Thank you, and thanks to Stifel for this opportunity to talk about our SS Innovations and what we have been able to achieve. Good afternoon, everyone here. We are a very rapidly growing company, and we started out roughly about two, three years ago. We have been kind of like a submarine for a long time, and we finally have surfaced when we are listed on Nasdaq in April of this year, and becoming more and more visible. I think Let me see the slide. Next one here. Typical disclaimer. Here is an image of the SSi Mantra system, and I must say it is quite different compared to all other technologies. The goal was to not copy da Vinci and to make it different, hopefully better, and also be applicable for almost all specialties, including cardiac. Most importantly for me was to make it affordable, so we can really penetrate and serve more and more people. Let's see. Here's a snapshot of our company. We really differentiated in terms of what we have been able to produce as SSi Mantra 3. I must point out, our team works very rapidly. SSi Mantra 3 from SSi Mantra 2, completely a new generation was created in five months, absolutely unbelievable pace. Have a whole host of all different types of instruments for multi-specialty. On top of that, 20 cardiac-specific instruments that we have. We are very advanced in both AR and VR. Basically, the team is led by robotic surgeons. We have a wonderful group of world's who's who as part of our advisory board, and we meet at certain frequency. Outside of India, we have a system in seven other countries actually today. We have done more than 6,000 cases with absolutely phenomenal results, with zero device-related any adverse event. More than 127 systems now have been installed over just a period of roughly two and a half years. All specialties are covered. It's a soft tissue robotic system, so from mouth down to pelvis. We have done over 100, all kinds of complex procedures with our system. We have done 56 plus telesurgeries now, including 14 cardiac surgeries that I personally have performed. The longest one was from 10,000 kilometers away from France into India. Our system is designed not only for every specialty, but also including cardiac. Me being a cardiac surgeon, somewhere we found that the other dominant player had stopped supporting cardiac, and there was a huge need for this thing. We have developed it that way. We finally commercialized after our development and clinical trials, et cetera, in 2022 in India. This is a snapshot, gives you a global overview of all different types of surgeries that we have done. Majority, of course, are general surgery cases because of the sheer spectrum of the disease and the urology, gyne. Essentially everything has been covered. Currently, our market cap has been hanging around between $1.3 billion-$1.5 billion. The symbol is SSII, and we are on Nasdaq. Again, on the right side, it shows our really tremendous growth trajectory, from last year to the third quarter this year, 195%. If you look at our revenue cycle also, there's a significant continuous year-on-year growth rate of significance here. We have now, in terms of the whole investment highlight, very distributed leadership and board with proven track records. Very large and addressable market that exists today because of the monopoly and the cost issues. Almost 7 billion people globally do not have easy access to the system. When we look at in terms of technologically very advanced system, while being cost-efficient. Now we have been completely validated in terms of both clinical results, in the large number of cases, as well as acceptance by various hospitals purchasing our system. We are in India as a starting platform, but our goal is global. As I mentioned, we have seven systems out there in different countries. Every week, literally, we are being approached from various different countries as our regulatory registration process is ongoing. In terms of the revenue, it will be both the CapEx and recurring revenue, typical of surgical robotic field. Our goal is really a long-term goal in terms of create a very sustainable growth because of our track record, our results, the cost efficiency, and the global need actually of a surgical robotic system that doesn't exist today. A little bit about myself. I'm actually by training, a cardiac surgeon, and got involved with robotics back in 2002. Part of the Intuitive Surgical cardiac trials, I was part of it, which led to approval both for bypass surgery and atrial fibrillation. Initially, trained in Canada, then been literally in the U.S. for almost close to four years. Currently, I do have a controlling interest of the SSI in terms of the shareholding. Dr. Vishwa is our Chief Executive Officer for Asia Pacific region. He's a physician and very large exposure to robotics. Dr. Fred Moll, I'm sure does not need any introduction. He was a founder of Intuitive, and Auris, the last stint he had. He has joined us actually, he's on our board, as well as our Vice Chairman. He's a major shareholder with almost 10% shareholding at the company level. We have Naveen as our CFO, he comes with, again, 20+ years of experience, both very familiar with the various accounting principles, including U.S. side. Barry is our COO for Americas and a board member. Barry and I were connected some time for development of robotics, I think we just persisted. Barry and I remain great friends, he's got almost 40+ years of experience in running public companies and brokerage firm, et cetera. Dr Annadurai is a board member, he's known in India as a moon man. He led two moon missions, and the Mars mission successfully, while there. We are in dialogue with him about how we can put our miniaturized system into the space when India is ready. Tim Adams is a senior physician in Ascension Hospital system. Dr. Somashekar has got probably the largest robotic experience in India, over 9,000+ cases, a wonderful surgeon, and he's been tremendous help in our various guidance. When we look at the global scene, again, just to qualify that, lot of this study that has been reported by others has been before many other companies have come, including us. I'm sure these numbers may not reflect when the real time comes, five years later now, because things are changing very rapidly. Even then, the projected growth is almost, from current, in 2031, over $16 billion, almost $17 billion. The number of procedures is expected to quadruple. I think on the right side, you see all the different reasons how everything will be changing, because of the technology availability, changing demographics, the disease burden continues to increase. There are workforce challenges that occur, and the robotics is really very helpful in doing these minimally invasive complex operation that returns people back to their functional status. The patients benefit hugely, in terms of the less trauma, tiny little incisions, so they stay in the hospital much shorter. 