July 25, 2024 • 40 mins
Asensus Surgical plans to develop augmented intelligence capabilities that digitize surgery to lower variabilities during procedures, drive better results and ultimately expand the adoption of robotics, CEO Anthony Fernando says. In this episode of Bloomberg Intelligence’s Vanguards of Health Care podcast, Fernando sits down with BI health care analyst Matt Henriksson to discuss Asensus, the current barriers that keep robotic surgery’s penetration rates low and its pending acquisition by Karl Storz. Asensus’ product pathway includes the next-generation Luna robotic system, including TrueWrist 5mm instruments as well as enhancements to its Intelligent Surgical Unit.
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Episode Transcript
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Speaker 1 (00:19):
So welcome to another episode of the Vanguards of Healthcare
podcast series. My name is Matt Hendrickson and I am
the healthcare analyst at Bloomberg Intelligence, which is the in
house equity research platform of Bloomberg LP. We're pleased to
have with us today Anthony Fernando, CEO of a Census Surgical,
a medical device company innovating robotic technologies for general and
(00:42):
pediatric surgery. You can dive deeper into the company by
typing inn as XC equity go on your Bloomberg terminal. Anthony,
thank you for joining.
Speaker 2 (00:51):
Us today to be back.
Speaker 1 (00:54):
Yeah. No, it's great to have you back as well.
And you know when we were last talking about this
time of year ago, a lot has changed since then.
But maybe why don't we start with listeners who are
new to the story about with a quick overview of
what a Sense of Surgical is and what the company
(01:14):
is developing.
Speaker 3 (01:17):
Sounds great, so at a high level that our primary
goal is to create a digital surgery platform by digitizing
the interface between the surgeon and the patient in order
to drive higher level outcomes by reducing variability, this enables
(01:39):
consistently superior outcomes. We call this performance guided surgery, and
this has two components. One is a surgical robotic platform.
Second is the digital interface what we call the ISSU
that also has cloud capability in order to drive augmented
(02:03):
intelligence to continue to monitor and improve the outcomes overall.
You know, as you guys know, you know, we talked before.
You know, robotics have been around for a very long time.
But despite how long it's been, the penetration or the
adoption has been you know, low to mid single digits,
(02:26):
and there are multiple reasons for it, and one of
them are being the outcomes have not improved. So that's
where but we are focusing on in performance guided surgery
comes in. It's not just a robot. It's a lot
more than a robot, trying to provide the benefits of
(02:47):
robotics but also improve the outcomes that the surgeon could
deliver to the patient by reducing variability. So that that's
who we are and that's currently what therefore Casino.
Speaker 1 (03:01):
Well, that's interesting. We'll dive deeper into kind of all
those those points there, but we also probably should talk
a little bit about the recent announcement that you came
out of press release about a month ago with your
recent announcement with Carl Stores.
Speaker 3 (03:20):
Yeah, so what we announced was we've announced a merger
with Carl Storts. Currently, we've filed a merger proxy on
the fourth actually on the seventh of July, I believe, uh,
and currently seeking sharehold a vote to close this transaction.
(03:45):
So I mean it's uh, it's I would say it's
a a pretty good match between the two companies given
the plans and strategies and also the assets that company has.
We are very excited about it and really looking forward
to working our way through seeking shareholder approval.
Speaker 1 (04:10):
Right, And so you know that's a big development there,
And you know, why don't we now start diving a
little bit deeper into some of the points we just
talked about, And maybe let's start with the current landscape
of robotics surgery. You talked about penetration being in the
low single digits, but what's what's the potential base of
(04:36):
the soft tissue surgery market.
Speaker 2 (04:39):
So when you think.
Speaker 3 (04:40):
About soft tissue surgery, that the currently three techniques, as
you well know, once open surgery, laparoscopy, and then robotic surgery.
If you look at the global landscape, I would say
robotics is probably in the five to six percent range,
(05:02):
and the remaining ninety four ninety five percent is split
between open and laparoscopy. Globally, I mean, US tends to
have a much larger share in robotics, probably in the
mid to high teens for the US, and then the
rest is again split between.
Speaker 2 (05:26):
Open and laparoscopy. And you know.
Speaker 3 (05:31):
I think that's like it's like I said earlier, I
think that's the landscape today. But robotics has is accepted
and there are some benefits to robotics. However, the costs
remains significantly high, one for acquisition and second even from
(05:53):
a per procedure basis, and as a result, penetration remains
pretty low overall.
Speaker 1 (06:01):
Actually, and so that's interesting too, the cost because you know,
we will talk about the competitive landscape probably a little
more in detail later, but you know, the largest competitor
in the market is doing, you know, roughly two million
procedures per year, and the question is is that are
(06:25):
they still not getting enough procedures done per robot to
make that cost per procedure in line with laparoscopic surgery.
Speaker 2 (06:37):
Yeah, I think so there's a difference, right.
Speaker 3 (06:40):
I couldn't comment exactly about the utilization of their system overall.
But if I would assume that if one made that
investment and commitment.
Speaker 2 (06:53):
To acquire that product, that they're meeting the.
Speaker 3 (06:57):
Expectation of how many procedures UH to be performed in.
Speaker 2 (07:03):
Order to make the business case for that product. You know.
Speaker 3 (07:07):
On the other hand, laparoscopy, it does not have h
It's just a technique with the with the.
Speaker 2 (07:14):
With a set of instruments.
Speaker 3 (07:16):
So there's there's no large capital investment or long term
commitment required when you perform laparoscopy. So that that's I
think that the fundamental difference UH and and robotic surgery.
And I think you know, you talked about the number
(07:37):
of units, but I think it also goes to.
Speaker 2 (07:42):
The training of the surgeons.
Speaker 3 (07:45):
You know, the surgeons had you know who come out
of residency programs, have had prior experiences, so they tend
to have a preference towards leveraging robotics compared to laparoscopic
technique or open technique. And then the institution has to
(08:05):
support each technique that they tend to use a mix
of it. I would say mix of it at most institutions.
So I think as several factors that kind of play
in to making that.
Speaker 1 (08:18):
Decision, okay, And so maybe that's an interesting segue into
your current system in the market with the scenthanced Surgical
Robotic system, because some of your comments in the past
have talked about how it most replicates laparoscopic surgery itself,
(08:39):
So maybe what are some of the design features of
that system that is able to differentiate itself from kind
of the other products that are currently in the market.
Speaker 3 (08:50):
So I mean that two aspects to its One is
the feature feature set and the other one is more
on the training side. So I started the training side.
We cater to laparoscopic surgeons, which means that we don't
train a surgeon on how to perform surgeon. We only
(09:10):
train the surgeon on how to use the equipment, and
given that this is laparoscopy, the surgeon is able to
perform the surgery in a very similar fashion to laparoscopy,
including port placement. So that's the training side. On the
technical side, we again try to mimic laparoscopy, so we
(09:33):
enable the use of five millimeter and three millimeter straight
laparoscopic instruments, which the surgeon are very familiar with, and
then we augment that with other features. We provide haptic
feedback or force feedback so that the surgeon can feel
with their instrument. Then there's eye tracking camera control where
(09:57):
the surgeon can now do three things at the in time,
move two instruments, one on each hand, and then by
the gase of their eyes, they can move the camera
without needing an assistant to do that.
