Titan Medical CEO Sees ‘Unique Opportunity’ for Enos Surgical Robot

Cary Vance, CEO of Titan Medical [Photo from Vance’s LinkedIn page]

Titan Medical CEO Cary Vance discusses Enos robotic surgery platform, Medtronic and supply chain silver linings.

Medical Titan Chairman and CEO Cary Vance said he knew what he was getting into when he was approached to lead the robotic surgery company.

“The challenges, I knew what they were,” said Vance, who had served on the company’s board for two years when he became CEO of Titan in July. “I knew we had the opportunity to meet these challenges and I knew the people I would be working with…could make sure the strategy we had was executed.”

Vance sees “a unique opportunity” ahead of Toronto-based Titan, who is fabrication of the Enos surgical robot platform with plans to enter clinical use next year.

In June, Titan delayed its Investigational Device Exemption (IDE) submission timeline to the FDA for the Single Access Robotic Surgery System, push back from the first quarter of 2023 to the middle of the year. The company said supplies of some key components and materials delayed production and verification and validation testing.

Titan still has an early 2025 release date if all goes according to plan through the regulatory process.

“You not only have to follow this process and execute it, but you also have to be able to anticipate,” Vance said. “Think about pricing, reimbursement, business strategy. You also need to think about the innovations that need to happen post-launch. Just because you’re competitive in 2025 when you hit the market doesn’t mean you’ll still be competitive with that exact product in 2027.

“You need to be able to add additional functionality that meets certain market needs,” he continued. “We intend to do that.”

About Titan’s Enos Surgical Robot

Enos has a light, a camera, and several arms that drive instruments beside the table. Instead of multiple arms coming from multiple directions and through multiple incisions, the arms, instruments, and camera enter the patient’s body through a single 25mm insertion tube.

Because the arms go through a single insertion, they have to be dexterous. Vance described them as snakes in terms of flexibility. They have reach and flexibility, but also stability to grip and move tissue.

Titan Medical Enos Surgical Robot
The Enos surgical robot platform. [Image from Titan Medical]

With an open procedure, however, surgeons need to be able to see what’s going on, Vance said. Titan’s Enos has cameras for viewing. This includes a tilting 3D HD camera allowing physicians to focus on the surgical site while remaining present in the room.

Vance said Titan’s platform offers intuitive hand controls and comfort for the physician. Physicians’ comfort ensures they don’t get so tired that they rush processes or make bad decisions.

The single incision has advantages for the patient: reduced pain and reduced risk of infection and scarring. This means less need for opioids and painkillers, faster recovery time and faster discharges.

“We try to make sure we’re talking to all stakeholders,” Vance said. “When you think of surgery like this, you think of the doctor, their comfort level, their ergonomics, their ability to see and do what they need to do. … We think when we go to the market, if we want people to care, [the system] must tackle the real value drivers that exist.

Titan’s work with Medtronic

Titan has a long-standing relationship with medical technology giant Medtronic, including a range of purchase orders, milestone payments and more.

In September, Titan and Medtronic have reached a development agreement on surgical robots. The agreement based on a 2020 Development and License Agreement. Titan has achieved all three milestones set out in the agreement, including raise $18 million in capital in October 2020. In May, Titan signed a $2.6 million purchase order with Medtronic provide instruments and cameras for preclinical activities.

“Medtronic’s interest has been in Titan’s ability to innovate,” Vance said. “That was the genesis of the arrangement we had about two and a half years ago when we were asked to develop technology for them.”

Vance said the arrangements with Medtronic brought a bit of a culture shift to Titan. This transformed what he considered a “culture of execution” into a “culture of accountability”.

There is an additional benefit in the purchase contract. Titan manufactures instruments and cameras for Medtronic preclinical use. In doing so, Titan increases its own savvy around this process by being able to “look over its shoulder a bit,” Vance said. Witnessing Medtronic’s preclinical work may help Titan use this same technology with its own system.

“We’re really proud of our team,” Vance said. “Like any small business, you really have to learn how to execute milestones well. I think we were able to do that very well for them, both in the time frame and at the level of technology that they were looking for. They were very happy with us and they paid us. They wouldn’t have paid us if they weren’t satisfied.

Navigate supply chain conditions

The supply chain issues that delayed Titan’s regulatory timeline had silver linings.

Vance said the effort to address these issues has brought Titan closer to its manufacturing partners. For example, while Titan makes its own instruments and cameras, it outsources the manufacturing of the doctor’s workstation and patient cart to a company called Benchmark.

“It’s a tough macro environment in the supply chain,” Vance said. “Because of that, it’s not like we can just say, ‘Here’s the design. Here is what we have. Build it.’ It was us, working on the phone daily and going to their facilities with them coming to ours to help creatively figure out how to overcome it.

Vance put it simply: time is money, and money is survival in Titan’s business. The company cannot waste a day or even a minute. These supply chain constraints forced companies to get creative and fostered a strong response from Titan and a better relationship with its contractors.

“We are very pleased with our ability to resolve this issue,” Vance said. “We have some really smart people on our board who are dealing with this issue on a much larger scale. They gave very good advice on the different avenues we can take to solve it. It was very helpful.

The future of surgical robotics

Is the surgical robot space getting too cluttered? Intuitive Surgical remains a leader, while Medtronic and Johnson & Johnson play their game. Smith+Nephew, Stryker, Zimmer Biomet and many others are also competing.

RELATED: 16 Surgical Robotics Companies You Need to Know About

But competition can be a good thing, with rival companies pushing each other and together helping to make robotic surgery mainstream.

“It’s good for companies to push the envelope,” Vance said. “Small, large, multi-arm, single-arm, endoluminal, disposable, it’s all here. … I think the rising tide of business is going to lift all the robotics boats.

The challenge remains to provide the best solution economically, clinically and logistically. Even with all the companies around, Vance thinks Titan will still be second to market in the single-access space, after Intuitive.

Even in the competitive environment, Vance believes a piece of the market is there for Titan.

“Can we take some of that market share? We believe we can, but with the market share that [Intuitive has], they’re still in the single digits of the number of surgeries being performed,” Vance said. “The whole picture is moving from laparoscopic and manual surgeries to robotic surgeries. We have barely scratched the surface.

Christine E. Phillips