State of Medtech Podcast

Autonomous Surgery: How Andromeda Surgical Is Building a New MedTech Playbook with Nick Damiano and Dave Messina of Pioneer Fund. What if the next billion-dollar MedTech companies are built more like Silicon Valley startups than traditional device businesses? I sat down with @nickdamian0 , Co-founder and CEO of @andromedasurg , and @DaveMessina , General Partner at @pioneer_fund , for a deep conversation about TechMed, autonomous surgery, venture capital, and how the company-building playbook in healthcare may be changing. One idea kept coming up: speed compounds. Andromeda is not trying to jump directly from zero to fully autonomous surgery. Nick’s approach is to start with a focused clinical problem, work closely with surgeons, collect repetitions and data, improve the system quickly, and then expand the platform into additional procedures. The business model follows the same logic. Instead of optimizing only for early revenue, Andromeda is prioritizing utilization and learning because more usage can create more data, more features, and a stronger platform over time. Dave also explains what early-stage investors can evaluate before meaningful revenue exists. Founder speed, unique insight, customer pull, ambition, and the ability to learn quickly can reveal far more than a traditional revenue chart at the earliest stages. We also get into founder-led companies, FDA strategy, AI hype, process power, surgical robotics, competitive moats, and why the fundamentals of building a great business matter even more as technology becomes easier to create. The TechMed opportunity is not simply building better devices. It is building healthcare companies that can learn, scale, and compound like technology platforms. Episode Breakdown: 00:00 Why Autonomous Surgical Robots Could Outperform Human Surgeons 00:52 Intro 01:12 Meet Nick Damiano and Dave Messina 02:12 How Pioneer Fund Invested in Andromeda Surgical 02:50 Why Early-Stage MedTech Investing Requires Conviction 03:44 Is Traditional MedTech Venture Capital Falling Behind? 04:19 Why Silicon Valley Investors Think Differently About MedTech 05:24 What Is Tech Med and Why Does It Matter? 07:23 How MedTech Can Move at the Speed of Software 08:55 Why MedTech Needs Category-Defining Innovation 10:05 How FDA Regulations Can Accelerate Autonomous Surgery 11:16 Why Incremental Innovation Can Drive Faster Adoption 12:15 Market Engineering and MedTech Growth 14:14 Why Faster Feedback Loops Matter in MedTech 15:20 How Andromeda Surgical Accelerates Product Development 16:29 How Andromeda Improved Robotic Surgery Efficiency 17:11 Why Surgical Robotics Data Could Be More Valuable Than Revenue 17:53 What Investors Look for Before a MedTech Company Generates Revenue 20:11 Why Andromeda Surgical Is Building a Platform, Not a Product 20:48 How to Build a Competitive Advantage in MedTech 21:44 The Seven Powers Behind Andromeda Surgical's Strategy 22:30 How Automation Helps MedTech Startups Move 10 Times Faster 23:20 Why Andromeda Prioritizes Data Over Short-Term Revenue 24:12 What Uber's Growth Strategy Can Teach Surgical Robotics 24:44 How Network Effects Could Transform Autonomous Surgery 25:27 What Makes a MedTech Founder Worth Investing In? 27:00 Why Investors Value Unconventional Founder Backgrounds 28:46 Why Replacing MedTech Founders Can Be a Costly Mistake 30:31 Why Founder-Led MedTech Companies Perform Differently 31:02 What Y Combinator Taught Silicon Valley About Founders 32:25 Successful Founder-Led Healthcare Startups 33:45 Why MedTech Needs Business Model Innovation 35:03 How Founders Balance Conviction With Coachability 35:17 Why Great Founders Don't Need to Know Everything 36:37 Can Silicon Valley's Startup Playbook Work in MedTech? 37:45 Why Founder Mode Matters in Surgical Robotics 38:41 What Makes Andromeda Surgical's Founding Team Different? 39:31 Why Building a Great Business Matters More Than Ever 40:35 How AI Is Changing Competitive Advantages in Healthcare 42:19 Why Pioneer Fund Backed Andromeda Surgical 42:57 Could Autonomous Robots Make Surgery Safer? 