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A surgeon utilizing the Moon Surgical Maestro surgical robotics system. | Supply: Moon Surgical
The Moon Surgical Maestro robotic surgical procedure system faces some stiff competitors — and the system developer plans to make use of that to its benefit.
In an interview with Medical Design & Outsourcing, Moon Surgical CEO Anne Osdoit, and Chief Expertise Officer David Noonan mentioned the know-how behind what they described as their system’s key profit: the power to collaborate with surgeons.
“We’ve constructed a collaborative robotic, which isn’t essentially what you sometimes see on the market available in the market,” Noonan mentioned. “[Most] robotic arms are extraordinarily stiff. If you wish to attempt to seize a maintain of that and use it to govern it, you may’t as a result of the payload and the stiffness are what’s wanted to execute the duty.”
However Maestro is designed to let surgeons straight transfer the laparoscopic devices connected to its robotic arms and maintain them in place. That reduces pressure on surgeons and frees up assistants, rising process effectivity and effectiveness.
“When a person attaches an instrument to our system, they nonetheless manipulate the instrument in the best way that they used to earlier than, by way of its deal with if it’s a grasper or by way of the digicam head if it’s a laparoscope,” Noonan mentioned.
The know-how satisfied Dr. Fred Moll — co-founder of surgical robotics chief Intuitive Surgical — to hitch Moon Surgical first as an advisor and now as board chair.

Moon Surgical CEO Anne Osdoit. | Supply: Moon Surgical
“His first response was considerably skeptical, and till we actually had one thing to indicate him and put into his arms, it was arduous for him to image what we might be doing,” Osdoit mentioned. “That’s one thing we’re additionally experiencing with surgeons that now we have to unravel. Till they’ll contact and really feel it, what we’re doing is so totally different from the opposite surgical robotic approaches that folks have a tough time even understanding the way it’s potential and representing it of their minds.”
Touchdown Moll is only one of Moon Surgical’s accomplishments this 12 months. After successful its first FDA clearance for Maestro in December 2022, the system developer adopted up with European Union CE mark approval in April 2023. Then got here a $55.4 million funding spherical in Might and the addition of Chief Monetary Officer Anne Renevot and Business Technique VP Lisa Jacobs to the management group.
Moon Surgical closed that Collection B funding spherical lower than a 12 months after its $31.3 million Collection A spherical — and a few 12 months and a half prior to Osdoit beforehand anticipated.
“Since we introduced the A spherical we’ve had fixed inbound curiosity from traders, and on the finish of final 12 months we realized there is perhaps folks on the market prepared to present us some cash and within the present setting it could be silly to not take it,” she mentioned. “We had additionally reached numerous vital milestones that justified a brand new spherical with new pricing and new phrases. In any other case, I’m unsure our historic traders would have been supportive.”
The most recent spherical will fund growth and commercialization with a restricted market launch deliberate for 2024 and a full business launch in 2025.
Moon Surgical is bettering Maestro’s design from the primary model that received FDA and EU approval.
“It’s not a model of the system that we felt we might scale from,” Osdoit mentioned. “We have now principally translated all our learnings right into a business embodiment that not solely appears rather a lot nicer — it appears wonderful — however has the identical core structure and functionalities and incorporates a number of the learnings from our preliminary feasibility research the place we’ve handled 50 sufferers.”
To scale for manufacturing, Moon Surgical is working to stabilize the design and assemble the mandatory infrastructure and sources, notably elements for the arms that set Maestro aside.
Maestro’s gentle contact within the surgical robotics arms race

