September 11, 2025 • 41 mins
“We've been working with NVIDIA for a number of years now and we integrated a medical grade, GPU in our commercial product”, CEO Anne Osdoit explains to Bloomberg Intelligence in her description about how AI is being incorporated into Moon Surgical’s surgical robot. In this Vanguards of Health Care podcast episode, Osdoit sits down with BI analyst Matt Henriksson for an in-depth interview on Moon Surgical, the benefits of its Maestro AI-powered surgical platform, and how Maestro can address the current barriers that have kept penetration rates of robotic surgery low.
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Episode Transcript
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Speaker 1 (00:17):
Welcome to another episode of the Vanguards of Healthcare series.
My name is Matt Hendrickson, the medical technology analyst at
Bloomberg Intelligence, which is the in house equity research platform
of Bloomberg LP. We're pleased to have with us today
and Ostuwitt, CEO of Moon Surgical, a privately held medical
device company that is expanding surgical robotics with its Maestro system,
(00:39):
And thank you for joining us today.
Speaker 2 (00:41):
Thanks Matt, it's great to be here.
Speaker 1 (00:43):
It is likewise and so and why don't we just
start off with a quick overview of your career path
and the steps that led you to being the CEO
of Moon Surgical with pleasure.
Speaker 2 (00:53):
So I'm forty four years old. I am a mother
of four children, based in Paris, and I've worked in
medical devices for my entire career. I wanted to be
a medical doctor as a kid, and for a variety
of reasons, ended up not pursuing that. You know, when
you study in Paris, there's a high chance that you're
(01:14):
going to be living with your parents if you were
born and raised in Paris, which was my case, and
the perspective of you know, staying for another ten to
twelve years at my parents' apartment while doing med school
was a little daunting, I have to say, so I
just decided to work in the medical industry, but taking
(01:34):
another path right which was by medical engineering, and studied
both in France and in the US, and after that
always wanted to be back and based in Europe. But
have you know, an international exposure in the medical space,
and that's what I've done for the last you know.
Speaker 1 (01:52):
And so Ben then that leads up to Moon Surgical
and maybe before we dive deeper into the robotics, based
just what a quick overview of the mic system is
and what it can do.
Speaker 2 (02:02):
So the mastro system is a platform that is used
in soft tissue surgeries, minimally invasive soft shoe surgery specifically,
so things that would be abdominal surgery, thoracic surgery, urologic surgery,
GYN surgery, and interventions that are typically done through a
keyhole you know approach. So really trying to leverage this
(02:26):
practice which has become the standard of care over the
last four years, and turning it into something that can
be robotically controlled and made digital, basically integrating a data
component into that, but really delivering a platform that elevates
the way surgery is done today, rather than completely changing
it and shifting it to another paradigm.
Speaker 1 (02:49):
Yeah, and you know you're talking about just minimally invasive
robotic soft tissue surgery. A lot has been developed over
the last and even twenty years in the robotic space.
What is your view of just the current landscape of
robotic surgery. What have been some of the key developments
that have taken place. What are some of the things
that you're seeing that you know or you know loopholes
(03:13):
or you know, gaps that could be filled.
Speaker 2 (03:15):
So that's a great question. You know, I think it
has been a very exciting field, right, I mean, you're
an analyst, you cover these things. You know how much
citement there has been for robotic surgery, and it is
gradually becoming the new standard of care, right one one
way or another. I think in our field, which is
soft to shoe minimillion vasive surgery, there is of course
(03:37):
a very dominant player, which you know is Intuitive Surgical
and they have the immense credit of pioneering the field
with an amazing product which they have been deploying for
the last twenty twenty years and has been an immense success,
right and this is of course a proxy in an
(03:59):
example everybody he looks to it. It has been deployed
to this date in procedures that were originally complex procedures
where you needed that risted capability for fine futuring abilities
right then. And of course from that it has expanded
to lower acuity indications. And so what we've seen in
(04:22):
the last ten years is, you know, basically a basket
a series of followers trying to emulate what Intuitive Surgery
has done in multiple ways, with different nuances, different you know, specificities,
trying to develop products that might be more accessible, that
(04:45):
might be easier to set up. I mean, there's a
number of different variants if you will, of what the
DaVinci platform from Intuitive Surgical represents. But but in a
way they've all been following this principle behind what a
surgical robot is supposed to be, which is that it's
(05:07):
a closed system and it puts the surgeon behind a console.
Speaker 1 (05:11):
Y it's almost looks like a video game exactly.
Speaker 2 (05:15):
So it's a closed system, meaning that you're using surgical
instruments that are provided together with the surgical robot and
our proprietary which means that the surgeon has to let
go from you know, their laparoscopic habits and preferences, and
specifically when it comes to surgical instrumentation, they can be
(05:35):
fairly picky, but they like to use. And then the
second thing is, as you said, it puts a surgeon
behind a console and they are then you know, operating
by manipulating sophisticated joysticks essentially which completely change the gesture
and and really reinvents the way surgery is done. And
so we say we're not a robot in a sense
because we don't meet those two createria. Yeah, we're not
(05:57):
a closed system. We're compatible with any type of surgical
instrumentation out there, and we don't put the surgeon behind
a console. We keep the surgeon at the bedside, operating,
you know, as they would operate in a laparoscopic environment
with their surgical technique and operative setup and room workflow
as they typically do. But we elevate that too.
Speaker 1 (06:18):
Yeah, it's interesting because this is not the first time
I've heard about mimicking a laparoscopic approach. For the listeners
who are kind of newer to the story, what is
exactly the labar topic procedure kind of you know, beyond
just being simply a minimally invasive procedure.
Speaker 2 (06:34):
So the minimally invasive surgical approach aims at basically improving
recovery right for patients. So it is about threading these
long and thin instruments inside the abdomen through these tiny
incisions and then basically replicating what you would do in
(06:54):
an open surgery through these tiny instruments in a way
that is in a way blind to the surgeon. Right
you're inside the abdomen, so you do need the support
of a camera to see what's going on inside the belly.
You do need the support of someone exposing the tissue
for you, retracting tissue on the side throughout the surgery
(07:17):
so that the surgeon can access what is relevant at
any time with the surgery. And these are functions that
appeared in the operating room with mini million invasive surgery.
Right before mini million invasive surgery, the surgeon could just
see and they could just access what they needed to access.
But minimillion invasive surgery drove the distribution of roles and
(07:41):
responsibility in the r and the creation of these new
functions which are you know, managing the vision for the
surgeon and managing the ability to access tissue. And so
this is what we're covering with our platform, really equipping
the surgeon at the bedside with an extra pair of
hands and the ability to control these two instruments, the
(08:01):
scope and the retractor.
Speaker 1 (08:03):
Yeah. Yeah, and this, you know, now we can dive
into a little bit into the Maestros system. And you know,
one of the quotes I heard or you know, you
had in a press release it was three instruments with
just two hands, And I think this is what you're
you're getting at here with you talking about, you know,
being able to use the tools and the imaging and everything.
(08:23):
Do you just dive a little deeper into how you
can be able to do three instruments with two hands
at one time type thing?
Speaker 2 (08:29):
Yeah, with absolutely So, as I said, we're equipping the
surgeon with basically the ability to control two additional instruments.
These two instruments would be held by our Maescra platform
which has two arms, and so basically we're you know,
turning the surgeon into a four armed surgeon and they
can very easily switch between these four instruments which are
(08:54):
used in these in these surgeries. And you know a
four instruments surgery will cover the vast man TOF tissue surgery.
So the two of these instruments are held by our arms.
When the surgeon grabs one of these instruments, the arms
will automatically unlock. They will offer no mak asistance. The
surgeon is a really move them as they would if
(09:16):
the instrument was not by an arm, and then as
soon as the surgeon needs to let go because they
need to maneuver another instrument, the arm will understand that
and hold the instrument's table in the desired position. So
you can just very easily go from one instrument to
the other with the support and the stability that you
would expect from a human and probably a better one, right,
(09:39):
because it is perfectly reliable.
