Serial MedTech Inventor Tackles Surgical Scarring With ZipLine Closures

By Bernadette Tansey. This article originally appeared on Xconomy, January 9, 2014.

There’s a straight line from Amir Belson’s boyhood dreams to ZipLine, a startup exploring new ways for patients to heal after surgery.

When Belson was six or seven, he started bringing his inventions to his father. At age nine, the Israeli youngster showed his dad a detailed drawing of an airplane that had turboprops on its wings, so it could lift off like a helicopter and then fly straight ahead.

“Since I was a kid, I was always fascinated with new ideas,” says Belson, who is now a prolific Bay area medical device innovator.

By the time Belson had become a doctor and served as a flight surgeon for Israel’s air force, he carried a piece of paper in his wallet listing 64 ideas for inventions to solve problems he had observed. He brought the list to Stanford University when he arrived for a fellowship in 1998.

Belson tapped into the Bay area’s thriving technology and funding networks, and founded his first company in 2001. Starting with one of the ideas on his wallet list, he formed Neoguide Systems, maker of a computer-guided colonoscopy scope, which was sold to Intuitive Surgical in 2009. But even while he was nurturing the growth of Neoguide, Belson kept adding to his list of 64 ideas.

Belson now has nine active companies that he founded to develop his inventions, including Campbell, CA-based ZipLine Medical, launched in 2009. The company is in the first phase of marketing a novel device to improve the process of closing surgical incisions.

The inspiration for ZipLine arose from the uneasiness Belson felt during his days as a medical resident, when he assisted an experienced surgeon with births by Caesarean section. After the delivery, the surgeon would sew up the uterus and the muscle walls, but leave the final closure of the skin to Belson.

“Guess who this poor woman hates after five years?” Belson says. Although the veteran surgeon did the bulk of the work, patients saw only the inevitable scars on their skin, he says.

Belson decided that the prevailing methods of closing surgical incisions—needles and thread, or staples—created too much pain and scarring. Now, ZipLine is selling a stick-on surgical closure that eliminates the need to pierce the skin. The device, which is quickly applied and then tightened to close the incision gap, reduces scarring and cuts down on costly operating room time, Belson says.

Sewing or stapling puts the most stress on the points where the skin is punctured, depriving that small area of blood flow and oxygen, Belson explains. The localized pinching of tissue starts the process of fibrosis and scarring.

“This tiny point sees all the tension,” Belson says. ZipLine devices are designed to distribute the stress more evenly across the skin, and reduce pain.

ZipLine closures are made up of two Band-aid-like strips that surgeons apply on either side of an incision, parallel to the cut. The two sticky strips are connected across the incision’s opening by a series of thin plastic ties. Each tie has a small ring at one end. To bring the edges of the incision together, surgeons pull on the rings of each of the plastic cords, which are studded with little bumps that ratchet through small clips. Once the cords are tightened, the bumps prevent them from slipping back through the clips.

The goal is to deliver the advantages of each of the traditional methods of closing incisions. Staples, such as those typically seen in knee surgeries, are quick. But they can leave scars that look like railroad tracks, Belson says. Suturing with needle and thread is slower, though the scar may be less noticeable if the surgeon is skillful.

The ZipLine technique is designed to combine the speed of staples with the improved appearance of sewn closures. The method is easy to master, so the final closure of the skin can be turned over to a less experienced member of the operating team, says Eric Storne, ZipLine’s vice president of marketing.

Storne says the company worked closely with surgeons and nurses to refine the design of the device. As the recovering patient moves, structural elements in the ZipLine closures redistribute strain from any one point of the healing incision to the overall surface of the device. Staffers at the 13-employee company have been helping road test the stick-on closures, Storne says.

“We’re wearing these everywhere on our bodies—bellies, knees, and chest,” Storne says.

In the development stage, ZipLine closures were used in hundreds of surgeries, Belson says. The commercial launch of the product began in June, with an initial focus on plastic surgery, cardiology, and orthopedics. The closures come in 15- centimeter and 8-centimeter lengths, but they can be combined to cover longer incisions like those created in operations along the length of the spine for scoliosis, Storne says. The strips can also be snipped into smaller lengths to cover shorter stretches of skin. A single 8-centimeter ZipLine device costs $60.

Aside from a possible improvement in the cosmetic appearance of scars, ZipLine’s sales pitch is that the closures save money. In addition to reducing operating room time, the elimination of skin punctures from staples or needles may protect both patients and surgical staff from infections. A surgical site infection typically costs as much as $25,000 to treat, and a needle stick suffered by a staffer can cost about $600, the company estimates.

The ZipLine closures can be worn for two weeks, and can withstand normal patient activities, such as sweating and showering. Patients may be able to remove the closure device themselves, rather than coming back to the hospital, as they would to have stitches or staples removed after an incision heals, Storne says. These visits to have sutures or staples removed are not reimbursed by Medicare and other health insurance plans, he says.

ZipLine was initially funded with $1 million from XSeed Capital Management of Portola Valley, CA, followed by a $5 million round led by Claremont Creek Ventures of Oakland, CA.

ZipLine is typical of the ideas Belson is most interested in developing these days, based on lessons he learned through his first company, Neoguide. The ZipLine device is much simpler than the Neoguide platform. That technology included many elements to make colonoscopy less painful, or make other surgeries less invasive—a camera-equipped, snakelike cable, armed with sensors to transmit its path through the body to a computer.

Belson’s other companies include Menlo Park, CA-based Thermocure, which is developing a device to quickly cool the bodies of stroke and heart attack patients to prevent a cascade of damage in the heart or brain; and Naples, FL-based Vascular Pathways, which aims to improve the success rate of inserting IV catheters with a device called the AccuCath Intravenous Catheter System.

Meanwhile, Belson continues to develop ideas, and now has about 300 patents issued or pending. He’s become part of a noted Bay area lineage of medtech inventors. After his arrival at Stanford, he met Paul Yock, a distinguished medical device inventor and founder of Stanford’s Program in Biodesign for budding entrepreneurs in biomedical engineering. Yock introduced Belson to other innovators who were instrumental in forming Neoguide. Yock also became Belson’s mentor.

“His mentor was Thomas Fogarty,” Belson says, referring to the renowned cardiovascular surgeon who in 1960 invented the balloon catheter that transformed clot removal surgery. “I’m like the grandkid of Fogarty.”

But Belson says his thought process is very different from the methodical steps taught at the Biodesign Program, where participants carefully outline a problem, propose a number of solutions, and then choose the best invention. Belson was one of the earliest participants in the program and “Great companies come out of it,” he says.

But “The way my brain works is a little weird,” he says. Often, solutions emerge before he fully understands the problem.

Belson never had the chance to pursue the hybrid helicopter/airplane whose design he showed his father when he was nine years old. About ten years later, Belson recalls, he saw a similar drawing in a popular science magazine. NASA was developing a plane just like the one he’d envisioned.

These days, he’s the father reviewing proposals from a new set of small inventors.

“Now I get it back, because I have four boys,” Belson says. “Three of them are doing this all the time.”