January 10, 2023

Zeta Surgical - Building the Robotic Surgery Platform

Nathanael Wang

State of Surgical Navigation Systems

As the state of technology and medical knowledge has vastly improved over the past twenty years or so, the ability to create and utilize computer-based applications that track surgical instruments positions throughout a procedure has become a reality. These devices are known as surgical navigation systems (SNS), and they have revolutionized how doctors work within the operating room, streamlining the overall operative workflow and aiding pre-operative planning with intraoperative navigation.

These systems work by combining pre-acquired magnetic resonance imaging (MRI) or computed tomography (CT) with a tracking system. The tools are then “registered” in the system and provide accurate spatial information during their interventions, helping reduce surgeon error and reducing hospitalization times. Currently, the surgical navigation system market comprises three primary products: legacy navigation systems, neurosurgical robots, and mixed/augmented reality. However, all of these products present some major challenges, including slow deployment times, the ability to be used only within the operating room, and requirement for the patient to be anesthetized.

This can be problematic as many surgical procedures, specifically in neurosurgery, if emergent, have to be performed in ER/ICUs, and due to the issues of SNS mentioned above, these procedures have to be done with freehand. For example, usage of the External Ventricular Drain (EVD) is one of the most common and most important life saving procedures done in the neurologic intensive unit. Unfortunately, since SNS is limited to intraoperative care and is not available bedside or in the Emergency Department or ICU, most EVD is currently done with freehand. With no guidance and a high skill level requirement, EVD suffers from an unstable success rate of ~60-90%. Other procedures that are not commonly guided, thus resulting in varying effectiveness and success, include Deep Brain Stimulation (DBS), Low Intensity Focused Ultrasound (LIFU) and Transcranial Magnetic Stimulation (rTMS).

Enter Zeta Surgical. Targeting the neuronavigation market, Zeta aims to revolutionize the way that neurosurgery is done, shifting the traditional practice of asleep/OR-based workflows to awake/outpatient-based ones.

About Zeta Surgical

Think about ultrasounds. They are portable, quick, widely accessible, and they ultimately have a variety of usage cases that are applicable to emergency and everyday types of cases. According to co-founder and CEO Jose Amich, Zeta Surgical’s goal is to create the “ultrasound” of robotics and surgical navigation, vastly expanding the currently limited usage of only intraoperative cases.

The way that Zeta is able to make this ultrasound-type of device a reality is through its real-time patient tracking, markerless registration technology, sub-millimeter accuracy, and autonomous robotics. The core of their technology is operated off a computer-vision based algorithm developed by co-founder Raahil Sha. This first-of-kind technology differentiates Zeta from the other major competitors because with their dynamic neuronavigation registration system, if the patient were to move or slip during the procedure, Zeta would not require re-registration, reducing case time and ensuring effective, accurate tracking throughout the entirety of the procedure. With this type of real-time registration, neurological procedures that were reserved for the operating room can now be done bedside on an awake patient in an emergency room setting, and the 30M+ US trauma patients can be better served and cared for  in their emergent state of being.

In addition to the real time registration that is happening at multiple times per second, Zeta also boasts impressive speed and accuracy that many other companies fail to offer. With Zeta’s tools taking less than 10 minutes to get up and use, procedures will take a lot less time than if it had been performed in an operating room and hospital caseload can more than triple what it is currently. While its product is both quick and versatile, Zeta does not sacrifice any accuracy in the process. Several preclinical studies with Zeta’s software prototype on a medical model and human cadavers demonstrated Zeta’s accuracy of placement to be around 0.8mm. For reference, the gold standard of surgical navigation systems is approximately 1 mm.

TSVC’s Conviction

When looking at our investment thesis, TSVC focuses on three primary pillars: the market, the technology, and the team. Fortunately, Zeta Surgical satisfies all three.

Starting off with the market, Zeta would like to first focus its efforts on EVD, and they eventually would like to work on solutions for DBS, LIFU, and rTMS. The global EVD market was $5.3B in 2019 and is expected to grow to $9.5B by 2027. rTMS and DBS are both billion dollar markets and are expected to grow to 9-10% within the next five years or so. LIFU is currently in its very beginning stages of usage, but it has been proven to be extremely useful in the field of neurosurgery and for neuromodulation. Zeta plans to be the first versatile LIFU system in the market, drastically lowering the cost by replacing the MRI component in current LIFU systems.

The technology involved is pioneering and first-class. Armed with an extensive IP portfolio, including their software, competitors will have a tough time catching up or arising due to the immense number of technical factors involved. Generally speaking, no other company has the technology with the same speed, accuracy, or ability to register and track a patient over time. Additionally, these other companies’ systems are not available for bedside or outpatient use, making Zeta the first “lightweight” SNS in the market.

The team is composed of two young co-founders: CEO Jose Amich and CTO Raahil Sha. Both are graduates of Harvard and  have been partners for many years. Jose is a natural entrepreneur, showcasing a strong domain knowledge, leadership skills, and passion for his project. Raahil is an excellent software engineer, developing Zeta’s core computer-vision based software and is constantly working to improve the algorithm. While they are new to the complex medtech industry, they have a strong advisory board backing them up and a good connection with Harvard Medical School.

With the potential to expand a fast-growing neuronavigation market, proprietary algorithm software, and a dedicated and knowledgeable team, TSVC strongly believes in what Zeta Surgical can bring to the table.







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