INTO THE FUTURE
Trends such as robotics coming on stream
Arecent BBC Panorama programme asked the question ‘could a robot do your job?’ which left many of us wondering if we’d be rendered obsolete by machines.
While there is no way a robot could ever replace a surgeon, robotic technologies are being used by surgeons during certain procedures already and this will be one of several trends likely to shape the future of the med-tech sector in Ireland.
First introduced in the 1980s to place a needle for a brain biopsy, robot-assisted surgery involves the use of an advanced surgical tool to perform minimally invasive surgery.
The device includes up to four robotic arms equipped with surgical instruments, which are controlled by the surgeon from an operating console a short distance from the patient.
Designed to give surgeons greater control, access and accuracy during the surgical procedure, the technique has been used in a wide range of surgical procedures to date, including diseases in urology, gynaecology, cardiology and diseases of the head and neck.
In addition to supporting the surgeon, it benefits patients by minimising trauma and scarring, enabling them to heal faster after surgery.
Jeanne Bolger, vice president venture investments at Johnson & Johnson Innovation – JJDC, says that robotics is becoming increasingly important in helping surgeons deliver optimal outcomes to patients and there are ongoing efforts globally to improve the technology around surgical robotics.
For example, this year Ethicon – a medical device company in the Johnson & Johnson family of companies – entered into a strategic collaboration with Google with the aim of advancing surgical robotics.
“This collaboration is interesting as it brings a new player into the med-tech space. Google has started to actively invest in healthcare and will bring its expertise in informatics, Big Data and algorithms to bear while Ethicon brings the technical aspect in understanding clinical problems. Johnson & Johnson has significant expertise from being in the operating theatre with surgeons and innovations often come from understanding the physicians and the challenges they face in healing patients,” says Jeanne.
Reduction in risk
Staff mechanical design engineer at Stryker Instruments Ireland Conor Mac An Tuile agrees that robotic-assisted surgery has become popular based on the reduction in risk to patients due to the accuracy provided by the navigation technology involved.
“Using robotics means the cutting tool will only dissect the bone required during surgery and the risk of severing critical soft tissue such as an artery is virtually eliminated. While navigated surgery has been around for a while, it is being expanded to make it suitable for more procedures,” he says.
“The future of med-tech will continue to be about companies continually innovating to improve patients’ lives, whether that is a new product that reduces risk in the operating room, reduced recovery time or aids the surgeon. By watching the surgery happening and the tools used, med-tech design engineers will continue to create user needs and develop concepts based on what they have witnessed – for example new ways to reduce the size of incisions in order to make the procedure less invasive and therefore reduce recovery times.”
Last May Stryker Instruments launched a product that had been three years in the making based on this approach to innovation – the Precision Oscillating Tip Saw – which is a device used in orthopaedic procedures.
“The day after it was launched, the product was used during a procedure on the knee of an elderly patient in Boston who had arthritic, weak bones. The surgeons decided to wait until our product was launched to perform the procedure due to its soft tissue protecting and cutting control features as the existing product on the market may have led to her bone fracturing. The procedure went perfectly,” says Conor, who was one of the many Stryker employees in Ireland who saw a video of the feedback from the case.
Jeanne says that in general terms the advances happening now in surgical robotic technologies are leading to more standardisation in practice and more positive outcomes for patients.
“If you think of the old way of doing surgery, you think of people being opened up with large incisions from the bottom of the breastbone. Nowadays it is all microsurgery that leverages technology guided by the surgeon. There has been a major revolution in neurosurgery where wires through veins and arteries are being used instead of having to open the skull. Less invasive surgeries such as these are much better for patients in terms of hospital stay and recovery times.
“Because of these transformational technologies surgeons can operate on more patients and have more predictable outcomes. As surgical robotics becomes more mainstream even surgeons outside of highly specialised centres are empowered by this technology.”
Med-tech meets ICT
Ibec group the Irish Medical Devices
Association (IMDA) has highlighted the convergence between medical technologies and information and communications technology (ICT) as a major trend influencing the future of the sector.
In practice, this translates into a totally connected world where drugs, devices, diagnostics and ICT are integrated allowing things like remote patient monitoring using wearable technologies.
It has led to the emergence of the so-called ‘smart factory’, known as Factory 4.0, where the internet of things allows equipment and mobile devices to talk to each other without human interaction as well as ‘additive manufacturing’ – which is defined as the process of joining materials to make objects from 3D model data.
