Elliot Street, Inovus - Spotlight Interview | LSI USA '23

Transcription

Nick Talamantes  

Hey Elliot, thank you so much for joining me in the studio.

Elliot Street  

Thanks for having me. Lovely to see you.

Nick Talamantes  

It's good to see you again. Tell me what's new with Inovus?

Elliot Street  

Yeah, so well I mean, since last year, the big announcement for us was the launch of our digital surgery platform Totem. Pretty unique. When we think about digital surgery, lots of people immediately jumped to technologies that are being used in the AOR. Our platform has been built initially, and primarily to drive an ecosystem of surgical simulators the ecosystem that we built the business on. And we launched at the back end of last year at the American College of Surgeons annual Congress. And it's been a real whirlwind since we since we launched actually, it's been really well received. So yeah, that's the big update.

Nick Talamantes  

So tell me what is Totem?

Elliot Street  

Yeah, so as I mentioned, we broadly call it a digital surgery platform. Effectively, it's a piece of software that exists to add value to the hardware that we manufacture. So we manufacture a whole portfolio of laparoscopic hysteroscopy simulators and all sorts of other simulators and surgical training technologies. And in the analog form, they're brilliant. But the modern day surgeon and the way we're moving when it comes to surgical training, is requiring a lot more data. And so to be able to capture that data and provide the value they need, we needed to digitalize our hardware that we had. And so we looked at this and said, Well, this concept of digital surgery is a burgeoning thing. The narrative around it is yes, these are the things that we're putting into theaters. That's things like video capture, video, transcoders, maybe some objective, performance metrics, all of these sorts of things. And we felt the best way to describe totum, therefore, was as a digital surgery platform, but as I say, powering the simulators and adding that extra value. So I mean, we weren't going to put all the features of the platform because we'd be here for a while. But it's got some some amazing technology in there. So some augmented reality technology, that digitalize is soft tissue models, which means the surgeons get what we call natural haptics while they're operating. But in a really immersive environment without the use of headsets. So that's a big thing for us, our surgeons don't stand in theater wearing headsets. We don't want our simulators, teaching them to wear headsets to operate. So it's a big thing for us, we had to invent some technology to do it, which is really cool.

Nick Talamantes  

That sounds really cool. Tell me a little bit about the surgical simulators that are kind of at the front end of the Totem platform.

Elliot Street  

Yeah, absolutely. So so they are effectively I call it the host for the platform. They provide this amazing amount of intrinsic value I mentioned, we've been building a business for 11 years with with people adopting these pieces of hardware. So we have a whole portfolio of laparoscopic trainers, and I'll talk about those, I guess, first of all, so traditional sort of box trainers, but their hybrid box trainer. So sitting in the box trainers are the soft tissue models. And the great thing about a box trainer style of simulated means you can put any instrument you like into the device. So I'm sure you've heard me talk about this before. In other forums where I'm talking about the the analogy of sports, training and sports athletes and sports stars when it comes to learning surgery. The beauty of using a box trainer Star model means you can put the instruments that you're going to use on game day. So when you're in theater into the simulator, and learn how they feel in the hand, learn how they feel on the soft tissues. That's like a tennis player practicing with exactly the same racket that they're going to use on game day as they do during the week. So boxes, soft tissues in the boxes and instruments going in there to operate on. And then the digital platform tracks those instruments, and makes it more immersive with all of the augmented reality.

Nick Talamantes  

So the augmented reality is actually overlaid in this simulator of yours?

Elliot Street  

Yeah, correct. So it you'll have the soft tissue models. And then there's a digital handshake between the model and the digital environment. So when you pick the model up and move it around, the digital environment will move around with it. Because that's what you get if you're using a purely virtual platform. But then there's also this amazing digital handshake that communicates between the two. So if I cut through a blood vessel, in the real environment, it will trigger a bleed in the digital environment. And then that's triggering our surgeons to think about, okay, what do I need to do interactively to remedy that problem? So they'd go and use electric cautery or die thermia, whatever you want to call it to stop the bleeding.

Nick Talamantes  

So then does the augmented reality create a visual adverse event, let's say if they nicked something on the soft tissue model, or does the soft tissue model have other realistic properties to it that simulate an adverse event occurring?

Elliot Street  

Yeah, the adverse events are all in the digital environment. When we were thinking about this in this continuum of how are we going to show bleeds, or leaking bile ducts or whatever it may well be? And one of the big things for us is repeatability and scalability of the training we want In the surgeons to be doing these hundreds, if not 1000s of times. And if we built in the adverse events into the real life environment, that would have meant a lot of mess, and loads of time resetting up the models between each use. So we took that friction away. And that's why we do those digitally. So bleeding digital, once you've stopped it, there's no mess inside the box, you just take the model output and you want in and away you go,

Nick Talamantes  

that sounds like a much better solution than having to one purchase all the other additional model parts that you would need to simulate those adverse events. But also make it easier to reset, replicate over and over again, so that you're consistently learning the best techniques to deal with those complications as they arise. Who is this surgical simulator for? Is this for new physicians, current to current practicing surgeons who need to learn new techniques? Is there an ideal persona that you're pursuing with this product?