Speaker 2 (10:11):
So that's on the robotic side.
Speaker 3 (10:13):
And then the Intelligence Surgical Unit or the i SU
has several other digital features that we offer in you know,
automated camera control, measurement tags, those are some other current
features but growing in terms of features over time, and
(10:35):
also be able to collect data and provide that feedback
to surgeon. So that's currently what's on the market. While
the senhand system will be replaced here sometimes in the
coming years with the lunar system, but the i SU
is continuing to grow and gain momentum and improve with
(10:59):
more data that we collect through the sentance platform.
Speaker 1 (11:03):
Well, it's interesting because it sounds like the ISU, and
we'll dive more into kind of the more of those
specifics about the measurement and the digital tags, but that
ISU seems to be a bridge between doctors using the
sinhanced surgical system and then ultimately doctors converting or starting
(11:23):
with the lunar system when it comes to the market.
Is that a right way to think about it?
Speaker 2 (11:30):
Exactly?
Speaker 3 (11:30):
That's kind of how I've been explaining it to it.
It's really the bridge, right, because the bridge is the data.
It's the surgical video and the insights that we can
glean from the data that we collect. We collect robotic
manipulator data, we collect surgeon console data, and then we
(11:50):
collect the surgical video, and then we triangulate all these
three streams of information in order to glean insights which
tend to be very valuable where we can take these
insights and make certain observations and then help to improve
(12:12):
the surgeon's technique or could improve how the surgeon performs
the procedure, so that the surgeon can learn from how
better to perform a certain procedure. And then there's a
whole nother safety element where we can prevent certain avoidable
errors from happening during the surgery, but again through that collection.
Speaker 2 (12:36):
So it's definitely a bridge.
Speaker 3 (12:38):
So irrelevant of what robot you have or what robot
is being used, where it's senhands or lunar or the
console the is SU and the data becomes the bridge
from senhands to the future product.
Speaker 1 (12:52):
That's interesting. And then just you know, going back to
the robotic arms themselves you talked about and being five
millimeters almost as Yeah, five milimeters almost as small as
three milimeters. How does that compare to some of the
other robotic arms that are in the market.
Speaker 3 (13:13):
Yeah, so currently a majority of what's on the market
eight millimeter.
Speaker 2 (13:18):
If you talk about the big companies.
Speaker 3 (13:20):
That are out there, it's all eight millimeter is what
they either have on the market or planning to be
on the market. So we decided we're not going to
go that route. We're going to stick to the standard
of laparoscopy, which is five millimeter and three millimeter, and
that's where we are going to continue to operate on
(13:41):
five and three.
Speaker 1 (13:43):
And so, I mean it's just, I mean it seems
like though if I'm if I'm a surgeon or if
I'm a patient, I feel like smaller would be better.
So how do you market that to the hospitals and
how do you get the hospitals to market to the patients.
Speaker 3 (14:02):
Yeah, So there's two elements to this as well. So incision.
That the instrument size is a direct correlation to incision size,
and smaller the insight is smaller the incision, there's less
probability of infection, less pain. You know, some of the
(14:22):
surgeries are performed using three millimeters instruments even without a
troca using subcutaneous insertion, and with that you don't even
have to suture, so it's obviously faster recovery as well.
So that's the patient side of it. And second for
(14:44):
the surgeon, when the surgeon has smaller instruments, you actually
can see your field of view is a lot better
compared to larger diameter instruments, So that that's typically what
we talk about, and the surgeons have a very good
appreciation for both of those, primarily for incision size, and
(15:08):
that's the reason why you know five and three tend
to be preferred over the larger instrument size.
Speaker 1 (15:14):
And then that also then allows you to treat pediatric
patients probably better than traditional end effectors could.
Speaker 2 (15:23):
Is that correct, Yeah, exactly.
Speaker 3 (15:26):
So we you know, initially we were not we didn't
go after the pediatric market, but once the surgeons saw
that we had five and three millimeter instruments, the pediatric
surgeons actually approached us saying, hey, you know, three millimeter
is what we would love to do for pediatric patients.
And on top of it, you guys have haptic feedback.
(15:47):
So it was more of a surgeon pool where the
surgeons came and told us, why don't you get the
approval so that we can operate on.
Speaker 2 (15:58):
Pediatric patients. And so far it's been.
Speaker 3 (16:03):
Extremely successful on the pediatric front several other sites, you know,
last year and even this year. Year to date, almost
all the several systems we replaced have been into the
pediatric market, so that that's been a pretty good success
for us thus far.
Speaker 1 (16:23):
That's interesting. And then, as you know, just kind of
now taking like a little step back, and you know,
you saw that opportunity, what decisions did you have to
make as the CEO to kind of either divert assets,
divert resources, change the business model? I mean, what when
you saw that opportunity, what were the steps that you
(16:43):
had to make to kind of make that a realization
with gain the now getting robots placed into these pediatric hospitals.
Speaker 3 (16:51):
I think again, the first decision was to understand the
regulatory landscape and be able to see clearance for pediatric
patients because we didn't have a pediatric label at the time.
It was only for adult patient population. So that was
a primary decision we had to make. And then while
(17:14):
that was going on, as you know, from an economic
point of view, the pediatric market is a relatively small market. However,
there's not many players in that space given that it's
a small market, so for us, it was quite intriguing saying, Okay,
we have a product, we have the right tools, and
(17:37):
even though the initial market size is small, you know,
do we want to enter this market and create a solution.
Speaker 2 (17:47):
And obviously the answer was yes.
Speaker 3 (17:49):
So despite the overall size, given that it was an
underpenetrated market and also very underserved market and also very
high sport in terms of patient population, I think they
came together and that was the criteria that we based
our decision on to enter the pediatric space.
Speaker 1 (18:12):
That's interesting and so moving. Then, you know, we talked
a little bit about the I s U. You talked
about some of the features that are currently there, but
what what when you were when you're marketing this to
a physician or to a hospital, what what are you
(18:33):
comparing it to with traditional robotic surgery or traditional labroscopic surgery,
even in traditional open surgery. How are you how are
you marketing this to them as saying that this is
something that you need to have in your O R.
Speaker 3 (18:47):
Yeah, so Matt, you know this is something that doesn't
exist today, right Ah, he doesn't existing surgery until we
introduced the I s u uh analy is that we
provide are really from everyday life. You drive your car,
you know, you have a backup camera that beeps at
(19:09):
you or even automatically hits the brakes if there's an
object in the back.
Speaker 2 (19:13):
If you're driving on the highway, the car.
Speaker 3 (19:15):
Stays in your lane, and if it goes to the edge,
it will vibrate, giving you an alert to move back
into your lane or even kick you.
Speaker 2 (19:24):
Back into your lane.
Speaker 3 (19:25):
So things of the sort we are used to in
everyday life, where certain peripheral activities help us be safe.
