SS Innovations International, Inc. (SSII) November 2025 Conference Transcript

I'll hand things over to Dr. Srivastava to introduce himself. He's the founder of SS Innovations. So he's got some slides to walk through today. And for those of you who are listening online, they're available on the SSI website.

Thank you. And thanks to Stifo for this opportunity to talk about our SS Innovations and what we have been able to achieve. good afternoon everyone here and so we are a very rapidly growing company and we started out roughly about two three years ago and we have been kind of like a submarine for a long time and we finally have surfaced when we uplisted on Nasdaq in April of this year and becoming more and more visible and I I think, let me see the slides, next one, typical disclaimer, here is an image of the mantra system, and I must say it is quite different compared to all other technologies, and the goal was to not copy Da Vinci and to make it different, hopefully better, and and also be applicable for almost all the specialties, including cardiac. And most importantly for me was to make it affordable so we can really penetrate and serve more and more people. So let's see. Here's a snapshot of our company. We really differentiated in terms of what we have been able to produce as Mantra 3. And I must point out our team works very rapidly. So Mantra 3 from Mantra 2 knew completely a new generation was created in five months. Absolutely unbelievable pace. And have a whole host of all different types of instruments for multi-specialty. And on top of that, 20 cardiac-specific instruments that we have. We are very advanced in both AR and VR. and basically the team is led by robotic surgeons so we have a wonderful group of as part of our advisory board and we meet at certain frequency and outside of India we have system in seven other countries actually today we have done more than 6,000 cases with absolutely phenomenal results with zero device-related any adverse event. More than 127 systems now have been installed over just a period of roughly two and a half years. All the specialties are covered. It's a soft tissue robotic system, so from mouth down to pelvis. And we have done over 100 all kinds of complex procedures with our system we have done 56 plus tele-surgeries now including 14 cardiac surgeries that I personally have performed and the longest one was from 10,000 kilometers away from France into India and our system is designed not only for every specialty but also including cardiac me being a cardiac surgeon so somewhere we found that the dominant player had to stop supporting cardiac, and there was a huge need for this thing, so we have developed it that way. We finally commercialized after our development and clinical trials, etc., in 2022 in India, and this is a snapshot that gives you a global overview of all different types of surgeries that we have done, and the majority, of course, are general surgery cases because of the sheer spectrum of the disease and the urology, gynae, essentially everything has been covered and currently our market cap has been hanging around between 1.3 to 1.5 billion. The symbol is SSII and we are on NASDAQ and again on the right side it shows our really tremendous growth trajectory from last year to the third quarter this year, 195%. And if you look at our revenue cycle also, there's a significant continuous year-on-year growth rate of significance here. We have now, in terms of the whole investment highlight, very distinguished leadership and board with proven track record. Very large and addressable market that exists today because of the monopoly and the cost issues almost 7 billion people globally do not have easy access to the system so when we look at in terms of you know technologically very advanced system while being cost efficient and now we have been completely validated in terms of both clinical results in the large number of cases as well as acceptance by various hospitals purchasing our system we are in india as a starting platform but our goal is global and as i mentioned we have seven systems out there in different countries and every week literally we are being approached from various different countries as our regulatory registration process is ongoing in terms of the revenue it will be both the capex and recurring revenue typical of surgical robotic field and our goal is really a long-term goal in terms of create a very sustainable growth because of our track record our results the cost efficiency and the global need actually of a surgical robotic system that doesn't exist today a little bit about myself i am actually by training a cardiac surgeon and got involved with the robotics back in 2002 and part of the intuitive surgical cardiac trials i was part of it which led to approval both for bypass surgery and atrial fibrillation and initially trained in canada and then been literally in the u.s for almost close to 40 years and currently i do have a controlling interest of the ssi in terms of the shareholding dr vishwa is our chief executive officer for asia pacific region again and he's a physician and very large exposure to robotics. Dr. Fred Moll, I'm sure, does not need any introduction. He was the founder of Intuitive, and Oris, the last assistant he had. And he has joined us, actually, on our board, as well as our vice chairman. And he's a major shareholder with almost 10% shareholding at the company level. We have Naveen as our CFO, and he comes with, again, 20-plus years of experience, both very familiar with the various accounting principles, including the U.S. side. Barry is our CEO for Americas and a board member, and Barry and I were connected some time for development of robotics, and I think we just persisted, so Barry and I, they were in great France, and he's got almost 40 plus years of experience in running public companies, brokerage firm, etc. Dr. Anadurai is a board member, and he's known in India as a moon man, so he led two moon missions, and the Mars mission successfully while there, so we are in dialogue with him about, you know, how we can put our miniaturized system into the space when India is ready. Tim Adams is a senior physician in Ascension Hospital System. Dr. Sumashekar has probably the largest robotic experience in India, over 9,000 plus cases, a wonderful surgeon, and there's been tremendous help in our various guidance. So when we look at the global scene, and again just to qualify that, a lot of this study that has been reported by others has been before many other companies have come, including us. So I'm sure these numbers may not reflect, you know, when the real time comes, you know, five years later now, because things are changing very rapidly. So again, but even then, the projected growth is almost, you know, from current to, in 2031, over 16, almost 17 billion dollars. And the number of procedures is expected to quadruple. And I think on the right side you see all the different reasons how, you know, everything will be changing because of the technology availability, changing demographics, the disease burden continues to increase, there are workforce challenges that occur, and the robotics is really very, very helpful in doing this minimally invasive complex operation that returns people back to their functional status. The patients benefit hugely in terms of the less trauma, tiny little incisions, so they stay in the hospital much shorter. 