Surgeon-turned-entrepreneur creates device to prevent surgical delays

Bariatric and general surgeon Dr. Maria Iliakova sets a silver, metal canister on the wooden table, its contents clanging around. She opens it to reveal a hodge-podge of surgical instruments, taking a few out and turning them in her hands thoughtfully. At the moment, in her canary yellow suit jacket and gray linen pants, she looks more ready to command a boardroom than an operating room. Being an entrepreneur in addition to a surgeon is not something she ever thought she’d do, but it all started with the surgical container of tools on the table.

She was at 1 Million Cups at MERGE in Iowa City on Feb. 28, preparing to deliver a pitch on her business, Innovation Surgical, producer of the KIM Smart Cart – a surgical “vending machine” on wheels that dispenses and tracks OR tools, an invention of her own making. The surgeon-turned-entrepreneur says both professions keep her very busy, but she wouldn’t have it any other way.

Early life

Growing up in Kansas City, Missouri, Dr. Iliakova looked up to her mother, Mira Mdivani, an immigration attorney from Moscow, Russia. Ms. Mdivani worked primarily with companies bringing in foreign workers to be doctors, nurses and engineers, which exposed her daughter to a wide variety of professions, particularly in the medical field. Seeing the impact her mother and her clients made on the community spurred her to make a positive change in the world as well, and she explored the possibility of a career as a patent attorney. “I’ve always been interested in science, chemistry, biology, physics… I thought that would be a nice way to combine the two worlds,” said Dr. Iliakova, she ultimately landed on medical school. She attended the University of Kansas Medical Center, obtained a master's in biochemistry and bioinformatics at Georgetown University, D.C., and then received biology, chemistry and Spanish degrees at University of Missouri-Kansas City. Infectious diseases and neurology were two subjects that interested Ms. Iliakova while in medical school, but it wasn’t until her last year that she became enamored with surgery. She witnessed the first-hand importance of organ donation while on transplant surgery rotation. “I had never seen anything like that. (It) looked like magic to me, as far as I was concerned,” she said.

Surgical delays call for solutions

It was while working in the OR at Mercy Iowa City that Dr. Iliakova noticed surgical delays were often linked to difficulties in tracking tools, a problem she was determined to rectify.

“Over 50% of cases have a delay relating to a tool that’s missing,” she said, a problem that plagues community hospitals and large hospitals alike, no matter how streamlined the hospitals operate. The current system involves manually entering each tool and its container on a spreadsheet, but once it leaves the room, it becomes difficult to track, she said. “Not only are the tools not getting tracked, but even the containers are not getting tracked,” she said. The concept of a surgical tool tracking device was already something Dr. Iliakova was pursuing when the hospital announced bankruptcy in August 2023. Calling it an “opportunity to help create solutions,” she began to pursue a design in earnest. “It helped me to realize that there are really no certainties in the world,” she said, of the hospital’s bankruptcy. “You can be in a great job and you can have a great role. But ultimately, you can't control a hospital going bankrupt as a surgeon,” she said. Informatics and efficiency have always been of interest to Dr. Iliakova, and the more efficient a system is, she said, the better the likelihood of more patients receiving care. “That means a lot more than dollar bills or an efficiency metric. It literally means that more people get to access surgical care,” she said. “(Inventory management) may not be a sexy problem, but it's actually extremely important problem, because if this is what's leading to delays this often, and it's something we can make even 1% better, than that means we can potentially add an extra case to every OR that's using a tool that can help us fix this problem,” she said.

Surgeon-turned-entrepreneur

The same month that Mercy Iowa City announced bankruptcy, Dr. Iliakova reached out to Paul Heath, director of the University of Iowa’s Small Business Development Center, who connected her to Venture School through the John Pappajohn Entrepreneurial Center (JPEC). Venture School’s seven week program – “an incredible resource,” she called it – gave her a framework for creating a business plan and moving forward as an entrepreneur. She settled on the name "Innovation Surgical" for her new company, and won first place and $2,000 at the final pitch competition. While conducting customer discovery – one of the first steps she took – she spoke to over 300 people, including surgical technologists, OR circulator nurses, OR directors, janitors, central processing directors, data analysis, CEOs, CFOs, chief administrative officers, accounting, vendor contracts, patients, software engineers and representatives of the surgical tool industry to better understand the problem in order to fix it. “It's been a process,” she said. “It's been very humbling, because sometimes as a surgeon, you're kind of trained to always have the answer. And so coming into this process, I had to come in with a lot of curiosity and humility and understand I had no idea how to fix it.” Dr. Iliakova sketched designs for her device on anything from paper napkins to notebooks before settling on a prototyping studio and design team, who were able to make her idea – the Kim Smart Cart – a reality.

