BackTable Innovation – Details, episodes & analysis

Surgical arteriovenous fistula (AVF) creation has been a mainstay of dialysis care for multiple decades. What does it take to break into such an established space with a new endovascular medical device? In this episode of the BackTable Podcast, Dr. Jeffrey Hull discusses the challenging journey of developing the Ellipsys system for endovascular AVF creation. --- SYNPOSIS We trace Dr. Hull’s path from the device's initial conception in 2006, through the first-in-human cases in 2013, to regulatory approval and acquisition by Medtronic in 2020. Dr. Hull highlights the roles of key business mentors, the importance of multidisciplinary collaboration with vascular surgery and nephrology, and the impact of investment. He also shares valuable insights on the benefits of having competitors and selecting a well-thought-out exit strategy. Additionally, we explore deep vein arterialization (DVA) as another application of endovascular AVF creation in the context of peripheral arterial disease. --- TIMESTAMPS 00:00 - Introduction 03:05 - The Birth of the Percutaneous AV Fistula Creation 15:04 - First-in-Human Cases 17:58 - Navigating the Startup Journey 21:52 - Identifying Mentors and Investors 27:33 - Competition and Criticism 36:43 - Regulatory Hurdles 44:45 - Acquisition by Medtronic 49:14 - Deep Vein Arterialization for Peripheral Arterial Disease 54:40 - Final Thoughts and Advice --- RESOURCES Avenu Medical: https://avenumedical.com/ Gracz KC et al. Proximal forearm fistula for maintenance hemodialysis (1977): https://pubmed.ncbi.nlm.nih.gov/839655/ Hull JE et al. The Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access (2018): https://pubmed.ncbi.nlm.nih.gov/29275056/ Endovascular Today- Update on Percutaneous AV Fistula Creation (2015): https://evtoday.com/articles/2015-june/update-on-percutaneous-av-fistula-creation Mallios A, Jennings WC. Percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System-the state of the art (2020): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353338/

In a society where discussions about medical malpractice are often concealed from the public eye, this episode of BackTable shines a spotlight on the powerful documentary ‘A World of Hurt: How Medical Malpractice Fails Everyone,’ produced by Viknesh Kasthuri, a fourth-year medical student at Brown University. Released earlier this year, the film explores how the American medical malpractice system harms and disconnects patients and providers through three compelling case studies. --- SYNPOSIS We delve into Viknesh’s motivations and the process behind creating the documentary, discussing the need for improved provider education on lawsuits, effective communication with patients and legal teams, and strategies for coping mentally and emotionally throughout this intensive process. Additionally, Viknesh provides a behind-the-scenes look at documentary production, including filming during the COVID pandemic, creating environments for patients and providers to share their stories, and submitting the documentary to film festivals. --- TIMESTAMPS 00:00 - Introduction 02:40 - Inspiration Behind the Documentary 06:10 - Technical and Legal Aspects of Documentary Production 14:34 - Releasing the Documentary 17:04 - Physician and Patient Responses to Medical Errors 20:27 - Highlighting Communication Resolution Programs 23:04 - Educational Gaps in Medical Training 26:43 - Exploring Systemic Solutions to Management of Medical Errors 30:16 - Final Thoughts and Future Projects --- RESOURCES A World of Hurt Documentary: https://www.youtube.com/watch?v=09IVcL6pACU BackTable VI Ep. 77- Doctors and Litigation: The L Word, with Dr. Gita Pensa: https://www.backtable.com/shows/vi/podcasts/177/doctors-litigation-the-l-word The L Word Podcast with Dr. Gita Pensa: https://doctorsandlitigation.com/podcast-2 BackTable ENT Ep. 90- Coaching Physicians Through the Stress of Malpractice Litigation, with Dr. Gita Pensa: https://www.backtable.com/shows/ent/podcasts/90/coaching-physicians-through-the-stress-of-malpractice-litigation Michigan Model Communication and Resolution Program: https://www.uofmhealth.org/michigan-model-medical-malpractice-and-patient-safety-umhs

