Bryan Lord, Pristine Surgical - High Definition Single-Use Visualization System | LSI USA '24

Bryan Lord  0:03  
My name is Bryan Lord, I'm the CEO of Pristine Surgical. Thanks to the LSI folks, we're delighted to be back with you for another presentation. I think we all know in this room that minimally invasive surgery is revolutionary. In the olden days, surgeons used to look in through an eyepiece today, they look on a screen. But basically the form factors that has been unchanged since the 1970s, the way arthroscopic and other minimally invasive surgery is performed. The systems I liken these to the old stereo systems that we used to lug up and down our dorm room floor, they're big, they're complex, you have to go through 35 Different sterile processing steps after every procedure. So you see a little process flow, I call this the asteroid belt of equipment that needs to be tracked down. And they're expensive. So the current solutions cost more than that pioneer stereo system, they cost about $100,000 to purchase about five to $6,000 a month in recurring service fees, and about $125 per case for sterilization expense when you do all of the math, excuse me, and they're prone to contamination as well. As you heard Matt    Ginn talk earlier. A few presentations ago, there's a significant problem, particularly in the flexible endoscopy side of things about sterile processing, and about the contamination that's prevalent throughout the endoscopy suite that the FDA has paid a lot of attention to as well. So our mission is to address I'll stay on theme here to address the pain that I just described. It's to simplify endoscopy. So we're doing that with the next generation of digital endoscope. So you can see here our single use kit, the entire kit that you see on the left hand side of the of the screen is single use. And that plugs into our box called our image processing unit for lack of a better, more creative term. And it's a simple razor razor blade model, right. So we are in the midst of our nationwide launch our device we brand named Summit, we've introduced the world's 4k, first 4k single use arthroscope. A couple of key features to point out so this is fully integrated. And by what by that what I mean is we integrate that camera head that typically is outside and the current incumbent device and put that actually on the tip of the scope. We also take the light source, the external light source and the light cabling and light can we put that and replace that with a high brightness LED on the tip of the scope as well. This is designed for full on surgical procedures. So you might be familiar with some companies, for example, like trice or the Arthrex nanoscope. That's a diagnostic arthroscope. It's a cousin. But that's used for in office procedures not for full on surgical procedures on an under anesthesia, where you're going to be doing for example rotator cuff or ACL types of repair. That's what we're doing full on surgical procedures and full on replacement for that rod lens scope. We've taken great strides to make sure that our device is dropped into the hand familiar to the surgeon, so a surgeon designed ergonomics. So we're that fin is is where the light source used to actually come into. And in a rod lens scope, the surgeon is or is used to grabbing for that light source to be able to rotate the image on the screen the writing mechanism, we've replaced that, that that tactile feel with a fin and important to integrated water delivery. Sometimes people forget that this is a really cool single use surgical device. But an important part of visualization is the delivery of water, actually to insulate the joint, so that you can actually see. And so this is connected to a water pump delivers water to the into the scope and fluidics as my friend Ted knows here is a key part of visualization. And we've taken great strides to make sure that it's integrated well with all the existing pumping infrastructure out in the marketplace. So to be clear, this is 100% single use and 100% sterile from the factory. We think this is perfectly positioned for ambulatory surgery centers. So 90% of arthroscopy is are performed in ASC is today 85% of ASC is our kind of mind, Pa if you think about it that way, therefore less operating rooms 56% of ASC is and we'll study we came across talk about issues with physical space limitations. So a lot of them are multidisciplinary. So they're gonna be wheeling around, you know, these pioneer stereo systems, if you will follow my analogy, from room to room for procedure to procedure. And there's a lot of challenge with space limitations. 33% of these ASC is surveyed. I'm a little surprised by this, it's not higher, maybe this was a little bit dated, report issues with cash flow and access to capital and 13% of ASCs report issues with sterilization of equipment. So it's not necessarily the same level of acute concern about sterilization that you see on the flexible side of things, but you do see concerns about sterilization in terms of the laborious process flow, and that certainly hits ASCs. This is a simplified system that also reduces expenses. So I talked about what the costs are the current solution by contrast, we cost nothing in terms of capital expense, we're going to deploy the capital out. That's part of our system out into the field for free. Of course with a single use device, no service expense Of course, with a single use device, there's no reprocessing expense, as well. So how do we actually reduce that expense, we'll reduce that expense by somewhere, we believe between five to 40%. It depends upon what the use case is, what the different process flow and what the state of equipment is. But if you think today about those three buckets