Todd Usen, Activ Surgical - Studio Interview | LSI Europe ‘22


Todd Usen

Todd Usen

President & CEO, Activ Surgical
Read Biography
President & CEO, Todd Usen of Activ Surgical are utilizing AI, near-infrared fluorescent imaging, and robotics to enhance surgical visualition and navigation beyond what is visible from traditional imaging systems (e.g. endoscopy).


Nick Talamantes  0:00  

Todd, thank you so much for joining me here at LSI Europe.


Todd Usen  0:03  

It's a pleasure to be here. Thank you.


Nick Talamantes  0:04  

Tell me a little bit about what you're doing the company you're working with.


Todd Usen  0:07  

Well, Activ Surgical, we are foundational technology was our founder, Dr. Peter Kim was at Children's National Medical Center in Washington, DC. And he completed the world's first fully autonomous robotic surgery of soft tissue. And from that, he was approached by some venture and said, Hey, we want to make a company out of this. So after the data was published, and in 2017, Activ Surgical under a different name, originally and now active surgical, became a company and I was joined on in January of 19 2019, as its first CEO, and Activ is basically taking our technology and it's, it's our algorithm, it's our software, it's Advanced Visual imaging, and applying it to any laparoscopic procedure, arthroscopic procedure, robotic procedure allows physicians in real time to see things that aren't visible during a normal surgery, such as real time blood flow, real time key critical structures. From there, we collect the identified surgical data video from the procedures, it's annotated by surgeon surgeons all over the world. And then it gets into our machine learning algorithm. And all we're doing is we're going to be feeding back additional information live to the screen for our physicians, which will show them key things like veins versus artery key critical structure identification, key landmines and landmarks that you want to either avoid or go after. I almost consider it like, in ways in GPS, you know, up ahead is an accident, so go a different way. Up ahead is a key landmine or landmark that you want to avoid. So avoid it. And we're basically doing that in real time for our physicians so they can have the opportunity to see that. But first, we're in there for the science and hopefully really preventing readmission rates and, and some poor outcomes for some patients in many of these procedures.


Nick Talamantes  1:52  

That's fascinating. So are you tech? Are you hardware? Can you maybe enlighten me a little bit about what you guys offer?


Todd Usen  2:00  

Yeah, no, it's interesting. We you know, are you guys robotic? Are you med device? Are you tech? And I like the word digital, you know, you get it all. And we can be lumped into any, any any place. My background is, I've been at large companies and many were med device companies. The word med tech has been people throw it around, but it's there's the med but is the tech really tech. So I like to think we're a med tech technology. Because we work with robotics, we work with traditional technology, we we can be lumped into a robotic category, we have that we own the patents for autonomous robotic surgery. But again, I'm not building a robot. So I believe we're med tech. And we have the medical device, which we're in there with today. And then through our machine learning algorithm and our annotation process and all of that and the insights that we're going to be providing back to our physicians in real time. That's the tech partnerships that we have. So we have great supporters from medical imaging companies like Sony is on our cap table. And then at the same time, we have wonderful partnerships like Nvidia, who's also on our cap table for inferencing models and working with our insights as we go forward. So I really do say that we're at the we're the bridge between medical device companies and tech all coming together and hopefully Activ Surgical can sit right in the middle and get everyone into the operating room together.


Nick Talamantes  3:15  

That's an interesting niche to be in. What sort of stage company are you at right now? Are you commercial? How are you guys doing?


Todd Usen  3:23  

Yeah, Activ. We started, thankfully, our limited market release this year, and in the late spring, and we're our commercial stage organization. And we're out there right now. And we're focusing on key institutions around the US in small batches. We're still calling a limited market release, we wanted to make sure that we're meeting the needs of our physicians and making sure that we're building the right technology doing the right software upgrades when you need it. We went through FDA from concept through the FDA and less than two years of the device and the technology that we're using. So yeah, we're very excited working with some of the key major ID ends in the United States to start. And our CE mark is coming a month from now, October timeframe. And we're excited. We have great partners in Europe already some great physician advisors and all specialties that have been wonderful advisors, and also wonderful people getting ready to begin using the technology and their procedures.


