From Track Fields to Robotics: The Inspiring Journey of Maggie Nixon
In a recent interview, Capstan Medical CEO Maggie Nixon shared her fascinating journey from a student athlete with a passion for medicine to a leading innovator in medical devices and robotics. Growing up near Chicago, her interest in science and math, coupled with a natural inclination towards medicine, set the stage for her future career. A standout moment in high school was being ranked nationally in track and field, which led to her recruitment by Stanford University on a full scholarship. Initially pursuing pre-med, her path took a dramatic turn when she encountered the field of perfusion technology during a summer job in Wisconsin. This experience ignited her interest in medical technology over clinical practice.
Returning to Stanford, Nixon pivoted her studies to biomechanical engineering with a focus on medical device design. Post-graduation, she joined Intuitive Surgical, a then-small company pioneering in surgical robots. Nixon's career at Intuitive spanned over two decades, where she contributed significantly to the development and launch of the Da Vinci Xi surgical system, among other innovations. Her roles evolved from instrument design engineering to leading clinical development engineering and later, overseeing regulatory and quality aspects, including a pivotal role in Intuitive's expansion into the Chinese market.
Nixon's journey is marked by overcoming challenges and leveraging opportunities for growth and innovation. Her work in instrument design, clinical development engineering, and regulatory and quality oversight at Intuitive Surgical highlights the intersection of engineering prowess and clinical needs. The transition to leading Capstan Medical alongside long-time colleague Dan Wallace underscores her commitment to advancing medical technology, particularly in cardiac and robotics, aiming to revolutionize valve replacement surgeries through robotic platforms.
Nixon emphasized the importance of understanding the problem you're solving from multiple perspectives and building a diverse, dynamic team to foster innovation. Her vision for the future of AI and robotics in medicine includes leveraging AI for preoperative planning and surgical navigation, aiming for consistency and quality in patient care. Personal reflections on doing business in Santa Cruz highlighted the unique blend of technical skill, creativity, and lifestyle that fuels innovation and team building in a cutting-edge, yet balanced, work environment.
Nixon's narrative is a testament to the impact of multidisciplinary approaches in medical technology, showcasing how a blend of engineering, clinical insight, and innovative thinking can drive advancements in healthcare.
Interview
SCWorks: Tell us about your background and journey.
Maggie Nixon: Let me go back to how I landed in medical devices. I grew up outside of Chicago and was always a very science and math sort of person from very early on. I didn't really have a picture of what I wanted my career to be, but I was super interested in medicine. I think it's one of those things that people just gravitate towards: to help people. Medicine is a place where those people usually just settle into. In high school, I was a student athlete. In my senior year I was ranked nationally in track and field for shot put, discus. I was recruited by Stanford University, and I had an amazing opportunity to go to Stanford on a full scholarship. And I'm like, all right, here we go. I'm going to throw heavy metal objects at Stanford, and I'm going to study pre med and it was definitely interesting.. So I went through my freshman year, all of the pre med classes. Between my freshman and sophomore year, my parents moved from Chicago to Wisconsin.
So I came home to Wisconsin for the summer and got a job at the local hardware store. A woman from across the street comes over and she says: “hi, I heard from your parents that you're studying pre med at Stanford. I'm a perfusionist, and I run the heart lung bypass systems for open heart surgery.” I believe I said “that's really cool. I'd love to learn more about that”. “Well actually,” she continued “my perfusionist assistant just went into preterm labor, and I don't have an assistant. I don’t have a back-up lined up so if you are willing to go through this training, you could come be my assistant”. She then handed me about eight binders and said, “you have the weekend”.
I went through all the binders, and took the tests on Monday.
The next day I was in the cardiac
The next day, Tuesday I was in the cardiac OR, or as the lackey for this amazing perfusionist, getting this front row view into how cardiac surgery worked. It was incredible. So I still worked at the hardware store in the evenings, but at 05:00 a.m.. I was setting up equipment in the cardiac ward.
The clinicians loved having this teenager in the ER that was interested in everything that was going on. So they frequently prompted me with “Maggie, come take a look at this. See this? We're doing this here and all of that”.
The most stunning thing that happened from that experience, though, is I realized that I was much more enticed by the products, and the technology that went into how these patients were getting served. I went back to school my sophomore year, and I applied myself to biomechanical engineering with a focus in medical device design. Stanford had a design your own major in the engineering department. They had a master's program for it at that point, but I did an undergrad program that I designed with Dennis Carter, my mentor, and stepped away from pre-med. It was awesome. I do believe that ‘design your own majors' is code for taking a whole bunch of units that don't go towards your master's, but I graduated. The day after I graduated, I started at a small company called Intuitive Surgical, which was surgical robots.
