Asensus Surgical, Inc. Reports Operating and Financial Results for the Third Quarter 2022


RESEARCH TRIANGLE PARK, N.C., Nov. 10, 2022 (GLOBE NEWSWIRE) -- Asensus Surgical, Inc. (NYSE American: ASXC), a medical device company that is digitizing the interface between the surgeon and the patient to pioneer a new era of Performance-Guided Surgery™, today announced its operating and financial results for the third quarter 2022.

Recent Highlights

  • Over 1,900 procedures were performed globally during the nine months ended September 30, 2022, representing growth of 27% over the prior year
  • Five new Senhance program initiations year to date, 3 in Germany, 1 in Japan, 1 in CIS region
  • Submitted FDA 510(k) application for pediatric indication in the U.S.
  • Received the Society of Laparoscopic & Robotic Surgeons 2022 Innovation of the Year award for the Intelligent Surgical Unit™(ISU™)
  • The Company had cash, cash equivalents, short-term and long-term investments, excluding restricted cash, of approximately $88.3 million at September 30, 2022

“We are very pleased with what we have accomplished this quarter, with impressive utilization metrics, a growing base of clinical evidence highlighting the benefits of the Senhance system and the ISU, and the growth of our installed base,” said Anthony Fernando, Asensus Surgical President and CEO. “As we have made great progress towards the ongoing development of Performance-Guided Surgery and its suite of digital capabilities, we look forward to continuing to progress the platform to enable safer, more consistent surgery - resulting in better outcomes for hospitals and patients alike.”

Digital Surgery Portfolio Expansion

Expanded Global ISU Machine Vision Capabilities
The Company continues to expand the utilization and applicability of the ISU globally. The Company is seeking CE Mark approval for expanded machine vision capabilities in Europe, which the Company continues to expect to receive in late 2022. The newest ISU features include: real-time 3D measurement, digital tagging, image enhancement, and enhanced camera control based on real-time data while performing surgery. The expanded machine vision capabilities have both U.S. FDA 510(k) clearance and Japanese PMDA approval.

This filing included a review of the entire Senhance System platform, and if successful, would represent one of the first robotic surgical systems to be approved through the new, more rigorous MDR process.

Articulating Instrument Launch
These instruments are currently in a pilot launch in the U.S. and Europe, and the Company continues to expect a full scale commercial launch by the end of 2022. Articulating Instruments offer better access to difficult-to-reach areas of the anatomy by providing two additional degrees of freedom.

U.S. Pediatric Regulatory Submission
The Company submitted its 510(k) application for pediatric clearance in the U.S. during the third quarter of 2022. The Senhance System’s unique combination of the 3mm instrumentation with 5mm camera scope combined with haptic feedback make it a unique robotic assisted laparoscopic solution for pediatric surgeries.

Market Development

Procedure Volumes
During the first nine months of 2022, over 1,900 procedures have been completed utilizing the Senhance System, a 27% increase over the same period in 2021. In the third quarter, surgeons performed over 600 procedures, representing an 18% increase over the third quarter of 2021. This growth was primarily driven by strong utilization trends as a result of an expanded installed base and a growth in new surgeon users at existing installations as well as a broader market recovery.

When a procedure is performed with a Senhance System, the Company is able to collect robust data, including surgical video. Over time, the accumulation of this digital surgical data library will enable the Company to generate powerful clinical insights that will fuel the development of Performance-Guided Surgery capabilities to help surgeons reduce surgical variability and drive consistently superior surgical outcomes.

Clinical Registry (TRUST)
The Company is leveraging its growing body of real-world clinical data through the utilization of its TRUSTTM clinical registry. The Company believes TRUST is the largest multi-specialty robotic-assisted laparoscopic registry in the industry. The Company continues to grow this body of clinical data to support its commercial strategy as well as help to facilitate an increasing number of high-quality clinical publications demonstrating the value of the Senhance System and Performance-Guided Surgery, with over 2,000 patients enrolled to date. The registered procedures consist of approximately 67% general surgery, including abdominal and thoracic, 15% GYN, and 18% urology.

Clinical Validation
During the quarter, there were three peer-reviewed clinical papers published providing further support for the clinical utility of the Senhance System across a variety of surgical specialties.