Moon Surgical’s Maestro surgical robotics system has two arms that may maintain the identical laparoscopic devices that surgeons already use. | Supply: Moon Surgical
Intuitive Surgical’s da Vinci system stays the chief to beat in mushy tissue surgical robotics. However Osdoit thinks one purpose surgical robotics hasn’t snatched a bigger share of complete process quantity — apart from the fee — is that surgeons aren’t snug working on a affected person from a surgical system console within the nook of the room.
“What we needed to do after we began Moon was present an answer that may ship the advantages of robotic surgical procedure — the issues that surgeons love — perhaps not with the whole diploma of sophistication that you may have in a da Vinci system, however one thing that may be applicable to cowl the overwhelming majority of surgical procedures, perhaps even 70%, 80% of what you’ll do with the da Vinci,” she mentioned.
Maestro’s disposable couplers permit surgeons to make use of the identical laparoscopic instruments as they did earlier than, besides they’ll do the identical procedures with one fewer individual within the room.
“The surgeon is his or her personal assistant utilizing our system,” Osdoit mentioned. “The idea is it’s the robotic that adapts to the surgeon and never the surgeon who adapts to the robots. For sufferers, we hope to extend throughput, cut back anesthesia time and provides the surgeon higher management and confidence over what’s finished throughout the process, which finally ought to flip into higher take care of sufferers.”
To do this, Maestro permits surgeons to make use of their very own arms to govern devices however holds them completely nonetheless when the surgeon releases them.
“Our structure may be very totally different to that extra conventional serial manipulator with stiff joints all the best way alongside the levels of freedom,” Noonan mentioned. “Our design really began as a haptic interface, on this case, an impedance management system which is mechanically clear.”
Whereas conventional robots are mechanically inflexible, a surgeon can seize Maestro’s arms and transfer them round, with the robotic arms making themselves really feel gentle by compensating for their very own mass and the mass of the connected instrument.
And whereas a extra conventional robotic has a motor and a gearbox to offer torque amplification, Maestro’s system has no gearboxes.
“Our torque amplification comes from the mixture of a capstan with a pre-tensioned tendon that wraps round after which goes to a bigger capstan, so we get a gear ratio by taking a capstan wrapped round a smaller diameter pulley to a bigger diameter pulley,” Noonan mentioned. “And that method lets you principally amplify the torque whereas having little or no backlash and no friction between gear tooth, which is what you get on a extra conventional gearbox.”
The system senses motor present on the motor aspect to deduce the pressure being utilized to a joint, detecting when a surgeon is making an attempt to maneuver the arm as a way to help that motion.
“We’ve bought a number of modes,” Noonan mentioned. “The arm can act as a robotic and it may well transfer our laparoscope as a way to observe the surgeon’s instruments to have the ability to reposition in a hands-free method but in addition can information the surgeon to a sure place, it may well maintain completely nonetheless, or present suggestions to the surgeon concerning what kind of pressure it’s experiencing elsewhere.”
The tendons are fabricated from stainless-steel, and the system additionally has a sequence of springs for passive compensation. Whereas the majority of the system’s weight is in its base, the group is making an attempt to drive down the mass and inertia of the linkages and transmission mechanisms that reach to the distal joints.

Chief Expertise Officer David Noonan. | Supply: Moon Surgical
“You’ll be able to algorithmically compensate for lots of stuff, however there are some issues you may’t,” Noonan mentioned. “We’re making an attempt to attenuate that perceived mass as a result of finally transparency of the system is absolutely what we’re combating for: it’s straightforward for the surgeon to maneuver it, she or he doesn’t really feel prefer it’s there, and it turns into the very best assistant for that surgeon versus a clunky or difficult device they must adapt to.”
What’s subsequent for Moon Surgical
As Moon Surgical builds extra Maestro techniques, it must clear up shortages of essential sensors like encoders.
“That’s been an actual ache level,” Noonan mentioned, with lead instances of as much as 40 weeks.
The Maestro system makes use of a minimum of two encoders to measure joint angles at every motorized axis. The entire encoders are redundant, and the system compares the sensors on every joint to ensure every joint is working as wanted — and that each one the sensors are working as effectively.
“In surgical robotics, one of many issues from a design perspective you’re all the time searching for is to ensure you by no means can have uncontrolled movement. That’s the large no-no,” Noonan mentioned. “All our joints have redundant encoders, and also you’re always trying to
detect a failure of a type of by always measuring the 2 of them.”
Moon Surgical is continually scouring the web for out there encoders, and for early prototypes even resorted to purchasing merchandise containing encoders solely for the encoders.
“In that case, it’s essential to solely have two of every thing or, , 2X of every thing. After which as we undergo our verification and validation cycle and now we’ve bought six models, we have to ensure you’ve bought 6X of every thing,” Noonan mentioned. “As we go towards commercialization and what the construct plan is for subsequent 12 months, you’re really typically making choices primarily based on what’s out there versus what you may choose.”
Moon Surgical is at the moment assembling nearly every thing within the Maestro system apart from the arms, with plans for closing testing of the arms within the subsequent few months earlier than internalizing manufacturing. The corporate’s arm provider relies in France, so internalization of the arm is to be finished there whereas the remainder of the work is going on in San Carlos, California.
“Our general technique is to maintain a comparatively lean and environment friendly manufacturing group,” Osdoit mentioned, “which signifies that because the sub-components of our system get actually secure over time, we might be capable to outsource them to OEM companions after which simply hold the ultimate meeting and testing in-house and leverage our infrastructure and group increasingly more to get extra throughput. … We’re originally.”