So that's kind of what we are bringing to surgery, saying,
you know, all the technologies that we're used to in
everyday life, tools that we have on our smartphones, and
(19:48):
these safety features in your car. We're trying to bring
all of those two surgery and enable you to use
tools like measurements and tag and automatic camera con and
then also the suite of safety features at your fingertips
that you can use without any additional equipment. It just
(20:09):
comes with the system and when you're performing surgery. So
the goal, the ultimate goal with all of these is
to reduce the cognitive burden on the surgeon because surgery
is a very high stress environment and the surgeon using
a robot obviously have less physical fatigue because the surgeon
(20:31):
is seated in a comfortable position, but the cognitive fatigue
is still pretty high because surgeon has to orchestrate everything
in the r But by providing these tools that they
can deploy as they see fit, you know, reduces the
cognitive fatigue of the surgeon because we are taking care
(20:52):
of certain elements in a peripheral sense, thus helping the
surgeon focus on the patient.
Speaker 2 (20:58):
And deliver a higher level of care.
Speaker 3 (21:00):
So that's typically you know that that's what we do,
and that's kind of how we explain this to surgeons.
Speaker 1 (21:08):
Yeah, and then also it catches my attention is the
potential for being able to collect big data and then
using that to assist surgeons in the future. What are
the next steps for kind of utilizing that big data
to kind of help with surgeons, either in the decision
(21:29):
making process during the procedure itself or with training new
surgeons on how to use the technology.
Speaker 3 (21:38):
So, Matt, we are I would say, we are relatively
at an early stage. We are collecting data. We are
trying to build models out of this data. Given the
scale of this data, we partnered with Google Health Cloud
in order to collect the data and start putting them
in the right containers. So we are in the process
(22:03):
of developing these models. Now we have the infrastructure, you know,
we have the architecture, the infrastructure in order to do this.
So over time, you will see surgeon with you know,
us deploying procedures, specific applications in order to help surgeons
perform better surgery. Right, I mean when we look at
(22:25):
the data, you know, some of the very simple procedure
like a goal bladder removal, we have seen some procedures
being done in the twenty minute range and some procedures
the same procedure without any complications being done in the
eighty to ninety minute range.
Speaker 2 (22:43):
So they shouldn't be that different.
Speaker 3 (22:47):
So that's that those other kinds of things that we
are seeing and then we'll be able to navigate these
surgeons to perform the best possible procedure, with the goal
being where we can learn from everywhere and be able
to deploy it anywhere.
Speaker 1 (23:05):
That's interesting because it sounds like you could potentially standardize
how the procedure plays out, you know, given there's no complications.
So that's kind of interesting. You know, then you can
make if you make that eighty minute procedure down to
that twenty thirty mine procedure, you're saving one hour of
r space or our time.
Speaker 2 (23:26):
Ye, standardization is the right word.
Speaker 3 (23:28):
That's definitely the direction that this will ultimately ultimately lead to.
Speaker 1 (23:34):
Yeah, and so and then I guess the question is
too because it can be used as a standalone unit.
Do you are how do you be? Would you have
to segregate the data of is s U procedures that
were done with a robotic system and is SU data
(23:55):
that was done laparoscopically.
Speaker 3 (23:59):
Not necessarily because the ISU is a vision based system,
so the primary data source is the surgical video.
Speaker 2 (24:09):
So we currently don't have.
Speaker 3 (24:11):
A standalone product, but we do intend to come up
with a standalone product for laparoscopy so that they could
use these digital technologies without a robot, however, I must
say that the fidelity of the two platforms will be different.
The fidelity or a robotic platform will be significantly higher
(24:33):
because it has a lot more precise control versus without
the robot. In standard laparoscopy, we can still deploy the
tools and provide certain warnings and sound alerts and visual cues,
but we can actually stop you from doing something.
Speaker 2 (24:52):
So the solution is still the same.
Speaker 3 (24:56):
Conceptually, but the level of fidelity will be different.
Speaker 1 (25:00):
Interesting, and so what what what have you provided the
timing for the standalone version of the I s U
to come to market?
Speaker 3 (25:08):
We have not bad We're not provided timing. It's it's
on our roadmap and we'll have to work through. But
currently the priority is really on the lunar platform.
Speaker 2 (25:18):
Got it?
Speaker 1 (25:18):
And you know that that's a great segue into the
lunar system because you're you're you're essentially transitioning from one robot,
the sent Hands, to a new one, the Luna. So
what are some of the differentiating features between those two robots?
And if we're talking about differentiation, what differentiate will differentiate
(25:39):
Luna from some of the other robotics systems that are
in the market.
Speaker 2 (25:45):
Yeah, great question.
Speaker 3 (25:46):
Now I think from the rest of the market, this
will probably be this is a digital native product, so
this we did design this from the ground up.
Speaker 2 (25:56):
It will be a state of the art robotic manipulator. UH.
Speaker 3 (26:02):
You know, it has three or four arms, UH, smaller
footprint uh and and really high level of precision. And
the surgeon console is also something where we've put in
a lot of effort and there's a lot of innovation
that has gone in.
Speaker 2 (26:21):
Uh.
Speaker 3 (26:21):
This will be the first surgeon console for soft dissue
soft tissue surgical robotics that has untethered handles. Where this
is they're more like game controllers where the surgeon will
have full dexterity of motion from the handles and they'll
(26:45):
be you know, seated in a comfortable position. And again
this is this is different from all the other systems.
And in addition to all of this, the most important
piece will be the instrument. So we call it the
Trust Instrument platform, which will be a true five millimeter
(27:06):
instrument with a rist at the end, so increasing dexterity
and range.
Speaker 2 (27:14):
Of motion and accessibility for the surgeon.
Speaker 3 (27:17):
So I think taking the untethered handles on the console
and coupling it with the Truist five millimeter fully rested instruments.
I think surgeons will be able to perform surgical task.
Speaker 2 (27:32):
A significantly unique way and also a very.
Speaker 3 (27:36):
Instinctive manner in how they will be able to perform
the surgery. So we are extremely excited about this platform
because we think it will really be a game changer
in terms of performance from a technical point of view,
and then also from a per procedure cost point of view.
Speaker 2 (28:00):
We believe we'll be able.
Speaker 3 (28:01):
To offer significantly better solution and value proposition to the
surgeon and to the hospital.
Speaker 1 (28:09):
Yeah, and actually, you know, let me just dive a
little bit deeper, so I have a better understanding of
two features you talked about. The first is the tether
versus the untethered. What exactly is the tether component of
the robotic arm and why what's the benefit of removing
that tether?
Speaker 3 (28:30):
So this is the teather is on the surgeon console, okay,
where the surgeon has handles and these handles are mechanically connected.
Speaker 2 (28:39):
To the console.
Speaker 3 (28:40):
Oh okay, So the surgeon has surgeons moving levers on
the console in order to move the instrument on the
robotic arm. So that's what we've untethered there. So our
handles on the lunar system just has a cable going
between your hand piece and the console.
Speaker 1 (29:01):
Oh okay, so that's when you were talking about like
the video game controller right right, So.
Speaker 3 (29:05):
It can't have any mechanical constraints. So now you have
total freedom of motion on your hands that match the instrument,
so you can make you can make any move that
you would like. Uh be ba seated extremely.