20% of my cardiac patients used to go home when I was in Texas next day. 50% two days or less. So there's a huge benefit actually to the patient and their back to functional recovery in a week to 10 days or so. Surgeon, I think the superior ergonomics, the technology attributes of tremor filtration, 3D highly magnified vision and surgeon gets to sit and operate so I can tell you one thing that this absolutely will actually extend the surgical careers of surgeons when they have the most experience and instead of retiring they can continue operating actually and from the hospital side again the shorter hospital stay less use of resources early discharges so increased throughput for the beds same bed can be used So essentially, across the spectrum, all the stakeholders benefit from this wonderful technology. Again, in terms of the market, when you look at the global, of course, intuitive has dominated the scene. But mainly, it has been mainly developed economies, United States, Europe, and Japan. So it's almost like when you look at the global scene, seen that almost 7 billion people do not have easy access, and the biggest factor has been cost. And so when you look at the surgical volume, only less than 1% of the global surgical volume that is addressable through minimally invasive technique and at some point robotically. So these numbers are very small, so it kind of gives you an idea of what will occur in future. I think as more and more robotic companies are coming up. So, what is the reason actually for very uneven penetration? Most important has been the high cost of acquisition, the running cost and the maintenance agreements, et cetera. There's a lack of mentors, again, because this gets all tied up, so if you're not doing enough, you will never become good, so you're not able to teach others. And in the developing economies or even in the United States, there's only 35 percent penetration. So essentially for economic reasons, it is not available. And so I think when you look at all of these factors, I think there's a huge opportunity in relation to what mantra system represents actually. Being in India, one of our focus was to really look at the Indian market with a 1.4 billion population, 70,000 hospitals, and almost 25,000 are multi-specialty large hospitals. There are many hospitals that are smaller hospitals, anywhere from 30 to 50 to 100 beds. And again, because of the nature of our system, you know, we have been able to put these systems in tier two and tier three cities because of the affordability, surgeons' capabilities. And when they advance further, they can, you know, go on and add more arms. So, and we'll talk about that in a minute. And I think it just kind of gives you, again, a nutshell summary in terms of the scene in India. we have trained more than 1,400 surgeons. And in India, actually, it is projected. If you look at the global scene of 16.8 billion projection for 2031, in India alone, if you're looking at 4 billion market opportunity, which is very significant, it's almost like 20% of the global market opportunity. So this is what is anticipated in India. In terms of the system, as I mentioned, we are completely differentiated from our dominant player today. And so we have what we call a modular system. Each arm is mounted separately on a cart. Then our surgeon command center is open-faced. So you get to sit straight. You have a very large monitor, the hand controls, which is very unique to us on the magnetic sensor-based control, which are very lightweight with tremendous precision. And ours is the only Surgeon Command Center that is equipped to be able to control five arms sitting right on that console. VisionCart gives 3D vision to everybody. If you look at all of the robotic companies, they currently still offer only 2D vision. And I'll just narrate a very quick story. I was operating in South Korea launching the program a nurse put knife right through the heart I asked her what happened she said I couldn't tell how deep I was going so right from the beginning we adopted that everybody can see what the surgeon is seeing and they have the same 3d large 4k 32 inch monitor and so basically you avoid accidents the learning curve is shortened it's great for training people who are hanging around in the room. Again, I've pretty much covered all of these things. And one of the advantages of the modular design is you can use three, four, or up to five arms. And ours is the only system that has five arm capability. So we have developed certain enabling technologies which are automated. And we will use the fifth arm to deploy those. So if you look at other technology or their designs, it will be very difficult. And also the three, when we looked at actually all our procedure, and almost 70 different types of procedure can be done with the three arms. And this is one of the huge opportunities for Mantra system with a three arm configuration, with a full robot, with all the bells and whistles, to be able to penetrate the ambulatory surgery centers once we get past the FDA in the United States. over 40 different types of for multi-specialty and 20 plus cardiac specific instrumentation and as you are aware that currently no other company is touching cardiac and intuitive used to but five years ago or so they decided to stop making stabilizer which is used for bypass surgery and so essentially we have a completely full spectrum and ours is the only system today that can do entire spectrum of cardiac surgery using the robotic assistance and we have done that in our cases both for intracardiac application as well as the bypass surgery and we have some very unique instruments you know we have developed a stapling device so we have everything that intuitive has and more I think one of our unique instrument is this articulating vessel sealer nobody else has with an endo wrist and this also is reusable so it makes it very cost effective other thing that we are working on on the left side is what we call an automated coronary connector so literally bypass surgery can be done joining two arteries on the heart in six seconds which normally would take around 20 plus minutes or so and it creates a predictable anastomosis is work in progress. We have developed the prototype and we are going to proceed with clinical trials, et cetera. Very advanced in terms of our tele proctoring capabilities and it's like the old Tom Cruise's movie, The Minority Report, you have multiple screens. You can manipulate, enlarge them, rotate them and you can tell it straight on. So it is literally one of the biggest challenges is how to proctor people. And so this allows you to proctor people, so literally I have sat in India in my office having lunch while proctoring people 2,000 kilometers away without having to travel. So this is a huge advantage in terms of launching programs. And also the combination of tele-surgery and tele-proctoring is like having an attending in the room. If you're learning, a surgeon is guiding you, and when you get into trouble, they can take over and finish the operation. So this again will be a huge actually modality for us and currently to my knowledge again this combination to this advanced level doesn't exist actually anywhere else. And we are creating actually all kinds of mixed realities. Our team also has developed ability whereby we can any of these diacom images, CT, MRI, we can convert them on the fly into 3D model. the surgeon can manipulate so again this feature to my knowledge does not exist at that level of advancement actually globally today. We