Mark Slack On Raising A Record-Breaking $660 Million In The MedTech Space To Pioneer Robots To Perform Keyhole Surgery

Mark Slack is a pioneer in medical robotics and one of the key figures behind CMR Surgical, a company now valued at over $3B. His incredible journey and path to entrepreneurial success was shaped by early challenges, military service, and a deep-seated commitment to improving healthcare through innovation.

CMR Surgical has attracted funding from top-tier investors like SoftBank Vision Fund 2, LGT, Escala Capital Investments, and Ally Bridge Group.

In this episode, you will learn:

• Mark Slack’s journey from South Africa to building a $3B company was driven by resilience, discipline, and a passion for innovation.
• Competitive sports and a career-ending injury pushed him toward medicine, shaping his entrepreneurial spirit.
• His military experience as a combat medic in Angola taught him invaluable lessons in discipline, character, and observation.
• Slack’s observations in the medical field led to breakthroughs in surgery, influencing his decision to create innovative solutions like CMR Surgical.
• CMR Surgical’s success is built on creating accessible, affordable, and safe robotic surgery solutions for hospitals worldwide.
• Fundraising success was bolstered by rigorous research, clinical evidence, and a clear value proposition, raising $660M in 2021.
• Navigating complex regulatory frameworks remains a significant challenge for medical innovators, but modern approaches to data curation can help streamline processes.

 

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About Mark Slack:

Mark Slack is a co-founder and the Chief Medical Officer of CMR Surgical. He is a Consultant Gynaecologist with a strong background in clinical and translational research.

Mark trained as a medical doctor and Gynaecologist in South Africa, graduating with the Gold Medal for Obstetrics and Gynaecology for the Fellowship of the College of Medicine of South Africa.

He has continued to pursue a combined clinical and academic career with several successful innovations in surgery and Gynaecology. In addition, he has a strong interest in basic science research.

He still practices clinical medicine and surgery in Cambridge and is on staff at the Clinical School of Medicine at the University of Cambridge.

Mark actively participates in clinical and basic research and student teaching. He also has strong academic links in the USA, Canada, Europe, Australia, and South Africa.

His work resulted in him being awarded the Simms Black Professorship of the Royal College of Obstetricians and Gynaecologists and the “Leading Clinical Researcher” award by the National Institute of Health Research in 2015.

Mark has published over a hundred original peer-reviewed articles and contributed to over 25 textbooks.

His interest in minimal-access surgery led him to explore the possibilities of improving the uptake of minimal-access surgery by the utilization of more sophisticated surgical tools such as the robot.

Connect with Mark Slack:

• LinkedIn
• ContactOut
• Crunchbase
• RocketReach

Read the Full Transcription of the Interview:

Alejandro Cremades: alright Hello, everyone, and welcome to the Dealmaker Show. so Today, we have a really amazing guest. you know We’re going to be learning quite a bit you know on what they’re up to. you know Really remarkable. They’re building a rocket ship. um We’re talking about a valuation of over $3 billion in the last round. It was over $600 million in one go, so let that sink in.

Alejandro Cremades: and We’re going to be talking about you know basically the main motivations behind starting the business, ah how they went about raising money from where, what were some of the frustrations along the way, as well as the frustrations of being an innovator in a world and in a segment that is heavily regulated, as well as to how you unlock or not support from government.

Alejandro Cremades: so Again, very inspiring conversation, the one that we have ahead of us, and without further ado, let’s welcome our guest today, Mark Slag.

Mark Slack: Thank you.

Alejandro Cremades: Welcome up to the show.

Mark Slack: Thank you very much for having me, delighted to be here.

Alejandro Cremades: So originally born and raised in South Africa. So give us a memory lane.

Mark Slack: that

Alejandro Cremades: How is life growing up over there?

Mark Slack: yeah It was interesting, um yes, very much born and bred family from two, three generations there. um It was a difficult time in South Africa, politically it was a strange time and it was in the time of apartheid.

Mark Slack: um So as white people, we are very privileged. My parents were very left-wing, liberal, anti-apartheid. I’m so brought up complaining about the government, but so I went to school there. It was very peaceful. It was very, um we were encouraged to take part in sport. um And yes, a very sad um time as well because of the apartheid discrimination against people basically and the on on their colour alone. And very pleased to say those days have gone in my home country.

Alejandro Cremades: That’s incredible. So you were actually a champion athlete. So how do you think that that thing that competitiveness, you know, has fueled, you know, you as well on who you are and and how you tackle, you know, life towards an entrepreneur?

