Everyone, welcome to Vicarious' Beta 2 Demonstration Day. Before we begin, I'm just going to go through our disclaimer page, as management will be making forward-looking statements based on several estimates and assumptions that are accurate only as of today's live webcast. For a full list of the risks and uncertainties around the business, please go to our 10-K and other reports with the SEC. With that, I can now turn it over to Adam Sachs, our CEO and Co-Founder, to kick things off.
For joining today, and Welcome to Vicarious Surgical's Beta 2 Demonstration Day. Today is a really significant day for Vicarious Surgical as it marks our progression from technology through Beta 1 to Beta 2 and then out to FDA approval. This will be the final iteration before our V1.0 of our system. We'll be taking all of the feedback from our hospital partners, from surgeons, and using that to refine our technology and our Beta 2 system into V1.0 next spring. Today, you'll be hearing from a number of speakers, including our very own Sammy Khalifa.
Sammy is my Co-Founder and our Chief Technology Officer, and he'll be giving you a background today on the core technology behind what we do, the decoupled actuators, and how that technology leads to key differentiators that are able to bring increased value to surgeons and to hospital systems. In addition, we are extremely fortunate to be joined today by three guest speakers. We're joined by David Sylvan of UH Ventures. UH Ventures is the innovation and commercialization division of University Hospitals, one of our COE partners. As the Head of UH Ventures, David oversees their strategic initiatives, business development efforts, industry collaboration, as well as a variety of other things that all further the UH mission in supporting and shaping value-adding opportunities in healthcare. He comes from a 30-year background in diverse including 15 years in capital markets and investment banking.
Joining David today is also Kendra Gardiner. Kendra is Director of Product Strategy at UH Ventures. She's responsible for relationship management, opportunity value assessment, portfolio and project management, and ecosystem building. Kendra collaborates across the entire UH Ventures lines of service, with strategic partners and clinical leaders in order to advance the most promising development and co-development opportunities. Kendra has more than 20 years of diverse corporate, nonprofit, and economic development experience. Last but not least, we're extremely excited to be joined today by Dr. Igor Belyansky. Dr. Belyansky has been a consultant of Vicarious Surgical for the past year, and in addition to that, he also leads our surgeon luminary group. Dr. Belyansky is Chief of General Surgery at Anne Arundel Medical Center, in Annapolis, Maryland, and he's a fellowship-trained laparoscopic surgeon, a specialist in abdominal wall reconstruction and complex hernia repair.
With over 1,500 robotic cases, he's arguably the top hernia repair surgeon in the country. Dr. Belyansky will walk you through an IPOM-plus hernia repair, as well as an r-TAPP abdominal wall reconstruction that were performed using our Beta 2 system at Tufts Medical Center in a cadaveric model. After the prepared remarks today from each of these speakers, we'll also have time and set up a Q&A panel. All the speakers will be available, I ask that you please hold your questions to the end. Before I hand it over to David, I'd also like to take just a few minutes and walk you through the why behind what we're doing and what drives us, our partners, and our investors. Vicarious Surgical was founded on the mission to revolutionize robotic surgery with our own next-generation robotic technology.
Through our technology, we aspire to solve for the shortcomings and drive further efficiency in surgical procedures, improve patient outcomes, and reduce overall healthcare costs. As just a bit of background, surgery really began with open surgical procedures. With open surgery, a surgeon takes a scalpel and quite literally opens up the patient's abdomen, making a large incision. Through that incision, they're able to operate with their own hands, they can see with their own eyes. Unfortunately, the incision cuts through all the layers of the abdominal wall and damages the abdominal wall. That damage to the abdominal wall leads to 15%-20% complication rates, all from the abdominal wall failing to heal correctly, not from the work done on the organs inside the abdomen. That is what minimally invasive surgery is all about.
The idea behind minimally invasive surgery is that if a surgeon keeps those incisions small enough, smaller than about 2 cm or even 1.8 cm, the surgeon can then bluntly dissect through the layers of the abdominal wall. They use a scalpel to cut through the skin, then they use a tool called an obturator to separate the muscle fibers as they push their way through the abdominal wall. What that means is that when they remove the instrument, the fibers come back together, the abdominal wall heals naturally and readily, driving complications down to about 1% for the patient, but all at the cost of vastly increased complexity for the surgeon. The surgeon must now triangulate to a single point in the abdomen. They have to use their instruments to actually generate the motion by pivoting about the incision site.
It makes the surgery incredibly complex. Even with a wrist on a stick that helps a lot with suturing, the surgeon is still creating the entire kinematic profile, the motion profile of any multi-port surgical robot that they use for every procedure based on where they make the incisions and where they want to operate inside the abdomen. There is a solution to this. It's to put everything in through a single incision.
Unfortunately, every single port surgical robotic technology to date has been built on flexible robotics technology, and those systems are just far too weak to do most surgical procedures and to even have that force level, they require large incisions at a minimum of 2.5 cm, again, requiring you to use open surgical technique, cut through the muscle fibers with complication rates from the incision site alone at a minimum of about 8%. The result of all of this is out of 39 million addressable procedures worldwide across abdominal surgery, there are 39 million addressable robotic procedures, over half of them are actually performed with open surgical technique today. There are a few reasons for this.
It really comes down to the difficulty of use of education and of setup, because with a multi-port surgical robot, the surgeon has to generate 4 degrees of freedom of motion based on the incision site, based on where they choose to put the incision. The result is that it takes a lot of surgeries, in many cases hundreds of surgeries, to really gain true proficiency in these systems. Overall, the limited capabilities of the systems limit their adoption, the high cost, increased workflow burden, high consumable costs, service costs, and capital acquisition costs all contribute to lack of availability and lower utilization overall. The total utilization within those 39 million addressable cases is about 3.2%. When Sammy and I got together, we were roommates at MIT. It's where I met Sammy.
We were both studying mechanical engineering with a focus on biomedical engineering and robotics. The two of us had a lunch with Dr. Barry Greene, who's been a longtime family friend and is an incredibly experienced laparoscopic surgeon. Dr. Greene walked us through everything that I just showed you, all of the challenges that surgeons face around robotic technology in the operating room today. We really believed pretty early on that single port was the ideal solution. We set out to solve the challenges fundamentally behind single port because flexible robotics just do not have the force for any given incision size. Existing rigid robotic systems have coupled motion, which is a linking of the motion between each of the joints in the arm. Sammy will go into more detail in his section.
Essentially, the summary is that it causes an exponential buildup of force each joint that you go up the arm. We set about to solve these problems. We worked on our decoupled actuator design for a few years. Once we solved that, we're really able to attract some A-list investors, including Khosla Ventures, Innovation Endeavors, AME Cloud, E15 VC, and Bill Gates' Gates Frontier venture fund. We're also able to bring in some amazing partners and advisors, including Paul Hermes, who formerly ran the Medtronic Hugo program, and David Styka of Auris Health. Off that, we turned our system with their advice and their support into our Beta-1 system and took our company public last year.
Since Beta 1, we've buckled down, taken the feedback from our hospital partners and our surgeon partners, and continued to invest in our technology to evolve Beta 1 into the Beta 2 system we'll be showing you today. We're incredibly excited about the opportunities that Beta 2 provides and the value that Beta 2 provides surgeons and our hospital partners, and we believe that they see the value too. With that, I'll turn it over to David Sylvan from UH Ventures.
Well, good morning, everyone. Thanks for, thanks for taking the time. Adam, thank you for that very generous description of my background. My mother would be, would be very proud. I'm David Sylvan. I have the privilege of leading the innovation, the commercialization, and the early-stage capital deployment platform for University Hospitals. Why that's germane for today's conversation is that we act as the front door, if you will, the enablement mechanism, the conduit when it comes to matching a solution to a well-defined unmet need together with the appropriate stakeholders, domain, or environment where the problem to be solved is housed. We act as a matchmaking mechanism. As I'm sure you can probably appreciate, we see literally hundreds of opportunities a year. We don't have the bandwidth, the time, the resourcing to be able to lean into all of these.
We see many, many shiny objects. Our role is to define and divine those with the magnitude of the unmet need, the definition around the problem statement, and the appropriate stakeholder can all come together like hockey player and puck. That takes a long time, that takes a process, that takes a lot of diligence. We're fortunate in an example like this where all of those elements came together in a very elegant and seamless manner, hence here we stand today. In this context, we're gonna walk you through the background of who University Hospitals is, because that will give some credence and some gravitas to why this type of relationship is important.