44:55 Why Andromeda Started With One Surgical Procedure 46:44 Why Solving Smaller Problems Accelerates Bigger Breakthroughs 47:32 How Beachhead Markets Accelerate Surgical Robotics Adoption 48:29 Why Focus Is Critical for Early-Stage MedTech Startups 49:15 What Waymo's Development Can Teach Autonomous Surgery 49:45 Why a16z Is Investing in Autonomous Surgical Robotics 50:46 Why More Competition Could Benefit Surgical Robotics 51:13 What Advice Would Nick Give New Autonomous Surgery Startups? 51:39 Why General-Purpose Autonomous Surgery Is So Difficult 53:45 Is AI Hype Creating Unrealistic Expectations in MedTech? 55:03 Why Ambitious Surgical Robotics Claims Need Evidence 55:42 How Smaller Milestones Make Breakthrough Innovation Possible 57:15 Why Magical Thinking Is Dangerous for AI Startups 58:15 Why Experienced Founders Still Need Open-Minded Thinking 59:09 How Industry Experience Can Create Hidden Biases 01:00:31 Why Andromeda Hires for Learning Speed Over Experience 01:01:24 Why a Young Regulatory Leader Outperformed Industry Veterans 01:02:43 Why Big MedTech Experience Doesn't Always Translate to Startups 01:04:06 Why Startups Must Challenge Traditional Industry Assumptions 01:04:43 Can MedTech Move Faster Without Sacrificing Regulatory Rigor? 01:05:25 Why Saying No Is a Competitive Advantage 01:06:23 How Strategic Focus Accelerates MedTech Innovation 01:07:18 Why Founders Must Avoid Distracting Opportunities 01:08:13 Why Andromeda Rejects Traditional Surgical Robotics Business Models 01:08:53 Why Copying Intuitive Surgical Is a Losing Strategy 01:09:34 What Intuitive Surgical's Success Teaches the Next Generation 01:10:25 Why Software Could Become the Future of Surgical Robotics 01:11:10 Where to Follow Nick Damiano and Dave Messina 01:12:00 End

If you’re in Massachusetts you have two choices. 1. Vote for @mikeminoguema is a serial entrepreneur who grew a heart technology company from $4M to over billion in revenue and exited for $17B, is a father of 5, a patriot, man of faith and combat veteran. 2. The status quo which, if you look at Massachusetts today, has been a complete disaster frankly. Get out and vote.

Could Space Medicine Become the Forcing Function MedTech Innovation Needs? Matthew Kuhn of Skybound Medtech. What happens when getting to space becomes easier than keeping humans healthy once they arrive? I had a fascinating conversation with Matthew Kuhn(@matthewkuhn) , Founder and CEO of Skybound Medtech (skyboundmedtech.com) , to explore one of the most interesting emerging categories in MedTech: space medicine. Matthew’s thesis is that as launch costs fall and humans spend longer periods beyond Earth, human physiology becomes the next bottleneck. That creates problems traditional healthcare was never built to solve. Microgravity accelerates muscle and bone loss. Earth-based supply chains disappear. A medical emergency on Mars could involve a communication delay long enough that waiting for instructions from a physician on Earth is no longer practical. That pushes medicine toward autonomous robotics, reusable medical devices, physical AI, local clinical decision-making, and entirely new approaches to human performance. What I found especially interesting is that this is not only about astronauts. Space can act as a forcing function for medical innovation because many physiological problems become dramatically accelerated in extreme environments. Technologies developed to keep people healthy in space could eventually translate back into aging, rehabilitation, chronic disease, and healthcare on Earth. Matthew also explains why Skybound is building at the intersection of space, defense, and clinical medicine, using a venture studio model designed to turn mission-critical problems into standalone companies. The real opportunity may not be adapting Earth medicine for space, but using space to force medicine to invent what comes next. Episode Breakdown 00:00 Why Space Medicine Could Change Healthcare Forever 01:07 Meet Matthew Kuhn, Founder of Skybound MedTech 02:24 From Johnson & Johnson to MedTech Entrepreneurship 03:30 How Lockheed Martin's Skunk Works Inspired MedTech Innovation 05:03 Could Removing Gravity Transform Modern Medicine? 