Ananth Ravi, MOLLI Surgical - Spotlight Interview | LSI USA ‘23

The company's technology eliminates the need for wires and radioactive seeds for tumor localization with a magnetic-based system that is precise, reliable, and easy-to-use.
Ananth Ravi
Ananth Ravi
Co-Founder, President & CEO, MOLLI Surgical


Nick Talamantes  0:14  

And thank you so much for joining me in the LSI studio today.


Ananth Ravi  0:17  

Appreciate it. Thanks for having me.


Nick Talamantes  0:18  

Tell me a little bit about the work you're doing at MOLLI Surgical,


Ananth Ravi  0:22  

I'd be very happy to. so at MOLLI, we're a medical device company that's focused on making precision surgery simpler. And our focus is really on enhancing the patient journey. And it stems from really, we, we really want to make sure, and from a clinical career, we were focused on getting dose in and effecting cure. And somewhere on the path, we forgot that a patient journey through that treatment is just as important as the treatment itself. And it was from one patient of breast cancer patient who, as part of my clinical care, I had the fortune of meeting, and she talked about her journey of having a wire placed. And for those that don't know, the kind of conventional treatment for breast conserving surgery is the patient comes in in the morning after fast and the night before they get this hook wire looks like a fishing hook placed in radiology. And then they wait for surgery and it can wait for a couple of hours. And they're in pain. They're in discomfort, this patient particular she fainted from that discomfort. And so she's telling the story. And immediately, we recognize that just getting cure and putting dose and trying to get cures, just not enough, you have to pay attention to that journey, and try to make it better and so that her MOLLI was born. So instead of a hook, why we place this tiny little permanent magnet. It's called the Mali marker. It's the size of a sesame seed, so there's no wire that protrudes from the breast. And then the surgeon uses a wand and a tablet, to find it much like the GPS finds it, the precision removes it accurately. And it gives them that confidence that whatever this detected in radiology can be removed with precision, and will result in really amazing cosmetic outcomes for the patient


Nick Talamantes  2:15  

is this device currently commercial.


Ananth Ravi  2:17  

So we are early revenue, we've had the fortune of helping around over 5000 patients actually across North America. And we are in 60 institutions throughout North America, we have various size institutions too, which is really nice, right? It's not just your big pillars and academic centers of excellence, which we have, we have centers that do over 600 cases a year. And then we have smaller regional facilities that also use MOLLI. And that's kind of nice that they do 50 to 70. But you see, we can it's it democratizes, this high quality care and this better experience for patients across the spectrum. So it's been really nice to see this kind of early growth and customer customer uptake.


Nick Talamantes  3:00  

It's safe to say that you're a disruptive technology from the status quo or current standard of care for localizing treatment in breast cancer surgery is Has there been any challenges in maybe evangelizing the product and getting surgeons to convert to adopting it who are sort of stuck in their ways, they're used to doing things a certain way, and they don't want to adopt something new, they can't be bothered.


Ananth Ravi  3:26  

So you would think that that's the case that, you know, we've been so wires have been around since the 70s. Incredible pedigree, it works. However, everybody recognizes even surgeons, they all recognize that that patient experience is lagging. And so for them, their struggle is not that they don't want to adopt the technologies, how to adopt that into a workflow that works. And there's so overburdened right now with just taking care of their patients, that they need industry, to show them the path, like lead them down the path and how this can be adopted and worked into their workflow, versus assuming that they're just not champions for the technology. So that's our challenge is to educate the master. This is the reimbursement pathway that can help you. This is the process flow that will optimize your efficiencies. And one of the big things that we highlight to surgeons, and to radiologists is by using technologies like MOLLI, you can actually increase your efficiency and create reproducibility and reliability and Yukako workflows. Because right now with with wire, I use this analogy all the time, so forgive me but like it's a three legged stool, right? You have to have radiology, you have to have surgery and pathology, all working perfectly every time for every person patient in that day. For the system to kind of work if something happens in radiology, the first thing the entire thing goes into disarray and you end up canceling patients. It's pretty significant. Versus MOLLI, you implant the marker and you can implant it 30 days in advance so radiology can do their thing. Surgery can do their thing. and they can each optimize their workflow. And they run now predictably on time. So the burden on physicians in the healthcare system is dramatically reduced, because they're not calling up radiologists, where's the patient? How come you guys are delayed and the patient or the patient fainted because she starves, is fasting. And then none of that happens. And the more you put it in, everybody has a seamless workflow. But our job as industry is to educate that this is the workflow that you can imagine. And fortunately, we've been having that success. But you know, so that's where surgeon champions are, are out there. We just need to show them the way.


Nick Talamantes  5:38  

Certainly Clinical Research and Education go a long way to lubricate the process of adopting a new technology like this. You mentioned that the device, the marker itself can be implanted 30 days in advance, does this biodegrade at all? Or is it it stays exactly in place.