Mark Slack: Well, it’s um i always i always are often in I often employ people who come from ethnic backgrounds and Japanese ethnic backgrounds because I know they have a competitiveness in them. I was extremely competitive. I was a middle distance runner. I played a lot of sports, but the one I really excelled in was middle distance. um I had ambitions to go to the Olympics one day.

Mark Slack: and which were beaten by injury and that itself when I started getting injuries. um I maintained motivation. I didn’t give up. I then moved my attention to academia and got into university to study and read medicine. So um in many ways it drove me towards what I ended up doing as a profession.

Alejandro Cremades: Okay. So then, so then in your case too, I mean, injuries really push you in, in a different direction, right.

Mark Slack: Absolutely.

Alejandro Cremades: And and in a direction that the

Mark Slack: one yeah It introduced me to doctors that I saw and admired what they were doing and um it also meant I’d lost something I wanted um and it gave the motivation to succeed in something else.

Alejandro Cremades: So then let’s talk about a you getting into medical school because obviously you’re like, you know, maybe there is something here for me to explore as an alternative.

Mark Slack: Yeah, I mean, medical school was an interesting one. Because I’d been such a high-level athlete, my marks weren’t that good. And when I decided that I wanted to go to medical school, my teachers said, well, there’s a problem. You don’t have the high enough marks. I said, well, what do I need to do to to get in? They said, well, you have to work bloody hard. So I settled down for my last year at school, worked incredibly hard to get the grades you needed to get a first-class pass.

Mark Slack: to be able to apply for medical school and applied and got in. So that was that was good. It was um and very exciting. You know, the world of medicine, I found it’s something I really enjoyed. There were challenges. You had to learn a lot and to be good at it. You really needed a dedication. um So yes, a great profession.

Alejandro Cremades: So then I mean quite impressive that you decided to really go you know and and into the army into the into the service there and and all of a sudden you find yourself being a doctor in the middle of a battlefield. I mean I’m sure that was quite shocking and and transformative for you.

Mark Slack: Well it was quite weird because in South Africa we had conscription so you weren’t entitled to to um you weren’t entitled to decide whether you wanted to go to army. um You either went to the army or you went to jail or you left the country but then you could not go back. um I then went in, I went as a doctor and I volunteered to serve in Angola.

Mark Slack: that way see

Mark Slack: Sorry, I thought it was silence. My apologies. Let me just move that out.

Mark Slack: and

Mark Slack: My apologies, Alexandra. I thought they were all silenced. and So I had to go into the military and um so I volunteered to go to Angola. So I wouldn’t be serving against a South African. And I served as a combat medic, so I flew what we would call medivacs. We flew in helicopters to pick people up who were injured, bring them back, operate on them, and then take them back to South Africa. And I also served um supporting Angolan soldiers um from one of the rebel armies for a while. So a very interesting time. Learned a lot, learned a lot about myself, learned a lot about strength of character, and learned a lot about discipline.

Alejandro Cremades: So then in this case, a you know quite transformative, obviously, as you were saying, you know learning a lot about discipline. and how do you How do you find yourself all of a sudden landing in the UK?

Mark Slack: Now that was so partly that goes back to I was very worried that the South African government would never give up, that they would never break apartheid. And um I thought that it was just going to end in a conflagration and a terrible war. um So I made a decision to go and try the UK.

Mark Slack: um When I got to the UK, I got involved in research, I got involved in sub-specialisation, which I really enjoyed. And um so partly because of the politics in South Africa and partly because of the opportunities in the UK, I moved into the UK and um have been here ever since and have ah really enjoyed living here and have enjoyed ah my professional life here.

Alejandro Cremades: So then let’s talk about getting into Cambridge too and and and hitting it on the on the research side of things because that has been you know quite pivotal for you.

Mark Slack: Yes, so um I got into my subspecialisation and came into Cambridge. um I ended up as the Head of Gynecology in the University Hospital. um I was doing a lot of research in my subspecialty. So we did work in pharmaceutical work. We also did research in surgery, different operations.

Mark Slack: um which is fantastic to do. Plus, there is a huge supporting network. You can’t have an ego in Cambridge. There’s so many talented people around you, so many people bright, more Nobel laureates walking around Cambridge than they are in most countries of the world. And um so that was a very inspiring place to be. And um I had some ideas as well. I started getting interested in the business side.

Mark Slack: um of medicine. So some of my um ideas we um developed Johnson & Johnson and um they took over as a as a as products for me and took them to global launch. So I got the good experience in in taking an idea you know on the um business side and um taking it through his business case and um yeah taking it to launch.

