Symani Microsurgical Robotic System: Interview With Mark Toland, CEO Of Medical Microinstruments

Medical Microinstruments, a medtech company with offices in Pisa, Italy and Delaware, USA, has developed the Symani Microsurgical Robot. The robotic system is designed to assist with microsurgical procedures, and it boasts a variety of advanced features to achieve this goal.

These include a suite of the world’s smallest wristed surgical instruments, tremor reducing technology, and motion scaling (7-20X), to allow surgeons to perform very small and precise movements. The company has also paired with a software company to develop a surgical simulator to help with training surgeons on the system.

Medical Microinstruments recently announced $75 million in Series B financing as part of a drive to speed clinical development and commercialization of the system. Medgadget had the opportunity to speak with Mark Toland, CEO of Medical Microinstruments, about the technology

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Conn Hastings, Medgadget: Please give us an overview of the Symani System.

Mark Toland, Medical Microinstruments: Microsurgery — the suturing of very small anatomy such as vessels (arteries and veins), ducts or nerves — requires high visual magnification and specialized precision instruments. The Symani Surgical System® enables robotic-assisted microsurgery, a revolutionary innovation that allows physicians to complete procedures that are difficult to achieve when manually suturing extremely small vessels. We are pioneering a new surgical space, supermicrosurgery, which allows microsurgeons to address vessels under 0.8 mm in diameter. Our goal is to ensure patients have access to these complex procedures so that they may be healed more efficiently, allowing them to return to their daily activities and improve their quality of life.

Symani will enable surgeons to address extremely small anatomy with increased precision and reproducibility. It is the only system that offers wristed microinstruments designed to improve a surgeon’s ability to access and suture small, delicate anatomy. The platform provides motion scaling (7-20X) and tremor reduction to allow the surgeon to perform precise micro-movements through macro gestures.

Symani is a flexible platform consisting of two robotic arms that can be easily positioned over any anatomical region to facilitate surgical procedures. Unlike many surgical robotic platforms that require large rooms or dedicated space, Symani can easily be wheeled between ORs.

Medgadget: What procedures is the system suitable for?

Mark Toland: In Europe, Symani is CE mark approved for open surgical procedures where precision and motion scaling are deemed beneficial by the surgeon. More specifically, Symani is designed to improve a surgeon’s ability to repair anatomical structures such as veins, arteries, nerves, and lymphatic vessels as small as 0.3 mm in diameter.

These techniques are commonly used in surgeries spanning multiple specialties throughout the hospital: reconstructive plastic surgery (after cancer or traumatic accidents), orthopedic surgery, lymphatic surgery, nerve repair surgery, head and neck surgery, and pediatric surgery, to name a few.

According to our research, there are over two million microsurgical procedures annually that could be addressed by Symani in the U.S. and EU alone.

Medgadget: How is the Symani system designed to overcome the challenges of microsurgery?

Mark Toland: By evolving surgical intervention from a manual process to one that leverages robotic technology, we can open the door to procedures that have never been done before. The state-of-the-art Symani features 7-20X motion scaling with tremor reduction to address the demands and complexity of microsurgery and supermicrosurgery. This powerful combination allows surgeons to scale their hand movements while seamlessly articulating our proprietary NanoWrist® robotic microinstruments.

Symani’s NanoWrist instruments are the world’s smallest wristed surgical instruments, intended to improve a surgeon’s natural dexterity and range of motion beyond the capability of the human hand.

The Symani Console consists of an ergonomic chair and OperaAir Controllers along with a footswitch. While comfortably seated, surgeons can focus entirely on the critical step of suturing rather than stabilizing their hands. They can move the controllers in the same manner as they would with manual instrumentation, only they are able to make larger movements thanks to the motion scaling. The console offers the flexibility to be sterile and positioned at the patient bedside or can be used with a heads-up 3D visualization system.

To accelerate the expansion and adoption of robotic microsurgery, MMI launched the Symani Surgical System Simulator in partnership with VirtaMed to improve, expand, and digitize the training pathways for Symani. It is exciting to see that after just a few basic exercises on the Simulator, surgeons are able to already use the robot to perform surgeon knots and anastomosis. We believe that improved training pathways, such as the Simulator, enable quicker surgeon adoption and potentially better outcomes for the patients.

Medgadget: Please give us an overview of the wristed instruments that come with the system, and how they can help to improve a surgeon’s dexterity and range of motion.

Mark Toland: Symani combines proprietary innovations including NanoWrist Instrumentation as well as tremor-reducing NanoScale® technology. The NanoWrist micro- and super-microinstruments offer 7 degrees of freedom (expanded movement and orientation) and add the needed dexterity to confidently access and suture hard to reach anatomy.

The NanoWrist Needle Holder and Dilator allow for an unobstructed view while the distal wrist provides a wide range of motion, enabling the precision and control necessary for surgeons to manipulate and suture delicate anatomy.

The tips of the new Supermicro NanoWrist instruments are half the size of the tips of our initial microinstruments and are tapered to allow surgeons to address small veins, arteries, and lymphatic vessels. This new instrument kit is ideal for lymphatic surgery, replantations (fingers, toes, ears, etc.) and the growing use of perforator-to-perforator free flaps which may offer patients a more superficial flap, a shorter procedure and improved functionality after surgery.

Medgadget: How has the system been received so far? Where is it currently available?

Mark Toland: Symani received CE Mark in November 2019 and is commercially available in Europe. After implementing our limited launch strategy, Symani has been placed in eight European hospitals. It is exciting to see that our procedure volumes grow every month as the robotic approach moves towards a standard of care at these centers. Our surgeons have mentioned that patients are happy and reassured when they hear that a robotic approach is finally available for microsurgery. We will continue to expand commercialization in Europe while beginning to lay the groundwork for a launch in the U.S. and Asia Pacific markets.

Medgadget: Congratulations on recently securing some Series B financing. How do you intend to use these funds?

Mark Toland: The $75M in funds will be used to launch MMI into our next stage of growth as we continue our mission to improve the quality of patient care by pushing the boundaries of microsurgery. We have a two-fold approach that involves accelerating plans to grow our installed base while building clinical expertise and evidence. More specifically, we plan to expand indications and support ongoing commercialization activities in Europe, where the system received CE Mark in 2019, and expedite plans for access in the U.S. and Asia Pacific markets.

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