Ananth Ravi  5:56  

I mean, I think that's the one facet of our technology that we were just fundamentally obsessed over, was making sure that the radiologist and the surgeon would have 100% confidence that when you put the marker in, you're gonna find it and you'll find the lesion is associated with. And so what we've seen is that because when you implant the marker, it actually goes through wax plug, it creates a slow clumping unit that keeps it in place. And so over the 30 days, it's stable and in place, often with clips and biopsy clips, people talk about migration, that actually happens right at the time of implantation when you have your needle. And if it's not properly designed, which is something again, we were just obsessing over these little details. If it's not optimally vented, you end up when you pull the needle out of the patient, you suck the clip back with you. So with us, we've we've designed our introducer. So that that that feature is in place. So when we drop it, it stays where it is, and then it's ready to go for surgery and the surgeon will find the mark when they need it most.


Nick Talamantes  7:01  

The efficiency of the product sounds brilliant, I have done a little bit of research to prepare myself to talk with you just a little bit. I'm no expert, as you probably are. I've researched that are approximately 200,000 cases of invasive breast cancer in the United States alone each year, how many of those women are eligible for breast conserving surgery?


Ananth Ravi  7:23  

It's 70%. and above, it's, it's because what's happening now, and this is great. We've got better screening tools, we're able to detect cancers a lot sooner. And if you're at the age of 40, and over go get screened, it is absolutely critical. But because you're detecting it earlier, it's hard to find they're not palpable anymore. So you need tools like this a lot more. So you know, 70% are eligible, and the vast majority of these patients still get wire. So you know, the market is compelling. There's a large number of of patients out there that we could we could improve their lives. And you're just talking about the US right now, globally, there's 2 million patients that get diagnosed annually with with breast cancer. And that's just breast cancer. There's all sorts of other disorders and lesions that can use localization devices.


Nick Talamantes  8:17  

We'll come back to that, because that's really interesting. But I want to look at the 30% in the US who aren't eligible for breast conserving surgery. Could your technology be used now to expand eligibility prevent women from needing to have a mastectomy? Or is that largely related to how far the disease has progressed?


Ananth Ravi  8:38  

So, you know, we've had some instances where localization devices have been used in mastectomy patients. And actually, there's this wonderful story that came out of of UMC Texas, where a patient that was on track to get a mastectomy, actually, by using several MOLLI markers, they were able to confine the amount of tissue that was removed and spared her a mastectomy, and she was actually able to get a breast conserving technique, and then they match the volume reduction on either side. And she ended up with an incredibly, incredibly amazing cosmetic outcome. And she was delighted at the fact that she didn't have to have a mastectomy. So there is this potential of not going for that for those but for those patients who have extensive disease that have spread mastectomy is still an option. That being said, we're not just to localize the lesion. There are other places where they have localized lymph nodes with the MOLLI marker so like, if it's spread regionally, you can target particular lymph nodes and remove those that could be originally with disease. So using the technology outside of the breast space and outside of just breast disease is something we're really excited about and we're getting a lot of surgeons, not just breast surgeons can contacting us about these novel use cases,


Nick Talamantes  9:24  

I'm sure there's a lot of hope that comes with knowing that your quality of life can be improved with the use of this device by conserving breasts and not having to go through a mastectomy. That's really terrific. Let's come back to that mention of other applications for the MOLLI marker and your platform. Where are you guys currently looking at taking this technology? Next? Are you allowed to talk about it a little bit?


Ananth Ravi  10:27  

No, I think it's, it's very much in line with our future vision. And I'm excited to talk about it, because I think it is something that medtech in general should get behind and support. And the reason for that is we've got such amazing advances in radiology, you know, we're able to see things down to sub millimeter like accuracy. And we're interrogating function with functional PET imaging, and all these new radio isotopes, and radiopharmaceuticals, that just give us such a amazing picture what's happening at the cellular level. And then in surgery, we have robots now that can fit inside lumens of like, you know, your esophagus, and they have multifunction tools, and have micron precision and movement. But the surgeon still relies on sight. And these tumors and lesions are smaller than a millimeter now, sometimes, and are based off of purely functional, they look normal by just staring at it. So by touching it and seeing, you really don't know what's normal, and what's malignant tissue. So that's where Molli comes in, right? So what if we could marry the promise of radiology with surgery, and now use the sophisticated surgical teeth, but have a method to say like, this is the spot that you need to remove. And you don't have to be hampered now by the human body and our limitations of sight and touch, you can actually use a sophisticated imaging to now give you that precision that's missing. So we're actively looking into expanding into thoracic and colorectal as our next big areas of interest.


Nick Talamantes  12:11  

Those seem like very promising markets for such a novel localization technology like this, let's take a look at what brings you to LSI this year.


Ananth Ravi  12:21  

So this is our first year at LSI. And let me tell you, it's been a phenomenal meeting. I was just talking to Paul, our CFO is here with me. And we have really come here with the intent to just form relationships, you know, they always say when you're go out there genuinely form connections with people when you don't really have needs from them. And so we're just forming relationships, telling our story a little bit, and engaging with the medtech community, investors strategics. And the reality behind it is by building these relationships, all we're asking for as anybody that, you know, aligns with our vision and finds our story compelling to reach out to us, because all we're trying to do now is accelerate our growth. See if we can get into these spaces where we see true benefit and there's true untapped potential there. And if anybody can help us with that growth, we'd be happy to chat and provide any details and information.


Nick Talamantes  13:22  

Ananth thank you so much for stopping by the studio and telling me about the work you're doing in Mali surgical. It's been a pleasure,


Ananth Ravi  13:28  

appreciate it. Thanks for the time.


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