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Duke Surgical Resident is Building a Medical Device Company

In foreground, from left to right: the Lacuna Medical logo on a transparent white paint splash, and a cut out headshot of Muath Bishawi. In the background, an abstract image of red and blue fluid.

by Fedor Kossakovski

“When I was a child, my cousin had a heart defect,” remembers Dr. Muath Bishawi, a Cardiothoracic Surgery Resident at the Duke University School of Medicine Department of Surgery. “I was curious: How could you have a hole in your heart?”

Headshot of Muath Bishawi, smiling slightly at the camera, in official white coat with Duke Surgery logo and his name spelled out over a blue dress shirt and green tie.
Cardiothoracic Surgery Resident Muath Bishawi has tapped the resources at Duke University to help his entrepreneurial journey. Credit: Muath Bishawi/Duke University.

Sporting green scrubs, Bishawi has just emerged from an hours-long heart transplant surgery – yet he’s still full of energy as he recounts what set him on the path to becoming a cardiovascular surgeon and inventor.

“Most of my childhood toys were actually never in the form in which they were purchased, but rather in pieces,” says Bishawi. “I just had a really big interest in how things worked, and the human heart was always a kind of a fascinating machine.”

Now both a heart surgeon and a Ph.D. biomedical engineer, Muath continues to tinker. Lacuna Medical, a medical device startup company he founded in 2017 by drawing on multiple Duke resources, recently secured seed funding led by Duke Capital Partners to develop a new kind of catheter.

“At the end of the day, what I would like to see is this device being used in, and helping, patients,” says Bishawi. “My future goal is treating disease in the operating room, but without accepting the fact that this is all we can do – rather, how can we treat these diseases better?”

Born in Jordan with Palestinian origins, Bishawi came to the United States when he was thirteen years old. Settling in Poughkeepsie, NY, there were no doctors in the family, but that didn’t stop Bishawi from pursuing a Bachelor of Science, a Master of Public Health, and a Doctor of Medicine degree, all at Stony Brook University.

When time came to rank his preferred programs for residency, Bishawi put Duke University School of Medicine at the top of the list, in large part due to its support of resident research and connection to the Pratt School of Engineering.

“When I interviewed here at Duke, I did bring up that my interest during my research years was to pursue a Ph.D. in engineering,” says Bishawi.

Soon he got the news he matched for residency at Duke. Bishawi, the first doctor in his family, packed his bags and headed south to be a cardiovascular surgeon.

Duke is where the heart is

“I knew there was a problem when I was on clinical duties,” says Bishawi.

He had been putting in shifts at the Durham VA when he had a frustrating experience caring for a patient with an end-stage cancer. The medical team was trying to make this patient as comfortable as possible but, to Bishawi’s disappointment, the patient kept returning to the hospital. Even more frustrating was that the issue was not the disease, but rather a catheter placed in his gallbladder that kept falling out or getting obstructed.

“I kept thinking: ‘All this guy needs is just a catheter that keeps working so he can spend that quality time with his family. And we just needed a better solution,'” says Bishawi. “At that point, I didn’t really have an idea of how to fix it.”

This problem of slipping or clogged catheters gnawed at Bishawi even as he started his research year, which turned into two, then three, and eventually four years and a Ph.D. in Biomedical Engineering. He remains a research scientist in the Duke University Pratt School of Engineering Department of Biomedical Engineering.

Working under the tutelage of Professor George Truskey, Bishawi gained experience in fluid mechanics research – filing that away as a tool to address the clogging of catheters. A Duke Innovation & Entrepreneurship course gave Bishawi the framework for how to design a medical device to address a need – and gave him another tool as he pondered a real-life solution to the real-life problem he had identified.

“I was taking a shower and I thought of it,” says Bishawi.

Animation showing how Lacuna Medical’s catheter is inserted, curls in on itself, and protects proximal holes from clogging.