Elliot Street  

Yeah the, I'll ask this question with our mission statement? And actually, basically, every question I ever get answered, asked about universe I can answer with our mission statement. So our mission is to become the world's partner for surgical training. So let me expand on how that answers your question. When we think about surgical training, let's think about the segment's or the categories, or the people that have touch points there. That's early stage residents learning the art of surgery from day one. That's the more senior residents, the fellows, that's the attending physicians who have already become qualified, but are learning perhaps new techniques or working on their complex techniques, then it's the perioperative team. So pas on physician associates, you're starting to learn basic skills. But then there's a wider ecosystem beyond just those people. So you go all the way down at the undergraduate space with surgical technology or surgical technicians who are learning surgical skills. And then we also think about the medical device companies that are servicing all those people. So those med tech companies are churning out some brilliant innovations. They're turning them out so fast, that new surgeon or the surgeons that are there with these new technologies are thinking how am I going to use this safely? And the device companies are looking at it saying, How are we going to make sure the soldiers can use these safely? So they're looking to training or simulation techniques to allow them to do that? So to answer your question, the platform because it is agnostic, we can put any brand of instrument into it, whether or not that's the laparoscopic trainer, whether or not it's the hysteroscopy platform, we can put any device companies brand them. And then we have this whole range of training environments that serve the needs of a very junior surgeon, they won what we call part proxies, that picking up the hoops and moving hoops around all the way through to full procedure training. So really difficult lap co leads or vaginal vault closures, which the more senior people need to learn. So it comes back ultimately to the summary of we're looking to be the world's partner for surgical training. And therefore it's a hormone estimate technology that can serve the whole ecosystem.

Nick Talamantes  

Maybe staying on that idea of partners and then fusing in the med tech companies does do the companies that you work with need to partner with you to develop specific devices with sensors in them to interact with the simulator, or is as it's as you said, it's completely agnostic. I take up a laparoscope from Olympus, I inserted into the simulator. And it's good to go, yeah, sorry, you're working with anyone in particular, to develop maybe new ways to use the surgical simulator with their devices and for training, or you don't really need to do that.

Elliot Street  

It's the other way around. So because there's so much new technology, what the way we look at it, and the service or the service, the value added service that we provide to the whole community, the whole ecosystem, is there should be some constant somewhere. Right? So all these devices are different that from the straight stick laparoscopic instruments to that we're seeing this boom in human operated robotics. So lots of really, really cool companies, they're coming through, where you get all the value of articulating instruments or wristed instruments, but you're holding them in your hands like a like a laparoscopic instrument all the way that and through to the robotics platforms. Doesn't matter who you are in that list, you can put your devices into our simulator, and we don't have to necessarily customize it. There are some times some customization features to totem when people want to include the specific techniques or specific procedures or specific names that their products share. But the actual hardware and as you say, the sensors, it's all completely agnostic and good to go.

Nick Talamantes  

Why use a box simulator versus VR? You know, VR has become a very trendy technology within our industry and within the wider digital surgery market. What are the advantages of a box simulator? Like the technology that you guys are developing compared to VR today?

Elliot Street  

Yeah, thanks. When we think about VR, we it's important that we sub segment that so you've got the traditional mainframe VR system so shoulders that we stand on today if industry has been around for 30 years, more recently, but this boom and headset basically dA. So mainframe VR, that has software and motors giving you some form of haptic or feel feedback, the headset VR, they're pretty much the majority of them, you have a headset on, and then you have the handset. So there's really no haptics, no feel. So you're, you're doing motions, and then you're working through cognitive steps, fine for understanding the cognitive steps of a procedure, not necessarily fine for what's the subtle feel of this tissue versus this tissue. So we put haptics at the center of our most important requirements. And that's where the box trainer model has real advantage because we can put tissues in a box, and ultimately humans are tissues in a box. And then we operate on those with the actual instruments that we're going to use in real life. And there's loads of evidence, that huge repository of evidence to show that box trainer based simulation actually accelerates the learning curve quicker than virtual reality based simulation. What we then did is said, Okay, what we don't want our customers to have to do is make that difficult decision between, I want to do my box trainer based simulation. But when I'm a little bit beyond that, how do I then extend that? So we did this hybridized approach box trainers at the core, we digitalized it with the digital platform. And now the customers can go on that journey in one in one solution and not have to make a difficult compromise.

Nick Talamantes  

I imagine there's also a competitive advantage of being able to immediately start practicing with a new device in your simulators compared to a VR environment where you have to build all of that even if there is haptics involved with that VR simulator. There's a lot of lead time involved to get a surgeon training with a new device in a virtual environment.