Speaker 1 (09:41):
Well yeah, because anytime I think you know of a surgeon,
you talk about the steadiness of a surgeon's hand, ye,
but it's still not as steady as a rigid arm.
Speaker 2 (09:50):
Absolutely, And if you think about surgical assistance, which is
the ability to manage you know, the vision and the
exposure and access for the surgeon, it's even worse. Right,
it's inherently flawed. You know, you have someone who is
standing next to the surgeon or across the r table
and trying to anticipate what the surgeon wants to see
(10:12):
or access at any given moment in the procedure, which
is a very difficult task, especially when you have to
hold things stable for minutes or out. Yeah.
Speaker 1 (10:20):
And then so with the arms, which is very interesting.
When you wants to grasp it, it becomes loose and
you can move it anywhere you want, and then when
you let go, it becomes rigid. When I'm thinking of
like a traditional you know, Da Vinci robot and it
the arm moves automatically and everything. Does the microsystem allow
for that optionality as well? Or is this is this
the differentiating feature where it creates this kind of new
(10:43):
platform of how you can do robotic surgery.
Speaker 2 (10:45):
So that's a great question. This feature of moving the
arm in a way from a distance, right, manipulating the
arm exists in our case. For setup, you would typically
define your default setup poses for the system, which are
based on the surgeon references and which chinical indication which
and when you start a procedure you would say, hey,
(11:06):
it's doctor Smith doing a sectomy, and then the system
would automatically set up and you don't have to move
to do that, they'll move by themselves. But during the procedure,
we we like to have everything on there the control
of the surgeon, with the exception of the SCO pilot feature.
Speaker 1 (11:24):
Okay, okay, And you know this is a great sequeing
to the scope pilot feature because that got recently FDA approved.
What what is sco pilot for the listeners and you
know what jumping ahead here, what with its AI capabilities
allows it to do things that other robots can't do
(11:45):
at this point.
Speaker 2 (11:46):
So in the typical surgery, as I mentioned that the
surgeon would rely on the scope to see what's happening
inside the abdomen, right, so they would typically need that
scope to be repositioned constantly throughout the procedure to make
sure that they have their instruments in the right view,
(12:08):
which means of course they need their instruments in the
field of view, and then they need the appropriate level
of zoom to do whatever they need to do, which
can be navigated, which can be future, which can be
clip stable, etc. And you can imagine that every surgeon
has a different way of manage that scope during the procedure.
(12:28):
Some surgeons like it close, some surgeons like it from
further out. Some surgeons like to move it a lot.
Some surgeons are comfortable when you know, it's a lot
more stable. And this is something that the surgical assistant
has to adapt to. Right, As we said, they're supposed
to anticipate what the surgeon wants to see, and they're
(12:48):
supposed to adjust to what this specific surgeon's preferences might
be in terms of how they like their vision managed.
But all of this and be bought or learned by AI, right,
I mean, it is complex to some degree, but it
is something that you can process in a computer and
(13:10):
render in real time. So what we've done is we
have essentially servoyed the scope to the tip of the
surgeon's instruments, the tips of the instrument that they are
holding manually, and we are controlling the position of the
scope to make sure that these instruments will remain in
the field of you at the desired distance from the camera,
(13:34):
learning from how that specific surgeon has been operating over
you know, a number of procedures.
Speaker 1 (13:40):
And this sounds kind of like we were just talking
about a few minutes ago, where you would have the
assistant on the surgery floor trying to anticipate where the
surgeon wants to go with, you know. And the thing
about AI is that it can be able to, you know,
accumulate much much more data points than a human can,
and be able from that information be able to then
be able to anticipate it potentially better than what a
(14:02):
human cut.
Speaker 2 (14:03):
Absolutely and if you think about some of the implications
of that, it means that we can tell a surgeon
when they're doing better, you know, based on how their
scope is positioned. We can also train a younger surgeon
to operate like a more experienced surgeon. There is this
thing in minim million vasive surgery where naive surgeons or
(14:26):
less experienced surgeons tend to zoom in a lot, right,
because they need to be closed to feel they're in control.
But as you get more experienced, you typically zoom out
to have a broader field of you and a better
sense of safety from that broader control, you know. Scoopilot
is also a safety feature in the sense that the
(14:47):
greatest risks in soft issue surgery occur when your instruments
are not in the field of you anymore, which makes sense, right,
I mean, that's when you might be cutting things without
even noticing. That is something that we help with driving
surgeons to use best practices in scope management and vision.
(15:07):
It's something that we can do with that feature.
Speaker 1 (15:09):
Yeah, and so you know, this is actually kind of
scopilot being FDA approved. You've received FDA approval for the
microsystem overall about what about.
Speaker 2 (15:18):
A year ago.
Speaker 1 (15:19):
Now, how has that launch been over the last twelve months?
And mainly let's maybe say the first part of it
pre scope pilot and then post scope pilot.
Speaker 2 (15:29):
Yeah, so SCOO pilot has not yet been deployed in
the US right, It's coming in the next few weeks.
Right before we deployed it, we were waiting for an
additional clearance from the FDA, which we got in June,
which covers two things. One of them is what's called
a PCCP predetermined Change Control Plan, which is the ability
(15:52):
to evolve an AI algorithm basically PERFECTICS performance without having
to go back to the agency mark that the FDA
has put in place specifically for AI algorithms initially to
do that. And so it enables us to add training
data sets, to add instrument classes to make sure that
(16:12):
we're able to recognize more instruments for more brands with
more diversity, and so we wanted this to be cleared
by the FDA before deploying's Copilot because we wanted the
ability to leverage the data that's coming from those sites
for that additional training and increase performance. And the second
thing that was in that latest clearance was what we
(16:35):
call enhance connectivity, which is the ability for our systems
to be connected through five G and or Wi Fi,
which is also a way for us to push updated
versions of the algorithm right, an enabler, if you will,
of further iterations of scopilots. So we're about to deploy
scoopilots in the next few weeks. It has been used
(16:58):
in Europe in routine fashion. So for the last twelve months,
what we were doing was a limited market release. Limited
in the sense that we deployed twelve systems between Europe
and the US, each geography, and we studied how those
systems were used and adopted. It was not about the product.
(17:22):
The product hasn't been changed where of course working on Copilot,
but product has been performing incredibly. It's extremely reliable, you know,
surgeons like it's very sticky, right, but it was more
about understanding how surgeons were using it initially, what it
(17:42):
took to train them, what type of indications they were
using it for, how they were expanding from these indications.
It was about understanding what is the sweet spot in
terms of number of surgeons per program, how many systems
do they need, how can they share systems, when do
you get in to scheduling conflicts. It was about understanding
(18:03):
how administrators model the impact of the system and a
return on investment model, which is critical for our sales process.
And then, last, but not least, and probably the most
unanticipated outcome, I would say it was about understanding the
exact sales profiles that we need based on how exactly
(18:26):
we want to structure the sales process and what those
interactions are and so over the limited market release we've treated,
I think today I don't have the latest numbers, but
greater than seventeen hundred patients, which means that the system
has been used extensively. Right, we have enough diversity and surgeons,
(18:46):
indications and sites to be very confident about the product's
performance and how surgeons like to use it on a
regular BA And we've had now a number of discussions
with administrators to understand how to leverage that data into
(19:08):
and turn it into dollars.
Speaker 1 (19:09):
Yes, publicly, number I saw was eleven hundred patients and
that was in your March twenty twenty five press release.
So there is you know, that's a good incremental six
hundred patients being done over the last six months or so.
What's kind of the biggest or you know, with the
design feature itself, how have physicians transitioned from having used
(19:33):
the joysticks for a traditional robotic system with your more
hands on approach.