The puzzle pieces of his experience all fell into place. The key insight, thanks to the fluid mechanics work, was that the first several holes of the catheter were the most important for unimpeded flow. So, with his newfound biodesign skills, Bishawi came up with the idea of having a catheter curl in on itself after insertion, protecting the important first few drainage holes.

Bishawi turned to another Duke mentor, medical device expert Professor Ken Gall, to help finalize the design. Bishawi also joined Duke Capital Partners – then called the Duke Angel Network – as part of their two-year Associate Program for Duke professional students, and began learning about start-ups from the inside while participating in screening Duke-affiliated life science companies for potential investment.

Bishawi appreciates not only the exposure to hands-on diligence of companies which accelerated his entrepreneurial experience, but also the emphasis which Duke Capital Partners Managing Director Kurt Schmidt places on cultivating a supportive educational environment.

“Kurt sets a great culture for Duke Capital Partners,” says Bishawi. “He really embraces the educational arm of Duke Capital Partners, which is often ignored in these types of venture investment groups.”

Now, he really felt ready for his own entrepreneurial endeavor. A few months later, in the fall of 2017, Bishawi and Gall co-founded Lacuna Medical with the goal to advance their catheter device.

Heartbeat of innovation

In an operating room cluttered with tubes and equipment, two surgeons fully geared up in green scrubs, masks, and gloves lean over a patient who is covered with blue and green surgical sheets.
Bishawi, left, holds a needle driver during an operation with one of his clinical mentors, Dr. Carmelo Alessio Milano. Credit: Muath Bishawi.

“Duke is a unique place in that we have one of the best medical schools in the country, one of the best engineering schools, one of the best law schools, and one of the best business schools – all within walking distance of each other,” says Bishawi.

The talent and resources concentrated at Duke were indispensable for Bishawi launching his start-up. Mentors and leaders at Duke were very supportive throughout the process, with Bishawi highlighting the enthusiasm for collaboration cultivated by his Ph.D. advisor, Truskey, and Department of Surgery Chair Dr. Allan Kirk.

Duke’s Office for Translation & Commercialization also played an important role, with licensing manager Dennis Thomas, Associate Director, Life Sciences, and  Robin Rasor, Associate VP for Translation & Commercialization, pitching in to help.

“I worked with them very closely through this invention process,” says Bishawi. “They were incredibly flexible as well as really supportive.”

Bishawi also values Duke’s integration into the burgeoning local entrepreneurial ecosystem, especially all the infrastructure available to life science start-ups. He points to the robust supply of local talent, access to contract manufacturers, a reasonable cost of living, and the availability of various types of funding like from organizations such as the North Carolina Biotechnology Center.

“When we raised our pre-seed round, we had an idea on the back of a napkin,” says Bishawi. “Having investors that believed in the concept and idea at such an early stage is critical and it’s missing in a lot of ecosystems around the country.”

A heartfelt commitment

“For this seed round, it was an obvious choice who to pitch and see what would happen,” says Bishawi of the decision to come back to Duke Capital Partners as a start-up founder.

Duke Capital Partners was impressed with his pitch, and decided to lead the recently-announced seed round.

“The process was incredible,” says Bishawi. “We had a lot of interested parties and it moved very quickly.”

With seed funding secured, Bishawi looks forward to accelerating Lacuna Medical to the next stage. Beyond the financial support, Duke Capital Partners member and former Chairman and CEO of Medtronic, William A. Hawkins III, will join the Lacuna Medical Board of Directors.

Right now, the team is working on additional biocompatibility testing and resubmitting the catheter design to the US Food and Drug Administration. If that goes well, clinical testing in humans is up next.

Every step along this path is complex and risky, but Bishawi’s drive to tinker, iterate, and improve keeps pushing him forward – with Lacuna Medical and beyond.


Learn more about innovation support and investment provided by Duke’s Office for Translation & Commercialization and Duke Capital Partners.