The Smart Magazine About Medical Technology Innovations
New Care Solutions for Overweight
“Most of the world’s population live in countries where overweight and obesity kill more people than underweight.” (WHO).
Obesity has quickly become the 21st century’s worst health problem. This creates numerous opportunities for innovation. In this special feature, we talk about smart implants, non-invasive tools and innovative devices coming both from large providers and recent start-ups
If diet, increased physical activity and medication do not sufficiently reduce weight in severely obese people, a new electronic device may help. The Maestro Rechargeable System by US-based EnteroMedics targets the nervous system and blocks vagus nerve signals between the brain and the stomach. Thus, it curbs hunger...
The Elipse is a novel intragastric balloon for weight loss treatment by Allurion Technologies that does not require invasive medical procedures or anesthesia when being placed inside or removed from a patient’s body. Dr. Shantanu Gaur, co-founder and Chief Scientific Officer at Allurion Technologies, recounts his company’s path to innovation.
Interview Of Dr. Shantanu Gaur
Chief Scientific Officer, Allurion
MedicalExpo e-magazine: Shantanu, when most medical students still learn how to take patients’ histories, you co-founded your own healthcare company with your classmate Samuel Levy in 2009. How did you come up with the idea?
Dr. Shantanu Gaur: We were in our second year at Harvard Medical School, and very interested in developing medical devices for large unmet needs. So Sammy and I would keep a running list of different problems and ideas that came up during our lectures.
What struck us about weight loss and obesity was that between diet and exercise on the one end of the treatment spectrum, and weight loss surgery on the other, there were very few solutions available. There was a clear gap, which we wanted to fill.
ME: What were the main steps you had to take, until actually holding The Elipse in your hands for the first time?
SG: The first step was to recognize that people had been trying to fill that gap for quite some time. And from studying the clinical literature, we found that intragastric balloons were the most widely tested devices in that category.
But while proven safe and effective, intragastric balloons were limited by a need for endoscopy and anesthesia, when implanting and removing them. That raised the total cost of the therapy, and also made it necessary to work with endoscopy-trained gastroenterologists.
So we thought it would be a pretty neat idea, to take the balloon concept, but make it a procedureless treatment, that different types of physicians could offer. Once we had a really good sense of what we wanted to create, we went to the fabric store, got some raw materials, and hand-stitched our very first prototype. From that we filmed a video, to help us raise some money.
Around that time, we also got connected to Dr. Ram Chuttani and Jonathan Wecker, who were key in the formation of our company, and in building our network of investors, so that we could do more sophisticated prototyping.
It can be swallowed and excreted without endoscopy or anesthesia
ME: Which features of your device do you consider to be the most innovative?
SG: The innovation that really gave rise to Allurion is the ability to build a balloon from film that is extremely thin, yet strong and chemically resistant enough to last in the stomach. It can be swallowed and excreted without endoscopy or anesthesia. When we did our first human study in October 2013, we used a balloon that lasted for six weeks. The one we are using in our most recent clinical trial this year is intended to last for four months.
ME: With a view to commercializing your product, can you tell us something about the key areas you are currently working on?
SG: We are in the process of applying for the European CE marking, and we intend to start commercializing The Elipse in Europe after we get approval. Simultaneously, we are contemplating our U.S. FDA strategy, and hope to start collecting some U.S. clinical data in the near future. Once we feel comfortable with the clinical data, and have the European approval, a lot more markets around the world open up to us, and we will consider them very seriously.
ME: Is there something the healthcare industry can learn from your path to this innovation?
SG: What everyone in medicine should understand now is that innovation comes from the most unlikely places. It does not take a seasoned medical device executive or a very senior physician to come up with a good idea. All it takes is a really keen understanding of a common problem, and a simple solution that a lot of consumers would want. That is really where the biggest innovations in healthcare are going to come from in the coming years.
Although obesity is a chronic problem, most weight-loss programmes based on dietary restriction unfortunately do not lead to long-term weight reduction. The average dieter often finds that over time, they end up heavier than when they began dieting. On the other hand, bariatric surgery, even in morbidly obese...
