The New Standard of Care: What Market Opportunities Are Ripe for the Next Generation of Digital Surgery? | LSI Europe '23

Transcription

Peter Thier  0:05  
Good to have you all up here with us we've got a great panel going on tonight so that Jonathan from AiM Medical Robotics, Jeff from Moon Surgical, got Lawrence from Image Navigation, got Nicholas from Medinbox. And I thought maybe we'd start with some easier questions kind of lob out there and first one I have for you guys is tell us where you're from and something great to do from your city. Let you first

Jonathan Sackier  0:34  
Speech defect, I'm from London. thing to do in London is go for a ride in a black cab. They have to do a four year training course called the knowledge riding around the city on a moped and also learn to speak cockney rhyming slang, which is a street patois, composed of couplets. I wrote a few down do you want me to? 

Peter Thier  0:57  
Yeah, please share.

Jonathan Sackier  0:57  
It's medical too. So "I got in the flounder and hayver and said, Would you Adam and Eve it. Take me sharpish down the doubting cynic, I got a right Michael in my Paris, happens when I have a horse or a pony. Reckon it's my child fonts, I'm gonna need some Persians or a drum. Better yet, take me down the battle cruiser. I'm gonna get right Brahms and list because this ain't no bleeding bubble baths." And I'll tell you what it means afterwards. 

Jeffery Alvarez  1:30  
I grew up in San Francisco Bay Area. And one of my favorite things to do is go out to the coast to a town called Halfmoon Bay, and just enjoy the waves in the ocean. But most especially eat at a place called Barbara's Fish Trap. And this is a place that has wonderful fish and chips and the most amazing clam chowder. But be warned, they only take cash. And so you gotta you gotta come equipped with a pocket full of cash and not not credit cards, but it's fantastic city and wonderful restaurant.

Peter Thier  2:02  
It's a beautiful part of the country.

Lawrence Obstfeld  2:05  
Good afternoon. I'm located now in Jerusalem. And I think my three favorite things to do are one, the Machane Yehudah food market, with many vendors, don't buy the tea, the dried tea. But the spicy food, the non spicy food, the noise, the confluence of people, it's great. It's on the light rail, take the light rail around. And if you're in Jerusalem, go to the museum of the blind. It's, it's fantastic. We're talking about augmented vision that will give you the experience of what it's really like if you don't have sight.

Nicolas Gausserand  2:42  
So I'm almost the local one because I'm from the other side of the border from a city called Toulouse. And so most of the panel is from the other side of the ocean. But in Europe now as very important, actually to me, it's the World Cup of rugby. And two, this is the capitol in front of families I would really recommend to to see a game in Toulouse, we are feeding the national team. So we have something like 10 players in the national team. So good looking them.

Peter Thier  3:17  
That's great. I'll give you a share on my end too, because lately I'm from Boston, remembering a little south of Boston out of the cape, Cape Cod. And lately we like to try and swim with the sharks. So if you don't know we've got the largest population of white sharks in the world right now off of Cape Cod. Cool. The other one I want to throw out to you guys just because I'm personally interested. What was your favorite concert? Or most recent concert show?

Jonathan Sackier  3:46  
There's a jazz club in London called Ronnie Scott's go there whenever I can, amazing place and now that there's no smoking and it's even better so yeah, I go as often as I can there last week. Wonderful. 

Peter Thier  3:57  
I'm gonna make you take me

Jonathan Sackier  3:59  
 With pleasure.

Jeffery Alvarez  4:02  
If you've worked with me, then you know that I'm a big fan of reggae and my favorite concert was ground nation which is a fantastic rave, reggae band. That was one of my most memorable concerts. That's great.

Lawrence Obstfeld  4:19  
I'd love classical music in theory. But I will talk about an event I was actually to which was my nine year old son's last baseball game. He is the strikeout king and his team. If you're in Europe, that's not like striker. It's not a good thing. It means you swing three times at the ball you miss you're out. So in the quarterfinals, nine swings, three strikeouts, the semifinals, nine strings, three strikeouts, extra innings bottom of the seven. He's already struck out twice. He has two strikes out of and he ripped the ball to the First hit the game winning run, his friends poured Gatorade on them. It was a life changing event for him and the family. That's my favorite concert.

Peter Thier  5:09  
That's a memory for life. 

Nicolas Gausserand  5:11  
For me, it's quite recent It was last summer we have a famous jazz festival. And as a young piano player called Sasha and tama, he's something like 26. He's just amazing. He's, uh, he was playing alone with a guy on drums. And it's someone to listen to discover. It's just amazing. 