In this episode of the BackTable Podcast, host Dr. Aaron Fritts interviews guest Dr. John Qiao about exploration of physicians’ role in medical innovation, particularly among interventional radiologists. Dr. Qiao shares insightful information about the origin of RadioClash and details his journey as an entrepreneur. Through this discussion, Dr. Qiao covers the challenges encountered during the startup phase, the invention of a single-probe electroporation device, and the future applications of this novel medical technology. The episode concludes with broader advice on how to manage the demands of professional work, entrepreneurship, and personal life. --- SHOW NOTES 00:00 - Introduction 02:39 - Dr. Qiao’s Journey into Medicine and Entrepreneurship 11:40 - Birth of Radioclash: A Unique Solution for Cancer Treatment 17:58 - Future of RadioClash: Targeting Metastatic Cancer 25:20 - Future of Electroporation Therapy 35:21 - Challenges of Building a Company 44:37 - Path to Market and Future Plans 47:28 - Balancing Clinical Practice and Entrepreneurship --- RESOURCES RadioClash website: https://www.radioclash.co/ News Article on Dr. John Qiao: https://voyagehouston.com/interview/meet-john-qiao-m-d-of-radioclash-ltd-co/ Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086111/ The Abscopal Effect: A Reemerging Field of Interest: https://ascopost.com/issues/november-25-2018/the-abscopal-effect-a-reemerging-field-of-interest/ BackTable VI Episode #402 - Immunotherapy in HCC: Evolving Treatment Paradigms: https://www.backtable.com/shows/vi/podcasts/402/immunotherapy-in-hcc-evolving-treatment-paradigms Tavo and Pembrolizumab in Patients With Stage III/​IV Melanoma Progressing on Either Pembrolizumab or Nivolumab Treatment (Keynote-695): https://clinicaltrials.gov/study/NCT03132675 PANFIRE-3 Trial: Assessing Safety and Efficacy of Irreversible Electroporation (IRE) + Nivolumab + CpG for Metastatic Pancreatic Cancer: https://classic.clinicaltrials.gov/ct2/show/NCT04612530 Radiofrequency Ablation for the Palliative Treatment of Bone Metastases: Outcomes from the Multicenter OsteoCool Tumor Ablation Post-Market Study (OPuS One Study) in 100 Patients: https://pubmed.ncbi.nlm.nih.gov/33129427/ The improvement of irreversible electroporation therapy using saline-irrigated electrodes: a theoretical study (Northwestern study): https://pubmed.ncbi.nlm.nih.gov/21728392/ Irreversible electroporation reverses resistance to immune checkpoint blockade in pancreatic cancer: https://www.nature.com/articles/s41467-019-08782-1

In this episode, Dr. Aaron Fritts interviews Dr. Patrick Neville, a vascular surgeon and entrepreneur. Dr. Neville shares his journey of identifying a clinical problem and developing a solution, which culminated in the innovation of Wire Watch, a tool designed for efficient wire management during endovascular cases. Dr. Neville discusses the importance of believing in your solutions, the need for persistence, and the value of strategic partnerships in navigating the startup process. His partnership with the engineering firm BioTex led to the development of a simple product that is now used in cases by interventionalists across multiple specialties. --- SHOW NOTES 00:00 - Introduction 02:12 - Recognizing the Importance of Wire Management 06:42 - Partnership in Product Development 09:14 - Wire Watch in Action: User Experience 16:15 - Cost Savings and Clinical Adoption 22:44 - Mindset for Approaching Device Innovation --- RESOURCES Wire Watch: https://www.biotexmedical.com/wirewatch/ BioTex Medical: https://www.biotexmedical.com/

In this episode of the Back Table Innovation Podcast, host Dr. Diana Velazquez-Pimentel, a radiologist and biomedical engineer, chats with Dr. Alim Mitha about the novel idea of biodegradable flow diverters and the future of interventional neuroradiology. Dr. Mitha is a cerebrovascular, endovascular, and skull base neurosurgeon and biomedical engineer at the University of Calgary. During his neurosurgery residency, Dr. Mitha also completed a master’s degree in biomedical engineering. Afterwards, he pursued additional fellowships in cerebrovascular and skull base surgery, as well as endovascular neurosurgery. Since then, he has started a research lab focused on tissue engineering and biomedical device development. He explains the role of flow diverters and how they are used to guide blood flow away from the intracranial aneurysms. While flow diverters have been applied to treatment of many different types of aneurysms, Dr. Mitha notes that these devices carry thrombogenic risks. During his training, he saw that it was not preferable to deploy a flow diverter in a young patient who would have to remain on antiplatelet therapy for the rest of their life. As a result, Dr. Mitha began to develop a polymer-based biodegradable flow diverter that could be absorbed by the body after the aneurysm had been occluded, in addition to being visible on non-invasive imaging. He explains the process of building a prototype, incorporating a company, joining a start-up incubator, and now performing first in-human-clinical trials. --- CHECK OUT OUR SPONSOR RADPAD® Radiation Protection https://www.radpad.com/ --- SHOW NOTES 00:00 Introduction 03:05 Understanding the Role of Flow Diverters 08:17 The Conception of a Biodegradable Flow Diverter 11:35 The Challenges and Successes in Prototyping 13:53 A Path Towards Commercialization 16:10 Considerations for Clinical Adoption 24:00 Developing Skills for Engineering and Entrepreneurship 27:29 First-In-Human Trials and Early Feedback 30:36 Innovating Within the University of Calgary --- RESOURCES University of Calgary Creative Destruction Lab: https://creativedestructionlab.com/locations/calgary/ The Brain Conferences: https://www.fens.org/meetings/the-brain-conferences

