Yesterday I was invited to the exclusive SS Innovations update meeting with a special focus on the US. Whast's new... updates, techn ology updates and regulatory updates...
I have to say... this company moves fast and is building a very impressive system and supporting and surrounding ecosystem.
Read here about some of the key updates from that meeting.
The SSi Mantra is the first "Made in India robot." And you need to understand a few things about the company and the founder. The company is based in India - and their mission is to bring the high end performance (and more) of surgical robotics - but at the affordability that more of the lower and middle income countries can gain access to surgical robotics; and the benefits it brings to patients.
They have built an impressive headquarters in Gurgaon, Haryana, India. Within that factory they have a massive workforce of highly skilled individuals that are building the systems, instruments, simulators and more. (I'll leave it for thjem to disclose the exact size of the building and numbers of employees.)
For those that don't know Mantra 3 - go to my other post HERE to get the background - as this post is a an update from the company. This will help.
Indian = cheap right? Not so functional?
No. If there is one thing I want you to walk away with is that they will be cost effective in their manufacturing costs, amount of profit they see as fair, intruments and services. But that in no way should imply an "inferior" or cheap robot. Quite the opposite. Mantra is a feature rich and highly capabale robot that is capable of doing some of the most difficult procedures in robotic surgery - and doing them well.
The company presented their initial procedure graphs stating the number of procedures and the mix across specialties. Now a few things jump out. First you should look at Cardiac procedures. Valves, Bypass, ASD closure etc. That alone should tell you the level of dexterity and precision this system has. But any other keen eye should see that this is not just a "Urology" robot - instead the largest number of procedures are in General surgery - including mutiquadrant procedures. And that is important when we talk about capability. Because no only does the modular design (now 30% slimmer) allow multiquadrant - it is one of the only systems that has 5 arm capability. 1 X camera (a very nice Olympus Flexible Endoeye) and 4 Instruments (and you can pick from a very extensive range.)
It uses either an open cockpit design - or this type of AR 3D HD headset - with either choice of system using non haptic arm controllers. This is one of the first systems to allow a choice for the surgeon - immersion or open cockpit. And I find that quite intriguing.
Yes you are reading that right. Already they have over 40 specialist instrument types - and that is what allows them to be genuinely multi specialty. And in there, they have some very interesting end effectors. They have clip appliers, multiple clip appliers, Harmonic instruments and specialist instruments tips of all types.
Now you add to that they have developed a 6 second arterial anastamotic coupler. That is now going way beyond what we see on other robots. Even more, you add into that a complete range of fully capable cardiac instruments (needle holders clamps, stabilisers etc etc). Note from me, I think this is their biggest differentiator compared to most other systems in development or even on the market. It's not that da Vinci haven't done cardiac - but what I'd say is that as Dr. Sudhir Srivastava is a cardiac surgeon and the founder of SSi - so he has a huge bias to cardiac surgery. It is a focused differentiator for them. And well, you need to understand that if the system is working well in these precision procedures... it will work just fine for general and thoracic procedures.
The next thing that they discussed in details was also the emerging field of "Robotic Telesurgery" where the Mantra 3 is not only capable - but has already been performing multiple 5G linked surgeries and (maybe more useful) 5G linked proctoring support. So again, a leading set of features that we see on the Mantra 3. This is not a "budget" robot.
I want to just comment - the iteration from Mantra 2 (following deep in clinical use feedback) to Mantra 3, was a mere 5 months. Which is an incredibly short period of time. But it shows that SSi have the capability to iterate at speed. Somthing some of the more traditional companies have lagged behind in, and others could learn about. Upgrades and updates need to come at a much faster rate from everyone.
To put some of their speed and size into the frame they showed this graphic. Which for a company in India alone is quite a feat. So the question was asked quite clearly about what are their plans to come out of India and expand into other geographical areas?
Let me start by saying a fact, that many who have not worked much outside of FDA and CE may find surprising. There are over 100 countries around the world that do not require CE or FDA to be able to use a product. They often rely on local registrations, some rely on those prior registrations - but many will rely upon the ISO 13485, and the Indian authority certification. So what was clear at their meeting was they have every intention to expand into multiple markets - including Europe and the USA.
They made it clear they are in process for both MDR and FDA, and although could not give an accurate clearance date (who can?) they are hopeful that they could see clearences by the end of 2025 in those major markets. At that point, I do think the bigger strategics may need to watch for market share points.
Now this all makes SSi very ambitious - and what was interesting was that they beleive that a machine as "capable as a da Vinci" with world class training systems, VR simulation, trainer simulation, pre surgery image rendering into 3D, proctoring, 5G and cardiac applications - if it can be placed at the right price point - even in EU / USA there is a large section of the market where the economics (without loss of performance) could tip the balance for some users and hospital systems to be tempted to engage with them.
In fact - I won't say which system - but they had a senior manager of one of the big hospital systems in the room that endorsed that approach. He said there was a vast part of the US market untapped - where a highly proficient system (that can do all procedures) but at a significantly lower price point - would be an attractive proposition. So maybe their approach could be more successful than many (including me) think in the USA.
One voice that is highly supportive of the SSi company and their approach is the world renowned Dr Fred Moll - founder of Intuitive.
Dr Moll was clear about a few reasons why he endorsed the system. Firstly, he was clear that the system is highly capable, he praised the innovation and he talked deeply about the telesurgery - feeling OUS that would have a profound place in surgical robotics.
But he also talked about "Coming Full Circle" to cardiac. Where he was clear that was an important yet underserved market today. He thinks that the focus of SSi on cardiac will have a profound pull for many hospitals across the globe as we see a resurgence in cardiac robotics. And finally, he is wanting to see a wider use of robotics, in more markets and more middle income countries. To that end he believes if SSi can keeo their promise of a mjor redution in cost, then that dream he had back in the early days of Intuitive could become real.
Now why might some of you care even more? Well unlike many of the private VC led robotics companies, or even some of the pre - revenue companies, and a few on market systems, you can buy shares on the OTC market for SSi. So for those looking at a small ticket price per share surgical robot - then this stock could be quite an interesting place for you.
Disclaimer: I do not own any stock in this company or advise on buying or selling stock. I am clueless on this. Buyer beware.
But this is a chance for those that like a flutter to potentially get a ticket on the SSI stock ride?
So what are my overall thoughts on SSi.
One word - "Interesting." I think the focus on cardiac and several of their innovations take this well past another "me too" in either boom robots or modular robots. I do love a good modular robot - as you know. But the capability for 5 arms and to load on 40 instruments - with a super focused set of Cardiac instruments is quite intriguing to me.
5G telesurgery and their broad set of digital tools around the platform add more intrigue, and give me a sense that in many markets this could be an attractive proposition. Especially if their "promise" of a 30% plus reduction in total ownership costs are made real... Then there are big markets. and even segments of other markets that could be tempted to buy into an SSi Mantra.
In all I think it is a great system - and will without doubt have a degree of success. How much market share it can take globally, and particularly in Europe and USA in terms of both units and value will be something we can watch together.
Final thought - the people behind this are brilliant and super nice people; motivated by a genuine cause. And I can tell you - in this industry - that means a lot. Worth cheering them on just for that.
These are just the opinions of the author for educational purposes only. You should not rely on this information for investing purposes.
Comments