Speaker 2 (19:38):
It's it's a great question, and it was really one
of our questions going into this limited market releases. You know,
are are we speaking to the Vinci surgeons, Are we
speaking to latprosk py surgeons? Are we speaking to both?
And how do we speak to these different audiences in
a way? Right? And so when you speak to surgeons
who have aparience with surgical robots, you know, the first
(20:02):
thing we tell them is, hey, what do you use
it for? What do you miss when you don't have it? Right?
And what they miss when they don't have it is
typically image control and stability. That's like a big thing, right.
They can't go back to traditional surgery once they've experienced that,
and they like force, they increased control, they like the autonomy,
(20:24):
and of course they leverage the futuring abilities, but only
for select indications. There's a lot of clinical procedures where
you staple more than your future right, right, and more
and more because staplers have become incredibly good. And so
when you start telling them, okay, are there clinical procedures
(20:45):
where you might debate whether you do this procedure laproscopically
or robotically? And you know, what are the questions that
you ask yourself? Then? Is it accessibility? Is it cost?
Is it speed? What are we trying to solve here?
You kind of find that space where it's not black
(21:07):
and white, right, and as that gray space that we
want to get into. And you know, some surgeons will
tell you, look, I don't know how to do lapros
copy anymore. They're gone, and you know that's too bad.
But I would say most of them don't say that,
especially when you go in the lower acuity settings where
penetration of other platforms being limited.
Speaker 1 (21:30):
Yeah, we'll jump back into those positions who've lost that
labority skills. But when you talk about low acuity cases.
Which cases are you referring to?
Speaker 2 (21:39):
So I'm referring to the really the bread and butter
of surgery, right. The vast majority surgeries are what's called
benign cases. And this is great and yes, means that
the vast majority of surgeries are done on people who
are not that sick, right, And it's about gold ladder removal,
(22:00):
it's about hernia repair, it's about bariatric surgery of course,
which you know took a hit, but it's recovering to
some degree. And so non cancer surgery especially, and these
are done primarily in regional or community hospitals, small to
mid sized IDNs, and ambulatory surgery centers, and so this
(22:25):
is really what we're targeting. You know, in our seventeen
hundred or eighteen hundred procedures to date, seventy five percent
would be gold adder removal, so colysostectomies, hernia repairs, and
bariatric surgery. The rest is scattered over you know, tens
and tens actually more than sixty type of procedures, and
(22:48):
it would be whatever the surgeons had on schedule those days.
But the reality is that these surgeons that were targeting,
they do mostly these bread and butter procedures.
Speaker 1 (22:58):
Yeah, and so then the physicians who have forgotten laparoscopic surgery,
is this something where the maestro can help them get
that skill back, or are you not focusing on them
and you're focusing more on those who are still doing
laparoscopic but you're saying this is an easier way to
do it or both.
Speaker 2 (23:17):
So initially, when we start a program, we're focusing on
people who are still doing laparoscpic surgery. Typically they would
be doing both, right, but they still have you know,
a fair number of cases done laparoscopically. And then when
we expand the programs, we will go to occasionally surgeons
who who have not done laproscypede in a long time.
(23:39):
You're right in the sense that we might help them basically,
you know, with that practice because it's a lot less annoying,
it's a lot more efficient, right, And again it's about
asking them that question what you miss when you don't
have your typical robots and telling them, hey, we can
(24:00):
delivered that right for the most part, in a way
that is a lot more accessible, a lot easier to implement,
So you know, why not give it a try?
Speaker 1 (24:08):
Yeah, And so you know you're going through this initial
limited launch. Have you guys provided a timeline of when
you think you will go expand beyond that limited launch, So.
Speaker 2 (24:20):
We allowed ourselves a year for the limited launch, right,
so you know is done and what we're doing right
now are essentially the adjustments from what we've learned, which
is essentially building a salesforce, yes, and refining our messaging,
adjusting our commercial offers to the feedback we've received and
(24:44):
how people typically model the benefits ahead of going broader,
which will happen by the end of the year.
Speaker 1 (24:50):
By the end of the year, okay, And so you know,
one of the things also about the salesforce and the
commercial model talking about yeah, intuitive again because their business
model is both the robots and the tools. But you
and Moon Surgical, you talk about you know, off the
shelf instruments, so it seems like very agnostic with the instruments.
So how is the business model for the robot itself?
(25:13):
And then you know, adding on to the second part
of that question, is there a long term strategy to
have your own Moon Surgical instruments?
Speaker 2 (25:21):
So I answered the second question first, So there's no
long term strategy. Have our own instruments. It's not an
easy thing to building surgical instruments. You cover you know,
many companies in that area. You know that a number
of you know, players in our field have been plagued
or limited by their instrument portfolio in terms of breadth,
(25:41):
in terms of ability and capabilities, et cetera. So it
is it is actually quite a challenging activity to be
to be developing instruments. The laproscopy instruments on there are
great and insurgents love them so so in terms of
the business model and how we approach the market hit,
our preference has been to sell the system as a service.
(26:08):
You're essentially providing a surgical assistance service and this can
be monetized in a number of different ways, right, And
what we're fining, especially in the US market, is that
you need to provide that flexibility. Typically, we've gotten feedback
on the fact that providers, especially in this lower acuity segment,
(26:30):
don't have a lot of access to capital dollars. I mean,
they like the fact that it's positioned as a service.
They like the fact that they pay based on how
much they use it. They like the fact that it's
predictable to some degree. It's capped depending on the offers,
(26:51):
and so we have a variety of offers depending on
you know, basically what their constraints are. And so it
can be a pure per click, it can be a
rental and then an additional per click. But but generally
what it means is you don't need to be selling
something for each procedure, right You're you're selling again a capability.
Speaker 1 (27:17):
Yeah, that's kind of per click. It's interesting. Yeah, as
for a robotic system, because yeah, the pay as you
go type model. Yeah, and so that sounds like the
next steps. You also have highlighted something called Maestro Insights.
So what is that and how will that add to
the overall ecosystem of surgical One of.
Speaker 2 (27:39):
The great opportunities we have is, you know, our platform
has been developed in the last four years, right, so
it's digitally native in the sense that from the get
go we could put inside the system a lot of
capabilities in terms of two things, in terms of sensing
and in terms of computing. Right. So in terms of sensing,
(28:01):
we have depth cameras at the top and bottom of
the front of the system, which informs us on what's
going on in the room. Essentially we have of course
the lap ross you as an input. The arms themselves
are high resolution force sensors, so we know everything about
efforts applied on the instruments by the surgeon. And then
(28:24):
we have a microphone just you know, listen into the
R And then in terms of computing, we've been working
with Nvidia for a number of years now, and so
we integrated a medical grade GPU in our commercial product,
you know, a couple of years ago, and that's cured
by the FTA. So what it means is, you know,
(28:45):
we've we've really created and equipped the operating room with
that data hub and and we occupy that great you
know location in the R right just next to the patient,
next to surgeon at the bedside. And so what we
can do with that is start leveraging key what we
(29:07):
learn right, which is, okay, how do we perfect the
setup based on the surgeon's preferences, did the surgeons forget
anything or the staff on the in the tray or
on the table before they they're getting started, How long
is this procedure gonna last? And based on how it's
(29:27):
going right, and when should we be prepping the next patient,
getting them down, notifying anesthesia et cetera. When is that
surgeon doing a better job, you know, based on the
steps of the surgery helping them manage their inventory. We
can see everything that is being used in the r
(29:49):
and in the abdomen, right, so we can help them
with that as well, helping them manage their staff. You know,
we know that some surgeons are able to not have
an assistant in the room for certain types of procedures
using our system, so we can help them dynamically deploy
their staff and the way that is optimized. So this
is what my astral Insights is about. It's really about
(30:10):
leveraging this unique data set and turning it into more
workflow efficiencies.