We're also gonna walk you through, and I'll introduce you to my colleague, Kendra Gardiner, who's gonna take you through our very impressive lineage when it comes to minimally invasive surgery. Then she'll cross-walk that to the problem statements around robotically assisted surgery specifically and our emphasis around centers of excellence. Who are we? We are a large regional healthcare system, roughly $5.5 billion top line. We serve patients all the way from primary to quaternary care in a 16-county circumference in Northeast Ohio. 33 or so thousand caregivers, a couple hundred physician offices, 50 or so outpatient facilities, and one of the country's largest ACOs with almost 700,000 lives under care.
Our flagship is the Cleveland Medical Center, our quaternary care facility. We have formal affiliation and relationship agreements with Case Western Reserve University, their School of Medicine, their Faculty of Biomedical Engineering. We also have an affiliation with NEOMED, which is Northeast Ohio's Medical College, Medical University. That's in Rootstown. We have formal relationships with the likes of the Technion Institute in Tel Aviv, Oxford University in England, with the latter two focused specifically around small molecule drug discovery and commercialization, and a lot of that we do in conjunction with Morgan Stanley. Our main campus also features Rainbow Babies & Children's Hospital, one of the most recognized pediatric facilities in the country, one of the highest ranked.
The MacDonald Women's Hospital, which is Ohio's only standalone women's care delivery facility, and Seidman Cancer Center, which is part of the NCI-designated case cancer comprehensive collaborative. Someone had a good day with alliteration. This depiction is our expansion out east, it's strategically important for this conversation because this is roughly a half a billion dollar expansion. It's gonna add about 80% to our OR capacity in an outpatient setting, along with that will come the adjacencies, the dialytics, the imaging, the endoscopic capacities, et cetera. Very important to our collaboration with Vicarious Surgical. This all sets the stage for why UH. We lean very heavily into this living lab concept that I described before.
This notion of what we offer from an organizational perspective to an early-stage med tech is critical because if they can make it work in our facility, we act as an exemplar for systems anyway. It can work, it can work anywhere. Research is in our DNA. Last year, this current year that we're in, our research spend exceeded $200 million, and that included industry-sponsored. We have a commitment to increase that by $700 million over the course of the next eight years. We boast 19 clinical care delivery and research institutes, and at last count had probably more than 3,200 ongoing clinical trials or research initiatives. We're perfectly positioned as a partner to a med tech and device company.
Our core mandate as an innovation platform is discovery, design, develop, and deploy, and we look to opportunities where we can do that in a collaborative design setting, such as the one that we've established with Vicarious. We're very active in the centers of excellence construct as well, which makes us very excited about this opportunity. We already offer the likes of hip and knee, of bariatric, of cervical and lumbar, cochlear ear, AFib, and of course, the opportunity to lean into and build robotic assisted surgery as an additional COE is extremely exciting. This will give you a quick graphical depiction of our throughput metrics. I think germane to this conversation, the lower right represents blue sky.
That's the disproportional number of outpatient surgical procedures. Kendra's gonna take some time to break down the case mix there, as it would be specific to Vicarious. Then you'll see in the top the number of unique patients seen. The new MRNs that we add on an annual basis, of course, adds opportunity from a heft perspective. We're incredibly excited to be here. Very quick anecdote. Our clinical champion, Dr. Sabik, our UH Ventures Chief Medical Officer, Dr. Rothstein, they had the chance to travel here to Boston at the beginning of this relationship. These are very, very difficult people to impress, rather. I know because very often they tell me how little I impress them. They're very, very vocal with regard to their opinion.
They both came back as giddy children. I know something important's about to happen when Dr. Rothstein summons me, and he starts the sentence with, "Dude." "Dude" is usually followed by something that's exciting. He began to gesticulate with his arms, and candidly, I thought he was having a seizure, but he was trying to describe what he'd seen in Beta 1. That was really a catalyzing moment for us to say there's so much traction from the perspective of the users and the experts, there's something here. Remember, that was, that was Beta 1. You're gonna see Dr. Belyansky, and you're gonna see the demo in a second, and it is incredible. My only personal disappointment, and Adam and Sammy, I'd be remiss in not expressing this to you now publicly, is they won't allow me to touch anything.
With that, Kendra?
Thank you, David. I was also on that trip with Dr. Rothstein and Dr. Sabik when we came, and it was prior to our signing. It was part of our diligence process to determine if this was the right opportunity for us to hitch our wagon to. I was also giddy, but I also looked like I didn't know what I was doing when I tried to drive it. I shared this with David the other day that both Dr. Sabik and Dr. Rothstein are not robotic surgeons, but to see them get on the Beta 1 system and easily be able to do it as if they'd been doing robotic surgeries for their entire career was pretty impressive.
My task here with you is to share with you more additional information about our experience in minimally invasive surgery, and I'm gonna do that by first introducing you to some of our surgical experts and innovators in our system. I wanna talk to you about how we've grown our robotics program over the last 14 years and give you some of the data in terms of how that shows up in terms of the mix of modalities. Before I do that, though, Adam did a great job of sharing my background. I think for me, this is exciting because I spent a large part of my career in actually manufacturing.
It's not too often that I get to geek out on projects like this where I get to blend the healthcare experience and bring some of my background to bear in terms of understanding the complexity of what this team is trying to accomplish and how far they come each iteration that they turn the feedback. With that, I'd like to introduce you to four gentlemen. We've been very fortunate to have the likes of these men in our presence. Dr. Ponsky is famous for inventing the PEG tube, as well as the minimally invasive procedure to place that tube. It's also known as the Ponsky tube. He was Former Chair of Surgery at University Hospitals before ending his career at the Cleveland Clinic. Dr. Sabik, located next to him, is the Chair of the Department of Surgery.
We've mentioned him a couple times, I won't elaborate further there. He is an expert in minimally invasive valve re-repair, as well as coronary artery bypass grafting. Dr. Jeffrey Marks is an international POEM expert. He also spearheads an active animal lab, where he is exploring new techniques around endoscopic procedures and devices to go with that. He also trains surgeons and residents in those techniques. Dr. Raymond Onders is another prolific innovator in our system. He has developed a minimally invasive procedure and a device for diaphragm pacing, it had its first, you know, national spotlight when he implanted that device in the then paraplegic Christopher Reeve, also known as Superman, when he successfully transitioned him off the ventilator to breathe on his own.
The next set of slide is just, I wanna take a moment to give you another snapshot of other surgical experts in our system. Each of these individuals use robotics regularly in their practice. I wish I had more time. I'm not gonna go into all of them. This information will be posted publicly. These are individuals that, in addition to others in our system, will be getting involved as we continue to move this forward. Today, UH has eight soft tissue robotics systems in our hospital. We have three at our Cleveland Medical Center. We have five additional robots in what we call our community hospitals. It's important for us to make sure that patients have access to these tools and technology, as well as our surgeons.
Getting those out beyond our quaternary medical center was really a priority for us. We started our program in 2008, and we have deliberately paced the growth of that as technology has evolved and as newer surgeons or current surgeons have asked and demanded this type of technology in our system. They have been active in building the most recent business case that was approved in 2020, I think that was June 2020, where we looked to further expand our robotics program at that time. I've listed three key elements that were important in that business plan at the time. One is incremental growth. This is where our surgeons became really important.
Based on their conversations with their patients, their knowledge of the demand in the market, could they help us predict the incremental growth that we could expect to see by bringing in additional robots? The second was clinical excellence. We know as a system if we don't have innovative tools available to our surgeons or available to the new surgeons coming out of school, we are not an attractive hospital system, and that was really important. The last piece, which many of you know because you cover this market, was the ability to change the way that technology was acquired. With the removal of the upfront capital cost, moving it through to a pay-per-click model enabled us to make this decision a little bit easier than maybe in the past.
As a result of that, this data kind of demonstrates the growth that we've been able to see with the bringing in of those new robots in 2020. If you compare the first two quarters of 2020- 2021, we nearly doubled our growth of robotics cases in just that time period. It hasn't continued to double, but it was pretty apparent immediately that as soon as we brought these robots in, that we were immediately doing more cases. If we look over the time period, though, from 2019- 2022, we have grown from about 800 cases to 1,900. What is interesting, though, as Adam alluded to earlier in terms of utilization, we do know that we're still underutilizing the robotic systems that we have in-house today.
