Signature Series: Scaling Robotics Beyond Singularly Focused Procedures to Combat Scarcity and Rising Cost | LSI USA '25

Henry Peck  0:08  
John, all right. Josh. Andy, thank you for joining me, Josh. It's been a long time since we got to do one of these on stage. Last time we did this, I remember the clip so vividly. It was the beep, beep. What it was the Silicon Valley Bank lab, yes, which was a fun one. Quite a quite a year to have the event was like months after. So glad we're doing this now, and your roles have evolved since that time that we talked last so first, kind of, before we jump in, I want to set the stage a little bit we have kind of investor, operator transitions represented on stage. Josh, very successful operator career with Orris health, endogastric solutions, etc. Now running Mandera, you've had a one of the largest exits in Medtech, you know, history. Why jump back into the operator? See? Why not be an investor? It looks so much fun. It

Josh DeFonzo  0:56  
is fun. I think it is romanticized, though, so for any of the investors in the room, or, you know, audiences following along at home. It's challenging. I think, I think both investor and entrepreneur have a relationship that is unique and that there's some understanding of one another's worlds, but not complete understanding of one another's world. So, I mean, I have a lot of respect for investors. I think the challenge there is that they're judged over a much longer time horizon. You don't necessarily have the same level of control. And at the end of the day, I am a builder. So there's something that I really felt passionate about doing, a maintaining relationship with Lux. So maybe I'll go back to investing some day, but for now, back to operating.

Henry Peck  1:36  
Yeah. What about you, Andy, would you go back to back to investing? Do you miss

Andy McGibbon  1:39  
it? Yeah. I mean, there's certainly things that I miss and some things that I don't I think there's, you know, no matter which side of the table you're on, you're still raising money. And that's not any easier to get money from an LP than it is to get from a VC. So I think it's just kind of pick your poison on which battles you want to choose. I think one of the things, in addition to the learning cycles, is when you're in an operator role, the ups are up and the downs are down. When you're an investor and have a portfolio, there's always ups and always downs. So it's a very different experience.

Henry Peck  2:09  
Yeah, I think the the exciting thing now is we get you both in the thick of operating two extremely unique businesses with some commonalities and common threads that we'll draw on. So to start here, kind of focused on the robotics aspects of your companies and the technology side. Can you both just quickly explain you know what your robot is, so we can see it in our mind. And Josh, we'll start with you.

Josh DeFonzo  2:32  
Yes, you'll hear from Andy in a moment. But essentially, my robot is a small handheld, collaborative robotic device. We make custom software that integrates with imaging, specifically ultrasound. And what the system is designed to do is enable all healthcare providers to be able to perform consistent, needle based procedures. And really, where that starts is in things like vascular access biopsy. So I don't want to steal any of Andy's thunder. It's like the things that Andy it's everything, but what Andy and his team do, hopefully? So

Andy McGibbon  3:04  
yeah, I mean, I think we both use needles at some level, but that's about it. So I'm here on behalf of vitetro. And Vitestro is an autonomous blood drawing robot. So it's really focused on putting the needle in the center of the vein and getting the blood out. And the way that looks is something very different. It's a basically a console, about five feet by two feet by five feet tall. Patient sits down, puts their arm in, presses a button, does everything from finding the vein, drawing the blood, filling the vials, shaking the well, I should say, inverting the vial, which is a big problem with the existing status quo, and then puts a band aid on. So it's really doing everything that you can imagine a phlebotomist does today.