Peter Thier  5:33  
That's great. I was an 80s child. Def Leppard 80s. Rock was one of my favorites back then, and my most recent one, so I'm drummer. Alright, let's throw you guys some some real questions, I want to give you a chance to really talk a little bit about yourself, your company, and really understand how it's changing the game in your particular space.

Jonathan Sackier  5:54  
Well, I feel a bit of a fraud because I'm here as I'm an investor, and I'm on the board of AiM Medical Robotics, but it's my fourth robotic rodeo. And I'm blessed by knowing nothing about anything, frankly, a number of years ago, I had the good fortune to be introduced to your (Name), who was the true genius behind Computer Motion, but I helped him transition from being you know, a defense based technology to a medical technology. And I, you know, just got to do the things that I had no right to be doing. And that company did really very well became the backbone for what is now the intuitive platform. And then you'll ins next rodeo was a company called in touch which was a holonomic platform for telemedicine. I served on their board. Humans become a wonderful and very dear friend. And I've helped him now with his world telehealth initiative. And I came across this technology, someone cyber stalked me actually through LinkedIn. And I saw this technology and I thought, My goodness, if you can do true image guided surgery in neurosurgery, I did six months of neurosurgery in my training, and I saw that you know, the brain, there's very little room for error. I spend most of my time Googling around in people's pelvises dealing with colon cancer. This is a whole different kettle of fish, if you will. Well, and yeah, pretty much it's important in all surgery, measure twice, cut once, but in neurosurgery it's critically important. And I know enough about the subject to be dangerous. And the true innovators here are Greg Fischer, who has built a robot that works inside an MRI. They've taken it all the way to human use in prostate. But and that was all done with NIH money. We then licensed it started the company. But we've chosen as our first target neurosurgery because it's not a cluttered environment. No one else. There's a few other people playing in prostate I believe. And no one was doing what we are able to do. And the other name to mention is Julie Pulitzers, Julia is a very, very brilliant functional neurosurgeon. And it was her idea to do this. And Julia is a force of nature and one of the sweetest people on the planet. So my role is just to try and tell silly jokes and help them get the money together and all the different assets. So it's an amazing adventure. And just one other thing. And I'm going to steal shamelessly from Bill Cook, who said if you put the patient at the center of anything you do in medicine, and you make their experience of healthcare better, you'll be commercially successful unless you're a complete klutz. So it's our job not to be complete klutzes.

Peter Thier  8:39  
You're doing a great job so far. We'll throw it to you as well.

Jeffery Alvarez  8:44  
Let's see. So my background was originally in mechanical engineering. I got an MBA along the way at the Haas School of Business at Cal Berkeley. I've been in surgical robotics for a long time since 2006, I had the opportunity to work at a company called Hanson Medical that did intra vascular robotics, and led some activities in their advanced development group. From there, I joined a company called aurus health that as their first employee and helped grow that business through its first five and a half years of, of life. We started off in cataract surgery, we built a cataract surgery robot that could actually go in and remove a cataract it was fantastic, but ultimately pivoted to interventional pulmonology and biopsy and lung lesions. At Moon Surgical. I'm the Chief Strategy Officer. It's a fantastic soft tissue robotic platform that is really revolutionising the space in a way that we haven't seen to date. It's an entirely new category of robotic surgery, where we enable surgeons to have complete control over all of their instruments without compromising their surgical technique, their preferred instrument set and we do so in a way where we really have the ability to monitor the operating room with a variety of sensors and understand how to improve workflow for efficiency. One thing I've learned throughout my career is how important workflow is in understanding workflow especially around robotics, and optimizing it. And at Moon Surgical we've we've kept user experience and workflow efficiency at the at the heart of things and have developed a platform that is so incredibly easy to use. It only takes about 15 minutes to train a surgeon before they're, they're functional and running and you can't hold them back anymore.

Peter Thier  10:39  
Love what I've seen about that thus far as well. And alright, so now we're going kind of in a different direction with Image Navigation but really wholly supportive of what we're trying to do with the industry here. GPS navigation for the dentist.