Lots of questions as to why, but it's just a fact that some of them still sit idle, and we'll talk more about that later. One of the other points that I made on the prior slide was around talent attraction. In 2021, we were very fortunate to attract Dr. Haynes to our surgical program. I'm introducing him to you today because Dr. Haynes immediately, once Dr. Sabik came back and he was very excited, he saw the technology, realized it wasn't just a garage. We kind of joked when we were coming like, "What is this company? We don't know that much." A lot of diligence. He immediately thought of Dr. Haynes. Dr. Haynes, I'm not going to read his background, but he is. When he started his residency program, he immediately sought out robotics and invested a lot of his time there.
Day to day, I'm very fortunate that I have the leadership of Dr. Haynes to help convene the right people, have the right conversations, provide his insights, fly out. He was here last week with the team. As we continue this relationship, we'll hear more about Dr. Haynes and his commitment here. When we break this down by specialty, these are the top 10 cases that UH completed in 2021. These are just robotic cases. I've highlighted ventral hernia just to call out the first indication that Vicarious is indicating that they're gonna move forward for FDA approval.
What I found really surprising about this data is that of those 208, ventral hernia is the second most completed procedure within our hospital system today, but of the 1,200 cases approximately, that 208 only represents 17%. 17% of the ventral hernia cases today are done using robotics, and 70% are still done open. This really just kind of confirms the point that Adam was making earlier that, you know, when you get these complex cases, that tool that we have doesn't necessarily fit for that procedure or the comfort level of the surgeon doesn't match it either. It just reaffirmed that this really starts to confirm what we know about the unmet needs of the current robotic systems.
I'd like to talk with you a little bit about that next. Before I jump in, a couple things to note. What I'm about to show you is our internal perspective. It's based on a small subset relative to the, you know, the country and even our system. These were all people that are experts, that have used robotics, that understand it, both from their practice, but from an administrative or supply chain perspective. I was the person that compiled all of this information, so if you wanna talk to me afterwards, I'm happy to do that. As I was compiling it and understanding it, I would turn back to our clinical leaders and check with other people to say, "Does this look right to you?" A lot of confirmation.
I also believe that this data is only the beginning. I mean, these unmet needs will evolve as technology advances, as we learn more. I've done my best to represent that for you today, and I've broken this into two groups. I'm gonna talk to you first about the surgical team's perspective, and I'm gonna talk to you about the supply chain and administrative perspective. I've broken this into seven categories, and the gradient on the slide from left to right, the blue is our perspective on how well the technology today is satisfying that category, and the yellow is really the opportunity. I'm not gonna talk about all of these, all seven of them, but I will leave this up here long enough for you to kind of understand it. I wanna talk about the most important, at least from our perspective.
Visibility inside the body is crucial. As Adam was opening, he talked about the ability to triangulate and have the multiple ports in to get the views that you need to be able to see inside the body. It's not enough. There are so many complex cases today that we can't do based on our surgeon's perspective because you just can't see it or you just can't get there. Visibility is crucial. The other thing that I hadn't really thought about was fluid management. This is burdensome and time-consuming as surgeons get into the body and consistently have to pull the arms off to wipe them with already a lot of moving parts. I'm not gonna talk a lot about advanced guidance today. We all know that advanced technologies are coming. They're showing up more and more in healthcare. We're finding utility in them.
As we start to improve visibility in these other things, layering on those advanced capabilities are just gonna continue to add to things that need to be solved for inside the body, whether that's measurement systems or identifying, body parts, whatever it might be. I think once we get in there and we have the visibility, you know, the sky's kinda the limit. The other one I wanna mention is that so much of what's compared from a surgeon's perspective is what it's like when I do it open and what it's like when I do it with a robot. Today, you know, you can't really replicate that. How do you use technology around force and tension sensing? How do you make up for the fact that you can't actually feel what you're doing? Today's technologies don't allow you to do that.
The next two categories I'll talk about quickly. These are increasingly important, especially in today's tight labor market, where we're consistently, week by week, training new people to join surgical teams. While your surgeon may remain the same, and their competency is high, they're well-trained, the surgical team around them might not be. The ability to train teams up quicker on systems that maybe aren't as complex, but maybe easier to learn will be important. We have instances now where we have highly trained surgeons that are robotic surgeons, but don't have the confidence the team around them is ready yet, and so they will opt for not using robotics in those cases.
I personally can't envision, or maybe even thinking about being a patient, or I maybe want less time training. As we think about new systems, they need to be, they need to kind of round out the tools and technologies we have to allow people to move easily between the right tools. The next two are really kind of centered on a lot of that movement today. The robot functionality, a lot of it's happening outside of the body, which ties into the bedside experience that is impacted by that, whether that is having access to the patient or creating safety hazards around the room for the people working. The last two here, really kind of play off the former categories. We know if we can improve some of these other aspects, we'll get to better patient outcomes.
That could be that we're now doing cases we couldn't do before. When we're thinking about the cases we already do, that'll improve. I think there's enough information out, at least that I've read, that if you start to minimize the injury you cause to a patient, if you make it easier for the surgeon to navigate those spaces, you will eventually impact how the patient recovers. That's only one perspective that feeds into a business case when we're thinking about technology. We always wrap around, and we've spent a lot of time. It's been really interesting for me, again, to be partnered with Vicarious and to be able to convene these conversations.
Some of these conversations that are informing what you'll see here today have happened as I've listened to the conversations between our supply chain and administrative teams with the Vicarious team. It's also happened as I'm following up and having additional conversations myself. When you bring these two perspectives together is when you start to really inform the best way to bring new technology to the table and acquire it, which is why that is the first category on the slide, because technology acquisition costs today are pretty prohibitive from making robotics really accessible for surgeons across lots of hospital systems. These are difficult decisions for hospital systems to make. You've got robot consumables, and for new systems, a lot of upgrades to your facilities to even bring them in in the first place.
Of course, once you have that sunk cost, it's a little easier, but if you have multiple hospitals in your system like we do, it's a little more challenging. That also plays into the cost to manage, maintain. The next two categories here, the footprint and mobility, really interesting conversations as I was sorting this out. Today, our systems are mobile, and it is the claim that they are mobile. They are mobile. You can move them. Unfortunately, the footprint is so large that you can't move them easily. While they're movable, you might not be able to actually get them into the room. It requires special teams to do that. Some of our rooms just aren't, quite frankly, aren't big enough.
For us, these categories really go hand in hand in terms of being mindful, especially as hospitals are kind of going through a great, what I call the great reconciliation of real estate and space and utilization and throughput. These two things are going to have to be critical considerations. These last three are really, for data insights, this is really kind of opportunistic, and I think it kind of speaks to we don't know what we don't know. As hospitals become more savvy in their use of data in terms of performance monitoring and expectations, I think systems newer systems or even the current systems have a real opportunity in terms of being able to provide real-time access and business case support as we understand how well our systems are performing.
That can feed into then being able to view cycle times and start to understand that a little bit better. With that, I think I've mentioned our collaboration at least five times in this presentation, but I wanna talk to you about what it actually is. We kicked off in June of 2022, about six months ago. We've broken this agreement or collaboration into four phases, and we're technically still in phase one, so six months in. In that six months, I can tell you, it feels like we've moved mountains.
We've spent a lot of time convening a lot of conversations, providing access to our space and ORs so that the Vicarious team can come in and observe workflows, engage with folks, get insights, that have really been able to kind of translate into how they're thinking not only about their physical product but how does that product come to you as a system? How is it used in practice? We're still, as the yellow star indicates, in phase one, but we're beginning to plan for phase two, which will be additional testing and then preparing for clinical trials and then hopefully one day expansion. As we return to Cleveland tomorrow, I'm really excited to continue this work. The team at Vicarious is constantly on it. They're one of the best partners that I currently get to work with.
What we've got coming up is we're working on building out a surgeon summit to occur hopefully in Cleveland so that we can convene enough of our surgeons to further the insights gathering that will feed into V1. At the top of this slide, for reference, it's just kind of a myriad of the things that we have been doing in the last six months, the conversations we're having. Some that might be surprising, which would include supply chain, really trying to tease out economic models and what makes sense and gather the right perspectives to make good decisions. We've convened nurses around human factors testing, which was really cool.