that today are being used out in the field, and if all you're doing is using our system complementary to existing equipment, today, you're going to pay capex upfront, you're going to pay service fees per month, and they're going to pay sterilization expense on a per case basis. We'll charge nothing as previously mentioned, for that upfront capex payment will charge a monthly subscription fee. And by that you get access to the to the box, you get access to the pristine Connect platform, which we'll talk about in a few slides. And then we simply pay as you go. So it aligns also with cash flow, that as you use your as you perform your procedures, you actually align your expense with it. So with that, we believe our hard cost savings will be somewhere in the five to 10% range, again, just utilizing the side by side with existing equipment. And if you add in sauce, soft cost savings will probably bring you somewhere in the 25 to 30% range. Now important is the 4k device 70% of instruments out in the field today have not upgraded before k, if you have not upgraded to 4k, we're going to add about 1010 percentage points absolute to your cost savings. So same numbers, same configuration, and by that then we move to that five to 40% is the range that we are seeing savings out into the field. Importantly, on the economic side of things, a simplified system also increases revenue as well we think there's there's really interesting opportunity on the efficiency side and revenue generation side as well. So today, if you have kind of a simplified process flow, you got the setup, the procedure itself, the cleanup, and then the sterilization, you might have a busy surgeon have five procedures or so you know, on the docket, we eliminate the setup, you get to the same length of the procedure, you eliminate the cleanup and you eliminate the sterilization, you're able to turn that or over faster. And so as a result of that, you take those five procedures make that six, you make that seven, now you've got an opportunity to add more seats in the bus, you're going to generate more revenue as a facility for a given fixed amount of overhead. We also believe that our simplified system, believe it or not, will reduce the environmental impact. So it's not uncommon. People say single use okay disposable, you know, don't like that. But we actually have came across a study from the Austin group out of Minneapolis that actually weighs all of the different PPS that goes into a single sterilization process, we'll eliminate at least one if not two trays from a sterilization process and each one of our procedures, and will reduce the waste if you simply weigh the amount of PPS that goes into that based on that study based upon the weight that we have in our single use kit by as much as 50%. And we also will eliminate all the water usage all that contaminated water that goes into the sterilization process. And we have a partnership with the waste energy group as well, that if our customers want to opt into that, we'll turn our scopes into sustainable energy. And the image quality side of things as mentioned 70% of the scopes in the field are 1080 P or four or 720 P, it's important to think about the pixel density of the scopes. But it's also important to remember that over time, that scope is only as good as it comes off the showroom floor. It gets nicked up and dinged up through the course of utilization and by the time it's about 30 procedures in it needs to be taken out for refurbishment. So if your shoulder is the one sitting there in the operating room, and that surgeon has that device after 29 uses, they're probably not seeing a 4k image on their screen. 30% of the scopes are 4k, beautiful, very nice image just like ours, but they degrade also in the similar fashion. So the way to think about our image quality is that our simplified system delivers 4k visualization for every procedure. So it's really bimodal. Right and the way to think about that and we've been getting rave reviews stellar gorgeous, better than my than my current scope when we've had our device out into the field. So it's really, we're really proud of the of the quality. Our system connects to the cloud also. So that box that I talked about Wi Fi connected, it does two things. It automates the inventory management. It also allows us to do a whole digital health platform as well with a whole bunch of roadmap of really interesting features. And this enables us with our business models that we call scopes buy subscription. So this simplifies our operations gives us predictable inventory. And it also is a very powerful business model. If you follow the SAS industry think about this as a SaaS business model, right? It turns capex sales into recurring revenue, we have a high CAC to LTV ratio, and projected med tech margins. So as I mentioned, I'm overall all wrap up here full nationwide release is underway. The response has been outstanding. Our first procedure was done at Southern California orthopaedic Institute had dinner with Dr. Gillman last night. He's over the moon with our capabilities and progress and I'll wrap up with this. Our product roadmap is exciting. We're going to be we're launching here as I mentioned in sports medicine, so our nationwide release is underway by this time next year We expect to have our single use laparoscope out into the field. And then we have a flexible scope also, as well. We've demonstrated all of these we have a functional prototype ready to go into manufacturing laparoscopy side of things, and then a functional prototype. That's really a beautiful image as well on the flexible endoscopy side of things. So I'm going to wrap up here. I thank you very much for your attention and for your time. Thank you