Speaker 1 (30:19):
And so then what is the timeline for that potentially
reaching the market.
Speaker 2 (30:23):
So my istro Insights is functional, it's being deployed in
pilots starting now in August and you by the end
of the year. And it is a platform we're going
to add to you know, and the capabilities are infinite, right.
So we're starting with you know, a version that is
(30:47):
free right, which is basically tracking usage, right, providing data
on usage. We used to send monthly PDFs and this
is basically live with the connectivity so it's real time. Uh,
it's you know, remotely accessible force urgeons and staff and administration.
(31:07):
But we're going to add to it as we go
and some of the features will be behind a paywall
and others will be accessible to everyone.
Speaker 1 (31:15):
Interesting. Yeah, and then the other thing too that I
was thinking about as well, as you're talking about the
algorithm for the actual Maestro system itself, and you're talking
about updating those algorithms from time to time. Now, is
this those algorithms need to be FDA approved before the
next generation comes out or is that something that can
be done internally kind of almost real time?
Speaker 2 (31:36):
So Maestro Insights, I mean the beauty behind behind my
istral in size is that it's not essentially not regulated.
So I mean some of the features might be, but
for the vast majority, it's not. So that's that's an
easy one, right. You can deploy and update things whenever
we want to. On on the FDA side, so we
(31:57):
have co Pilot which can be updated based on this
cured PCCP. I mean, it's still it's a framework, right,
So there's a cadence. There's a number of triggers that
allow you to update it, and then you need to,
of course, make sure that you meet a certain you know,
performance criteria before deploying it. But we can do that
(32:19):
without going back to the agency. If we develop similar
types of AI algorithm, it's the same thing the first time.
They'll have to be approved by the day and evolutions
can be managed more autonomously.
Speaker 1 (32:33):
Yeah, because it's interesting, because I mean there's so many
iterations and updates that could be done with these algorithms
in real time almost that it's post prohibitive to kind
of have to keep going back to the FDA with
every single change in the algorithm too. But at the
same time, you want to make sure that you don't
want that original algorithm to kind of go veer off
course because of all these little tweaks over the long run.
Speaker 2 (32:56):
Yeah. Absolutely, I mean, especially if you're thinking about the
locations of physical AI, which is what we're doing, which
is using AI to move something physically into the operating room, right,
I mean, that's it's it's not just using AI to
read an image or something, it's actually doing something inside
a surgery. Right. So in our case, we are fortunate
(33:20):
that the surgeon is always next to the system at
the bedside. The surgeon can always override and you have
our algorithms by just grabbing the instrument and moving it manually.
But you know, on a broader scale, the risks can
be can be a lot more important.
Speaker 1 (33:37):
Yeah, and so yeah, so I've got a lot of
these developments going on over the next several years. Yeah,
when you put your CEO head on and you got
to think about a path to profitability, how are you
balancing those investments with you know, turned cost savings to
be able to get to that path, Because especially now
(34:00):
with you know, small cap, publicly traded med tech companies,
profitability is a huge you know, is gained a lot
of attention from investors. So how do you balance that
over the long run.
Speaker 2 (34:12):
It's a great question, and you're right, profitability is kind of,
you know, a question that is being asked or has
been for the last two to three years, right, Nobody
cared before that, but and it is really related to
your ability to you know, raise more money in case
you fall short, right, right, yeah, which which has been
very very challenging, and so I think so we were
(34:35):
focused on initially for a few years on building the platform, right,
which was mostly hardware, and going forward, our roadmap is
very largely digital, right, so, which means different resources, different
ways of developing things. It means also more of a
business development mindset than a pure R and D internally
developed mindset, because a lot of these bricks can be
(34:58):
developed by others and you know, either in license or
acquired or you know, developed or deployed in some sort
of partnership, which is a great opportunity. We don't want
to reinvent everything. And in terms of profitability, I think
our focus is about growing the program right if you
think about it, for these bread and butter procedures, if
(35:20):
you start using our platform in a room, there's no
reason why you wouldn't have it in the other rooms
where they're doing the same thing. Right. So it's about
really horizontally and vertically growing these programs by having multiple
systems in these hospitals or ass which is our way
(35:42):
of more instruments if you way, if you will, and
the reason why we also have clinical account managers right
with the goal of growing these programs to a point
where you do run into scheduling conflicts and you need
multiple systems, right, and then upselling with the digital capability.
Speaker 1 (36:00):
Yeah, and I think you're starting to see that more
and more, just with you know, hospitals having two, three,
even four robotic systems because you know, they're just the
capacity is just reaching its max. And we talk a
lot about just you know, the initial adoption of robotic surgery.
How do you see this all playing out in five
to ten years, especially with you know, robotic systems that
(36:24):
we're talking about having such different you know features and
you know, targets and all those other factors. Is this
a potentially a rising tide lifts all boats moment as
more and more procedures become capable of being done robotically.
Speaker 2 (36:42):
I like this. I think we absolutely believe that the
future is robotic and digital, right and that minimalia days
of surgery is shifting to new But we also believe
that it's going to be a continuum of offerings right
in the old world, if you will. You know, there
(37:03):
was just kind of a dual proposal, right, I mean,
there was nothing in between. But but in a way,
there's going to be a spectrum of solutions evolving laproscopy
to the full fledge sophisticated toe robotic systems, which are
absolutely needed in certain clinical procedures, but not in all
(37:25):
of them.
Speaker 1 (37:26):
Yeah, And I think it's you know, it always comes
back to me. It's just the fact that you're able
to with the Maestro system, be able to do everything manually.
So if something does happen, you have that kind of
escape Yeah, yeah, button right there to kind of go
and kind of do it manually and everything.
Speaker 2 (37:41):
It's basically instant conversion if you needed Yeah.
Speaker 1 (37:46):
Yeah. And so you know, perhaps will close out the episode,
and you know, you start it off by saying, you're
a mother of four, is the advice that you would
give your kids just going through your career path and
everything about you know, what is the best thing, especially
now also with Ai. You always hearing the horror stories
of how AI is going to just take every single
(38:07):
job in the world. But what are you, from your
perspective and your experience with that, what are you telling
your kids about their career paths or as an advice
to them.
Speaker 2 (38:18):
It's you know, it's a constant question, right, even with
you know, friends and other parents and kids. But I think, well, first,
I mean I let them do what they want, right,
So I mean they take advice only to some degree.
But I think it's it is about leveraging that as
a source. Right. It's not about you know, becoming leasy
(38:41):
or anything. And it's about using the tools that you
have at your disposals to you things that you know
you're not necessarily good at or not necessarily interested in,
but freeing up some bandwidth or time to do other things, right, uh,
and just expanding your horizon. I think one of the
(39:03):
things I'm amazed off with with my kids is how
much more exposed they are to the world then I
was as a child. And you know, I was very
fortunate to grow in multiple countries and be very exposed.
But what they have, you know, at their fingertips is
(39:23):
so much broader, right, And so just keeping a curious,
open mindset, trying things, shalling them if it doesn't work,
looking for what's right for you, but but always you know,
seeking you know, basically to broaden your horizon and make
your you know, kind of daily life richer in a way.
Speaker 1 (39:45):
Yeah, I mean I see that with my two kids too,
and just the fact that they always want to keep
learning and stuff like that, just you know, just I
want them to keep that that that motivation to keep
learning and trying to expand their horizons.
Speaker 2 (39:57):
And they tell us a lot. Yeah, because because they'll
find tools and things and hear about things that you know,
we might not have scenes, which I find very interesting.
Speaker 1 (40:08):
Yeah, it's fascinating to watch them grow up. And thank
you so much for joining us. To appreciate you coming in.
Speaker 2 (40:14):
Thank you it was a pleasure.
