Hand Surgery that Feels Like Steroid Injection: Prof. Frédéric Schuind, Spirecut

Prof. Frédéric Schuind: 0:00

For the patient, the treatment seems like they get an injection of steroid, while we do really surgery.

Alex X-Health.show: 0:14

Hi, I'm Alex and welcome to the X-Health.show, where I talk to visionaries behind the latest innovations in healthcare. For the eXtra health of the future. We're in Muttenz, Switzerland, in a colourful co-working space called The 5th Floor. If you're curious, there's actually a view towards green Jurassic mountains. We're meeting here Professor Frédéric Schuind, CEO of a startup Spirecut and Professor Emeritus of prosthetics, orthopaedics, and surgery. With decades of experience in hand surgery. No wonder he replies to my questions with surgical precision really. Spirecut patented and manufactures minimally invasive surgical instruments for common hand affections, such as carpal tunnel syndrome and trigger finger. You'll hear about hand surgery of yesterday, today, and tomorrow, hand surgery recovery time – spoiler alert – dramatically reduced, the use of ultrasound in hand surgery, and the bold move from the operating room to business. What do you see when you look at people's hands?

Prof. Frédéric Schuind: 1:28

Well, when I look at people's hands, I see the beauty of the mobility, the sensibility of the hands and I know that a lesion can represent, even very minor, can represent a big handicap for the people.

Alex X-Health.show: 1:44

So do you see, in other words, like, do you see when people have problematic hands? Do you immediately see that?

Prof. Frédéric Schuind: 1:52

We know very easily by listening to what the people say and by looking at problems, what are their problems.

Alex X-Health.show: 2:01

Do you see more hands with problems now than, say, 20 or 30 years ago?

Prof. Frédéric Schuind: 2:10

Well, it has changed completely. Because to 20 or 30 years ago we were seeing a lot of traumatic hands from heavy industries, from wood factories, and this has almost disappeared because of security at work. And now we see more

people with quote: 2:29

"degenerative condition" that is osteoarthritis, that is a nerve compression, the tendon problems, and other things.

Alex X-Health.show: 2:40

So what are the changes that you see?

Prof. Frédéric Schuind: 2:45

Maybe we see more and more patients with problems of diabetes mellitus. So these patients suffer for example of trigger finger and this trigger finger is very severe and affects several fingers of the hand.

Alex X-Health.show: 3:01

So we'll come back to the trigger finger. But please tell me, why did you choose hand surgery as your specialisation?

Prof. Frédéric Schuind: 3:10

Well, I chose hand surgery because it's a very nice combination of a very delicate and complex, sophisticated, anatomy that of course you have to respect during the surgery, but also a combination of fixing the bones, putting prosthesis when needed, and also doing techniques of plastic surgery to change the arrangement of the skin, and also doing microsurgical repairs off vessels or of nerves.

Alex X-Health.show: 3:41

Do you remember, like, one of your first surgeries, hand surgeries? How was it? How did it look like?

Prof. Frédéric Schuind: 3:50

Well, at the time people were staying long time in the hospital. Now they come for day surgery, nothing of that was organised and the techniques were very rudimentary as compared to now. Now we use arthroscopy we use microsurgery, and as we'll speak later on, sonography also.

Alex X-Health.show: 4:14

What did the operating room look like?

Prof. Frédéric Schuind: 4:20

Well, you have a surgeon of course you have an assistant, you have a nurse in the operating room, sometimes there are also medical students. There is the anesthesiologist that is present. The surgery is done under tourniquet. So it's completely different than the technique with Spirecut. With Spirecut the surgeon can operate alone. Even a nurse... it's better to have a nurse, but even a nurse is not indispensable. It's done under local anaesthesia. There is no tourniquets, no anaesthesia also.

Alex X-Health.show: 4:55

So you have a vast experience in I hand surgery. But also I read that you went on some surgical missions to developing countries. Could you tell me a bit more about that?