Henry Peck  3:47  
So the robotics that you're talking about here sound very different than what I think of when I think of robotics in healthcare historically, I think of large format surgical robotics. I think of orthopedic surgery, these kind of high complexity procedures where the value proposition of robotics is precision and things of that nature. Talk a little bit about why you're applying robotics to these different aspects of healthcare, and how you think about the value and the opportunity there. Andy,

Andy McGibbon  4:17  
yeah. I mean, I think if you look at what intuitive is doing, and relative to phlebotomy, where there's billions of blood draws a year, the scale of the volume is so different, the trade off there also being, the value per procedure is very different. So I think when you look at robotics outside of healthcare, and I'll let Josh address that as well, I think it's a lot of repetitive, mundane tasks that are automated frequently. And I think when you look in healthcare, there is no more repetitive and common repetitive task as drawing blood. And so I think that's where we really took that approach of and this was the original Sonder thesis of saying, okay, within healthcare and robotics application. And how can you start moving down that per value or per procedure value pyramid, and at the same time move up in the per or, I should say, volume of the procedure in general. And so we started with that, with with Neptune medical, another portfolio of a company of ours, which is robotic GI endoscopy, you know, that starts moving that path, and then we started looking at other more common procedures, like phlebotomy. Here we are,

Josh DeFonzo  5:25  
yeah, it's pretty similar inspiration for us. Oftentimes, when you think of robotics, you think of more complex systems, and then, because they're big and they're complex, they have a certain cost threshold. And so we do, as innovators, what anybody in med tech does who's worth their salt, which is, okay, well, if it's gonna cost me this much money, how can I work within the reimbursement the unmet clinical needs? And what happens is, you, generally speaking, move further up the healthcare, interventional food chain. And the inverse problem to that is, if you are targeting a subset of operating rooms, it's actually really hard to build these businesses from a supply chain perspective. You know, when you plan your go to market, you're going to place three robots in the first year, maybe 10 in the second, like no suppliers getting out of bed for that. So I think from our perspective, the challenge that we posed to ourselves was, how do you make healthcare robotics look more like they do in warehousing and manufacturing? And so my co founder is a PhD roboticist. We actually didn't know that we were gonna be in healthcare in the beginning. We step back and there's, you know, globally, about 500,000 robots shipped per year. Intuitive, Surgical, who is an incredible company, I think has 10,000 active robots. I don't know how many they sold over time, but I think that's what they advertise. And so that's like a fraction of what's going on in the world of robotics outside of healthcare. And so, you know, we began this search to say, like, where you were talking about the dull, the dirty, the dangerous, like, where in healthcare Do you have a wild imbalance of demand and supply and efficiency, and how do you make robots fix that problem? And so that's how we landed, to some extent, on the needle based procedures set as well as we realized that, generally speaking, you're not going to get cancer treatments without a biopsy. You're not going to get an Endovascular procedure without great special access. You're not going to have orthopedic procedures without injections, right? And at the end of the day, when we looked at the available claims data for these things, about 90% of the hundreds of millions of procedures that are performed, of procedures are done by 10% of healthcare providers, the number is woeful. And so we just said, Hey, that's a problem that we can really sink our teeth into and hopefully, like, democratize something with a simpler robot.

Andy McGibbon  7:33  
And you mentioned, okay, pick up a thread on that too. I think, because I think so much of med tech is about the per procedure reimbursement, and how do you fit into that paradigm? And I think it's so. I'm now on the operator side, pitching to investors, and that's always a question, well, what's the CPT code for having your blood drawn? Actually, that's completely irrelevant to our business model. It's not a piece of the puzzle. And so I think when you start looking at other areas of the hospital where automation makes sense, where robotics makes sense. It also you have to start thinking about the business model and the economic argument very differently. And you know, frankly, I think that's something a lot of med tech investors have a hard time wrapping their head around,

Henry Peck  8:10  
yeah, you talk about the the types of robots that exist outside of healthcare, looking at that as a guiding post for how to apply them to different areas of healthcare. Talk about the build of your system for a moment. For a moment, do you take inspiration from the types of robotics that are out there in terms of the architecture, then the way that they look and the way that they perform, the types of technologies that you're using to augment those robotics? How do you, you know? How do you think about what exists and applying it to your business?

