Gabriel Börner preferred playing pinball to studying at upper secondary school and therefore failed to get into a medical programme. Today, he is a senior consultant in surgery at Helsingborg Hospital and a researcher at Lund University. He has invented a "sewing machine" to suture patient's wounds after abdominal surgery. Although the journey there was longer than he could ever have imagined, he has had a great time. Or at least, almost always.
It is Wednesday and nearly five o'clock in the surgical department at Helsingborg Hospital. Although late in the day, it is a hive of activity, with medical staff in blue surgical scrubs and light blue disposable caps preparing for the next procedure. In one of the operating theatres, an elderly man has just been put under anaesthetic and is ready for surgery. He has a bleeding tumour in his stomach and requires an emergency operation. Gabriel Börner, a senior consultant at the surgical department, exchanges a few words with the physician on duty as he heads into the operating theatre and offers his assistance should the procedure prove to be complicated.
From pinball enthusiast to surgeon
Gabriel Börner has been a surgeon in Helsingborg for over 20 years. But even though his mother was a vascular surgeon, it was not entirely a foregone conclusion that he would become a physician himself. During his time at upper secondary school, he was mostly interested in playing pinball and performing in a band. He was held back twice due to frequent absences and left school with poor grades. Applying to study medicine was out of the question.
"I had to improve my grades in adult education in order to get into university."
The idea for a surgical sewing machine
Gabriel Börner can now also call himself a researcher at Lund University and an inventor. In 2009, he attended a lecture given by a fellow surgeon. It was about the importance of closing the wound in the abdominal wall with small, even stitches following an operation. Although the outcome of wound closure is crucial to the risk of complications, this aspect has long been underestimated.
"Most surgeons find that closing the incision is fiddly and time-consuming. Often, they're tired after a long operation and really just want to go and have a cup of coffee."
After the lecture, Gabriel Börner began to wonder whether there might be a simpler way to achieve a more standardised suture, regardless of how tired or inexperienced the surgeon was.
"I enjoyed needlework at school and have always enjoyed altering old clothes myself. Based on that, I came up with an idea of what a "sewing machine for connective tissue" might look like."
Why wound closure matters
An important rule following abdominal surgery is to suture only the fascia - the connective tissue - and avoid including muscle or fat, as these tissues then risk having a reduced blood supply and dying. Complications such as the wound splitting open or infection can lead to a longer hospital stay, a course of antibiotics and, in some cases, a repeat operation. Another complication is an incisional hernia, which can occur if the muscles and connective tissue have not healed properly. However, if the stitches are done correctly, the risk of these complications is halved.
"These complications may seem trivial, but they can have very serious consequences. Patients undergoing open surgery are often frail and in poor general health, which makes ensuring a secure abdominal closure particularly important. We operate on many cancer patients, and if they experience complications after surgery, this can, for example, delay further treatment such as chemotherapy."
From sketch to prototype
To develop his idea for the sewing machine, Gabriel Börner got in touch with instrument technician Mats Christensson and, over a cup of coffee at the hospital, sketched out his idea on a napkin.
"When Mats then brought the prototype, I was absolutely amazed to see that it looked exactly as I had tried to draw it!"
But it would take eight years and some 30 prototypes before the research team had a working solution. There was a lot of testing involved and many setbacks. But even though it took a long time, Gabriel Börner feels that he has always had people around him who recognised the potential and were interested in his medical innovation. Eventually, the first studies showed that the mechanical "sewing machine stitch" was both quicker and more precise than manually closing the wound edges, and was cheaper in the long run. This encouraged him to go on and marked the start of a doctoral thesis at Lund University.
"For me, it has been important to avoid animal testing. However, we have many hunters at the clinic, which is why we have been able to carry out studies on moose fascia. It's been very valuable to me. Later, when it came to clinical trials, surgeons at Helsingborg Hospital used and evaluated the results of the sewing machine, which was named SutureTOOL."
Overcoming setbacks and finding support
One of the challenges has been to find investors who believe in developing the tool for the market. The first agreement Gabriel Börner signed with an investor turned out to be based on completely unrealistic terms.
"I mean, that deal was… come and help me out. We had such different expectations of each other. They thought we were much further along than we actually were, and we had barely even started."
Gabriel Börner has received a great deal of help from LU Innovation, which has acted as an advisor and played a part in turning his innovation into a patent and an international company. Gabriel Börner's advice is not to tell too many people about your product at the start, and be thorough about drawing up non-disclosure agreements. He believes that if you involve friends and acquaintances at an early stage, you have, in effect, already "sold off" parts of the company, which can become very complicated later on when investors come on board. Instead, focus on clearly defining who the customer is, who can pay, and what the market looks like. This will provide a solid basis when approaching innovation systems.
"I underestimated both the cost of developing a product like this and the time it takes. It's sometimes said that it takes 10 years and SEK 100 million to develop a new medical innovation. For me, it was 17 years. It's important to talk to your partner about what this means in everyday life. Running a project like that can be incredibly demanding and almost addictive, and in my case, my marriage really suffered."
A product reaching the market
But although the road ahead is long and there are many hurdles along the way, no obstacle is insurmountable, observes Gabriel Börner. It often comes down to money or finding a more skilled engineer who can solve the problem. The project has also run in parallel with new guidelines for abdominal closure using a zigzag suture. At the same time, the development of other surgical instruments, including those used in keyhole surgery, has transformed the surgical landscape. Gabriel Börner is not quite sure himself how it all came about, but the invention has come at just the right time. Today, the company has around 20 distributors worldwide. The product was recently approved for sale under EU safety regulations and is currently being rolled out in the EU and the US. This year, Suturion received the annual Medtech4Health Innovation Award.
"These past 17 years have been great fun. Almost always. Even though there are times when you don't really feel up to it, you also build up a huge network, both nationally and internationally. It becomes a way of life and a passion."
Future research ambitions
Looking ahead, Gabriel Börner has several research projects he would like to pursue. These include a study to investigate whether surgical nurses could learn to close surgical wounds just as effectively as a surgeon, which would not surprise him. He also plans to conduct a qualitative study to investigate why so many surgeons still do not suture in accordance with the new guidelines.