Prof. Frédéric Schuind: 5:11

Well, I had the occasion to be invited as a professor in Rwanda, in Congo at the time it was called as Zair, in Niger, in Vietnam also. And teaching a local surgeons so that they can later on provide care to many patients, but also operating myself patients. These were excellent experiences in my life.

Alex X-Health.show: 5:38

So what did that give to you?

Prof. Frédéric Schuind: 5:42

Well, it gave me... I think the... the sense that we are fortunate in Europe, in general, or in Western countries to have such a good system of medical care. Because for example, if you have osteoarthritis of the thumb in Africa, or carpal tunnel, or trigger finger, while you don't go to see a doctor, you just suffer with it, that's it.

Alex X-Health.show: 6:09

Now, while being a doctor, you switched to business a few years ago, how did that journey start?

Prof. Frédéric Schuind: 6:20

Well, the fact is that my grandfather, he came from Olten to Belgium, actually, where all my academic career was. And then he started a big company that is still in the family. So I had always the idea to be an entrepreneur. And so... but I had a very successful and unhappy career as a professor in Brussels, of surgery and of orthopaedics. But then when came the age of retirement, I believed that it was a time to start the company.

Alex X-Health.show: 7:00

And that was... Was Swibrace the first one? Or was there any other?

Prof. Frédéric Schuind: 7:06

Swibrace was the first company, this company develops braces. And the idea is actually the innovation at the service of the patient. Because with these braces adapted to fracture care, we would like to reduce the number of surgeries for relatively stable fractures of the wrist or of the ankle, for example.

Alex X-Health.show: 7:29

I actually, you know, when I discovered that you're a surgeon and you developed Swibrace, I was, like... I started laughing because that's a surgeon who tries to avoid the surgery, which is, I mean, with my experience, when you go to the surgeon, there's always, almost 100% of certainty that you will be, you know, on the operating table. How did that idea come to you?

Prof. Frédéric Schuind: 7:59

Well, I think I like to promote minimally invasive type of treatments. And I think that there are some complications of surgery, though we help a lot of people with the treatment of fractures and that if we do better casting, we could avoid surgery in many patients. And a little bit the same for Spirecut, so we develop instruments of minimally invasive surgery, so we don't need a skin incision and the next day the patient have no dressing, they can wash their hands, and go back to their activities. This is my idea actually, to offer appropriate treatment of the conditions with minimal or if possible, no complication and return as quick as possible to a good quality of life.

Alex X-Health.show: 8:49

So how does it... let's start with Swibrace, with the cast – how does it work? How does it support the patient?

Prof. Frédéric Schuind: 8:57

Well, we do a scan of the limb and then we can develop 3D-printed braces that perfectly fit the anatomy of the patient. And these braces are very well tolerated and provide better contention also, of the fracture. So it helps really the patient and for stable or not to deep fractures it can really replace surgery.

Alex X-Health.show: 9:26

Yeah, I could see they look like a net, actually. A net around a person's hand and wrist. And you know there was the person climbing in it so you can wear it and you actually do all kinds of activities.

Prof. Frédéric Schuind: 9:41

You can do sporting activities you can wear also these braces under your clothes. So it's very comfortable. We have done a survey study with the Inselspital Bern, and we could demonstrate how it's efficient and comfortable for the patients.

Alex X-Health.show: 9:58

So Spirecut is a different story. It's still surgery. But it's, as you say, it's a non- or less-invasive surgery. Could you tell now the story of Spirecut? Like, yeah, where did the idea come from?

Prof. Frédéric Schuind: 10:12

So we founded the company Swibrace. And then I was still Chief of Department in Brussels. And one of my collaborator, Professor Moungondo, started to operate patients under sonography, which is ultrasound, like the ultrasound used in pregnant women. And he could achieve excellent results with this technique. But we decided to make an instrument and to patent this instrument. And to start a company with this idea. This is the idea behind Spirecut company.

