Clinical Services Journal 17 Nov 2023
A Cambridge-based manufacturer of surgical robots has put UK MedTech on the map – setting an example of how clinician-led innovation can be scaled-up at pace. The Clinical Services Journal visited CMR Surgical’s new state-of-the-art facility and saw first-hand how the company plans to boost innovation in the UK.
CMR Surgical – the global surgical robotics business – recently marked the opening of its new surgical robotics manufacturing facility in Cambridgeshire, UK, with an open day attended by pioneering surgeons, top hospital executives from around the UK, robotic surgery experts, healthcare leaders, as well as the team behind the Versius robot.
CMR was first established in 2014 with a mission to “transform lives by making minimal access surgery (MAS) more accessible and affordable” and to “democratise access” to the benefits of robot-assisted surgery. The Versius robot fits into virtually any operating room set-up and integrates seamlessly into existing workflows, increasing the likelihood of robotic minimal access surgery.
Since its launch, the company has seen rapid growth and the new manufacturing facility in Cambridge will help meet increasing demand for Versius across Asia, Middle East and Africa, Asia Pacific, Latin America as well as Europe. Acting as a global hub for exports, serving over 20 markets, the site is home to production, quality, manufacturing engineering, supply, operations, and logistics
The unveiling of the Cambridge facility represents a commitment to home-grown innovation from the UK. Twenty NHS hospital partnerships – including Royal Papworth Hospital NHS Foundation Trust; Addenbrooke’s hospital, part of Cambridge University Hospitals; and Milton Keynes University Hospital NHS Foundation Trust – are currently using Versius, and the opening of the first UK surgical robotics manufacturing facility further strengthens the UK ecosystem for developing and adopting new innovation
Barrington D’Arcy, Chief Operations Officer at CMR Surgical, said: “We are proud to have a new global manufacturing facility that is located close to our R&D teams in Cambridge, and in the UK where Versius was born. When we look at what we set out to achieve, the fact that we are designing, developing and building Versius in the UK, in order to help patients locally and globally, is incredible and in line with what we set out to do as a business. Making a surgical robot is complex and I hope this state-of-the-art facility can help to further boost innovation in the UK.”
The new facility also has a firm commitment to supporting the environmental agenda, by incorporating solar panels and rainwater harvesting, for energy efficiency and sustainability
Supporting clinical entrepreneurs in the UK
Speaking at the opening of the facility, Professor Tony Young, the National Clinical Lead for Innovation at NHS England, honoured the contribution of the ‘godfather of robotic surgery’, John Wickham – who first coined the phrase ‘minimally invasive surgery’. He pointed out that John Wickham had contributed to the design of many instruments that we see today – going on to develop the field of laparoscopic surgery and then robotic surgery. In a paper published in the BMJ, in 1994, John Wickham accurately predicted the adoption of technological advances in surgery, including the use of VR and robotic consoles.
That man had a vision, and that vision has almost entirely come true,” commented Prof. Young. “But what does the vision of the future look like, and will it hold up in another 30 years’ time?”
He suggested that the future will be focused on precision healthcare – it will be about “getting things right” down to the individual level, and it will utilise data, AI, digital, pharma and genomic advances in delivering improved care.
“In the UK, we have more Nobel prize winners per head than any other country, but our ability to translate that into world-leading businesses does not match that of our international competitors,” Prof. Young commented. He pointed out that Europe, the Far East and the US have tended to dominate the business sector. “However, when you look at this facility today, you can see how we are starting to change that,” he commented.
Prof. Young went on to highlight the Clinical Entrepreneur programme – run by NHS England’s Innovation, Research and Life Sciences group and delivered jointly with Anglia Ruskin University. The programme welcomes applications from a diverse range of clinical and non-clinical healthcare professionals with an interest in entrepreneurship and innovation.
“We should be celebrating our clinicians who become entrepreneurs; we should be holding them up as people who can help us make great improvements in patient care, patient outcomes and the patient journey,” he asserted. “In the first six years, the programme created around 500 start-ups…To put that into context, an NHS England Work Force Development Programme has created over 7% of the UK life science industry. They have benefitted over 130 million patients and professionals through their innovations.”
Prof. Young predicted that the clinicians of the future will have to become ‘multi-linguists’ in terms of understanding e-commerce, partnerships, science, digital, technology and AI. They will need to go beyond learning about medicine and surgery, and will need to understand entrepreneurship and how to change care pathways. However, he added that “our diverse workforce must be supported” to drive clinical innovation in the UK. While the UK has a long and proud history of discovery and invention, we have been less successful at turning these great ideas into world-leading businesses. He asserted that we must not let other countries “be the ones to capitalise on clinical innovations”, adding that he believed that the UK could become “a world leader” in robotics – building more robots in this country than any other region.
Scaling up MedTech manufacture in the UK
David Lawson, the Director of Medical Technology at the Department of Health and Social Care (DHSC), said it was “fantastic to see how CMR Surgical has grown” and that the scale-up has been “a huge achievement” in a very short space of time.
