In April of 2023, Northgate Technologies acquired Allotrope Medical, a startup medical device manufacturer started by Albert Huang, a former General Surgery resident at Houston Methodist Hospital. Albert founded Allotrope Medical in 2016 after developing a new device to verify ureters and increase the predictability of cytoscopy. Over the next 7 years, he refined the technology, raised investor funding, received FDA clearance, and brought the technology to the market. Tune in to hear his journey!
Good evening. Welcome to the sixth and final episode of season three of the CV. Live Innovation on the loose streaming live from Houston Methodist Hospital here in Texas Medical Center. Now, I'm Dr Stuart Carr, Director of Innovation Engineering for the heart and vascular center. And tonight, we have something extra special to close out season three. So I'm delighted to have on the show. Dr Albert Wang Albert is CEO and founder of the startup company, Mary. Oh, my teleprompter. The script has gone messed up. He's a CEO and founder of the startup company, a medical which was recently acquired by Northgate Technologies and he's here tonight to give a first hand account um from having a medical device idea to spinning that idea out in a startup company and to lead that company to a successful exit. Now, what does it take to launch an exit? A start up company in the Texas Medical Center? Well, stay tuned and find out. Now, before we proceed, I'd like to invite the audience into our discussion. So please submit your questions via web at TV dot com using the bay as a user name or text the bay to 37607 alongside your question. You can also add your question into the live youtube stream. Now, it was a few weeks ago and I was at home, I'm thinking, ok, who are we going to get on to close out? Episode three? And I was scrolling through linkedin and it was uh something that popped up and we're going to see a little slide here and I was absolutely shocked. we play the slide guys. All right, here we go. I was absolutely amazed to see this Northgate technologies acquires a medical. I thought, wow, Albert has done it. What a massive win for the Houston Metic ecosystem. And within a couple of minutes, I was phoning him up saying, hey, Albert, I got to get you on the show. The Houston ecosystem wants to hear your story. So Albert, thank you. I'm honored to have you on the show. Tell us about your journey, sir. Yeah, a pleasure. Stu And before I start doing some screen share, you know, just wanted to say, uh you know, again, thanks. I'm, I'm still processing everything, right. I'm uh it's, it feels like just yesterday that uh we finally closed the deal, but this was, you know, not only years but even in the diligence process, like months in, in the works. And uh you know, you can't really talk to anybody as you go through all of these uh really stressful processes right in the back and forth in the negotiations and the aspects of diligence. So um on the other side of that, you know, it was very uh relieving to be able to not only kind of share that success, but also take a little bit of a breather uh as we immediately move into the next phase of the life of the technology that I created that I built allotrope around. Uh now being shepherded to even greater success uh in the hands of North Gate technologies. So, um here I, I can uh start by sharing these slides and, you know, just because not everybody that's uh attending here uh may have heard about us. That's obviously totally OK. Um Here to share not only the technology but the story, um not only of the company but because as a solo founder, uh creating all this then steering this ship to where we are today, you know, atrop in many ways, is kind of me as well as you know, it's, it's, it's, it's a part of me and, and the origin story of it is wonderful. And, and the reason I'm really honored and to have this opportunity to kind of share this story with you all is that, of course, it came from me literally being in the operating rooms over at uh at the Methodist main operating rooms, right? So, um so as you all know, of course, the company um is or was a trope medical now a wholly owned subsidiary of Northgate Technologies Incorporated. But it's a technology that uses electrical stimulation uh to enhance surgical precision. And I'll share a little bit more about that as well. Um It was actually kind of hard for me to dig up old photos of myself when I launched this company of me being in the operating room. But I happened to find one of these uh where I must have been just doing research or something along those lines, maybe in a porcine lab. But I would always start with this when I would pitch and present to everybody. And I would share the story about how minimally invasive surgery is advanced, the field of medicine. I don't need to tell that to all the folks on uh attending this webinar, of course, because we're definitely all on the same page of uh where we are with the cutting edge of technology. But what we all also know is that it comes with its own challenges. And we look at these challenges either at the glass half full or glass, half empty, kind of way of these are things we complain about or these are opportunities for next generations of innovation, right? And so I founded a electro medical to solve one of these challenges for myself and hopefully for other folks that are surgeons all around the world. So this picture and this is an example picture, not the actual case itself, but uh was why I created stem site, right. So late one night, this was probably back in 2013. Uh I was working with one of the senior surgeons late one night operating on somebody's colon that had come in through the er, had uh perforated diverticulitis, lots of inflammation, not looking or doing very well and needed to go to the operating room urgently for um exploration, wash out and ultimately a resection of their colon. Um to do that, we wanted to approach it laparoscopically in this case, um to isolate and remove the colon, we needed to identify the ator. So this being the two millimeter y 23 millimeter wide tube that connects the kidney down to the bladder that carries the urine made in the kidney down there. And you certainly do not ever want to cut that. But now our field of view is bloody with a lot of inflammatory tissues as well because the area was inflamed and angry from the infection process. And we got down to three stringy tissues running across our field of view and then the colon and we could not move forward with the case until we figured out which one of these was the ureter because that's the one you can't cut. And the other two we could and let's move forward with the operation for the patient. Um Typically you would wait for the to move or wiggle on its own because nothing else moves like that in that part of the body and sometimes you can pinch it to irritate it to make it move. But try as we might, none of those three stringy things in our field was moving at all. And so that really not only slowed down the operation to a crawl, which we were moving forward with at a good pace, but also increase our stress level. Right? It's like, are we moving forward safely? Are we moving forward in a timely fashion, patients still under anesthesia? So then what we had to do was dissect each and every one