Lawrence Obstfeld  10:53  
Yes, dentists are challenged to do implants in the jaw. It used to be that dentists made their their income doing crowns. But now implantology is extremely important to the dentists and drooling does grow in the jaw, it doesn't require the same agility or hand eye coordination as doing a prep a cavity, Crown prep. However, there's visualisation challenges because the bone is submerged the dentist is now doing orthopedic surgery. So what Image Navigation does is enable the dentist to see on screen where he's drilling. And using this the skills that he's built up without compromising any of the hand eye coordination skills that he's built up over the over the years. I came into the company in 2008, it was a division of a publicly public Australian company had run out of money. My partner and I bought the company we we paid off all the debt and built up the team and we had now invested 20 plus million, I have a couple of roles. One of my roles is to adhere the r&d goals to the US market because the way dentistry works in the US is much different than the way dentistry works in Israel. Your target market is much the target market, the large target market, we have dentists that on CT scanners doesn't exist in Israel. And so that involves a lot of discipline with the r&d team. And also understanding how to develop the workflow that's patient centric and, and dentists centric. So on a small team and you know, I need to do a lot of hands on management of strategy whether you know people who are more qualified than I, and even some project management, but it's a lot of fun. And now we're out here raising a B round.

Peter Thier  12:58  
Nicolas, really enamored of what you guys are doing it back and box for the audience.

Nicolas Gausserand  13:03  
At Medinbox, we are digitalizing international rooms and in cath labs. Since 14 years, we were the pioneers in what we call the medical video collaboration. At the beginning, we came from medical education, I had the chance to work with the pioneers in interventional cardiology. And we were filming and transmitting procedures for live education or recorded case and learning a technique is observed and been observed. So, we moved from transmitting images for educating large audiences to giving access to the rooms from people from around the world to give guidance during during procedures and interventional rooms are very complex environment that a lot of Imagine if you take only an image of camera, you will not have the entire view of the of the procedure. So we are integrating complex systems. We have built the platform and we allow all the the team or the medical teams to receive guidance to we reduce also the unimportant bottleneck for the industry about the technical support. A lot of procedurals requires a sales rep or clinical expert to be on site in the operating room with the surgeon and they have difficulties to find the good match they are difficulties to adjust the agendas of everybody and giving this remote access is removing the barriers and reducing the this this bottleneck.

Peter Thier  14:54  
And Nicholas remember right you've had great uptake with your system thus far. So a lot of inch First in the market in your system already.

Nicolas Gausserand  15:02  
Yes, there's a lot of interest, we already have a large footprint. So the companies, we have created the company in 2010, we have more than 350 systems worldwide, we are in every continent. And so he has a lot of traction. And it started, it took a long time, why? Everybody's always asking why it's so long, we are all started. And the market was long, too. Say to open because it was difficult to the transition was difficult from the inperson to the digital. And the COVID happened a couple of years ago. And it was a real game changer for us. Because from pilots or just projects, we moved to the only available solution on the market. So we got a lot of exposure at that chain at that stage. And it changed everything for us. 

Peter Thier  16:11  
That's why I had a question for you as well too, and that you've taken maybe a different tack to some others that are in your space, right? You don't use a robotic arm correct in design. Why that decision. And how's it helping you advance the game for for image,

Lawrence Obstfeld  16:30  
okay. We use navigation because first of all, it's easy to connect to the teeth, and you're you have all the hard the bone that's connected to the teeth. You can also screw put screws into the jaw if there are no teeth. So it's ideally set up for navigation wherein you can have fiducials attached to the jaw and to the handpiece. Right. Okay, the wildcard is that the patient is moving and the tool is moving at the same time. There's no general anesthesia. So if you use any of the methods of general, for hip surgery or spine surgery, when you have a barcode type tracker and you have a delay of a half a second or a second half in the image update, then the navigation won't work. So we decided to put our investment into developing a no lag tracking, we update the onscreen position 50 times a second is faster than the blink of an eye. And that allows the dentist to operate freehand and he can depend on what's on the screen. But if you can't depend on what on the screen that it it would be logical in dental implantology to go to a robotic arm, but a robotic arm has a cost of $60-$70,000 at least the ones that are our competitors using. And I don't think it's as accurate as the the hands of the actual dentists. So I guess it was we saw an opportunity we saw the clinical need, which was to let the dentists operate. And we saw an opportunity to create real time tracking with no delay.

Peter Thier  18:02  
Thank you. Jeff, I'm gonna come back to you as well, because I remember from our conversation, you guys really have decided to take a specific, unique tact in robotic surgery. Right, supporting the surgeon versus going after kind of the same markets and others are going up. So tell us a little bit about why you decided that.

