Monarch President Aleksandra Popovic explains what’s special about the upgraded system and offers advice for developing robotics and AI.
Johnson & Johnson MedTech’s minimally invasive Monarch platform was the first robotically assisted bronchoscopy system to market. [Image courtesy of J&J]
Johnson & Johnson MedTech‘s Monarch robotics-assisted bronchoscopy system reaches deep into the lungs for biopsies, offering a minimally invasive alternative to transthoracic needle biopsy while maximizing diagnostic yield for earlier, more definitive results.
“Robotics has significantly improved the patient experience because they [can get a more definitive diagnosis] and they’re given therapy within days of the exam,” Monarch President Aleksandra Popovic said in an interview. “Before that, a lot of patients would receive an exam and be told, ‘We don’t know yet what it is. We were not in the lesion, we didn’t get enough cells, we didn’t get enough tissue. You need to either come back or we can wait for your nodule to grow a bit.’ It’s very disruptive to a patient’s life.”
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J&J just supercharged Monarch with the FDA-cleared Monarch Quest, which has upgraded hardware and software for improved navigation using data from its sensors and GE HealthCare 3D cone-beam computed tomography (CBCT) scans, helping the physician understand where the device is and how to get to the target.
“Physicians are going after smaller lesions and those that are deeper in the lung, and those are the best ones to catch early because the treatment is much better than [those that] grow bigger,” she said. “Monarch enables confidence in getting to these places, and with Monarch Quest we are taking the next step. We invented this category. We were the first robot there, and we are reinventing the category.”
What’s special about J&J’s Monarch robot
Johnson & Johnson MedTech says its Monarch system’s telescoping scope-in-sheath design allows for independent articulation and insertion force redirection, enabling physicians to reach further into the lung and “make small adjustments to place the biopsy needle into different areas of the nodule.” [Image courtesy of J&J]
J&J acquired the Monarch system through its $3.4 billion purchase of Auris Health in 2019. The technology was developed for stability and flexibility, and Monarch’s robotic telescoping bronchoscope is a key feature.
“We have a scope-in-sheath design that gives rigidity and stability when you need it and flexibility when you want to make tight turns to really go very deep in the lung,” Popovic said. “… As you’re moving, there is no motion of the scope from the respiration. Once you’re there and you want to do a biopsy, it gives you a really stable channel to put any sort of device — diagnostic or therapeutic — through the robot and it gives you confidence it’s always going to go to the same place once you’re there.”
The system uses marionette wires running down the scope for control.
“The motors are outside of the body, so we control a passive bronchoscope actively from the arms,” she said. “That’s a safer way to do things, and our physicians like doing that because they can mentally separate the actuation from the devices.”
Johnson & Johnson MedTech’s Monarch platform has two robotic arms. [Image courtesy of J&J]
The latest version has three times more computing power with a new Nvidia chip and improved algorithms for better navigation that integrates that CBCT imaging, electromagnetic tracking, respiratory data and the scope’s vision.
“It’s truly real-time, AI-driven navigation, which gives much smoother navigation, much more precise navigation, and more confidence to go after really hard-to-reach nodules,” Popovic said.
The latest version has enough onboard computing power for more software updates as soon as this year to build its AI capabilities for improved navigation and segmentation. It also includes new cybersecurity protections, including a physical door lock on the tower to limit access and a unique key for every customer.
The future of robotic bronchoscopy
The Monarch system can be operated with a handheld controller while the physician is sitting, standing or moving around the patient. [Image courtesy of J&J]
Right now, the Monarch system is mostly used to help clinicians diagnose lung cancer, but the system is also cleared for therapeutic use.
“We talk about our product as an open product,” Popovic said. “We have a channel and we have a camera so you can use the camera and the channel at the same time, and physicians are using the robot also for therapy. The therapy isn’t developed a lot, but in the future our platform will be for diagnosis and therapy — and therapy will grow.”
Those therapies could include ablation or pharmaceuticals, but Popovic said they “are not taking sides” and “will enable everything.”
“We work very closely with our J&J Innovative Medicine group that is developing in situ drug delivery, so drugs are an opportunity. Some sort of energy deployment is also an opportunity,” she said.
J&J wants to expand endoluminal robotics beyond bronchoscopy and already has clearance for urology procedures. Researchers have reported positive outcomes using Monarch for minimally invasive percutaneous nephrolithotomy to remove kidney stones.
“In addition to potentially helping urologists achieve stone-free patients in a single procedure, this approach could help reduce the need for retreatment after kidney stone removal and decrease risks and complication rates,” University of California, Irvine School of Medicine Urology Chair Dr. Jaime Landman said after the first robot-assisted kidney stone removal, which used the Monarch system.
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Advice from the system’s development
Johnson & Johnson MedTech Monarch President Aleksandra Popovic [Photo courtesy of J&J]
Popovic sees Monarch as a good example of what medical robotics should be now and in the future.
“You have to have a really good robot — stable, reliable, something that people have joy in using — and then you have to have a strong software backbone to add information and help people use the robot to its best capabilities,” she said, and that takes strong teams. “We spend a lot of energy getting the right people, and then very close collaboration between software and hardware. It should feel like one team.”
Testing is also crucial, with Popovic encouraging other device developers to organize verification and validation “in a very structured way. … not rushing, but doing it systemically so everything talks well together.”
“Testing with real-world data is the most important thing,” she said. “There are a lot of AI algorithms out there, but we as an industry have to come to a place where there’s a lot of trust in AI, and the way to build trust in AI is to test it and spend more energy in testing than in development in order for customers to have a good experience with AI. … The two most important things in AI [are] getting the right data — not a lot of data, the right data — and testing, being willing to spend most of your energy making sure the algorithm works versus making sure the algorithm is set up in the system.”
And what is the right data?
“The right data is from real cases, properly grouped, properly understood,” she said. “The wrong data is synthetic data, generic data that is not really giving the right focus.”
If you want to join Popovic’s team, she’s looking for engineers with a passion for improving medtech.
“There are a lot of engineers out there, but it’s a smaller group that’s passionate about impacting patients and physicians. That’s No. 1,” she said. “And then strong multidisciplinary skills. The best roboticist knows a bit of software, a bit of hardware, control systems, and some will be more experts in one or another, but we want people who are rounded engineers, who can think about a system and not only about the components. Those really thrive in this environment, and they are the best people we have.”
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