Alex X-Health.show: 10:50

So how does it work?

Prof. Frédéric Schuind: 10:54

The instrument is like a very special needle. So it's very thin, it's 1.5 millimetre in diameter, and then we do a simple puncture, and then under sonography, while we know exactly what we operate, we make more room in the carpal tunnel for the median nerve or in the trigger finger for the flexor tendons. This is how it works.

Alex X-Health.show: 11:18

What are conditions? So let's start with the carpal tunnel? What is this? What are the symptoms?

Prof. Frédéric Schuind: 11:27

Oh, the carpal tunnel is a very common condition. I'm sure you know somebody around you, I don't know, your mother or auntie, or whoever who is suffering of a carpal tunnel. She is awakened every night with tingling sensation in the fingers, it's very painful, and during the day, she has also this sensation when she uses her mobile phone for example or does some activities. And the treatment is very simple, you just make more room for the median nerve and the problem is solved because it's related to the compression of the median nerve. The problem is that you need an incision and this incision needs maybe two weeks to heal. Many surgeons put a plaster cast and also you have less strength in your hand. And the average duration out of work is one month.

Alex X-Health.show: 12:20

So this is how it used to be. You also did surgery like this, that carpal tunnel...

Prof. Frédéric Schuind: 12:26

Oh, I did a lot of cases with open surgery and before also a lot of cases with endoscopy which is with a small incision. But it's a little bit more dangerous, at least to the technique that we develop under sonography, because under ultrasound we see very well the structure and also the incision is even less than with endoscopy.

Alex X-Health.show: 12:49

Okay, so with the regular surgery, you basically need to cut the skin right? What does it look like, actually, could you tell?

Prof. Frédéric Schuind: 12:59

Oh, it's an incision that the surgeon makes as small as possible maybe two centimetre at the palm of the hand, it heals quickly, but the scar is painful during a long time.

Alex X-Health.show: 13:11

And now with the Spirecut, so how does this change? How does the surgery change? Like, what do you do?

Prof. Frédéric Schuind: 13:19

We do the surgery under local anaesthesia, it can even be in the office not even not in the operating room. And, and the surgery lasts maybe five or ten minutes, it's very short. And the patient have a dressing but the next day there is no dressing anymore. They can wash their hands, they can go back to their activities. Of course for very heavy professional activities, like working in a farm for example, then it's still painful during a couple of weeks. This we cannot avoid because a ligament is section and has to heal.

Alex X-Health.show: 14:04

But then what does it look like from the surgeon's perspective? Is it much more difficult then? Because you're using just a tiny tiny tool and then also sonography to support. Yeah, how does this change the the experience of the surgeon?

Prof. Frédéric Schuind: 14:22

Well for the surgeon it's completely different than normal surgery because he holds in one hand, usually the non-dominant hand, the probe of the sonography and in the other hand he uses our instrument to perform the surgery. There is no skin opening, he has to look on the screen what he does, so it's very different. I must say that it's not so different than another type of surgery that many surgeons do which is arthroscopy, which is manipulating in one hand the endoscope and the other hand an instrument or looking on the screen. So they have some experience. I must say that other possible doctors who could treat in the future carpal tunnel, trigger finger with our technique, are radiologists and physical medicine doctors who are really trained in sonography. The hand surgeon will need to be trained in sonography, not especially in Switzerland, because a lot of them already use sonography – more for diagnose than for treatment but it's coming.

Alex X-Health.show: 15:28

[MID-ROLL BREAT] This episode is brought to you by the X-Health.show, and me. So if you like this podcast, be generous hit follow, leave a review, that'll help me invite more such amazing guests for you. Thank you. [END MID-ROLL BREAK] And how was it received by fellow surgeons, the professor Moungondo's new way of surgery, of treating trigger finger or carpal tunnel syndrome?

