Featured in Fierce MedTech’s “Fierce 15”

In medtech, innovation almost always means iteration.

That doesn’t mean the work can’t be novel, or unique, or groundbreaking—but it means identifying how there can be medical needs still unmet, because yesterday’s technologies simply couldn’t reach far enough.  

The companies that make up this class of the Fierce 15 exemplify the idea of moving the field forward by using innovation to build upon what’s come before—and working to improve the accepted standards that may have worked well, or just well enough for some, or frankly not very well at all. 

They’re working on new modalities, safer and stronger approaches, and more accessible science. They aim to deliver what tomorrow’s patients are waiting for. 

Averto Medical

Helping colorectal surgery patients avoid ostomy

CEO: Kenton Fong  Founded: 2016  Based: San Francisco 

The scoop: One of the hardest decisions for about 130,000 patients facing colorectal surgery each year is not just whether to undergo the procedure, but how to live with the procedure that comes with it.  

After extracting a tumor or removing a significant portion of the bowel, many patients will require an ostomy—an opening created through the skin that diverts the flow of waste out of the body and into a disposable bag to avoid contaminating, injuring or even tearing open the surgical site as it heals. 

Averto Medical aims to eliminate ostomies from standard practice by solving an engineering problem that has eluded developers for decades. Its ColoSeal implant acts as a high-tech bandage for the interior of the colon, securing the surgical connection and allowing stool to pass by without harm. 

“Protecting the colon is fundamental in gastroenterology and colorectal surgery, and people have worked on solutions for this for probably 40 or 50 years, going back to the 1980s—but no one's really figured out how to do it in a reliable fashion and a safe fashion,” CEO Kenton Fong said in an interview.  

“Turns out it's pretty hard to keep things anchored in the bowel and allow for reliable protection,” Fong added. “People have tried using sutures, staples, staple lines, weird contraptions on the outside of the bowel, stents—all kinds of different things. But ours is much simpler than any of those.” 

What makes Averto Medical fierce: Trained as a plastic and reconstructive surgeon, Fong has been called in many times to repair ostomy ports after they are no longer needed—though many patients live with these supposed temporary procedures for the rest of their lives.  

Reversing an ostomy “has an 18% complication rate, a half-a-percent mortality rate, and it's no piece of cake,” Fong said.  

“Every colorectal surgeon knows this—that patients will avoid having their colon cancer surgeries because they just don't want to have the ostomy and live with the ostomy bag.” 

Fong has also worked in negative pressure wound therapy, which employs a vacuum seal to help close both acute and chronic wounds that may be slow to heal. Previously, he helped co-found Spiracur and develop its SNaP dressing for pressure ulcers, surgical incisions and trauma.  

That negative-pressure approach is also employed by the ColoSeal device, which creates a vacuum around its circumference to hold it in place without disrupting the blood supply or causing any lasting damage to the healthy colon. 

“The bowel is always trying to push things out of it, but this anchoring force that we create is so strong that the bowel would actually tear before it displaces,” Fong said. “But when you remove the device—which is very easy to do, it takes about five minutes—and we look histologically at the area where we anchored it, it's completely indistinguishable from the tissue, so it’s truly atraumatic. That's the secret sauce, if you will.” 

The ColoSeal device, which can be placed with a minimally invasive endoscope, has already been used in about 40 patients, according to Fong. In February, the company obtained a breakthrough designation from the FDA, as it works to set up a randomized, controlled trial and pursue a de novo clearance. 

“I saw ostomies and ostomy complications, and I realized that if you could avoid an ostomy to begin with, that would be the best solution—because there really is nothing more minimally invasive than avoiding the surgery altogether.” 

Investors: Averto raised $30.5 million in a May 2024 series A round led by Cormorant Asset Management and joined by Venrock Healthcare Capital Partners, LifeSci Venture Partners, CVF and others.