Speaker 1 (40:15):
Yes, and thank you to our listeners for tuning in today.
We hope you join us for future episodes, and if
you'd like to stay up to date, you can click
the subscribe button on Spotify or your favorite streaming platform.
Speaker 2 (40:26):
Take care
Speaker 1 (41:03):
Us
Welcome to another episode of the Vanguards of Healthcare series.
My name is Matt Hendrickson, the medical technology analyst at
Bloomberg Intelligence, which is the in house equity research platform
of Bloomberg LP. We're pleased to have with us today
and Ostuwitt, CEO of Moon Surgical, a privately held medical
device company that is expanding surgical robotics with its Maestro system,
(00:39):
And thank you for joining us today.
Speaker 2 (00:41):
Thanks Matt, it's great to be here.
Speaker 1 (00:43):
It is likewise and so and why don't we just
start off with a quick overview of your career path
and the steps that led you to being the CEO
of Moon Surgical with pleasure.
Speaker 2 (00:53):
So I'm forty four years old. I am a mother
of four children, based in Paris, and I've worked in
medical devices for my entire career. I wanted to be
a medical doctor as a kid, and for a variety
of reasons, ended up not pursuing that. You know, when
you study in Paris, there's a high chance that you're
(01:14):
going to be living with your parents if you were
born and raised in Paris, which was my case, and
the perspective of you know, staying for another ten to
twelve years at my parents' apartment while doing med school
was a little daunting, I have to say, so I
just decided to work in the medical industry, but taking
(01:34):
another path right which was by medical engineering, and studied
both in France and in the US, and after that
always wanted to be back and based in Europe. But
have you know, an international exposure in the medical space,
and that's what I've done for the last you know.
Speaker 1 (01:52):
And so Ben then that leads up to Moon Surgical
and maybe before we dive deeper into the robotics, based
just what a quick overview of the mic system is
and what it can do.
Speaker 2 (02:02):
So the mastro system is a platform that is used
in soft tissue surgeries, minimally invasive soft shoe surgery specifically,
so things that would be abdominal surgery, thoracic surgery, urologic surgery,
GYN surgery, and interventions that are typically done through a
keyhole you know approach. So really trying to leverage this
(02:26):
practice which has become the standard of care over the
last four years, and turning it into something that can
be robotically controlled and made digital, basically integrating a data
component into that, but really delivering a platform that elevates
the way surgery is done today, rather than completely changing
it and shifting it to another paradigm.
Speaker 1 (02:49):
Yeah, and you know you're talking about just minimally invasive
robotic soft tissue surgery. A lot has been developed over
the last and even twenty years in the robotic space.
What is your view of just the current landscape of
robotic surgery. What have been some of the key developments
that have taken place. What are some of the things
that you're seeing that you know or you know loopholes
(03:13):
or you know, gaps that could be filled.
Speaker 2 (03:15):
So that's a great question. You know, I think it
has been a very exciting field, right, I mean, you're
an analyst, you cover these things. You know how much
citement there has been for robotic surgery, and it is
gradually becoming the new standard of care, right one one
way or another. I think in our field, which is
soft to shoe minimillion vasive surgery, there is of course
(03:37):
a very dominant player, which you know is Intuitive Surgical
and they have the immense credit of pioneering the field
with an amazing product which they have been deploying for
the last twenty twenty years and has been an immense success,
right and this is of course a proxy in an
(03:59):
example everybody he looks to it. It has been deployed
to this date in procedures that were originally complex procedures
where you needed that risted capability for fine futuring abilities
right then. And of course from that it has expanded
to lower acuity indications. And so what we've seen in
(04:22):
the last ten years is, you know, basically a basket
a series of followers trying to emulate what Intuitive Surgery
has done in multiple ways, with different nuances, different you know, specificities,
trying to develop products that might be more accessible, that
(04:45):
might be easier to set up. I mean, there's a
number of different variants if you will, of what the
DaVinci platform from Intuitive Surgical represents. But but in a
way they've all been following this principle behind what a
surgical robot is supposed to be, which is that it's
(05:07):
a closed system and it puts the surgeon behind a console.
Speaker 1 (05:11):
Y it's almost looks like a video game exactly.
Speaker 2 (05:15):
So it's a closed system, meaning that you're using surgical
instruments that are provided together with the surgical robot and
our proprietary which means that the surgeon has to let
go from you know, their laparoscopic habits and preferences, and
specifically when it comes to surgical instrumentation, they can be
(05:35):
fairly picky, but they like to use. And then the
second thing is, as you said, it puts a surgeon
behind a console and they are then you know, operating
by manipulating sophisticated joysticks essentially which completely change the gesture
and and really reinvents the way surgery is done. And
so we say we're not a robot in a sense
because we don't meet those two createria. Yeah, we're not
(05:57):
a closed system. We're compatible with any type of surgical
instrumentation out there, and we don't put the surgeon behind
a console. We keep the surgeon at the bedside, operating,
you know, as they would operate in a laparoscopic environment
with their surgical technique and operative setup and room workflow
as they typically do. But we elevate that too.
Speaker 1 (06:18):
Yeah, it's interesting because this is not the first time
I've heard about mimicking a laparoscopic approach. For the listeners
who are kind of newer to the story, what is
exactly the labar topic procedure kind of you know, beyond
just being simply a minimally invasive procedure.
Speaker 2 (06:34):
So the minimally invasive surgical approach aims at basically improving
recovery right for patients. So it is about threading these
long and thin instruments inside the abdomen through these tiny
incisions and then basically replicating what you would do in
(06:54):
an open surgery through these tiny instruments in a way
that is in a way blind to the surgeon. Right
you're inside the abdomen, so you do need the support
of a camera to see what's going on inside the belly.
You do need the support of someone exposing the tissue
for you, retracting tissue on the side throughout the surgery
(07:17):
so that the surgeon can access what is relevant at
any time with the surgery. And these are functions that
appeared in the operating room with mini million invasive surgery.
Right before mini million invasive surgery, the surgeon could just
see and they could just access what they needed to access.
But minimillion invasive surgery drove the distribution of roles and
(07:41):
responsibility in the r and the creation of these new
functions which are you know, managing the vision for the
surgeon and managing the ability to access tissue. And so
this is what we're covering with our platform, really equipping
the surgeon at the bedside with an extra pair of
hands and the ability to control these two instruments, the
(08:01):
scope and the retractor.
Speaker 1 (08:03):
Yeah. Yeah, and this, you know, now we can dive
into a little bit into the Maestros system. And you know,
one of the quotes I heard or you know, you
had in a press release it was three instruments with
just two hands, And I think this is what you're
you're getting at here with you talking about, you know,
being able to use the tools and the imaging and everything.
(08:23):
Do you just dive a little deeper into how you
can be able to do three instruments with two hands
at one time type thing?
Speaker 2 (08:29):
Yeah, with absolutely So, as I said, we're equipping the
surgeon with basically the ability to control two additional instruments.
These two instruments would be held by our Maescra platform
which has two arms, and so basically we're you know,
turning the surgeon into a four armed surgeon and they
can very easily switch between these four instruments which are
(08:54):
used in these in these surgeries. And you know a
four instruments surgery will cover the vast man TOF tissue surgery.
So the two of these instruments are held by our arms.
When the surgeon grabs one of these instruments, the arms
will automatically unlock. They will offer no mak asistance. The
surgeon is a really move them as they would if
(09:16):
the instrument was not by an arm, and then as
soon as the surgeon needs to let go because they
need to maneuver another instrument, the arm will understand that
and hold the instrument's table in the desired position. So
you can just very easily go from one instrument to
the other with the support and the stability that you
would expect from a human and probably a better one, right,
(09:39):
because it is perfectly reliable.
Speaker 1 (09:41):
Well yeah, because anytime I think you know of a surgeon,
you talk about the steadiness of a surgeon's hand, ye,
but it's still not as steady as a rigid arm.