Nick Talamantes  4:14  

That's very interesting. What's the market opportunity look like for med tech?


Todd Usen  4:20  

Yeah, well, I mean for for Activ Surgical. The reason why it was so compelling to me again, as I shared coming from my cut my teeth at Boston Scientific and had a chance to leave the United States in a division. That was that was cool. And you get the opportunity that was the President over at Smith and Nephew and a wonderful company that gave me great opportunities. And I learned a lot about how to be a president of an organization. And then I was brought over to Olympus in a similar role as the president of med device. So I never looked at, okay, I'm going to go to the startup and it's going to be really this amazing situation until I look at this technology and this is where the med tech comes in. The third leading cause of deaths in the world are preventable medical errors, of which 26% of those are preventable surgical errors. That means a patient's on the operating room table, and they don't have a terminal disease, they might be getting their gallbladder removed, they might be getting some, they could be getting a prostatectomy, a colorectal procedure, and esophagus procedure, but patient procedures that are serious, but not not not life threatening. And unfortunately, there's things that a physician doesn't always see not because the physician is not trained. But not everything is visible to the naked eye. There's critical structures that might be nicked or punctured, there is blood flow that might be perceived as being there when it's not. And it's not enough. It's not adequate when you sew something back together. So the opportunity when you start thinking about the fact that 26% of of these preventable medical errors are surgical errors, that's a big deal. Johns Hopkins had a paper there was over 400,000 deaths annually from preventable surgical errors. And that's something that we need to work on, and with the opportunity to give physicians more opportunity around the world. So to answer the question of the opportunity for med tech, you and I could be sitting here right now. And I could do a surgery surgical procedure here in London, in England, in London, we're outside of London, but here in England, my data from my procedure can be helping physicians all around the world, because it gets annotated with a bunch of other data from physicians. And the information that I have, I could be a world expert. I could be sharing this information when the screen goes on. And someone's using active site technology with someone that's on two or three procedures, that that patient should have the confidence that their physician has the same information that I do on every single case. So my data gets to be shared with everybody around the world. So hopefully, that's where the med tech opportunity is. It truly can democratize surgery, in the sense there's over 3 billion patients worldwide that have no access to medical care, which there's also a shortage of surgeons. So that doesn't mean every surgeon is of equal skill. And even if they were they don't have equal practice, because some places you can do 500 procedures a year others you can do five, the person that the surgeon is doing five, we want to make sure it has the same information that the surgeons use doing 500. And that's something that this technology and tech med tech can do. The medical device, and then the technology assessment that goes with it.


Nick Talamantes  7:16  

It's exciting that the technology that you and other companies are developing is making it easier to bring parity up for surgeons throughout the world. improving patient outcomes. It's really great to see. Tell me a little bit about what's coming next for Activ Surgical what's what's the future roadmap look like?