20% of my cardiac patients used to go home when I was in Texas, next day. 50%, two days or less. There's a huge benefit actually to the patient, and they're back to functional recovery in a week to 10 days or so. Surgeon, I think the superior ergonomics, the technology attributes of tremor filtration, 3D highly magnified vision, and surgeon gets to sit and operate. I can tell you one thing, that this absolutely will actually extend the surgical careers of surgeons, when they have the most experience and instead of retiring, they can continue operating actually. From the hospital side, again, the shorter hospital stay, less use of resources, early discharges, so increased throughput for the beds, same bed can be used. Essentially, across the spectrum, all the stakeholders benefit from this wonderful technology. Again, in terms of the market, when you look at the global, of course, Intuitive has dominated the scene. Mainly, it has been mainly developed economies, United States, Europe, and Japan. It's almost like when you look at the global scene, that almost seven billion people do not have easy access, and the biggest factor has been cost. When you look at the surgical volume, only less than 1% of the global surgical volume that is addressable through minimally invasive technique, and at some point, robotically. These numbers are very small, so it kind of gives you an idea of what will occur in future, I think as more and more robotic companies are coming up. What is the reason actually for very uneven penetration? Most important has been the high cost of acquisition, the running cost, and the maintenance agreements, et cetera. There's a lack of mentors, again, because this gets all tied up. If you're not doing enough, you will never become good, so you're not able to teach others. In the developing economies or even in the United States, there's only 35% penetration. Essentially for economic reasons, it is not available. I think when you look at all of these factors, I think there's a huge opportunity in relation to what Mantra System represents actually. Being in India, one of our focus was to really look at the Indian market with a 1.4 billion population, 70,000 hospitals. Almost 25,000 are multi-specialty large hospitals. There are many hospitals that are smaller hospitals, anywhere from 30 to 50 to 100 beds. Again, because of the nature of our system, we have been able to put these systems in set Tier 2 and Tier 3 cities because of the affordability, surgeons' capabilities. When they advance further, they can go on and add more arms. We'll talk about that in a minute. It just gives you again, a nutshell summary in terms of the scene in India. We have trained more than 1,400 surgeons. In India, actually, it is projected, if you look at the global scene of $16.8 billion projection for 2031. In India alone, if you're looking at $4 billion market opportunity, which is very significant, it's almost like 20% of the global market opportunity. This is what is anticipated in India. In terms of the system, as I mentioned, we are completely differentiated from our dominant player today. We have, is what we call a modular system. Each arm is mounted separately on a cart. Our surgeon command center is open-face. You get to sit straight. You have a very large monitor, hand controls, which is very unique to us on the magnetic sensor-based control, which are very lightweight with tremendous precision. Ours is the only surgeon command center that is equipped to be able to control five arms sitting right on that console. Vision cart gives 3D vision to everybody. If you look at all other robotic companies, they currently still offer only 2D vision. I'll just narrate a very quick story. I was operating in South Korea launching their program. A nurse put knife right through the heart. I asked her what happened. She says, "I couldn't tell how deep I was going." Right from the beginning, we adopted that everybody can see what the surgeon is seeing, and they have the same 3D large 4K 32-inch monitor. Basically, you avoid accidents. The learning curve is shortened. It's great for training people who are hanging around in the room. Again, I've pretty much covered all of these things. One of the advantages of the modular design is you can use three, four, or up to five arms. Ours is the only system that has five-arm capability. We have developed certain enabling technologies which are automated, and we will use the fifth arm to deploy those. If you look at other technology or their designs, it will be very difficult. We looked at actually all our procedure, and almost 70 different types of procedures can be done with the three arms. This is one of the huge opportunities for Mantra system with a three-arm configuration, with a full robot, with all the bells and whistles to be able to penetrate the ambulatory surgery centers once we get past the FDA in the U.S. Over 40 different types for multi-specialty and 20 + cardiac-specific instrumentation. As you are aware that currently no other company is touching cardiac. Intuitive used to, but five years ago or so, they decided to stop making stabilizer, which is used for bypass surgery. Essentially we have a completely full spectrum, and ours is the only system today that can do entire spectrum of cardiac surgery, using the robotic assistance. We have done that in our cases, both for intracardiac application as well as the bypass surgery. We have some very unique instruments. We have developed a stapling device. We have everything