True Digital Surgery | September Riharb

True Digital Surgery develops next-generation solutions for the operating room. The company's flagship system, Occipta, is a heads-up, digital mircoscope and imaging platform intended to improve surgeons' control and visualization capabilities during reconstructive surgery.
September Riharb
September Riharb
VP of Corporate Development, True Digital Surgery

September Riharb  0:01  
Good morning. So I recently learned from 23andme that I am mostly Irish and that I have a ton of cousins. So I feel like we're probably related. So Happy St. Patrick's Day to all my cousins. And I wanted to say thank you to LSI. This is the first time that True Digital Surgery is presenting at the conference and we're very excited to participate. So jumping right into it. So true digital surgery is a commercial stage med tech company that is commercializing a digital microscope, and we are what we like to call a startup on rocket fuel. Because we've already gone through an acquisition, our legacy company True Vision systems, was the first to develop a 3d surgical microscope. They commercialize that product in 2008. And they sold it through strategic partnerships with B Braun's company ASCII lab, and with Leica. And the activity with Alcon in the ophthalmology space took off very quickly, and Alcon wanted to vertically integrate. So they acquired the company, but focus mostly on ophthalmology, they decided to spin off the other assets. And that was the development of true digital surgery at the very tail end of 2018, beginning of 2019. So the board of directors of True Vision came over to true digital surgery. And the chairman and CEO of True Digital Surgery is Aidan Foley. And the company now carries forward with that relationship with ASCII lab. And that is focused in the neural surgical space in the spine space. The contract with Leica timed out, we had our Series A at the beginning of 2019. That board invested it was an insight around $5 million. And then our series B took place at the end of that year in 2019. And that was taken fully by ASCII lab who now owns 25% of the company. And right now we're looking at our Series C and looking to raise between 30 and $50 million. So as I mentioned, Aidan Foley CEO and chairman of True Digital Surgery, Aidan has a very strong background as a CEO and one of his experiences was leading the digital division of Kodak Eastman, and he was there as the transition from film to digital took place. And he had a front row seat to that three year disruption in the market. So he knows full well how quickly the space can move from an analog to digital environment. And that was one of the reasons he was an early investor in True Vision Systems. And then myself, I have a strong med tech background, I've been basically launching disruptive technologies my entire career. I have a background in imaging, my background and robotics. And I kind of span all the specialties, the medical specialties. So moving into the story, the microscope was developed and commercialized broadly in the 1960s. And 60 years later, the technology that was developed back in the 1960s is still utilized today. So looking through basically a series of lenses and focus light, you can magnify the view to be able to work on microscopic structures. But what it requires is that the surgeon is attached to a machine. And the assisting surgeon is also attached to the machine. And typically the machine the microscope is set up optimized for the primary surgeon who still has to stand very still and look through the ocular microscopes. And typically it's at the tail end of a multi hour procedure is when they do the most complex part of the procedure. So it's very challenging for them. And a lot of them end up getting neck and back fusions. And then the assisting surgeon has to figure out how to line up with their ocular eyepiece. And many times the surgeons are different sizes, different heights. So he's either standing on a stool, or she's dipping down.

It's a challenge. So the development of the digital microscope separates the surgeons from the technology freeing up both a surgeon and the technology. And as you can see from this image on the right, the surgeon with our exes scope, which is the category that our product falls into, looks over the camera at a 3d microscope, and they look through polarized glasses, which gives them that depth perception. And they can see the image that they would normally see through the ocular microscope but in a much broader field of view. And they also have a greater depth of field and it's crystal clear on the on the monitor. So to walk you through quickly the technology that pieces it's a very A small compact mobile system rolls right in. So walk you through the different pieces. So first, the surgical monitor screen there is one that's attached to the cart, it is a smaller one that is usually used by the assisting surgeon. And then the primary suit surgeon uses the big 55 inch monitor that we just saw on the previous image. The camera itself number two, it's very small, has the handles on either side. And it has a 10x optical zoom, your standard analog microscopes have a 6x. So the surgeons are seeing magnification greater than what they've seen with our standard instrumentation. It has a working distance, which optimizes the position of the camera. And actually some of our IP is associated with the design of the camera such that it maintains that close relationship to the surgical site, which is important because basically image resolution is associated with depth from that surgical view, as well as there's fluorescence that we use in the procedures. And basically you want to be as close to the surgical site with fluorescence so that you mitigate light dispersion. So that is something unique to our technology, as is HDR imaging, which in a nutshell basically means that you don't have much shadowing, the light is optimized. And then we have a a light source that's an LED, which is a cool light source, as opposed to your standard analog microscopes, which have a xenon light source, which puts off a lot of heat. And that means that they have to irrigate that surgical site to protect the patient's tissue.