These papers can be found at the Company’s website, www.senhance.com/us/resources.

During the quarter, the Company received the Society of Laparoscopic & Robotic Surgeons 2022 Innovation of the Year award for the ISU. Each year, The Society of Laparoscopic & Robotic Surgeons recognizes the most innovative products that have a multidisciplinary application in minimally invasive surgery.

New Program Initiations
During the third quarter, the Company announced four Senhance System initiations:

  • Evangelical Hospital Goettingen-Weende in Göttingen, Germany
  • Saiseikai Shiga Hospital in Ritto, Japan
  • The Clinic for General and Visceral Surgery at the St. Bernhard Hospital in Kamp-Lintfort, Germany
  • A hospital in the Commonwealth of Independent States (CIS) region

Subsequent to the end of the third quarter, the Company announced one additional Senhance System initiation, bringing the year to date total to five:

  • The Dr. von Hauner Children's Hospital at the Ludwig Maximilians University of Munich, located in Munich, Germany.

For the full year 2022, the Company continues to expect to initiate 8 - 10 new Senhance Surgical Systems.

Third Quarter Financial Results

For the three months ended September 30, 2022, the Company reported revenue of $2.6 million as compared to revenue of $2.6 million in the three months ended September 30, 2021. Revenue in the third quarter of 2022 included $1.2 million in system revenue, $0.3 million in lease revenue, $0.8 million in instruments and accessories, and $0.3 million in services.

For the three months ended September 30, 2022, total operating expenses were $17.2 million, as compared to $16.7 million, in the three months ended September 30, 2021.

For the three months ended September 30, 2022, net loss was $18.9 million, or $0.08 per share, as compared to a net loss of $16.1 million, or $0.07 per share, in the three months ended September 30, 2021.

Adjusted net loss is a non-GAAP financial measure. See the reconciliation of GAAP to Non-GAAP Measures below. For the three months ended September 30, 2022, the adjusted net loss was $16.9 million, or $0.07 per share, as compared to an adjusted net loss of $14.3 million, or $0.06 per share in the three months ended September 30, 2021, after adjusting for the following charges: amortization of intangible assets, change in fair value of contingent consideration, and employee retention tax credit, all of which are non-cash charges.

Balance Sheet Updates

The Company had cash, cash equivalents, short-term and long-term investments, excluding restricted cash of approximately $88.3 million as of September 30, 2022.

Conference Call

Asensus Surgical, Inc. will host a conference call on Thursday, November 10, 2022, at 4:30 PM ET to discuss its third quarter 2022 operating and financial results. To listen to the conference call on your telephone, please dial 1-866-652-5200 for domestic callers and 1-412-317-6060 for international callers, and reference conference ID 10171489 approximately ten minutes prior to the start time. To access the live audio webcast or archived recording, use the following link https://ir.asensus.com/events-and-presentations. The replay will be available on the Company’s website at https://ir.asensus.com/events-and-presentations.

About Asensus Surgical, Inc.

Asensus Surgical, Inc. is digitizing the interface between the surgeon and patient to pioneer a new era of Performance-Guided Surgery by unlocking clinical intelligence for surgeons to enable consistently superior outcomes and a new standard of surgery. This builds upon the foundation of Digital Laparoscopy with the Senhance Surgical System powered by the Intelligent Surgical Unit (ISU) to increase surgeon control and reduce surgical variability. With the addition of machine vision, augmented intelligence, and deep learning capabilities throughout the surgical experience, we intend to holistically address the current clinical, cognitive and economic shortcomings that drive surgical outcomes and value-based healthcare. Learn more about Performance-Guided Surgery and Digital Laparoscopy with the Senhance Surgical System here: www.senhance.com. Now available for sale in the US, EU, Japan, Russia, and select other countries. For a complete list of indications for use, visit: www.senhance.com/indications. For more information, visit www.asensus.com.

