Their first crude prototype was tested on a watermelon. Yet, six years later this Chennai-based start-up says it’s already selling its products in three continents to 150 customers – mainly labs and hospitals.
Taking the discussion on India’s indigenous medical technology landscape further, here’s a look at Chennai-based Perfint Healthcare.
Perfint develops robotic assistants to doctors for certain procedures in cancer treatment that require a high level of precision and refinement. These procedures could be cancer biopsies (taking a sample of suspected cancerous tissue from the body for testing), or pain relief (delivering painkillers straight to the site), or tumour ablation (burning a tumour by shooting radiofrequency or microwave or other forms of energy directly at it).
These procedures are non-surgical yet invasive in that needles have to be inserted into the body to perform these tasks.
S Nandakumar, founder CEO, Perfint identifies certain challenges faced by doctors while performing such procedures “freestyle” (without any robotic assistance) using imageing machines such as the CT to guide them.
One, he says, is precision (hitting the right spots). The second is the time taken and cost of possibly multiple sittings; sometimes the deep-seated or delicate position of the tumour close to a vital organ impedes complete access and a repeat procedure may be needed to finish the job. The third is the patient’s exposure to radiation resulting from repeated CT scans to check the efficacy of each procedure.
PIGA, Perfint’s platform technology, is engineered to work in tandem with imageing machines such as the CT to assist doctors in performing the procedure optimally thereby avoiding repeats. The robotic arm uses image guidance to position needles over the site so as to maximise efficacy in a single sitting.
The PIGA platform was first used in biopsy. Then it was adapted for pain relief. The latest offering, launched as recently as June 2, is for tumour ablation.
Branded Maxio, it appears to be Perfint’s most ambitious up until now. “There are technological differences that make it that much more sophisticated,” says Nandakumar. In addition to the CT, it also works in tandem with the PET-CT a more sophisticated imageing device. It monitors patient breathing, and movement and provides feedback. Like a car’s “parktronic” it sends off warning beeps if the needle is in danger of touching a vital organ. With simulation, it helps the doctor arrive at how many needles to use, where to place them and in what sequence etc.
All this, feels Nandakumar, should encourage a larger number of doctors to attempt tumour ablation than are doing now.
Perfint, with $4.7mn in revenues in fiscal 2012 (and a reported target of $100mn by 2016), has been flying under the radar preferring not to take on the likes of GE and Philips in their core imageing offerings such as CT scanners, or ultrasound equipment. Hence the need for niche products.
There are several challenges that it faces. One, of course, is making a viable market out of these niches.
Consider, for instance, that the idea of tumour ablation itself is still in its nascency in India. Nandakumar says that the challenges of freestyle ablation are a key reason why not too many doctors attempt it.
However, it is also true that ablation is relevant only in a relatively small percentage of cases.
According to Dr Sameer Kaul, head of surgical oncology at New Delhi’s Indraprastha Apollo Hospital and reportedly a pioneer of radiofrequency tumour ablation in the country it is a last-resort procedure chosen only in those cases where “there’s nothing better to offer.” Dr Kaul adds, “While surgery is always the preferred option, ablation is used primarily as a palliative procedure to buy time for the patient who is inoperable for any reason.” For instance, a tumour on a cirrhotic liver which cannot be operated upon can be burned using this technique.
“There isn’t an endless number of such cases,” he says adding that while robotic assistance is a “nicety” it “does not make an earth-shattering difference.”
In some applications, robotic assistance can help relatively less experienced doctors to attempt certain procedures. Dr Shivanand Gamangatti, associate professor at the department of radiology in New Delhi’s All India Institute of Medical Sciences, a leading government-owned teaching hospital, says Perfint’s biopsy device Piga-CT has made it possible for trainee doctors to perform biopsys with greater comfort and confidence. But experienced doctors do freestyle procedures with similar outcomes, he says.
Then, of course, there is the cost of the robotic assistant which has to be borne by the hospital in anticipation of sufficient volumes to spread it over.
The other challenge is provenance. There is some amount of “subtle, underlying disbelief” that an Indian company can pull off such an innovation, says Nandakumar. That is being countered with results, he says.
The third is the eco-system. It is vital for Perfint to work closely with doctors to fine-tune and validate its concepts and products since they are, after all, the end-users. “Doctors in India are so busy (treating patients) they hardly have time for anything else,” says Nandakumar. This is one reason why Perfint is to open an advanced technology lab in Seattle. “With an office in Boston, I can get a meeting almost overnight with a doctor from Harvard who will spend good quality time (with the product or concept),” he says. The other reason, not surprisingly, is experience in multi-disciplinary fields such as integrating robotics with biology which is lacking in the country.
Then, there’s funding. Backed by venture capital and also some soft loans from the Indian government, it is currently on the road to raise private equity funding.
With products sold in India, south-east Asia, Australia, and Latin America, Perfint is confident it can take on these and other challenges. China and the US are on the radar. The company is proactively mining data from informal registries of procedures done within and outside India using its products. This is to demonstrate clinical and economic efficiency to regulators and prospective customers.
Perfint’s progress is but a small step for Indian med tech, no doubt. The giant leap is some time away.