November 11, 2015      

Joanne Pransky, associate editor of Industrial Robot, recently interviewed Yulun Wang, an inventor and authority on healthcare robotics. Wang has degrees in computer science and electrical engineering from the University of California, Santa Barbara. He conducted research on endoscopic robots and founded Computer Motion Inc. in 1989.

In 2001, the U.S. Food and Drug Administration approved Wang’s voice-controlled AESOP (Automated Endoscopic System for Optimal Positioning) robotic arm. AESOP was the first surgical robot to receive such clearance.

Wang’s ZEUS Robotic Surgical System was used in the “Lindbergh Operation,” the world’s first telesurgery, with a doctor in New York performing a procedure on a patient in Strasburg, France.

Wang co-founded InTouch Technologies Inc. in 2002. Computer Motion merged with Intuitive Surgical Inc. in 2003. Wang holds more than 100 patents and serves on several boards, including the American Telemedicine Association Board of Directors.

This interview is available free to Robotics Business Review readers until Dec. 10, 2015. Here’s a preview:

Pransky: You are really the founding father of both the surgical and remote-presence robots; can you tell us how you first came up with these ideas and the technical evolution of these robotic solutions?

Wang: After studying computer engineering as an undergrad and a graduate student at the University of California, Santa Barbara, in the early ’80s, I was trying to figure out what I wanted to do my Ph.D. in. I was always, for whatever reason, enamored with robots, and I also thought of robots as the next evolution that would allow computers to interact with the physical world. I decided to obtain my Ph.D. in electrical engineering, specializing in robotics, at UCSB.

I then researched the market opportunities for robots in the late ’80s and early ’90s. I was fortunate enough to win some grants from NASA to set up a shop to start going, and I just kept looking into different industries.

When I started connecting with friends of mine who had become medical doctors, I learned about the laparoscopic minimally invasive surgery industry, which was just taking off. In minimally invasive surgery, there’s all of a sudden a layer of technology separating the surgeon from the patient.

The surgeon’s now looking at a TV screen, has instruments going into little holes and doesn’t even really see what’s going on in the patient except for what’s on the TV screen. That layer of separation between the physician and the patient really allowed the opportunity to enhance the surgeon’s capability.

Being in healthcare all this time made me very aware of its challenges: the macro challenges of the aging population, costs going too high, the increasing complexity of medicine, the further bifurcating of the available medical staff across more and more disciplines, and the ongoing, very high disparity of quality of care.

Operation Lindbergh

Jacques Marescaux performs the world’s first telesurgery using the ZEUS robotic system.

Triggered by the Lindbergh telesurgery procedure and the merging between Computer Motion and our competitor Intuitive Surgical — to overcome our differences — I started InTouch Health about a year later with the thought of combining robotics with the Internet.

We were wondering if we could actually replicate the telesurgery experiment in a more generalized manner, using the Internet as the network to provide connectivity. By doing that, we would be able to bring expertise anywhere where it’s needed at any time, to improve patient care and improve accessibility, both at lower costs.

Initially, we couldn’t figure out where the real applications were to be able to align a clinical need with a viable business model and a financial return on investments for our customers. We were fortunate enough to find the concept of TeleStroke.

When a patient comes into the emergency room with a stroke, there’s a three-hour window in which, if you can get a stroke neurologist to take care of that patient quickly, you can really bring perhaps a full recovery.

However, if the expertise is not brought in on a timely basis for that same patient, the patient could die. That’s a big difference, and TeleStroke provided the necessary remote, timely care during a stroke patient’s critical period. This became the beachhead application of building InTouch.

Today, we do over 30 different clinical applications, but the whole idea of being able to bring the right expertise at the right place at the right time to do the right thing and thereby improving quality of care while reducing costs started with stroke and then moved to various other applications over time like TelePediatrics, TeleCritical Care, etc.

Pransky: What do you see as the next evolution of remote presence (RP) robots?

Wang: Being able to get into autonomous kinds of capabilities. We actually have an experiment going on where the robot is autonomously making rounds from patient to patient and capturing data sets — such as video, audio — for the physician to review at a later time.

Pransky: If you could wave a magic wand to solve one technical problem that exists today for you, what would that be?

Wang: One of the things is probably “bucks.” It’s getting the healthcare system, which is under tremendous pressure, to drive costs down. [InTouch’s] RP-VITA runs approximately $5,000 a month for the entire service, which is pretty reasonable. To expand it into rounding it to long-term care facilities and lots of other healthcare facilities, that cost has to come down. That would be my magic wand.

I strongly believe that a systemic deployment of telemedicine or virtual care or connected care, whatever one wants to call it, can fundamentally drive a higher-quality system to everybody at a lower cost in a substantial way.

The challenge for a company like InTouch or anybody else is that the healthcare system is quite messy, with a lot of complexities in terms of who gets paid by whom and how, what are the motivations, and all the different constituents, etc.

Pransky: Computer Motion was a public company and InTouch Health a private one. As the CEO and co-founder of each, what have the differences been for you? In other words, what pros and cons can you share for other robotics entrepreneurs?

Wang: Computer Motion was my first time through the whole process. I really learned a lot on how to start, grow and build a company up. With Computer Motion, the fortunate thing is that I found some business mentors.

One in particular was Bob Duggan, who really was instrumental in helping me learn how to be an entrepreneur, and to drive that to its level of success. Having to construe that whole cycle of private funding, raising capital, going public and merging with another company, has provided me with a better understanding for my second time through the whole process with InTouch.

There are pros and cons of both. The reality of being a public company and being held fully accountable for the financial metrics is a great challenge. The pros are you have a lot more flexibility with regard to capitalizations, strategies, a lot more flexibility in terms of board compensation, and perhaps a lot more visibility. A smaller company is always working to become more visible so that customers can see them.

On the private company side, the advantage is you don’t have that massive constraint of the quarterly measurements by the public market, and you don’t have your stock moving up and down on a daily basis, which you just know everybody in the company’s watching. You don’t have to deal with those things.

But then you have much more constraints with regard to access to capital, and you do have to optimize the structure for things like that.

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