Hypervision Surgical
2/4/2024
By:
Donald Harmitt
Snapshot
Founders
Michael Ebnor
Tom Vercauteren
Sebastien Ourselin
Jonathan Shapey
Founded
2020
Stage
Seed
No. of employees
~20 (as of Feb. 2024)
Headquarters
UK
Total Funding
~$8 million
Thesis (TL;DR)
Over 300 million surgeries are performed each year. More complex procedures are a matter of life and death depending on whether the surgery is successful and complication-free during and post-operation. Yet, surgeons still rely on the human eye to determine critical outcomes such as the adequate removal of healthy tissue and whether a tissue is sufficiently perfused. These are important factors to prevent post-operative complications which affects patient outcome and lead to morbidity in some cases, and is also a cost burden to patients and healthcare facilities if follow-up procedures are required.
Current medical imaging tools used during surgery for tissue characterisation and visualisation, include ultrasound imaging, intraoperative computed tomography (CT), MRI, and others. However, these procedures have their drawbacks such as radiation exposure, require the use of exogenous contrast agents, extremely costly, and takes up a sizeable amount of space in the operating room. Hyperspectral imaging is a relatively new innovative method which addresses these disadvantages, while providing clear intraoperative characterisation of tissues and fits seamlessly into the surgical workflow.
Hypervision Surgical is a medical imaging company using safe light to guide surgeons during surgical operations equipping them with computer-assisted tissue analytics with the goal of patient safety and outcome, and precision for surgeons. Hypervision Surgical’s medical imaging system offers real-time tissue characterisation using AI, is hardware agnostic, fits into the surgical workflow, and does not require exogenous contrast agents.
Company Overview
Hypervision Surgical
Hypervision Surgical is on a mission to equip clinicans with augmented vision using cutting-edge computer-assisted analysis for improved surgical precision, to enable greater patient outcomes. Hypervision Surgical is building an advanced propreiatary surgical imaging and data analytics platform which leverages AI and edge computing to transform surgical outcomes, making it easier for surgeons to discern healthy vs infected tissue without using contrast agents.
Problem
Up to 12 out of 100 surgeries have surgical procedures which involve complications. With over 300 million procedures performed annually, this becomes a considerable amount of complications per year. These complications can be caused by a surgeons lack of abillity to completely discern healthy vs infected tissue with the naked eye or through standard surgical red/green/blue (RGB) imaging cameras. This increases the already complex surgical procedure when deciding which sections of the tissue need to be removed or remain intact. Joining two areas after infected tissue removal via a surgical connection, leads to further issues if they are not well perfused. For instance, 10% of severe complications occur in bowel cancer surgery, of which 35% have a slim chance of survival. There is a clear gap in the market for an objective interaoperative imaging system which provides objectivity in tissue characterisation in real-time, enhance patient outcome and surgical precision
Hypervision Surgical is addressing several key problems:
Lack of existing intraoperative imaging which produces real-time feedback and spatial resolution, while meeting stringent operative constraints in the clinical environment to seamlessly integrate into clinical workflow
Reliance on surgeon’s subjective visual assessment to completely discern healthy vs unhealthy tissue in critical operations such as neurosurgery
Increased patient complications and healthcare costs due to incomplete tumour removals or minimal healthy tissue preservation
Founders
Product/Technology
Hypervision Surgical’s advanced technology leverages the application of light to achieve a non-invasive and non-contact medical imaging system for tissue visibility and characterisation during surgical operations. The hyperspectral imaging system provides real-time surgical guidance allowing surgeons to distinguish between healthy and infected tissue which is invisible to the human eye and to existing standard red/blue/green medical imaging cameras.
Hypervision’s imaging system works by splitting light into a number of spectral bands beyond the red/blue/green and provides diagnostic insights into tissue properties. The secret formula behind the real-time capabilities is the use of their partner NVIDIA’s (Clara Holoscan and AGX) GPU-accelerated processing power to leverage edge computing and GPU parallel processing in achieving low latency and high performance. This combined with AI computing allows real-time recording and playback analytics from this integrated system, differentiating Hypervision’s imaging system from competing technologies in the clinical setting.
The Hypervision Medical Imaging system consists of a HSI camera connected to a computational workstation which processes the data captured from the camera into real-time characterisation of the input data. The connecting link is the source of the power needed to support the real-time monitoring. The system benefits from both manual dexterity or can be held in a fixed position depending on the requirement of the clinician for a particular surgical procedure. The HSI camera is connected to an optical scope which controls zooming and focusing, and is linked together via an eye-piece adapter. The flexibility, sterility, and design requirements of the system is key in ensuring seamless integration into the clincal workflow, differentiating Hypervision’s technology from other systems. A schematic diagram below adapted from the Hypervision Surgical team’s research paper offers a visual schematic of the system configurations.
