Diagnostics & Imaging Week National Editor

If your word-connection skills aren't up to snuff, you might easily mistake Acrobot (London) as the name of a company associated with the circus.

It isn't, but the name does suggest acrobatics, in this case helping orthopedic surgeons avoid having to jump through hoops while conducting procedures.

The company, spun out from Imperial College London in 1999, was "development-focused" until 2006, said CEO Graeme Brookes. "During 2006, we basically took the technology and developed it into a product range. And then we wrapped a business plan around that product range and were able to get investment behind the business."

Using that impetus, "we hit the market with products in 4Q07, and it's only really since then that we have been accelerating toward commercializing that technology," he told Diagnostics& Imaging Week.

The company's name also derives from and suggests robotics, which plays also in its growth plans. But Brookes is quick to point out that there's more to Acrobot than the end-game of robotic-assisted surgery.

"The issue for us, and for me as CEO, is to try to build the brand, to help people understand what we are about, because you look at the name and it has 'robot' in the name, so people think, ah, it's that robot. But we have more than that, so we have to build sequentially in terms of adoption."

"Sequentially" means the company's two currently CE-marked products, Acrobot Planner and Acrobot Navigator, which are tools surgeons can use to more precisely carry out their procedures.

"The technology that came out of Imperial College is basically a technology which can be applied in the robotics area," Brookes told D&IW. "The difficulty in orthopedics is that getting the surgeon to move from a conventional surgical technique to a robot is quite a big stretch."

He added: "What the company did is to step back and say, 'Look, to get the robot to do what we want it to do, we have to navigate it to the right place, and to be able to navigate it to the right place, we have to have a plan. After that came a more stepwise product range which was more easily adopted."

Simply put, "We help the surgeon to plan with our planning product, and after that, to then navigate to the right place with our navigation product, and then, finally, we have Sculptor, a robotic product, which is in advanced development."

So, Brookes said, "out of this technology has evolved a sort of stepwise product range. The Planner and Navigator went on sale last year, and the Sculptor is going into clinical trials this month. We hope to have that available later this year."

Acrobot featured its work-in-progress Sculptor at its booth during the American Academy of Orthopaedic Surgeons (AAOS; Rosemont, Illinois) annual meeting in San Francisco last month.

A sort of "coming out" party for the company, AAOS was "an opportunity for us to show people what we're doing now," Brookes said, as well as "an opportunity for us to showcase the Acrobot Sculptor in its new guise, which is our core IP, now crystallizing into products to fit the operating theater.

"That's what we intended to do at AAOS, and reaction at the booth was really positive."

Brookes said that at the meeting the company featured "a lot of hands-on with the Sculptor that we had there at the booth, and the feedback from that was very positive. That's what we were looking for, to try and gauge input from the world beyond the designing surgeons. Basically, it was very well accepted."

Saying that orthopedic surgeons "tend to be conservative," he added that "they're also incredibly keen to look at what's new. Our approach is slightly different than the approaches tried in the past. It's almost a misnomer to call it robotics, because what we have is a hand-held tool that takes the cutting tip to the bone, which feels natural."

With the Sculptor system, "we have what we call 'hands-on robotics.' The surgeon is cutting the bone and is controlling how fast he cuts the bone, where he cuts the bone first and so forth. And the robotic element only switches on when he may be trying to stray into an area that he shouldn't. It's free to move within a space, in what we would call the 'safe zone.' The controls only would switch on when he's trying to move the cutting tool into the wrong place."

He said the system maps out "very accurately the shape of the prosthesis and the shape where the bone needs to be connected. We know we can cut exactly that shape. We are able to constrain the motors and prevent the bone being cut in the wrong way."

The way Acrobot sees its technology being adopted, he said, "is that we can give the surgeon something that is intuitively more like he's already doing. We're giving him an intelligent tool which tells him when he may be going wrong."

Sculptor features a robotic head mounted on an ergonomic trolley, which will be "fairly low cost."

That's what the company is testing now.

"It's not a clinical trial, purely an ergonomic test in clinical circumstances to see that what we're offering is right for the orthopedic OR," he said. "We're doing that in London, initially at one center, then branching out so we get input from a multitude of surgeons."

The company anticipates getting the CE mark for Sculptor in 1Q09, and "we will see how things progress over the next six months or so here, and then we will consider our 510(k) application in that sort of timeframe. We're looking to be on market in the U.S. by 3Q09."

Acrobot recently received European Medical Device Directive approvals for Planner and Navigator and ISO certification for its companywide quality management system, which Brookes characterized as setting the stage for broader commercialization.

"From our perspective, it's still early days for Acrobot," he acknowledged, "but we have a nice, interesting portfolio that we've had some very positive feedback on."