Mark Slack: CMR Surgical and beyond

Chris - Set the scene, then. A person who sits down at your robot, what's their experience as a surgeon compared to if they've got to stand over the patient with the probes going in to do keyhole manipulations. For people who haven't seen this, you blow up someone's tummy with gas and then stick tubes down that you then put your tools in, don't you? So how does this differ when they're using your robotic experience?

Mark - The big way that I show this to people who are not necessarily keyhole surgeons and so on, is I use what we call a dome; so, it's a model and I hang a tiny needle on the end of string, into the dome, and I give them a normal laparoscopic kit and say, "Pick up the needle." And they can't. Then, I do the same in a robot: I put the needle into a dome, I put the robot into it and I say, "Try and pick up the needle." And, instinctively, they can get across and pick up the needle. So I believe we can train people much quicker and much more effectively on a robot than we can with keyhole surgery.

Chris - Is the robot intervening in the procedure? When you move, presumably a joystick or a paddle, to manipulate the objects inside the patient, is that a direct connection or is the robot saying, I know what Mark wants to do, but he's not doing it as well as he could so I'm going to intervene and change it a little bit to make it even better?

Mark - Not yet. That's, I think, quite a while away. At the moment it's a slave master. The surgeon remains the master and the robot is a slave. What it does is it gives you better vision, it gives you precision, it gives you better control and, as I said, it reduces training duration. But at the moment it's still 100% - all the decisions, all the work, all the movements - are controlled by the surgeon that's operating it.

Chris - Could you, in the future, do that, though? Could you see a future where you, as an expert in some of those procedures that you've helped to pioneer, could sit in Cambridge and operate on somebody in Cape Town?

Mark - Telesurgery is a big and interesting area. Some years ago, they did an experiment where a surgeon called Jacques Marescaux operated in Strasbourg on a patient in New York. But in order to achieve that, they laid a cable, and they did it the day before 9/11 - so they got not a lot of publicity out of it. There's trouble with the speed of light. If you are operating a very long distance away, when you move your hand, the instrument will be slow to move on the screen behind you. Technologically, we will overcome those things to a degree. At the moment, what we do have is, when we did our first lung case in Germany, the surgeon supervising - it was the middle of Covid, it was in England - was able to watch over a television monitor and give advice. That's something that's growing quite fast. Actually having a surgeon operate remotely, it's a whole different conversation because would you want your surgeon to be 300 kilometres away when things went wrong? I don't know.

Chris - What about doing a road test on a procedure? Everyone's different, everyone's anatomy is different inside so, therefore, though we have a generic way of approaching things, it's the skill of the surgeon being able to drive over those bumps in the road that are going to be specific for that patient. So can you take your system, take really high quality scans of that person, build a sort of rendition, a mock up, and almost play a computer game to try out your approaches to see what's going to be the best way down that road? Is that one way to learn or to try tough procedures?

Mark - Now Chris you've got me worried that you've been going through the company's files! I think that's one of the most exciting areas. I've just been visiting a simulation laboratory where they make really high fidelity models. And so, yes, I do see you could do a scan of a person's anatomy, you could build the model out of plastic or synthetic substances, and the surgeon could then practise the surgery ahead of going in. I do think that's within reach, very soon in fact.

Chris - Did you think this was going to take off the way that it did? Did you see yourself sitting here, we are in one of your offices, that's a sign of success, isn't it, that you haven't just got one office in one building, you've got multiple buildings in multiple places. Did you see it taking this trajectory and at this sort of pace and reaching this sort of scale when you started all this?

Mark - No, not at all. As I always say, if I knew then what I know now, I probably wouldn't have started. But anyway, here we are. I thought it'd be like all my other projects that I'd brought in. I suspected I'd continue to be a gynaecologist at Addenbrooke's practising happily and then I would do a day or two a week at the robot. But it just became impossible. I couldn't keep up. While I've maintained a very close contact with my colleagues in Addenbrooke's, and I have an honorary contract, I had to come full time because the volume of work was so high. Did I see it going where it's going? I hoped it would. What people don't realise, Chris, is that thousands of people, millions of people, are injured and die as a result of poor surgery, and something's got to be done internationally to improve surgical training and surgical outcomes. I think the robot is one of the ways of achieving that goal. A million people die in the world due to surgical complications. That's a big figure. We give the coronavirus a good run for its money.

Chris - How do you switch off at the end of this? Is it sports, still? I know when you were younger you said it began really running around a racetrack, that brought you into contact with the medical profession. Are you still doing that kind of thing? You still derive that pleasure and that switch off opportunity from sport? Or do you put your energies elsewhere?

Mark - People said, do I still run? I said, "I think these days you'd call it jogging." So I don't run competitively at all. I still like to go out and do a bit of exercise. I love sailing. My wife introduced me to dinghy sailing, so it's nothing big or expensive and we like as a family to sail and my boys sail as well and that's lovely. I also have two daughters. They don't sail, but I'm ambitious I can persuade them to join us. So sailing for me is one of the places I get away completely, I walk away from everything and I get in the water and I'm pretty bad at it. I'm sort of sailing for my life as such. The other one is I enjoy cooking and I don't know that I'm a stunning cook, but it's again somewhere where I can switch off a bit and just enjoy it. I just enjoy time with the family, going for walks and things like that. I don't switch off as well as I should - my wife does have a complaint about that.