This was back in 2000. Surgical robots were a novel concept. The company had about 80 people. The system was not quite yet FDA approved, but had completed initial clinical studies. I started there as an instrument design engineer, which was leveraging the kind of medical device design space that I had studied in school. But I had never done an internship. I had never done anything. So I was pretty much the youngest engineer at this then small company. My boss was Dan Wallace, who is our CTO here now at Capstan. Back in 2000 is when Dan and I met, I was on the original cardiac team for Intuitive. Intuitive was originally focused on cardiac surgery.The big joke was Intuitive shot for the heart and hit the prostate because they pivoted when they learned that cardiac may not be the ideal first application. However, there are other places where robots can really help do minimally invasive surgery in tight spaces. The tight space just happened not to be the chest, it was the male pelvis, which was how the team had made that transition. So I went from designing cardiac instrumentation for the first couple of years at intuitive to designing broad instrumentation for a wide variety of applications.
I spent my next decade at Intuitive in instrument design and leading one of the instrument design teams. Later I transitioned over to clinical development engineering, which is a role that straddles engineering and clinicians, translates clinical needs from surgeons into engineering specifications in a way that is super powerful because clinicians and engineers don't necessarily speak the same language. This role is really about translating between those two worlds. I led the clinical development engineering team through the Da Vinci Xi development and launch. I remained for about five years in that role, and then moved over into regulatory and quality. We were looking to bring an engineering and clinical mindset in the regulatory and quality part of the world. I figured out how to do complaint handling and post market data analytics, and stepped in and led product quality for a little while at Intuitive, to scale that organization beyond the multi port system to the single-port system and endoluminal systems. In my last couple of years at Intuitive, I led China operations and strategy. So we had an amazing joint venture in China that we were really trying to figure out how to best serve the China market.
I was part of setting up the strategy to better enable robotic surgery in China, as well as transition some of the production and engineering activities into China. This took me from 2000 to 2022. Dan and I had been fast friends back in 2000, and we stayed in touch all along. He has been an incredible entrepreneur doing a wide variety of things in the robotic space,the cardiac space and imaging all over. And in 2022, he reached out saying, “we've been looking for an opportunity to work together, and this is it. We've got cardiac and robotics coming back together”. So it was almost like we were coming back home to some extent. It was not in the surgical space, but in the cardiology space. He had put together an early team of implant engineers, catheter technologists, and robotic engineers, tackling valve replacements in a whole new way. Valve replacements are traditionally done with open heart cardiac surgery which is tough on the patients and the surgeons. Cardiac surgery is high stakes and ripe for innovation to come in and really give patients who need alternative options to treat their valve disease.
I joined Dan in 2022 to really grow Capstan Medical in a different way, grow our implant development capabilities, our catheter capabilities, and establish a robotic platform to serve the market more broadly.
SCWorks: Can you name any particular challenges that you've overcome throughout your career?
Maggie Nixon: That's a big question. I think what careers are made of is a series of hurdles, there are technology hurdles, personal hurdles or market hurdles. I've had a wide variety of all of those. I think overcoming those hurdles is how you build a skill set to move into future phases of your career. I think some of the hurdles that have been probably most personally – I'm trying to think of the right word – personally beneficial – have been in the combination of team building and in technology hurdles. I'll give a couple of examples.
Let's start with technology hurdles. When we were developing the DaVinci Xi system, there was an immense amount of capability that was being designed into the system. But with an immense amount of capability comes complexity. This is when you have redundant kinds of joints in the system arms that makes it more challenging to control. Our device had become very complex, and from a clinical perspective, we had to look at what is most clinically enabling, and is it the complexity and just figuring out how to control the complexity, or is it simplifying?
We had to make a decision on whether or not to keep capability in the system or pull it out. In the end, we made a decision to simplify the robotic arms in a way to remove some of the degrees of freedom. We had to march through this and look at what we are seeking to accomplish clinically, and what's the best way to do that? When it came down to it, we had this amazing technology that the engineers were super passionate about. But from a clinical perspective, we had to show whether or not it was going to be effective. And the decision that we had to make was to simplify. You can imagine what a challenge it is to tell a phenomenal group of engineers that maybe their design was not the right solution. It is a really tough message to put across. But we did. We had to navigate through that and have everybody rally behind doing that. We even took a delay in product launch in order to make that decision. But it was an important one that I think has shown to benefit the product down the road.And now the technology may come back, but it just wasn't the right timing for it.
So I think that's a great example of a technical hurdle to a team building hurdle. I think I have taken some of my greatest pride in making phenomenal teams that bring together just a broad set of experiences, a broad set of personalities that feed off of each other and where the output is greater than the sum of its parts. And some of that means that you've got tons of different opinions in a team, but the team is stronger for it. And so sometimes that challenge about navigating so many different personalities or opinions really benefits in the long run. I think this is an approach that could be a hurdle in every team that I've built through my career, but it has always worked out to be fundamentally beneficial in the long run.
SCWorks: Was there market validation done in advance to determine if this just an engineering passion, or a problem seeking a solution?