Andy McGibbon  8:39  
Yeah, I can. I can dive in on that. I think, for for our setup, right? If you think of a traditional hospital outpatient phlebotomy suite, you're constrained roughly to a 12 by 1210, by 10 kind of setup. And so we that was one of our core criteria, is, how do you fit into that? From a real estate perspective, I think one of the, I guess, also, evolutionary things that came out of this was looking at it not just from a, okay, what is the end result? Look, but we really went back and forth with hospitals to refine what are the needs of that, and also with patients. Because, I mean, I think it's a, it's a very personal interaction, you know. And like a lot of things, patients are conscious. They're they're actually interacting with the device. And so that was also something that we took a lot of inspiration into is, you know, nobody really wants to stick their arm in a black box to have a needle poke them. But how can you make it open accessible? And I think we just released our brand name of aletta, which is really about Dr aletta Jacobs, bringing it back to a personal, you know, companion, rather than a robot. So that was very important as we thought about how we designed the product. I

Josh DeFonzo  9:40  
mean, in terms of, like, where we got the inspiration, the architecture from, I wouldn't say that we looked at existing designs, but, but it was more the case that, like, if you define what a robot is pretty broadly, like a Roomba is a robot, right? So they don't have to be humanoid robots. They don't have to be forearm laparoscopic robotic systems. And so we on a first. Principles basis. We're really dealing with that same sort of economic equation that Andy was talking to. Everybody's gonna say to you as a CPT code for this, what's the CP code for that? And as you move, I'm gonna call it down the food chain, chain do higher volume procedures, they don't reimburse as much. So we knew that we had to make an architecture that was super cost effective, that delivered value for people. And so as a result, architecture doesn't look like anything you would expect. Our robot is about 180 grams, which is about the weight of your iPhone or your Android device, and it clicks onto an ultrasound and then really just acts as an image stabilizer around someone's hand. So ours looks very dissimilar from what I think people would think of as like an iconic robot. You bring

Henry Peck  10:38  
up the Roomba as an example of a consumer robot, right? Non humanoid. It's not this, like crazy futuristic thing of one of our, you know, mutual friends at the event, his son tells me, or he told me, that his son thinks the Roomba is alive. Thinks it's like a like a dog. He rides it around, he takes care of it. He takes it to the park. So much they had to get him a second Roomba, so he'd leave the regular Roomba alone. And the reason I bring that up is because different types of people probably interact with these robots very differently. We're used to, you know, the highest end bariatric surgeon interacting with the da Vinci. We're not so used to what robotics look like in phlebotomy or, you know, in other areas. And so how do you think about the what's, what's the response been from providers that maybe haven't been as seasoned or trained on robotics. All of a sudden you inject this technology into their

Andy McGibbon  11:27  
workflow. Yeah, I'll jump in. This very interesting paradigm that we operate in is very different. If you think of a surgical robot where a surgeon is ultimately driving that with our device, it's essentially autonomous. And so we're really trying to de skill this to the extreme, because that's how it works to get coming back to the economics. And so when we thought about how is a user going to use this, our main users that we were thinking about was really the patient and the phlebotomist and the clinical KOLs that you'd normally think about driving the development of the device weren't really as insightful into what the needs of the phlebotomist and the patients are. So I think that really, you know, I guess I'm still gonna wait for my pet, Roomba, but I think we really thought about it from a consumer perspective. How could the patient and the user end up being

Josh DeFonzo  12:13  
comfortable with that? Yeah, I mean, it's super, super similar. So if you have a robot that's more commonly used, I think it has to be even more approachable. You know, I think a lot of people in robotics, and I've heard this, like, pretty classically, when you're talking to people, like, oh, the first version is going to have workflow challenges, and they'll, they'll point back to something intuitive did, like, 30 years ago, like the first prostatectomy and took 15 hours. Like, sorry, but that was 30 years ago. And I don't think that the expectation is that's okay anymore, right? So I think that the market has been conditioned to see what like excellence looks like. And so you have to ask yourself, when you inject a robot into a workflow, you own all of the workflow. And so, you know, on a first principles basis, is like, how do you make it just work? It sounds really kind of trite to say that, but it, but it needs to. IPhones wouldn't be as successful as they were if they didn't just work. AirPods probably wouldn't sell as many of them, though, mine don't connect all the time. But you know, there's something about that user experience that I think is really special. So if you're gonna try to enhance somebody in some way, I reject the premise that there's a trade off that has to be made. And of course, there's some trade off around the edges, but if it's big, existential stuff, like, I just don't think it's gonna

Andy McGibbon  13:19  
work. Yeah, maybe building on that too. I think looking at Neptune medical, which I mentioned previously, I remember in their pitch deck, they had one of my colleagues, five year old sons, driving the robot, because that's how intuitive it was, and it's and I think as you start moving to these higher volume things, you don't want something that's, you know, a high burden just to to operate. Right?