of those little strands up towards the head to see if it connected to the kidney and then down toward the bladder to see if it connected down there really taking forever to do this and need to be very careful at the same time. And during 11 of these moments where we took a little bit of a break, I looked up at the head of the bed and saw the anesthesiologist doing what they always do, taking a, a little uh facial stimulator and touching into the patient's cheek to see if uh the cheek muscle twitches because they're giving the patient a paralyzing chemical to allow the belly to inflate with air. So we have a good working space and that immediately reminded me, oh, electrical stimulation makes muscles move. We we know this uh you know, we see late night ads promising a six pack abs by putting little stickers on our belly things along those lines. And then I also thought, oh, but the ureter is smooth muscle. So there's got to be an electrical type signal that the body is sending to make the ureter move. And if I could figure out what that signal is and how to co-opt it. The ureter, which one of these three stringy things it could be is gonna move if I deliver that stimulation signal, no matter what because it has to, if the body is wanting it to. And so we finally got through that case safely for the patient, they recovered well and everything was, was good. But I was stuck with this idea of going, what if we had a way to control ur or movement that would allow us not only to verify a structure as ator, but also would actually allow us to move more quickly through all aspects of the operation. And so really what good is an idea that remains an idea, right? I left that or with this little thing in the back of my head. And uh I went home and just like other people that have come up with ideas. I worked at the dining room table, I bought things on ebay and radio shack when it was still around and put things together, right? And, and hacked together a little prototype. So I, I tried, I, I had an idea, I started soldering little things together and I experimented, I put different pieces together. I went to the research institute's fourth floor, mighty lab and um uh piggybacked on other people's labs or freshly sacrificed large animal models and said, hey, can I test my little device on that? And I'll help clean up everything afterwards as a kind of a tradeoff and, you know, had to evolve the technology and evolve the form factor of the device and then some of it didn't work, right, or it didn't work perfectly. Um I didn't know what that electrical signal needed to be, but instead of just saying, ok, well, that didn't work. I tried again. And so ultimately, I came up with a form factor that allowed me to come up with what became and has become stem site, which is this final thing and in a small way, ideally change the world, right? Ideally take this idea from my brain, create a physical form factor of it that not only is something that solves or helps solve a problem that I identify in the or but through a lot of uh market analysis, a lot of interviews and ultimately years of broader discussions, both at surgical conferences and societies and also just talking with clinicians. One on one is that this is a problem and a challenge that is present in millions of operations around the world. And so to create something that now is on the market that can fit into other surgeons hands and in their workflow. I do, you know, have this rare opportunity to kind of just push health care and technology and the better of humanity for just this tiny, little bit. Right? And I, I really love that in the midst of everything that we do. And so what is it that I created? Um ultimately, and what's on the market right now? And what's actually at places such as Methodist Willow Brook is the allotrope stem site system or now the NT I STEM site system. It is a signal box that sits in the operating room, uh nonsterile. It's over there with the surgical energy generators and things along those lines. And it allows you to use your existing laparoscopic or robotic instruments to trigger your uteral peristalsis or vermiculation. If we want to be specific about it on demand, using your existing tools is really the biggest breakthrough of all of this. So we're actually empowering surgeons with a new feature for their existing instruments. And as we all know, laparoscopic tools, although the field has continued to evolve the instruments in your hands and the functional tips of these have really remained unchanged for 30 in many cases, almost 40 years at this point in time now. And so we're giving you a brand new feature out of those that you never had before. And we do this by using electrical stimulation. And this can help surgeons identify or verify critical structures such as the ureter during surgery, relieving your frustration, increasing your efficiency and also providing this undercurrent of injury risk mitigation or a safety component to the entire operation. Not only benefiting the clinicians patient on the table, but also the health system as a whole by demonstrating and allowing you to demonstrate that you are doing the best for your patient. Um and being able to document as such with uh the usage of allotropes, uh stem cell technology as an FDA cleared product. So this is essentially what I created, right, the electrical stimulation technology or a signal that mimics the body's own signals to trigger movement. Um Sometimes we like to say we're hacking natural physiology by mimicking the beginning portion of the action potential of smooth muscle uh signal stimulation and by building this into the surgeon's instruments and into their workflow, we're delivering a new capability without really interrupting any other aspect of how the surgeon moves to the operation and their cadence, their steps in the operation. We fit into all of that in a very seamless fashion. And again, our focus for the technology is protecting the ureters during surgery, right? This 2 to 3 millimeter wide structure not always visible for those that operate in the pelvis, for the colorectal and general surgeons that are on uh attending tonight and as well as uh those that are in the obstetrics and gynecology magic field as well as potentially urologists as well. But yet identification is a critical step in so many operations, right? Hysterectomies, colon, resections, endometriosis, uh excisions amongst many other types of uh cases. And we all know that the field of medicine is uh continues to change and evolve, right? And injuries to the urinator is unfortunately one of the leading causes of litigation, not only for gynecologists, um but also for really many other folks that operated in the lower abdomen, pelvis. And so, you know, we're, I love that we're um doing this presentation with a bunch of health care providers so that I can show all these wonderful surgery videos that not everybody likes to see, especially during the evening time. So I'll start off by just a very simple video of how the technology works in a very clean field to verify that a structure that the surgeon believes is the er truly is. So using existing laparoscopic instruments connected to stem site, touch a structure you think is the ureter and immediately trigger that full length manipulation, right? So, uh just like