Marketing the KIM Smart Cart

The Kim Smart Cart is named for Kim Russell, a surgical tech Dr. Iliakova worked with at Mercy Iowa City who was instrumental in helping her implement the da Vinci Xi Surgical System robotic program. “Anytime I got to work with Kim, I knew that it was going to be a great day, and I knew that cases were going to go really smoothly – that patients were going to do really well as a result,” she said.

Dr. Iliakova describes the Kim Smart Cart as a moveable, surgical “vending machine” that dispenses and tracks OR tools. Central supply staff load the metal surgical containers into the machine, and an app tracks the location of the Kim Smart Cart at all times. A digital interaction interface vends the tool containers for the surgical staff. Dr. Iliakova is also working on creating object recognition software and making the machine autonomous, but for now it’s “keep it simple, stupid,” she said. While the KIM Smart Cart is not quite a reality yet, Dr. Iliakova is currently working on agreements with some Iowa hospitals to trial the prototype this fall. "The goal of the in-hospital trials this fall is to determine a useful and easy-to-use design for the first commercial version of the KIM smart cart," she said, noting that her team of advisors include tool processing specialists from multiple surgical facilities. It's too early in the process to attach a retail sticker to the KIM Smart Cart, but there are plans to use a leasing model for annual cost of equipment comparable to existing instrument carts, offering annual data packages on surgical tool use and tracking to hospitals and third parties. "We also plan to have an option available that is integrated with electronic health records available as a premium service to simplify billing for surgical procedures," said Dr. Iliakova. Marketing has thus far been limited to hospitals with a previously established relationship with Dr. Iliakova, but she plans on presenting the KIM Smart Cart and surgical tool tracking technology at several surgeon conferences this year: SAGES 2024 in April, ASMBS 2024 in June, and IFSO 2024 in September. She's working on a publication as well. "Marketing is tough, but (I) intend to start small (and) build a really useful product and service that works well for the people it serves," she said.

Learning to be flexible

Dr. Iliakova operates best when she stays busy, she said, and noticed the same trait in the entrepreneurs she met at Venture School. Starting her own business has required more flexibility and unstructured time, which was something she was unaccustomed to in her eight-year career as a surgeon. “A lot of my time has been structured for many, many, many years,” she said. “When you're doing your own business…you really have to be creative, and you have to be comfortable being alone, sometimes. You have to be comfortable with unstructured time and being very flexible, because sometimes you really want to go down a certain path, but that's not where you need to go, based on the feedback you're getting from potential customers or from others involved in the business, or from the resources you have.” The entire process has been a learning curve in many other ways, she said. “Don't try to predict the next step,” she said. “Have a plan, have a backup plan and definitely try to stick to the commitments that you've made, but otherwise, be flexible. And keep your ears open at all times – do more listening than you're doing talking.” Dr. Iliakova still performs surgery as a traveling surgeon, primarily in Iowa, Washington and Florida, with plans to open her own practice in general and bariatric surgery, which will be based in Iowa City starting this June. In addition, she will be using operating rooms at UIHC Downtown Campus and the Iowa City ASC, as well as offering outreach clinic and surgery services to other Iowa rural and community hospitals -- all in addition to booking demonstrations of her device. “As a surgeon, I honestly thought it would be difficult to do surgery, plus start a business, and I won't say it's not. But the huge benefit of being a surgeon while doing this is, I constantly get to do customer discovery and see what's working and what's not. “Plus, I also just really like being a surgeon. That is definitely my favorite thing to do, is to be able to actually operate on someone and to be able to help them fix a problem. But this (business) just makes me feel very immersed, which is extraordinarily helpful when you're building a solution to a problem that you really care about.” Dr. Iliakova lives in Iowa City with her rescue dog, Sasha, and submitted a patent for her device in November 2023. You can find out more about her business at innovationsurgical.net.