Neal Patel, Endoluxe - Spotlight Interview | LSI USA ‘23

Transcription

Nick Talamantes  0:14  

Dr. Patel, thank you for joining me in the studio. Thanks for having me. Tell me a little bit about what you're doing and Deluxe.

Neal Patel  0:20  

So my name is Dr. Neal Patel. I'm the CEO and founder of Endoluxe, we have been doing wireless endoscopy for the last eight years. It started when I was a resident, in training, trying to do a procedure in the middle of the night in the emergency room on a patient and I could not get the equipment that I needed. And it realized that after hours and hours of trying to lug around big heavy carts and finding all the different components to do a bedside, endoscopy procedure, I realized with my co founder, there has to be a better way of doing it. And it set us on this wonderful journey that we've been on, on on miniaturizing what we see in the tower technology that you see today. And so one of the biggest pain points that we saw is you have these big, clunky towers that are very expensive, that are hard to move around, that are still to some degree antiquated. We haven't really changed how we've done endoscopy since we first put a camera on endoscope, yes, we've seen improvements in resolution. But we haven't seen any big major change, like we saw when we went from Cray supercomputers to laptops. And so what we set out to do was figure out a way we can democratize the use of endoscopic visualization in a way that we bring the cost down in the healthcare system, improve access to care in the United States and around the world for endoscopic visualization platforms that currently sometimes are out of reach to folks in other countries. Here in the United States, we we realized that a lot of smaller clinics in the rural areas, in the offices and surgery centers. They're very price sensitive to costs, and anything that we can do to help improve that so that our surgeons who are customers can better do what they need to do see inside the body in a way that they can do it in a cost effective manner. But then on top of it employ technology that we see in our iPhones every day, put it in that same type of tower technology, so they get all the technology at their fingertips to help improve visualization lead to better outcomes. And let's start adding more and more features that have traditionally not been added in traditional towers, we see a lot of times that it's just about putting an image on a screen, we want to do more than that, we want it to not just be another dumb camera head, we want it to be smart. We want it to be intelligent. And more importantly, what we're seeing at this conference is data is key. And one of the things that we decided to do sort of almost on accident was that we realized that we have a very amazing data capture platform that makes it very seamless to capture video and picture data. And as a surgeon, myself, I know how hard it is to get this data from the operating room, a lot of times you have to burn it on a CD, or a USB drive, it's very cumbersome for us to be able to do that and show it to our patients. So one of the things that we incorporated into our technology is the ability for seamless data capture.

Nick Talamantes  3:11  

You've given me a lot to unpack right there, which is great. We're going to try and touch on everything. But I want to start on something that I'm personally very interested in, which is the idea of the digital operating room making the operating room smarter, more intelligent, empowering the surgeon. Tell me a little bit about how your product is the next generations maybe of intelligent endoscopy.

Neal Patel  3:35  

Yes. So one of the things we realize on this journey is we have access to all this great video data. And so as a urologist, we do quite a bit of Cystoscopy endoscopy, where we're looking at the lower urinary tract. And one of the things that we realized very quickly is we have a lot of great homogenous data, video data, same CMO sensor, same lighting conditions, different different body. And we realized very quickly that we can leverage this data and very quickly what our company did just to show what we're about. And what we can do is we built neural networks to basically start identifying anatomy. And so we started like a baby. This was during the pandemic, when we didn't have a whole lot to do for a little bit of time. We said, Let's teach. Let's teach the system to identify first where it's located in the body. And so we're able to have our algorithm live detect where it is in the body. So we're understanding anatomy, then we said, look, we can take it a step further, we want it to understand what it's seeing. And so we started doing bounding boxes around critical structures inside the lower urinary tract. And very soon we realized, well, we can get it to the point where we can do Instant segmentation where we can look at the contouring of the different organs. Is it moderate? Is it severe? Is it abnormal? Is it normal? And that's sort of where we got with our system where we can say, Look, we can create these detection algorithms to help with clinical decision support. And a lot of times what a lot other companies are doing we're seeing it all over all over the place now is, you know, we're using AI envision to help, you know, augment the surgeons experience, because right now, you know, as a surgeon, we look on the screen, and we see what we see. But it would be great for us to start seeing more data about what we're seeing, what is the angulation of our system? What are the colors that we're seeing? Are we seeing any sort of abnormality? How are we positioning our hands outside of the body, which could actually affect how we deploy therapy inside the body, all those things we don't have access to. But now we do with our technology. We are the first camera system that employs a lot of these smart technologies into the scope handle that no one else has done so that we can give that data back to the surgeon and let them act on it.