that Intuitive has and more. I think one of our unique instrument is this articulating vessel sealer. Nobody else has with an EndoWrist. This also is reusable, so it makes it very cost-effective. The other thing that we are working on the left side is what we call an automated coronary connector. Literally bypass surgery can be done joining two arteries on the heart in six seconds, which normally would take around 20 + minutes or so. It creates a predictable anastomosis. It is work in progress. We have developed the prototype, and we are going to proceed with clinical trials, et cetera. We are very advanced in terms of our teleproctoring capabilities, and it is like the old Tom Cruise’s movie, "Minority Report." You have multiple screens, you can manipulate, enlarge them, rotate them, and you can telestrate on. Literally one of the biggest challenges is how to proctor people. This allows you to proctor people. Literally, I have sat in India in my office having lunch while proctoring people 2,000 km away without having to travel. This is a huge advantage in terms of launching programs and also the combination of telesurgery and teleproctoring is like having an attending in the room. If you are learning, a surgeon is guiding you, and when you get into trouble, they can take over and finish the operation. This, again, will be a huge actually modality for us. Currently, to my knowledge, again, this combination to this advanced level, doesn't exist actually anywhere else. We are creating actually all kinds of mixed reality. Our team also has developed ability whereby we can, any of these DICOM images, CT, MRI, we can convert them on the fly into 3D model the surgeon can manipulate. Again, this feature, to my knowledge, doesn't exist at that level of advancement, actually, globally today. We have created a bus, which has our SSi Mantra system that also has built-in telesurgery capabilities. Not to have the patient to operate there, because it's not in sterile environment. Our next project is, of course, to build a mobile operating room with all the standards. This bus is used really to increase awareness, training of surgeons. Instead of bringing them over, bus can be parked outside the hospital, and surgeons can come and train. Again, as you can see, telesurgery, in fact, can be done sitting in the bus, and it already has been done. This is our latest advance. It is an independent surgeon command center. Believe it or not, I used this thing roughly two weeks ago to do a cardiac case 300 km away while sitting in my living room. This will be so disruptive. Just imagine when the system is there in the operating room, you don't want to tie the operating room, just to do telesurgery. The console is big and all of that thing. This is completely independent. The foot tray goes inside, and that is the total surgeon command center. We have these AR glasses give you beautiful magnified 3D vision. You can place these in doctor's offices, in clinics, or I can sit at my home and operate on three different patients staggered in three different hospitals without having to travel. I think this will be absolutely disruptive, and this was the whole idea of the development of robotic system back in the '80s, was long-distance operation, whether in space or battlefield. Now we have come full circle with technology that is available, the high-speed connectivity that is available. This really is done with a very low latency, so it's almost real time. You don't even feel that you are operating long distance. I think I'll skip some of these various advanced platform, but if you can see literally when we have compared ourselves with other existing system, I think we literally have more features, more specialties, and ultimately cost-effective to be able to serve many, many more patients and really penetrate the global availability of these systems. Our facility is a world-class facility, 70,000 + sq ft of space right now. All the different departments are there, that one expects actually. Our current capacity is to be able to do 20 system per month. Everything actually is done in India, in terms of being indigenous for the country. We have designed the system there. Almost everything is manufactured in India, assembled there, and tested and integrated. The only thing we bring from outside are the thing that currently are not manufactured in India, certain motors, certain sensors and drives, et cetera, which also is changing as we go. Our current cumulative base, as you can see, tremendous growth story. I've talked about the various countries that it is available today. In terms of the procedure, again, very significant growth compared to some of the other competitors. This gives you overall landscape of places that we currently have approval. It's almost like there are, including India, there are 10 places. I think Colombia, we just got. We are proceeding with the U.S. and European approvals, as you can see, many other countries. There are almost 120 countries that do not require U.S. FDA or CE. It's a huge target, and these are the countries that are underserved today with the robotic system. As we speak, almost 20 other different registration processes at different stages are ongoing. Our U.S. FDA, this month, in fact, we are filing for the U.S. FDA approval, and based on our three pre-sub meetings with FDA, we are going for 510(k) application approval process for multiple indication. Because of our very large experience and absolutely phenomenal results, in relation to our system. In fact, we were advised that there are other predicates today. Because Moon, Distalmotion, CMR, Senhance, et cetera. We are going for that, and we are pretty confident, I think, that our projected target is first half of next year. Of course, there are no guarantees, as one knows with FDA. Things can go back and forth. We are very confident that out of multiple indications that I think around six, including robotic-assisted coronary bypass surgery. FDA may approve some or may ask us to do trial for others, which is not a problem at all. We are absolutely prepared. In terms of the European, again, stage 1 audit has been completed. Again, we anticipate European approval sometime first half of next year. This