Speaker 2 (29:19):
Comfortably, okay.
Speaker 1 (29:21):
And then the other one is the true with the
true risk technology, And how does that differ from some
of the other the end effectors that are out there
today that don't have true rest risk technology. What what
benefits in I'm assuming it's you're able to reach regions
(29:43):
of the anatomy that would be tougher to do without
true risk technology. But walk us through that a little
bit in more detail.
Speaker 3 (29:50):
Sure so, Matt. So the primary difference is the diameter
of the instrument. So what's out there today, They're eight
millimeters in diameter with the RIST and what the trust
instrument is a five millimeter diameter with a full six
degree of freedom RIST, including you know, habiting feedback or
(30:15):
forced feedback. So that's the primary difference, and the second
secondary is on the economic front. We believe we'll be
able to get a reasonable amount of lives from these
instruments in order to make the per proceedure cost go down,
so that using technology becomes more affordable compared to what's
(30:41):
out there today.
Speaker 1 (30:42):
Yeah, okay, that makes sense. And then you know one
of the other things. You know, if we've talked about
the arms, the true rist, we've talked about the is
U capabilities, one of the other functions that's key to
robotic surgery is the visualization as well, so other developments
that are being done for lunar that are different from
(31:05):
Senhans So Matt.
Speaker 3 (31:08):
For visualization, we have internally not focused on visualization even
for senhands, and our strategy has always been partnering with
best in.
Speaker 2 (31:20):
Class visualization technology.
Speaker 3 (31:22):
So today we partner with car Storts, with Olympus and
with Striker and offer their visualization systems. So with you know,
moving forward with this car Stores merger, that's something that
we will continue to move down that path of leveraging
(31:45):
existing technology because we can't be experts at everything, right,
so we are focusing on the manipulation part and then
the digital element, and then we will partner with best
in class visualized session companies.
Speaker 2 (32:01):
To bring that into the mix.
Speaker 1 (32:04):
Got ch And you know, we'llso go back to the
partner in a few minutes. But now with the lunar,
what are the next steps between now and the FDA approval?
And maybe kind of as a one aid to that
is what indications are you looking to get with an
(32:25):
initial approval?
Speaker 3 (32:27):
So right now we are in the final stages of
our design, so we have to freeze the design, which
we're hoping to get done towards the end of this year.
And once we freeze the design, then we will move
into validation and verification testing with the intent of making
(32:51):
a five to ten case submission in the second half
of twenty twenty five. You know, we are fortunate that
we have the same and system already approved, so we
are leveraging Shands as amapredicut and we intend to follow
a traditional five ten K pathway when we file the
(33:13):
file of a five ten K H And as for indications,
our expectation is to be able to get very similar
indications that we already have on the senthand system.
Speaker 1 (33:26):
Gotcha. Okay, now that's good to know. And so, you know,
as we're kind of now we're talking about we've we've
talked about the pipeline and everything, and you know, going
back to the Carl Stort's partnership, where are you able
to talk about what you see as helping you get
(33:51):
from where we are now to that potential FDA approval
timeline of second half twenty twenty five or is that
something we're you see that you could as a standalone
but now you're just going to be part of the
Carl Stortz family.
Speaker 2 (34:06):
Yeah, Matt, So you know, I can't say too much
about this.
Speaker 3 (34:11):
You know, once we get the sharehold vote and shareholder rural.
The shareholder meeting is scheduled for August seventh, and if
you get the vote, get enough votes, and get the
merger proved, then we will be part of Carl Storts
and we would no longer be a publicly listed company
(34:34):
at that time.
Speaker 1 (34:36):
Okay, understood, understood. And so maybe just you know, talking
more broadly, now, if we think about the next you know,
between now and you know, let's say second half of
twenty twenty five, twelve months from now, how has the
market opportunity changed with regards to going from a traditional
(34:57):
hospital to an outpatient or an ASC setting, which we've
kind of seen with other procedures in other segments I'm
thinking of, like orthopedics or in cardiovascular procedures. How does
that shift if anything going on with the robotics.
Speaker 2 (35:19):
Yeah, so I think in order to move to.
Speaker 3 (35:23):
AC kind of a setting, you know, economics and workflow
efficiency become two primary drivers.
Speaker 2 (35:32):
So that is something of interest.
Speaker 3 (35:33):
It is one of our target markets, and that is
something that we've been able to design and consider and
factor in as we've worked on our lunar platform to
be able to provide certain workflow efficiencies and also meet
(35:54):
the cost targets in order to be a productive system
for that setting. So that and we do think that
more and more surgeries are being moved in, you know,
outside of the main hospital setting to these surgical centers,
and our goal is to try to create a solution
(36:17):
that adds value to that and fits the existing ecosystem
in order to be productive, rather than introducing technology and
having them change their overall model. So we are pretty
bullished on that segment and feel that that is something
(36:40):
that's going to continue to grow and we definitely want
to be part of that segment.
Speaker 1 (36:46):
Yeah, that's interesting. And so what is what I guess
what are the kind of the two or three major
procedures that you see the most transitioned from a traditional
hospital to these outpatient procedures.
Speaker 3 (36:58):
It's primarily the high volume, right, It's it's you know,
high volume procedures. It's you know, sama, you know generalism,
primarily benign procedures in general surgery and kaynecology where there's
either no hospital stay required or very short uh kind
(37:19):
of stay. So I think it will primarily be in
the general and gynecology in US men.
Speaker 1 (37:26):
That's that's that sounds good and so Anthony, as we're
closing out this episode, one of the one of the
new questions I've been asking CEOs is whether there's a
book either you read recently or back in your college days.
But that's maybe most influenced your decision making process, and
(37:49):
especially because in the light of what we talked about,
there's been a lot of decisions and changes to your
business model that you've had to make as you've went
from Sindhand Surgical to you you know, Luna coming out
potentially next year, and then even the business model of
you deciding to partner with Carl Stortz. So I'm curious
(38:11):
if there's a book that you could you recommend to
the listeners about what's helped your decision making process.
Speaker 3 (38:18):
All right, that's a fun question. I would say, Matt.
The book that's kind of had an impact on me personally.
I think it's called The Art of Possibility by Benjamin Xander.
Speaker 1 (38:34):
Okay, you know, it.
Speaker 3 (38:35):
Kind of talks about how to shift your perspective from
scarcity to abundance.
Speaker 2 (38:46):
You know, basically, it's a mindset.
Speaker 3 (38:48):
Of how to how to see things in order to.
Speaker 2 (38:54):
Make progress and move forward.
Speaker 3 (38:55):
So that's something that I thought was pretty It's been
a while, It's it's not nothing recent, you know, but
it's been a while, but it still sticks around.
Speaker 1 (39:08):
It's a it's very fitting that you've mentioned that book
now after what we've talked about with how you've been
able to transition this company from an older robotics system
and bridging it to a newer robotics system and then
as we were talking about with the Carl Stortz partnership
as well, So it seems very fitting there. But Anthony,
(39:28):
thank you for joining us. Today and sharing your wisdom
of how you've transitioned this company and how you see
the robotic market playing out over time.
Speaker 2 (39:40):
Thank you, Matt, really appreciate you giving us this opportunity.