Henry Peck  13:43  
The thing Josh you said earlier about where your robots play, right? You're playing a phlebotomy, you're playing a biopsy and adjacent procedures. Sounds like you guys have covered everything. We're friends, yeah, but sounds like he hasn't covered everything, right? That's that's all the all the unmet needs. We've covered it all. We've got intuitive now. We've got these two robots. We have a testra. We got Mandera. We're done. We're done, right? We're done. Can you talk about from your needs finding process that you did when you started Mandera, which was an interesting process, tell me, you know, did you find a couple of other inefficiencies you could have gone after? Are there, you know, one or two, or are there orders of magnitude more?

Josh DeFonzo  14:18  
I think there are millions. Is probably a little hyperbolic. There are 10s of, if not hundreds of opportunities for robotics in care delivery. If you just want to focus on the hospital setting, people will always talk about how much you know I have a technology. It's more efficient. I'm making the operating room more efficient, right? Whatever the dollar amount is, I don't even know off top my head anymore. But like a hard fact, that is true, we spend one point true to trillion dollars in hospital based spending. In the United States, there's about 6000 hospitals, right? They don't all do surgeries. The average hospitals operational expenditure is $200 million and the average percentage of that, which is labor, is about two thirds. It's called $140 million if you divide that. By a half a million minutes a year, which is about how many there are. The hospital spends $225 a minute on labor. So whenever you see people sitting around, screwing around, wasting time with something like that, is an opportunity. It doesn't always have to be. I'm gonna go change the world. And, you know, do remote thrombectomy. That's a novel, that's a that's a novel and noble thing. I'm gonna cure cancer. Like care delivery in this country sucks. Being a patient in a hospital sucks. And we always tell people like that is all that should suck. Receiving care should not suck. And so whether it's like moving materials from the shipping dock up to sterile supply, whether it's automating, you know, central sterile supply. Like there's a million things you could do, and it doesn't have to be, oh, the secret three and burst $60,000 and we're gonna make a mint here. I think you can make a mint by doing really well and delivering simpler robots that are task specific to do just kick ass jobs and solve unmet needs, frankly. But yeah,

Andy McGibbon  15:56  
and I think there's one, one thing that was new to me as I dove into the world of the laboratory side of the hospital is, if you look at what happens is, for example, after a blood sample is taken, it's actually extremely automated. No human touches it. From the minute that blood is put on a conveyor belt until the results are spit back to the patient. Most of those samples don't have anybody touching that. And so I think it's interesting, when I look at where there are opportunities for automation, there's some interesting ways, even in the hospital, to look for inspiration that aren't surgical robotics. And I think, you know, I think also the other trend here of robotics, and I guess, kind of delivery of care, you know, if you look like forward health, I know you know that unfortunate outcome there, but I think you start looking at things where it is bringing technology closer to the patient. We already have a staff shortage. You're gonna have to automate and have to have robotics as a part of those solutions. I believe, with

Henry Peck  16:47  
your robotics being one piece, obviously, over time, the generality of Robotics has been kind of more pervasive in healthcare. It's no longer the kind of maybe as shiny piece of technology at the moment, but AI, autonomy really the technologies at the moment. And if we look at where healthcare is today with those technologies versus what's happening outside of healthcare and self driving, for example, I'd say that healthcare isn't exactly the fastest moving of the AI, adoption areas. When you think about actually delivering real value with autonomy, AI, computer vision, etc. How are you sourcing talent? Where's your talent coming from? How are you building your teams? Are these people coming from bona fide Medtech, strategics, other robotics companies that have operated in, you know, more of the traditional format outside of healthcare, healthcare,