I can tell you that projects like this, where there is really meaningful progress and a really talented team leading the work, for us as a hospital system also presents us an opportunity to bring joy. I can't tell you the number of times I have seen joy on the faces of people in our supply chain team, which never smile, like never smile, to just think about being able to be in a front row seat and seeing something so impactful being developed. Our nurses and scrub technicians that participated in some of the human factors design sessions, just like their minds are blown when you think about what they're currently dealing with in robotics to what it might be one day. I think you'll get to see a little bit of that today with the Beta 2 demonstration.
With that, I'm gonna let the expert technology whiz come up here, Sammy, to talk more about the Beta 2. Thank you.
Thanks, Kendra. As our UH partners just touched upon, there's an enormous amount of untapped potential to provide both technologic and economic value and benefit to surgeons and hospital systems. I'm gonna take some time to walk you all through our proprietary technology and how that enables our Beta 2 system and highlight some of our key differentiators. Let's start first with our decoupled actuators. Our decoupled actuators are the key to how we're able to surpass today's limitations of today's rigid and flexible robotic systems. It enables us to deliver a minimally invasive robotic platform with enhanced capabilities that addresses the unmet needs of surgeons and hospital systems, while also providing the foundation for future robotic innovation.
Simply put, our decoupled actuators are an enormous engineering feat that solves for the buildup of forces within a joint. For reference, a typical joint that exists in a rigid multi-port robot today is driven by a series of cables that twist and turn through a complex set of pulleys and channels as they pass through their proximal joints and ultimately end at the joint that they control. As the cables pass through these proximal joints, they impart forces on these joints that, if uncorrected, causes unwanted motion of that joint. To put it a bit more simply, if the system wants to control just one joint of the robot, other joints will inevitably move, causing what is known as coupled motion.
With today's current technology, the more joints a device has, the more cables it has running through each of those joints, and the more cables it has running through those joints, the more forces it has acting on those joints. Finally, the more forces it has acting, the more unwanted coupled motion it has, and it is up to the software system or the control system of the device to compensate for that unwanted coupled motion. At some point, however, if you keep adding more and more joints to a device, the amount of force inside that joint, and therefore the amount of unwanted coupled motion, becomes so great that the system can no longer independently control the joints.
This presents a fundamental and physical limitation to the number of joints today's rigid multi-port robotic systems can incorporate inside the abdomen of the patient and is the reason why today most surgeons are forced to operate with wrist-on-a-stick instruments that force them to triangulate their motions inside the abdomen. This restricts the range of motion of the surgeon as well as restricts the access to the patient and requires the surgeon train to perfect the setup of these complex robotic devices as well as simply control the motion of the robot. The first several years of this company's existence was dedicated to developing these decoupled actuators.
They eliminate coupled motion by optimizing joint surface, cable pathway, and it allows the cables to pass through the joint without imparting a force on them. As you can see in the video behind me, as one single joint is moved, only one set of cables is actuated. This level of decoupling is unprecedented in surgical robotics today. Again, by decoupling the motion of the joints, we're able to solve for that long outstanding issue of force buildup and unwanted coupled motion. This, because we're able to do this, we're able to incorporate six additional degrees of freedom relative to today's technologies per robotic arm inside the abdomen of the patient. This enables us to fully mimic the human wrist, elbow and shoulder. This affords us nine actuators in each arm, each of which correlates to an independent degree of freedom.
This is important because in robotics, in order to fully move an object, you need at least 6 degrees of freedom. Typically X, Y, Z, yaw, pitch, and roll. If a robot only incorporates six joints, then the number of ways that it can both approach an object and then move it once it gets there is extremely limited. A counter example, humans have many redundant degrees of freedom in their arms that enable humans the freedom to choose the way they approach an object, and then choose the way they move it once they get there. By incorporating 9 degrees of freedom, we mimic the redundancies of humans, thereby enabling our anthropomorphic robot to match the motion and dexterity of the surgeon.
Overall, this provides the surgeon a much more natural experience that allows the surgeon to focus on performing the procedure rather than on how to control the robot. In addition to this human equivalent motion and improved dexterity, our decoupled actuators enable superhuman joint flexibility that gives the surgeon not just the ability to work forward, but also to work upwards, downwards, left, right, and even facing all the way backwards towards the incision site. It's unbelievably incredible. All of this combined with the ability to pivot externally about the incision, about the incision sites provides a full true 360 degrees of anatomical access.
In our testing with our surgeon partners conducted on cadavers, surgeons are able to enter the abdomen from nearly any location, work at nearly any angle, and work on nearly any surface without the need to manually reposition the system. Due to our unique design, we're able to incorporate 28 high fidelity sensors in each of our arms. These sensors are used to estimate the force, motion, and location of the arms in real time. The ability to capture this data in conjunction with our visualization capabilities lays the foundation for advanced intraoperative feedback and post-procedural education on surgeon technique and efficiency. This is the future that our team is building towards today. Another exciting aspect of our robot today is its visualization capability.
For reference, the visualization ability of surgical robots marketed today is inherently limited because of the small size of the sensor that needs to be incorporated at the end of the endoscope. The size of a sensor and the size of a lens stack directly correlates to the quality of the image coming out of it. However, because of our unique camera and trocar design, we're able to fit a larger, much more capable camera that provides for unprecedented image quality. Again, our decoupled actuators really shine here. They enable us to incorporate three degrees of freedom in our camera, so that our camera is able to pass through the trocar in a sideways position and then fully deploy once inside the abdomen.
Again, it's the decoupled actuators that allow our camera to yaw, pitch, and roll, giving the surgeon a full 360 degrees of viewing capability within the abdomen of the patient. Surgeons finally have the ability to maintain awareness of their surroundings while without breaking focus on their target anatomy. In surgery today, a common problem that is encountered is a dirty camera. Kendra alluded to this earlier. The solution to that today is to simply pause the operation, to manually extract the camera, to clean it by hand and then reinsert it. This completely disrupts and delays the flow of a surgery. This is a large pain point for most surgeons today.
We decided to take it upon ourselves. I'd like to introduce our solution to this today, which is a self-wiping feature that we like to call blinking. By adding this feature, we're able to save surgeons and operating room teams an immense amount of time and frustration. Complementing our camera's hardware is our proprietary software stack that enables 4K high resolution, high clarity, high frame rate with autofocus, adjustable lighting, and full motion tracking. In order to facilitate such an array of visualization capabilities, we have equipped our camera with a liquid cooling solution to mitigate any issues that would otherwise might compromise surgeon visualization. Again, because we're able to fit a larger camera, we have the physical space to include additional advanced sensors. Sensors such as LIDAR, structured light, and multi-wavelength detection.
Combining this enhanced sensing capability with an advanced software stack that incorporates machine learning and artificial intelligence algorithms, we're able to do incredible things. Incredible things such as overlaying the output of that multi-wavelength sensing live in over our real-time updating 3D depth map. It's absolutely incredible. As you can see, it's the real estate afforded to us by our unique hardware platform that enables us to pack in an unprecedented amount of sensing capability, which in turn creates the opportunity for incredible future software innovation. We are unbelievably excited about the capability of our visualization and sensing technology and the potential to provide surgeon with...
Surgeons with new smart features such as independently detecting different dyes, fluorescence, autofluorescence, structure identification such as uterus or other organs, and just general proximity and location tracking of our robot in real time inside the abdomen. We continue to develop all of these features and more in R&D today and expect to provide future offerings that empower surgeons to make well-informed patient decisions and perform more efficient and effective procedures. Now, to take a holistic view of our system, surgeon feedback across our centers of excellence partners as well as our surgeon luminary group has been overwhelmingly positive in regard to the robot and its capabilities that I just reviewed with you. However, there has been some clear room for improvement, particularly in the ergonomics of our Beta 1 system.
Our Beta 2 system incorporates an enormous amount of feedback to improve surgeon comfort. Diving deeper, our former hand controllers of our Beta 1 system were of a free-floating game console inspired design. Again, after much development testing with our partners, we decided to opt for a set of linked hand controllers with customized grips. Additionally, our earlier Beta 1 prototypes incorporated a display that either required the surgeon to wear a polarized set of 3D glasses or don on a virtual reality headset. Both of these afford the surgeon a very immersive experience. Again, after discussions with our surgeon partners, overall guidance emphasized the ability to maintain interaction with the operating room is much more advantageous.