06:11 Why Space Exploration Needs New Medical Technologies 07:53 How Manufacturing in Space Could Improve Medicine 09:09 Which Surgeries Could Benefit From Zero Gravity? 10:16 What NASA's Twin Study Revealed About Aging 11:19 Telomeres, Longevity and the Effects of Space Travel 12:43 Could Space Research Unlock Longevity Breakthroughs? 13:30 Market Engineering and MedTech Growth 15:28 What We Still Don't Understand About Space and Human Health 15:52 Why Osteoporosis Is a Major Challenge in Space 16:11 How Microgravity Accelerates Bone and Muscle Loss 17:23 What Happens to Astronauts After Long Space Missions? 18:46 Why Space Is So Dangerous for the Human Body 19:11 Is Space Medicine an Entirely New MedTech Category? 20:44 Why Space Medicine Could Accelerate Medical Innovation 21:17 How Space Research Could Transform Healthcare on Earth 22:18 Why MedTech Needs More Moonshot Innovation 23:23 Why Space Medicine May Require Autonomous Surgical Robotics 24:59 Why Disposable Medical Devices Won't Work on Mars 26:07 Could Space Accelerate Autonomous Surgery? 26:30 What Happens When Someone Has a Heart Attack in Space? 26:59 Why Mars Communication Delays Make Remote Surgery Difficult 27:40 How NASA and Space Companies View Space Medicine 28:48 Why the Space Economy Is Changing So Quickly 30:22 NASA's Moon Base Plans and the Future of the ISS 30:47 Why Private Companies Are Building the Next Space Stations 32:06 What the AI Boom Can Teach Us About Space Innovation 33:55 What Is Skybound MedTech's Business Model? 34:20 Why Skybound Focuses on Space, Defense and Longevity 35:26 How Skybound Makes Deep Tech Ventures Investable 35:58 Who Invests in Space Medicine Startups? 36:13 Why Traditional MedTech Venture Capital Is Challenging 37:01 How Space and Defense Funding Opens New Opportunities 37:33 Why Early-Stage Investors Are Demanding Revenue 39:18 What Silicon Valley Gets Right About Startup Investing 39:47 Why MedTech Investors Are Moving Toward Later-Stage Companies 41:20 Could Space Medicine Attract a New Class of Investors? 42:04 The Rise of Brain-Computer Interface Startups 42:28 Which BCI Companies Are Leading Innovation? 43:51 How Motif Neurotech Is Advancing Brain Stimulation 44:52 Why Colossal Biosciences Wants to Revive Extinct Animals 45:44 How De-Extinction Could Create Valuable New Technologies 46:43 What Skybound Can Learn From Colossal Biosciences 47:20 How Moonshot Missions Create Commercial Opportunities 48:39 The Unexpected Story Behind Skybound MedTech 50:35 How Reusable Rockets Inspired a New Healthcare Vision 51:07 Why Human Physiology Could Become Space's Biggest Bottleneck 52:14 How a Father's Curiosity Sparked a MedTech Idea 53:48 What Growth Hormones Reveal About Human Physiology 54:44 Could We Prevent Muscle and Bone Loss in Space? 55:19 How Skybound Chooses Which Technologies to Develop 56:08 The Challenge of Testing Medical Devices for Space 56:34 Could NVIDIA's AI Simulations Transform MedTech Discovery? 58:26 Why Medical Device Innovation Needs New Discovery Models 58:39 Can Digital Twins Simulate Human Biology? 59:45 Is Skybound MedTech a Venture Studio? 01:00:10 How Skybound Plans to Build and Spin Out MedTech Startups 01:01:27 Why Houston Could Lead the Next Space Medicine Revolution 01:02:06 Should Medical Innovation Start in Space or on Earth? 01:02:25 Why Skybound Starts With the Challenges of Space 01:03:01 Final Thoughts on Space Medicine and Breakthrough Innovation 01:04:00 End

Great session at #MTC26 @iRhythmTech CEO Quentin Blackford had a great point on medtech and tech. The winners in our space will own Clinical accountability but that we have to find ways to do partnerships with big tech to amplify the value we deliver to patients.