Start-ups series: Vibrations in the body show the surgeon the way

Minimally invasive procedures have long been established. Around 20 million needle interventions are performed worldwide every year, and around 4 million knees are treated arthroscopically. The good thing for patients: as long as there are no complications, the surgical method causes less pain, recovery is quicker and there are no unsightly scars. For the doctors performing the procedure, this means that in many cases they have to place their needles very precisely, for example in the spine, without sight or technical assistance. They have to rely on their sense of touch and experience. This can lead to errors and complications.

„Duel of steady hands“

Anyone who has ever played "Doctor Bibber" knows how easily an "ouch alarm" can be triggered during an operation. In the well-known board game, the "duel of steady hands" according to the manufacturer's advertising, children slip into the role of the doctor.

The founders of Surag Medical GmbH, Moritz Spiller and Alfredo Illanes (both CEO), Nazila Esmaeili (CSO) and Thomas Sühn (CTO), are working to ensure that everything goes well during minimally invasive surgery in the adult world, without an "ouch alarm", so to speak. Surag's technology - a portmanteau of "Surgical Audio Guidance" - enables non-invasive and continuous monitoring of minimally invasive procedures, which can make them more precise and increase patient safety.

The team of founders (from left): Moritz Spiller and Alfredo Illanes (both CEO), Nazila Esmaeili (CSO) and Thomas Sühn (CTO) ©Hans-G. Unrau, Unrau Fotografie

The technology is based on the use of vibroacoustic signals that are generated in the instrument during the procedure and transmitted to the operating room via loudspeakers. The sensor units react to the smallest vibrations that occur when the doctor hits tissue structures with his needle - similar to how they are perceived by instruments that measure vibrations in the earth.

Expertise from earthquake research

Co-CEO Alfredo Illanes comes from precisely this field of work. The doctor of engineering transferred the experience he gained in earthquake research in his home country of Chile to medicine at Magdeburg University Hospital. This is also where the four founders met - as members of a research group. "Alfredo gave us the concept of using sensors to analyse vibrations in the needle," says Moritz Spiller about the beginnings of the company, which was founded in 2021 as Surag Medical GmbH.

Competitors are approaching the existing problem in minimally invasive technology in other ways that require new instruments. Moritz Spiller: "We, on the other hand, have used standardised interfaces to attach our sensors to the back of existing instruments. This means it never comes into contact with the patient's tissue. This allows for a low risk class, which means less effort is required for authorisation. However, the technology also offers a cost advantage for users. We are talking about vibration sensors and they are very cheap. That's why we can offer this for 30 euros per operation today. 

The technology was developed from the initial idea to product maturity in close collaboration with doctors from Magdeburg University Hospital and other hospitals abroad. "We had access to existing medical equipment, could actually go into the operating theatres and talk to the doctors every day. This constant feedback had a massive influence on our development. That's why our products also come from practical experience. A doctor described a problem to us and we designed a solution for it," reports industrial engineer Spiller, who is responsible for organisation and financing issues at Surag.

Nominated for entrepreneur award

Over the years, the founders have received funding from various sources for their practical and promising research approach: for example from the German government's Exist research transfer programme or from business angel Professor Michael Friebe and the experienced product developer and regulatory expert Dr Axel Boese, who also encouraged the founding of the company. In 2021, Surag Medical was then part of the 4C Accelerator in Tübingen, an incubator specialising in the promotion of innovations in medical technology. The nomination in the start-up category of the prestigious "Saxony's Entrepreneur of the Year 2024" award in April 2024 is likely to provide an additional boost.

 
Surag took first place at the Female Founder Challenge 2022 in Berlin. ©Surag Medical GmbH

So far, everything has gone according to plan and there should be no problems with the next round of financing, which is due in the summer, especially as all technical issues seem to have been resolved. What is still missing is certification. The desired authorisation for the European market is expected in the middle of next year.

Only then can Surag start thinking about making money. "We will start with sales partners from the medical technology trade in Germany and Europe, at least for the large area, because building up our own sales team requires an extremely large amount of resources," says Spiller. Contacts are already in place with medical technology companies worldwide. However, one or two of the company's own sales staff are to be deployed regionally around the current company location in Leipzig in order to have a direct line to important customers and receive unfiltered feedback.

Cooperation with robotics companies

Spiller sees a large field of application for Surag sensors in robotics. It is expected that more than 20,000 surgical robots will be in use worldwide by 2030. They too - or even more so - will need reliable support when navigating the body. Spiller: "Our technology is very versatile. We have vibrations in all instruments, not just needles. We are already offering other medical technology companies that manufacture robotic systems the opportunity to develop our technology for their applications."

In future, AI is to be used there, which can report feedback directly to the robot in electronic form. "That's where we actually want to develop: into a system house for smart, autonomous medical technology, both with our own products and through partnerships with established manufacturers, and we already have good contacts with the top 5," says the CEO, outlining the Surag team's vision for the future. This could make it possible to make minimally invasive surgery even safer across the board and at the same time help doctors and hospitals to be economically successful and thus keep the costs of the respective healthcare systems under control.

"Every time an ouchie is successfully removed without the alarm being triggered, the little doctor receives money." This is the path to success in "Doctor Bibber" - but also in reality.