have created a bus which has our mantra system that also has built in tele-surgery capabilities not to have the patient to operate there because it is not in a stable environment as our next project is of course to build a mobile operating room with all the standards so this bus is used really to increase awareness training of surgeons you know instead of bringing them over bus can be parked outside the hospital and surgeons can come and train and so again as you can see tele-surgery in fact can be done sitting in the bus and it already has been done. this is our latest advance it's an independent surgeon command center and believe it or not I used this thing roughly two weeks ago to do a cardiac case 300 kilometers away while sitting in my living room and this will be so disruptive just imagine when the system is there in the operating room you don't want to tie the operating room just to do tele-treasury and the console which is big and all of that thing so this is completely independent the foot tray it goes inside and that is the total surgeon command center and you know and we have these air glasses give you beautiful magnified 3d vision so you can place these in doctors offices in clinics or I can sit at my home and operate on three different patients staggered in three different hospital without having to travel I think this will be absolutely disruptive and this was the whole idea of the development of robotic system back in the 80s was long-distance operation whether in space or battlefield now we have come full circle with technology that is available the high-speed connectivity that is available and this really is done with a very low latency so it's almost real time you don't even feel that you are operating long distance I think skip some of these various advanced platforms, but if you can see literally when we have compared ourselves with other existing systems, I think we literally have more features, more specialties, and ultimately cost effective to be able to serve many, many more patients and really penetrate the global availability of these systems. Our facility is a world class facility 70,000 square feet of space right now and all the different departments are there that one expects actually and our current capacity is to be able to do 20 system per month everything actually is done in India in terms of being indigenous for the country and we designed the system there. Almost everything is manufactured in India and assembled there and tested and integrated. The only thing we bring from outside are the things that currently are not manufactured in India, certain motors, certain sensors and drives, etc., which also is changing as we go. So our current cumulative base, as you can see, tremendous growth story and I've talked about the various countries that it is available today and in terms of the procedure again very significant growth compared to you know some of the other competitors this gives you a overall landscape of places that we currently have approval you know it's almost like there are including india there are 10 places i think colombia we just got we are proceeding with the U.S. and European approvals, and as you can see, many other countries. So there are almost 120 countries that do not require U.S. FDA or CE. It's a huge target, and these are the countries that are underserved today with the robotic system. So as we speak, almost 20 other different registration processes at different stages are ongoing. Our U.S. FDA, so this month, in fact, we are filing for the U.S. FDA approval, and based on our three pre-sub meetings with FDA, we are going for 5-10k application approval process for multiple indications. Because of our very large experience and absolutely phenomenal results in relation to our system, in fact, we were advised that there are other predicates today. And so because, you know, moon, digital motion, CMR, SANA, et cetera, so we are going for that. And we are pretty confident, I think, that our projected target is first half of next year. Of course, there are no guarantees, as one knows with the FDA, things can go back and forth. But we are very confident that out of multiple indications that I think around six, including robotic assisted coronary bypass surgery, and the FDA may approve some or may ask us to do trial for others, which is not a problem at all. We are absolutely prepared. And in terms of the European, again, stage one audit has been completed and so again we anticipate European approval sometime first half of next year and this will really open up great opportunities for us for global penetration. In terms of our revenue again very significant growth story in terms of our revenues and it only actually also gives the validity that the hospitals are accepting our system. And we, in fact, have beaten Da Vinci in India this year, more than double number of systems we have sold, considering that they've been in the country for the last 22 years. So one can actually see the adoption against Da Vinci in relation to because of the nature of the system, the technology, the capabilities, and all these other bells and whistles that we have talked about. The gross margins will continue to improve as we move forward with the greater volumes. And currently, our recurrent revenues are not very high, which is expected. It's not unusual when you are starting as a new company. If you look at the interior history around 25 plus years now, and so as the install base increases and the volumes increases, our record revenues will continue to grow because of the propriety nature of our instruments and consumables. goals. In terms of growth strategy, I think the value is written there, lower cost for an advanced technology, very short learning curve actually for Damiichi users is like five minutes. We have seen very significant improved patient outcomes and of course differentiated features including the usb or cardiac capabilities in terms of multi-specialty hospital you know we are putting all these systems various different models and each hospital we are seeing actually growth from the time of installation to generally it takes about a year for things to stabilize I think so we are seeing that ongoing thing and in terms of our marketing strategies of course we have a wonderful advisory board both national and international the medical conferences seem to be a biggest way to reach out to most end users being doctors and the hospital administration because initial recommendation is done by the physicians and then we have training program very organized training program. We have a classroom whereby 50 people or so we can train at one time and we have a digital wall we can bring live surgeries right there so people don't have to go to the operating rooms to witness, which is a waste of time or congested space, etc. And then we have a partnership right now with Johns Hopkins for some of the R&D developments, etc. So as a company young company and we are very restless so very fast actually and we are constantly looking at various newer innovative approaches and so i think we have a product timeline also for future this is just a summary of our financials here we are currently cash flow positive we just sold roughly three systems in india we support ourselves because of relatively low cost structure. But again, our revenues are quite significantly going up quarter on quarter and year on year. So with that, I want to thank you very much and take any questions that you may have.