Jeffery Alvarez  18:22  
Yeah. So with us, one of the things we realized is there's a large surgeon shortage that we're facing. And it takes about nine years to chain a train a general surgeon, for instance. And the last thing you want to do is introduce technology that is complex, so complex that requires them to do additional fellowships, or they have to spend weeks of training programs. And so we said what can we do to empower their existing tools, there are existing techniques to enable them to do more, you know, with with those things they already have. And so in looking at that, we figured out that one of the most important things was to not disrupt the surgeon from looking at the screen, the laparoscopic feed video feed, because when they're looking at the screen, and they're manipulating the tools, that means this surgery is progressing. And in our development process, we thought about all the things that we could do. And if it brought that surgeons away, eyes away from the screen, we thought really hard on whether that was worth it or not. Because if we can keep the surgeon going, if we can keep that procedure progressing, then that doesn't disrupt that workflow. It doesn't disrupt the flow of laparoscopy

Peter Thier  19:44  
Focused on workflow. Yeah. All right, maybe I'd like to understand a bit more about your journeys right through through this process as well. So trying to help us understand and Lawrence, we'll start with you this time. Kind of the challenges that you guys have experienced in it Developing getting this funded, approved and commercialized over the last several years.

Lawrence Obstfeld  20:09  
So I started operating the company in 2008. And the GPS for dental implantology GPS needs a map which is a CT scan of the jaw. However, dental CT scanners in 2006 cost $500,000. So the investor base, the investors I spoke to view this as a scientific oddity because taking a DENTAL PATIENT for an implant down to Mount Sinai Hospital and putting them in a CT scanner, make no sense. So, I really couldn't get any meetings with VCs until like 2016 or 2017 when the inflection point was reached and dental CT scanners started to take off. Even so it was really difficult. So we were able to fund primarily through angels. And it's like that Radler Kipling poem if you can hold on when every nerve and sinew says give up. We face many of those I had a very, you know, very courageous partner with a longer term vision. And you know, King Solomon says cast your bread on the waters, and the interpretation is you don't know what is going to come in for you. So I never dreamed that my investor would put up over $10 million into the company. But that's what happened. The other thing that that irritates me, no end is that one of our competitors raised 130 million. And I am sure I'm better. And I admit I'm jealous. And you would think that one of the savvy VCs that invested in that would have done an internet search and called me but some of these guys I wrote and they wouldn't even take a meeting. So I think that's part of the barrier of, you know, lack of in person contact, I think I think this conference helps. I've met a couple of people here that I couldn't otherwise meet. I also think the game shifted from when I was an analyst and investment banker sending emails to people and calling people as much harder to connect with people now. That's sort of the crystal,

Peter Thier  22:23  
We've got investors in the crowd, let's make sure we change that. Thank you. Yes. Nicholas. Challenges you experience through the last several years really, since 2010, getting this commercialized.

Nicolas Gausserand  22:37  
So we have, especially three, we bootstrapped so far. I think there's not a lot of companies like us in, in this area, and also as something that gives us the feeling to be like, you know, like a cactus in Greenland. We are profitable. So someone told us that maybe that's just the organizer who are profitable in this in this place. But it's linked that how the business was was driven. So we started for medical education, with Fred, Weaver, QL, all around the world. So it was the leading education, educational centers. And we were investing every time the results in software development and sales. And for the sales, we never had the sales force. It was always our sales force was the our customers. So we developed the business like that. And I remember just after COVID, I started to receive calls from from VCs asking us how much that we need needed and no answer because at that stage, we were still in the process to to develop organically the company and they were starting to explain you have people raising money, look at Poximie, look at Avail. And we said yes. Okay, that's interesting. And, but we have to process and to think, and we have processed now we are done thinking and and we are in the process now to raise money, but it's quite new. We are not in a rush. We are looking for partners who will help us to develop the $2 billion business and that's, that's a new story, which is very, very interesting and, and challenging because I think it's not the perfect timing to raise money today, but it's it's challenging and really interesting.

Peter Thier  24:56  
Nice road that we talked about, kind of from inception. Till now, Jonathan, you came on to kind of help through some of these challenges, right, helping him through some of these challenges. 

