RISK FACTORS
An investment in the Company involves a significant level of risk. Investors should carefully consider the risk factors described below
together with the other information included in this prospectus. If any of the risks described below occurs, or if other risks not identified below occur, our business, financial condition, and results of operations could be materially and adversely
affected.
Risks Related to our Business
We have a history of operating losses, and we may not be able to achieve or sustain profitability. In addition, we may be unable to continue as a going concern.
We are a medical device company with a limited operating history. We are not profitable and have incurred losses since our inception.
Substantial doubt exists about our ability to continue as a going concern as a result of recurring losses and an accumulated deficit. We continue to incur research and development and general and administrative expenses related to our operations.
Our net loss for the year ended December 31, 2013 was $28.4 million, and our accumulated deficit as of December 31, 2013 was $93.3 million.
We expect to continue to incur losses for the foreseeable future, and these losses will likely increase as we prepare for clinical trials of our products and continue to commercialize our cleared or
approved products. If our products fail in clinical trials or do not gain regulatory clearance or approval, or if our products do not achieve market acceptance, we may never become profitable. Even if we achieve profitability in the future, we may
not be able to sustain profitability in subsequent periods. Absent a significant increase in revenue or additional equity or debt financing, we may not be able to sustain our ability to continue as a going concern. On January 8, 2014, we filed
this prospectus as part of a Registration Statement on Form S-3 to register $100,000,000 of our securities for sale from time to time. Once such Registration Statement is declared effective by the SEC, we do anticipate proceeding with offerings of
our securities in accordance with the shelf registration statement requirements. We cannot assure you that we will be successful in obtaining such additional financing on terms acceptable to the Company or at all.
We will require substantial additional funding, which may not be available to us on acceptable terms, or at all.
The net proceeds of recent financings, including the Private Placement, will not be sufficient to support clinical and pre-clinical
development of our products and product candidates and provide us with the necessary resources to commercialize these products and product candidates. While we are currently focused on our SurgiBot System product, we intend to advance multiple
additional products through clinical and pre-clinical development in the future. We will likely need to raise substantial additional capital in order to continue our operations and achieve our business objectives.
Our future funding requirements will depend on many factors, including, but not limited to:
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the costs associated with the integration of the respective businesses and operations of SafeStitch and TransEnterix Surgical;
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the costs associated with establishing a sales force and commercialization capabilities;
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the costs associated with the expansion of our manufacturing capabilities;
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our need to expand our research and development activities;
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the rate of progress and cost of our clinical trials;
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the costs of acquiring, licensing or investing in businesses, products and technologies;
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the costs and timing of seeking and obtaining FDA and other non-U.S. regulatory clearances and approvals;
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the economic and other terms and timing of our existing licensing arrangement and any collaboration, licensing or other arrangements into which we may
enter in the future;
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our need and ability to hire additional management, scientific, medical and sales and marketing personnel;
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the effect of competing technological and market developments;
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our need to implement additional internal systems and infrastructure, including financial and reporting systems; and
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our ability to maintain, expand and defend the scope of our intellectual property portfolio.
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Until we generate a sufficient amount of product revenue to finance our cash requirements, which may never occur, we expect to finance
future cash needs primarily through public or private equity offerings, debt financings or strategic collaborations. We do not know whether additional funding will be available on acceptable terms, or at all. If we are not able to secure additional
funding when needed, we may have to delay, reduce the scope of or eliminate one or more of our clinical trials or research and development programs. To the extent that we raise additional funds by issuing equity securities, our stockholders may
experience significant dilution; and debt financing, if available, may involve restrictive covenants that limit our operations. To the extent that we raise additional funds through collaboration and licensing arrangements, it may be necessary to
relinquish some rights to our products or grant licenses on terms that may not be favorable to us.
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We may fail to realize some or all of the anticipated benefits of the business combination of
SafeStitch and TransEnterix Surgical, which may adversely affect the value of our common stock.
The success of the
integration of TransEnterix Surgical will depend, in part, on our ability to realize the anticipated benefits and cost savings from combining the respective business and operations of SafeStitch and TransEnterix Surgical. To realize these
anticipated benefits and cost savings, we must successfully combine the acquired business with our legacy operations and integrate our respective operations, technologies and personnel, which is particularly challenging given the geographic and
cultural differences between the personnel and facilities based in Florida and North Carolina and the lack of experience we have in combining businesses. If we are not able to achieve these objectives within the anticipated time frame or at all, the
anticipated benefits and cost savings of the acquisition may not be realized fully or at all or may take longer to realize than expected, and the value of our common stock may be adversely affected. In addition, the overall integration of the
businesses is a complex,
time-consuming
and expensive process that, without proper planning and effective and timely implementation, could significantly disrupt our operations. Further, it is possible that the
integration process could adversely affect our ability to maintain our research and development operations, result in the loss of key employees and other senior management, or to otherwise achieve the anticipated benefits of the acquisition.
