Why is the Middle East an interesting market for Brainlab?

VILSMEIER: For Brainlab, the Middle East has always been a critical market. We focused early on customers here. Healthcare professionals here generally have a very high level of education and they were often trained in Europe or in the United States. There was also a very early investment in excellent imaging technology. So what was missing was the best way to fully exploit high-resolution images from computer and magnetic resonance tomography and to make sure that that precision is being used for surgery. The precision should be used in a way where incisions can be smaller and surgeries can be less invasive and tumors, in the brain for example, can be reached with greater precision and that is what our technology provides. Considering that Brainlab already has 70 customers using our navigation technology in the region, we already have a lot of feedback and have more or less condensed that into a new generation of technology that we are introducing here.

Which countries in the region do you consider the best growth potential?

VILSMEIER: Right now we have the biggest install base in Saudi Arabia. But I have been personally travelling in 5 or 6 countries in the region. It is unusual for medical device companies to have such a focus on the Middle East, but I think it is very critical because the needs are really different and the way hospitals are set up and nurses work here are different. So that is something that really sets Brainlab apart. A lot of medical companies are really focused on the US market and while the United States represents about 45% of our market, we have nevertheless modeled the need and the workflow and the design of our products according to markets that we also have in the Middle East. We have been able to refine that around the feedback that we got from customers in the region.

What are the biggest challenges that you face in doing business in the Middle East?

VILSMEIER: Sometimes the budgeting processes can be lengthy and complicated. This is something that is very complicated for companies that are not necessarily Middle Eastern. For us, the key element for success was our regional manager, who is from Iraq and has been key in maintaining customer relationships here. With him, I think we will continue to succeed in the years going forward.

What are some of the advantages in doing business here in the Middle East?

VILSMEIER: In our experience, doing business here in the region is mostly influenced by the fact that people mostly look at premium products and premium technology. Brainlab has always positioned itself as being the best you can get for precise neurosurgery. So there was a different appreciation for what our technology can do. We found customers to be highly trained technologically, very sophisticated, and based on the very high-end market share we had in Germany and the close ties between neurosurgeons there and neurosurgeons in Saudi Arabia, that has made it easy for us to succeed. The main challenges that we have to work through are bureaucracy and budgeting processes in certain markets. Over time, we have been able to resolve that. Projects typically take more time than we initially think, but ultimately the end result comes.

How have recent technological advancements impacted business for Brainlab?

VILSMEIER: Brainlab is always looking ahead in terms of medical innovation. We have, for example, Intel as a strategic investor in Brainlab, so this way we get insights into new medical trends. I travel a lot throughout Asia where you see a lot of new technologies, even at gadget shops in the airport in Hong Kong or Singapore before they become commonly known in the rest of the world. So Brainlab has always tried to be at the cutting edge of technology. We have even been inspired by science fiction movies to bring the most advanced ideas to the medical field. Many customers say our digital light box technology that uses a multi touch interface works like the iPhone. But, in fact, we released that technology 6 months before the release of the iPhone. In fact, it was inspired by the movie Minority Report where crimes in the future are manipulated on a big touch screen. I bought the DVD of that movie and gave it to one of our best project managers and said here is a million dollar budget, this is what I want for the medical field and the results of that are now included in our new curve navigation system.

What is navigation and how does it enable better surgery?

VILSMEIER: Navigation in neurosurgery can be best explained like a GPS system for the human body. It allows you to track the incision of a surgical instrument and shows its tip relative to an image of computer tomography or magnetic resonance tomography that was obtained prior to surgery. With that information, surgeons can navigate past bio-critical structures through a small opening in the skull safely to a tumor to perfectly resect the tumor. The same technology can be used to place screws in the spine or to pick the perfect size and shape of a hip implant and make sure it goes exactly where it needs to go. The problem with navigation is that it is based on pre-operative images. One of the trends that has been recently important is to also take new images during a procedure to verify that a tumor has been completely resected.

In terms of that equipment relative to the population, Saudi Arabia for example, is the country with the highest density and availability of that technology. Unfortunately, many patients still believe that they need to travel abroad to get their treatment in Europe and North America, when in fact you have the best doctors and technology and can receive the best treatment right here in the region. One of the trends in healthcare is that hospitals are acquiring more and more digital medical information. There is an explosion of anatomical data, metabolic data, and functional information in higher and higher resolutions. It becomes increasingly important for physicians to analyze that information and make sure that nothing slips their attention. Therefore, the technology that we are introducing here always uses more displays, more space, more interactive intelligent views that allow surgeons to manipulate the information with their fingertips. Allowing them to bring the existing data alive so they can make better decisions in the operating room to achieve more precise and safer surgery for the benefit of their patients.