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November 21, 2016 Issue



Automated Continuous Irrigation System with Robot for Changing the Solution Bags during Laparoscopic or Endoscopic Surgery



Amir Gilead

Chief Executive Officer




Interview conducted by:

Lynn Fosse, Senior Editor, CEOCFO Magazine, Published – November 21, 2016


CEOCFO: Mr. Gilead, according to your site, FlowMed is a continuous irrigation system. Could you tell us what continuous irrigation is?  

Mr. Gilead: Continuous irrigation sounds like something in agriculture, but in medicine it is the operation of cleaning the lens of laparoscopic equipment during laparoscopic or endoscopic surgery. In this type of surgery, the surgeon enters through a small hole or through an opening in the body with a thin tube. A laparoscope or an endoscope displays the image of the operation or inspection site onto a screen. When operating inside the body, usually there is bleeding and the lens is often covered with blood. The image on the screen is blurred, so the surgeon is not able to see what they are doing. The traditional way to clean the lens and the area is by washing with a solution that is administered from a plastic bag through plastic tubes into the surgical tool. This rinses the lens. The diluted blood is suctioned out through another opening in the surgical tool. The plastic bags of solution hang on the pole and when the solution runs out, the nurse needs to swap out the empty bag with a new one. If the nurse does not do it in a timely manner, due to error or too many simultaneous tasks, then blood covers the lens, obscuring the image and the surgery stops. Imagine that you are under anesthetics and bleeding. The screen shows a blurry image. The surgeon cannot stop the bleeding until the nurse swaps the bag, starts the flow, and only when the blood has cleared, then the surgery continues. Actually, this stoppage of the surgery causes a lot of tension in the OR, is a source of risk to the patient, and a waste of time, which is money.


CEOCFO: What have you developed at FlowMed to change what has been happening?

Mr. Gilead: We have automated the swapping process. We developed a robot, where six bags are loaded to the robot. One of them is designated as the buffer bag. Each bag is weighed. When the system senses that the active bag is close to empty, the buffer bag continues to supply the required flow. The system removes the spike from the active bag, moves it to the next available bag (that is full), removes the bag's cap and pushes the spike into the new bag. It opens the flow from this new active bag and closes the flow from the buffer bag. In this way, the flow never stops and the problematic situation that I described before does not happen. Our system is actually a robot that maintains continuous flow, preventing unnecessary, wasteful, and dangerous halts during surgeries.


CEOCFO: Where are you in the development process?

Mr. Gilead: We had the idea, applied for a patent, and the patent was accepted, in the US, in June 2016. We still have applications pending in Europe and Israel. We built the system and began clinical trials in a university hospital in Israel. We participated in several procedures using the equipment, and they were all successful. We now need to take all the feedback that we received from the clinical trials and implement it into the next model. We need to build the next model and receive approval.

CEOCFO: What has been the reception from the medical community?

Mr. Gilead: Every physician that we met says that if this system will be in the OR they will certainly be using it. Everyone has experienced the problem as it actually happens quite often during procedures. We also have shown that we can reduce surgery time, and that easily translates to money saved. Our system also saves money on tubing and solution bags. The estimated savings is $30,000 to $70,000 a year, per system. On our board, we have three MDs that are very excited about it. We are in a situation where the medical community thinks that this is a viable solution and is the future for every OR. This task has to be done automatically.


CEOCFO: What was the biggest challenge in creating the technology? Has this been tried before?

Mr. Gilead: There were several ideas for developing continuous irrigation systems. The concepts, ideas, and patents had several tubes connected to several bags, opening one after the other. However, this meant that after surgery, many bags that might not have been used were thrown away. With our system, the next bag is opened. In our next model, we will also be using the solution remaining in the bag for the next surgery by maintaining sterility of the bag while in use. The system ingenuity is in its simplicity. We have a patent on it.


We also have three other pieces of challenging technology:

  • Weighing the bags successfully, even as they are held by the bag neck

  • “No return set” (as described above), enabling continuous use also for the next procedures

  • Identification of the tubing with RFID, prevents the system from accepting used tubing ensuring that sterility is maintained. It also prevents third party sales.

These are technologies that we implement in our system and the thing is that our innovations in technology enable significant improvements in the way that solution is administered.


CEOCFO: Are you seeking funding or partnerships?

Mr. Gilead: The Israeli innovation authority funds 40% of our expenses. The rest is from private investors and municipal investors. At this point, we have used most of these funds. Therefore, we need the next round. We are bringing a real solution and we have a big potential market of $1.2 billion for systems, and another $200 million per year in disposable sets (plastic tubing). Therefore, all together it can be a very good return on a comparatively small investment. The good thing is that we are very close; about a year from actually starting to sell. Another point is that also big companies in operating room equipment are going in the direction of OR automation. This is exactly, what we are doing. Therefore, once we start selling, whomever has invested money with us is likely to receive a very fast and large return when such a company purchases the technology.


CEOCFO: How have your past ventures helped you in FlowMed? What have you learned from previous efforts?   

Mr. Gilead: First, I am a veteran of the high-tech industry. I started my career in medical equipment. Later on, I was in some other fields such as semiconductors and robotics. All these helped me to understand the ability of technology to accomplish amazing things and how to develop ideas and solutions. Whenever you have a difficult problem, you know that you can reach a solution. Developing this belief is very important, because there are very difficult times in startups and you have to find solutions, otherwise you get stuck. Also, regarding achieving funding; I was involved with this in previous startups, which helps me in understanding that the next person that I talk to might be the one who that we are actually looking for, and is able to believe that everything can be done.


CEOCFO: What will change in the next iteration of your system?

Mr. Gilead: In our present system, we included a pump. We realized that there are many kinds of pumps that control the flow of the solution into the laparoscopic tools according to the procedure and the surgeon. Our next system will include only the bag swapping part, which will reduce the cost by half, reduce the regulation needs and enable us to reach larger market. It will increase our success. Since something like 50% of the bags are wasted we found a solution that maintains the bags for the next procedure. This saves a lot of medical solution, a lot of plastic waste, and is better for the environment. It will also make preparing for the next procedure shorter. This is because if you have the system loaded with six bags and you only use half a bag on that procedure, you can continue to the next procedure without any preparation, where before you had to remove the bags from the previous procedure and load new bags for the new procedure. These and other things that we learned from our clinical trial will be implemented in our next model.


CEOCFO: There are always many new products in the medical arena. Why does FlowMed standout?

Mr. Gilead: First, our only competition is the historical nurse, poles, and bags system. We stand out by bringing automation to something that should have been thought of long ago. For example, suction in hospitals is something that is automated, and oxygen now comes from a wall outlet. We stand out by bringing medical solution automation into the OR. It is a simple and a good solution; saving money, which is the direction of every hospital today. Management looks at how to save money. Initially they say, “Well, if I buy a robot it costs me money instead of saving money, because I do already have a pole, a nurse and bags". However after understanding the benefits they realize the savings and say: "Since now we throw away the partially filled bags, and since stopping the procedure or preparing the solution for the next operation wastes OR time, and since we might be risking patients and causing complications, we will be saving money". If you do the full calculation, you see that it is better to have the robot that takes care of everything and actually saves money. As I said at the beginning, it saves $30,000 to $70,000 per system per year.


“Our only competition is the nurse, poles and bags. This is what they are using. Therefore, we stand out in bringing automation to something that should have been thought of long ago.”- Amir Gilead





Amir Gilead








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