Elliot Street  

Yeah, absolutely. That's a big. It's an amazing technology. But it is very expensive to develop. And therefore it becomes very expensive to deploy for that exact reason that you mentioned, which is when you're coding, well, what should this piece of tissue feel like when you're touching it with this instrument, completely, virtually. And then you're trying to tell the image what these motors should tell you from a haptic perspective, it's, it's really difficult. And so yeah, we, we have this unfair advantage of being able to scale the number of modules and the content really, really quickly. And very quickly on that the way we've approached totem, I know we started talking about totem, we've approached the building of totem is we've taken an API and SDK first framework approach. This has been that those buzzwords have been flying around LSI, USA 2023. And it's been really nice to sit in the, in the in the sessions and go, I've got a really good technical team, they really know what they're doing. Because these guys have been doing it for the last sort of 2436 months building out the totem platform, they came to us and said, We know that we want to build this platform, primarily for a laparoscopic simulator, and then a hysteroscopy simulator. But we also know that we're going to take the technology and apply it to all sorts of different simulators. And to be able to do that at scale. And without it taking three years each time we want to make a new simulator, we're going to need to take this API SDK first framework. And just for anyone that's listening, that doesn't understand what that means. That's effectively, you're building technology in little distinct modules, such that if you have to change one part, it doesn't knock the whole thing down. And then you also have a framework of instructions, that pretty much allows anyone to pick those modules up. And as long as they can read the instructions, they can use that for their own use as well.

Nick Talamantes  

It's great that you're future proofing future applications. So could you maybe tease out what some of those future applications and future simulators you're going to be putting out are going to be?

Elliot Street  

Yeah, absolutely. So comes back again, I can answer all the questions with our mission statement, which was to become the world's partner for surgical training to get there. I'll talk about what does it practically mean when we actually say that as a mission, when we've achieved our mission, this is a multi decade mission, by the way, we're one decade into a multi decade mission, when we've achieved it, any, any patient on the planet, those having an operation, will be able to turn to their surgeon and say, How did you learn how to do this? And their immediate answer will be well, of course, I simulated and trained on the inverse platform x. For this particular procedure, I had to do it this many times, to this objective standard before I touched a patient. Then once I started operating on patients, I do it a certain number of times every year to an objective standard in the simulated environment on this platform. And by the way, before your procedure, I'm going to warm up a couple of times on that platform as well. So that's what that mission looks like to then answer your question. Well, for us to achieve that we have to apply the same approach of haptic first, so natural haptics, first powered by digital platforms to every single vertical in surgery. So at the moment, we're in general surgery, gynecology. Big things for us in the pipeline, our orthopedics. Vascular is a big part because they're doing lots of training there. But ultimately, you think of a surgical specialty and that's where we're going to be ending up going.

Nick Talamantes  

Yeah, that's great. You know, I'm briefly familiar with some of the ways they do surgical training in the vascular space. And they use these really complex models, and they have the model flow, and they're pumping fluids through it, being able to do it in a box simulation. There are clearly numerous advantages over using a physical model like that. Why don't we shift gears a little bit and talk about in this three years, and now at LSI? your this is your third LSI? Yeah, absolutely. How has that journey been for you guys? Starting when we first met? I think it was last year, around this time. What's, what's the journey been like? And how have you learned? I guess, from that meeting to this one, what have you learned from this bat meeting to this one.

Elliot Street  

I mean, first of all, we've done a lot, because the caliber of individual that comes to SI is astonishing, across the founders, the strategics, the the the investment community, amazing, we'll probably touch on a few of those bits. But I think the interesting if anyone is watching this, and they're starting their journey in innovation, or in a new space, or they are considering coming to LSI, and they're like, I'm gonna go to that event. And I'm not going to know anyone there. And that's scary. That is scary. So the first time I turned up to LSI, I didn't know anyone. I literally knew no one. And I thought, okay, I'm going to have to take that first year as a learning point, because I can't possibly think I'm going to come to LSI in my first year, knowing no one not being integrated into the ecosystem at all, and think are going to come away with that with a sort of golden bullet that's going to that's going to solve all our business problems. So year one, laying the groundwork came back in year two, suddenly, I'm turning up and I'm seeing friends. And those friends are now saying, oh, let me introduce you to this person and this person and this person and this person. So now you're compounding being within that ecosystem. And as long as you're providing value to those people, and they like you, then that's going to keep happening. So now by the time we get here for year three, it's for me personally, and for us as a business, our ability to make contact with the specific investors, we want to speak to the strategics we want to speak to I think they've seen us turn up enough times now to go, okay, they're not going anywhere. We've heard that same thing a couple of times, now we're starting to resonate with what they're saying. And that journey that we've been on is becoming really powerful. And the compound effect of it has been, it's been amazing. What have we learned? I think the best the best thing we will learn based on everything I've just said there is you've just got to keep turning up.

Nick Talamantes  

That's how you become a superstar like Elliot Street here.

Elliot Street  

Yeah, it's that consistency. I honestly the yeah, it's night and day between day one of year one. And where we are now day three of year three for us. It's yeah, it's amazing,

Nick Talamantes  

Certainly, and he laughs but when Elliott walks into the room, everybody knows who he is. So he's doing quite well and it's great to see and follow the journey that you and your company have been on. Elliot, thank you so much for joining me in the studio today. It's been a pleasure. 

Elliot Street  

Thanks for having me. Really enjoyed it.