Todd Usen  7:34  

Sure. So the nice thing is we start with what we call active site. An Activ Site is a small device that attaches between a camera and a scope and a laparoscopic or arthroscopic procedure. Those are being used today in our first limited market release, both robotic procedures are being done, about 40% of our procedures have been done robotically. To visualize things that you can't with the robot today robots great. We're not competing with robots, we're not competing with scopes. The goal is we work with them all to hopefully give the enhanced vision to the surgeon and information that they can't get from the existing technology. And they can take all the advantages of their wonderful scope, technology and robotic technologies have the original reason they purchased it. But so ActivSite is basically the opportunity to see blood flow perfusion in real time, anytime that you want. And that's not the way that surgery is done today. There's no way to see it in real time, you inject a dye today. And it's very effective. It's been around for 70 years. But once you inject the dye, no matter what happens in the procedure, it's no longer real time until all that dye disappears from the patient dissipates and comes out. You can't really tell if there's active blood flow or there's not active blood flow. Our ActivSite allows you to see that in real time. You can clamp a vessel it'll show you the blood stopped, you can unclamp it, it'll show you in real time it hasn't with a dye it stays the same color the whole time, whether your clamp or unclamp. And all you're seeing is the dye color. That's not a knock on it. That's just why medical technology comes out to enhance and see new things. Then we like I said before we're collected the the next phase is the insights and we're starting to see critical structures in cases. We're doing prostatectomy procedures and we're able to see what's called the neurovascular bundle when you're identifying nerves. The number one complication or one of the complications is side effect of a prostatectomy we're removing prostate cancer one in six men have this issue at some point and if you can remove the prostate and get the whole cancerous tissue out, that's preferable but unfortunately one of the side effects is you can clip some of the nerves along the side and that that damages the patient's function future ED and what have you. So many patients don't choose to get a prostatectomy. They choose to get localized chemo, if you can, with a technology like we're showing that we can see what's called the neurovascular bundle and the landmark artery. If you can show this in real time to a physician. It's almost like Lane Assist. You're in your lane. If you go out of your lane it's going to it's going to buzz like your car's steering wheel may or you'll see we're staying in lane assist so the doctor can continually monitor Through that, make sure that they're, they're staying away from the nerves as they're removing the prostate and patients, hopefully at the end of the day can get a full prostate prostatectomy and know that they retain their function. And those types of things are happening right now. That becomes active insights. And as we're collecting more and more data, we're sharing things like I said, venous flow versus arterial flow, other key critical structures anatomies, your order identification, what's called critical view of safety, identification of what we're seeing with our science. But as you continue to do the machine learning algorithm, those are our insights. And then what's called Activ Assist is where we started from, we actually can program and work with the robotic technology to make sure that the robotic imaging systems know exactly where they are, they know the distance from a scope to an instrument from an instrument to a landmark. And we can measure that distance inside. And then we get to what's called active pilot, which is our foundational technology of autonomous robotic procedures that basically with the press of a button, we can complete certain certain parts of a function surgery autonomously. Wow. And that's so we're focusing hard focus on Activ Site and ActivInsight right now. Because the market globally there's, there's over 50 million procedures that are done annually right now that for just traditional perfusion identification, whether laparoscopic or open procedures, the opportunity to see blood flow, which is the first principle of surgery nor the patient's bleeding is a great opportunity for us.


Nick Talamantes  11:22  

So is your technology then compatible with all forms of laparoscopic endoscopic devices?


Todd Usen  11:29  

Yeah, the beautiful thing now is in the rigid scopes and laparoscope. So again, my coming from a company like Olympus and Carl Stuart's and Stryker, those technologies are wonderful technologies, all those companies, other companies like Arthrex, or Smith and Nephew, whether they're in orthopedics, or laparoscopic Conmed. Companies that make these systems, yes, you can have an active active image module and active site image module can work seamlessly between the cameras and the scopes. And basically, they retain all their superpowers. The scope, when you press the button on an active image module, we go through our own light engine at that point. So you've seen the overlay or a contrast view that shows you the profusion that shows you the colors, the map so you know exactly where it's something's bleeding or not, or key critical structure. When you take your hand off of the button, you're right back to the system that you bought and cherish from those companies. You're watching your view right through their processes. And there are so we're it's strictly a pass through and we were not interfering are doing everything we can to not interfere with why the hospitals purchased those technologies in the first place.


Nick Talamantes  12:32  

So the device agnostic approach, you might say you have it has helped with adoption and scaling.


Todd Usen  12:38  

Yeah, it helps in the sense that right now, there's been a big three in laparoscopic technology, it's been Carl Stuart's Stryker, Olympus, it's very hard to move the needle and market share points. And it's also there's a lot of loyalty and rightfully so. And the fact that we can walk in, and I'm not trying to sell a scope and a tower to compete with them, because that's really hard to do. And I'm not sure that's really a necessity, they have great technology. But the opportunity to take my system and work with them to take the benefits that they offer and and enhance it with advanced visualization that that they're not offered anywhere else. It's not because they don't have it. Thankfully active surgical has it a technology that's patented and do our own protective device. And our form factor is allows us to go interchangeably between many systems. And then the fact that it's starting to be used in robotics. And they're just actually taking the doctors are willing to utilize this technology through an accessory port right now, to visualize blood flow in real time are key critical structure that they can't see. And we've been blown away by the early success in robotics, that wasn't going to be our early target. We know we work with robots, but we, you know, we're doing some code development with some of these companies. But before we even have to do that we can we're working in multiple robotic cases as we speak.


