be the need of both these categories. We are aiming for AR-based surgical guidance and AR-based surgical training, which will be adopted by the surgeons of the first category. Using the learnings and data from these solutions, we will ultimately navigate towards the second category.
Your final thoughts?
Vikas Karade: Deep technology startups usually have a long journey but are super interesting and exciting. A medical device startup needs even more patience. However, all of this is super-exciting. We aim towards automation in surgeries, and technologies like these will be a small but important part of upgrading civilization.