Nick Talamantes  5:43  

So this is all happening in real time, then they're able to visualize things that a normal endoscope would not be capable of doing right there in the OR. 

Neal Patel  5:52  

That's correct. 

Nick Talamantes  5:53  

That's fascinating. Tell me a little bit about where endo Luxus today. Are you guys commercial? Are you preclinical?

Neal Patel  6:00  

Yes. So we are commercialized with our first generation device. This device basically uses any analog endoscope that's in the operating room and works on any specialty. Any scope that has an eyepiece and a light source our current system works with so you can think about almost every specialty currently is is using some sort of rigid or flexible analog endoscope. So our current system is commercialized, we began strategic distribution about six months ago. We're generating quite a bit of sales now. We're very excited about it. Now we get the fun, excitement of of scaling properly. So our first generation device is commercialized, we're expanding into different specialties. Now, our beachhead was urology, we sort of secured that markets and now we're going under going after other markets like in EMT, orthopedics, laparoscopy, Gynecology, emergency room medicine, any place that would use our technology, we're trying to get it into those locations, where we are going with our next generation that we're in the process of commercializing is, our current system addresses about 70% of the endoscopy market, which is analog endoscopy, it still has a long way to go before it's replaced by pure digital, but we are seeing the market shift there. And so our next our next generation system, we have developed the world's first wireless, digital disposable interchangeable endoscope. So we'll be able to do high resolution, low latency, and the scope tip will be brand new every single time. So image quality will always be there. Sometimes with traditional scopes, those break down over time, you don't have as good of him as quality, longer use of scopes with digital disposable, it's a brand new chip on a tip every single time. And we're leveraging our wireless technology with it to make it very easy for the surgeon to use. And on top of it all of our back end data collection to make it very easily to collect that data to show the patients and also for us to do fun, fun things in the future with that data.

Nick Talamantes  8:04  

You mentioned that this device can be used in 70% of endoscopic procedures today, correct? 

Neal Patel  8:11  

Correct, our current generation device

Nick Talamantes  8:12  

That's 20 million or so endoscopic procedures, that eventually your technology will be able to be used in 100% of them?

Neal Patel  8:20  

That's where we're going. So the next generation system will fully complete that product line so that we can address every type of procedure that's done on the market.

Nick Talamantes  8:27  

In your opinion, why hasn't there been a faster switch from analog to digital? Is it a cost issue? 

Neal Patel  8:33  

Yeah, it's a great question. It has been cost, you know, their analog has been the mainstay, I mean, it will still always be there. You know, and I feel a little bit about like Bill Gates saying, we only need eight megabytes of memory. But you know, the analog endoscopy is gonna be here to stay for a while. And I think the reason is, is that, you know, you've got these good, rigid endoscopes, you've got all these platforms already out there deployed across the world that is designed around these analog scopes. So it's gonna be a very tough transition over the years, to switch to something that's pure digital. You know, there's costs, you know, right now, there's resistance to change, I mean that we have sterilization, maintenance contracts, all these things are already in place. But what they're realizing is that there's a huge cost to sterilization, there's surgical site infections, that you got to be worried about, you know, quality of your image degrading over time, repair costs, maintenance it, it all starts adding up. So the economics start shifting in the favor of a disposable digital technology. And so, you know, we do feel that, you know, at least for the next couple of decades, analog will be there, the market share will slowly shift towards digital, especially as what we're seeing right now is reimbursement is happening in the urology field for disposable scopes. And so that's going to shift the entire paradigm for what we've been seeing in healthcare as far as reimbursement for these procedures because now we are We are helping the physician get better technology. And I think that's going to be great for the patients, it's going to be great for the advancement of the field. And that's why we're making that big push into digital as well.

Nick Talamantes  10:11  

Yeah, I'm definitely noticing a lot of disposable endoscopy companies emerging, getting regulatory clearance. It's definitely shifting in that direction for all the reasons that you just mentioned. I'm curious with your next generation product, the digital version, what's the resolution going to look like on that device?

