Mark Slack: Innovating new medical technologies

Chris - How did you then end up on this path to where we are sitting today? You've come to the UK, you are working in obs and gynae and you're doing academic/clinical work around that. But how does that translate into being a co-founder of what's dubbed in the industry a 'unicorn,' a business that's gone from a startup to worth more than a billion in valuation in a very short space of time? Take us on that journey.

Mark - Going back, Chris, to your original question, you said to me, "Why medicine?" There was the personal, meeting the doctors, there was the fact that my teachers were saying, "Well, you do quite well at school so maybe medicine is a good line for you," to getting into medicine and finding, gosh, I really enjoy this, this is really fascinating and there was just so much that I found interesting. And then, when I qualified, it became even better. I really found I enjoyed it. I became quite obsessed with it. When I first came to the UK I was now a qualified gynaecologist and working in a DGH, but myself and an Australian colleague started introducing new operations which hadn't been done in the UK before, which we introduced and wrote up and published. I met this chap, Marcus Carey, who's the professor in Melbourne, and I met him in Canterbury. We've now had a lifelong of working together academically and that was the spark of what really became my expertise. I realised I think quite laterally - I would have ideas and one of my professors took me aside one day and he said, "You know, Mark, you've got some really interesting ideas in your head. Just keep them in your head until you have the proof to justify them." That was the best advice I ever got because I then started learning to do the research to prove the points that I was trying to convey to people.

Chris - And how does that turn into the technology that you've gone on to help develop?

Mark - So the first one we introduced was an operation called Sacrospinous Fixation, which was the first paper of its kind in the UK and it's a very commonly performed procedure now. I was then doing a lot of research and doing a lot of pharmaceutical trials, and that's when I started finding that I would see things and think, 'That doesn't make sense and perhaps it could be done differently.' So I co-invented a machine to measure pressures in the bladder and so on, which was then taken to global launch by Johnson and Johnson. Then I did another operation with Marcus which, again, we took to global launch with J&J. So it grows. You start and then, I suddenly realise, 'Well, I have a skill here where I seem to have ideas that I can translate to something relatively useful.' That is the next part of that journey ahead of the robotics starting.

Chris - How did the robotics get started, though? Was that because, all of a sudden, there was a technological revolution? The internet's there, so there's rapid transmission of information and data, there's computers that are sufficiently powerful to make this sort of thing possible, there's cameras and endoscopes and that kind of thing that make this kind of technology now possible. Is that how it happened?

Mark - There's a far more simple story as well. One of the things that's happening is, I trained a lot of laparoscopic surgeons and realised that I couldn't train all of them to do the operation at a level that it really needed to be done at because laparoscopic keyhole surgery, as we should rather call it for the listeners, is technically really difficult and not everybody can master the technique. I was worrying, what can we do? And then of course, as you say, there was all this technological advance; there was a robot out on the market, there was computer driven early AI starting to help in all these areas and I started to think, could a robot, which has got 3D vision instead of 2D vision, it's got magnification, if you move your arm right, the instrument goes right whereas in keyhole surgery you move your arm right, the instrument goes left - there were lots of things that I thought, 'Gosh, that'll make it easier to do.' I was then looking at the robots that were around and trying to work out whether this would be a solution. But that's not actually how I got into robots.

Chris - And how did you get into robots then?

Mark - So my wife was pregnant with our first son and she was attending the National Childbirth Trust on her own and, after a couple of weeks, the woman in charge said, "Do you have a partner?" And she said, "No, I'm married." And she said, "Well, you must bring him along." And my wife said, "Believe me, leave him at home." Far less disruptive. Anyway, Luke, my co-founder then came to my wife and said, "I believe you're a surgeon." And she said, "Yes I am." And he said, "I want to speak to you about robotics." And she said, "You're speaking to the wrong member of the family. The other one at home is going on about it as well." And so Luke and I, both of us having careers where we've done lots of innovation, lots of inventing, met by chance. And it's one of those - God, I'd be presumptuous to say - but it's almost like a Beatles moment where you meet somebody special who compliments some of your own skills and talents. Luke was just inspiring to meet: intelligent beyond belief, competent, and he came round to my house, as I always say, in a car that shouldn't have been on the road. We sat down and started to discuss it in my drawing room on the ground, drinking Diet Coke. And that's literally where it started.

Chris - Imagine if you'd been drinking whiskey, it might have gone even better!

Mark - Or faster! Exactly. So Luke and I, he would then come around every evening. He worked not far from where I lived and he'd come around and we'd discuss things. I had very clear ideas of what I thought was important. He had very clear ideas and then, of course, the other founders were there as well, Paul and Keith and Martin. It literally started with five of us in Cambridge, all people working in and around Cambridge, most Cambridge graduates but all working in the ecosystem.

Chris - So what was the gap you spotted where you thought, this is the existing solution, this is the problem, this is what we can solve, and what did you do about it?

Mark - Well, the big gap was, keyhole surgery's been around for 35 years so, if it was perfect, about 80% of surgery by now would be done by keyhole, but only about 40% is. Now, keyhole surgery has a million advantages over open surgery: it reduces infections, it reduces pain, it reduces complications. And yet, despite all these advantages, in America, 'the most advanced medical system in the world,' only 40% of surgeries are done by keyhole. So clearly there's something wrong with keyhole surgery - and it's technically bloody difficult to do, beyond the reach of some people. So, could the direct mapping, the 3D vision, the precision of the instruments, etc., overcome that? That's what we set out to do. The robot that Luke designed was an open console allowing good communication with the teams, the hand controls just made life so much easier. I taught one of the secretaries of state to tie a knot in about 30 minutes. If you were dealing with normal keyhole, that would take about 60 hours.