To those ends, our current Beta 2 surgeon console consists of a new stereo 3D viewer that still provides an immersive view but also maintains the surgeon's ability to interact seamlessly with the operating room. Additionally, the Beta 2 surgeon console is fully motorized so that a surgeon can personalize the armrest position, the display height, depth, and tilt to their preference and comfort. Although our Beta 2 system and likely our first go-to-market offering will not incorporate a head-mounted display, we still intend to offer it in a future release. Turning now to the patient cart. The most obvious change is the new industrial design. More notably, our system can now be positioned and docked by a single person, and the surgeon now has complete direct control of our motorized insertion, rotation, and brakes of the system.
As Kendra touched upon earlier, it's valuable to both the surgeon and the hospital system to have a robotic system that is easy to use, easy to operate, is capable of being broken down, and moved if necessary. Because the majority of our robot's motion occurs inside the abdomen of the patient, our architecture is much simpler, our footprint is much smaller, and our robot is much more mobile. There will be no need for a hospital system to dedicate a room or a space for our device. As you can see, with our decoupled actuators, we've been able to build a robotic platform that addresses the unmet needs outlined by our partners here today and many others. The Vicarious Surgical system provides unprecedented dexterity, anatomical access, and visualization.
Beyond just that, our platform forms the foundation from which we can build future value-add software and data innovation. I'm very proud of what we've accomplished with the Beta 2 system to date. The recent cadaveric labs performed by Dr. Belyansky have strongly reinforced my confidence in our ability to deliver on our vision of revolutionizing robotic surgery. Now, to give you all an overview from the surgeon's perspective, I'll invite Dr. Belyansky to come walk you through his experience driving the Beta 2 system. Thank you.
Thank you. All right. Good morning, everyone. Thank you very much to Vicarious Surgical for asking me to speak here today. This is a great honor. My name is Igor Belyansky. I'm Chief of General Surgery at my hospital. I'm also Director of Abdominal Wall Reconstruction Program. I am also, currently at present, probably 90% of my surgeries are performed robotically. Kind of just to give you all perspective where my field has been, you know, it's been a field of e-evolution, and 10 years ago, when I just finished fellowship and start, most of these procedures were done through an open approach, and just fast-forward now, it's incredible what the patients in the hospitals have went through with the evolution and what we're doing now. In 2015, I described a procedure.
It's called eTEP access, ventral in hernia repair. It's now been adopted all over United States as well as the world. I've traveled kind of teaching this, lecturing about this. I've been invited to 13 countries to operate by invitation. As a result, I teach fellows and residents on daily basis. I also have surgeons from domestically, internationally come visit me on a monthly basis. With that in mind, I had this opportunity. Vicarious approached me about a year and a half ago to ask me to work with them.
For me personally, this was an incredible opportunity to really be at the ground level and have a say and to actually have a say how the future system, robotic systems are actually developed. I've been continued to be very impressed with the team itself of how they're taking some suggestions and go back and return with really value add type of solution to the problems that we've seen. Without further ado, in a second, I'm gonna play the video that is gonna show two different cases. The first case is gonna be a robotic hiatal hernia repair.
What that is, those of you not familiar, the, you know, we don't have any surgeons in the room besides me, I don't think, is a repair of the hernia, where we close the defect robotically and place the mesh inside the abdominal cavity and secure the mesh usually with stitches. The second case is gonna be robotic preperitoneal repair. It's a more popular repairs now recently, where we keep the mesh completely extraperitoneal, and the section of peritoneum is a little bit more challenging. Go ahead, guys. Please, play the video. The video will start with me walking in the operating room and, sitting down in a surgeon consult.
As a video is going to start playing in a second, as Sammy talked about, you know, the surgeon consult is completely something new that's now available in the market there. We took the best of both worlds. It's immersive experience where you look at this, but at the same time, you're able to maintain your peripheral vision and able to stay connected with the operating room. Currently, right now, when we do surgeries, we really don't know what's going on in the operating room unless you hear what's going on. This is a solution to it. We're now connected to our team members. The docking procedure is a little bit, it's much more straightforward. It's a single port, and we don't have to worry about triangling the ports anymore.
There's no learning curve anymore of actually knowing how to place the ports. One port, just dock it anywhere else. Here you see that Sammy talk about the camera. Very unique camera, nothing like this available in the market. The benefits of this camera is to be able to take a look around 360 degrees of just. Here we are looking at the defect that we created, which we're about to start closing. The next thing after the camera is introduced, you'll see me, my left hand being introduced, which is an atraumatic grasper. You can actually grab intestine with this grasper and manipulate adhesions or scar tissue if you need to. The right side here, this is a needle driver here. Now I'm gonna start suturing.
Again, this first procedure is a robotic hiatal procedure. The procedure is going to start with me suturing the defect. We're using a barbed suture. This is a standard thing that we do in surgery for those defects. One thing, as you're watching this video, please note we're actually using two cameras. This camera that you view, that you get right now is the proprietary camera that we use to record this to give you guys an understanding what the robot looks like, what the motions actually look like from the side. The camera is looking over the left shoulder of the robot. We will transition to a surgeon's view in a second, just so you see what the surgeon sees. As you see me suturing here, just things to pay attention to.
If, again, you guys not being surgeons, but, if you had any experience looking at this, is looking how the needle goes through tissue, how the instruments are able to push the needle, the fidelity of movement, the efficiency of movement, the ability of me, the surgeon, being able to place the stitches just the right interval, so away from each other. The way we close this defect, we use what's called a shoelace technique. We'll place the stitches, and as we go, at the end, we'll tighten them up just like you shoelace your shoe. Okay? Next, in just a few seconds, we're gonna see the surgeon's view, and I'll go through what the surgeon sees when they operate. This is the surgeon's view, and this is a GUI screen.
As you're looking at this, couple of things to look for right away. It tells you which instruments I'm using. On the left side, it's telling me that I'm using grasper. On the right side, it's indicating that I'm using a needle driver. The more interesting thing about, specifically about this robot is how we are maneuvering it and understanding for a surgeon the relationship, the 3D relationship with the robot inside the abdominal cavity. This is the lateral view. It's showing me that I'm pitched up, and the camera is rolled a little bit up. You can see the camera view right here. On the right side, you can see the top-down view. I'll come back to that in a second, but see how the camera right now is shifted.
Our shoulders are square to this defect, but we shifted a little bit to the right because we're looking, working from left to right of the abdominal cavity. This is again, a view from the left shoulder of the robot, and you see the stitches are not tied yet. They're in place now. Now I'm gonna go through where I'm gonna tighten them up, and so everything is gonna be nice and snug. This is how you want the defect to be closed at the end. You know, some questions that we had sometimes, how strong are the instruments to be able to drive needle to pull through? Obviously, as you can see here, this is something that's achievable with the instrumentation that we have here right now. Next thing is introduction of the mesh. The way we introduce...
Several ways to secure the mesh, but the way us robotic surgeons, we do this now, we usually take a stitch and run it through. There's different ways to do it. You can take several stitches. This is a monofilament stitch that you can pull through all the way as you're taking the bite and tie it to itself. Again, as you do this, pay attention that I'm able to control the needle in such fashion to take just the right equal bites and just making it really nice and snug. And as you see me work here, let's just talk about how the robot moves again. As you move here in the screen from screen right to the screen left, what we're essentially able to do right now is to scrap the defect and continue staying scrap. We call this crab walking.
Essentially, here are the arms, and we can crab walk from left to right, from right to left, and kind of switch the. This is really helpful for somebody who is calling a defect in front of you. If I need to, I can actually pivot, and I completely turn my shoulders this way and operate in the left lower quadrant. I can turn completely and operate in the right upper quadrant. You know, we can pitch the whole everything down and actually roll the camera up and stretch the hands up and work like this. We can do the opposite. We can pitch up and look down and look the work the intestine. Incredible degrees of freedom of movement and very unique to this specific robot.
Here we are almost finished with the IPOM, then we're gonna tie this. You see here, we're pitched down, looking up at the end. This is just a view from inside the surgery. The next procedure is the TAP procedure. Again, this is a more difficult procedure dissection-wise. It's a little bit more challenging because now you're trying to peel away this very essentially paper-thin layer that lines the inner abdominal cavity. Peritoneum in the even alive patient, it's very paper-thin. Now, this is a cadaver model, obviously, and, you know, this is a little bit more difficult, cadavers, to reproduce this dissection. Here we are doing this, and actually we're diving in here. What you see laterally, we're actually diving into the space called pre-rectus and prevesical space.