the esophagus, you start that wave and it will go all the way down from the kidney down to the bladder, allowing you to visually see the pathway that the ureter takes instantly with the existing tools in your hand, letting you move forward with your case, right? You will know if the ator takes a odd pathway, um or if it goes the right direction and you need it to go or if you're doing endometriosis excisions. You can say, ah I need to be careful taking out that spot of endometriosis on the wall because it's right on top of where that Ur's pathway is so full ureteral awareness. And even if you get into more complex cases like this on the Da Vinci robot, for example, our system connects with the robotic instruments as well. You can use it to confirm that. Ok. That's where the is enter in this case into the retro pair kneel space with the same tools you're already using. The surgeon doesn't leave the console, simply hits a foot pedal whenever they want to deploy the stimulation signal for stem site and can check right. So now here they say, all right, I'm pretty sure it's dead center, stimulate it, trigger the movement and verify. It's exactly where I think it is. Now, I can move on with my case. And when I'm using hot instruments, I don't want to inadvertently injure the der with thermal spread. I can check to see the is here and know that I can. Now in this specific case, stay uh medial to the ureter since we're working on the right side of the abdomen here, knowing that I'm doing my operation, but I'm being safe the entire time. So I have full ureteral awareness at any time. I can check just like this again and make sure I'm not getting too close to the ureter as I move forward with my case for our colorectal colleagues here, uh stem cell can do dissection. And then as you get to an area where you're looking for the ureter, is that critical key step? And first step of the operation, you can say, OK, is this where the ureter might be or is this structure the ureter? You see no movement that's not gonna be where the ator resides. You can test any other areas or any other structures. Instead of doing a lot of digging or you know, time consuming dissection, maybe in the wrong space stimulation can very easily help you figure out what and where the ureter might be. So in this case, nothing is determined to move like the ureter. So that surgeons dissecting here makes a small window and sees this little flash of white very deep in this tunnel they've created. And now using stimulation, they'll stimulate here and they see it constrict and nothing else moves like that except the urinator. And now the rest of the case moves forward quickly. They can simulate again just for our benefit to be able to see it. But now by seeing that they know they can follow that left and right horizontally across the field of view and move forward with their case quickly and safely and easily. The way that our system works when it's installed in an operating room is that I wanted us to be able to deliver the stimulation signal through whatever tool that that was already in the surgeon's hands. So in many cases, you saw here uh using the uh robotic platforms, we have a series of adapters that allow you to use the existing instruments to deliver our stimulation signal. And there's a very simple toggle that you do between the electrocautery electrosurgical signal that the instruments typically deliver or our stimulation signal. You cannot do both. At the same time, you have to push a button to select either one and stim site has its own dedicated foot pedal. So there's a kind of what we call two factor authentication when it comes to safety of delivering the stimulation signal with your existing tools. And so that's on the robot, we can deliver it through any standard bipolar laparoscopic instrument graspers made by uh everybody from like Olympus, the Con Med, the Richard Wolf. And also um we can deliver it through certain advanced bipolar instruments. In this case, uh Metronic or Cadian ligasure instrument, we can again either or deliver our stimulation signal through the ligature instrument or with the push of a button. They can be using rigor short just like they always have without any sort of change at all. And so that's where we are with the technology uh today. This is what's on the market we've been on the market now for at this point. Now, gosh, like 2.5 years um have had a lot of amazing traction stem site has been used. And at this point now, at last count, I think we estimated about 1000 cases um advancing the surgical efficiency for the physician with a simple workflow integration and um all at a very nominal cost and in a very workflow and user friendly kind of way. And so, you know, that really is where we are today with allotrope, right? We've been fortunate enough to earn along the way, a lot of these awards and accolades um we've taken investment in from Y Combinator uh taken in well over a million and a half dollars from National Science Foundation for grant funding. We've won top innovation at uh uh startup pitch competitions as well as in surgical society conferences and uh competitions there such as surgical Disruptive Technology Summit, such as SAGES amongst others. Um And it's kind of fascinating now to see this idea that I had that I spun out a Methodist that was ultra medical now is a Northgate Technologies Company uh of where following the acquisition. Now, I am the chief medical officer over there. And really, it's my job now um to continue shepherding stem side as a technology and continuing its growth. Now, from what was previously a very small sales team and core commercial team into a much bigger sales team that has nationwide and really international reach and continuing to uh tell this next chapter of, of the stem site story and the electron medical story. And so with that. I'll, I'll stop there stew and, you know, start with any questions that you all or any of the uh folks on the call may have. Thanks Albert for that. You know, it seems like saying of one chapter at the beginning of an X for you. Um So we've got a bunch of questions coming in and it looks like I'm trying to sort it technical ones from the more kind of personal anecdotal word. Um So, you know, I just question myself actually, how close do you need to be to the with your device to actually stimulate it? Yeah. So what we tell the surgeons is that straddle with your instrument, any structure or a series of structures that you believe may be the. So, you know, just when we operate, everything's always purposeful, right? Everything is focused on within the jaws of whatever our operating tool is. So we simply say if you think the one of these three structures of the take your instrument and you can open it as wide or as narrow as you want to either encompass all three of these structures and see which one moves or if you're in a small dissection area, you can actually narrow the tips of your instrument and kind of straddle one or the other. In either situation, if the ureter is there, it will trigger that ureteral movement that you'll be able to see moving down your field of view and are you using like a DC pulse or is it an AC like an alternating current pulse? Yeah. Great question as well. Right. It's, it's actually, um it's actually neither. It's a single