Toronto robotics startup hopes to expand options for surgical procedures

Trauma surgeon Joao De Rezende-Neto stands by an operating table in the simulation area of St. Michael’s Hospital in downtown Toronto.

On the table in front of him is a silicone replica of part of a human abdomen. His eyes remain fixed on the screen above the table, showing the view of a camera inside the abdominal cavity.

In Dr. De Rezende-Neto’s hands are the controls for slim robotic arms that are, currently, inside the abdomen and grabbing at a fake gall bladder. With the twist of a wrist, the roll of a thumb or the pull of a trigger, the surgeon can use the tiny grabbers at the ends of the robotic arms to perform delicate tasks, such as stitching up an incision.

The makers of the device – Toronto startup Revolve Surgical Inc. – hope to bring it to hospitals across Canada and the United States in the coming years.

They say the tool makes it easier for surgeons to conduct laparoscopic procedures, in which a surgeon makes small incisions in a patient’s abdomen and inserts tools and a camera. The company says its device expands options for these procedures, which improve patient outcomes, at a price that is far more affordable for cash-strapped hospitals than other robotic aids.

The team recently celebrated a major milestone: Bringing the device from simulations to a real operating table. Dr. De Rezende-Neto performed the first human surgery – an appendix removal – with the Revolve arm on Oct. 1.

The road to that first real human operation has been a long one for the co-founders. Matthew Kang and Peter Francis first met during placements working on surgical tools at the Hospital for Sick Children in the summer of 2015, while they were graduate students in engineering at the University of Toronto. (Another co-founder, Alex Gordon, left Revolve this summer to join another company.)

Mr. Kang said their goal was to create and commercialize a new surgical device that helped patients. “We wanted to make something that would have a real, truly positive impact on people,” he said.

They founded Revolve in 2019, and went through two startup programs shortly after: the Creative Destruction Lab at U of T in 2020 and the famed Y Combinator in Silicon Valley in 2021.

Since then, Revolve has held some early fundraising rounds and continued to iterate and improve the technology. Its surgical arm received investigational testing approval from Health Canada and premarket clearance from the U.S. Food and Drug Administration last year.

The human testing at Unity Health Toronto is the team’s first pilot project. It began this year with a goal of using the device in three patients who needed their appendix removed and met certain eligibility criteria.

Dr. De Rezende-Neto, who has given advice to the Revolve team for years, says their device fills a gap in the market that few other technologies can fill in North America right now.

At the low end of the market are regular laparoscopic procedures that allow the surgeon to operate without needing to open larger holes in the patient, greatly improving recovery.

But Dr. De Rezende-Neto says that traditional laparoscopic tools have limited range of motion. The robot-assisted Revolve system can do much more, which opens up options for procedures that can be performed laparoscopically. “This, to me, is the main advantage of this robot,” he said.

At the high end of the market are remote-controlled robotic systems that can be operated from a console at a further distance. Revolve’s system is not as advanced as those options, but also not nearly as expensive. Mr. Kang said Revolve is hoping to price its system to be a fraction of the seven-figure cost of the more advanced robotics – such that a hospital could stock all their operating rooms with Revolve systems at the price of one advanced system.

The team is also building capacity into the Revolve system to eventually integrate AI, Mr. Kang said, with the hopes it will assist surgeons with precise movements.

Developing the technology has been slow in some ways because of the need to be careful and keep patients safe, he said.

But “truthfully, some of the harder challenges are working within systems that move maybe at a different pace than we’re used to,” he said.

Medical technology companies founded in Canada have long said it is hard to build a sustainable business selling to Canadian hospitals and health authorities because of limited budgets and risk aversion.

Mr. Kang said Revolve’s main market for selling devices will be U.S. health care providers.

“While we are so proud to be Canadian and love our health care system here, the truth is just that the American market is more primed for innovation and adopting newer technologies earlier,” he said.

Even so, the Revolve team has been making the devices in-house so far, and is in talks with local manufacturers to continue making them in Canada when they are ready to build at scale, Mr. Kang said. The team hopes to make its official commercial launch next year.