Sometimes you gotta go one layer up just to maintain the flap and not to make those holes. Once you create the pocket, the next thing we're gonna do is actually close the defect, which is right there. I mean, a very cool shot to where you can see the whole robot and to see what it's in action. Now we're gonna start closing the defect, and again, this is. You've seen this already once. This is a barbed stitch going from left to right. You can go from right to left to right. I'm a right-hand surgeon. It's easier for me usually to work from left to right. You can see as I take the needle, this needle is gonna go through this little hole there. It's just on the first pass.
It's a fine point movements that this instrumentation allows you to do. Very difficult actually to do this laparoscopically, to go through a needle, through the little hole. Here we are actually looking inside. Again, look at the left. We're pitched up and looking up towards the defect. Let's keep attention, pay attention to the right side, and what you're gonna see, you're gonna see that crab walking, where we're gonna stay centered, and we're gonna face the defect and keep our shoulders square to the defect and transition from left to right as I close the defect. This is a very unique way of controlling this and making this easier to. See, I just moved, shifted over, and it tells you that you're doing that.
It can orient the surgeon the whole time to what's going on inside the abdominal cavity. Once this defect is closed, Not shown here, we're gonna pull the stitch through, and then we're going to introduce the mesh, and the mesh is gonna cover the defect, and we're gonna use what we call cardinal stitches to secure the mesh in place to make sure the mesh does not rotate. Very cool how it just shifts over. Again, if I want to, I can then, if I wanted to look at something, I can turn around completely. I can also, without moving the shoulders, I can also just turn my head and control the camera and keep the things in place. In almost like a, lack of a better word, humanoid type of motion.
This is the last stitch that's being placed here. We're gonna cut it. Now we're gonna start closing the peritoneal layer. This step in real life sometimes is very difficult to perform because this peritoneal flap can be right in front of your face, and here you are working like this. What we're doing here, we're using the design of this equipment to actually pitch down to create extra space. We're creating extra space by pitching down, rolling the camera up, and putting the hands up, and we create the space. Now we have room to work in. Very unique solution to this problem. Once this flap is closed, this procedure is complete, and the mesh is completely extraperitoneal. Just a view outside, and you can...
The best way I think about the controls, it's my fingertips are becoming an extension of the instruments. That's how I feel when I operate, and this is what the feeling is like when you do this. This concludes my presentation. Thank you very much, everyone.
Thank you so much, Dr. Belyansky. You know, I've seen that video, I don't know, probably two dozen times at this point, and it never gets old for me. I really love watching it. I also wanted to further emphasize that both of the views, both of the cameras in the abdomen there, actually every intra-abdominal view you saw was shot with our camera technology. We put two of our cameras into the abdomen, in this case, one for the third-person view, so that we could show you all today. I'm incredibly proud of our team and wanted to thank everyone for the amazing work to get us to this milestone today. You know, we committed to this milestone a few years back, and I feel incredibly proud of what we've delivered.
Next, we'll be looking to our of our system, taking all this feedback and turning it into that initial manufacturing production build that will be V1.0. We'll be then over the course of 2023, going through a variety of different tests, everything from sterilization, biocompatibility, human factors, electromagnetic compatibility, just to name a few, all to ensure that our technology and our device is safe and effective before human use. This will allow us to obtain the ISO 13485 and NRTL certifications that we need to take our device to the FDA. At the same time, we'll be building out our entire supply chain, continuing to build out our entire supply chain as we ramp production of sterile devices into our clinical trial build.
I'm incredibly excited and proud of all of the work that our team has done overall. You know, as you've seen, there's an incredible opportunity with our core technology that we've proven out with Beta 2, and we've proven out how much value this technology can have to surgeons and our hospital partners to ultimately improve patient lives. Thank you everybody so much for joining today. We're gonna take just a couple of minutes to set up for our Q&A panel.
Great. I think we're gonna get started with Q&A. Looks like Ryan's got one up front right now, so coming over with the mic.
Thanks for the presentation. Congrats, Vicarious, on all the development. Ryan Zimmerman, BTIG. A couple questions for me. For the University Hospitals people, you talked about eight systems that you have in place right now. Talk to us about, you know, why it makes sense to potentially switch at some point, whether that be economic, logistically, and how you manage having multiple systems in your organization?
Yeah. Great question. Thanks for asking. You know, for us, it's always important to ensure that there isn't so-called concentration risk. When we look at exemplars, for example, in imaging and radiology, very common for us to see magnets from a variety of manufacturers. There's Siemens in-house, there's Medtronic, there's J&J, there's et cetera. I think for us, it's important to ensure that there isn't concentration risk, and it's also critical for us to ensure that we now have systems that meet and match the criteria of our new physical plant configurations.
What we have and what we will continue to use, by and large, can't be moved, and we really have to lean into what our future needs to look like from the perspective of expanding our center of excellence when it comes to robotics, and that's gonna imply mobile systems. Candidly, we're also. It's incumbent upon us to lean into innovation. It's part of our mandate from the standpoint of, where is the technology going, and how do we cater to the needs of the pull from a surgical perspective? The final piece will be the clinical outcomes, whether it's zero defect, whether it's the notion of do no harm, or the broader implications around valued care and access. Those all tie very neatly back to our relationship here with Vicarious.
We're very comfortable with the management of redundancy around multiple systems, multiple offerings. Anything to add?
Okay. Very helpful, a nd then, for Dr. Belyansky. Sorry. For you, talk to us about what-
speaks to you most about the system? Is it the ability to tack a mesh in the abdominal wall with full range of motion? Is it the anti, kind of, fogging features that they're introducing now? What's gonna resonate with you, and what kinda gains would you think, whether that be operationally, economically, from having that capability relative to existing systems on the market today?
Yeah, sure. It's, it's not gonna be a one particular thing. I mean, as you've seen, there's so many different, in a way, ways that Vicarious Surgical provide a solution. I mean, we'll start with just kind of going from the top. You know, single-incision platform. Novices surgeons do not have to learn how to triangulate and how to place the port, so it's a kind of a much more dynamic way of placing the port wherever you need to. Docking simplified. Once the triangulation happens inside automatically, camera, which is able now allowing you to not having to clean and able to see everything inside. Instrumentation, which again, is very dexterous as you've seen. I mean, you know, so it's...
The next thing is, like you have to think about for surgeons, access, right? Like how, what access do surgeons have to robotics? This is an alternative here. You know, somebody like me would be very interested in using a system like this in the future.
Hi, Adam Maeder. Piper Sandler. Thank you for taking the questions and for today. This has been great, and congratulations on the progress. A couple from me, and maybe just to start, probably most applicable for the University Health folks, but would love to ask about just kind of the, you know, capital budgets as we head into 2023. Obviously, it's, you know, a very topical item. We may be heading into a recessionary-type environment. Just any color on how your system is thinking about budgets next year?
Carefully, I think is the first answer. Yes, certainly what you point out is what we're all facing from an industry perspective. There's no one that's left unscathed. That forces you as a system to be very discreet with regard to where you do place your bets and where you don't. What is unwavering is our need to lean into patient care and outcomes, and that does trump all. From the perspective of making go, no-go decisions in a zero-sum game, the decision to lean into clinical care is never going to falter. That always takes priority.
Given the breadth of the physical plant, the number of hospitals, there are lots of choices, fortunately, to be able to be made from the perspective of what we might curtail, what we might stall, what we might look to from the perspective of a, of an alternate business model. Not everything needs to be capital intensive. We've begun very early exploratory theoretical conversations with Vicarious around what might that look like in a more capital-light type environment.
That's helpful color. Thank you. Then maybe for the follow-up, this is kind of a bigger picture question, probably for University Health as well as Dr. Belyansky. How do you think about single-port robotics versus multi-port versus endoluminal? How do you see the robotics landscape shaping up over time? Are these things complementary? Are they cannibalistic? Will this be kind of bifurcated by indication? Just any kind of big picture thoughts there would be helpful. Thank you.
Yeah. For to see the evolution, but, you know, the products, like Vicarious, you know, makes you think that there is gonna be a big space in single-incision platform surgery, especially as the trocar size is really down to 1 point. I think my mic is out. Yeah, no? The smallest trocar size that is gonna be if going commercial, gonna be available commercially. I think there is gonna be a big space for this, and it'll be interesting to see how things continue to evolve, but the things gonna you know, like as a functionality doesn't change. I think, you know, I mentioned in the in having access, surgeons having access.