Speaker 1 (39:44):
Yeah, and thank you to our listeners for tuning in
today and we hope you join us for future episodes.
If you'd like to stay up to date, you can
click the subscribe button on Spotify or your favorite streaming platform.
Take care.
Speaker 2 (40:14):
USUS laser US tons PAS
So welcome to another episode of the Vanguards of Healthcare
podcast series. My name is Matt Hendrickson and I am
the healthcare analyst at Bloomberg Intelligence, which is the in
house equity research platform of Bloomberg LP. We're pleased to
have with us today Anthony Fernando, CEO of a Census Surgical,
a medical device company innovating robotic technologies for general and
(00:42):
pediatric surgery. You can dive deeper into the company by
typing inn as XC equity go on your Bloomberg terminal. Anthony,
thank you for joining.
Speaker 2 (00:51):
Us today to be back.
Speaker 1 (00:54):
Yeah. No, it's great to have you back as well.
And you know when we were last talking about this
time of year ago, a lot has changed since then.
But maybe why don't we start with listeners who are
new to the story about with a quick overview of
what a Sense of Surgical is and what the company
(01:14):
is developing.
Speaker 3 (01:17):
Sounds great, so at a high level that our primary
goal is to create a digital surgery platform by digitizing
the interface between the surgeon and the patient in order
to drive higher level outcomes by reducing variability, this enables
(01:39):
consistently superior outcomes. We call this performance guided surgery, and
this has two components. One is a surgical robotic platform.
Second is the digital interface what we call the ISSU
that also has cloud capability in order to drive augmented
(02:03):
intelligence to continue to monitor and improve the outcomes overall.
You know, as you guys know, you know, we talked before.
You know, robotics have been around for a very long time.
But despite how long it's been, the penetration or the
adoption has been you know, low to mid single digits,
(02:26):
and there are multiple reasons for it, and one of
them are being the outcomes have not improved. So that's
where but we are focusing on in performance guided surgery
comes in. It's not just a robot. It's a lot
more than a robot, trying to provide the benefits of
(02:47):
robotics but also improve the outcomes that the surgeon could
deliver to the patient by reducing variability. So that that's
who we are and that's currently what therefore Casino.
Speaker 1 (03:01):
Well, that's interesting. We'll dive deeper into kind of all
those those points there, but we also probably should talk
a little bit about the recent announcement that you came
out of press release about a month ago with your
recent announcement with Carl Stores.
Speaker 3 (03:20):
Yeah, so what we announced was we've announced a merger
with Carl Storts. Currently, we've filed a merger proxy on
the fourth actually on the seventh of July, I believe, uh,
and currently seeking sharehold a vote to close this transaction.
(03:45):
So I mean it's uh, it's I would say it's
a a pretty good match between the two companies given
the plans and strategies and also the assets that company has.
We are very excited about it and really looking forward
to working our way through seeking shareholder approval.
Speaker 1 (04:10):
Right, And so you know that's a big development there,
And you know, why don't we now start diving a
little bit deeper into some of the points we just
talked about, And maybe let's start with the current landscape
of robotics surgery. You talked about penetration being in the
low single digits, but what's what's the potential base of
(04:36):
the soft tissue surgery market.
Speaker 2 (04:39):
So when you think.
Speaker 3 (04:40):
About soft tissue surgery, that the currently three techniques, as
you well know, once open surgery, laparoscopy, and then robotic surgery.
If you look at the global landscape, I would say
robotics is probably in the five to six percent range,
(05:02):
and the remaining ninety four ninety five percent is split
between open and laparoscopy. Globally, I mean, US tends to
have a much larger share in robotics, probably in the
mid to high teens for the US, and then the
rest is again split between.
Speaker 2 (05:26):
Open and laparoscopy. And you know.
Speaker 3 (05:31):
I think that's like it's like I said earlier, I
think that's the landscape today. But robotics has is accepted
and there are some benefits to robotics. However, the costs
remains significantly high, one for acquisition and second even from
(05:53):
a per procedure basis, and as a result, penetration remains
pretty low overall.
Speaker 1 (06:01):
Actually, and so that's interesting too, the cost because you know,
we will talk about the competitive landscape probably a little
more in detail later, but you know, the largest competitor
in the market is doing, you know, roughly two million
procedures per year, and the question is is that are
(06:25):
they still not getting enough procedures done per robot to
make that cost per procedure in line with laparoscopic surgery.
Speaker 2 (06:37):
Yeah, I think so there's a difference, right.
Speaker 3 (06:40):
I couldn't comment exactly about the utilization of their system overall.
But if I would assume that if one made that
investment and commitment.
Speaker 2 (06:53):
To acquire that product, that they're meeting the.
Speaker 3 (06:57):
Expectation of how many procedures UH to be performed in.
Speaker 2 (07:03):
Order to make the business case for that product. You know.
Speaker 3 (07:07):
On the other hand, laparoscopy, it does not have h
It's just a technique with the with the.
Speaker 2 (07:14):
With a set of instruments.
Speaker 3 (07:16):
So there's there's no large capital investment or long term
commitment required when you perform laparoscopy. So that that's I
think that the fundamental difference UH and and robotic surgery.
And I think you know, you talked about the number
(07:37):
of units, but I think it also goes to.
Speaker 2 (07:42):
The training of the surgeons.
Speaker 3 (07:45):
You know, the surgeons had you know who come out
of residency programs, have had prior experiences, so they tend
to have a preference towards leveraging robotics compared to laparoscopic
technique or open technique. And then the institution has to
(08:05):
support each technique that they tend to use a mix
of it. I would say mix of it at most institutions.
So I think as several factors that kind of play
in to making that.
Speaker 1 (08:18):
Decision, okay, And so maybe that's an interesting segue into
your current system in the market with the scenthanced Surgical
Robotic system, because some of your comments in the past
have talked about how it most replicates laparoscopic surgery itself,
(08:39):
So maybe what are some of the design features of
that system that is able to differentiate itself from kind
of the other products that are currently in the market.
Speaker 3 (08:50):
So I mean that two aspects to its One is
the feature feature set and the other one is more
on the training side. So I started the training side.
We cater to laparoscopic surgeons, which means that we don't
train a surgeon on how to perform surgeon. We only
(09:10):
train the surgeon on how to use the equipment, and
given that this is laparoscopy, the surgeon is able to
perform the surgery in a very similar fashion to laparoscopy,
including port placement. So that's the training side. On the
technical side, we again try to mimic laparoscopy, so we
(09:33):
enable the use of five millimeter and three millimeter straight
laparoscopic instruments, which the surgeon are very familiar with, and
then we augment that with other features. We provide haptic
feedback or force feedback so that the surgeon can feel
with their instrument. Then there's eye tracking camera control where
(09:57):
the surgeon can now do three things at the in time,
move two instruments, one on each hand, and then by
the gase of their eyes, they can move the camera
without needing an assistant to do that.
Speaker 2 (10:11):
So that's on the robotic side.
