Microbot Medical Inc. (MBOT) Earnings Call Transcript & Summary

Welcome to our fourth episode of accessibility for all webinar. We started this initiative based on the increased interest in our Liberty robotic system technology by multiple stakeholders, ranging from physicians, investor, strategic partners and others, which coincides with our continued efforts towards the regulatory and commercialization phases for the next 12 to 24 months. The feedback so far from all stakeholders was outstanding. Our ability to bring forward experts to discuss the market unmet needs, [indiscernible], personal experience in the robotics space in general and using the LIBERTY device was extremely valuable to our stakeholders as it's evident by the increased number of participants in each of our accessibility webinars to date. We have and will continue to partner with industry leaders such as physicians, hospital administrators, entrepreneurs, technicians and financial experts for live discussions and Q&A sessions to address top-of-mind health care-related topics and continue to deliver added value to our stakeholders. As such, I'm sure that during today's session, you will gain much value by listening to Dr. Giora Weisz, one of the early users of robotics in the endovascular space. And therefore, I would like to introduce you to Dr. Eyal Morag, our Chief Medical Officer, to lead our session today. Dr. Morag?

Yes -- to the audience and everybody else who joined us. It gives me tremendous pleasure and it's honored to have Professor Giora Weisz here with us. We'll start by just introducing Giora officially. Dr. Weisz, is an Associate Professor of Medicine at Columbia University Medical Center. He's the Director of the Interventional Cardiology at the New York Respiratory and Hudson Valley Hospital. He is a member of the faculty of the center of Interventional Vascular Therapy at Columbia University Medical Center. Giora is a practicing active interventional cardiologist. He is a clinical researcher -- was pioneered Novo robotic enhanced coronary interventions as well as navigation and positioning technologies. His areas of expertise include cardiac catheterization, coronary artery disease and diagnostic angiography. He is a practicing interventional cardiologist, Dr. Weisz has particular interest in current and innovation -- innovative technologies in the cardiovascular medicine. He published extensively in the most prestigious peer review medical journals. He is a principal investigator for pivotal clinical studies leading to FDA approval of cutting-edge technologies for interventional cardiology device positioning and navigation and robotics as well as leading multicenter studies in Interventional Imaging and the combination of PCI with pharmacological anti-ischemic treatment. Giora, I hope I didn't miss anything and welcome. It's a pleasure to have you here.

Thank you, Eyal. Thank you, Harel. It's a pleasure to be here. You make me blush a little, but [indiscernible] this time.

I would like to start the session with obviously, touching on your extensive experience. I mean, you were one of the pioneers of endovascular robotics being the PI for Corindus. Can you share with us what attracted you to the endovascular robots and some of the kind of the journey that you shared with the other of the visionaries in this field?

Thanks for the question. That reminds me the old day. That's been, I think, over 10 years now or even more, that I'll tell you a personal story, how it all started. One Friday, I'm driving to the hospital to Colombia and my boss calls me, Giora, I need your help. Can you do me a favor? Can you go to the animal lab today to help these guys with Corindus with an animal experiment that they are doing? And my boss ask, I have to do, right? So I turn my car and go to the animal lab. And before that, I knew about that and I said, that's interesting technology. They can -- there's a machine that can move the wires, maybe the balloon and -- but why do I need it? Everybody tells me that I have such gifted hands. I can do -- I'm doing such amazing procedure. Why do I need machine to help me? I know what to do. I'm doing that well usually. And -- but I went there, and I was a lot of very skeptical. And when I left afternoon, I was a different person in this field, because I was so impressed with the potential. It was the early study, it was even before our first human experience. And I was so impressed by the possibilities that it gives not just by moving -- it's not about moving the wire and that, but about being able to do precision procedures by being able to make better decision by making -- being able to do better measurements. So multiple components of the system showed the potential here. Of course, it was far away from that, maybe still there is room to go but I became really in 1 day, I changed from being skeptic to a big believer and since -- ever since. And maybe you're talking using a big name of pioneers I think it's -- talking about pioneers, I want to mention the real pioneers in this field, the people that started invented the idea of robotic endovascular procedure, I hope you can see on my screen on the left [indiscernible]. It started with this idea of having a robotic procedures, joined him his partner was [ Tal Windo ] that ran the company for many years until maturity. And on the other side, I'm sure you heard in another webinar, I think, last time about the [indiscernible] that's really one of the biggest names in robotics, not just in endovascular in [ Veneto ] [ de Vinci ]. The system does not exist anymore for various reasons, but doesn't matter. But having people believe in the concept and moving this field forward is a great thing.