In this episode, interventional radiologist Dr. Bryan Hartley interviews Dr. Woojin Kim, a musculoskeletal radiologist and serial entrepreneur. Dr. Kim is a musculoskeletal (MSK) radiologist with a background in imaging informatics and a founder of three companies. He outlines his journey, from his early life as an immigrant in the US to his entrepreneurial successes in the field of radiology. Dr. Kim shares the processes, challenges, and lessons learned from founding and exiting three different startups. As an MSK fellow, he developed Yottalook, a search engine for radiology images, which eventually became his first company, iVirtual. After a brief time working in private practice, he returned to academia and co-founded his second company, Montage, a radiology search and data mining tool that offers clinical and operational analytics. Later on, he entered the artificial intelligence (AI) space and co-founded Equium, an application for radiology resource and staffing optimization. In recent years, Dr. Kim has shifted his focus to non-interpretive AI, a field that is centered around streamlining the radiologist’s workflow and improving work-life balance. Throughout the episode, Dr. Kim shares advice for other entrepreneurs. He highlights the importance of building companies with good co-founders whose skills and experiences complement each other. He also encourages listeners to look at other industries and network to gain ideas about how to improve their own fields. Finally, he emphasizes that companies that are looking to be acquired should demonstrate adequate knowledge over return on investment, total cost of ownership, and regulatory requirements. --- SHOW NOTES 00:00 - Introduction 01:35 - Dr. Woojin Kim’s Medical Training 05:11 - Developing an Interest in Informatics 11:04 - Creating Yottalook and iVirtuoso 17:00 - Building Montage Healthcare Solutions 24:45 - Acquisition of Montage and Working for Nuance 27:33 - Leveraging AI for Resource Optimization 32:58 - Rad AI and the Impact of Noninterpretive AI 41:24 - Advice for Aspiring Entrepreneurs --- RESOURCES Rad AI: https://www.radai.com/ Equium: https://www.equium.io/ Nuance: https://www.nuance.com/index.html

In this episode of Back Table ENT, host Dr. Gopi Shah explores the entrepreneurial journey of Dr. Rohan Walvekar, an otolaryngologist at Louisiana State University-New Orleans and innovator/CEO of nDorse, a team engagement software application. Dr. Walvekar shares his experience in launching ‘nDorse’ — his novel team engagement software designed for healthcare providers. This idea was sparked from his realization that daily contributions and positivity within the healthcare space could be better recognized with real time feedback. He noticed that hospital nursing turnover was high, which could have been attributed to insufficient engagement and connection with coworkers. The nDorse software application can be used by anyone in an organization and allows users to post meaningful recognitions (via messages, emojis, pictures, GIFs) for their coworkers, with the ability to tag recognitions to the organization’s specific mission and values. Since its implementation, nDorse has been adopted even in various educational and financial institutional settings. Dr. Walvekar describes his journey to creating the application, including the software building process, initial sales, mentors, and the nDorse team. He also offers advice for physician entrepreneurs about being thoughtful with innovation and resilience in the startup sphere. --- SHOW NOTES 00:00 Introduction to the Podcast 02:46 A Focus on Real Time Recognition for Coworkers 04:48 Introduction to nDorse: A Team Engagement Software 13:06 Market Research and a Minimum Viable Product 20:16 Product Launch and First Customers 23:04 Financing the Project 26:03 Pitching to New Clients 29:00 Team Members and Mentors 31:44 Balancing Innovation with Clinical Practice 36:20 Challenges During the Entrepreneurship Journey --- RESOURCES nDorse: https://www.ndorse.net/ BackTable ENT Ep. 115- Management of the Plunging Ranula: https://www.backtable.com/shows/ent/podcasts/115/management-of-the-plunging-ranula Healthcare Plus Solutions Group: https://healthcareplussg.com/