quarter of a second impulse that mimics the beginning portion, that kind of initial spike of an action potential. And that's it. And then it gets out of the way of the body's automatically propagating signal because it's smooth muscles will propagate their signal automatically down via gap junctions, right? Sort of like when you swallow food, you initiate that movement, but then that signal propagates on its own. So there's no frequency to the signal. It's actually a very brief impulse. And what we say is because I like analogies. It's either the first domino in the row of dominoes that automatically happens that fall down or it's like the person, the, you know, the football stadium that starts the wave and then the rest of it takes over. So we're just that beginning portion of that way. And, and how did you come to find that information to decide on that was a bunch of trial and error or was it in the literature? You know? Um Yeah, it was, it was actually a lot of uh trial and error or, or uh maybe we should, we should uh academically call it research, right? So it was a fair amount of research. Um There wasn't a whole lot in the literature up to this, up to the point that I started this around um mimicking or capturing what was an efficacious artificial signal that could trigger smooth muscle movement uh in a reliable fashion. And so that was allowed that also, of course, allowed us to generate our intellectual property and the kind of body of intellectual property that we have right now. Um But yeah, we went through, you know, for lack of a better term, a lot of large animal studies, um we had to test every possible variation of different types of signals uh balanced unbalanced, what kind of wave form, what kind of speed of decay? Uh what kind of peak voltage, uh what kind of current all these um all these different things needed to be tested uh focused specifically on ureter smooth muscle. Recognizing that as we dive deeper into all of it is that uh ureteral smooth muscle is very different from intestinal smooth muscle movements. And what can kind of trigger intestinal parasols or even colonic uh mass movements in that kind of smooth muscle movement. Uh The ureter was very much a unique kind of structure that may be at most is mimicked by uh esophageal smooth muscle movement. So we had to characterize and determine and develop a signal that was not only state but also efficacious without needing to do any sort of adjustments, right? Like you, we just couldn't have a final product where the surgeons got to turn it up or turn it down or adjusting, they're al always just gonna turn it to 11, right? Uh And they just hit the foot pedal. And so we needed to come up with a signal that we knew could work reliably every single time, but also was gonna be safe for the patient and, and all that research that was done while you were still here at Methodist and you say you were doing it in. Yeah. So the initial work uh kind of the unofficial official work was done um uh at mighty uh doing Porcine labs. Um after that and once I spun out the technology working with the technology transfer office at Methodist and licensing that initial IP out that I had written um we did some of our animal labs subsequently back at bit uh as uh an outside company as a coming in and using the facility is no different than intuitive or gore or some of the other uh uh medical device companies have uh been able to use the wonderful facilities over there. Um So we did a number of our labs there in other situations, we had to do them in different parts of the United States. Um Sometimes it's because we had a key opinion leader that needed to participate in the lab or we needed to do the lab under a very specific setting um and bring in local specialists uh to participate in those labs. Um Sometimes we would have to use other facilities for that purpose as well. But, um, a good, good number of the uh large animal labs and human factors engineering work was, was done not only right here in Houston in the labs here, but, uh, but at night, that's great. Um, no, there's always that point where you people come up with a great idea. And then you're like, 00, I got to check online and the patent office to see if someone's already kind of patented that idea. So, so how did you go about, you know, your validation and, and what other kind of competition and other ideas were out there at the time? Yeah, this was, this was actually interesting. This was, this was one of a list of maybe like 20 ideas that I thought were all amazing that I kept on my phone as I would like, leave the or late nights each night as a resident, right? And uh as I moved into my research years, I was like, oh, now I finally have time to kind of like work through all these. And uh I simply went on to like patents dot google dot com and started searching every possible variation of, you know, for this specific case, like, you know, identification, smooth muscle stimulation, things like that and nothing would show up. And um kind of the support started to kind of be there of like, hey, this is actually uh an open space that doesn't seem like there's anything on the intellectual property standpoint. And at the same time, I'm also double checking that by, you know, looking at what might be on the market or what might be coming on the market by doing regular Googling or looking at youtube to see if like any pitch competition presentations had come up or, um, you know, having conversations with, uh my kind of very early network of other med tech entrepreneurs at that time to kind of put out feelers and say, like, is there something like this out there? And, you know, uh luckily enough, like this was an untapped and untouched space uh completely. Really? So I guess that leads into the next question, you know, what was the turning point? What was the point you're like? All right, I'm gonna do this. Um, you know, even before this call right before the presentation, we were kind of chatting about like the, the kind of history and the genesis of all this. So it kind of leads back to me as a person, right? I've always loved the Tinker. I always loved to build, um, you know, did everything from working on like guitar effects pedals when I was younger with my dad, like soldering components to in med school, like working on a vintage car when I had absolutely no business doing that. Um, didn't know what I was doing at all and then kind of figured it out and then worked on vintage motorcycles, sound systems, things like that I always loved to build and Tinker. And that was also the reason why I went into surgery, right? This was a very hands on specialty within the world of medicine where you are quite literally going in and repairing something with your hands right now, evolving into things like robots and advanced equipment. But um this is also a field that I always saw as like ripe for technology innovation and ideas and physical things that you could work on. And so when I had this idea and I started building prototypes and things along those lines during my research years, um a lot of success in all aspects of life, right? Not just startups is, is not only uh timing but luck, right? And so I had this idea, I had a um a friend that was also a mentor that also became a board member and investor in allotrope, like