“Consolidation of hospitals and insurers, reduced government spending on healthcare and increased demand for services has put price pressures on the provision of med-tech products. There is now a real drive for increased data from med-tech companies to produce better patient outcomes,” says director of IMDA Dr Sinead Keogh.
“A major opportunity exists for the med-tech sector to leverage the benefits that converging technologies bring as Ireland is home to the top ten ICT companies in the world.
“To stay at the forefront it is important that we build capabilities and infrastructure in terms of new business models that can adapt to connected health solutions, which will be demanded by patients, and also in terms of ‘Factory 4.0’ and additive manufacturing. As such we have called on the Government to fund the establishment of an industry-led research and technology institute for Factory 4.0.”
It is Nypro Healthcare’s view that the medical device ecosystem is rapidly changing from the standalone ‘device – patient – physician ‘ model to include access and mobility outside the hospital.
“With all the technology advancements and the need to deliver care in all healthcare settings including the home – this presents many benefits but also challenges as we move forward,” says Padhraic McGinn, general manager of Nypro Healthcare Bray, whose core business is to provide a ‘one-stop shop’ from early device concept through to high volume production and packaging.
“It is critical that medical device manufacturers should have a considered strategy on how mobile connected health and the internet of things will affect their current business model.”
Nypro Healthcare’s Bray and Waterford facilities are already ahead of the curve in this regard, Padhraic notes, having developed a strategy which included the creation of a world-class device development design centre co-located with manufacturing facilities.
“This capability is supported by our purpose built Blue Sky Centre in San Jose California which is a showcase for advanced technology solutions leveraging all industry sectors,” he says.
“Technologies such as optics, printed electronics, low power electronics, radio frequency and wireless are all of great value in terms of developing innovative connected devices.”
Factory 4.0
Michael Daly, group engineering manager, Mergon Group, a technical moulding and automotive solutions provider, believes that Factory 4.0 has the potential to change the world.
“Right through the healthcare system things will become much more automatic. Because of better communication across mobile devices, hospitals will feed right back to the manufacturers which will see where the value in their device is and how to design the next device better with the customer in mind,” he says.
“It will lead to mass customisation rather than mass manufacturing. 3D printing will allow companies to produce one-off parts at low cost. It has already allowed titanium ribs to be made for a patient in Australia which saved their life and work is currently being done on creating living organs using this method.
“Convergence of technologies will lead to a situation in the medtech sector where companies are potentially not selling actual devices but the hours taken to run those devices – it’s a new business model already in use by the likes of RollsRoyce which now makes most of its revenue from the running hours of aircraft engines rather than the engines themselves.”
The skills revolution
As Sinead notes, advanced and additive manufacturing and the emergence of convergent med-tech will fundamentally impact the skills needed to work in the industry.
“We must embrace the skills revolution, adopting strategies to ensure continuous up-skilling and development of Ireland’s workforce so that they have the skills needed today for the med-tech businesses of tomorrow,” she says.
“There is huge potential for future growth, but this will only be possible if suitably qualified and skilled people are readily available.”
Established in 2008, the IMDA Skillnet provides training, upskilling and cross-skilling to medtech, pharmaceutical, biologics and biopharma manufacturers and has grown substantially in recent years in direct response to industry needs – to date it has trained over 4,000 trainees and delivered over 20,000 training days to companies.
“The key to the success of the IMDA Skillnet is that it provides enterprise-led training. A steering group of companies drives its agenda and bridges the necessary gaps,” explains Pauline O’Flanagan, manager of the IMDA Skillnet.
“For example, the group identified a growing skills need for regulatory affairs professionals in light of European directives pre-2020. We then developed the first full master’s course in this area for medical devices in conjunction with NUI Galway and Sligo Institute of Technology. It is designed to aid the conversion of people working in quality roles to regulatory affairs.”
A survey of IMDA members earlier this year revealed that 81% of companies are looking for engineers while 45% have vacancies for regulatory affairs personnel.
Looking to the future, Pauline says an important development this year was that IMDA Skillnet was approved to deliver a new manufacturing technician apprenticeship and manufacturing engineer apprenticeship for the med-tech sector.
“This will form part of the future dual education system and help address the fallout of students from third level education engineering courses as well as providing a new route for young people into the sector,” she notes.
THE FUTURE OF MED-TECH WILL CONTINUE TO BE ABOUT COMPANIES CONTINUALLY INNOVATING TO IMPROVE PATIENTS’ LIVES