And so the actual experience with the core path system. I mean, you -- how many -- can you just remind us how many patients you actually catheterize with the system -- with the Corindus?

I stopped counting. It's a large number of hundred people, the procedure that we did. And we started -- I can share with you, we started that the early days, we did the first in-human study just the first 11 patients that we did, and that was a big thing. It was published in one of the -- maybe the best interventional journal in the field, and it was 100% success, no issues, no complications, and that led us quickly to move to a pivotal study that led for the FDA approval of the system 2012. So 10.5 years ago, that was basically a registered study that the FDA agreed was 164 patients that were not randomized at all enrolled. And I can tell you I personally did 40 of those patients because that was the max that every scientist was allowed. And we approach 41 patients, 40 agreed to be part of the study. There were like -- actually patients were excited about this idea to [indiscernible], even if it's new, even it's still experimental. They were really excited about the idea and the concept. We showed them picture that showed in the system before the procedures and except one that has nothing to do with -- no objection about the system, we just didn't want any -- its name to be documented anywhere I didn't want. So basically, it was a very successful study 164 patients in 9 sites, 20 physician participated in the study. And we had 98.8% device success, 97.6% clinical success, and the most important, no device-related complications. And I even did from our side, I did kind of compared it to the manual procedures that were done by the same operators. And we see that -- and it's important that we don't trade off something for the physician and change for the patient. So the contrast media volume that was used the fluoroscopy time, the radiation dose were all lower when we use the robotic system as compared to manual proceeding. It's not a randomized study, just historical the same period of time by the same operators, but it all shows basically the flavor of a safe system that can bring benefit to patients.

So that's fascinating, very interesting, very solid data that you have there. And I was wondering, you mentioned all the great stuff and advantages, but what would be the -- how would you do describe some of the technical challenges and the drawbacks of the system of the core path.

It's an initial system. So you have to be kind living piece if it's not perfect yet because it's a first generation. You have to be forgiving to thing and not to expect too much. But that was the early days. And of course, over time, with more experience, we expect more things for that. To let me show you the system, and I don't want to sound in any way critical here, but let me share this my screen again, please. So you can see the system, right? You see the screen. So basically, that's the way it's illustration of a cath lab. There was -- in the corner of the cath lab what we also call the cockpit that was a leaded cockpit, so it's kind of a corner that it's -- you see how thick it is basically because of lead, where the interventions can sit without the heavy apron -- lead apron sitting in an ergonomic way and manipulate the wires, the [indiscernible] having dedicated screen that are slaving the pictures from the big screen in front of the table. This is the machine that can be used by either clicking or by using the joystick, the one joystick is for the guiding catheter. Another one is for the wire and the third one is either for pushing pooling the balloon or stand. And that's basically manipulates and those devices that are hooked inside this cassette. And this cassette, you see, it's connected to the access side, the arterial access side of the patient. And we load the wire, we load the balloons, we load the stand and manipulate it from the corner of the cath lab, so not exposing to the radiation. Talking about radiation, maybe it's important to say it's one of the early benefit that were really easy to prove is the reduction of radiation exposure to the intervention list. And we show the same numbers, whether we did it in the pivotal study or the first study and other follow-up studies that when we measure the radiation exposure the table side as compared to inside when we were sitting inside the cockpit, we had 95% reduction in radiation. If you ask me, I was very proud of showing that 10 years ago. Now I think we can even go better and by being -- by having better systems that you don't need to sit in a cockpit in the corner of the cath lab and you can avoid it. But what you could see is basically the large footprint of the system inside the cath lab, whether it is the cockpit itself, that's -- this is -- it's a large -- the nurses hated that because it took all the working area and a relatively large cassette that is connected to the side, whether it's feminal, whether it's radial, but it's really large, and it's always a little cumbersome. So one of -- you asked me about limitation at that time, having this large cassette that has to be hooked to the patient in the right angle, in the right way was not always easy.

So you mentioned in the slides that the system was actually approved by FDA. And I think, I believe it was a summer of 2012. But we really have not seen or you have not seen a widespread adoption, right, of the system, and I would like to expand and extend better why you think that is.