the very first one that was also a physician that I would run ideas by. We would meet every once in a while and chat. And I had known him since I was in medical school. And when I told him this that day, he's like he paused and he's like dig into this one more. This one is really interesting and I don't think anybody's in this space at all, like or not approaching it with a stimulation signal and things like that. And so that got me kind of working on this one with more effort and energy and more time. And at the same time as all this uh Texas Medical Centers um Innovation Institute uh had just opened the applications for at that time, they were doing um medical device and uh digital health like cohorts alternating uh each year or every six months. And so just at that moment that summer of 2016, they were opening up the first cohort for medical device focused startups. And I said, well, I'm gonna apply, I'll put together a presentation deck. I'll share the form factor of the technology as it is right now, the idea, the clinical need and how I'm approaching solving it. And here's my general idea of the business and the market opportunity potential. And if I apply and I get it, then I'll step away from the clinical world and the Department of Surgery at Methodist and see where this takes me, right? Seeing that as the, even though it was like in its infancy of me exploring this kind of new career pathway career in quotation marks um that this was perhaps the world that I fit best into, right, where I can build on my formal knowledge of medicine, of surgery, but also feed this other creative tinkering building side of me that would always need to be satisfied one way or the other, either in the professional setting or working on projects at home. But this was like that perfect marriage, potentially both of these things. And so I applied, they accepted me and uh and then we kind of never looked back from there. I think it was 2016, right? That they, they basically launch that you. Um So, you know, come back to a little bit more technical stuff, you know, can you maybe just comment on your regulatory affair and FDA approval pathway? Like, like how did they go through the FDA? Yeah. So this was uh we went through as a uh FDA class 25 10-K medical device. Um There was kind of two strategies to this, right? Like um the goal that I had from the beginning was get the market as quickly as possible, which is kind of the same goal that most uh medical device companies have. But I didn't want to uh I wanted to focus on getting to market first um and foremost, versus looking at or exploring other things like um DeNovo pathways or things along those lines that may increase, you know, um company visibility or evaluation so that I, I really want to focus on just getting to market first. And so I wanted to just pursue a very classic 5 10-K pathway, which is what we ultimately did. Um This uh obviously, it's a sum of a lot of the work leading up to it. But um speaking of luck and timing, right, we actually um started the FDA submission process uh right in the midst of COVID. So this was the um really throughout the first portion of 2020. And then ultimately, we got clearance at the end of 2020. Um we did all of our submissions and things like that. And, you know, I think we were fortunate in that a lot of all the engineering work and that body of knowledge have been done. And really, for FDA, it's a lot of documentation and document collating that need to be done, which people could do remotely in different parts of the US and put together this submission um and submit it to the FDA um in the midst of all of this and obviously, the FDA S was still, you know, open for business. And so we were able to have good dialogue with them. Everything was done just like we are right now via Zoom. And um we were able to kind of move through with uh with all those components and got clearance in November and then we're off to the races with commercialization shortly thereafter. Superb, you know, talking about commercialization and funding, I believe you said you raised about was it 2.5 mil or so um Do you want, do you want to just comment on that? Like and also who funded you? Yeah, so we kind of had funding just like other companies in different tranches, right? So early on the first money into the company was investor money mostly from uh Houston uh angel investors. Uh So individuals that believed in me, believed in the technology and the market opportunity um as well as like what they call like a micro VC. So uh Houston Angel Network uh at that time was uh um was one of the big investors in us. And then the lead investors group called Houston Health Ventures, which is uh some of the members have evolved into a Texas Halo Fund um and continue to invest heavily into the life sciences um and life science opportunities in the Houston uh startup ecosystem. So I raised money with that first group, which was a whopping $350,000 and then raised um in between that what we call bridge round fund funding um uh to get us to the next round, formal round which is a series a uh so um in the midst of all that, we also took in grant funding in parallel. So that was about $1.7 million in grant funding over the first three years. And then in total investment monies raised uh from uh private individuals and organizations. That was probably another hm about uh $6.5 million. So total with that plus grant money all the way through exit was about $8 million. Wow. So I was, I was off there by a little bit. Oh, it's ok. I mean, it's like we were talking mostly about grants So, um uh it sounds like a lot of money but, you know, the feedback that I had gotten continuously or consistently from a lot of folks is that to take a technology and product from idea all the way to exit in a seven year timeframe with about, you know, $8 million invested into it is not only a short amount of time, but a relatively small amount of money um to take a device all the way to, to where it is today. So, I mean, I it's an end of one for me. Right. So I, I think the word on it, um, um, certainly wasn't easy but, uh, it's kind of neat to, to think about, um, you know, having, having beaten some of those odds as well, which is kind of crazy. So, so what, what was your top three expenditures? I mean, was it lawyers, lawyers and lawyers or, you know, um, probably near the end, uh, for sure. Yes, but they're, they're a natural component of, of, uh, of getting a, a transaction completed. I think it, it varied by the life, um, life cycle and at least like just like the, the, the stages that the company was in right early on, almost everything was all research and development, right? Animal labs, engineering fees and costs and things like that all live until FDA clearance moment. FDA clearance happened. All of that money essentially flipped over into commercialization. So, hiring a a commercial leader in the company hiring really high quality sales reps and then also building inventory became a much uh bigger expenditure than really, even the first four years of the company uh combined like it, you know, in the beginning when you're doing like R and E and some of these things, you can, you know, you can, you can be scrappy about some of those components, right? But the moment you shift over and you need to hire