In March 2018, Pharmstandard lost one of its most mysterious co-owners - Egor Kulkov. According to the company itself, it lost the status of the beneficiary of Cyprus Augment Investments Limited, which owns 96% of JSC "Pharmstandard". As Vademecum found out, health care remained in the sphere of the entrepreneur's interests, but their geography and profile changed. Now Yegor Kulkov is the largest shareholder of the British start-up CMR, which already this year wants to present to the public an alternative to the robotic surgeon da Vinci - cheaper, more compact and more convenient.

In the rating of the richest Russian businessmen Forbes, Yegor Kulkov occupies the 195th place with a capital of $ 500 million. The rating was prepared back in February. At that time, the major part of Kulkova's condition was the share in Pharmstandard, where, according to the Kommersant newspaper, he owned 30%. Kulkov is actually a co-founder of Pharmstandard. He studied at Novosibirsk State University on the same course with Viktor Kharitonin, in 1999 both became co-owners of Aresbank, and then, together, bought the UfaVita plant, which later became a member of Pharmstandard. In March 2018, the beneficiary of "Pharmstandard" Kulkov ceased to exist, and on this well-known information about him ends. No publication has ever managed to talk with him, his photos are not available for public access, the reasons for changing the composition of the shareholders of Pharmstandard are unknown.

But Vademecum managed to find the trace of Egor Kulkov in the British public health. Judging by the available documents, he has been the main shareholder of the ambitious project Cambridge Medical Robotics (CMR) for several years already. CMR is developing a surgical robot Versius, which, according to her plan, should put an end to the single dominance of da Vinci produced by the American Intuitive Surgical. The British think that their robot will be cheaper, easier, able to adapt to any surgical needs, and in addition, it will be easier to manage.

How will all this be achieved? In 2017, the fourth year of life, CMR first unveiled a photo of its development. 90% of the photo is taken by a black background, on which the outlines of a manipulator arm with a sharp sting at the end vaguely appear. "We specially made such a photo," explained Patrick Portage, representative of CMR, to Vademecum. "The market is very highly competitive, we must protect our know-how."

WANTED ZEVSU

The permanent leader of the market of robotic assisted laparoscopy, da Vinci, about 20 years old. The very minimally invasive surgery, thanks to which he was born into the world, is not much older. In the 70s of the last century, they began to do the ligation of the fallopian tubes, by the beginning of the 1980s the surgeons had already mastered a whole series of gynecological operations through small incisions. And then, in the 80's, the story da Vinci began. Initially, it was developed by order of the military, to carry out operations directly on the battlefield - the surgeon who ran the robot could be in shelter. But then the company Intuitive Surgical acquired the development for civil use. Technology in those years seemed promising, there was a competitive struggle: two robots, Zeus and Aesop, were developed by Computer Motion. Between competitors there were violent patent disputes. But in the early 2000s Intuitive and Computer Motion agreed on a merger: it so happened that the player in the market actually remained alone. The revenue of Intuitive Surgical in 2017 reached $ 2.55 billion. The leader's yellow jersey allows the company to work with a very high net profit of 21% in 2017. To save their positions, about half of this amount Intuitive spends on R & D. The present da Vinci is already the fourth generation and exists in several variants.

Still, the creation of rival da Vinci is still considered a promising business. In the world there are several dozen companies trying to work in this direction. The potential demand is high: according to CMR estimates, at least 6 million different operations a year require robotization, while 4 thousand da Vinci working around the world still do a few hundred thousand operations per year. Prospects are also in the future competitors believe that da Vinci - the design is quite massive, expensive and not very simple to use for commercial purposes.