Speaker 3 (10:13):
And then the Intelligence Surgical Unit or the i SU
has several other digital features that we offer in you know,
automated camera control, measurement tags, those are some other current
features but growing in terms of features over time, and
(10:35):
also be able to collect data and provide that feedback
to surgeon. So that's currently what's on the market. While
the senhand system will be replaced here sometimes in the
coming years with the lunar system, but the i SU
is continuing to grow and gain momentum and improve with
(10:59):
more data that we collect through the sentance platform.
Speaker 1 (11:03):
Well, it's interesting because it sounds like the ISU, and
we'll dive more into kind of the more of those
specifics about the measurement and the digital tags, but that
ISU seems to be a bridge between doctors using the
sinhanced surgical system and then ultimately doctors converting or starting
(11:23):
with the lunar system when it comes to the market.
Is that a right way to think about it?
Speaker 2 (11:30):
Exactly?
Speaker 3 (11:30):
That's kind of how I've been explaining it to it.
It's really the bridge, right, because the bridge is the data.
It's the surgical video and the insights that we can
glean from the data that we collect. We collect robotic
manipulator data, we collect surgeon console data, and then we
(11:50):
collect the surgical video, and then we triangulate all these
three streams of information in order to glean insights which
tend to be very valuable where we can take these
insights and make certain observations and then help to improve
(12:12):
the surgeon's technique or could improve how the surgeon performs
the procedure, so that the surgeon can learn from how
better to perform a certain procedure. And then there's a
whole nother safety element where we can prevent certain avoidable
errors from happening during the surgery, but again through that collection.
Speaker 2 (12:36):
So it's definitely a bridge.
Speaker 3 (12:38):
So irrelevant of what robot you have or what robot
is being used, where it's senhands or lunar or the
console the is SU and the data becomes the bridge
from senhands to the future product.
Speaker 1 (12:52):
That's interesting. And then just you know, going back to
the robotic arms themselves you talked about and being five
millimeters almost as Yeah, five milimeters almost as small as
three milimeters. How does that compare to some of the
other robotic arms that are in the market.
Speaker 3 (13:13):
Yeah, so currently a majority of what's on the market
eight millimeter.
Speaker 2 (13:18):
If you talk about the big companies.
Speaker 3 (13:20):
That are out there, it's all eight millimeter is what
they either have on the market or planning to be
on the market. So we decided we're not going to
go that route. We're going to stick to the standard
of laparoscopy, which is five millimeter and three millimeter, and
that's where we are going to continue to operate on
(13:41):
five and three.
Speaker 1 (13:43):
And so, I mean it's just, I mean it seems
like though if I'm if I'm a surgeon or if
I'm a patient, I feel like smaller would be better.
So how do you market that to the hospitals and
how do you get the hospitals to market to the patients.
Speaker 3 (14:02):
Yeah, So there's two elements to this as well. So incision.
That the instrument size is a direct correlation to incision size,
and smaller the insight is smaller the incision, there's less
probability of infection, less pain. You know, some of the
(14:22):
surgeries are performed using three millimeters instruments even without a
troca using subcutaneous insertion, and with that you don't even
have to suture, so it's obviously faster recovery as well.
So that's the patient side of it. And second for
(14:44):
the surgeon, when the surgeon has smaller instruments, you actually
can see your field of view is a lot better
compared to larger diameter instruments, So that that's typically what
we talk about, and the surgeons have a very good
appreciation for both of those, primarily for incision size, and
(15:08):
that's the reason why you know five and three tend
to be preferred over the larger instrument size.
Speaker 1 (15:14):
And then that also then allows you to treat pediatric
patients probably better than traditional end effectors could.
Speaker 2 (15:23):
Is that correct, Yeah, exactly.
Speaker 3 (15:26):
So we you know, initially we were not we didn't
go after the pediatric market, but once the surgeons saw
that we had five and three millimeter instruments, the pediatric
surgeons actually approached us saying, hey, you know, three millimeter
is what we would love to do for pediatric patients.
And on top of it, you guys have haptic feedback.
(15:47):
So it was more of a surgeon pool where the
surgeons came and told us, why don't you get the
approval so that we can operate on.
Speaker 2 (15:58):
Pediatric patients. And so far it's been.
Speaker 3 (16:03):
Extremely successful on the pediatric front several other sites, you know,
last year and even this year. Year to date, almost
all the several systems we replaced have been into the
pediatric market, so that that's been a pretty good success
for us thus far.
Speaker 1 (16:23):
That's interesting. And then, as you know, just kind of
now taking like a little step back, and you know,
you saw that opportunity, what decisions did you have to
make as the CEO to kind of either divert assets,
divert resources, change the business model? I mean, what when
you saw that opportunity, what were the steps that you
(16:43):
had to make to kind of make that a realization
with gain the now getting robots placed into these pediatric hospitals.
Speaker 3 (16:51):
I think again, the first decision was to understand the
regulatory landscape and be able to see clearance for pediatric
patients because we didn't have a pediatric label at the time.
It was only for adult patient population. So that was
a primary decision we had to make. And then while
(17:14):
that was going on, as you know, from an economic
point of view, the pediatric market is a relatively small market. However,
there's not many players in that space given that it's
a small market, so for us, it was quite intriguing saying, Okay,
we have a product, we have the right tools, and
(17:37):
even though the initial market size is small, you know,
do we want to enter this market and create a solution.
Speaker 2 (17:47):
And obviously the answer was yes.
Speaker 3 (17:49):
So despite the overall size, given that it was an
underpenetrated market and also very underserved market and also very
high sport in terms of patient population, I think they
came together and that was the criteria that we based
our decision on to enter the pediatric space.
Speaker 1 (18:12):
That's interesting and so moving. Then, you know, we talked
a little bit about the I s U. You talked
about some of the features that are currently there, but
what what when you were when you're marketing this to
a physician or to a hospital, what what are you
(18:33):
comparing it to with traditional robotic surgery or traditional labroscopic surgery,
even in traditional open surgery. How are you how are
you marketing this to them as saying that this is
something that you need to have in your O R.
Speaker 3 (18:47):
Yeah, so Matt, you know this is something that doesn't
exist today, right Ah, he doesn't existing surgery until we
introduced the I s u uh analy is that we
provide are really from everyday life. You drive your car,
you know, you have a backup camera that beeps at
(19:09):
you or even automatically hits the brakes if there's an
object in the back.
Speaker 2 (19:13):
If you're driving on the highway, the car.
Speaker 3 (19:15):
Stays in your lane, and if it goes to the edge,
it will vibrate, giving you an alert to move back
into your lane or even kick you.
Speaker 2 (19:24):
Back into your lane.
Speaker 3 (19:25):
So things of the sort we are used to in
everyday life, where certain peripheral activities help us be safe.
So that's kind of what we are bringing to surgery, saying,
you know, all the technologies that we're used to in
everyday life, tools that we have on our smartphones, and
(19:48):
these safety features in your car. We're trying to bring
all of those two surgery and enable you to use
tools like measurements and tag and automatic camera con and
then also the suite of safety features at your fingertips
that you can use without any additional equipment. It just
(20:09):
comes with the system and when you're performing surgery. So
the goal, the ultimate goal with all of these is
to reduce the cognitive burden on the surgeon because surgery
is a very high stress environment and the surgeon using
a robot obviously have less physical fatigue because the surgeon
(20:31):
is seated in a comfortable position, but the cognitive fatigue
is still pretty high because surgeon has to orchestrate everything
in the r But by providing these tools that they
can deploy as they see fit, you know, reduces the
cognitive fatigue of the surgeon because we are taking care
(20:52):
of certain elements in a peripheral sense, thus helping the
surgeon focus on the patient.