people, you need to have benefits and you don't wanna shortchange yourself on making sure you have the best possible world class team um to execute on this and you need to also build inventory. These are all the costs that you cannot cut, right? Uh or, or, or uh or cut corners on. And so, um I learned very quickly that uh commercialization is not only a completely beast unto itself but a very expensive one at the same time. Do, right? Yeah. Now shifting more into the kind of personal anecdotal story time, you know, humanizing you, Albert, right? You know, you know, what was your lowest point during this? And I guess what was your highest point? Sure. Um So, you know, you always hear about having a startup is roller coasters, right? And there's both small ups and downs and very big ups and downs. I mean, the one that will forever stick in my mind because it was, it was a turning point in the company of saying it, it was, you know, it's always do or die. But like this was really one of those moments, right? When I actually created the technology and envisioned it, it was, it was gonna be a single use disposable long stick with built in batteries and a circuit board built into a little push button that deliver that simulation. And when you're done with the stick, you throw it away just like a lot of other things we do in the or right. And that was what I created in the beginning. That's what we moved forward with, with engineering costs, human factors work. It's what was presented to investors all the way up until the summer of 2018. So the first like two years of the company was just solely focused on building the single use disposable, right? And I was heavy down that pathway, not thinking about anything else, but you know, as we talk with surgeons and get their feedback and show them videos of the large animal labs and run labs where they use it and give us feedback. It really started to bubble to the surfaces. Albert, I like what this technology does and the problem that it's solving for me. But this is the wrong form factor. The time I need to verify a structure is right then and there when I'm doing my operation, I can't be thinking about having somebody grab another product from central supply and me waiting for it or then peeling open a pack and pulling a tab and then me now changing out my instrument and potentially shifting my, my exposure point or my field of view for another tool just to stimulate something to take it out and continue my dissection, that's just not fitting my workflow. And so I remember this moment because at this point, I was, I was actually were temporarily living out in San Francisco um because Y Combinator had invested in us. So we need to spend time with their program and their, and their folks out there. And I was standing on the street in Selma and my uh chief of operations at that time, my first hire, um he told me he goes, Albert, they're telling us our baby is ugly, right? And those were hard words to hear because I had not envisioned any other form factor for the technology at all. I was all in on single use disposable. And at that moment, it was just like, well, I don't have another solution for how to deliver this signal. And I was like, this is the product, the product is the product. Like I can't do anything else about it. But we were hitting this wall even in um just market research that this was not going to work, this was not going to sell. Surgeons were not going to integrate it into their work flow because of the form factor that it was in. And so, um I basically like, stared at the wall in our uh sublet um uh house in or, or apartment in San Francisco for like three days. And, and these are the moments where it's like, it's, it's do or die right here. It's like this is the moment you see what you could do because the option is the company dies. But I never looked at that as an option. So I was like, there's got to be a solution. And then that's when I made that really large, essentially paradigm shift away from a sign that is disposable by recognizing, oh the surgeons, we're always using instruments that deliver electrical signals to the body, right to your question earlier as to what's the voltage, what's the frequency? Right? We're used to hearing those things because we're delivering a high voltage, high frequency signal from our tools that burn tissues to stop bleeding. The, you know, essentially, you know, reform the collagen filaments within to, to um to do our dissections in a bloodless field with advanced bipolar tools. And I was like, but all these instruments are just two pieces of metal, they can conduct any electricity, so I can send our stimulation signal through existing tools. And I just need to be able to have a way to deliver that. And that was when I shifted away from the singular disposable and moved to creating the first version of what became stem site as a signal box, right? And so that was both, that was a low point because at that moment I thought the company was dead, but that, you know, shifted as these things do into total excitement from not only myself but from my board, when I was both telling the bad news and then came back a week later with this totally different thing. And when I described to them, you know, they're like this, this solves so many of those challenges and that's what allowed us to kind of move forward. So that was probably like both a low point and a high point. Um you know, as we move through and just because it still fresh in my mind, like through the diligence process of working with a big medical device company that's looking to acquire us and building from there. Um that uh uh that's something that had its low points, right? Because you're under so much stress, everything is at stake, you know, your, your team is also wondering, expecting, asking you like for updates because they're excited, but they also are not sure what the implications of an acquisition is. Like there is a kind of perpetual stress that as a solo founder, there's nobody else to shoulder that burden, right? So it's all on you. But then of course, when you finally sign on the dotted line and the deal closes, like there's this kind of sense of relief, I wouldn't even call it elation. It's just this sense of, OK, I can take some sort of a breath now because I know I'm not on the other side of that and, you know, it kind of, it's still percolating now. But, um, definitely like relief is another component of that. Yeah, I mean, I think that what you've illustrated there is a classic example of, um, innovation being a move and target. Right. You know, and it's usually a concept, you know, it's ready fire aim, right? It's like it just, it's moving all the time and that's a great example there. Um, and I know, you know, we touched on, you know, we both have kids, etcetera and we touched on kind of family. And I said to you, would you do this again in your current situation? Maybe? Comment on that. Yeah. You know, iii I hate to sound like a broken record but like, you know, all these things are kind of luck and timing, right? I mean, I started the company like we had touched on like seven years ago back in 2016. I mean, your, my point in life point in career were very different than, than they are now right now. You know. Uh I was a surgery resident, right? I, it was just