Source: Hypervision Surgical
Hypervision Surgical Imaging Example
Hypervision Surgical Imaging Schematic
Source: Hypervision Surgical
Key Features:
Wide-field tissue characterisation
Real-time tissue analysis
Quantitiative AI imaging including perfusion assessment of tissue and blood vessels
Surgical workflow interoperability
Customer Benefits
Hardware and procedure agnostic – used with open to minimally invasive, robotics, and microscopic surgeries
Non-contact measurement – quantitative intraoperative measurements can be executed without patient contact using artificial intelligence
Real-time and wide-field tissue information – allows differentiation and monitoring of healthy vs normal tissue vs other types of bodily components, increasing surgical precision and safety
Independent of exogenous contrast agents – no injection of exogenous contrast agents required which reduces side effects
Business Model
Hypervision Surgical is undergoing clinical evaluations for brain and colorectal surgery to further progress to commercialisation. The company needs to provide evidence of economic and clinical effectiveness to healthcare providers and insurers to inform the reimbursment payment process. The company is currently evaluating suitable software-based business models, including charging a fee per surgery, akin to typical payment models for many medical devices.
Hypervision Surgical will likely need to start with individual hospitals with sufficient budget before achieving reimbursement and adoption on a national scale, as long as insurers are willing to cover the device. Per pay use business model appeals to a wider market, as the device becomes more accessible to a broader range of healthcare providers including those who might have limited financial resources to afford the upfront cost of purchasing expensive equipment. This widens the customer base for Hypervision beyond large hospitals and practices.
Pricing
Hypervision is considering charging a fee per surgery as a potential business model. Looking at other competitors pricing models, Activ Surgical charges a fee of $150,000 per year upfront (which works out to $12,500/month).
Depending on the type of mobile C -arm (medical imaging devices based on X-ray technology) used for intraoperative imaging, these machines can range from $40,000 to above $250,000. Hence, Activ Sugrical’s Imaging platform is priced well below the more expensive C-arms but also considerably above the lower-end. This is likely to recognising the value-add of the product while remaining compeititve on pricing to increase adoption. Depending on predicted adoption rate and annual usage of the product, a charge per use pricing model will need to be priced effectively to ensure the premium is high enough to recognise the value-add of surgical complication cost savings while aligning with healthcare provider’s propensity to pay for the device at a suitable price point.
Strategic Partnerships
Market Snapshot
Forecast Period
2023-30
Market Size (Base Year)
~8-12B
Market Size (2030)
~17-31B
Compound Annual Growth Rate (CAGR)
~9-14%
Estimated Total Addressable Market (TAM)
~3B
Source: Venture Views Analysis (Market size calculations are based on average 3rd party market research reports). The TAM is calculated using both a top-down and bottom-up approach and is based on the European and North American market only.
The global intraoperative imaging market is forecasted to reach between £22-30 billion with considerable growth at 9-14% CAGR driven by a range of factors such as the rise in minimally invasive surgery and the need for surgical precision. This has been supported by the increased digitisation within medicine driven by more compact and innovative imaging solutions, AI, and machine learning. Due to the rising geriatric population increasing pressure on healthcare systems, I believe there is substantial room for growth within the intraoperative imaging market. One of the reasons for this is hospital centres are increasingly focused on patient-centred care, e.g. PCORI in the US, which means clinicians prioritise providing the best care to improve patient outcomes using the most efficient solution to meet vast demand and the rising incidence of complex medical conditions. Intraoperative imaging gives surgeons that third eye to navigate surgical sites during operations to more accurately achieve appropriate removal of unhealthy tissue or tumours, reducing the need for subsequent operations and improve patient recovery and outcome.
AI has left no stone unturned and is also infiltrating the intraoperative imaging space especially in hyperspectral imaging and extended reality applications to provide insights in real-time, enhancing the surgeon’s precision and decision-making ability. As AI and edge computing continues to advance, we will see an acceleration of the capabilities within real-time imaging capabilities potentially incorporating predictive analytics during surgery, and analysing intricate detail beyond the human eye. However, the high costs of imaging equipment is a key restraint for the market, as healthcare providers are seeking the most cost-effective method to integrate into their operating room. We are likely to see cheaper solutions using more innovative technologies such as extended reality and hyperspectral imaging. As these technologies are radiation-free, more cost-effective, and have a smaller form factor (physical footprint), we can expect to see an increasing market share as the market matures.
Drivers:
Rise in minimally invasive treatments e.g. laparoscopy
Growing investment in digitisation e.g. AI within the healthcare system across developed economies
Increased prevalence of chronic conditions like cancer and cardiovascular illnesses resulting in more surgeries being performed
Growing geriatric population increasing demand due to higher prevalence of surgeries among the elderly
Competition
Source: Venture Views Analysis. The list is not exhaustive.