The heaviest part of da Vinci is a console with four hands. It weighs just over half a ton, says Stanislav Alekseev, head of projects for strategic development in the company "Medical Partners", which sells a medical robot in Russia. 264 kg weighs the surgeon's console with a 3D monitor and control joysticks, another 200 kg is a video set with a screen and a video signal processing device. It costs da Vinci in Russia from $ 2.5 million, and annual sales are measured by pieces. "Medical partners" sell da Vinci in our country since 2008, before that there was another distributor - more than a decade, 29 robots were sold, says Alekseev. Private medical centers among buyers are only two - EMC and GC Medsi. Probably, soon there will be one more.

Last year in Russia, according to the "Medical Partners", 4221 operations were performed on da Vinсi, 851 in the first quarter of 2018. About 70% of them are in the urological sphere, including prostatectomy, 13% on abdominal surgery and gynecology. The overwhelming majority of transactions are conducted on quotas within the framework of the VMP. The need for robotic laparoscopy, says Alekseev, is so much higher than the sentence that it makes no sense to make specific estimates. The robotization in many ways is hampered by high cost. In Russia annual maintenance da Vinci costs 9-10 million rubles.

Very expensive surgical tools for the three arms of the robot (the fourth hand is entrusted to hold the endoscope). A set of instruments for urology, worth 10 operations, costs $ 23,000. Meanwhile, for the payback of the robot, Alexeyev cites US data, he should be used at 200-250 operations a year, that is, virtually every day. And this means that the tools will have to spend about $ 500,000 per year - more than maintenance. On some Russian da Vinci it is possible to conduct even several operations per day, Alekseev assures. But, according to CMR, a stationary robot is in any case more difficult to use continuously than mobile: rivals da Vinci have something to strive for.

GOLD HANDS

CMR adheres to a policy of complete information closeness. Patrick Portage told Vademecum that he would not answer any questions so as not to accidentally uncover technology. And the numerous official speeches of the company's management are mainly devoted to innovation in the broadest sense and joy in connection with working in a company where this innovation thrives.

Sometimes, however, politics fails: The Guardian, for example, published an unobtrusive, quite contrast photo, where the hands of Versius are very clearly visible and the surgeon's workplace is slightly worse. CMR intends to make its robot more flexible, mobile, better tuned for specific operational needs than da Vinci. Each hand of the British novelty exists separately and is fixed not to the general rack, but to the operating table. According to some CMR clauses, it seems even that the number of hands can vary depending on the specifics of the operation. Another idea of ​​CMR is to do ergonomics for the surgeon, as well as the simplicity and intuitive control of the robot's hands.

About the weight, the approximate price, time to enter the market and other important parameters of its novelty CMR does not report. Other projects in this area are not so closed, Stanislav Alekseev states, and makes a pleasant conclusion for da Vinci that if CMR is silent, perhaps it simply has nothing to tell. But investors have a different opinion. Persistently hiding what he does, the British start-up is much more transparent in the financial sphere. Cambridge Medical Robotics was established in 2014 and in the same year received seed financing from the company Escala Capital.

In January 2015, the full list of CMR shareholders was published. Of the 1 million issued by the time the shares of 707 thousand, that is more than 70%, belonged to Escala Capital. This is not about the well-known Spanish Escala Capital, where Vademecum reported that it had nothing to do with CMR, but about Cyprus Escala Capital Investments Cyprus Limited with the sole owner Egor Kulkov born in 1971, Russian by nationality living in Switzerland. Find it failed: Portadej from CMR said that he has no contacts with Kulkov, and he never saw this person at all. Pharmstandard did not respond to Vademecum's request. And even an attempt to find him not in the place of work, but at the place of residence did not give anything: the publication of "Russian Switzerland", usually well-informed about the Russians living in this country, nothing is known about Yegor Kulkov.

In the summer of 2016, immediately after the successful completion of the tests on the corpses, the circle of CMR participants expanded. ABB Technology Ventures, the Swedish-Swiss technology conglomerate with a total turnover of $ 34 billion, is represented in a hundred countries and specializes in the development and production of robots, among other things. Its interest in the British start-up ABB was explained by Vademecum by the fact that "it usually invests in the development of potentially breakthrough innovations that go beyond the scope of traditional technological development" and promised that it can, among other things, test the hands of robots in its laboratories, but also about the like-minded Egor Kulkova could not say anything.