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Forward-Looking Statements

This press release includes statements relating to the Senhance System and our 2022 third quarter results. These statements and other statements regarding our future plans and goals constitute "forward looking statements" within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934, and are intended to qualify for the safe harbor from liability established by the Private Securities Litigation Reform Act of 1995. Such statements are subject to risks and uncertainties that are often difficult to predict, are beyond our control and which may cause results to differ materially from expectations and include whether we will be able to continue to progress the Company’s platform to enable safer, more consistent surgery resulting in better outcomes for hospitals and patients alike; whether the Company will receive CE Mark approval for expanded machine vision capabilities in Europe in late 2022; whether the Company’s articulating instruments will undergo a full scale commercial launch by the end of 2022; whether the Company will receive a pediatric clearance for the Senhance Surgical System from the FDA; whether the Company’s TRUST clinical registry is the largest multi-specialty robotic-assisted laparoscopic registry in the industry and whether the Company will continue to grow the Trust registry data to support its commercial strategy; and whether we will initiate 8-10 new Senhance Surgical Systems placements in 2022. For a discussion of the risks and uncertainties associated with the Company’s business, please review our filings with the Securities and Exchange Commission (SEC). You are cautioned not to place undue reliance on these forward-looking statements, which are based on our expectations as of the date of this press release and speak only as of the origination date of this press release. We undertake no obligation to publicly update or revise any forward-looking statement, whether as a result of new information, future events or otherwise.


Asensus Surgical, Inc.
Condensed Consolidated Statements of Operations and Comprehensive Loss
(in thousands, except per share amounts)
(Unaudited)

  Three Months Ended  Nine Months Ended 
  September 30,  June 30, 
  2022  2021  2022  2021 
Revenue:                
Product $1,964  $1,922  $2,565  $3,651 
Service  335   395   1,067   1,180 
Lease  264   254   991   925 
Total revenue  2,563   2,571   4,623   5,756 
Cost of revenue:                
Product  3,057   1,993   4,316   4,671 
Service  365   342   1,506   1,344 
Lease  982   1,015   2,752   2,794 
Total cost of revenue  4,404   3,350   8,574   8,809 
Gross loss  (1,841)  (779)  (3,951)  (3,053)
Operating Expenses:                
Research and development  6,741   4,469   20,422   12,773 
Sales and marketing  3,615   3,551   10,936   10,166 
General and administrative  4,853   5,557   15,378   13,397 
Amortization of intangible assets  2,398   2,804   7,601   8,533 
Change in fair value of contingent consideration  (416)  278   (1,168)  1,013 
Property and equipment impairment        432    
Total Operating Expenses  17,191   16,659   53,601   45,882 
Operating Loss  (19,032)  (17,438)  (57,552)  (48,935)
Other Income (Expense), net:                
Gain on extinguishment of debt           2,847 
Change in fair value of warrant liabilities           (1,981)
Interest income  291   122   806   253 
Interest expense  (99)  (65)  (440)  (77)
Employee retention tax credit     1,311      1,311 
Other (expense) income, net  (29)  33   (261)  (3)
Total Other Income (Expense), net  163   1,401   105   2,350 
Loss before income taxes  (18,869)  (16,037)  (57,447)  (46,585)
Income tax (expense) benefit  (55)  (32)  (224)  4 
Net loss  (18,924)  (16,069)  (57,671)  (46,581)
Comprehensive loss:                
Net loss  (18,924)  (16,069)  (57,671)  (46,581)
Foreign currency translation loss  (1,655)  (931)  (4,018)  (2,397)
Unrealized gain (loss) on available-for-sale investments  86   (53)  (610)  (53)
Comprehensive loss $(20,493) $(17,053) $(62,299) $(49,031)
                 
Net loss per common share attributable to common stockholders – basic and diluted $(0.08) $(0.07) $(0.24) $(0.21)
                 
Weighted average number of shares used in computing net loss per common share – basic and diluted  236,713   234,337   236,373   224,300 
            


Asensus Surgical, Inc.

Condensed Consolidated Balance Sheets
(in thousands, except share amounts)
(Unaudited)