Risks in integrating the respective operations of SafeStitch and TransEnterix Surgical in order to realize the anticipated
benefits of the acquisition include, among other factors:
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failure to effectively coordinate research and development efforts and capabilities effectively;
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failure to adequately communicate our product capabilities and expected product roadmap;
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failure to compete effectively against companies already serving the broader market opportunities expected to be available to us and our potential
expanded product offerings;
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coordinating research and development activities to enhance the introduction of new devices and platforms acquired in the acquisition;
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failure to successfully integrate and harmonize financial reporting and information technology systems of the two companies;
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integrating a senior management team as well as directors from both companies into our Board of Directors;
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retaining and integrating key employees from TransEnterix Surgical and SafeStitch;
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managing effectively the diversion of managements attention from business matters to integration issues;
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retaining TransEnterix Surgicals relationships with partners and integrating partnering efforts so that new partners acquired can easily do
business with us; and
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transitioning all facilities to a common information technology environment.
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In addition, the actual integration may result in additional and unforeseen expenses, and the anticipated benefits of the integration
plan may not be realized. Actual cost synergies, if achieved at all, may be lower than we expect and may take longer to achieve than anticipated. If we are not able to adequately address these challenges, we may be unable to successfully integrate
the respective operations of SafeStitch and TransEnterix Surgical, or to realize the anticipated benefits of the integration. The anticipated benefits and synergies assume a successful integration and are based on projections, which are inherently
uncertain, and other assumptions. Even if integration is successful, anticipated benefits and synergies may not be achieved. An inability to realize the full extent of, or any of, the anticipated benefits of the acquisition, as well as any delays
encountered in the integration process, could have an adverse effect on our business and results of operations, which may affect the value of the shares of our common stock.
We have incurred significant costs related to the Merger and expect to incur additional costs as integration plans continue. If we are unable to offset the costs of the acquisition through
realization of efficiencies, our financial condition, liquidity and results of operations will suffer.
We have
incurred, and expect to continue to incur, various non-recurring costs associated with combining the operations of TransEnterix Surgical and SafeStitch, including, but not limited to, legal, accounting and financial advisory fees. The substantial
majority of non-recurring expenses have been composed of these costs and expenses related to the execution of the acquisition, facilities and systems consolidation costs and employment-related costs. We have also incurred fees and costs related to
formulating and implementing integration plans. Additional unanticipated costs may be incurred in the integration of the businesses. Although we expect that the elimination of duplicative costs, as well as the realization of other efficiencies
related to the integration of the businesses, should allow us to offset incremental acquisition and acquisition-related costs over time, this net benefit may not be achieved in the near term, or at all.
We have a substantial amount of indebtedness, which may adversely affect our financial resources and our ability to operate our business.
In connection with the Merger we became a party to, and jointly and severally liable for, $9.4 million of outstanding
debt of TransEnterix Surgical, and the associated obligations owed by TransEnterix Surgical under a Loan and Security Agreement, dated January 17, 2012, among TransEnterix Surgical, Silicon Valley Bank (SVB) and Oxford Finance LLC (Oxford) (the
SVB-Oxford LSA). The Second and Third Amendment to the SVB-Oxford LSA, dated as of September 3, 2013 and October 31, 2013, respectively, amend the SVB-Oxford LSA among the
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lenders and the Company (as so amended, the Amended Loan Agreement). The Amended Loan Agreement evidences a term loan, which will mature on January 1, 2016 (the Term Loan). Our resulting
substantial level of indebtedness and other financial obligations increase the possibility that we may be unable to pay, when due, the principal of, interest on, or other amounts due in respect of, our indebtedness.
Further, under the Amended Loan Agreement, we are subject to certain restrictive covenants that, among other things, may limit our
ability to obtain additional financing for working capital requirements, product development activities, debt service requirements, and general corporate or other purposes. These restrictive covenants include, without limitation, restrictions on our
ability to: (1) change the nature of our business; (2) incur additional indebtedness; (3) incur liens; (4) make certain investments; (5) make certain dispositions of assets; (6) merge, dissolve, consolidate or sell all
or substantially all of our assets; and (7) enter into transactions with affiliates.
If we breach any of these
restrictive covenants or are unable to pay our indebtedness under the Amended Loan Agreement when due, this could result in a default under the Amended Loan Agreement. In such event, SVB and/or Oxford, as the case may be, may elect (after the
expiration of any applicable notice or grace periods) to declare all outstanding borrowings, together with accrued and unpaid interest and other amounts payable under the Amended Loan Agreement, to be immediately due and payable. Any such occurrence
would have an immediate and materially adverse impact on our business and results of operations.
Some of our technologies are in an
early stage of development and not yet proven. Further, our related product research and development activities may not lead to our technologies and products being commercially viable.
We are engaged in the research and development of minimally invasive surgical devices, robotic surgical devices, and intralumenal medical
devices that manipulate tissues for the treatment of certain intraperitoneal abnormalities. The effectiveness of our technologies is not well known in, or may not be accepted generally by, the clinical medical community. Further, some of our
products are still in early stages of development and are prone to the risks of failure inherent in medical device product development. In particular, any of our products in clinical trials may fail to show desired efficacy and safety traits despite
early promising results. A number of companies in the medical device industry have suffered significant setbacks in advanced clinical trials, even after obtaining promising results at earlier points. The occurrence of any such events would have a
material adverse effect on our business.
