Medtronic’s Hugo system is making robotic-assisted surgery more cost-effective and accessible than ever before. The modular and portable apparatus includes a tower, console, pedestal, monitor, surgical instruments, pedals, and four robotic arms that surgeons can control to perform minimally invasive medical procedures. It is equipped with 3-D visualization technology and cloud-based video capture capabilities. Hugo is one of the most elegant and complex medical devices on the planet—but Ishak Akyuz remembers when it was little more than duct tape, bolts, and two-by-fours.
Akyuz is Medtronic’s chief counsel, responsible for legal affairs associated with the company’s surgical robotics business. He’s spent the last eight years in east coast labs helping a cross-functional team of mechanical engineers, electrical engineers, regulatory advisors, quality control inspectors, patient safety consultants, and medical affairs experts design, build, and test Hugo prototypes.
The sleek surgical robot started out as a sketch on a whiteboard. Akyuz was one of the first robotics employees at Covidien (which Medtronic acquired for $43 billion in 2014), and says the start-up atmosphere was full of inspiration, innovation, and ingenuity. Inventors, scientists, and engineers left no stone unturned. In the early days they experimented with off-the-shelf objects, brought tools from their own garages, improvised using parts from industrial robots, made last-minute trips to the hardware store, and tinkered after closing time.
It was all done in the name of science. Akyuz and his colleagues were on a quest to design the best product to decrease size, drive down costs, reduce the barrier to entry, and bring new possibilities to robot-assisted surgery. “Technology and robotics will change the future of healthcare, but current solutions are too expensive to use. We are changing that,” Akyuz says.
Minimally invasive surgery offers many benefits. Surgeons encounter fewer variables and enjoy greater control. Patients recover faster with shorter hospital stays, less pain, and smaller scars.
The Hugo project team set a series of short sprints with timed goals and went through about eight prototypes. Akyuz arranged legal protections for the novel ideas his colleagues generated and worked to negotiate and license existing software and technology, including IP from DLR—Germany’s research center for aeronautics and space.
Once they had a viable and working model, Hugo entered its testing phase. Surgeons entered Medtronic’s labs to test the device in various conditions, while control experts worked around the clock to ensure quality and reliability.
Finally, in 2021, Medtronic was ready to introduce Hugo to the public. While hospitals and health systems were receptive to the modular, upgradable, and open console design, Hugo still needed to prove its performance abilities and clear regulatory hurdles. In June, doctors in Chile first used the system for a prostatectomy. Later, surgeons in Panama performed a series of gynecological surgeries with the device. In October the Hugo system received the necessary CE mark approval to make it available in Europe and Akyuz says the team recently received approval to use Hugo in a clinical study in the United States.
These steps are helping Medtronic put pressure on Intuitive Surgical, whose $1.5 million da Vinci systems fill operating rooms around the world. Although Intuitive has enjoyed an uncontested monopoly for two decades, Hugo is built to compete. “We designed this robot with patients and surgeons in mind,” Akyuz says.
Medtronic’s design team interviewed hundreds of doctors to build a user-friendly, patient-centered, cost-effective alternative to the market leader. Da Vinci is hard to move; Hugo is portable. Da Vinci is expensive to repair and maintain; Hugo features individually upgradable components. Da Vinci has an immersive console that makes collaboration difficult; Hugo has an open console, making it easy to share ideas and engage with the surgical team.
Despite the availability of da Vinci for over two decades, just a small number—Akyuz estimates 3 percent—of all surgeries are completed with robotic systems. That means Hugo has the chance to compete by expanding the playing field.
The global COVID-19 pandemic, skills shortages in healthcare, the increasing cost of care, and other factors are driving the demand for robot-assisted surgery to an all-time high. Some industry experts expect it to nearly triple, reaching 11.8 billion by the end of 2025. Akyuz believes Medtronic will be ready to meet that demand.
Data and analytics will be a key part of that process. Medtronic recently acquired Digital Surgery for its advanced video recording, storage, and data capabilities. Practitioners can use related solutions to get analytics and compare a surgeon’s performance against peers and industry benchmarks to advance training and align with best practices.
Other pieces of software can pre-scan surgical areas and alert surgeons about possible polyps. While these innovative features ooze with potential and actionable insight, they also raise privacy and data security concerns that Akyuz diligently addresses.
It’s another way he’s helping Medtronic find a competitive edge, and in the “robot wars,” a little bit of competition is good for the industry. With new players entering and companies going head-to-head, patients come out on top.