Josh DeFonzo  17:37  
there's a lot, lot to unpack there. So the first part, the AI piece, I'm super excited about what, what, you know, machine learning, artificial intelligence, can do in healthcare. I'd say the structural disadvantage. And if anybody in the audience has a solution for this, I would love to talk to you afterwards, like, if you're if you're designing or developing autonomous big rigs or cars, like you can plunk somebody in a car and go and generate massive unique data sets. It is really hard to get massive multi modal data sets in health care that include all of your radiological imaging, all of your H and P, your unstructured data, data, your genetic it's just it doesn't exist. And so the thing I beat my head on a wall against every single time I've been involved with a connected medical technology is like, where do you get the data? And somebody's always got, like, it's corny a DVD of like, I got these 600 patients. It's like, it's not, it's not, that is not data at scale. So I think that there's, like, a structural challenge for AI there, which leads to the second point, which is it is actually tougher, in my opinion, to recruit people in AI, in particular, in the world of robotics, particularly, as you've seen, like all the humanoid robots outside of healthcare garner so much interest in investment. I mean, there's just massive companies out there making laundry folding robots, and we actually compete against that. We don't necessarily see ourselves competing for talent, like another med tech company, necessarily. I kind of feel like we're all in it together. It's like, I worry about flight of, you know, intelligence in healthcare, it's really, that's really frightening. So we do manage to recruit people. We do pull people who are, like, very mission oriented from those tech companies. But it's, it's definitely not an easy lift. I mean, I think recruiting is one of the most difficult

Andy McGibbon  19:17  
things. Yeah. I think, yeah. I mean, if I look at figure AI, you know, it's like a 29 $30 billion valuation, and I think they maybe have a contract or two. So, I mean, we don't see those kinds of things in healthcare, and so I think, you know, when you use too bad to get, yeah, that's right, maybe next year, right? But I think you know that that does pose a disadvantage to us. I think the tastro specifically is a little bit of an exception. It's a Dutch company. So the pretty much every engineer we have is based there in the Netherlands, and actually has very good engineers. So we're first for and I would say, compounded with that, we're not competing with Bay Area AI companies. So I think that's provided a great advantage for us, but fairly unique to the situation. Know, if I look at other companies in our portfolio and Saunders portfolio is it's the same situation. I mean, you're having to compete in a very difficult labor pool with the buzz that's going on there.

Henry Peck  20:09  
You're talking about the the idea of these companies outside of healthcare, raising these massive rounds at these massive valuations. And there are some, you know, tremendous outcomes in B to B, SAS and high tech and whatnot. Obviously, your companies can't be playing for the traditional med tech exit. You've taken 90 what million in capital? How much 9999 and your company just announced the we've fed 50 and right large round. So if you just look at the simple math here, the, you know, $300 million exit probably doesn't move the needle for the needle for the investors, and that can't be why they're doing the deal. How do you think about your you know, where you're going with this company? What's the exit horizon? Where do you think it can be, and how big can it be? 

Andy McGibbon  20:53  
Go for it. 

Henry Peck  20:55  
You're on the record for this. 

Josh DeFonzo  20:56  
Yeah. I mean, so I have a very contrarian view of this, and I just, I think it is almost as hard to make and build a $10 million company as it is a $10 billion company. It's just, you're gonna have setbacks, you're gonna make wrong decisions that you need to learn from and correct quickly. And so my attitude has always been changing healthcare is hard because of the multi sided stakeholder dynamics. You deal with regulatory, who's the buyer, who's the user, who's the recipient, like, there's just, there's a lot of complexity there, and it has always really been difficult for me. My first two startups were definitely the investor syndicate was much more traditional. Med tech, we would be funded milestone to milestone, and I felt like 80% of our effort was fundraising and operating the company. And so I've taken a viewpoints like, You got to try to find people who are going to help you fund through two or three milestones. You got to stay super engaged with them. You got to be disciplined. You got to execute your ass off. But you should be trying to build the biggest, boldest, most ambitious thing you can. And so like, yeah, aspirationally, I don't know it'll happen, and I'm going to be humble about it, like we're trying to build trying to build minder as a standalone, self sustaining company that can scale and create a ton of value and hopefully go public. But I think you have to have that mentality from the start, and I think you gotta find people who are aligned to that vision and are gonna be willing to kind of wade through the muck with you, particularly the muck that is the healthcare ecosystem.