Before joining the DHSC, David Lawson had worked at Guy’s and St Thomas’ NHS Foundation Trust (GSTT) – the first site in London to adopt the Versius robot, in 2021. Here, the robot has helped to pioneer less invasive surgical approaches – including ‘transoral robotic surgery’ (TORS) to remove cancerous and benign tumours growing in the mouth and throat. The use of Versius in TORS surgery is part of a clinical research programme at GSTT. This less invasive approach has helped speed up recovery time for patients.
David Lawson pointed out that analysis from Imperial shows that 58% of the MedTech sector in the UK are start-ups. However, the UK has not been as good at ‘scaling up’. David Lawson commented that “we need more CMRs” and to learn from their example how to “make the leap” to becoming big, successful companies
“If we don’t grow as a country, we won’t be able to afford the NHS. We need to take advantage of our strengths as a country. This is why CMR is so important. It provides an example that ‘it can be done’ – that we can manufacture medical devices at scale in the UK, and that the UK is a great place to manufacture,” he commented.
David Lawson explained that there are four key pillars to the UK MedTech strategy:
- Ensuring resilience and continuity of supply of MedTech products
- Supporting innovation and encouraging thriving, dynamic markets
- Developing enabling infrastructure
- Specific focuses on key issues and markets
Sustainability and the circular economy are key to ensuring resilience in the supply chain, particularly around consumables, he pointed out. He cited the example of supply chain issues encountered for trocars, from Europe, around two years ago.
“Cancer surgeries across the country were at the point of being cancelled because a very low cost, single-use product, required for robotic surgery, wasn’t available. So, our strategy is to identify opportunities to move away from single use to reusable,” said David Lawson. “Part of the MedTech strategy is to consider supply chain resilience.”
With regards to innovation, there is frustration around the speed of adoption in the NHS, which has prompted the Secretary of State to announce a £30 million innovation adoption fund. There will be a full analysis of the ‘pain points’ for adoption of innovation, how we can get better at selecting the most effective technologies, and how we can become more consistent around decision-making on funding.
Data relating to MedTech will also be key, including registries and outcomes data, while creating a regulatory framework that supports innovation is also a priority. It is also important, from a manufacturing perspective, to ensure that an unnecessary cost burden is not placed on the UK MedTech industry, while NICE will have an important role to play in the objective evaluation of technologies, in much the same way that it does with medicines
“We need a better framework on how the innovation pathway works…If we get funding and reimbursement right, and regulation right, this is the ‘sweet spot’ – this is where we are trying to get to as a Department,” commented David Lawson
So, what does this mean for robotic surgery? The aim is to make the regulatory environment in the UK the best place for innovation globally,” said David Lawson. “For reimbursement, there needs to a logic and clarity about the processes, so when you are selling robots across the country you will know the process. These actions will help robotic surgery to progress,” he concluded.
Benefits for patients and surgeon
Visitors to the event also heard a surgeon’s perspective from Mr Barrie Keeler, a colorectal surgeon and robotics lead at Milton Keynes University Hospital (MKUH).
“We were one of the first centres in the UK to use the Versius for surgery. The pandemic slowed down the speed at which we implemented the robot, but we have now expanded robotic surgery across four specialties including colorectal, gynaecology, urology and general surgery. We have now surpassed 600 cases and continue to expand,” commented Mr Keeler.
He explained that the centre was already performing high levels of laparoscopic surgery, but the robot enabled further increases in access to minimally invasive surgery. Some of the benefits of minimally invasive robotic surgery include smaller incisions, faster recovery and shorter hospital admissions. A sub-group of patients receiving robotic surgery had shorter lengths of hospital stay compared to their laparoscopic counterparts, and this has resulted in MKUH saving around 450 bed days per year.
“The overall bed saving that we saw was much greater than we expected. But when we started looking at our clinical outcomes, we were surprised just how much they had improved. Just looking at some of our rectal surgical outcomes, 95% are getting minimally invasive surgery… Our oncological outcomes have been fantastic,” commented Mr Keeler.
He pointed out that there are also some unexpected benefits of using Versius – including the ability to attract more staff to Milton Keynes, and more inter-specialty collaboration: “There are patients that have undergone combined procedures by two or more specialties…Patients are being offered more complex surgery and it is being undertaken using a minimally invasive approach, with good outcomes.”
MKUH has also observed benefits in terms of surgeon welfare: “One of the first things I noticed about using Versius was the fact that, at the end of a long operative day, I wasn’t experiencing the same amount of discomfort that I would normally, if I was performing surgery via a keyhole approach. Speaking to colleagues, this was something echoed across all specialties.”
This has prompted MKUH to conduct an RCT to objectively assess the ergonomic benefits of Versius over laparoscopic surgery. The first of these studies has now been completed and the results will soon be published.