Prof. Frédéric Schuind: 16:02

They are, I think, very interested and also a little bit... they know that they will need some training. So I think especially the young hand surgeons or even the medical students – they are extremely interested. And they learn very quickly how to use the sonography. But there are a lot of advantages. Also for the surgeon: the surgery is quicker you can do in the office, you can operate without an assistant, he does not need other instruments than the one that we provide. So there are a lot of advantages also for the surgeon. So I think a lot of them will convert over the time to our technique.

Alex X-Health.show: 16:47

So you said it's quicker. Like, how long does it take?

Prof. Frédéric Schuind: 16:50

I think on average for trigger finger, it's six minutes and for the carpal tunnel is 12 minutes.

Alex X-Health.show: 16:57

That's stunning. That's I mean from the start to the end till the patient can go out?

Prof. Frédéric Schuind: 17:03

Oh, I don't count there the time to bring the patient in the operating... because we do that in the operating room now... to bring to the operating room or to bring him or her outside. No. But I just speak about the time of the surgery itself.

Alex X-Health.show: 17:17

And the regular surgery. How long does it take?

Prof. Frédéric Schuind: 17:21

Not so much time I say but maybe 10-15 minutes more. But also there is the time of the anaesthesia. Sometimes the anaesthesia is done in the operating room or it is done in another room. It depends. This takes time.

Alex X-Health.show: 17:38

We haven't spoken about trigger finger. Because this is also when we can use the sonar instruments so basically, the Spirecut instruments. What's trigger finger? How could you say are symptoms of it?

Prof. Frédéric Schuind: 17:55

Well, it's a blockade of the finger inflection. It's very frequent. Actually, all these diseases are very frequent. Carpal tunnel is one person in 10 and trigger finger about the same. And so it's a very painful blockage of the finger in the palm. And then the patient has to use the other hand to re-extend the finger. It's very frequent in diabetic patients. And the treatment... sometimes it goes away by itself. Many times an infiltration, injection of steroids can help the patient but usually it comes back after the injection. So the good treatment is just to make more room for the flexor tendons, and the problem is solved. And, but an incision is necessary in the palm of the hand and this incision is painful. And we can do that without incision. So it's much better for the patients. We did recently a clinical investigation and all patients operated, trigger finger, the next day could go back to all the activity. So it's really something that helps the patient.

Alex X-Health.show: 19:02

And how the patients... what were their... What did they say? I'm just trying to think, like, because they didn't have any such a surgery before, right? Or were there any patients that already have trigger finger treated?

Prof. Frédéric Schuind: 19:25

For the patient the treatment seems like they get an injection of steroid while we do really surgery. But for them it's like a puncture. That's it and the patients don't like anymore when they're offered this possibility to have open surgery.

Alex X-Health.show: 19:46

Do you think with these sono instruments you can actually make surgeons perform more such surgeries or yeah, what could be the benefit, like, say, for a hospital or a clinic?

Prof. Frédéric Schuind: 20:02

Well, the main benefit I think... Everybody benefits from the technique. And maybe the main benefit is the costs for the social security because the surgery can be done in an office, and not in an operating room, you know. In the United States one minute of operating room is over $50. So it's a lot of money that you can save. But especially you save a lot of money when the patient can go quicker back to their professional activities.

Alex X-Health.show: 20:34

So you said... the benefits for the patients, the benefits for surgeons also for insurance companies. Now from the company's strategy... from the company's point of view, the market is clear for your tools, right, these are hand surgeons. How would you like to see the development of hand surgery?

Prof. Frédéric Schuind: 21:05

So just about to your question... I think the users can be hand surgeons but also radiologists and physical medicine doctors, that's one thing. Well, I think in the future, the hand surgery will use sonography. Every congress we go now... for hand surgery it's a big topic. Sonography is used for diagnosis but more and more also for treatment. So this is a major advance in hand surgery now. And Spirecut really serves on this... I would not say fashion, but the new tool for the surgeons.

Alex X-Health.show: 21:44

Let's go back a bit. Because when you decided you want to start business, how did you start to gather the team? What were you looking for?