Speaker 2 (20:58):
And deliver a higher level of care.
Speaker 3 (21:00):
So that's typically you know that that's what we do,
and that's kind of how we explain this to surgeons.
Speaker 1 (21:08):
Yeah, and then also it catches my attention is the
potential for being able to collect big data and then
using that to assist surgeons in the future. What are
the next steps for kind of utilizing that big data
to kind of help with surgeons, either in the decision
(21:29):
making process during the procedure itself or with training new
surgeons on how to use the technology.
Speaker 3 (21:38):
So, Matt, we are I would say, we are relatively
at an early stage. We are collecting data. We are
trying to build models out of this data. Given the
scale of this data, we partnered with Google Health Cloud
in order to collect the data and start putting them
in the right containers. So we are in the process
(22:03):
of developing these models. Now we have the infrastructure, you know,
we have the architecture, the infrastructure in order to do this.
So over time, you will see surgeon with you know,
us deploying procedures, specific applications in order to help surgeons
perform better surgery. Right, I mean when we look at
(22:25):
the data, you know, some of the very simple procedure
like a goal bladder removal, we have seen some procedures
being done in the twenty minute range and some procedures
the same procedure without any complications being done in the
eighty to ninety minute range.
Speaker 2 (22:43):
So they shouldn't be that different.
Speaker 3 (22:47):
So that's that those other kinds of things that we
are seeing and then we'll be able to navigate these
surgeons to perform the best possible procedure, with the goal
being where we can learn from everywhere and be able
to deploy it anywhere.
Speaker 1 (23:05):
That's interesting because it sounds like you could potentially standardize
how the procedure plays out, you know, given there's no complications.
So that's kind of interesting. You know, then you can
make if you make that eighty minute procedure down to
that twenty thirty mine procedure, you're saving one hour of
r space or our time.
Speaker 2 (23:26):
Ye, standardization is the right word.
Speaker 3 (23:28):
That's definitely the direction that this will ultimately ultimately lead to.
Speaker 1 (23:34):
Yeah, and so and then I guess the question is
too because it can be used as a standalone unit.
Do you are how do you be? Would you have
to segregate the data of is s U procedures that
were done with a robotic system and is SU data
(23:55):
that was done laparoscopically.
Speaker 3 (23:59):
Not necessarily because the ISU is a vision based system,
so the primary data source is the surgical video.
Speaker 2 (24:09):
So we currently don't have.
Speaker 3 (24:11):
A standalone product, but we do intend to come up
with a standalone product for laparoscopy so that they could
use these digital technologies without a robot, however, I must
say that the fidelity of the two platforms will be different.
The fidelity or a robotic platform will be significantly higher
(24:33):
because it has a lot more precise control versus without
the robot. In standard laparoscopy, we can still deploy the
tools and provide certain warnings and sound alerts and visual cues,
but we can actually stop you from doing something.
Speaker 2 (24:52):
So the solution is still the same.
Speaker 3 (24:56):
Conceptually, but the level of fidelity will be different.
Speaker 1 (25:00):
Interesting, and so what what what have you provided the
timing for the standalone version of the I s U
to come to market?
Speaker 3 (25:08):
We have not bad We're not provided timing. It's it's
on our roadmap and we'll have to work through. But
currently the priority is really on the lunar platform.
Speaker 2 (25:18):
Got it?
Speaker 1 (25:18):
And you know that that's a great segue into the
lunar system because you're you're you're essentially transitioning from one robot,
the sent Hands, to a new one, the Luna. So
what are some of the differentiating features between those two robots?
And if we're talking about differentiation, what differentiate will differentiate
(25:39):
Luna from some of the other robotics systems that are
in the market.
Speaker 2 (25:45):
Yeah, great question.
Speaker 3 (25:46):
Now I think from the rest of the market, this
will probably be this is a digital native product, so
this we did design this from the ground up.
Speaker 2 (25:56):
It will be a state of the art robotic manipulator. UH.
Speaker 3 (26:02):
You know, it has three or four arms, UH, smaller
footprint uh and and really high level of precision. And
the surgeon console is also something where we've put in
a lot of effort and there's a lot of innovation
that has gone in.
Speaker 2 (26:21):
Uh.
Speaker 3 (26:21):
This will be the first surgeon console for soft dissue
soft tissue surgical robotics that has untethered handles. Where this
is they're more like game controllers where the surgeon will
have full dexterity of motion from the handles and they'll
(26:45):
be you know, seated in a comfortable position. And again
this is this is different from all the other systems.
And in addition to all of this, the most important
piece will be the instrument. So we call it the
Trust Instrument platform, which will be a true five millimeter
(27:06):
instrument with a rist at the end, so increasing dexterity
and range.
Speaker 2 (27:14):
Of motion and accessibility for the surgeon.
Speaker 3 (27:17):
So I think taking the untethered handles on the console
and coupling it with the Truist five millimeter fully rested instruments.
I think surgeons will be able to perform surgical task.
Speaker 2 (27:32):
A significantly unique way and also a very.
Speaker 3 (27:36):
Instinctive manner in how they will be able to perform
the surgery. So we are extremely excited about this platform
because we think it will really be a game changer
in terms of performance from a technical point of view,
and then also from a per procedure cost point of view.
Speaker 2 (28:00):
We believe we'll be able.
Speaker 3 (28:01):
To offer significantly better solution and value proposition to the
surgeon and to the hospital.
Speaker 1 (28:09):
Yeah, and actually, you know, let me just dive a
little bit deeper, so I have a better understanding of
two features you talked about. The first is the tether
versus the untethered. What exactly is the tether component of
the robotic arm and why what's the benefit of removing
that tether?
Speaker 3 (28:30):
So this is the teather is on the surgeon console, okay,
where the surgeon has handles and these handles are mechanically connected.
Speaker 2 (28:39):
To the console.
Speaker 3 (28:40):
Oh okay, So the surgeon has surgeons moving levers on
the console in order to move the instrument on the
robotic arm. So that's what we've untethered there. So our
handles on the lunar system just has a cable going
between your hand piece and the console.
Speaker 1 (29:01):
Oh okay, so that's when you were talking about like
the video game controller right right, So.
Speaker 3 (29:05):
It can't have any mechanical constraints. So now you have
total freedom of motion on your hands that match the instrument,
so you can make you can make any move that
you would like. Uh be ba seated extremely.
Speaker 2 (29:19):
Comfortably, okay.
Speaker 1 (29:21):
And then the other one is the true with the
true risk technology, And how does that differ from some
of the other the end effectors that are out there
today that don't have true rest risk technology. What what
benefits in I'm assuming it's you're able to reach regions
(29:43):
of the anatomy that would be tougher to do without
true risk technology. But walk us through that a little
bit in more detail.