Jonathan Sackier  25:07  
Yeah, I mean, from my perspective, as someone who who invest in I started companies, if it's when you start a company, it's because it's something you love, or you're good at, or preferably both. And if you think you've had a great idea, chances are a lot of people who haven't had that idea won't get it. If it's obvious, then it's probably not unique. And if it's obvious, then it's probably a me too product. And it's probably not going to give the great returns. I don't like to boast about those sorts of things. But when you get those things, right, my goodness, it's satisfying, right? So let me think, a couple of quotes, one would be have some of and I'm paraphrasing, I can never remember these things. "To the uninitiated that any sufficiently advanced technology is indistinguishable from magic." Investors, especially sophisticated investors, not me, I'm not sophisticated. But VCs, they want to see all sorts of projections, they want certainty, they want accuracy. And I've had conversations about AiM with some investors who said, come back to us when you've finished your first one human. So my dear chap, when we've done first in human, I'm not coming back to you. Right? If I have to mortgage my house and sell my kidneys, that's what I'll do. Right? Because that is not a venture investment. That's a sure bet. Right. So the environment has changed. The second quote, would I think it's Seneca, that "neither has a jewel sparkled without abrasion or a man achieved without challenge." I actually relish these things. It's what makes the juices flow, right? When you take something and you and you're told, no, you can't. And it's a Thursday evening, and you have no idea how you're going to make payroll. Incidentally, does anyone else think that we're in like the 1960s, in LSD dreams?

Peter Thier  27:04  
Very, because I noticed that a lot of the time. 

Jonathan Sackier  27:06  
But you know, we, this technology went through peer review at the NIH three times. And Greg Fischer won those grants. And anyone who's met this, he's a sweetheart, but he is he's like, if you call Central Casting said send me a mad scientist, you get Greg. boundless enthusiasm, brilliant invention. He then takes it all the way to using it on a human being on 30 human beings, in fact, in a prostate trial, and it did what it says on the tin. Now we've moved it to do the same thing in the brain. And people saying, Yeah, but you know, it's the brain. It's not the prostate. Yes. Understood. But it's, it's, it's the concept of targeting, it's the concept of precision. I fly airplanes for giggles, a Piper Cub can fly from point A to point B just like an F 16. Can. But they're, they're designed to do different things. And it's like saying, well, we can't build an F 35. Because we've never built an F35. Well, you built the F16. Technology's moved on, go with the flow, right. So I think I think the trick is, have a great team, you know, have a good idea. I certainly have a great team, have a great team and have a great team. We've got a great team. I'm just there as a cheerleader and glue.

Peter Thier  28:32  
And there's registering progress over the last

Jonathan Sackier  28:34  
Amazing progress. Last week, we we finished the the version that's ready to you know, go through the design history finalized. So 13485. We have done all the in vitro testing, we've done pigs, and we last week did a cadaveric head, we hit that foot, we hit the target the first time, and the Moto has hit the target first time every time. Because if anyone here knows anyone who's had a brain tumor, or Parkinson's disease, or epileptogenic surgery, and has had to have it repeated, because they missed, right? That's what this technology does. And the game, put the patient at the center of all we do will save money, we'll do it more effectively, more efficiently. It's a better patient experience. And it doesn't disrupt the workflow your as a surgeon, you're 100% Correct. Because if you disrupt the workflow, and by the way, what you don't do in the United States of America, where I practice for many years, you do not hit the medical team in the pocketbook. Because if you do that I don't care how good your technology is ain't working. And by the way, Tripling Ring a big thank you for the work that you guys did on on this technology. 

Peter Thier  29:49  
Thank you. Jeff, tell us about your journey.

Jeffery Alvarez  29:51  
Let's see. So I would say two of the biggest challenges that we continually face are distractions and assumptions and I think in flushing out any opportunity focusing on is this a distraction? Or is this something that we really need to do? is an incredibly important question that you need to answer. Ask yourself. The second thing is assumptions. And we all go through developing new technologies with base assumptions, the technology does this, it'll be successful. This is the value of grades, you constantly need to get out there and test that assumption. And that means also getting outside of your Echo Chamber, don't just talk to the same people that look like you or talk like you are in your network. Get out and talk to as many people as you can. And that is what allows you to bring that information back continuously iterate, change your assumptions, and ultimately end up with a product that is very high value to ultimately your customer. That's the the, the mindset that we've built at Moon Surgical, and has allowed us to actually stay very fast and focused. Because we've set up very deliberate milestones. And anything that comes up we say, is that something that we should be doing right now? Is that, you know, gonna take us away from moving the ball forward towards the next milestone. And we even think about, is it good enough to kind of move on to the next thing, right? Because you can always come back and grab the ball again, and move, move it, move it forward. And so we are constantly playing this game, where we're looking at our assumptions, thinking about our distractions, and figuring out how to keep progressing towards our milestones as aggressively as possible.

Peter Thier  31:45  
So it's a challenging thing to do, particularly with smart technical teams that want to investigate, resolve challenges that do come up you don't necessarily need to deal with right now. 