Prof. Frédéric Schuind: 22:00

In academic institutions because from the beginning I worked with academic institutions. And it's from there that I could recruit the talented people working with me and making the success, I think, for the company.

Alex X-Health.show: 22:17

So you were looking in Brussels, at the Université libre de Bruxelles?

Prof. Frédéric Schuind: 22:25

No, no, no. No, no, no. Actually, indeed... you must know my background. So I have double citizenship. And I decided after... when I was honorary professor in Brussels, to come back to Switzerland, where are my roots, actually, and to start the company in Switzerland. So initially Spirecut was in Fribourg and now, recently, as you know, we've moved to Basel area.

Alex X-Health.show: 22:55

Why, why Switzerland? Why not in Belgium?

Prof. Frédéric Schuind: 22:59

Well, because I got a very good support to start a company in Switzerland. That's one reason. Another reason, maybe not so important, because I like to live in Switzerland. And final reason, especially for Spirecut is that we need the expertise of the MedTech to produce our instrument. It's very difficult to produce our instruments, they are very tiny, they are bent, they have special features to allow a sonographic marking, and this needs the specialised MedTech industry from Switzerland, actually coming a long time ago from the watch industry. This expertise you don't find in many places in the world.

Alex X-Health.show: 23:48

Please tell me a bit more then about the tool because it looks very simple, right? When you look at it. But then you say it's not that simple to build.

Prof. Frédéric Schuind: 23:59

No, because it cuts in one plane, this is for safety. So actually, if we would come, which is not the case because we see very well what we do under sonoography, but for safety, if we come to a tendon or to a nerve, it won't cut the structure, it will really cut what is needed to be cut. Also there are features allowing to see the tip of the instrument under sonography otherwise you don't see very well, then you don't know exactly what to do. So it's adapted to sonography.

Alex X-Health.show: 24:34

What are the features? Because actually, I was watching one of the professor Moungondo's videos, also on sonography, and I mean, I could see the Spirecut tool so I guess, you know, surgeons – they can see the whole world... the whole hand world, you know, on this ultrasound.

Prof. Frédéric Schuind: 25:00

Yes, you see very well, you see very well, for example, the carpal tunnel, the median nerve, the transverse carpal ligament that you have to cut, you see the artery, you see the tendon, you see it very well. But what is important is not only to see the structure, but also to see your tool and know exactly where you cut. Because there are a lot of anatomical variations in the hands. And if you do it a little bit blindly, then it's dangerous.

Alex X-Health.show: 25:29

But then, this is how it used to be done, right? Oh, but you opened the skin, right, and you could see everything...

Prof. Frédéric Schuind: 25:37

Yes, that's right.

Alex X-Health.show: 25:38

And now with the sonography, you don't need to open it. But yeah, do you see it as well, as you would open that? I can imagine, you know, there are people who did the surgery, like, I mean, who specialise in this kind of surgery. And they are hesitant to switch because, you know how well can they see what's there?

Prof. Frédéric Schuind: 26:03

You see better, actually, under sonography than open.

Alex X-Health.show: 26:06

Oh, that's amazing.

Prof. Frédéric Schuind: 26:07

Yes, I have seen unfortunately, it was not done during my career, a very experienced surgeon cutting a very important structure because this stracture had an abnormal trajectory. And he discovered when it was cut, but he could not see before. So actually, when you are good at sonography, so the surgeon needs to have some training, it's safer.

Alex X-Health.show: 26:40

What was the first Spirecut success?

Prof. Frédéric Schuind: 26:43

Well, we won many prizes, actually, in the Swiss environment. The last prize was the Swiss Innovation Challenge. And it is after this prize that we decided to move to Basel area. Also, we got early on investors and these investors bring a lot of expertise to the company, which is very helpful.

Alex X-Health.show: 27:10

What do you need now? So what does Spirecut need now to expand or to develop?

