Reducing Risk. Restoring Confidence. Improving Outcomes

Rheia Medical is a MedTech startup founded to solve a longstanding but under-addressed challenge in surgery: safe and reliable management of the ureters during surgery in the pelvis and abdomen. We are developing U-Guide, a dual-function surgical device that both enhances intraoperative ureter visualization and enables injury detection, all without disrupting existing workflows.

Our Solution: A Dual-Feature Device for Safer Surgery

U-Guide is a medical device designed to address one of surgery's most persistent challenges: safe and reliable ureter management. It is the first and only solution to combine two critical functions in one seamless tool:

1. Enhanced Visualization — On Demand

With the push of a button, U-Guide activates the ureters with electrical stimulation, making them clearly visible to the surgeon. This enables faster and more confident identification, reduces time spent searching for the ureters, and lowers the risk of accidental injury.

2. Injury Detection — Without Cystoscopy

In addition to visual guidance, U-Guide provides intraoperative injury detection. This feature has the potential to replace cystoscopy, which is currently used at the end of surgery to check for ureteral injury—often too late to intervene effectively.

Importantly, in preclinical testing, U-Guide was able to detect thermal injuries to the ureter—types of damage that cystoscopy cannot identify. This added layer of protection may reduce the rate of delayed diagnosis, prevent postoperative complications, reduce medico-legal risk, and improve outcomes.

Due to the proprietary nature of the technology, further technical details are confidential.

Our Team: Bridging Clinical Insight with MedTech Execution

Rheia Medical is founded by a multidisciplinary team with deep expertise in medicine, design, business, and medical device development. Together, they bring the experience and commitment needed to take U-Guide from idea to operating room.

Rasmus Lundquist  

Co-founder & Chief Executive Officer (CEO)

Rasmus holds a Master of Science degree and brings over a decade of experience in medical device entrepreneurship. As co-founder of Reapplix, he helped develop and launch a Class II wound care device, now commercially available in both the U.S. and European markets.
His core expertise includes regulatory affairs, clinical trials, reimbursement strategy, and go-to-market planning.

rasmus@rheiamedical.com

Andreas Thorngaard Heitmann, MD

Co-founder & Chief Medical Officer (CMO)
Andreas is a medical doctor and trained BioMedical Designer with a strong foundation in neurology and neurophysiology. His dual background in clinical medicine and user-centered device design gives him unique insight into surgical challenges and practical innovation.
He previously bootstrapped a Class I medical device to market, gaining firsthand startup and regulatory experience.

andreas@rheiamedical.com

Trine Munch Agerskov

Co-founder
Trine holds an International Business degree from Copenhagen Business School and brings 13 years of experience from Novo Nordisk, where she held roles across business development, manufacturing, and supply chain.
Her strong commercial and operational background ensures Rheia Medical is well-positioned for sustainable growth. While currently supporting early-stage strategy and execution, Trine's expertise will be instrumental in navigating later-stage scaling, production planning, and market expansion.

The Unmet Need: Ureter Identification and Injury Detection

A Hidden Risk in Surgery



Ureteral injuries are a serious and underrecognized complication in pelvic and abdominal surgery. The ureters are thin, delicate structures that transport urine from the kidneys to the bladder—and they are often difficult to visualize during surgical procedures. Embedded deep within surrounding tissue, they can easily be mistaken for other anatomical structures.

When not clearly identified, the risk of unintentional injury increases dramatically. These injuries often go unnoticed during surgery, only to be discovered hours or days later when the damage has already led to serious complications.

The consequences of ureteral injury are significant:

  • Loss of kidney function

  • Chronic pain

  • Sepsis

  • Increased healthcare costs

  • Death

More than 75% of these injuries occur in women, making this a critical women's health issue and an urgent challenge in gynecologic surgery.

Existing Solutions Fall Short

Current methods to locate and protect the ureters rely on techniques that are often:

  • Highly invasive (e.g., dye injections, intraureteral devices)

  • Technically demanding, requiring specialist skills

  • Workflow-disruptive, increasing operating time

  • Limited in function, with limited ureter visibility and no ability to detect injuries

Even today, cystoscopy remains the gold standard for assessing ureteral integrity during surgery. This procedure involves inserting a small camera into the bladder at the end of the operation, typically after the main surgical work is completed. The surgeon observes whether urine is flowing from each ureteral orifice, to infer if the ureters are functioning properly.