  September 30,  December 31, 
  2022  2021 
        
Assets        
Current Assets:        
Cash and cash equivalents $13,870  $18,129 
Short-term investments, available-for-sale  72,481   80,262 
Accounts receivable, net  2,250   749 
Inventories  9,035   8,634 
Prepaid expenses  3,713   3,255 
Employee retention tax credit receivable  1,147   1,311 
Other current assets  1,034   957 
Total Current Assets  103,530   113,297 
Restricted cash  1,107   1,154 
Long-term investments, available-for-sale  1,937   37,435 
Inventories, net of current portion  3,441   7,074 
Property and equipment, net  9,145   10,971 
Intellectual property, net  1,529   9,892 
Net deferred tax assets  227   288 
Operating lease right-of-use assets, net  4,799   5,348 
Other long-term assets  2,938   1,014 
Total Assets $128,653  $186,473 
Liabilities and Stockholders’ Equity        
Current Liabilities:        
Accounts payable $3,637  $3,448 
Accrued employee compensation and benefits  3,868   3,559 
Accrued expenses and other current liabilities  1,320   1,617 
Operating lease liabilities – current portion  662   683 
Deferred revenue  357   543 
Total Current Liabilities  9,844   9,850 
Long Term Liabilities:        
Contingent consideration  1,203   2,371 
Noncurrent operating lease liabilities  4,630   5,006 
Total Liabilities  15,677   17,227 
Commitments and Contingencies        
Stockholders’ Equity        
Common stock $0.001 par value, 750,000,000 shares authorized at September 30, 2022 and December 31, 2021; 236,783,315 and
235,218,552 shares issued and outstanding at September 30, 2022 and December 31, 2021, respectively
  237   235 
Preferred stock, $0.01 par value, 25,000,000 shares authorized, no shares issued and outstanding at September 30, 2022 and December 31, 2021, respectively      
Additional paid-in capital  960,676   954,649 
Accumulated deficit  (843,045)  (785,374)
Accumulated other comprehensive loss  (4,892)  (264)
Total Stockholders’ Equity  112,976   169,246 
Total Liabilities and Stockholders’ Equity $128,653  $186,473 
  


Asensus Surgical, Inc.

Condensed Consolidated Statements of Cash Flows
(in thousands)
(Unaudited)

  Nine Months Ended  
  September 30, 
  2022  2021 
Operating Activities:        
Net loss $(57,671) $(46,581)
Adjustments to reconcile net loss to net cash and cash equivalents used in operating activities:        
Depreciation  2,481   2,416 
Amortization of intangible assets  7,601   8,533 
Amortization of discounts and premiums on investments, net  556   65 
Stock-based compensation  6,361   6,589 
Gain on extinguishment of debt     (2,847)
Deferred tax expense (benefit)  224   (4)
Change in inventory reserves  386   377 
Bad debt expense  9    
Property and equipment impairment  432    
Loss on disposal of property and equipment  97    
Change in fair value of warrant liabilities     1,981 
Change in fair value of contingent consideration  (1,168)  1,013 
Changes in operating assets and liabilities:        
Accounts receivable  (1,735)  113 
Inventories  (535)  (1,941)
Operating lease right-of-use assets  237   (3,174)
Prepaid expenses  (693)  1,220 
Employee retention tax credit receivable  164   (1,311)
Other current and long-term assets  (2,123)  2,098 
Accounts payable  449   1,376 
Accrued expenses  236   (588)
Deferred revenue  (139)  (81)
Operating lease liabilities  (53)  3,259 
Net cash and cash equivalents used in operating activities  (44,884)  (27,487)
Investing Activities:        
Purchase of available-for-sale investments  (25,588)  (88,232)
Proceeds from maturities of available-for-sale investments  67,702    
Purchase of property and equipment  (904)  (838)
Net cash and cash equivalents provided by (used in) investing activities  41,210   (89,070)
Financing Activities:        
Proceeds from issuance of common stock, net of issuance costs     130,361 
Taxes paid related to net share settlement of vesting of restricted stock units  (350)  (1,058)
Proceeds from exercise of stock options and warrants  18   30,838 
Net cash and cash equivalents (used in) provided by financing activities  (332)  160,141 
Effect of exchange rate changes on cash and cash equivalents  (300)  (181)
Net (decrease) increase in cash, cash equivalents and restricted cash  (4,306)  43,403 
Cash, cash equivalents and restricted cash, beginning of period  19,283   17,529 
Cash, cash equivalents and restricted cash, end of period $14,977  $60,932 
         
Supplemental Disclosure for Cash Flow Information:        
Cash paid for leases $729  $781 
Cash paid for taxes $79  $63 
         
Supplemental Schedule of Non-cash Investing and Financing Activities:        
Transfer of inventories to property and equipment $1,293  $2,156 
Reclass of warrant liability to common stock and additional paid-in-capital $  $2,236 
Lease liabilities arising from obtaining right-of-use assets $316  $3,857 
         


