Making specialized medical procedures possible anywhere in the world - that is what Christoff Heunis wants to accomplish with his start-up Flux Robotics. During his doctoral research, he developed a system that allows surgeons to place a cardiac catheter with the help of magnets. Next week, the company will take part in the international start-up event Slush in Helsinki.
Heunis embarked on this mission following a personal experience. He was 20 and studying Mechatronic Engineering in Stellenbosch, South Africa. The mother of one of his best friends suffered a stroke. "An unusual kind of stroke. Throughout the whole continent, there were only two or three neurosurgeons who could help her. An intense time. She was like a second mother to me.”
Improving productivity
The researcher recalls the impact that it had on him back then. "I was also dumbfounded by the enormous disparity between the availability of specialists and those who can be helped. It was at that moment that I decided I wanted to do something about that." Heunis chose biomedical engineering as his master's degree. While studying, he worked on developing technology that can help stroke patients in their rehabilitation.
Since biomedical engineering opportunities are still in short supply in South Africa, Heunis made the decision to look for universities in Europe. He chose the University of Twente in The Netherlands, where he began his doctoral research in 2017. "My task was to find a way to improve the productivity of cardiovascular surgeons through the use of innovative medical technology."
More difficult for surgeons
As a first step, Heunis first observed what happens in the operating theater. "We went to a local hospital without a single product, without any ideas. Although our lab was researching a wide variety of surgical technologies, I wanted to take an unbiased approach. I sat in the operating theater in surgery scrubs and gloves and took notes."
Heunis meticulously noted every move and act of the surgeon. He noticed several things. “An enormous number of X-rays are taken to visualize the guide wires and catheters in the body. We could cut those down because there are an inordinate number of images that are taken. You expose yourself to ionizing radiation. And you could, over time, develop cancer that way. I was also looking at the time it took for surgeons to ask nurses to pass them a particular instrument."
The research topic turned into one about minimally invasive surgery. "There are two choices for heart surgery. Open-heart surgery, whereby the surgeon opens up the entire chest. In this procedure, the patient loses a lot of blood, there is a risk of infection as well as a lengthy recovery time. Minimally invasive surgery is the other choice. In this, the surgeon uses thin and flexible instruments to do the same kind of operation through a tiny incision without having to open up the patient's chest. Better for the patient, but more difficult for the surgeon.”
Sub-millimeter level
"That's when the phenomenon of magnetic surgery came about." Heunis went on to develop Advanced Robotics for Magnetic Manipulation (ARMM). Specifically, he came up with an ARMM system to test the effect of using magnets to navigate guide wires. A small magnet is fitted to the end of the guide wire. "That wire is very flexible. By using a magnet outside the patient's body, you can simply move the inner magnet. And that's how the surgeon moves the guide wire toward the right place.
In a feasibility study on what are known as silicone phantoms, Heunis and his team were able to show that magnetically controlled instruments could perform the most difficult turns in the human body and in animal tissue, Heunis explains. "It's also a way to significantly reduce the number of X-rays that are needed."
Initially, Heunis had no intention of bringing his idea to market. That is, until two weeks before he had to defend his dissertation. He and other University of Twente researchers were at the time demonstrating their projects to surgeons at Medisch Spectrum Twente (MST), UMCG, and Meander Medisch Centrum Amersfoort.
Take the lead yourself
"I clearly remember one of the surgeons staying behind as the rest went over to the next table. He looked at the system and asked, 'Why aren't I using this? Why isn't this already in the hospital?' It was one of those brief moments in my life that completely changed my perspective. It made me stop and think and I asked myself the same question. I knew that if I wanted to make sure this technology was adopted in operating theaters, then I had to take the lead myself."
From that moment on, things started moving fast. Heunis signed up for START Bootcamp run by Novel-T. Where he was coached from being a researcher to becoming an entrepreneur. "I wouldn't say it was hard, but it does call for a lot of focus. You have to change your 'mindset', as it were. As a researcher, I really enjoy talking about the technology I make, but as an entrepreneur, I need to talk about why I'm doing it."
Heunis also signed up for the UT Challenge in the start-up idea category. "I wanted to know if my idea was viable or not," he said. He then went on to win. An article in the local Tubantia newspaper followed the next day. "That really got the ball rolling. Everything happened so fast after that." Flux Robotics was awarded a grant from the Dutch Research Council (NWO) and a start-up grant for the valorization of the technology.
To the market
This allowed Heunis to hire his first employee. He also used the funding to develop what is known as a minimum viable product. Within six months a mobile system was in place that surgeons at MST tested on phantoms. For that, he received a voucher from the university's pioneers in health innovation fund.
These experiments produced favorable results: surgery time was shorter compared to standard treatments and catheter placement was more manageable for the surgeon to perform. "We are now ready for the next step: clinical trials."
It remains to be seen as to when the system will hit the market, according to Heunis. "That depends on which regulations we follow. Do we opt for American certification or for European? The American one is currently more predictable. Either way, within three years it should be possible for a surgeon to use the system in the operating theater."
Slush
Flux Robotics also took part in the Finnish Slush last November. "Back then, there wasn't a system around at all," he said. He spoke with a lot of people about the problems they face, what their challenges are and what they do to address those challenges. "I drew on all those experiences in my own process."
Heunis is traveling to Helsinki again this year. "To tell other people about our experiences so far. And to use it as a way to give something back." Flux Robotics is part of a delegation of the four Dutch technical universities. "I've never heard of most of the other start-ups. We will be going there together. Being part of a group is instrumental for both short- and long-term growth. It's a great way to build relationships with other professionals who may be able to help you, or even work with you."
Back to his mission. "With this system, we are demonstrating that an intelligent robotics system in the operating theater can give surgeons - who are not necessarily specialists in vascular surgery - the ability to carry out highly complex surgery. So, my long-term vision is to make these kinds of technologies accessible and affordable to hospitals. Not only in Europe, but all over the world. Then you are giving others the opportunity to improve their skills, so you won't need to call someone from North Africa for an operation in South Africa."