Ultrasound-guided Ankle MIS and Internationalization from Taiwan to the World

Establishment of the Technical Learning Curve

Beyond clinical results, another important aspect of the ultrasound-guided minimally invasive Achilles tendon repair surgery is technical promotion and internationalization. Clinicians are most concerned about whether the technique is easy to master. The experience at Taipei Tzu Chi Hospital shows that physicians only need seven to eight surgical cases to operate proficiently. Each surgery takes approximately thirty minutes, and highly realistic teaching aids are provided for simulation practice, allowing physicians to become familiar with the operating procedures in a safe environment. Key points for skills assessment include locating the sural nerve, end-to-end suturing techniques, and specialized knot tying methods; these designs significantly lower the learning threshold.

Standardization of Intraoperative Complication Management

There are also complete standard operating procedures (SOPs) for managing intraoperative complications. Modern ultrasound has high resolution, which has greatly reduced problems related to unclear images. If anatomical variations are encountered, such as the rupture end being close to the calcaneal insertion point, anchor fixation can be used, followed by suture completion of the ruptured ends. The instrument design also avoids hooking nerves and blood vessels, and if an accident does occur, the physician only needs to relax the hook. These SOPs provide confidence to clinicians, ensuring the safety of technology promotion.

Expansion of Academic Influence

In terms of academic influence, Taipei Tzu Chi Hospital has published multiple SCI papers, including preliminary clinical results in 2012, a comparative study on retrocalcaneal bursitis in 2019, and a study on Achilles tendon insertion point rupture in 2021, with citations increasing yearly. Compared with top hospitals in the United States, Taipei Tzu Chi's number of papers in the field of ankle and foot minimally invasive surgery has reached the first place in Asia, demonstrating its leading position in the international academic community. Furthermore, the team has published the first specialized book on musculoskeletal ultrasound in Taiwan, establishing the foundation for education and inheritance.

Success of Industry-Academia Collaboration and Commercialization

The promotion of the technology is not limited to academic research but has further moved toward commercialization. Tzu Chi collaborated with National Taiwan University to establish the startup company Astron Medtech, which developed the TendMIN System. This technology won the first prize in the "Select Taiwan" startup competition in 2020. In 2022, it stood out from three hundred startups from forty-five countries worldwide to win the championship at the SelectUSA Pitch Competition in the United States. In 2024, the TendMIN system officially obtained US FDA certification and completed its first clinical application in Boston, USA. To date, more than one hundred and seventy US physicians have been trained, and sixty-four clinical applications have been completed, demonstrating that the technology has successfully moved out of Taiwan and entered the international market.