my wife and I, like we didn't have kids yet, you know. So our responsibilities, uh internal and external were, were far less than life now as life gets more and more complicated with other responsibilities. You have both family and externally, like, it'd be very difficult to even contemplate doing the startup at this point in life versus me when I was, like, very early in my surgical career and my physician career and going down that pathway. Um, you know, I wouldn't, I wouldn't be able to do it. Now, if this was the moment that I had started right, there would just be too many entanglements, too many implications, too many other responsibilities. Um I think that's also why like a lot of my uh startup founders are all very young, right? Because um those are the moments where you, where you can take that step away and can take that risk. Um, you know, should be a calculator risk, but you can take that risk then. So, so we, we, we've got a lot of questions coming in here, Albert. Um, surprise, surprise, right? Um Yeah. Ok. So, um, here's one here. How did you find and hire your c or your chief operations officer and other early employees? Yeah, this is all network and word of mouth, right? Um It's always people asking other people and like, so for my Chief of Operations, my, my first hire was somebody that, uh I was connected to through an, a network from one of my board members, one of my board members, we were talking and I was like, at that point, I thought I just needed an engineer to help me build this beyond me. So things on the dining room table, which my wife wasn't gonna tolerate for much longer. Um And so uh I was like, hey, I need it. I need to find like a talented like electrical engineer to help me build this and maybe has done devices before. So she reached out to her network, which is actually an mit uh business alum network. And somebody saw that post on their internal forum out in Colorado. And at that time, coincidentally, it was going to like a MedTech networking event that evening and met just there while having drinks, like my, who became the person who became a team of operations and they were chatting and he said, oh, I'm looking for my next gig. This is what I do. Like I saw this post and that's how we got connected for my first hire. And ultimately, he helped me far more than just the engineering portion. But with obviously everything in operations and manufacturing and stuff that I didn't even know existed. Um uh All of my subsequent hires have all been through network as well. So, referrals from uh folks like, you know, ultimately our VP of sales that was the VP of sales um at our time of uh acquisition was actually VP of sales for a friend's company. Um And when they had uh were at a point where, you know, they had exited and we would have these conversations later on and like asked about network. Like this name just kept coming up over and over again, not only from them but from other colleagues uh that were in the MedTech space. It's like a, you know, somebody who was like a true commercial leader, especially in the startup space. So it's a very specific skill set to take um a technology that's ready to go on market. So it's essentially $0 in revenue and build it from there, right? Where the whole us is a blank slate and to create a strategy and messaging from it, it's a different skill set than somebody who works at a big medical device company and grew revenue from $5 million to $50 million for a product, right? It's a very different skill set that I didn't recognize initially. But um you know, this person was that, you know, that person and uh and was also through network. So all these things are through network. The only ones that were not, were our sales reps. Um Ultimately, those were just postings that we put out there. But then um we're able to validate, you know, their capability and their credibility through our network as well. So even that was really uh at least validated through a, a small group of folks and your coo was, was it Jeff Jeff Castlebury? Jeff Castleberry. Got it. Um Next question is, does a do live demos to check out So, it sounds like you've got some potential clients out there customers that want to get their hands on your technology. Where, where can they go? Who can they contact? Yeah. So, uh, you know, um, I guess like for the time being, um, they can, they can contact me. It's Albert dot Wong at NT I surgical dot com now. Um, but, you know, we have a, we have sales teams in pretty much every major city in the United States. Um And, and can go through like NT I surgical dot com as a website to talk with somebody. What's interesting about our technology? And is that because it uses your existing instruments because it delivers an electrical stimulation to your existing tools and makes the ur move as you've seen the body make it move. When we talk with physicians, we don't bring any of that with us. So there's kind of no reason to, right. We do have a box, we do have a business model. It's an interesting activation card and whatnot, but the surgeon doesn't see touch or feel any of it when they operate, right? They use their own instruments, they hit a foot pedal, that's ours. But aside from that, they use their own tools. So there's actually nothing that we bring to demo. We show them some videos to show them how the technology works. But we really just talk about our uh what we call our four pillars of value. To the surgeon, right? It helps you have um verify the ureter at any step of the operation, gives you full ureteral awareness throughout the case because you can stimulate a structure that you think is the ureter at any time. And also stimulation actually makes the Urs move uh more frequently spontaneously. Um after you stimulate, it seems to wake them up and then it also shortens and seems to shorten cystoscopy time at the end of an operation because the Urs are moving so frequently on their own, the little urine jets that everybody stands around waiting. What seems like an eternity for come very quickly when stem site is used. And also there's a medical legal documentation capability because FDA has given us the unique indication that of use for stems inside is a uh uh a technology that verifies and identifies Urs during surgery, right? So we talk about all that and then the doctors use it in the operating room. There's actually nothing really for us to demo anymore. I used to bring the box around and then our VP of sales I brought him on. He's like, why are you bringing that around? And I was like, because you would think that they want to see the product, right? He's like, but the product doesn't matter. And I was like, what do you mean? He's like, well, they don't touch it. They're not the ones pushing any of the buttons. They're already using their own tools like it doesn't matter. So, just talk about it and in the day of surgery, like what you told them they're gonna do, which is sit at the console or the robot and use their own instruments to hit a foot pedal. That's all they're gonna do. Well. And I was like, oh, you're right. And so it was, it was also really interesting to see like a master of their craft at work on the commercial side too. Um Help us with that. So, yeah, and sure, like we don't bring anything to demos. Uh We show a video, we have a