Prof. Frédéric Schuind: 27:17

Well, like all the companies we need the more funds. Actually we are opening Series A. We also need, I think, a partnership with a major biomedical company to distribute in many countries. And also teach the surgeons the technique.

Alex X-Health.show: 27:40

What are the plans now for Spirecut?

Prof. Frédéric Schuind: 27:45

Well, you know, we had... The company was founded in 2020, in the middle of the COVID time, very difficult time. But we developed very quickly our product because we work not only on the first prototype but also on industrialization and also all the aspects of regulatory. So now we are ready to market launch. Actually we are already FDA listed. And we will get very soon the CE mark because the authorities imposed on us a clinical investigation, we had to operate a group of patients of carpal tunnel and of trigger finger. This is done now. We have excellent results demonstrating the efficiency and the safety of the device. And now very soon we'll get CE mark allowing us to sell a medical product on the market and starting with the Swiss market.

Alex X-Health.show: 28:47

Could you tell us a bit more about the research results?

Prof. Frédéric Schuind: 28:52

Yes, so we had one group of people with carpal tunnel and one group of people with trigger finger. All the patients could the next day wash their hands. The patients were evaluated after one week. After carpal tunnel, 80% of the people are working their way back to the professional activities or the patient were back to the activities of daily life. And then we re-evaluated the patients after two months and all the patients had returned to their activities. The scar itself... it's not really a scary so just a puncture, but the site of ligament section was still a little bit painful like with after open surgery and, I forgot the percentage, but a significant percentage of the patients for the trigger finger the results were really excellent. The next day the people could wash their hands, after one week they were all back to their all day activities and with no more triggering. And the same of course after two months.

Alex X-Health.show: 29:56

So when will sonar instruments be available, basically, for surgeons, and where?

Prof. Frédéric Schuind: 30:06

It will be available... It's now already available in the United States and in other countries following the FDA, like, for example, Israel or other countries. It will be available according to the European regulations that also Switzerland follow, so, when we get the CE mark and this depends on the time that the notified bodies, it is the complex pass in Europe, decide to give us the certificate. Maybe in three months, maybe in four months, I don't know exactly. We have actually this 23rd of June our first training workshop for surgeons, some Swiss, some foreign, in Bern, where we will really train them. And so, as soon as we got the famous CE mark, it will be available,

Alex X-Health.show: 31:04

Who are the first surgeons that signed up for the workshop?

Prof. Frédéric Schuind: 31:08

Some Swiss surgeons, Israeli surgeons, and one French surgeon.

Alex X-Health.show: 31:16

Is there anything special... I mean, any special characteristics of them? Like why would they want to try it first?

Prof. Frédéric Schuind: 31:25

Actually, most of them had already some trial because we have developed some special training system. But during this workshop, they will be able to do a trial on a really anatomical specimen, which they have not done yet.

Alex X-Health.show: 31:50

Is there still a chance if someone wanted to sign up for the workshop? Can they still do or is it already full?

Prof. Frédéric Schuind: 31:57

It's full, but nothing is impossible if somebody is really interested to follow this workshop.

Alex X-Health.show: 32:03

Okay, so thank you very much for the conversation. And now if you want to follow Spirecut, please go to spirecut.com which is S P I R E C U T .com. Thank you very much.

Prof. Frédéric Schuind: 32:25

You're welcome. And of course, anybody can contact me also whenever they want, or my team.

Alex X-Health.show: 32:31

[POST-ROLL] I'm totally impressed by the audacity of researchers turned startup founders, doctors turned entrepreneurs or ordinary parents turned healthcare innovators. People battling the battles that no one fought before. For the eXtra health of the future. So if you see a startup posting on LinkedIn, show them some love, hip Like, comment, "That's fabulous". If you have a couple drops more of that altruism, follow the X-Health.show, leave a review here, I'll be able to bring more of these visionaries to you. So a big thank you. You're awesome. See you next week.

SPEAKER: 33:16

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