Andy McGibbon  22:21  
Yeah, and I agree with that. I think, I think the so starting with Vitestro, definitely an opportunity that we see to take this public be a durable public company with plenty of opportunities in the in the product portfolio, to expand out from where we're established now. But I think the challenge is, yeah, very much. So in Medtech, everybody's doing the math on a three to $500 million exit, saying, Well, that's what most successful outcomes are going to be. And yeah, that ends up kind of rethinking how you approach your capital partners and how you're funding the company, and what you're funding for. And so making sure that you're aligned is going to be a very important part. And sometimes that's not the traditional folks that we see, you know, floating around the halls here sometimes. So

Josh DeFonzo  23:04  
yeah, and one other thing, I'll acknowledge that that is very much how the ecosystem is right. In healthcare, you've got a limited pool of strategic choirs, correct? It is a super important innovation engine. So it's not to knock it. I just, I think it is just as hard, though, to build $100 million or get a $200 million outcome as it is to swing for the fences. And so you just if, if that is one's orientation, which in robotics, I think it largely has to be robotics. I mean, Andy, you guys are 50 in, we're 99 in, and we've got a little ways to go. Like, we will probably raise, you know, God willing, another 50 to $100 million that's that's just an impedance mismatch, as you're pointing out with like, if you raise 100 and you're only getting three to five, no one's going. To five, no one's really playing for a three to five, I guess. So, pick your poison. Yeah,

Henry Peck  23:47  
I think that one of the things where I'm interested in to kind of see how it plays out, but it's really exciting to see, you know, smaller M and A revive this year. There's a lot of momentum, and we see the large strategics buying things earlier, hopefully, you know, a little bit before. It may not be kind of the like, you know, kind of off clinical data, like it was at one time. But it isn't just, you know, the shock wave size M and A anymore, which feels good at the same time. When you look at like, the shock waves and the irris and those things kind of come off the board and get tucked in. You talk about that consolidated set of strategic acquirers. I question if it's good for the health of the ecosystem long term. You know, if you think about a company like Wiz, for example, that got acquired by Google, there's a lot of companies that can buy and that company can be massive and buy its own companies. And do you think that? You know, how do you think about that for the health of the ecosystem? And hopefully, selfishly, you guys are thinking about becoming companies that can acquire other companies and continue to power that flywheel.

Andy McGibbon  24:46  
Yeah, I think consolidations is a big challenge in our industry for this perspective. It's not just necessarily an economic perspective, but I think if you can have successful outcomes, you can have little in, moderate out, you can have big in, big out. But I think when I think. Of you know, if I combine a few different data points here, if you look at that, that period from regulatory approval to get, actually getting your reimbursement, how long that takes? I mean, that's a huge barrier. That's where strategics actually can fund something through, you know. And when you have consolidation, if you start thinking about just, what are the incentives, you have an incentive to wait to buy something. I mean, if there's no competition, why take it out at whatever the the data is here, you always will get more de risk as time goes on. And so there's, there's really a mismatch of incentives there, and I think that, you know, poses a threat to innovative, impactful technologies actually getting out to patients, because they might die on the vine without a healthy ecosystem of funders and the acquirers, which are going to be that, you know, virtuous cycle, you got to build up. I

Josh DeFonzo  25:48  
mean, Andy covered it pretty well. I mean, it's, 

Henry Peck  25:50  
Oh, nothing, 

Josh DeFonzo  25:50  
oh I got, nothing.

Henry Peck  25:52  
Well, I got one for you then to maybe, let's see. So you Josh and Andy both maintain relationships with pretty prominent venture funds, both inside our space and out. Lux capital, you guys have proven operating careers now you're having these companies with these huge visions, incredible technology, going after massive problems. It must be super easy for you guys to raise capital,

Andy McGibbon  26:14  
of course. Yeah, yeah. Next question, tell me. Tell

Henry Peck  26:19  
me what it's been like raising capital for something like this. That's counter narrative, complex, et cetera.