Alejandro Cremades: So before that, you were you were also seeing a lot of a lot of things. um You know, you were even involved in the whole thing you know of implants that ended up being you know becoming dangerous.

Alejandro Cremades: So so obviously, you know, some of those things that you were doing that you were seeing kind of like push you in this in this direction, too. So what were some of those things that you were experiencing that kind of like started to feel that the that thought process, that the frustration you know that led you eventually to become an entrepreneur?

Mark Slack: yeah Yeah, I think one of the things is to be a good entrepreneur or an inventor or anything. You need to also be a very good observer.

Mark Slack: And you need to be an observer and honest when you see things that are different from the normal. You’ve got to be willing to think, oh, that’s different. And then you look at it and explore it and see whether something can be done. So you say the implants, they were using plastic um implants for um types of surgery. They use them for hernias. And in females, they were using it for prolapse operations. And I was aware that many, many years ago, 30 years ago, they had tried this with not great results.

Mark Slack: And um I um was very, very interested. So I um started looking at it. I then did work experiments in animals and I did laboratory-based work, which confirmed my suspicions that these umlants implants weren’t a good thing and shouldn’t be put in humans as they were being put, and started lecturing on that, talking about it. And um ultimately, these became found to be bad.

Mark Slack: um There was a huge amount of of um publicity around it and um it went to large class actions in the United States. I was the expert witnessing quite a few of them um as groups of patients sued the companies. So that was also a good reminder to me that if you’re going to do innovations in medicine, if you’re going to do innovations in surgery, you got to be sure that what you’re doing is safe.

Mark Slack: and you follow the rules that you do good, safe medical introductions at patients who don’t get harmed. So that was a really inspiring time of my life. But I’ve always been an observer, I’ve always criticized many, many years ago um when my wife had her first, our first child, she had quite a big hemorrhage and they wanted to transfuse her and I wouldn’t let them. Because I was scared of blood, I thought there were many dangers associated with blood.

Mark Slack: And um that, again, got me in a lot of trouble with my seniors. I thought, why was I interfering in the management? But my wife didn’t have a blood transfusion, which was good. And I went through, um you know, my career talking more on blood, doing more work on it. And in fact, now in 2024, the data shows that blood, of course, has some value. But in most cases, it’s not valuable. In 58% of transfusions, I think it’s harmful.

Mark Slack: um So it was that observation that I was willing to observe things, do different and be different. It doesn’t make you popular necessary. People can get quite cross with you when you challenge what the normal is and you’ve got to be a little bit thick-skinned as an innovator to go ahead and with your ideas and do it differently. And then of course I started questioning the way surgery has been done, which is why I got around to building a robot.

Alejandro Cremades: so Let’s talk about the ah the company. Let’s talk about CMR surgical. What ended up being the business model? How are you guys making money?

Mark Slack: Well, we started off, um there were um five of us who wanted to to um build a robot to help with keyhole surgery. Keyhole surgery is very useful. It massively reduces complications.

Mark Slack: um in surgery compared to the open surgery, but it’s very difficult to do and a very significant number of surgeons can’t do keyhole surgery, just too technically difficult. And we thought a robot might help that because with a robot you get three-dimensional view, you get magnification of the view, you have instruments that have articulated wrists,

Mark Slack: um it’s a All the functions are made easier, but the robots that were available in the market I didn’t like, they were too big, too expensive, they made you change many things. So we set out to build a builder robot that replicated the sort of robots, the surgery that you did with standard keyhole surgery. And that’s what we’ve done. So ours is quite small, very neat, and it enables you to do keyhole surgery in exactly the way you did it when you’re holding it with your arms. But a greater number of surgeons can do it. It’s more accurate, it’s um more precise, and so on. So that was the model. Now, number two, you’ve got to get a robot that fits into the flow of the hospital.

Mark Slack: You know, some of the big robots, you have to knock down walls to put them in. You have to reinforce the floor, raise the roof. Ours just fits in a normal theater. No disruption to the normal flow. It goes in. Training is relatively easy. we We have training programs on it. And then what you want to do is have that robot working five, six days a week. That then reduces the cost of it and it becomes a robot that is affordable for the health system to use.

Alejandro Cremades: So you guys have raised also quite a bit of money. How much have you guys raised too late?