However, this approach has critical limitations:

  • Retrospective detection: By the time cystoscopy is performed, the injury has already occurred. The opportunity to correct it intraoperatively may have passed, especially if extensive tissue closure has already taken place.

  • Incomplete diagnosis: Not all injuries result in immediate flow obstruction. Partial damage, thermal injury, or devascularization might not manifest as abnormal flow during cystoscopy and can be missed entirely.

  • Workflow disruption: Cystoscopy adds procedural time, requires switching surgical focus, and may need additional equipment or specialist assistance, especially in non-urologic settings.

As a result, many ureteral injuries remain undetected until hours or days later, when symptoms like pain, fever, or loss of kidney function prompt further imaging or intervention. By then, the consequences are more severe—and more costly.

The challenge of ureter identification and the consequences of missed injuries are not just theoretical—they are widely acknowledged by surgeons.

As part of validating the clinical need, we conducted a survey among 45 Danish surgeons, primarily gynecologists and general surgeons. The results confirmed that the problem is both common and serious:

  • 60% reported that the ureters are difficult to identify either often (more than 75% of the time) or sometimes (50% of the time).

  • Only 2.2% of respondents felt that ureters are never hard to identify.

  • Critically, 67.4% had either caused or observed a ureteral injury during surgery.

These findings underscore the day-to-day challenges in visualizing ureters and highlight the urgent need for better intraoperative tools.

Similarly, an independent Swiss survey among colorectal surgeons revealed that:

  • 83.7% of surgeons reported that identifying the left ureter negatively impacts operative time, either sometimes or regularly.

  • 61.8% had personally caused at least one ureteral injury in their career.

The study concludes:

"There is a clear need for noninvasive techniques to improve the visualization of ureters during colorectal surgery."
(Published in Colorectal Disease, May 2019) 

"Ensuring ureteral integrity is essential and should be a part of almost every gynecologic surgery. It's the number one preventable injury in gynecology."

Jim Greenberg, MD

Chief of Gynecology, Brigham and Women's Faulkner Hospital, Boston

Associate Professor, Harvard Medical School

Designed for Surgeons. Built for Workflow.

U-Guide is developed with a deep understanding of real-world surgical needs. Whether in specialized academic medical centers, regional hospitals, or community clinics without immediate access to urologic support, U-Guide is engineered to empower—not interrupt—the surgeon. It seamlessly integrates into diverse clinical environments, ensuring that safe and effective ureter identification and injury detection is accessible to all surgical teams, regardless of resources or setting.

Key Benefits:

  • Minimally invasive – No need to enter the ureter or inject contrast agents. U-Guide is designed to reduce risk and complexity.

  • Intuitive and easy to use – Designed for quick adoption by any surgeon, without specialist training or steep learning curves.

  • Seamlessly integrated – Fits directly into existing surgical workflows and setups without adding procedural time or requiring additional equipment.

  • Versatile in application – Effective across both open and minimally invasive (laparoscopic or robotic) procedures.

U-Guide empowers surgeons with greater control, confidence, and efficiency—without compromise.

Medico-Legal Risk Reduction

Ureteral injuries are among the most medico-legally sensitive surgical complications, often leading to litigation, extended hospital stays, and costly reoperations—especially when injuries are diagnosed late. By enabling early detection and documentation of ureteral status, U-Guide can help:

  • Reduce liability related to delayed or missed injuries

  • Support standard-of-care compliance with objective functional confirmation

  • Provide documented assurance of ureter integrity at the time of closure

This added layer of protection is highly relevant in a healthcare environment increasingly focused on accountability, patient safety, and cost-efficiency. 

"I once caused a ureter injury during a hysterectomy years ago. I still remember the patient's face, I remember her daughter and I remember her husband. These injuries leave a mark on you as a surgeon. Even during a relatively simple procedure it would help me a lot to know where ureters are located. If I know that I don't have to worry about ureters, I can speed up the procedure significantly."

Carsten Lindberg Fagö-Olsen, MD, PhD 

Chief of Benign Section, Department of Gynecology, Rigshospitalet, Copenhagen

This honest reflection shows the reality many surgeons face: even routine procedures carry risks that leave a lasting impact. U-Guide is being developed directly from this need. From the outset, we focus on solving a problem that matters, ensuring that the solution is not only innovative but also deeply aligned with clinical realities. 