In this episode, Dr. Eric Gantwerker and Dr. Nilesh Vasan, Founder/CEO of Adroit Surgical and Head & Neck Surgeon at University of Oklahoma (OU Health), discuss the development of Adroit Surgical. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/4Wi8D5 --- SHOW NOTES First, Dr. Vasan describes his surgical training and lifelong passion for invention. Originally from New Zealand, Dr. Vasan completed a head & neck fellowship at OU Health. His surgical experience includes private and academic practice. During his time in private practice, Dr. Vasan worked on interdisciplinary teams to manage difficult airways. He credits this experience with sparking his interest in developing better tools for intubation. Next, Dr. Gantwerker and Dr. Vasan review the development of Adroit Surgical’s first product, the Vie-Scope. The battery-powered Vie-Scope combines superior visualization with portability to facilitate intubation across settings. Hoping to improve visualization during hand-held laryngoscopy, Dr. Vasan sketched a modified anterior commissure laryngoscope that would become the Vie-Scope. He then worked with an experienced patent attorney who helped him develop and notarize his innovation. Then, the surgeons cover advice to building networks. A pitch competition in Oklahoma City connected Dr. Vasan with associates whose complementary expertise helped grow Adroit Surgical. Dr. Vasan then worked alongside a well-connected distributor who raised awareness of the Vie-Scope in his target markets. Today, the Vie-Scope enables successful first-pass intubation in emergent and operating room settings. --- RESOURCES Adroit Surgical: https://adroitsurgical.com/ “Crossing the Chasm” by Geoffrey Moore https://www.amazon.com/Crossing-Chasm-3rd-Disruptive-Mainstream/dp/0062292986 “Creativity, Inc: Overcoming the Unseen Forces that Stand in the Way of True Innovation” Ed Catmull & Amy Wallace https://www.amazon.com/Creativity-Inc-Overcoming-Unseen-Inspiration/dp/0812993012

In this episode, host Dr. Dana Dunleavy interviews NFL player Taylor Rapp and neurointerventional radiologist Dr. Wayne Olan about the role of the Q collar in safeguarding the brain from impact. --- SHOW NOTES Taylor Rapp, a native of Washington state, pursued his college education at the University of Washington, where he also played football. He was later drafted by the LA Rams and played for them for a few years. Recently, Taylor made a move to Buffalo, NY, and now plays safety for the Buffalo Bills. He recounts his brain injury and severe concussion in 2021 while he was playing for the LA Rams. Later on, he heard about the Q collar from his agent and subsequently incorporated it into his gear in the following season. Dr. Olan discusses the origin of the Q collar, which was initially developed in the military to protect and minimize brain movement. He highlights a study from St. Xavier High School in Cincinnati and Cincinnati Children’s Hospital where the role of the Q collar was examined utilizing Diffusion Tensor Imaging (DTI), a type of MRI technique that specifically examines the white matter tract. Within a cohort of 500 athletes, 77% of athletes who wore the Q collage showed no evidence of shear injury whereas 73% of athletes who did not wear the collar showed gray-white matter shearing injury. He further discusses the mechanism by which the Q collar protects the brain from injury. It stabilizes the brain and minimizes movement by decreasing venous return to the brain by 30%, which he compares to wearing a necktie. He makes an important distinction that the Q collar does not occlude venous return, therefore, does not have significant clinical adverse effects. They end the episode by advocating for the significance of educating younger athletes about the risks of contact sports and enhancing safety across all sports. --- RESOURCES Neck Collar with Mild Jugular Vein Compression Study: https://pubmed.ncbi.nlm.nih.gov/28437225/

In this episode, host Dr. Jose Silva speaks with Dr. Duke Herrell, CEO and CMO of Virtuoso Surgical, a robotic surgery tool known for its exceptional dexterity and precision. --- SHOW NOTES Dr. Duke Herrell is a minimally invasive urologic surgeon and professor at Vanderbilt University. Dr. Herrell came to Vanderbilt for his surgical fellowship, where he met Bob Webster, a mechanical engineer who had developed concentric tube robots made out of an elastic metal. Together, they worked to form the metal into curves that could create a tentacle-like motion for clinical applications. Over the next 15 years, Dr. Herrell and three co-founders started their company, Virtuoso Surgical, and received grant funding to move forward with their startup. The surgical device features two 1-millimeter dextrous tools inserted through a rigid scope that is capable of carrying a versatile array of instruments. The device is currently intended for the urologic procedures including removal and enucleation of prostate tissue, bladder lesion removal and sampling, and transurethral resection of bladder tumors (TURBT). Notably, the device addresses a critical issue in tumor staging by improving the accuracy of margin determination, which is a game-changer for the 50% of TURBT procedures that yield specimens lacking muscle or clear margin information. Beyond urology, the device has the potential to improve other surgical procedures that utilize a rigid scope in a constrained environment including pulmonology, neurosurgery, and ENT interventions. Dr. Herrell and his team are also developing EndoTheia, a micromachine instrument that functions as a steerable catheter, specifically designed for flexible ureteroscopy. This device is currently in the verification and validation phase. --- RESOURCES Virtuoso Surgical: https://virtuososurgical.net/