So the camera is held by a robotic arm. That's number three. And it's a six degree of access robotic arm. And it allows the surgeon to manipulate the position of the robot and it's intelligent, and that it can remember positions in 3d space. So a surgeon can save what we call a wave point, and then move to another location, save that waypoint, they can basically have as many wave points as they can remember, and they can move between them. And it sets not only that position space, but the lighting, the magnification all the nuances of the system in that position. And then another feature, which is just a toggle button allows them to rotate around a fixed point in space, basically a semi hemisphere. And as you think about this, with an analog microscope, they couldn't do those sorts of things because they have to move their body to be able to see everything and hold it for a long period of time. So this is all very new, very exciting for the surgeons. There's a control screen, which is used by the circulator has all the same features that the surgeon has with both the hand controls and then number six, which is a footswitch. And then the card itself allows for inputs from not only DICOM and standard communication, but any sort of endoscope, any sort of imaging all that can be displayed on the monitor in a picture and picture setting. So the way that we introduce this to surgeons is very straightforward. First, you talk to the ergonomic benefit, which they immediately identify with because statistically there are issues with the ergonomics associated with using the microscope. The first thing that they want to talk about though, once they understand the benefit from an ergonomic standpoint is the image because the image is everything. If you can't provide an image that is at the quality that they have to use, and they're used to using, they're not interested. So first we walked through the image, we talked about the optical zoom, we show that very exciting that they can see a greater field of view, because in the digital format, you can capture so much more data, and then that greater depth of field. Next, we talk about the robotics, we walk them through the wave points, we show them how to interact with the technology. And then the comfort is self evident. It takes about 10 minutes to do an in service in the hall. And then we roll it right into the procedure. So the technology is very intelligent. And as the surgeon becomes more familiar, we can teach them all the other attributes, but really getting them going. It's just a matter of sheer minutes.

So that is our commercial technology that we have in the market today. But the one that we're working on, this is our next platform, and we have a pretty comprehensive roadmap. This is the next one up, looks at specifically the cranial market. So this is the brain tumor market and looks at the use of the microscope and navigation which is always used one to one. So the surgeons use the navigation system to orient themselves during the procedure. But the information from the navigation system is on a separate monitor most of the time and usually that monitor is over their shoulder so they have to lift their head up, turn, look at the monitor, figure out where they are in space and reorient themselves back to the view and try to remember that information that they just had. So we took this opportunity to say, Okay, in this market, combining these two technologies makes a lot of sense. And literally decluttering, if you will, the operating room by having the Swiss Army knife of technologies also makes sense. So this technology that you see on the right is that same footprint, all the same attributes with an added tracking camera, that's the navigation camera. It's basically 10,000 more dollars in hardware. And then the software, the navigation software, we have a very simple GUI interface. And we're already showing this technology to potential strategic partners. So the total available market is very large, one and a half billion roughly for the microscopy side, and then another billion for the navigation side growing at a CAGR of 7%. And we believe by 2030, that the digital platforms will displace the analog microscope. True Digital Surgery distributes through strategic partnerships. And there's a reason that we've done that there's a benefit obviously to us because we have that brand name recognition right out of the gate. They have these relationships, which allows for very fast market penetration. There's a predictable revenue stream, even demo units are a revenue stream for us. And then it controls our SGMA. The partner benefits is that we have really have access to very innovative technology, very fast development times very efficient use of their budget, and of course with ASCII labs case they have to have our board seats and any new channel partners will also have board seats. ASCII Lab, our current customer has basically 200 salespeople in their neurosurgical field globally 100 here in the US another 100 OUS and because of the opportunity that they now see with ASCII lab as now it's been out on the market for about a year. They are building out an additional dedicated sales force. So 50 sales reps and about 15 support people globally who will focus just on this one technology. Thank you so much.

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