This holographic computer is worn like glasses. It allows professors and students to see in front of them the entire human body in 3D, to move it around and to remove and replace parts. This system of mixed reality—virtual reality superimposed on the real world—offers a view of the nervous system, the skeletal structure, the different organs and even blood circulation.
There is no screen to touch or mouse to click. The user simply gestures to create, shape and size the holograms.
Students can use it in class to clearly see muscles overlying the skeleton
According to Microsoft, HoloLens makes it possible to “bring a digital world into a real world.” Built on Windows 10, its combination of specialized components enable holographic computing. The optical system works in coordination with sensors, and the device contains more computing power than the average laptop. It is also completely untethered—no wires, external cameras, phones or PC connections are needed.
Students can use it in class to clearly see muscles overlying the skeleton. They can render the body translucent to look inside and understand cardiac anatomy.
A Case Western student who took part in the HoloLens project explains on the university website that when he saw the aortic valve in 3D in front of his eyes, he understood for the first time where it was and how it really worked. According to Mark Griswold, Case Western Professor of Radiology who experimented with the prototype, this technology could “improve students’ confidence in learning anatomy” without the stress of learning on a cadaver.
Endoscopy is a minimally invasive diagnostic procedure used to examine the interior surfaces of organs and tissues. Due to its use in a wide variety of areas and its adaptability to any type of surgical procedure, the global demand for endoscopy is very high. Advancements in endoscopic technology have created new opportunities for early and accurate diagnosis and treatment through the introduction of minimally invasive surgery, capsule endoscopy and robot-assisted endoscopy.
North America holds the largest share of the global endoscopy market, accounting for $14.1 billion in 2014, while the Asia-Pacific zone is the fastest growing region. Johnson & Johnson (Ethicon), Olympus and Covidien are the market leaders, holding a combined share of more than 50% of the global endoscopy device market in 2014. Other major players include Boston Scientific, Conmed, Fujifilm Holdings, Hoya, Karl Storz, Smith & Nephew and Stryker.
Growth Factors and Risks
IQ4I Research & Consultancy analysis indicates that the global endoscopic device market was valued at $32.3 billion in 2014 and is expected to grow to $47.4 billion by 2020. Endoscopy procedures offer an enhanced view of body organs. Their expansion is benefitting from both the rising demand for minimally invasive surgery and technological advancements such as high-resolution 3D systems, capsule endoscopy, and miniature endoscopes.
On the other hand, the shortage of endoscopic technicians and contamination risksassociated with the procedures are factors of concern which are expected to hamper market growth.
Endoscopes, Visualization and Documentation Systems
The global endoscopy market includes endoscopes, visualization and documentation systems, endoscopic accessories and services. Among them, endoscopes commanded the largest market of $12.73 billion in 2014 and sales are expected to reach $17.3 billion in 2020 with a CAGR* of 5.3%. Visualization and documentation systems are expected to grow at the highest CAGR of 9.7% during the forecast period. Narrow band imaging (NBI), high definition imaging (HDI), third eye retroscopes, double balloon endoscopy, capsule endoscopy and robot-assisted endoscopes are some of the technological advances in this field.
The global endoscopy market includes arthroscopy, bronchoscopy, cardiopulmonology, colonoscopy, laparoscopy and the ENT, gastroenterology, gynecology/obstetrics, neurology and urology fields. Laparoscopic applications represent the largest market of $8.67 billion. This figure is expected to increase at a CAGR of 7.4%, reaching $13.27 billion by 2020. Neurology applications are expected to grow at the highest CAGR of 10.3% during the forecast period.
An international team of engineers from South Korea, Switzerland and the United States is working on microscopic magnetic robotic beads that could act like “swimmers” and may one day be used to break up blood vessel occlusions.
These microrobots are chains of three or more iron oxide beads, linked together via chemical bonds and magnetic force. These chains are very small, on the order of nanometers, and can navigate in the bloodstream like a tiny boat.
American mechanical engineers at Drexel University explain that the beads are put in motion by an “external magnetic field that causes each of them to rotate.”
Because they are linked together, their individual rotations cause the chain to twist like a corkscrew, the movement propelling the microswimmers. By controlling the magnetic field, researchers can control the speed and direction of the microswimmers.
These microrobots may one day be able to navigate even the narrowest vessels, drilling through occlusions that would otherwise be inaccessible.