Photography by Gareth Iwan Jones
Milena Mileva and founder Prof Chris Hancock (right) watch a demonstration at Creo Medical’s lab
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When it returned, Margaret Kirkham’s lung cancer was just a spot on the chart, but sinister nonetheless.
Doctors told the retired careers officer that more radiotherapy was impossible, while a big operation on such a small growth was too risky.
But Mrs Kirkham was lucky. London’s Royal Brompton Hospital was trialling a new procedure that was promising to transform the treatment of lung cancer, a disease notoriously hard to see or feel until its late stage.
It involved a doctor inserting a tiny robotic catheter, developed by US surgical technology leader Intuitive Surgical, via the patient’s windpipe to follow a ‘map’ of the lung created by an earlier scan. Creo Medical’s MicroBlate Flex device was inserted into the catheter to treat the patient’s cancerous lesion.
Like others in Creo’s precision endoscopic toolkit, this miniature instrument can destroy (‘ablate’ in medical speak) cancerous nodules in their infancy, targeting them with super-high-frequency microwave energy.
In Mrs Kirkham’s case, the procedure took minutes. She made a quick recovery. As she told the Daily Mail, she soon afterwards embarked on a painting holiday in Spain that traditional, more invasive surgery would have forced her to miss.
Creo’s partnership with Intuitive Surgical on this groundbreaking ‘Ion’ robot-assisted bronchoscopy (lung) programme is a milestone in the UK company’s growth as a medical, technology pioneer.
Ingenious instruments
Baillie Gifford’s UK Team has held Creo, based in Chepstow, South Wales, since it floated in 2016. It’s a global leader in the pioneering field of surgical endoscopy.
Its new technology allows a flexible and steerable camera, which also contains a channel through which surgical instruments can be inserted, to enter the body via its natural orifices. Its ability to diagnose and treat almost simultaneously has long been a holy grail of surgery.
Creo Medical’s flagship product is the Speedboat. The advanced energy instrument’s name was inspired by its shape and ability to ‘surf’ layers of tissue in patients’ upper and lower digestive tracts. Its record of shortening operating theatre procedures and thus slicing through the UK’s chronic surgical backlog is matched by its shortening of patients’ recovery times in hospital.
One Kent NHS trust credits Speedboat with reducing the cost of each bowel operation by 38 per cent, amounting to savings of more than £5,000 per procedure on average.
The company’s story began in 2003 when Chris Hancock – a medical engineer driven to apply his mastery of microwave energy to helping patients – started experimenting in a friend’s garage. Years of trial and error led to the proprietary technology behind Creo’s CROMA Advanced Energy platform. The generator combines two types of energy: radio frequency (RF) for precision tissue cutting, and microwave for controlled coagulation, or preventing bleeds.
Creo’s tools are already transforming patient outcomes and creating new capabilities for endoscopic surgeons working deep inside the body, where the difference between triumph and disaster is measured in millimetres.
I caught up with Craig Gulliford, Creo’s chief executive, to discuss the company’s progress.
Milena Mileva: How important is partnering with Intuitive Surgical, the world’s largest robotic surgery company?
Craig Gulliford: Intuitive sought us out to collaborate on its Ion programme, which involves operating inside the lungs. It’s an important breakthrough, as, unlike with breast or prostate cancer, there’s very little screening you can do for lung cancer. I lost a friend to it six months ago – a fit, young, sporty guy who never smoked a day in his life. It’s unique technology on both sides. Intuitive’s Ion robot provides the stability to navigate very precisely inside the lung and get to the small lesions which can turn out to be early-stage cancer.
MM: How would you characterise Creo’s recent progress?
CG: We’ve made great strides since 2016 when Chris Hancock and I walked around the City with a plastic box full of prototype instruments to show investors. We founded the company knowing that surgery was moving into non-invasive endoscopy and that Chris had found a way to deploy focused microwave and precise RF energy in these very small spaces.
We were able to make single-use surgical instruments at the right price. The key products we envisaged are either in the clinic or about to be in the clinic, and we’ve done it in the timeframe we set out, Covid notwithstanding.
Craig Gulliford was a founding angel investor in Creo Medical and became chief executive in 2012
MM: What made Speedboat so successful?
CG: Chris designed a tool where the current flows between two poles, confining it to the instrument itself. Before this, RF surgery was monopolar. It applied over a thousand volts to the diseased tissue, passing the current through the organ to a return pad placed under the buttocks to complete the circuit.
But it was hard to direct the current, which naturally takes the path of least resistance. This made tissue burning and sticking together a huge challenge. With Speedboat, it’s the design of the instrument that determines where the current goes. That allows us to make a very sharp, precise little ‘blade’, usually at less than a tenth of the voltage used in monopolar surgery.
This localised current flow is confined to the instrument itself. These tools can get into very tight spaces and remove things with absolute precision that would otherwise have to be taken out by invasive surgery or just left there. Both can have negative consequences.
MM: What further uses are you discovering?
CG: One example is in the oesophagus [gullet], where the lining can be damaged by acid reflux, necessitating the removal of two or three centimetres of diseased tissue. With more primitive microwave and RF technology, it left scar tissue, so the patient had to go back up to 20 or 30 times to have the gullet dilated with a kind of balloon to avoid having a feeding tube.
With Speedboat, the precision is such that you don’t scar the underlying muscle. So after 12 weeks, the oesophagus is almost entirely back to normal. You’ve thus saved the NHS up to 3 repeat endoscopy appointments. That time can now be freed up to diagnose others, potentially saving lives.
MM: How will you continue to scale the business?
CG: One way is to train the key opinion leaders across our main market, the US, starting with the pioneering surgeons. They help us to refine techniques and skills, and they also produce clinical data, which we can publish as evidence. These surgeons can train others, who in turn train others.
Achieving this dense network is vital. We’re continuing to make the devices easier to handle, which makes it easier for surgeons to pick up the technique. And with increasing regulatory clearance in Asia-Pacific markets, we’re extending our global reach.
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