five minute video that's downloadable or watching on our website that talks to the technology, but it's kind of like self explanatory. Um Now that we've kind of refined it down message wise. So I think we're going to put all that information in the description uh later. So people in the audience can figure that out. So that, that, that'll be good. Um Someone's wondering, can you share something upcoming you're working on? Sure. You know, a lot of these things are kind of evolution of the technology, right? Um Or, or things that we're working on to kind of make this really, truly even more of a game changing product. So um along with FDA clearance, one of the other things that we receive from the FDA is what they call Safer Technologies designation. This is a pretty new two year old program where the FDA will look at specific technologies and say, is this something that makes an existing product or procedure safer? And there's not many products that have been uh granted this and definitely very few products that are on the market that have been given safer technologies designation by the FDA. But um uh last year, end of last year, uh we were granted that by the FDA. So one of the things that comes with that and the focus was shortening cystoscopy times stem site, you know, we provided them uh some early data with that. We showed them videos, talked about the technology and they gave us this designation. One of the things that we're working on right now is a couple of different clinical trials as we work to quantify that number down of saying um with and without stems site, what are average post procedure cystoscopy times looking like? And really do you remove the outliers of these super long or would definitely feel like super long cystoscopy times where surgeons are stuck just staring at that or waiting for it for some of their cases. Are we are we truly statistically making a difference that we anecdotally have already seen, we just wanted to quantify that. So a lot of the work is done around that. The other thing that we're working on um as well as more of these adapters to allow further integration into existing uh advanced bipolar instruments, right? So not just working with uh ligasure, for example, and uh robotic instruments. But going even beyond that, with some of the other folks that are on the market got it. We got a couple of minutes left. Um Someone's put here, I wonder if A I and the Da Vinci will ever be a thing? Well, I don't know, I think it kind of is a thing already. I mean, I, I was using chat GP T to create different variants of the titles that I sent you, Albert. So, yeah. Right. And the final one is I'm going to combine this. So I wanted to end on your words of wisdom. And there's actually someone here saying as an incoming med student in the Med center, what advice do you have for someone interested in MedTech? And are any programs or people here in the Med Center that you recommend getting in touch with? So maybe start with that and then end with your pearls or words of wisdom. Sure. I, I would say the, the, the ecosystem and landscape now is so different than even when, uh, you know, I was starting. Right. Um But some of the folks and some of the organizations that are here in town have persisted and evolved even more. Right. So, um, one of the ones that for, especially for med students and, and physicians as well that are interested in things, um, is called n Venture En Venture. Um, this is this kind of originated from a lot of rice phd students but has evolved into like an amazing entity that um really gathers like-minded people focused on um med tech innovation, especially in the life science space that get together and you can meet other people and build networks. So I would highly recommend that um as, as one of the organizations and then also just getting on to the Texas Medical Center Innovation Institute like T MC is mailing list because they have a lot of social even they have speakers that come in uh to the uh Innovation Institute. There's always events happening there and opportunities to get uh deeper and more deeply connected into the Innovation Ecosystem. These are some of the probably the two top things that come to mind um as uh as things that can kind of help you with that and really to segue that into still your kind of last um you know, ask of me uh I would say is that, you know, you, you can even though I'm a solo founder, like you can't go about this alone. Um Like really have to build your network, right? The difference between the startup world and moving through academia is academia is very linear, there's a form around it, there's a structure around it. And, and yes, we now have amazing programs such as Texas A and M and Methodists like NMD program, which is really planting these seeds um for med students that have engineering backgrounds as they move into formal uh medical training. Um You have to really, even with that, you have to spend a lot of time on your own and seek out people that maybe have a similar background to yours but have gone on and done uh you know, a startup, exited a startup or hey, how did this position start working for these big medical device companies or? Hey, I read about this position coming with this idea and building something out of it, reach out to these people on linkedin. I did that in the beginning too because every person's story in this world of innovation and and MedTech is different, there's no linear path, there's no real book that teaches you how to do this. And uh uh you know, you can't really get an MB A in the business side of this. You need to work with people that are willing to take you under their wing. And what I like about it. And what I really, really love about this space is that if you do the salaries, you'd be really surprised by how many people will be so willing to give you time and volunteer the time really at no costs, right? They really are passionate about this world that they've now lived in or are living in to give you their time to kind of shepherd you or at least show you and share with you their network and, and their words of wisdom. And so, um that's, that's what I would say like that I would not be here at this point today. If numerous people did not, you know, generously give me their time effort, energy. And then in many cases also like their investment and you know, which ties to their belief in me to kind of take this idea all the way through. But even at the very beginning when it was just me exploring the space, so many people were willing to just share their story with me. Um You know, I think people like to talk about themselves if you, if you ask them the right questions. Uh So you have to be willing to kind of travel around a little bit. But um I, I met with people, I never thought I would have a shot at meeting with just by simply sending them an email or a message and saying, I want to hear how you got to where you got to. And then these people have become mentors for me. Uh Just like they would be for you. That's superb. That's really good advice to Albert and, you know, we have 30 seconds left. So just want to see my hats off to you. You've knocked it off, you've done, this is medical and we'll be back with season four in September. So thank you all. We'll see you soon. Goodbye. Have a good night.