Josh DeFonzo  26:26  
Yeah, so I think again, it comes back you, and I talk about this a lot. So we have healthcare investors who invest in mindera, but they, generally speaking, are general technology funds that a subset of what they do is healthcare. They generally are managing more money, and they generally look at, sort of, what is the return that's needed, and what is the opportunity for the capital going in here. And it's, frankly, I think this is my view of it. They're diversifying into health care, versus somebody who's only in health care. Raising money from them has been, relatively speaking, more straightforward than in the health care environment. One of the challenges that we get in the health care environment we the healthcare environment, to be really frank, is my indication for use for my product is precise instrument placement with real time imaging. The next question I get from someone who's like, what is the one procedure you're going to start with? And well, it doesn't really work that way, because when a urologist picks it up, urologist put needles in the body for 12345, and they'll go, Well, do you have your pre clinical animal data on x and y? And you're like, No, the problem is, of the procedures that de urologist does today, 70% of the time someone else helps them with it. I now enable this person to do it themselves. They love it. They're excited they're going to do it. And they go, how do you know? I'm like, Well, when we get the money, we will finish the development of the product and show you So and these are real conversations, and it's super hard. I mean, a seeds and A's, I think relatively speaking, more straightforward, never easy. B is really, really hard. So when we raised our B, we were just finishing development, we had not submitted to the FDA, we had pre clinical data, and everyone's like, wait and see. Attitude, yeah. So it really is finding that person who believes in the vision. That's that first domino that falls over, who's like, I get the vision I'm in. I see that there's risk. I'm willing to assume that risk because I don't want to pay the price later. And when that person does it, you know, good things happen, but it is through a boatload of effort. I mean, it probably took us 12 months to sort of make that B, yeah. Well, yeah, I

Andy McGibbon  28:21  
agree. I think the B is very difficult round to raise, and I think, I guess, a couple pieces to build on that. I think to be appealing to the more general investors, I think you have to have those bigger stories, because that's also what they're looking for, generally speaking, is not these, you know, iterative, couple 100 million exits for them. You know, they're managing massive pools of capital, and they're going to need something big to move the needle for their fund size. So I think that's an important thing. And then I think for the B, you know, I'm now on the other side of the table. And yeah, the B is a difficult one. There's there. What we've what you know, our experience has been, is, is most med tech growth investors need the check boxes. They need the regulatory they need the US commercial traction. And then, you know, especially when you're looking at at capital intensive companies like robotics, you know, we're probably too late, so to speak, for the early investors. So it's an interesting kind of chasm that you're in right in that series B, and you need, and it's yeah, we'll see. 

Henry Peck  29:23  
And well, with the last minute here, I want to ask you guys, when we see you again this time next year? Where will Mandera be? Where will the test row be?

Josh DeFonzo  29:31  
Yeah, so we, we're pending FDA clearance. Now. Feel good about it. Don't know for sure. Hopefully we are cleared on the market. Our main objectives for our initial release is that people use the product, love the product, and that the clinical, operational and economic benefits are what we expect, that they are. So hopefully, this time next year, we're sort of emerging from our initial market release and starting to scale up. Yeah, and I

Andy McGibbon  29:53  
think for us, we're doing a lot of the US market development right now, we're a little bit, probably six to 12 months behind where. You are in terms of the US side of things, but on the European side, as a Dutch company, we're already CE marked, and so we'll really be focused on developing some centers of excellence over there, translating those learnings to our clinical partners here in the US.

Henry Peck  30:12  
Awesome. Well, thank you guys so much. I look forward to seeing you again when, when all those things are true, and then we can talk again about all the challenges you're facing.

Josh DeFonzo  30:20  
Thanks to you. Scott Kelly, the whole team, yeah, thanks for having us. 

Andy McGibbon  30:23  
Yeah, thank you.