We develop U-Guide hand in hand with the surgeons who will use it. Their insights guide every step, from functionality to workflow integration, so the design fits naturally into clinical practice. This close collaboration ensures the device tackles real challenges, reduces risk, improves efficiency, and empowers surgeons to deliver safer care. 


Market Opportunity: A Universal Need with a Focused Entry

Ureteral injuries are a cross-specialty surgical risk—yet the tools to prevent and detect them remain limited, outdated, or impractical. U-Guide addresses a well-documented and urgent gap in surgical safety across multiple high-impact clinical domains.

Target Users

Our primary users are:

  • Gynecologists (e.g. hysterectomy, endometriosis surgery)

  • Colorectal surgeons (e.g. resections, cancer surgery)

These specialties account for the majority of iatrogenic ureteral injuries, largely due to the ureters' close anatomical relationship to the uterus, ovaries, rectum, colon, and surrounding pelvic structures commonly involved in gynecologic and colorectal procedures.

Target Customers

U-Guide is suited for adoption across:

  • Academic medical centers and tertiary care hospitals

  • Regional and community hospitals, including those without urologist support

  • Ambulatory surgical centers (ASCs)

  • Integrated healthcare systems and insurers focused on reducing surgical complications and litigation exposure

The device's plug-and-play usability and workflow compatibility makes it practical for deployment across diverse surgical environments.

Clinical and Economic Drivers

  • Volume: Each year, there are over 6 million relevant surgeries in the Western world—including gynecologic and colorectal procedures—where ureteral injury is a known risk.

  • Incidence: Ureteral injury occurs in approximately 1–2% of these surgeries, with higher rates in complex or repeat cases.

  • Treatment cost: The average direct cost of a ureteral injury is ~$40,000, covering reintervention, imaging, prolonged hospitalization, and follow-up.

  • Litigation risk: The cost of litigation related to ureteral injury can exceed $500,000, making it one of the most expensive medico-legal complications in elective surgery.

  • Documentation gap: Cystoscopy remains the standard method of verification but is performed at the end of surgery and cannot detect thermal injuries, leading to delayed diagnosis and worse outcomes.

Adoption Potential

Validated through interviews with more than 50 surgeons and supported by preclinical proof of concept, U-Guide fulfills a critical and unmet need. Competing approaches:

  • Are invasive, time-consuming, or require specialist skills

  • Focus solely on identification, offering no injury detection

  • Rely on dyes or ureteral instrumentation, limiting adoption in routine practice

U-Guide stands out as the only minimally invasive, dual-function solution that improves patient safety, lowers medico-legal risk, and fits directly into the surgeon's workflow. 

Our Story: From Observation to Innovation

Rheia Medical was founded in 2023 as a spin-out from the University of Copenhagen, following the participation of co-founders Andreas Thorngaard Heitmann and Trine Munch Agerskov in the Novo Nordisk Foundation's BioMedical Design Programme—a prestigious, need-driven innovation fellowship focused on solving unmet clinical problems.

During their clinical immersion, Andreas and Trine repeatedly witnessed a challenge that was both subtle and significant: surgeons struggling to locate the ureters during gynecologic procedures. Across multiple procedures, this led to stress in the operating room, delayed procedures, and reliance on more experienced colleagues—even in otherwise simple routine procedures.

The pattern was clear, and it was not an isolated issue. The team began to dig deeper, interviewing clinicians across specialties and geographies. What they uncovered was a universal, under-addressed problem—a gap in safety and workflow that affects millions of surgeries every year.

This insight became the foundation of U-Guide: a device designed not just to solve a technical challenge, but to relieve cognitive load, reduce risk, and empower surgeons in real-time—whether in major academic hospitals or rural surgical centers.

With validation in hand and a shared vision, the founding team launched Rheia Medical to bring this solution to life. Today, the company builds on that same principle: that true innovation begins with listening—and ends with safer care for every patient.

In early 2025, Rasmus Lundquist joined Rheia Medical as co-founder and CEO, bringing over a decade of hands-on experience in building and scaling medical device companies. With a proven track record in regulatory strategy, clinical validation, and commercial execution, Rasmus was brought on board to accelerate the company's transition from early innovation to scalable medtech venture. His expertise has been instrumental in shaping Rheia's path toward regulatory approval, strategic partnerships, and market entry.