Like, why is more, not more surgeons using robot? Some of this access, some of this capital economics, you know, I'll let the people who understand this much better answer that question. Having systems available that to the hospital systems, perhaps that at a competitive price is gonna be something that gonna lead to surgeon adoption as access increases.
As I stated earlier, I'm not a surgeon, but I think what's been really interesting for me in engaging with robotic and non-robotic surgeons in our system is that I think in looking at the system, you start to open up a world of possibility where we haven't really been able to take robotics yet. I do think there will be a little bit of cannibalization of how we're doing current open procedures, but to the benefit of reducing or making better, bigger impact on patient outcome and impact to the hospital over time. I think there will be a rebalancing of sorts when you start to introduce new technology that allows you to do things that nobody could imagine or has had access to before. I think it will be interesting.
Yeah, that's, if I wasn't clear, what I think is gonna happen is more open cases are gonna be done robotically as we move forward. I mean, it's happening already, but it's gonna happen even faster with companies like Vicarious coming in, you know, coming on board.
Voice activation. Sorry about that. Josh Jennings from Cowen. Thanks for hosting this event, to the Vicarious team and for all everyone that's joined here. It's very enlightening. Maybe a question for David and Kendra from UH and also Adam and Bill from Vicarious, just thinking about cost-effectiveness of robotic surgeries. I think, Kendra, you mentioned in your presentation that that wasn't a huge consideration or it's becoming a bigger and bigger consideration, but maybe just talk about the collaboration, how important cost-effectiveness is of a system to UH, and how much you've kind of emphasized that in your feedback to Vicarious. Maybe for Adam and/or Bill, just the cost-effectiveness dynamics of the Vicarious system, anything from faster procedure times to the future of disposable costs and then capital costs.
I can speak to what I understand about previous business cases and making these kinds of decisions before. Open procedures today remain to be the least cost-effective to do. Cost has always been a consideration, and how you look at that cost per case over time is a really important input in terms of how our system evaluates bringing in new technologies. It's not the only variable, but incremental growth and being able to expand cases is really important in today's environment. In terms of how we're discussing this today, which is pretty exciting, I mean, we're years away from commercialization, and so to start to be able to kind of talk back and forth about how we look at those models and being able to develop models to put the information into the models and make...
Help feed that back to our partner in terms of helping them figure out how to really democratize this and take it into more centers, I think is gonna be really valuable.
Let me just add that the total cost of care equation is debilitating. It's untenable right now. We, as a system, are very meaningfully moving from volume to value, and the only way we can do that is to look at each of the base ingredients from a procedural perspective and work down cost to something that would be manageable when it's when it's bundled. The other element that you can never lose sight of, that we should never lose sight of, is zero defect and harm.
The extent to which a robotic procedure is proven, and the delta and the metrics were shown in some of Adam's earlier slides, the extent to which we can improve outcomes from the perspective of risk reduction, harm reduction, the cost there is immense, of course, notwithstanding the implications from a family, a, an individual, and a patient perspective. Those components are a little bit more hard to quantify. We certainly know that our, our risk oversight function, functionaries are very intrigued with what can be done when it comes to risk reduction.
I'm just gonna add a tiny bit to that. I totally agree, and with everything here, you know, I'd really emphasize that total cost of care. I think our cost of goods structure gives us a lot of flexibility, frankly, to work with our partners on how to do this, and it's really exciting to be able to work now on exactly what that model is, tease out across the entire, you know, hospital system where the value is, and then to, you know, be able to create a product offering that delivers, you know, better total value in reducing total cost of care.
One follow-up for Dr. Belyansky. Just wanted to hear your impression of the ergonomics of the Beta 2 system relative to other robotic systems and particularly the ventral hernia cadaveric case that you just showed us, and the r-TAPP element as well. Is, you know, how efficient is the Beta 2 system relative to other robotic systems and the ergonomics, I guess, are the two elements I'm curious about? Thanks.
When somebody says ergonomics to me, that to me means my comfort level, operating at the, you know, at a certain console. It is very comfortable. I do what I mentioned before at the end of the video. It feels like the instruments are truly an extension of my fingertips. That's the kind of the best way I can. It is comparable. It's essentially I was able to go from one system to this one, and the learning curve here was very short.
Efficiency of the movement, the dexterity.
Yeah. I thought the movement, the efficiency of movement, the dexterity, I mean, it was excellent. Yeah, yeah.
Uh, just like-
Great. Kyle Rose, Canaccord Genuity. Just first question for I guess Sammy is, obviously you've got Beta 2 here today. Can you just talk us through the milestones that are gonna happen before you get to, I guess, full lock of the device when we think about moving towards, you know, the FDA and trials and things?
Yeah, absolutely. Adam did touch a little bit on this earlier, but you know, we've got our upcoming V1.0 version of our robot that we will put that through a pretty rigorous set of testing through our V&V, our initial V&V, including sterilization testing, packaging testing, EMC, you know, basically all the things that we need to do to ensure the device is safe and effective. Yeah.
Great. Just one last one is, maybe this is for the UH team, you know, there's a lot of talk about data analytics and the sensors that the technology has. Can you just talk about how you think about and how the health system thinks about, utilizing and collecting that data and evaluating it over time?
The waste in hospital systems is incredible. I'm not just talking about durable equipment, and I'm not just talking about people's time. We waste all of the data that we gather. We have a very concerted effort from a system-wide perspective to harness data for insights gathering, to inform outcomes, to inform the manner in which we go to patient care, so to speak. We've entered into some formal arrangements with both AI companies and data aggregator platforms to give some underscoring to the importance of which we put to the data component. It's a totally unharnessed, unutilized, unleveraged asset right now in many respects. What's potentially offered here through V1 is very intriguing to us from an insights gathering perspective.
I also wanna add though that that data I think is gonna present itself in different ways. For the surgeon specifically working on that system, I think having access to information that gives them insights that they can't get today, that better help them navigate the surgical landscape inside, is gonna be pretty powerful. I think once we get outside of the system too, what you were speaking about is gonna be really important in terms of performance and utilization and ways that we can improve and feed that back in to our partners as we continue to make the technology better over time.
Just to add on a little bit. You know, I think this is an incredibly important part of our strategy, and, you know, access to data and insights, you know, is, you know, obviously a priority for you guys. It's also something we've heard from some of our other partners, as well as, very high up on the list. You know, it's not just... I mean, I completely agree about the existing data and health systems today is, I'd say underutilized probably. I think that partly comes from quality of data, and that really comes back to our sensing strategy and why, you know, we fundamentally believe from an engineering standpoint that, you know, data and analytics and insights, it's all, you know, candidly, it's all great buzzwords, right?
To actually generate what you need from it, you need it to be the right data, the right sensors collecting that information, and at the right time. We're building all of that out from a hardware standpoint. I think as Sammy mentioned, you know, not just the physical space, but the actual thermal management profile to be able to run a pretty high-power data collection system from inside of the patient's body.
Great. Hi, I'm Matt Miksic from Barclays. Follow-up if I could, just on maybe from Dr. Belyansky around, you know, where you see some of the initial traction of a system as it gets closer to market. Does this become sort of just like a really powerful, you know, single procedure, hernia procedure, sort of traction and interest? Or is, you know, is there truly this sort of, you know, cost structure benefit of sort of unleashing additional demand through a just a more cost-effective platform? I have one follow-up.
As you know, the original FDA application process is for ventral hernias, that's where the focus is right now. If I was, you know, on my own extrapolate where you can use it, there's a variety of things that you can do with this. You know, you can, you know, ventral hernias, incisional hernias, gallbladder surgery, inguinal hernias, prostatectomies, GYN surgery. I mean, I can keep going. All these procedures can potentially be addressed with the system. You know, that's up to the company later on to decide what they wanna do.
If I could just to follow up on, you're talking about data, Adam, and the kinds of data these systems, you know, you can pull off these systems for analytics. You know, your larger competitor in the marketplace, you know, has a pretty well-established ecosystem. You know, it's not something that anyone should expect you to be able to sort of snap, you know, your fingers and have with a small and growing install base. You know, what, you know, what similarities would you, would you hope to accomplish with a similar, you know, ecosystem concept? You know, how should we think about that kind of growing as the install base grows?
