New technologies are now appearing in surgical operating theatres, including robots designed to assist surgeons and their teams during operations calling for extreme precision. Bertin Nahum, founder and Chief Executive of Medtech, a company based in the southern French town of Montpellier which specialises in building surgical robots, was one of four finalists for this year’s Prix Marius Lavet, awarded for the best engineering inventions.

[Portrait of an Innovator] Bertin Nahum’s robots enable minimally-invasive surgery

An innovator ?

An engineer by training, Bertin Nahum discovered “quite by chance”, while carrying out his graduation project in cooperation with the neurocardiology hospital at Lyon, just how the new technologies can be harnessed to serve “what is undoubtedly one of the finest activities on earth – treating patients”.  Following this experience, Bertin Nahum decided to move into the field of medical engineering. He began his career at a startup based in Grenoble, which was pioneering technologies for use in neuro-surgery. The range of experiences he enjoyed there enabled him to acquire considerable expertise in surgical technologies and he then won a competition run by the French Ministry for Research whose prize was help in setting up an innovative tech company.  Nahum used the grant he received from the Ministry to launch his own company Medtech in 2002 and begin designing surgical robots. "What I’m really interested in is to work out how technologies, in my case robot technology, can help surgeons to operate on patients more efficiently,” he explains.

The disruptive idea ?

"As soon as Medtech was set up, we began to work on minimally-invasive knee surgery and we developed our very first robot, which we named Brigitte,” recalls Nahum. Brigitte was designed to assist surgeons in placing knee prostheses in a minimally-invasive manner – i.e. with the smallest possible incisions. Then, like many other innovation-oriented companies, Medtech was approached by US firm Zimmer, the world leader in orthopaedic surgical equipment.  Following negotiations, Zimmer dropped its initial offer to buy out Medtech and instead agreed to acquire the company’s portfolio of patents covering the knee prosthesis technologies.  Explains Nahum: "We reinvested the proceeds of this deal in a new research programme, which led to the creation of our next robot, Rosa.” Rosa is a sort of GPS system weighing around 250 kilograms, which guides the surgeon’s hand during extremely sensitive brain operations to correct such conditions as epilepsy and Parkinson’s disease, remove tumours or correct brain function.  “All in all, Robot Rosa is able to assist with close to 80% of all cranial surgery operations,” he claims.

Other technologies are available to provide this type of assistance but what is particularly innovative about Rosa is “her ability to work in close collaboration with the surgeon.” However, to ensure that this man-machine collaboration is at its most effective, the surgeon requires some special training. “A very important part of our job is to help the surgeon and the entire theatre team to use this technology to best effect. They are not engineers, so our aim is of course to develop user-friendly technology and our service also includes training the personnel to integrate the technology into the operating theatre,” underlines the Medtech CEO.  With this in mind, Medtech staff work hand-in-hand with different sorts of medical teams at various stages of development of new technologies, “to ensure that we remain fixed on the needs and the constraints of the surgical environment, but the design concept is created solely by Medtech,” he stresses.

Why did he get interested in this field ?

Minimally-invasive surgery is all about performing operations with ever-smaller incisions. "This is a very strong trend which you find in all fields of surgery – orthopaedic and abdominal as well as cranial,” says Bertin Nahum. The advantages of this approach are not purely cosmetic.  It also enables the patient to make a faster recovery, with less bleeding, less post-operative pain and reduced risk of infection. "But if you’re going to operate in this way, with smaller incisions, you need greater precision,” the Medtech founder points out. And this is where the robot technologies developed by his company come in.

There is little doubt that robotic technologies are set to play an extremely important role in the coming years to help met the demands of modern surgery.  There is a lot of talk about surgical robot manufacturers but in actual fact there are just a half dozen such firms in the world today. Most of them are based in North America, like the world leader, Intuitive Surgical, which specialises in abdominal surgery, including prostate surgery, with its ‘da Vinci’ robot. Medtech is currently the only one in Europe and there are as yet none in Asia.

And how does this affect us ?

Rosa has now been on the market for several years and this technology has helped to treat over 2,000 patients at 35 hospitals in France, Italy, Spain, the United States, Canada, and as far afield as China.

In France, cranial surgery is mainly performed at state-run hospitals. However, reveals Bertin Nahum:  “We’re now extending the scope of our robots to spinal surgery so going forward we’ll be working much more with private sector medical establishments as this type of operation is frequently performed at private clinics.”

So what does the future hold ?

At the present time, Medtech is concentrating on the central nervous system – i.e. the brain and spinal cord. "We’ve just brought on to the market a new generation of Rosa Robots, which are suitable for working with conditions of the spinal column," reveals Nahum, stressing:  “However, we do not intend to focus on all parts of the body and compete with other companies in their own fields. Our idea is that each company should be left to specialise in its own field of surgical robotics.”

So Medtech is set to continue broadening the penetration of its surgical robots in the field of cranial neuro-surgery and spinal surgery, with a view to enabling as many patients as possible to benefit from minimally-invasive surgery, assisted by technology such as Rosa. "Progress in surgical techniques is nowadays closely bound up with the deployment of new technologies to assist the surgeon. Close collaboration between the surgical profession and manufacturers like Medtech will enable surgeons to treat patients in an ever-more efficient manner,” concludes Bertin Nahum.

By Virginie de Kerautem