Nick Talamantes  13:57  

You've launched in the US, you have partners already here in Europe, that you're looking to bring the product, your technology to the market here. What brings you to LSI Europe?


Todd Usen  14:09  

Well, it's interesting. I thought the technology with the program, excuse me was outstanding. I was in Dana Point in early 2020. And we were raising at the time and I know that a lot of companies my size or our size come to a conference like this to raise money. I come to look for partners. Thankfully, we're not actively raising right now. But I don't believe in just running in meetings. Whether it's a VC or private equity day one is hey, I need some money. Can you help me out? And I like to build a relationship. There's so much talent and people that have skills that I don't have that you know, when when I look to raise money, I'm not really looking for the money up until now in the capital markets were problem. Money was fairly easy to get before our last raises. It was the partners that were not always the easiest. So they're interviewing me and at the same time it gives me an opportunity to interview them and say, Hey, guys, I have a ton of weaknesses, you can help me here, you can help me here. How do you make me better help a company, I look for partners that we can really talk about global commercialization, we can talk about strategy of distribution opportunities, and really where the technology is going, versus just talking about our next raise or babysitting the money that we have. So I really, to me to meet plenty of new investors also talk to different companies and strategics that we work with. And we're, we're interested in different technologies that are out there as well. I can start building that relationship. And I can find out how many of these people can help make me better as most as a leader, and in our company, how they can help our company. So that's why I came and I have an opportunity to be on a panel, which I'm excited to do. And then present Activ Surgical just to continue the talk track.


Nick Talamantes  15:48  

Tell me a bit about the panel that you're going to be on.


Todd Usen  15:50  

While I'm on the panel with, on its robotic innovation. Like I said, we get we get thrown into your the room in robotic innovation with some companies are doing robotics. I'm not doing robotics, we work with robotics. And so it's always good to hear what the technology is doing. Joe Mullins is the is the moderator of the panel. And I know Joe Joe has been a great supporter of Activ Surgical coincidence, and he's the moderator. We didn't set each other up. Let's pick these people. And I'm looking forward to just okay, you have a robot. Now what, that's really what the panel is almost okay, just by having a robot, is that enough? Maybe it is. And I think it gives people the opportunity to have those conversations of what in addition to the robot is needed for the patients? What are the outcomes look like? What are the with the clinical benefits? Do we need advanced visualization? Do we need AI? What do I get from my existing robot? What can I get for the future? And you know, what's the industry looking like in the future in the next five years, or 10 years? So?


Nick Talamantes  16:47  

Well, I'm looking forward to following what you're doing over to Activ Surgical and your company's progress. Is there anything else you want to share with us? Yeah, well,


Todd Usen  16:54  

first of all, I appreciate the opportunity. I've enjoyed the conference, it's nice to sit down and have a conversation with you. LSI does does a great job. And I think at the end of the day, it's I just like to think people keep an open mind about technology. A lot of, and I've been in the big medical companies. And a lot of us always believe that. If it's not invented here, it's not invented anywhere and our baby, don't call my baby ugly. We're never calling anyone's baby ugly, we want to take their babies and offer allow their babies to even flourish and grow more, they have more skill sets by using your baby and you put my little thing on there, we can make sure that we're working together with my technology with your technology, and we can give our physicians the best outcomes in the future. And then we're very excited. I believe that a lot of people say AI is the future, or data is the future. Those as I've said many times before, is those are bumper stickers. Everyone says that, but what does it really mean AI is a lot more than just all of a sudden we're going to annotate and get all this information and start feeding it back that starts with computer vision and sensing. And that's what active surgical does computer vision and sensing. And through our annotation process and machine learning algorithm, we're going to be able to provide this information but it takes time for every company to do it. And so we we we make sure that we're here to help both healthcare companies, as well as doctors and patients. And that's what we believe. And then we're also going to bring these technology companies like great partners at Nvidia and Microsoft that we have and bring them to the operating room as well. So hopefully we're the perfect marriage of med tech. Like I said med device and technology and we're in the med tech space. 


Nick Talamantes  18:29  

Todd, thank you so much for stopping by for the interview. 


Todd Usen  18:31  

I really appreciate it. Thanks so much.

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