Mark Slack: Right. So our first raise was about, we raised a tiny amount of money. We were very lucky. um A guy liked and heard our story and gave us enough money for the founders to leave the day jobs and start building. So we went from a computer generated image to operating in humans in five years, which is an incredible um record. We then raised about 300 million.

Mark Slack: um to and we employed many more people, got buildings, started building the robot. And then in 2021, we raised $660 million, which at the time was a med tech record. And that gave the company a market cap of about $3 billion and enabled us to expand the building to mature the robot and build a situation and for it to be sold in multiple countries.

Alejandro Cremades: And I mean one of the races was 600 over 600 million. I mean that sounds like a lot of money in one go. How do how do you go about doing that.

Mark Slack: No, it is a lot of money. I mean, 2021 was a good time to be raising money, but we had a very credible story. You know, we were able to show um the advantages of minimal access surgery, but the fact that not many sold, you know, in the United States, only 40% of people get keyhole surgery. 60% of people still get open surgery with all the complications. So we could show that, then we could show how keyhole could reduce complications, but difficult to do, and therefore the robot could help that.

Mark Slack: We had been very clever um and sensible. We had done early research. We had published it so we were able to show the people um how many cases we had done, the results we were getting from it, how long it was taking us to train people. um And so all along the way, we’ve had evidence and we’ve had been able to demonstrate what um we claim and so on. So it wasn’t just guessing. We could say, you know, we’ve done now so many patients. The other thing we did is from the very beginning, as I wrote, we we um put a registry in place. So every single patient operated on by the robot went into the registry. So when we’d say done 2000 cases and someone said, well, is your robot safe? I could say, well, we’ve done 2000 cases and we’ve had complications in X and they’ve done well, et cetera, et cetera. So we had all the results all the time. And we published that when we got to 2900

Mark Slack: and patients, we published those results in a big American journal. So, you know, people could see, not only had we built this incredible, like my co-founder, Luke, who actually designed the robot, is a genius in many respects. I mean, all the other robots are five foot eight, five foot ah ten and ten tall. They weigh 600 kilograms. Ours is tiny, small, five foot six tall, folds up into 38 by 38 centimeter footprint, can sit against the wall.

Mark Slack: And Lucas you know got it, but but in order to get people to find it, we had the safety, and we could demonstrate the training, and we could demonstrate the advantage in quite an early stage. So when we went for the big raise, we were able to say, we’ve done X number of patients, good results, e etc et cetera, et cetera. And people were very excited.

Alejandro Cremades: So let’s talk about also the frustrations that you guys have had to embrace because when you are executing on ah on a segment like this, it’s obviously as well heavily regulated. So um not only you have the uncertainty of building a business, but then also dealing with regulation. So how did you go about combining both and executing?

Mark Slack: Your regulations are real ah on an innovator’s nightmare. Now, I’m not against regulation. We have to have regulation to make sure that medical devices are safe, that they are introduced safely, that they are used safely on people. But the trouble is regulations are designed to try and prevent disasters that have happened in the past. But very often the disasters have happened because of um bad behavior on behalf of companies, almost criminality, rather than rather than um um you know sort of a lack of regulation. And they build regulations that won’t prevent problems in the future, but will add to the costs. And if you put too big a regulatory framework around it, that slows innovation hugely, and it raises costs massively. And if you’re a startup company, you have a burn rate.

Mark Slack: and And you have a certain amount of money. And you know trials are very, very expensive. A big clinical trial can cost you $3 million easily. And there’s a misunderstanding between devices and drugs. The top drugs in the world, $20 billion a year per drug they earn. The biggest med tech company in the world is Medtronic. They, as a company, make $20 billion a year. They have 800 products.

Mark Slack: So the return on investment in ah in a tech company is way less than in a pharmaceutical company. And yet they’re trying to put the same regulatory framework on tech as they do on pharma. And that’s just not going to work. And there are ways, there are propositions by academics to do the regulation more efficiently, um more affordably and better. And I think, you know, and that’s using things like real world data. We live in the world of data.

Mark Slack: We have databases. We can have registries of outcomes. We can put thousands of patients on relatively affordably, not just traditional clinical trials. We need to think of modern ways of curating data, keeping data, and proving safety of these devices.

Alejandro Cremades: So then let’s talk about tool how you unlock help from government. you know How do you go about that?

Mark Slack: Now that’s a difficult one. Now the United States does that I think quite well. If you build a factory for your company in the United States, um they will very often provide supplementary funding and help for people. um In Europe, that’s far less common.