Speaker 2 (09:50):
Absolutely, And if you think about surgical assistance, which is
the ability to manage you know, the vision and the
exposure and access for the surgeon, it's even worse. Right,
it's inherently flawed. You know, you have someone who is
standing next to the surgeon or across the r table
and trying to anticipate what the surgeon wants to see
(10:12):
or access at any given moment in the procedure, which
is a very difficult task, especially when you have to
hold things stable for minutes or out. Yeah.
Speaker 1 (10:20):
And then so with the arms, which is very interesting.
When you wants to grasp it, it becomes loose and
you can move it anywhere you want, and then when
you let go, it becomes rigid. When I'm thinking of
like a traditional you know, Da Vinci robot and it
the arm moves automatically and everything. Does the microsystem allow
for that optionality as well? Or is this is this
the differentiating feature where it creates this kind of new
(10:43):
platform of how you can do robotic surgery.
Speaker 2 (10:45):
So that's a great question. This feature of moving the
arm in a way from a distance, right, manipulating the
arm exists in our case. For setup, you would typically
define your default setup poses for the system, which are
based on the surgeon references and which chinical indication which
and when you start a procedure you would say, hey,
(11:06):
it's doctor Smith doing a sectomy, and then the system
would automatically set up and you don't have to move
to do that, they'll move by themselves. But during the procedure,
we we like to have everything on there the control
of the surgeon, with the exception of the SCO pilot feature.
Speaker 1 (11:24):
Okay, okay, And you know this is a great sequeing
to the scope pilot feature because that got recently FDA approved.
What what is sco pilot for the listeners and you
know what jumping ahead here, what with its AI capabilities
allows it to do things that other robots can't do
(11:45):
at this point.
Speaker 2 (11:46):
So in the typical surgery, as I mentioned that the
surgeon would rely on the scope to see what's happening
inside the abdomen, right, so they would typically need that
scope to be repositioned constantly throughout the procedure to make
sure that they have their instruments in the right view,
(12:08):
which means of course they need their instruments in the
field of view, and then they need the appropriate level
of zoom to do whatever they need to do, which
can be navigated, which can be future, which can be
clip stable, etc. And you can imagine that every surgeon
has a different way of manage that scope during the procedure.
(12:28):
Some surgeons like it close, some surgeons like it from
further out. Some surgeons like to move it a lot.
Some surgeons are comfortable when you know, it's a lot
more stable. And this is something that the surgical assistant
has to adapt to. Right, As we said, they're supposed
to anticipate what the surgeon wants to see, and they're
(12:48):
supposed to adjust to what this specific surgeon's preferences might
be in terms of how they like their vision managed.
But all of this and be bought or learned by AI, right,
I mean, it is complex to some degree, but it
is something that you can process in a computer and
(13:10):
render in real time. So what we've done is we
have essentially servoyed the scope to the tip of the
surgeon's instruments, the tips of the instrument that they are
holding manually, and we are controlling the position of the
scope to make sure that these instruments will remain in
the field of you at the desired distance from the camera,
(13:34):
learning from how that specific surgeon has been operating over
you know, a number of procedures.
Speaker 1 (13:40):
And this sounds kind of like we were just talking
about a few minutes ago, where you would have the
assistant on the surgery floor trying to anticipate where the
surgeon wants to go with, you know. And the thing
about AI is that it can be able to, you know,
accumulate much much more data points than a human can,
and be able from that information be able to then
be able to anticipate it potentially better than what a
(14:02):
human cut.
Speaker 2 (14:03):
Absolutely and if you think about some of the implications
of that, it means that we can tell a surgeon
when they're doing better, you know, based on how their
scope is positioned. We can also train a younger surgeon
to operate like a more experienced surgeon. There is this
thing in minim million vasive surgery where naive surgeons or
(14:26):
less experienced surgeons tend to zoom in a lot, right,
because they need to be closed to feel they're in control.
But as you get more experienced, you typically zoom out
to have a broader field of you and a better
sense of safety from that broader control, you know. Scoopilot
is also a safety feature in the sense that the
(14:47):
greatest risks in soft issue surgery occur when your instruments
are not in the field of you anymore, which makes sense, right,
I mean, that's when you might be cutting things without
even noticing. That is something that we help with driving
surgeons to use best practices in scope management and vision.
(15:07):
It's something that we can do with that feature.
Speaker 1 (15:09):
Yeah, and so you know, this is actually kind of
scopilot being FDA approved. You've received FDA approval for the
microsystem overall about what about.
Speaker 2 (15:18):
A year ago.
Speaker 1 (15:19):
Now, how has that launch been over the last twelve months?
And mainly let's maybe say the first part of it
pre scope pilot and then post scope pilot.
Speaker 2 (15:29):
Yeah, so SCOO pilot has not yet been deployed in
the US right, It's coming in the next few weeks.
Right before we deployed it, we were waiting for an
additional clearance from the FDA, which we got in June,
which covers two things. One of them is what's called
a PCCP predetermined Change Control Plan, which is the ability
(15:52):
to evolve an AI algorithm basically PERFECTICS performance without having
to go back to the agency mark that the FDA
has put in place specifically for AI algorithms initially to
do that. And so it enables us to add training
data sets, to add instrument classes to make sure that
(16:12):
we're able to recognize more instruments for more brands with
more diversity, and so we wanted this to be cleared
by the FDA before deploying's Copilot because we wanted the
ability to leverage the data that's coming from those sites
for that additional training and increase performance. And the second
thing that was in that latest clearance was what we
(16:35):
call enhance connectivity, which is the ability for our systems
to be connected through five G and or Wi Fi,
which is also a way for us to push updated
versions of the algorithm right, an enabler, if you will,
of further iterations of scopilots. So we're about to deploy
scoopilots in the next few weeks. It has been used
(16:58):
in Europe in routine fashion. So for the last twelve months,
what we were doing was a limited market release. Limited
in the sense that we deployed twelve systems between Europe
and the US, each geography, and we studied how those
systems were used and adopted. It was not about the product.
(17:22):
The product hasn't been changed where of course working on Copilot,
but product has been performing incredibly. It's extremely reliable, you know,
surgeons like it's very sticky, right, but it was more
about understanding how surgeons were using it initially, what it
(17:42):
took to train them, what type of indications they were
using it for, how they were expanding from these indications.
It was about understanding what is the sweet spot in
terms of number of surgeons per program, how many systems
do they need, how can they share systems, when do
you get in to scheduling conflicts. It was about understanding
(18:03):
how administrators model the impact of the system and a
return on investment model, which is critical for our sales process.
And then, last, but not least, and probably the most
unanticipated outcome, I would say it was about understanding the
exact sales profiles that we need based on how exactly
(18:26):
we want to structure the sales process and what those
interactions are and so over the limited market release we've treated,
I think today I don't have the latest numbers, but
greater than seventeen hundred patients, which means that the system
has been used extensively. Right, we have enough diversity and surgeons,
(18:46):
indications and sites to be very confident about the product's
performance and how surgeons like to use it on a
regular BA And we've had now a number of discussions
with administrators to understand how to leverage that data into
(19:08):
and turn it into dollars.
Speaker 1 (19:09):
Yes, publicly, number I saw was eleven hundred patients and
that was in your March twenty twenty five press release.
So there is you know, that's a good incremental six
hundred patients being done over the last six months or so.
What's kind of the biggest or you know, with the
design feature itself, how have physicians transitioned from having used
(19:33):
the joysticks for a traditional robotic system with your more
hands on approach.
Speaker 2 (19:38):
It's it's a great question, and it was really one
of our questions going into this limited market releases. You know,
are are we speaking to the Vinci surgeons, Are we
speaking to latprosk py surgeons? Are we speaking to both?