Jeffery Alvarez  31:54  
Yeah, yeah, there's a lot of times where we say, let's put that on the shelf. And we address it later. Right. 

Peter Thier  32:01  
Come back to that later. 

Jeffery Alvarez  32:02  
Yeah. And there's plenty of things like brilliant ideas that we should look at right now would be so cool on our system, but it may increase the friction, it may disrupt the workflow, it may delay timelines. And so it's let's we can't do that right now.

Peter Thier  32:19  
Great. And I'm going to be mindful of time here. So I'm probably gonna go to my my last question. Throw it all out. I'll let you but as you're starting to approach meeting your initial goals, kind of what's next for the organization? Where are you going next? Jonathan, why don't you start?

Jonathan Sackier  32:37  
Well, there's a very clear Gantt chart, you know what a Gantt chart is a piece of paper with colored lines and dates that no one in their right mind expects you'll hit. So yeah, we have that. And obviously, it's to bring it to market to the first target is to place a DBS leads with precision. Only one in 10 patients who have who qualify for DBS procedure go ahead with it, because they don't want to be awake with their head open. And they don't want to have to have a second operation. So if we can increase the DBS market, we think that's interesting. But then I personally want want us to explore I love that this expression assumptions and distractions, you know, there are some surgical targets that I'd like to hit with MRI imaging. And you know, when there's sufficient money and scale in the organization, because again, we you know, if you put the patient at the center of all you do, and we're all going to be patient sooner or later. So yeah, other targets, and then just sort of stand in the background and watch Greg Fischer do magic. Legos.

Nicolas Gausserand  33:44  
So Medinbox, we are committed to help medical teams to improve patient care. And for that, we still have this historical aspect of education and health between between doctors. And as we are using a lot of video a lot of material in rooms. The next stage will be to use all the data to to give guidance to allow the medical teams to watch very efficiency, watch, how to improve techniques to compare with other centers, and use all these data to always give a better patient care. This is what we are trying to do and what we want to do next.

Lawrence Obstfeld  34:33  
What we are doing now is is a pilot group of users have five to 10 users. We have approval in Israel will have approval in Europe soon. And we want to show high utilization rate among those users. And I really benefited from the guidance of my CTO and my board in stating the investors would like to see this pilot and yes, we have feature A prime that will be ready in 40 days. But let's not go with feature A prime, the users are receiving the system and quite a discount. So they will have to understand that it will be cumbersome in a number of areas and they will work with us. And then, you know, I have the team that goes the other way, if they're a little uncertain about something, though, they'll want to get it very strict and perfect. And we had explained to them, No, we're doing it very simple and basic. So that's it. It's a soft launch among a group of five to 10 users. We're training one user now as we speak, and then we'll layer in the improvements as they become tuned and finalized.

Peter Thier  35:42  
Jeff, I know you're gonna stay very centered on this question of what's next to keep focused on what's next? 

Jeffery Alvarez  35:49  
Well, I just wanted to reiterate, reaffirm what Warren's just said, it's incredibly important, the value of something like a soft launch, or getting your systems out there as quickly as possible is so important, because it lets you identify the things that you got right and go wrong, and what assumptions you just completely messed up. Right. So the sooner that you can do that, the better off you are at, you know, tweaking and changing your product so that you can resolve those those issues. So again, yeah, for what's next, you know, at Moon, one of the things that we did very early on is we dove deep into a value analysis and understood what are all the different ways that we could create value for all the different stakeholders across a care system, you know, whether that's the administrator, the surgeon, the patient, biomed, department, nurses, and then we identify these different kind of value raishin points, and then put ourselves in their shoes and said, What are the reasons that we would say, No, we're safe, this company is full of BS, like they don't know what they're talking about. And then thought about ways to actually dislodge those opinions. And that generated what we call our reasons to believe reasons to believe that our product does what it say it does. And that's what's next for us. We're out challenging our assumptions, doing things like pilots doing things like limited market releases, and starting to collect that information to go in with those reasons to believe and say, Look, this is what Maestro does, it'll change your operating room and keep your teams so incredibly happy.

Peter Thier  37:23  
That's a great way to think a willingness to challenge yourself, I think is such an important thing to do through any of these endeavors. So I want to thank you all for taking the time out of your day. I know it's been a busy day to sit down with us and talk through these your businesses, your challenges, your backgrounds. I don't know if the audience has any questions for allowing questions in the group but certainly happy to open that up. Otherwise, we will let everyone get to dinner and drinks tonight. So thank you all. Thank you. Thanks