That's true. So there were, I think, several thousands of procedures done overall. There was not many systems that were sold to hospitals? And why? I think it's a combination of it takes time to convince people about the benefit. We -- I talked a little about the radiation benefit. I can talk also a little about the precision benefit. But it takes time to change the way people do from I have those magnificent hands that I can even use a machine to help my hands to do things better. It takes time, takes away some ego. So that definitely takes time to take away ego. So it was easier with the younger interventionist. It's a large footprint. So you need the large cath lab to be able to have it. And in addition to that, it was expensive. And we can talk about adoption. We can talk about how you integrate such a system into a working cath lab, how much we spend in the U.S. about for health care, and it's not simple to increase the expenses. So we need to be very conscious about that.

Yes. So you're saying that approaching the hospital administration with capital equipment was definitely a challenge as well.

It's a challenge, but it's doable. I've done it in 2 different places that they worked and of course, it was easier for me because all they wanted or you are that's your baby, you write papers, you present us in conferences. Of course, it makes things easier, right, to admit. But beyond that, it was always the discussion, do hospitals or do administrators care about our radiation exposure. And although many people were skeptical about that, I was happily to learn that they do care. They do care, not because they care really about me, but they care also about the potential consequence of us having a radiation injury or sequela to lifetime radiation exposure. So when you explain those things to administrator, you -- when you sit with them and you talk about the advantages to the patient having a more precision procedure to being able to do, to get the wire and the catheter to places that otherwise could not get there. And to be able to free some of your attention to the decision-making, not just to the manual technical staff. If it gives you that -- also it makes you special. It makes you give you an edge over the hospital across the -- it does not have the system. It makes you -- makes you better improve not just a personal reputation, but the hospital reputation. I think those things they understand. So I think if you approach them in the right way, you don't -- you definitely are able to get systems integrated into your program.

So we are like over 10 years, I think, since Friday, it was approved. I mean, if you had to summarize what we really have achieved so far with endovascular robotics, kind of a summary of what has been done so far in achievements, when would that be?

I think we achieved 3 things. We demonstrated the feasibility that we can do remote control endovascular intervention. That this thing is possible. We achieved the fact that we did not hurt any patients. And I can tell you also though we have additional did another large -- 2 registered stents of 1,000 patients or 2,000 patients, no device-related complications. So it can be done. It can be done and it can be done in a safe way. And we definitely achieved it, proofed that we reduced the radiation exposure to the interventionalist. Those are the things being that we -- nobody can be -- can argue about and there's no disputable.

So let's -- assuming that we can address some or most of the technical challenges of the endovascular robots today. What is needed clinically as a clinician? As you mentioned, it's a challenge as far as our colleagues to kind of spread the word and accelerate the adoption for endovascular robots.

Yes. I think it's increasing the cycle of the believers and the early adopters. And that's -- then it will grow exponentially. There is no reason why it cannot grow. I think we need better -- maybe better systems. We need a system that has smaller footprints, better accessibility to any access side, a system that you don't need to sit and take away 1/3 of the cath lab just by what it was called the cockpit. If we have all those things together in a system that works well should be a winner.

So I guess your description or at least part of it kind of describes your dream robot, is that would be a correct statement?

Yes. And Eyal, when you and Harel showed me the -- even the early iterations of the Microbot system. I was -- you can tell my eyes was lighting up and I got excited because that was basically something that I was dreaming about -- being able to do that. Maybe we can show here show the animation, and I will share it with you the screen again. Can you see the screen now? So this is an illustration, but I think it really shows, you see the -- that is the footprint of the system. This is the part that is connected to the access is on the table. It has some parts. I will not go over the small technical. And this is the handheld device. So instead of having a big footprint, a cockpit sitting inside of the cath lab -- outside of the cath lab having a big cable connected, you can do everything that remotely in a way, it's wireless, it's not heavy you can push, pull, rotate, control, growing in very difficult way. We did a study together in anatomy of endovascular neuroanatomy that is definitely the most difficult -- was amazing. So that's my dream come true.

That's great. And as far as some modifications for the coronaries, I mean, specifically for your clinical indications, what would you add or change at this point?