And how do we speak to these different audiences in
a way? Right? And so when you speak to surgeons
who have aparience with surgical robots, you know, the first
(20:02):
thing we tell them is, hey, what do you use
it for? What do you miss when you don't have it? Right?
And what they miss when they don't have it is
typically image control and stability. That's like a big thing, right.
They can't go back to traditional surgery once they've experienced that,
and they like force, they increased control, they like the autonomy,
(20:24):
and of course they leverage the futuring abilities, but only
for select indications. There's a lot of clinical procedures where
you staple more than your future right, right, and more
and more because staplers have become incredibly good. And so
when you start telling them, okay, are there clinical procedures
(20:45):
where you might debate whether you do this procedure laproscopically
or robotically? And you know, what are the questions that
you ask yourself? Then? Is it accessibility? Is it cost?
Is it speed? What are we trying to solve here?
You kind of find that space where it's not black
(21:07):
and white, right, and as that gray space that we
want to get into. And you know, some surgeons will
tell you, look, I don't know how to do lapros
copy anymore. They're gone, and you know that's too bad.
But I would say most of them don't say that,
especially when you go in the lower acuity settings where
penetration of other platforms being limited.
Speaker 1 (21:30):
Yeah, we'll jump back into those positions who've lost that
labority skills. But when you talk about low acuity cases.
Which cases are you referring to?
Speaker 2 (21:39):
So I'm referring to the really the bread and butter
of surgery, right. The vast majority surgeries are what's called
benign cases. And this is great and yes, means that
the vast majority of surgeries are done on people who
are not that sick, right, And it's about gold ladder removal,
(22:00):
it's about hernia repair, it's about bariatric surgery of course,
which you know took a hit, but it's recovering to
some degree. And so non cancer surgery especially, and these
are done primarily in regional or community hospitals, small to
mid sized IDNs, and ambulatory surgery centers, and so this
(22:25):
is really what we're targeting. You know, in our seventeen
hundred or eighteen hundred procedures to date, seventy five percent
would be gold adder removal, so colysostectomies, hernia repairs, and
bariatric surgery. The rest is scattered over you know, tens
and tens actually more than sixty type of procedures, and
(22:48):
it would be whatever the surgeons had on schedule those days.
But the reality is that these surgeons that were targeting,
they do mostly these bread and butter procedures.
Speaker 1 (22:58):
Yeah, and so then the physicians who have forgotten laparoscopic surgery,
is this something where the maestro can help them get
that skill back, or are you not focusing on them
and you're focusing more on those who are still doing
laparoscopic but you're saying this is an easier way to
do it or both.
Speaker 2 (23:17):
So initially, when we start a program, we're focusing on
people who are still doing laparoscpic surgery. Typically they would
be doing both, right, but they still have you know,
a fair number of cases done laparoscopically. And then when
we expand the programs, we will go to occasionally surgeons
who who have not done laproscypede in a long time.
(23:39):
You're right in the sense that we might help them basically,
you know, with that practice because it's a lot less annoying,
it's a lot more efficient, right, And again it's about
asking them that question what you miss when you don't
have your typical robots and telling them, hey, we can
(24:00):
delivered that right for the most part, in a way
that is a lot more accessible, a lot easier to implement,
So you know, why not give it a try?
Speaker 1 (24:08):
Yeah, And so you know you're going through this initial
limited launch. Have you guys provided a timeline of when
you think you will go expand beyond that limited launch, So.
Speaker 2 (24:20):
We allowed ourselves a year for the limited launch, right,
so you know is done and what we're doing right
now are essentially the adjustments from what we've learned, which
is essentially building a salesforce, yes, and refining our messaging,
adjusting our commercial offers to the feedback we've received and
(24:44):
how people typically model the benefits ahead of going broader,
which will happen by the end of the year.
Speaker 1 (24:50):
By the end of the year, okay, And so you know,
one of the things also about the salesforce and the
commercial model talking about yeah, intuitive again because their business
model is both the robots and the tools. But you
and Moon Surgical, you talk about you know, off the
shelf instruments, so it seems like very agnostic with the instruments.
So how is the business model for the robot itself?
(25:13):
And then you know, adding on to the second part
of that question, is there a long term strategy to
have your own Moon Surgical instruments?
Speaker 2 (25:21):
So I answered the second question first, So there's no
long term strategy. Have our own instruments. It's not an
easy thing to building surgical instruments. You cover you know,
many companies in that area. You know that a number
of you know, players in our field have been plagued
or limited by their instrument portfolio in terms of breadth,
(25:41):
in terms of ability and capabilities, et cetera. So it
is it is actually quite a challenging activity to be
to be developing instruments. The laproscopy instruments on there are
great and insurgents love them so so in terms of
the business model and how we approach the market hit,
our preference has been to sell the system as a service.
(26:08):
You're essentially providing a surgical assistance service and this can
be monetized in a number of different ways, right, And
what we're fining, especially in the US market, is that
you need to provide that flexibility. Typically, we've gotten feedback
on the fact that providers, especially in this lower acuity segment,
(26:30):
don't have a lot of access to capital dollars. I mean,
they like the fact that it's positioned as a service.
They like the fact that they pay based on how
much they use it. They like the fact that it's
predictable to some degree. It's capped depending on the offers,
(26:51):
and so we have a variety of offers depending on
you know, basically what their constraints are. And so it
can be a pure per click, it can be a
rental and then an additional per click. But but generally
what it means is you don't need to be selling
something for each procedure, right You're you're selling again a capability.
Speaker 1 (27:17):
Yeah, that's kind of per click. It's interesting. Yeah, as
for a robotic system, because yeah, the pay as you
go type model. Yeah, and so that sounds like the
next steps. You also have highlighted something called Maestro Insights.
So what is that and how will that add to
the overall ecosystem of surgical One of.
Speaker 2 (27:39):
The great opportunities we have is, you know, our platform
has been developed in the last four years, right, so
it's digitally native in the sense that from the get
go we could put inside the system a lot of
capabilities in terms of two things, in terms of sensing
and in terms of computing. Right. So in terms of sensing,
(28:01):
we have depth cameras at the top and bottom of
the front of the system, which informs us on what's
going on in the room. Essentially we have of course
the lap ross you as an input. The arms themselves
are high resolution force sensors, so we know everything about
efforts applied on the instruments by the surgeon. And then
(28:24):
we have a microphone just you know, listen into the
R And then in terms of computing, we've been working
with Nvidia for a number of years now, and so
we integrated a medical grade GPU in our commercial product,
you know, a couple of years ago, and that's cured
by the FTA. So what it means is, you know,
(28:45):
we've we've really created and equipped the operating room with
that data hub and and we occupy that great you
know location in the R right just next to the patient,
next to surgeon at the bedside. And so what we
can do with that is start leveraging key what we
(29:07):
learn right, which is, okay, how do we perfect the
setup based on the surgeon's preferences, did the surgeons forget
anything or the staff on the in the tray or
on the table before they they're getting started, How long
is this procedure gonna last? And based on how it's
(29:27):
going right, and when should we be prepping the next patient,
getting them down, notifying anesthesia et cetera. When is that
surgeon doing a better job, you know, based on the
steps of the surgery helping them manage their inventory. We
can see everything that is being used in the r
(29:49):
and in the abdomen, right, so we can help them
with that as well, helping them manage their staff. You know,
we know that some surgeons are able to not have
an assistant in the room for certain types of procedures
using our system, so we can help them dynamically deploy
their staff and the way that is optimized. So this
is what my astral Insights is about. It's really about
(30:10):
leveraging this unique data set and turning it into more
workflow efficiencies.
Speaker 1 (30:19):
And so then what is the timeline for that potentially
reaching the market.
Speaker 2 (30:23):
So my istro Insights is functional, it's being deployed in
pilots starting now in August and you by the end
of the year. And it is a platform we're going
to add to you know, and the capabilities are infinite, right.