Speaker 3 (29:50):
Sure so, Matt. So the primary difference is the diameter
of the instrument. So what's out there today, They're eight
millimeters in diameter with the RIST and what the trust
instrument is a five millimeter diameter with a full six
degree of freedom RIST, including you know, habiting feedback or
(30:15):
forced feedback. So that's the primary difference, and the second
secondary is on the economic front. We believe we'll be
able to get a reasonable amount of lives from these
instruments in order to make the per proceedure cost go down,
so that using technology becomes more affordable compared to what's
(30:41):
out there today.
Speaker 1 (30:42):
Yeah, okay, that makes sense. And then you know one
of the other things. You know, if we've talked about
the arms, the true rist, we've talked about the is
U capabilities, one of the other functions that's key to
robotic surgery is the visualization as well, so other developments
that are being done for lunar that are different from
(31:05):
Senhans So Matt.
Speaker 3 (31:08):
For visualization, we have internally not focused on visualization even
for senhands, and our strategy has always been partnering with
best in.
Speaker 2 (31:20):
Class visualization technology.
Speaker 3 (31:22):
So today we partner with car Storts, with Olympus and
with Striker and offer their visualization systems. So with you know,
moving forward with this car Stores merger, that's something that
we will continue to move down that path of leveraging
(31:45):
existing technology because we can't be experts at everything, right,
so we are focusing on the manipulation part and then
the digital element, and then we will partner with best
in class visualized session companies.
Speaker 2 (32:01):
To bring that into the mix.
Speaker 1 (32:04):
Got ch And you know, we'llso go back to the
partner in a few minutes. But now with the lunar,
what are the next steps between now and the FDA approval?
And maybe kind of as a one aid to that
is what indications are you looking to get with an
(32:25):
initial approval?
Speaker 3 (32:27):
So right now we are in the final stages of
our design, so we have to freeze the design, which
we're hoping to get done towards the end of this year.
And once we freeze the design, then we will move
into validation and verification testing with the intent of making
(32:51):
a five to ten case submission in the second half
of twenty twenty five. You know, we are fortunate that
we have the same and system already approved, so we
are leveraging Shands as amapredicut and we intend to follow
a traditional five ten K pathway when we file the
(33:13):
file of a five ten K H And as for indications,
our expectation is to be able to get very similar
indications that we already have on the senthand system.
Speaker 1 (33:26):
Gotcha. Okay, now that's good to know. And so, you know,
as we're kind of now we're talking about we've we've
talked about the pipeline and everything, and you know, going
back to the Carl Stort's partnership, where are you able
to talk about what you see as helping you get
(33:51):
from where we are now to that potential FDA approval
timeline of second half twenty twenty five or is that
something we're you see that you could as a standalone
but now you're just going to be part of the
Carl Stortz family.
Speaker 2 (34:06):
Yeah, Matt, So you know, I can't say too much
about this.
Speaker 3 (34:11):
You know, once we get the sharehold vote and shareholder rural.
The shareholder meeting is scheduled for August seventh, and if
you get the vote, get enough votes, and get the
merger proved, then we will be part of Carl Storts
and we would no longer be a publicly listed company
(34:34):
at that time.
Speaker 1 (34:36):
Okay, understood, understood. And so maybe just you know, talking
more broadly, now, if we think about the next you know,
between now and you know, let's say second half of
twenty twenty five, twelve months from now, how has the
market opportunity changed with regards to going from a traditional
(34:57):
hospital to an outpatient or an ASC setting, which we've
kind of seen with other procedures in other segments I'm
thinking of, like orthopedics or in cardiovascular procedures. How does
that shift if anything going on with the robotics.
Speaker 2 (35:19):
Yeah, so I think in order to move to.
Speaker 3 (35:23):
AC kind of a setting, you know, economics and workflow
efficiency become two primary drivers.
Speaker 2 (35:32):
So that is something of interest.
Speaker 3 (35:33):
It is one of our target markets, and that is
something that we've been able to design and consider and
factor in as we've worked on our lunar platform to
be able to provide certain workflow efficiencies and also meet
(35:54):
the cost targets in order to be a productive system
for that setting. So that and we do think that
more and more surgeries are being moved in, you know,
outside of the main hospital setting to these surgical centers,
and our goal is to try to create a solution
(36:17):
that adds value to that and fits the existing ecosystem
in order to be productive, rather than introducing technology and
having them change their overall model. So we are pretty
bullished on that segment and feel that that is something
(36:40):
that's going to continue to grow and we definitely want
to be part of that segment.
Speaker 1 (36:46):
Yeah, that's interesting. And so what is what I guess
what are the kind of the two or three major
procedures that you see the most transitioned from a traditional
hospital to these outpatient procedures.
Speaker 3 (36:58):
It's primarily the high volume, right, It's it's you know,
high volume procedures. It's you know, sama, you know generalism,
primarily benign procedures in general surgery and kaynecology where there's
either no hospital stay required or very short uh kind
(37:19):
of stay. So I think it will primarily be in
the general and gynecology in US men.
Speaker 1 (37:26):
That's that's that sounds good and so Anthony, as we're
closing out this episode, one of the one of the
new questions I've been asking CEOs is whether there's a
book either you read recently or back in your college days.
But that's maybe most influenced your decision making process, and
(37:49):
especially because in the light of what we talked about,
there's been a lot of decisions and changes to your
business model that you've had to make as you've went
from Sindhand Surgical to you you know, Luna coming out
potentially next year, and then even the business model of
you deciding to partner with Carl Stortz. So I'm curious
(38:11):
if there's a book that you could you recommend to
the listeners about what's helped your decision making process.
Speaker 3 (38:18):
All right, that's a fun question. I would say, Matt.
The book that's kind of had an impact on me personally.
I think it's called The Art of Possibility by Benjamin Xander.
Speaker 1 (38:34):
Okay, you know, it.
Speaker 3 (38:35):
Kind of talks about how to shift your perspective from
scarcity to abundance.
Speaker 2 (38:46):
You know, basically, it's a mindset.
Speaker 3 (38:48):
Of how to how to see things in order to.
Speaker 2 (38:54):
Make progress and move forward.
Speaker 3 (38:55):
So that's something that I thought was pretty It's been
a while, It's it's not nothing recent, you know, but
it's been a while, but it still sticks around.
Speaker 1 (39:08):
It's a it's very fitting that you've mentioned that book
now after what we've talked about with how you've been
able to transition this company from an older robotics system
and bridging it to a newer robotics system and then
as we were talking about with the Carl Stortz partnership
as well, So it seems very fitting there. But Anthony,
(39:28):
thank you for joining us. Today and sharing your wisdom
of how you've transitioned this company and how you see
the robotic market playing out over time.
Speaker 2 (39:40):
Thank you, Matt, really appreciate you giving us this opportunity.
Speaker 1 (39:44):
Yeah, and thank you to our listeners for tuning in
today and we hope you join us for future episodes.
If you'd like to stay up to date, you can
click the subscribe button on Spotify or your favorite streaming platform.
Take care.
Speaker 2 (40:14):
USUS laser US tons PAS
Host
Jonathan Palmer
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