Neal Patel  10:30  

Yeah, so right now we're at 1080p, the biggest challenge in wireless endoscopy is getting good resolution, that low latency, so a surgeon can see an imperceptible difference of about, if anything more than 120 milliseconds, we can notice, we can notice that little annoyance in the delivery of the therapy or moving of the camera. And so what we are engineering towards is high resolution, low latency. And so one of the things Endoluxe is doing is we have partnered with Nvidia through their inception program. And it allows us to leverage a lot of the great new technology that NVIDIA is doing, they've just recently been named one of the top companies helping advanced AI and healthcare. And we're fortunate to be one of four medical vision companies in their in their inception portfolio, which will help hopefully allow us to get a lot of that processing power that we need to get you or get our customers to, you know, a 4k low latency wireless transmission. And so right now, you know, current system, it relies on the scope. I mean, everyone thinks that, you know, 10 ADP is what you see on the screen, it's really what comes out of the scope and what we can see. And so with our next gen system, because we're chip on a tip, we can say we're truly 1080p or truly 4k. But we do know that that's where we're heading better, you know, better resolutions always great. I can tell you personally, as a surgeon, there's probably not a big difference in 1080p versus 4k. But, you know, if we can keep pushing it, we will because we don't know what we'll be able to see with these types of sensors in the future.

Nick Talamantes  12:01  

NVidia is an exciting partner for a visualization video company to be working with. So congratulations to you guys on that partnership. Are there any other partners you're working with in the industry to bring your technology to the masses?

Neal Patel  12:13  

Yeah, we, we recently have been collaborating with the Mayo Clinic in their team in the urology division to help advance some of our initiatives in bladder cancer detection. You know, more specifically, we're looking at because our system has all these different sensors inside of it. And we have the ability to record video and picture data. How do we put it all together? How do we do mapping of the of the bladder to be able to record where all the tumors are reconstruct them in 3d? How do we create a GPS system so that when we go back in there, and patients who've had bladder cancer treated, and we have to go look at all their previous sites, it would be great for a map to tell us where we were before so that we can go and check every single area. And so those are the things that we're working on with the help of Mayo Clinic and their team and their know how, and giving us that expertise that we need to build on it.

Nick Talamantes  13:00  

So how does the cost of the EBS Orb system compared to that of a traditional analog or digital tower set up in the operating room?

Neal Patel  13:09  

Great question. So traditionally, these towers costs anywhere from 50,000 to more than 100,000, depending on the bells and whistles, and sometimes the customer that's buying it. And what we realized is when we started taking apart the systems that we bought third hand, the the technology in them, was fairly antiquated. And we realized that the same tech that we're seeing in our iPhones that we pay less than $1,000 for could be easily converted over into a medical device. And so what we've been able to do leveraging technology, leveraging the ability of miniaturization is that we've been able to create a product now that is selling for $15,000 on the market, which is drastically less than what you can find, even on the lower end of a brand new system. And so we feel that that cost change is a huge value add to our customers to our patients, to the ability to enable the technology to be used in places that normally would be prevented due to the costs. So we're seeing a lot of physicians interested in bringing us to their satellite clinics where they don't want to spend $50,000 for a brand new tower. We you know, we're seeing applications where we can change the site of surgery, or the site of a procedure because of the cost of it. This can fit in the white coat of a surgeon they can take into the emergency room and use it like they would use a stethoscope now. I mean, it is really changing the paradigm of where these types of diagnostics and procedures can be performed because of the cost.

Nick Talamantes  14:41  

I imagine then that your technology makes you extremely competitive against the traditional players in the market the strategics. Are there any other players doing the same thing with wireless endoscopy today and maybe how do you guys compare if there are?

