Operating rooms being offered cutting-edge, Zoom-like tech

Console uses overhead cameras to project live images of procedures

Operating rooms tend to be busy places, often bustling with not just the surgeon, but also a phalanx of aides, students, technical advisers and, yes, medical device sales reps. That’s not exactly an ideal environment for physical distancing.

Avail Medsystems, a Palo Alto, Calif.-based startup, is promising a better way for managing operating-room crowding in the age of COVID-19. The company is growing its fleet of “procedural telemedicine” consoles, a high-end Zoom-like service for the operating room that allows surgeons performing live procedures to collaborate with long-distance viewers following via a tablet or laptop.

The Avail console uses mobile overhead cameras to project live images of a procedure up to 30 times their actual size onto an HD monitor.

For an idea of what that means, onlookers — both in person and remote — can easily count a patient’s individual eyelashes from two metres off the surgical table, and annotate those images by touchscreen, in real time.

Both medical-device makers and investors are warming up to the product. In Avail’s latest Series B fundraiser, billionaire Dan Sundheim’s D1 Capital Partners pumped $100 million (U.S.) into the medical technology company with participation from technology-focused firms 8VC, and repeat investors Lux Capital, Sonder Capital and others.

The vote of confidence from D1, a high-profile fund, comes a few months after Avail closed a Series A fundraiser in March bringing total investments to $25 million. It installed its first console into a hospital in January.

Clinched deals

“In the work from home world, this is the largest industry — medical equipment — in the country that has no work-fromhome capability in any meaningful way,” said Avail chief executive officer Daniel Hawkins. Having the ability for medical device reps to remote in was less urgent until the pandemic struck with full force last winter. Reps are more than just salespeople. Doctors performing operations have come to rely on their expertise and guidance as modern devices become more complex and intricate.

Most sales reps don’t have a medical degree, but they are trained to know everything about how devices function. When a hospital buys equipment it can also get as part of the deal a rep to guide surgical teams on how to use each product’s various components. Unknown to patients, their presence amid procedures has become commonplace.

To date, Avail has clinched deals with a dozen large and mid-cap medical-device companies, and has 40 more contracts in the works, according to Hawkins. Avail’s remote link to operating rooms works on a subscription pay-for-use model.

The company installs the consoles at no cost. Hospitals, device companies, researchers and anyone else seeking to beam feeds in or out of the operating room are charged for the minutes used. Avail, which leases the consoles from a manufacturer, is selling a package of the equipment and its own software developed specifically for operating room communication.

Complex surgeries

“When COVID-19 hit, we had to take a different strategy,” said Dr. Bill Nicholson, a cardiologist and the director for complex coronary and cardiac intervention at Emory Healthcare.

Earlier in the year, he’d used the Avail console to train students on how to perform complex surgeries at various health systems in York, Penn.

But now Nicholson uses the technology to create a rotation of surgeons and aides who could come into the OR one week and work from home the next — a model not unlike rotational programs employed by banks at the beginning of the pandemic.

That’s allowed fewer people to be in the operating room at any given moment.

Nicholson is an avid user of the service. Working from home, equipped only with his iPad, he has advised surgeons with lesser experience how to do complicated procedure, such as threading a catheter through a patient’s arm into the heart’s main valve to improve blood flow.

Through his iPad, Nicholson has been able to virtually tap into one of almost 100 consoles that Avail has in hospitals and out-patient surgery centres around the U.S. At his insistence, Emory Healthcare is installing nine consoles in its facilities next week.