Blood vessels are blood vessels. If you can do it in the liver and you can do it in the kidney, you can do it in the brain and you can do it in the heart. The principles are the same principles. Of course, sometimes we use some different type of peripheral more coils, more extraction devices in the corner as we use more balloons and stents. But those are small nuances that basically look to me like kind of a small change, does not make a big difference. I hope the engineers are not cursing me now, but it's really not a big deal. And I think having a system that gives the answer to all the endovascular solution that will be a huge winner.

I think we're all reading the medical literature and all the robotic-related literature right now, I think there's kind of a striking surge in the nonvascular medical robots, orthopedics, general surgery, urology, like with de Vinci, of course, electrophysiology, bronchoscopy, percutaneous biopsies, lots of robots everywhere. What do you think is actually driving, what is driving the adoption and the change of perception and attitudes right now? I mean what is the reason for the change other than technology in addition?

I think we are in the era of technology, and that's all around us, right? I don't think there's a day that you don't involve in any discussion about CPT and any other AI, right? If you don't mention now it is, this, we have to mention that today. But it's part of that. It's part of technology and the capabilities, the technology led us to do better things and evolve. And let me -- I want to show you something about improvement and involvement. And I told you that we did a large registry with the coronary procedures. [ Shami Mahmood ] and myself, we are publishing that now in one of the medical journals still in press, so we cannot tell -- we cannot disclose. But I can show you those pictures, figures and numbers that we showed before in conferences, basically, a very high -- usually around 90, 90-plus percent technical and clinical success. And that was showing now a large number that would make people to move -- all the skeptics to move. And another, I think, very interesting figure, we took some of the sites that had the largest experience and those people that got them under the belt. And if you ask what's the learning curve. So the learning curve in the beginning is very -- it's very fascinating. And I think what -- with a small handheld device, it will be even faster because you don't need this whole architecture around you. But you can see here that over time, people did procedure with the system is higher lesion complexity. But despite that, the procedural duration was shorter and the PCI duration was shorter. So that's practice makes perfect. You don't need 10,000 hours -- 10,000 procedures with that. It's really a very, I would say, around 50 procedures with that system. And I honestly believe that with the Microbot System, you -- what we did in the animal and the model, I think from the 3 procedures, I've learned everything that I need to learn about the system.

And if you had to illustrate or think about your cath lab in 5 years or maybe more, what would that look like, you think?

It will be on the beach, like the picture behind you.

Hopefully, it will be on the beach, you'll be on the beach doing procedure remotely.

We can play wit the -- no. It's I would envision -- I don't know if it's 5 years. I don't want to put the time take on that. But the future, not very far. -- will bring with it, improve the technology that will enable us to make more precise procedures. I have to mention AI, but anyway, better to say that I would prefer to use your machine learning and decision make enhanced decision-making, but it will not be based on my gut feeling. But what illustrate the data that I get from the procedure -- while working and getting data that's helping to make better decision-making. And of course, technology that's does not depend on my fingers shivering in few years, right in the future. So it's still not moving...

Do you feel there's a generation gap like we are between the -- all the generation guys and the new one coming in on board, you're training fellows and residents.

I'm open to handheld. We were not born with, right, with a smartphone in hand, and we were not playing computer games, maybe Pac-Man. But now it's the younger fellows, even the younger pending. They're much more open that our boss as well for those new technologies.

So what's driving is actually the combination of the physicians needing it and the technology that enables it. That's...

And learning the benefits it brings -- really adopting the benefits for the benefit of the patient because we showed all those things, the most important person in the cath lab is the patient.

So, I absolutely agree it at the end of the day. And just from curiosity, when you had to obtain consent from a patient before introducing robotic procedure, what did you tell them?

So that -- I did it only for the studies. Once it's approved, I don't need, of course, I told them because I was walking back and forth from the table to the big cockpit. So I told them you will hear my voice, but sometimes it will be close to you, some time it will be far from you. So don't get upset. I'm not disappearing or not getting too close to you, we're just moving because we were some stuff we work next to you and some works from the robotic cockpit part. So you -- they need to understand. You just need to know what, what's going on. And when they got into the cath lab, I showed them the system. I showed this is the system, I will sit here. And from here, I'll do the part of the procedure, but I still have the skin track. I try to explain that basically, it's the same procedure, they are just enhanced technology and explained more, I think that we can get better results. And in one of the better results, it's me sitting on a chair rather than standing 10, 12 hours all day. And we know when we get tired and this one, our decision-making is not the same, at 8 p.m. is not the same decision-making as -- so that's all -- all benefits. It's hard to quantitize it, but definitely it's done.