Neal Patel  14:56  

Yeah, there are a few players in the market. I think everyone is starting to read realize just how everything else in this world has gone wireless that this is the next step in the or evolution. And so we have a lot of, of interest in going wireless, it is a very tough problem to solve. So very few people have have really addressed it mainly because of resolution and light and latency, which we spent years of r&d work on to make work. There are companies that are working on in the orthopedic space, what differentiates us from them is we are more general we are a system works with any scope in any specialty that has an IP center and a light source. There are other folks that are sort of focusing on specific specialties. We started in urology, but we're now we're expanding further. One thing that differentiates our scope from the rest is it's a complete all in one system, meaning that other systems that have tried, some companies have tried and failed in the past had just done either the wireless video signal, or you know, wireless video signal and a light source. Our's is all built in. And so one thing that gives us an all in one system, but the one thing that differentiates the most at least with our first generation system is that we have an onboard screen. And that's hugely important because when we talk about wireless, not that we'd like it, but sometimes there can be interference, especially in the operating room. And the last thing you want is being a surgeon doing a procedure, and your screen goes out because it has a interference in the wireless signal. And while we spent a lot of time and energy making sure that that doesn't happen, we built in a redundancy, which is the procedure can be done on the screen of the orb in a very nice way. And so we acknowledge that most people won't ever use the onboard screen, it's not technically designed as a surgeon, I wanted to still be able to see my image on a nice big wireless display in the alar. But in cases where you have a signal go out, we had this been used in medical missions out in Haiti, and they were literally doing the procedure like major procedures, just using the screen on on the camera. And so you know, that's what differentiates us is the fact that we have the all in one package, if anything goes out, you can safely complete the procedure with our onboard screen. And so that I think is a big differentiating factor for us compared to everyone else, because I don't think anyone else has done that. They're all relying on the robustness of the wireless transmission.

Nick Talamantes  17:16  

You're aware of your Achilles heel, so to say, and you've already come up with a way to protect it. And I love it. You know, we've talked a lot about the EBS Orb, can you give us sort of a walkthrough of the product? Now its features. Tell us about more about it?

Neal Patel  17:31  

Sure. So the orb itself, it's designed, it was designed for me, you know, I designed it for me to be able to use it. So one of the things that we worked in is the clamping mechanism is very similar to what standard surgeon would use for standard camera heads. So one of the things that I needed to design towards is that surgeons are notorious for nitpicking and being in a situation if they don't like one thing. It's done. And so we spent a lot of time making it very familiar. So this is a standard clamping mechanism. You put this in the head surgeon, they'll immediately know what to do with it, they'll put their scope on. They know how it works, our entire cower system latches on to the endoscope, and attaches onto the light post just like any other traditional camera system. And then it is used in whatever bodily orifice that's necessary to visualize inside. So you can see here on the screen as well. And then it's projected wirelessly to the OR it has a touchscreen built in for us to be able to control it here remotely, as well as see what's happening in real time. It has a built in gyro, so 12 o'clock is always up which is actually very important in surgery. So we take it for granted on our iPhones when the image is stabilized. It's something that we don't have in surgery that our system can provide. And then when we're done with the procedure, we can stop recording, which will save the data and encode it and then transfer it to our our base station. And then when we're done we just take the light off, which is very bright, we put on the system and the procedure is done. Everything can be controlled from your orb, and it can also be controlled remotely from our wireless display as well. And then the procedure itself can completely happen here. It has a two hour battery life fast charging in between. We have a cord just in case you need to go corded. We don't want you low on battery and you can't complete a procedure if it's long but we go corded our next generation system has a bigger battery stronger light source can last much longer. Generally these these orbs are used in procedures that lasts less than two hours. And usually meant for like quicker, faster diagnostic interventional procedures. That's usually the bread bread and butter of endoscopist. Anyway, we are moving into general surgery where this will be able to last longer for general surgery. And also our next generation system will address a lot of those longer procedures as well.

Nick Talamantes  19:57  

So when can we see the next generation system, when, is it have you unveiled it already or is?

Neal Patel  20:03  

Unveiling it here at this conference. It is our something we've been working towards for a very long time. And it uses the same core talent. We call it tower tech technology that allows us to be able to transmit our data very robustly and seamlessly with low latency and high res. So this system, we're debate debuting here at LSI. It's the complete wireless endoscope system. It has a hotspot battery, so allows you to go 15 hours if you needed to handle that sterilizable and an NP sets interchangeable for whatever type of scope that you need. So whatever specialty you're doing, if it's flexible, rigid, large diameter, small diameter, we're going to engineer it so that we can have an entire product line of disposable end pieces. What makes this great is that we can reduce the cost significantly. One of the biggest fall backs on disposable is the cost. We know that we can get the disposable tip down to a very, very low cost to make it financially model in a way that is not a financial burden to the end surgeon to the clinic or the hospital or facility that uses it. And we can make it for every specialty, because we are not worrying about the core technology which is separate. We're really working on the NPS which can be customized.

Nick Talamantes  21:29  

That is incredible. You go from a two hour battery life to a 15 addressing multiple other pain points and you're already ready to debut it. Thank you so much for showing this. Dr. Patel, thank you so much for joining me in the studio.

Neal Patel  21:44  

Thank you so much for the time