Asensus Surgical, Inc.
Reconciliation of Non-GAAP Measures
Adjusted Net Loss and Adjusted Net Loss per Share
(in thousands except per share amounts)
(Unaudited)


               
             
   Three Months Ended  Nine Months Ended
   September 30,  September 30,
  2022 2021 2022 2021
            
Net loss attributable to common stockholders (GAAP)$(18,924) $(16,069) $(57,671) $(46,581)
              
Adjustments           
 Amortization of intangible assets 2,398   2,804   7,601   8,533 
 Change in fair value of contingent consideration (416)  278   (1,168)  1,013 
 Property and equipment impairment       432    
 Gain on extinguishment of debt          (2,847)
 Change in fair value of warrant liabilities          1,981 
 Employee retention tax credit    (1,311)     (1,311)
Adjusted net loss attributable to common stockholders (Non-GAAP)$(16,942) $(14,298) $(50,806) $(39,212)
              
              
   Three Months Ended  Nine Months Ended
   September 30,  September 30,
 2022  2021  2022  2021
Net loss per share attributable to common stockholders (GAAP)$(0.08) $(0.07) $(0.24) $(0.21)
              
Adjustments           
 Amortization of intangible assets 0.01   0.01   0.03   0.04 
 Change in fair value of contingent consideration 0.00   0.01   0.00   0.01 
 Property and equipment impairment       0.00    
 Gain on extinguishment of debt          (0.01)
 Change in fair value of warrant liabilities          0.01 
 Employee retention tax credit    (0.01)     (0.01)
Adjusted net loss per share attributable to common stockholders (Non-GAAP)$(0.07) $(0.06) $(0.21) $(0.17)
              

The non-GAAP financial measures for the three and nine months ended September 30, 2022 and 2021, which provide management with additional insight into the Company’s results of operations from period to period without non-cash charges and are calculated using the following adjustments:

a)  Intangible assets that are amortized consist of developed technology and purchased patent rights recorded at cost and amortized over 7 to 10 years.

b)  Contingent consideration in connection with the acquisition of the Senhance System in 2015 is recorded as a liability and is the estimate of the fair value of potential milestone payments related to business acquisitions. Contingent consideration is measured at fair value using a Monte-Carlo simulation utilizing significant unobservable inputs including the probability of achieving each of the potential milestones, revenue volatility, EURO to USD exchange rate, and an estimated discount rate associated with the risks of the expected cash flows attributable to the various milestones. Significant increases or decreases in any of the probabilities of success or changes in expected timelines for achievement of any of these milestones would result in a significantly higher or lower fair value of these milestones, respectively, and commensurate changes to the associated liability. The contingent consideration is revalued at each reporting period and changes in fair value are recognized in the consolidated statements of operations and comprehensive loss.

c)  Property and equipment impairment associated with returned Senhance Systems under operating leases that are not expected to generate future cash flows sufficient to recover their net book value.  

d)  During the second quarter of 2021, the Company received notification from the U.S. Small Business Administration that the principal amount of its Paycheck Protection Program loan of $2.8 million and related interest had been forgiven.  Gain on extinguishment of debt of $2.8 million was recognized for the nine months ended September 30, 2021, in the consolidated statement of operations and comprehensive loss.

e)  The Company’s Series B Warrants were measured at fair value using a simulation model which took into account, as of the valuation date, factors including the current exercise price, the expected life of the warrant, the current price of the underlying stock, its expected volatility, holding cost and the risk-free interest rate for the term of the warrant. The warrant liability was revalued upon exercise and the final change in fair value was recognized in the first quarter of 2021. 

f)  During the third quarter of 2021, the Company submitted a refund for incurred employee payroll taxes of $1.3 million under the Employee Retention Tax Credit provision as part of the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”).  A corresponding tax credit receivable of $1.3 million was recorded on the condensed consolidated balance sheet at September 30, 2021. 

INVESTOR CONTACT:
Mark Klausner or Mike Vallie, 443-213-0499
invest@asensus.com

OR

MEDIA CONTACT:
Isabella Rodriguez, 708-833-1572
CG Life
irodriguez@cglife.com