Yeah. I mean, it's absolutely true that there is a moderate footprint of surgical robots out there today. You know, I think again, it's kind of looking at the specific data that are collected in surgical procedures is really important. You know, what's collected today is primarily just video data and then relative position movements, right? Not actually knowing exactly where the end effectors are, but rather just the relative movement of them relative to each other. That's really limited what you can do with that information, and that's why we've seen relatively limited insights that have come out of intraoperative data. I think it's kind of a black box in surgery today, despite, you know, despite the number of procedures that have been performed.
That's why we're building out our camera system that has, you know, all of these additional sensing modalities, can map the abdomen in 3D, can actually use fluorescent imaging, real-time throughout the entire procedure with multiple dyes and multiple wavelengths so that we know every structure that the surgeon is working with, every tissue. We actually know what they're doing from kind of a mechanical hardware sensing standpoint. With that, I'll pass it over to Sammy, can answer more about how that works.
What I'll just add is that, you know, it's not just about, you know, our unique architecture makes us well-suited to not just capture more data, but also better quality data. It's the combination of those two that probably uniquely poises us to do much better in terms of the insights that we can gather from the data that we're collecting. That's something that, you know, really excites me, and is something that I think is gonna really excite surgeons once they see what we can do.
Adam, for you, we didn't hear anything today on the clinical trial from the FDA. I don't know if you're, you know, wanna break some news or anything to us today. Any insights there, I think, would be helpful in terms of what you've learned since the last public forum.
Yeah. What I'd say so far is, you know, the conversations with the FDA have been really wonderful. It's, you know, they've been very collaborative, I think is the word I keep using, but it's exactly right. They are directly engaged, and they're helping us through this process, you know, to make sure that we set up the process for success and to ensure that our device is safe and effective. We're gonna keep working with them until we get to, you know, exactly the right answer here, and something that, frankly, they sign off on. Once, you know, we have that sign-off, we'll share it. It's been really positive.
Wolfe Research, thanks for taking the questions. For Dr. Belyansky, curious, do you have an estimate on the cadaveric cases or case that you've done, how much faster that is on the Vicarious system versus multi-port? The follow-up is, have you ever tried that case on the existing single-port technology?
Yes. I answer your last question first. I've never used existing single-port technology ever in my practice. When we were doing a lab here, the purpose of the lab is really for development of learning and kind of going backwards and forwards. Even this last lab, you know, we're not timing to see how fast on the... If you then afterwards looking at the video and actually looking at see how long it take, it takes about the same. It took me about like just under an hour to do each of procedure. It's very similar to how it is in kind of real life when I do a multi-port robotic system. It's similar.
A follow-up on, for the UH folks. I'm curious, you talked about waste in the system limiting utilization of your robot fleet, which if I'm doing the math right, 1,900 robotic procedures across eight robots, that's about 240 a year. I would describe that as kinda average for the global install base of da Vinci's. It's a two-parter. What can that number be from your perspective? 240 sounds like it's too low. How would you model your North Star there, 300 beyond? Yeah, that's the question. Just kind of when you dream your dream on your robot strategy, how many cases a year can be done for a single system?
I don't think either David or I could answer that, if I were to guess, it would be 100% utilization on anything that you invest in. I think there's so many limiting factors in why things are not utilized, though. We talked about earlier just the talent market. We've got a lot of turnover. Every hospital system's dealing with that. Sometimes that will limit your ability to use advanced technologies where the learning curve is high. Then case mix, you know, complexity of cases, some of those will not allow for you to use a robotic system even though your team might be trained. If I had to guess, I would imagine that our North Star would be 100% utilization of any very capital-intensive investment.
There's always gonna be the minimum threshold, that hurdle that we have to attain from a business model standpoint. We're gonna have to lean very heavily into the answer to your question just to get to the point to motivate why we would move forward with anything. It's definitely part of the collaborative build right now is to understand throughput, understand efficiencies from a setup and breakdown perspective, and then bring in the human factors when it comes to training and the fungibility of skills from a training perspective.
I do wanna add one thing, though. I do know from that business case that we set out, that we've met the performance metrics that we set in terms of expanding our robotics program. While the utilization may seem low, we've exceeded the targets that we set as a result of bringing those robotic systems in. That's good and bad. I mean, it just makes you question, you know, like, what more can be done and what more needs to be solved for to increase that utilization when you make those kinds of investments. As a system, we've been very pleased what we've seen as a result of bringing those robotics programs in. I think that sets the table nicely as we consider evaluating new technologies, such as the one we're talking about today.
Hi, I'm Sophia from Evercore. I was just wondering if you could talk about how you're thinking about the revenue model for this first version. Will hospitals be able to lease the robot? How are you thinking about competitive pricing?
Yeah, I think I'm gonna pass it to Bill, our CFO.
Yeah, thanks. It's a good question. I would say in terms of the revenue model, maybe getting back to, you know, Josh's question a little bit. Yeah, 'cause there's the revenue model, there's cost of acquisition, et cetera. Yeah, thinking first. Everything you've seen today probably starts with decoupled actuators, right? In addition to all the benefits that you've seen today, it has a tremendous cost advantage. What that enables us to do is to obviously, you know, compete obviously in a, you know, cash sale model, but also compete in other different business models. As we've talked about, you know, we're in discussions obviously with many of our hospital partners, you know, to accomplish that. We're nimble in terms of the business model.
I would say in terms of the acquisition cost, one of the side benefits as well is that we're poised to be priced lower than any of the existing alternatives. If you look at Intuitive, it might be a $2 million plus acquisition cost. We're looking to have a list price of about $1.6 million, and probably look to sell that for about $1.2 million, realistically. We're incredibly competitive just on a cash basis there. The disposables, the instruments and accessories are designed to be disposable, eliminating a significant cost and burden for the hospitals. The price point there would be about $1,500 per procedure. As well, we have a 10% annual support. We're able to do that there.
I think Dr. Belyansky was talking about maybe the comparable time. I think he's incredibly gifted and incredibly fast. I would say, I did hear after that procedure, I think you thought you wanted to do it in 35 minutes. So yeah. I think one of the things we should be able to offer, particularly to the average surgeon and surgeon and the novice surgeon, is the ability to do faster procedures. While hospitals are particularly focused on, you know, cost and, you know, lower acquisition costs, lower cost of consumables, and all those sorts of things, one of the things we hope to be able to do is drive more procedures per day with that fixed cost of a fixed surgical team, technicians, OR, all those different things.
If we can drive top line, you know, as well as have, you know, the, the nimbleness of business model and the lower acquisition costs, I think we're able to, address hospital concerns on multiple fronts.
Great. Thank you. That was really helpful. I guess one quick follow-up. Sorry about that. One quick follow-up, maybe more for Adam. You guys talked a lot about hospitals, but not a lot about the ASC setting, which has been a huge focus. Is that an area you're focusing on? How will your robot, you know, be better suited for that area than the existing robots on the market?
That's a very good question. The answer is, I'd say from a fundamental level, we have a huge potential advantage there. It's, you know, our cost of goods, our footprint, the overall efficiency, all of that makes us, you know, much better suited for the ASC setting. You know, that being said, there's still if you look at the market today, almost all surgical robots, especially in the United States, are installed in the hospital setting, either hospital inpatient or hospital outpatient. While ASCs are a really interesting opportunity and one that we will target, we're gonna target the low-hanging fruit first, candidly.
It's, there's, you know, as you heard, a lot of unmet need today in the hospital setting, and it's the setting that already has experience with surgical robotics. It's the business model that is already established. You know, despite not being, you know, exactly what people want, it does work and it does meet the business objectives for the existing surgical robotic technologies, even if it leaves a lot of room to be desired. We're gonna focus on that first, and then we're gonna expand out is a very long way of saying that.
Hi. Alexandra Higashi‑Howard , also from Evercore. Dr. Belyansky, for you. You were talking about the needle driver and kind of the tactile experience of doing those procedures. Can you talk maybe about the limitations you see on kind of tissue types that you could like go for procedures, kind of the experience of what it was like to be using that in the cadaver model, obviously, and just like how that differs from a normal open procedure and like what that tactile experience feels like?
It's actually, the experience, as we continue to progress over like this, the current model that we have or the current product, and the experience is very similar. I mean, that's the best way I can answer that question. you know, That's it really. You know, I don't wanna make this answer too long 'cause it's just a very simple answer. It's a very similar experience, and it's works.
On the drive, like.
Yeah.
on the tissue,
Yeah.
like you.
Yeah, yeah.
don't see any limitations to that?
No, no, absolutely not.