will really open up great opportunities for us for global penetration. In terms of our revenue, again, very significant growth story, in terms of our revenues. It only actually also gives the validity that the hospitals are accepting our system. We, in fact, have beaten da Vinci in India this year, more than double number of system we have sold, considering that they've been in the country for the last 22 years. One can actually see the adoption against da Vinci in relation to because of the nature of the system, the technology, the capabilities, and all these other bells and whistles that we have talked about. The gross margins will continue to improve as we move forward with greater volumes. Currently, our recurrent revenues are not very high, which is expected. It's not unusual when you are starting as a new company. If you look at the Intuitive history, around been 25+ years now. As the install base increases and the volumes increases, our recurrent revenues will continue to grow because of the proprietary nature of our instruments and consumables. In terms of growth strategy, I think the value is written there. Lower cost for an advanced technology. Very short learning curve actually, for da Vinci users, it's 5 minutes. We have seen very significant improved patient outcomes and, of course, differentiated features, including the USP of cardiac capabilities. In terms of multi-specialty hospital, we are putting all these systems, various different models, and each hospital, we are seeing actually growth from the time of installation. Generally, it takes about one year for things to stabilize, I think. We are seeing that ongoing thing. In terms of our marketing strategies, of course, we have a wonderful advisory board, both national and international. The medical conferences seem to be a biggest way to reach out to most end users, being doctors and the hospital administration, because initial recommendation is done by the physicians. We have training program, very organized training program. We have a classroom whereby 50 people or so we can train at one time, and we have a digital wall, we can bring live surgeries right there. People don't have to go to the operating rooms to witness, which is a waste of time or congested space, et cetera. We have a partnership right now with Johns Hopkins for some of the R&D developments, et cetera. As a young company, we are very restless, very fast actually, we are constantly looking at various newer innovative approaches. I think we have a product timeline also for future. This is just a summary of our financials here. We are currently cash flow positive. We just sold roughly three systems in India. We support ourselves because of relatively low cost structure. Again, our revenues are quite significantly going up quarter-on-quarter and year-on-year. With that, I want to thank you very much and take any questions that you may have. Yeah. I can kick things off with a couple questions- Sure myself. Just because what do you think about the biggest opportunity for growth for the Mantra system? Is it the cardiac capabilities? Is it the future of telehealth and the opportunity there, or cost, or is it a combination of the three? Where do you see it? I'm a little biased, of course, those things that you just mentioned. Also, having superior technology and being a robotic surgeon, I've seen literally and aware of everything that exists out there. I was one of the largest user of da Vinci for cardiac. When you look at in balance, the technology features and differentiation that we talked about, although da Vinci is a great system, I will never criticize it. They showed us a very different pathway to do very complex operation. Because of the monopoly, I think sometimes the incentive to innovate kind of settle down. If you look at our thing and how fast we have developed things, and we are constantly on the lookout to give more and more enabling technologies to the surgeons, especially on the cardiac side. The reason cardiac failed, because system was given, now you guys figure out. Cardiac being a very high-risk specialty, again, it died down. Then they stopped it. I think our technology features, which are superior, more user-friendly, shorter learning curve, an established proven safety with our results, lower cost, and commercial acceptance now in India, even though da Vinci is there. Okay? Of course, the differentiation of tele, all kinds of capabilities, including cardiac, that nobody in the world has done. The other thing I must mention also, we have developed pediatric instruments. The same system will also be used for pediatric, again, there's a huge population of children, that they still undergo conventional approaches. I think, in combination of all of these things, and also what market is available in rest of the world because cost has prevented the penetration for this. Robotic will be the future. I think at a point in time, every operating room will have a robot. This will change, the cost will come down. I think, our growth strategy, we are looking at all of these features, and in a very short time, we have seen that. Yes. Yeah. It's impressive what you've done in a short time. Yes I think you described it as a summary and emerging. I'll open it up. Yep See if there's any question in the back. You're in seven countries right now? Yes. What are your expansion plans, and what's your exit strategy? I can talk about the expansion plans first. We are constantly going into different countries. In fact, next week our system is going into Oman and Dubai, going into Greece, going into Central Asian countries. Literally, there is a constant need, and, of course, our system based on our results, and people have seen our performance. There's a constant, actually, increasing penetration globally. I think as we receive registration approvals in various countries that don't require U.S. FDA and CE, it's a huge market opportunity out there. Regarding the exit, I'm not so sure I can discuss that here. I'm sure you know better than that because they're going to throw me out of board. Any other questions? All right. Hearing none, thank you so much for your time. Thank you for presenting. Thank you. Appreciate it
Loading workspace