The intraoperative imaging competitive landscape is segmented into various application types such as fluoroscopy systems, ultrasound, MRI, and more recently hyperspectral imaging is emerging as a novel means to enhance a surgeon’s visibility beyond the human eye. If we take a look at the landscape, the majority of players are concentrated within fluoroscopy which account for majority of the market share, using systems called C-arms which leverage x-ray pulses to achieve real time imaging. Healthcare incumbents such as GE, Philips, Medtronic and others currently hold respectable market share within this fragmented space and collectively hold a high enough share of the market to create a relatively high barrier of entry for new players. This is due to established brand positioning of these companies, purchasing power, and high capital expenditure required to build C-arm systems. Startups and more early-stage players are emerging using new and innovative applications such as extended reality (mainly augmented reality), and more recently developing from R&D and clinical trials we are seeing hyperspectral imaging. As fluoroscopy, ultrasound, and MRI are all long-standing applications within intraoperative imaging, early-stage players have taken the opportunity to leverage new technologies to tackle the downsides of the conventional methods to demonstrate the superior clinical and economic effectiveness of these new methods. Extended reality has gained traction as competitors are using augmented reality to achieve real-time visualisation and is a direct non-invasive competing procedure used by competitors such as Activ Surgical. On the other hand, incumbents are primarily focused on enhancing their current products as seen with the shift from C-arm image intensifiers to flat-panel detectors, to enhance the interoperability and integration into surgical workflows and these systems already have a reimbursement system set up for adoption across the respective target markets. I believe we are likely to see increased M&A activity occurring in the near-time, however, large players with C-arm and ultrasound technology will need to thread carefully in order to prevent cannibalisation of their revenue core products, if hyperspectral imaging systems prove to be significantly superior for clinicians in the long-term.
The hyperspectral imaging subsegment is very nascent and is just protruding from R&D stages as the clinical equivalence to current applications is being demonstrated. Hypervision Surgical’s system has multiple advantages over the current applications such as non-invasiveness, genuine real-time visibility due to edge computing, and no requirement for using exogenous contrast agents. More importantly, their product’s form factor is relatively smaller compared to current C-arm systems and will take up less space in the operating room while providing seamless dexterity. Currently, the competitive landscape within the hyperspectral segment is primarily companies which focus on solely manufacturing multispectral cameras, or companies which create multiple components (e.g. camera and data analytics tool) or the end-to-end system. I believe we will see an influx of emerging players in the near-term as the technology matures, R&D expenditure increases in this space already shown by the increase in research papers/trials, and as manufacturing prices for real-time images decrease driven by the fall in graphic processing chip prices as the semiconductor shortage moves behind us.
Key Risks
High cost for surgical imaging systems driving slow adoption
Hospital budgets are limited and new medical device uptake requires clear evidence of economic and clinical benefits. Surgical imaging systems are costly with some competitor devices costing upwards of ~$150,000 per annum. Financial and budgetary restrains may deter hospitals from taking the leap to purchase Hypervision’s product, leading to slow user adoption
Required training and user proficiency
Healthcare professionals will need tailored training to fully realise the potential of the product especially in a pivotal procedure such as surgery. This will require time and costs to train clinicians which could drive reluctance to adopt Hypervision’s imaging system.
Growing competitive environment with alternative solutions
A number of emerging startups are entering the space using different types of solutions to provide innovative real-time imaging techniques such as C-arms and intraoperative ultrasound systems. Competitive threats will likely arise using hyperspectral imaging but also new entrants from other technology solutions vying for market share. This will depend on the favourable technology by healthcare providers for real-time tissue characterisation. However, Hypervision’s use of hyperspectral imaging boasts advantages over other alternatives due to not requiring exogenous contrast agents and being hardware and procedure agnostic.
Latest Investors
Latest Funding Round Amount: £6.5 million
Lead:
HERAN Partners
Redalpine
LifeX Ventures
ZEISS Ventures
Financials/Perceived Valuations
Hypervision Surgical raised £6.5 million in their latest funding round (as of March 2024), lead by a syndicate of Health Tech investors including HERAN Partners, Redalpine, LifeX Ventures, and ZEISS Ventures. Regarding future valuation, once Hypervision Surgical becomes revenue generating, we can look at similar public companies to potential understanding what sort of price to sales (LTM) range we could expect. For instance Basler AG price to sales (P/S) ratio has fluctuated between 1.5 to 2.6 in 2023 but has reached as high as 7.3 in Q3 2021. This is similar to other MedTech companies such as Fujifilm and Olympus (parent company of Quest Medical Imaging) who has a P/S ratio of 2.2 to 2.9 and 3.3 to 4.3 in 2023, respectively. According to Eqvista, the Enterprise Value/Revenue ratio industry average for Medical Electronics company is 3.86, which aligns closely with the examples given above. This can act as a guide for expected future valuations as Hypervision Surgical achieves commercialisation.
Recent News
July 2023 – Hypervison Surgical achieved ISO 13485:2016, a globally recognised standard implementing strict design, development, manufacture, and distribution practices.