I can kick things off with a couple of questions myself. Just what do you think about the biggest opportunity for growth for the mantra system? Is it the cardiac capabilities? Is it the future of telehealth and the opportunity there? Or cost? Or is it a combination of the three? Where do you see it?

I'm a little biased. But of course, those things that you just mentioned. But also, you know, having superior technology and being a robotic surgeon, I've seen literally and aware of everything that exists out there. I was one of the largest users of DaVinci for cardiac. And so when you look at imbalance, the technology features and differentiation that we talked about, although DaVinci is a great system, I will never criticize it. They showed us a very different pathway to do very complex operations. but then because of the monopoly I think sometimes the incentive to innovate kind of settled down so if you look at our thing and how fast we have developed things and we are constantly on the lookout to give more and more enabling technologies to the surgeons especially on the cardiac side the reason cardiac failed because system was given now you guys figure out and cardiac being a very high risk specialty again it died down and then they stopped it So I think our technology features, which are superior, more user-friendly, shorter learning curve, and established proven safety with our results, lower cost, and commercial acceptance now in India, even though DaVinci is there. And then, of course, the differentiation of tele, all kinds of capabilities, including cardiac, that nobody in the world has done. and the other thing I must mention also we have developed pediatric instruments so the same system will also be used for pediatric and again there's a huge population of children that is still undergo conventional approaches so I think you know in combination of all of these things and also what market is available in rest of the world because cost has prevented the penetration for this and robotic will be the future I think at a point in time every operating room will have a robot and this will change you know the cost

will come down so I think you know our growth is strategy we are looking at all of these features and in a very short time we have seen that yes yeah it's impressive what you've done in a short time and I think you describe it as a submarine emerging so I'll open it up see if there's any question in the back Yes, yeah.

So I can talk about the expansion plans first. We are constantly going into different countries. In fact, next week, our system is going into Oman and Dubai, going into Greece, going into Central Asian countries. And so literally, there is a constant need that, and of course, our system based on our results, and people have seen our performance. So there's a constant, actually, increasing penetration globally. And I think as we receive registration approvals in various countries that don't require USFDNC, it's a huge market opportunity out there. And regarding the exit, I'm not so sure I can discuss that here. I'm sure you know better than that because they're going to throw me out of board.

Any other questions? All right, hearing none, thank you so much for your time. Thank you for presenting.

Appreciate it.