Other investors are private asset management company LGT Global Invest and investment company Cambridge Innovation Capital. In September 2017, the next round of financing took place, CMR managed to raise another $ 26 million. Investors are the same plus the Norwegian private fund Watrium, in which they also did not want to talk about Vulkerecum about Kulkov. The CMR report, published at the end of 2017, reports that Yegor Kulkov controls 40.36% of CMR through Escala Capital Investments, in which he is a 100% beneficiary.

START-UP STAKEHOLDERS

If we leave aside the technological side of the issue, CMR, we can say, is thriving. After receiving the seed investment, a demonstration of the prototype took place. The company is constantly increasing the staff, now there are employed 170 people. Recently, another transfer to the new office of an even larger area took place, exceeding already 1 thousand square meters. m.

The main problem for CMR is one: startups trying to create a robot-assistant for a surgeon, around the world a lot. If you take for an axiom that the surgeon, who controls the robot's hands, will do the operation better than just the surgeon, this sphere looks extremely attractive. According to Research and Markets, the world market of medical robotic surgeons amounted to $ 4.9 billion in 2016, and in the coming years this market will grow by more than 20% annually. By 2025, robots are promised global sales at $ 20 billion.

Among other things, operations involving robots provide simply ideal opportunities for telemedicine: if signals from the hands of the surgeon to the manipulators still go through the wires, it does not matter where the surgeon is and what the length of the wires is.

In thematic reviews, there are sometimes even talked about half a hundred startups in the field of robotic assisted surgery. Here are some illustrative examples: most similar to the CMR German robot Avatera from the company Avatera Medical. It is a robot with four hands, fastened to the operating table, carefully thought-out ergonomics and, as the company reports, the opportunity to interact with the operating team in various ways. Industrial design does not exist yet.

At the stage of animal testing there is a Russian robot from the Institute of Design and Technology Informatics. About Korean Revo-1 so far, one is known, but the important thing: it is supposed to be made twice cheaper than da Vinci. Canadian Titan Medical has taken a different path: it has a single-port system, that is, all instruments are inserted through a single hole. This can make the operation less traumatic. The Araknes micro-robot with two hands and camera, the collective creativity of researchers from several European countries, will do without any incisions at all: it is introduced into the stomach through the esophagus. And the development of the American company TransEnterix shows that even cheaper and miniaturization can not be considered mandatory. Her robot Senhance is more expensive than da Vinci, $ 3 million instead of $ 2-2.5 million, but has along with other advantages of feedback: the surgeon feels the resistance of the material.

The "soft" side of the question is most carefully studied by Google, or rather, its medical unit Verily Life Sciences. Together with Ethicon, a division of Johnson & Johnson, Google acquired a license for the military robot Taurus, created to lay bombs, and rework it for medical use. The company wants to supply its robot with advanced visualization, at least advanced analysis of data and a variety of remote communication capabilities.

There is even more ambitious in the technological plan direction - an attempt to create a truly automated operating room where the robot acts independently, under supervision, and not under the supervision of a surgeon. It is interesting that one of such projects is being developed in Russia, by the MGMSU and several partners. It is assumed that this robot will be engaged in spinal surgery and will be able to screw bolts into the spine better and safer than humans, since the arm is firm, the focus is perfect, and the possibilities to summarize and analyze information are limitless.

The product, produced in industrial, not research scales, none of the many pioneers, apparently, has not yet created. The chances of the project in connection with this, of course, are growing. The total investment in these companies is much higher than the $ 46 million received by the CMR. For example, TransEnterix, which traditionally for this segment, does not earn anything yet, has spent $ 100 million on buying robotic technology alone from its Italian counterpart Sofar. The chances of CMR, on the contrary, reduce the abundance of similar very expensive projects. The question is which trend will outweigh.