And one last thing. I mean, I would love to continue this for a long time, but time is up. Last question, we don't really talk much about the support stuff and they're -- we're not working by ourselves in the cath lab. We have the tech and the nurses, everything. How was the adoption there as far as this...

They were excited to be part of this new system. They were very, very excited about that.

So there were no issues with adoption there.

No, not at all. On the contrary -- they were like big supporters, yes.

Great. So unfortunately, time is kind of up, I really -- first just want to thank you. for your time and attention. And I guess I'll have to open this for questions now. We have a couple of minutes for the audience.

It looks like we lost Dr. Weisz. If you don't mind, just give us 1 more minute, and we'll reconnect and we'll ask the questions that we have from the audience. He's reconnecting right now. Thank you all for your patience. We'll be right back. All right. And we have one question from the audience that is pointed for you, Eyal. While we're waiting for Dr. Weisz. Are there any specific aspects of the Liberty robotic system that you wish to be improved or enhanced.

Yes. I mean I think one of the major issues with the robotic system is the range of equipment and tools that I can -- that they -- I can navigate and move around. I mean we do have an open system with which you can load with different kinds of equipment that is over the shelf. And I think all of us in industry and specifically for me, I would like to increase the robotics segment of the procedure by enabling movement and the control of more tools. And that is a, I think, a challenge, definitely can be overcome, but that will be my first priority right now.

So there are some service and connection issues in the hospital where Giora as -- where Dr. Weisz is now. If you want to just give us maybe 10 more seconds and if he's unable to connect, the questions that we have, we can address them at a later time. All right. So I think now is a good opportunity for Harel to close the session. And I apologize. Thank you.

Thank you, [ Elena ]. I mean no apology necessary. This is part of our life today, right, remote control and remote webinars. So that's what we have. Personally, if I may say a few words, I was very excited to have Professor Weisz, join us today. If we go back 3 months ago, when we sort of started the initiative of accessibility for all webinar. We started by really trying to have all stakeholders not jump immediately into LIBERTY and what we can do. But first of all, understand why LIBERTY. Why the market needs it? What's the unmet need, patients, physicians, administrators. We have to remember value proposition. It's -- first of all, as the Professor Weisz said, got to be the patient. But if we look at everybody, we've got to look at all of our stakeholders and ensure that we add value. As we started 3 months ago, we really build that understanding of the market, the physicians, then we heard from the business people, last month at JPMorgan and their experience of bringing this to market. And today, it really brought all the professional side from a physician perspective together when you heard probably the biggest user of pretty much the only endovascular robotics system on the market. You heard the great things, how excited it is, most importantly, the value it brings to its patients and the adoption by the patients, pretty much all patients agreed to go through the studies they have done. But you also hear that it can be better. And we know that because there's less than 1% adoption of robotics in the endovascular space while there's a big gap in skills between geographies, between experienced physician, even within a geography. And today, having Professor Weisz really talk to us about his experience with the only robotic system and then hearing him saying that LIBERTY is a dream come true, puts everything together for those of you who participated in everything that we've done and understand why LIBERTY is the winner. And as we go through the next webinars, we're going to go back and bring additional stakeholders. So you can hear not only from one stakeholder or holders, but start expanding into administrator, into investors, how do they see as we go through the next 12 and 24 months, what's going to happen with the market and specifically with us is Microbot? So for those of you who joined us for the fourth time, thank you. We believe this continues to add value. For those of you who joined us for the first time, I highly encourage you to go back into our website and listen to the previous 3 episodes because they will put everything in perspective. And that will allow us to go into next month with the fifth episode and start growing the understanding of how LIBERTY not only fits within that market. but how are we going to grow the segment. That's very important and growing not just in terms of dollars, talking about volume, volume of users, volume of patients are going to get treated. How many of you know today that patients need to drive pretty much 100 miles each way to get the right treatment in the U.S. So can you imagine what happened outside the U.S. We, as a company, have an obligation to try and change that. So thank you for your time. Thank you, Dr. Morag, for leading this exciting session. Personally, I will thank Professor Weisz, when we can get him online and thank you, everybody. Stay safe, and I appreciate your time.

Thank you everybody.