Maggie Nixon: Yes. The market validation was always there. I think Intuitive has done a phenomenal job at showing how robots can really increase capabilities and really accelerate minimally invasive surgery, which is immensely valuable for the patients. That's different from deciding what is the right technical solution to access that market. I think the engineers came up with a broad variety of solutions that could tackle the market. When it comes down to it, though, how do you deploy that technology in the market? And this specific example was an extra degree of freedom in the arm, and that extra degree of freedom could be helpful, but then it also could get in the way. And there wasn't a consistent way to ensure that it was always helpful and never got in the way. So the trade off had to be between taking that extra degree of freedom out and what do you lose from a capability standpoint versus what do you avoid as a challenge to leveraging that technology. We did this by putting it to the test. We built the system. We built it with all the capability and then put it through every application it needed to go through.
So the team did about 20 labs through all the different surgical procedures that that device was going to do, with a wide variety of control methods on those devices, and tracked exactly when things were being enabled with that and when they were being problematic. We learned that we were causing more problems than we were solving. And that is how we made the decision. It wasn't about the position in the market. It was about how you deploy technology to address that part of the market. And so we had to systematically go through it and decide whether or not it was always going to be enabled or if there were too many downside
SCWorks: This is rich. I love it. What advice would you give entrepreneurs?
Maggie Nixon: I'm hugely biased to the product side of things, right? I am an engineer by nature, and you'll never take the engineer out of me. So first and foremost, always know the problem you're solving for and know it deeply. Look at it through multiple different lenses. Look at that problem from: I'm in the technical space,look at it from the clinical perspective, look at it from the hospital perspective, look at it from the policymaker and the insurer's perspective. Because that's how you really dial in what you're solving for. If you don't, you may miss something, like a really critical element of what you're solving for. So then don't be afraid to try different ways to solve it. Once you really understand it, make sure that you're not picking one path and putting blinders on whether or not that path is going to work. Challenge your assumptions constantly, bring in different perspectives, and look at other industries to say, hey, is there something else in another industry that I could leverage over here? Some of it is innovation that you need to create it from scratch, on your own and some of it is redeployment of capability from somewhere else. Sometimes it's just applying something different. And then the third thing that I would say is, build an amazing team to do it with you. None of that happens in isolation ever. And the best solutions come from a wild variety of opinions and perspectives that you kind of consolidate into a shared vision. And so the team has to be focused on doing that in the right way.
SCWorks: If you were to look into the crystal ball, what will AI and robotics look like in ten years from now?
Maggie Nixon: It's a great question. I think AI is such a broad term, right? It is such a broad term that can be used to do everything from automated motions and decision making all the way through to data analytics and trend identification. So it's really hard to kind of give a concise answer of all the places that it will touch medicine. From the area that I'm focusing on, which is figuring out how to bring new heart valves into a safe and repeatable clinical intervention to solve for these patients that don't have options right now. I think there's a few places that I think it's going to be really enabling. I think AI will help us with preoperative image analysis to optimize the intervention.. So this is where you can go through an image of a potential patient, compared against images of many, many other patients and what was beneficial for them, and have AI help you select what is the best intervention and what is the best way to do that intervention. And so I think it'll bring unique insights that will leverage a much richer data set than a single clinician's experience. I think feeding clinicians that additional rich insight will be incredibly helpful for AI. The other thing that I'm planning on using it for is navigation. Let's bring our device into the right spot, and then let's be able to auto back-up out of that spot to make it easier, reduce the cognitive load on the clinician to get the device to do what it needs to do. I think we've got some capability that we can use to put no fly zones and different control methods that will allow us to consistently have high quality surgeries. This is where a level of consistency from patient to patient makes a huge difference. And this is where I think the kind of controls and capabilities and image integration and preoperative planning will all come together to make that happen.
SCWorks: What do you like about doing business in Santa Cruz?
Maggie Nixon: Let's split that between business and personally. Personally, I have known for the last decade that I was going to be settling in Santa Cruz at some point. I love the outdoor nature of it. I love the friendliness of the people and really enjoy the free thinking environment that is Santa Cruz. How that plays into our business is a little bit different. I was talking about building teams and building teams with a variety of different perspectives and experiences. With Santa Cruz, it comes almost baked in. In Santa Cruz, you just have such an eclectic group of people that have come with deep technical skills and deep creativity. You bring those two together when you're trying to solve a problem in a new way. It's really powerful. And then you do that in a culture of, as I'm sitting here in the hallway, I've got team members skateboarding between locations, how awesome is that?.. We are doing cutting edge technology. We are driving huge critical milestones, tough schedules, but we're riding skateboards between our offices.. And it balances everything out. So I think it gives us a little bit of balance as we build a great company.
SCWorks: Flash questions: apples or oranges?
Maggie Nixon: Oranges.
SCWorks: Dogs or cats?
Maggie Nixon: Dogs.
SCWorks: Heaviest object you would throw now?
Maggie Nixon: Oh, I think I tapped out throwing my kids in the pool when they were about 60 pounds, which I think would still get me a bag of concrete right now, but that's probably my limit. So it's probably about 60 pounds.
SCWorks: For medical fashion. A stethoscope or a thermometer.
Maggie Nixon: Oh, stethoscope. I'm in cardiology.
SCWorks: Robots or humans?
Maggie Nixon: The intersection of them.