University of California San Francisco

Q&A: Learning the Language of Innovation

Lyo, Victoria

Victoria Lyo, MD, MTM
Research Resident (2013-16)
General Surgery Residency Program
UCSF Department of Surgery

Background and Education

  • Hometown: San Francisco, CA
  • Education: Wellesley College: BA, Biological Sciences and Chemistry
  • UCSF School of Medicine: MD and Certificate Program in Biomedical Research
  • Howard Hughes Medical Institute Medical Research Fellowship
  • UC Berkeley and UCSF: Masters in Translational Medicine

What drew you to surgery?

I thought I would be a primary care doctor when I started medical school. But in my third year, my very first rotation was general surgery over at Highland Hospital, and it was amazing. I think what really drew me to surgery was that I could use my hands to do something physically to help people. I had grown up playing the violin and making friendship bracelets – I was very arts and crafts oriented. And so it was second nature to tie knots, suture and cut things.

Why did you choose the UCSF-UC Berkeley joint Masters in Translational Medicine program?

In residency, I saw lots of situations that weren’t ideal. Patients would have a tube in their nose that sucks out the fluid from their stomach to help their bowel obstruction. A lot of times the tube wasn’t positioned right, or you’d have to futz with it to make it work. Such a simple tool has so many problems. Or in the operating room, some of the tools aren’t as ergonomic for women who have smaller hands. I thought that with our clinical background, maybe we could do something to influence patient care – whether that’s making a better medical or surgical device or improving therapy.

The one-year master’s program was a really nice overview, since I am not an engineer. The classes focus on engineering concepts – how you design things; the clinical aspect – what are the pain points in orthopedic surgery or general surgery that might need innovation; and business aspects.  Even if you have a great idea and you’ve made a prototype, how do you maneuver the design through commercialization and the regulatory pathway? How do you get the insurance companies to pay for it? You learn all the different elements to take an idea from your brain to the patient. 

Can you describe the project you’re working on during the research years of your residency program?

Incisional hernias are a very common complication after open abdominal operations; intestines push through a weakening in the abdominal wall muscle. About 400,000 operations are done every year to repair these hernias. The main focus of prior research has been about improving repair, but Dr. Hobart Harris (chief of the Division of General Surgery) has developed a product to prevent incisional hernias.

What’s your role on the design team?

Damien, our mechanical engineering student, uses CAD to design prototypes and facilitates 3D printing of prototypes. Our biomedical engineering student, Meg, helps us think about how we can measure whether the particles are mixed adequately. They’re both very used to doing calculations and doing benchtop testing for devices, but I provide a lot of clinical perspective, such as what it’s like to have a hernia or care for such a patient. I’ve also led animal studies in rats to refine the composition of our product. It’s a very nice balance between all three of us.

What’s an example of a way that an engineer would think that you wouldn’t have thought about before?

Our applicator has to mix particles with a liquid. In my mind, it’s very clear – you mix the two and it has a certain color and consistency, just like when you beat sugar into eggs. But for them, it’s – how do you measure whether the particles are adequately dispersed in the liquid, and how do we test whether it’s homogenously mixed? As opposed to eyeballing it. 

So it’s foolproofing the process so when it becomes scalable, someone who has never talked to you could read the directions and it will be done right every time.

Exactly – done right and done consistently every time. That was an interesting perspective that I hadn’t thought about. 

Are there other skills that are helpful for successful collaboration?

Everyone goes home and relaxes at the end of the day. What moves a project forward and gets people working hard is when you can’t get the idea out of your mind. You’re lying in bed and thinking – what else I could do? How could I change this to make it that? Having the fire in the belly is really important.

What have you learned so far from the Surgical Innovations Program that will help you in your career?

You don’t want to naively approach the FDA and ask them what they think about your project. The most successful way to have the FDA approve your product is to have a good plan and strategy for what you’re trying to do with your device and how you will demonstrate safety and efficacy. Our team previously had never interacted with the FDA before, but I’ve made 15 or 20 calls in the past month to bounce ideas off regulatory consultants. I can speak the lingo, pitch our idea, and talk about why one regulatory path might be better than another. They’ve given me feedback like, “Many companies don’t think about it in such depth – it seems like you’re very knowledgeable in this area.”

Right – not only do you need to be fluent in the language of surgery as well as engineering, but you also need to “speak” FDA.

Exactly. We also have to think about questions such as, how are we going to get the Centers for Medicare Services to pay for our product? Who will be our early champions? So thinking about different strategies, even in the marketing and commercialization path.

Have there been any other highlights of the program?

The brainstorming sessions have been extremely useful – a lot of fun and very educational. QB3 and the Entrepreneurship Center have put on great lectures as well. There was one last week on how venture capitalists will view your company, and how do you put a price tag on it?

Also, from moonlighting, attending the American College of Surgeons meeting, and talking with surgical residency applicants from all over the country, I’ve met a lot of medical students and residents. When I tell them about my project, they are all very interested in medical device innovation and pursuing a program like the MTM (Masters in Translational Medicine). At UCSF, we’re at a cutting edge of innovation and device design. It’s something that’s very unique to us, and I’m proud to be part of that new path.

– Elizabeth Chur