So we're starting with you know, a version that is
(30:47):
free right, which is basically tracking usage, right, providing data
on usage. We used to send monthly PDFs and this
is basically live with the connectivity so it's real time. Uh,
it's you know, remotely accessible force urgeons and staff and administration.
(31:07):
But we're going to add to it as we go
and some of the features will be behind a paywall
and others will be accessible to everyone.
Speaker 1 (31:15):
Interesting. Yeah, and then the other thing too that I
was thinking about as well, as you're talking about the
algorithm for the actual Maestro system itself, and you're talking
about updating those algorithms from time to time. Now, is
this those algorithms need to be FDA approved before the
next generation comes out or is that something that can
be done internally kind of almost real time?
Speaker 2 (31:36):
So Maestro Insights, I mean the beauty behind behind my
istral in size is that it's not essentially not regulated.
So I mean some of the features might be, but
for the vast majority, it's not. So that's that's an
easy one, right. You can deploy and update things whenever
we want to. On on the FDA side, so we
(31:57):
have co Pilot which can be updated based on this
cured PCCP. I mean, it's still it's a framework, right,
So there's a cadence. There's a number of triggers that
allow you to update it, and then you need to,
of course, make sure that you meet a certain you know,
performance criteria before deploying it. But we can do that
(32:19):
without going back to the agency. If we develop similar
types of AI algorithm, it's the same thing the first time.
They'll have to be approved by the day and evolutions
can be managed more autonomously.
Speaker 1 (32:33):
Yeah, because it's interesting, because I mean there's so many
iterations and updates that could be done with these algorithms
in real time almost that it's post prohibitive to kind
of have to keep going back to the FDA with
every single change in the algorithm too. But at the
same time, you want to make sure that you don't
want that original algorithm to kind of go veer off
course because of all these little tweaks over the long run.
Speaker 2 (32:56):
Yeah. Absolutely, I mean, especially if you're thinking about the
locations of physical AI, which is what we're doing, which
is using AI to move something physically into the operating room, right,
I mean, that's it's it's not just using AI to
read an image or something, it's actually doing something inside
a surgery. Right. So in our case, we are fortunate
(33:20):
that the surgeon is always next to the system at
the bedside. The surgeon can always override and you have
our algorithms by just grabbing the instrument and moving it manually.
But you know, on a broader scale, the risks can
be can be a lot more important.
Speaker 1 (33:37):
Yeah, and so yeah, so I've got a lot of
these developments going on over the next several years. Yeah,
when you put your CEO head on and you got
to think about a path to profitability, how are you
balancing those investments with you know, turned cost savings to
be able to get to that path, Because especially now
(34:00):
with you know, small cap, publicly traded med tech companies,
profitability is a huge you know, is gained a lot
of attention from investors. So how do you balance that
over the long run.
Speaker 2 (34:12):
It's a great question, and you're right, profitability is kind of,
you know, a question that is being asked or has
been for the last two to three years, right, Nobody
cared before that, but and it is really related to
your ability to you know, raise more money in case
you fall short, right, right, yeah, which which has been
very very challenging, and so I think so we were
(34:35):
focused on initially for a few years on building the platform, right,
which was mostly hardware, and going forward, our roadmap is
very largely digital, right, so, which means different resources, different
ways of developing things. It means also more of a
business development mindset than a pure R and D internally
developed mindset, because a lot of these bricks can be
(34:58):
developed by others and you know, either in license or
acquired or you know, developed or deployed in some sort
of partnership, which is a great opportunity. We don't want
to reinvent everything. And in terms of profitability, I think
our focus is about growing the program right if you
think about it, for these bread and butter procedures, if
(35:20):
you start using our platform in a room, there's no
reason why you wouldn't have it in the other rooms
where they're doing the same thing. Right. So it's about
really horizontally and vertically growing these programs by having multiple
systems in these hospitals or ass which is our way
(35:42):
of more instruments if you way, if you will, and
the reason why we also have clinical account managers right
with the goal of growing these programs to a point
where you do run into scheduling conflicts and you need
multiple systems, right, and then upselling with the digital capability.
Speaker 1 (36:00):
Yeah, and I think you're starting to see that more
and more, just with you know, hospitals having two, three,
even four robotic systems because you know, they're just the
capacity is just reaching its max. And we talk a
lot about just you know, the initial adoption of robotic surgery.
How do you see this all playing out in five
to ten years, especially with you know, robotic systems that
(36:24):
we're talking about having such different you know features and
you know, targets and all those other factors. Is this
a potentially a rising tide lifts all boats moment as
more and more procedures become capable of being done robotically.
Speaker 2 (36:42):
I like this. I think we absolutely believe that the
future is robotic and digital, right and that minimalia days
of surgery is shifting to new But we also believe
that it's going to be a continuum of offerings right
in the old world, if you will. You know, there
(37:03):
was just kind of a dual proposal, right, I mean,
there was nothing in between. But but in a way,
there's going to be a spectrum of solutions evolving laproscopy
to the full fledge sophisticated toe robotic systems, which are
absolutely needed in certain clinical procedures, but not in all
(37:25):
of them.
Speaker 1 (37:26):
Yeah, And I think it's you know, it always comes
back to me. It's just the fact that you're able
to with the Maestro system, be able to do everything manually.
So if something does happen, you have that kind of
escape Yeah, yeah, button right there to kind of go
and kind of do it manually and everything.
Speaker 2 (37:41):
It's basically instant conversion if you needed Yeah.
Speaker 1 (37:46):
Yeah. And so you know, perhaps will close out the episode,
and you know, you start it off by saying, you're
a mother of four, is the advice that you would
give your kids just going through your career path and
everything about you know, what is the best thing, especially
now also with Ai. You always hearing the horror stories
of how AI is going to just take every single
(38:07):
job in the world. But what are you, from your
perspective and your experience with that, what are you telling
your kids about their career paths or as an advice
to them.
Speaker 2 (38:18):
It's you know, it's a constant question, right, even with
you know, friends and other parents and kids. But I think, well, first,
I mean I let them do what they want, right,
So I mean they take advice only to some degree.
But I think it's it is about leveraging that as
a source. Right. It's not about you know, becoming leasy
(38:41):
or anything. And it's about using the tools that you
have at your disposals to you things that you know
you're not necessarily good at or not necessarily interested in,
but freeing up some bandwidth or time to do other things, right, uh,
and just expanding your horizon. I think one of the
(39:03):
things I'm amazed off with with my kids is how
much more exposed they are to the world then I
was as a child. And you know, I was very
fortunate to grow in multiple countries and be very exposed.
But what they have, you know, at their fingertips is
(39:23):
so much broader, right, And so just keeping a curious,
open mindset, trying things, shalling them if it doesn't work,
looking for what's right for you, but but always you know,
seeking you know, basically to broaden your horizon and make
your you know, kind of daily life richer in a way.
Speaker 1 (39:45):
Yeah, I mean I see that with my two kids too,
and just the fact that they always want to keep
learning and stuff like that, just you know, just I
want them to keep that that that motivation to keep
learning and trying to expand their horizons.
Speaker 2 (39:57):
And they tell us a lot. Yeah, because because they'll
find tools and things and hear about things that you know,
we might not have scenes, which I find very interesting.
Speaker 1 (40:08):
Yeah, it's fascinating to watch them grow up. And thank
you so much for joining us. To appreciate you coming in.
Speaker 2 (40:14):
Thank you it was a pleasure.
Speaker 1 (40:15):
Yes, and thank you to our listeners for tuning in today.
We hope you join us for future episodes, and if
you'd like to stay up to date, you can click
the subscribe button on Spotify or your favorite streaming platform.
Speaker 2 (40:26):
Take care
Speaker 1 (41:03):
Us
Host
Jonathan Palmer
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