Mark Slack: you know i’m i’m I’m in the UK, we’ve built a factory in the UK. um We got no help in building that factory. you know It’s in an area which needs employment. um It will provide employment. We could become a multi-billion dollar company and bringing income into it. And you would think that a country would unlock regulation a little bit, would provide support. Even you you’ve heard of the National Health Service, which we have in the United Kingdom.

Mark Slack: And when I sell a robot to the to hospitals in the National Health Service, I get no advantages of any other country. I go into the same tender process and the fact that whereas um when I go to India and I’m selling a robot in India, the Indian government has a policy called Made in India. And if I’m selling against a robot that was built in India, they get um advantages over me.

Mark Slack: um so So governments should think about supporting homegrown businesses and and getting them started so they can get to a point that they can compete internationally.

Alejandro Cremades: So then, obviously, you know incredible what you guys are up to, you know the fact that you’ve been able to raise you know all that money too and and how you’re serving you know folks. I think that vision is a really big one, no? um And something that has helped with propelling all of all of the incredible work that you guys are doing. So to that effect, Mark, if you were to go to sleep tonight,

Alejandro Cremades: And you wake up in a world where the vision of the company is fully realized. What does the world look like?

Mark Slack: Well, that’s the one I really do love. So my aim was multifold. When I came to start this, I said, I wanted to prove that you could build a very successful med tech company that could make a profit ethically and safely for the patients. So I would like to see now my, the big, the biggest company, robotic company in the world is an American company called Intuitive.

Mark Slack: They occupy about 4% of the minimal access market worldwide. They occupy a higher percentage in in in America. And they have a market cap of about 180 billion. and okay So I would like to, i would if we woke up and we had the success I wanted, we would remain um in control of our own company. We would be supplying a significant percentage of the robotic market for keyhole, just say 10%.

Mark Slack: I would like to think we are a company with a market cap of close to 200 billion. And we are building robots internationally selling to both the high income countries and the low and middle income countries at the right price. So it is an affordable system, improving health care. And to make a profit is not a problem. But I would like to make that profit while we are improving health and we’re providing it to the world. So my busiest robot that I have in the world is in Pakistan. And um it’s a low and middle income country and it works um satisfactorily in ah in a low income. Likewise, we have robots in England and France and Germany, so high income countries. so So my dream would be a large footprint in all over the world

Mark Slack: supplying both high-income and low-middle-income and delivering outstanding health care and to do that we would also be supporting and funding excellent medical research um so that the robot just developed got better and better both medically and engineering wise.

Alejandro Cremades: That’s fantastic. That’s fantastic. So Mark, let’s talk about now the the past and they’re doing so with a lens of reflection. Imagine I put you in a time machine. you know and I bring you back to maybe 2014 or maybe 2013 where you you were starting to incubate the thought of doing something. And let’s say you’re able to show up ah and see that younger self and be able to tell that younger self one piece of advice before launching a business. What would that be and why, given what you know now?

Mark Slack: So the one, yeah, there are lots of pieces of advice. The one big piece of advice is get a mentor. I came from a non-business background. So in the early days when I sat with my fellow and when the business people started joining us, I would look at my phone with Google, you know, what’s a K-Girl? What’s the difference between net profit, et cetera. So knowledge, and I think a business mentor is a very good thing, a more senior person, someone who’s been there before, someone who you can share your thoughts with and be guided. That’s one.

Mark Slack: Number two, always keep an incredibly close eye on the spend. Keep a very close eye on expansion. In some areas we expand it too fast.

Mark Slack: um you know, keep small, always earn ahead of spending, um and um keep a very open mind, which which I do do. But the things would be a mentor, and um the other thing is try as hard as possible not to lose control of the company um to investors, which ultimately most of us have to do. So when you get a big investment like we did, then you lose control.

Mark Slack: and I think ultimately um you would try and hold on to control.

Alejandro Cremades: Those are incredible, incredible things there. And I’m sure they’re going to inspire all the people that are listening. Mark, so thank you for sharing that. For the people that are listening that would love to reach out and say, hi, what is the best way for them to do so?

Mark Slack: um LinkedIn, I’m on markslack on LinkedIn and um it’s very easy to email me through my company on mark dot.slack at cmrsegical.com and I’m pretty good pretty good with responding to people.

Alejandro Cremades: Amazing.

Alejandro Cremades: Well, easy enough, Mark. Well, thank you so much for being on the Deal Maker Show today. It has been an absolute honor to have you with us, Mark.

Mark Slack: It’s been an honor to be with you. I’ve thoroughly enjoyed it. Thank you very much for inviting me.

*****

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