Our product research and development activities may not result in commercially viable
products.
Some of our products are still in early stages of development and are prone to the risks of failure
inherent in medical device product development. For any Class III devices, we will likely be required to undertake significant clinical trials to demonstrate to the FDA that our devices are safe and effective for their intended uses. We may also be
required to undertake clinical trials by non-U.S. regulatory agencies. Clinical trials are expensive and uncertain processes that may take years to complete. Failure can occur at any point in the process, and early positive results do not ensure
that the entire clinical trial will be successful.
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The results of previous clinical experience with our devices and devices similar to those that we
are developing may not be indicative of future results, and our current and planned clinical trials may not satisfy the requirements of the FDA or other non-U.S. regulatory authorities.
Positive results from limited in vivo and ex vivo animal trials and other early development work we have conducted or early clinical
experience with the test articles or with similar devices should not be relied upon as evidence that later-stage or large-scale clinical trials will succeed. We will be required to demonstrate with substantial evidence through well-controlled
clinical trials that our Class III products are safe and effective for their intended uses. Generally, clinical data is not required to support a 510(k) application, but if applicable for our Class II products, we may require clinical data to
demonstrate that the devices are substantially equivalent in terms of safety and effectiveness to devices that are already marketed under Section 510(k).
Further, our products may not be cleared or approved, as the case may be, even if the clinical data are satisfactory and support, in our view, clearance or approval. The FDA or other non-U.S. regulatory
authorities may disagree with our trial design and our interpretation of the clinical data. Any of these regulatory authorities may change requirements for the clearance or approval of a product even after reviewing and providing comment on a
protocol for a pivotal clinical trial that has the potential to result in FDA approval. These regulatory authorities may also clear or approve a product for fewer or more limited uses than we request or, for a Class III device, may grant approval
contingent on the performance of costly post-marketing clinical trials. In addition, the FDA or other non-U.S. regulatory authorities may not approve or clear the labeling claims necessary or desirable for the successful commercialization of our
products.
We are highly dependent on the success of our products, and we cannot give any assurance that our products will receive
regulatory clearance or that any of our products or future products will be successfully commercialized.
We are
highly dependent on the success of our products, especially the SurgiBot System. We cannot give any assurance that the FDA will grant regulatory clearance for the SurgiBot System, or will not require the more burdensome PMA submission and approval,
nor can we give any assurance that the SurgiBot System or any of our other products will be successfully commercialized, for a number of reasons, including, without limitation, the potential introduction by our competitors of more clinically
effective or cost-effective alternatives, or failure in our sales and marketing efforts. Any failure to obtain clearance or approval of our products or to successfully commercialize them would have a material and adverse effect on our business.
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If our competitors develop and market products that are more effective, safer or less expensive
than our products and future products, our commercial opportunities will be negatively impacted.
The life sciences
industry is highly competitive, and we face significant competition from many medical device companies that are researching and marketing products designed to address minimally invasive and robotic assisted surgery. We are currently developing and
commercializing medical devices that will compete with other medical devices that currently exist or are being developed. Products we may develop in the future are also likely to face competition from other medical devices and therapies. Many of our
competitors have significantly greater financial, manufacturing, marketing and product development resources than we do. Large medical device companies, in particular, have extensive experience in clinical testing and in obtaining regulatory
clearances or approvals for medical devices. These companies also have significantly greater research and marketing capabilities than we do. Some of the medical device companies we expect to compete with include Applied Medical, Covidien, Intuitive
Surgical, Johnson & Johnson, Olympus, Stryker, USGI Medical, Endo Gastric Solutions, Inc., ValenTx, Inc., GI Dynamics, Inc., Medigus, Ltd., and a number of minimally invasive surgical device, robotic surgical device manufacturers and
providers of products and therapies that are designed to reduce the need for or attractiveness of surgical intervention. In addition, many other universities and private and public research institutions are or may become active in research involving
surgical devices for minimally invasive and robotic assisted surgery.
We believe that our ability to successfully compete
will depend on, among other things:
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the efficacy, safety and reliability of our products;
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the speed at which we develop our products;
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our ability to commercialize and market any of our products that may receive regulatory clearance or approval;
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our ability to design and successfully execute appropriate clinical trials;
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the timing and scope of regulatory clearances or approvals;
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our ability to protect intellectual property rights related to our products;
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our ability to have our partners manufacture and sell commercial quantities of any approved products to the market; and
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acceptance of future products by physicians and other health care providers.
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If our competitors market products that are more effective, safer, easier to use or less expensive than our products or future products,
or reach the market sooner than our products, we may not achieve commercial success. In addition, the medical device industry is characterized by rapid technological change. It may be difficult for us to stay abreast of the rapid changes in each
technology. If we fail to stay at the forefront of technological change, we may be unable to compete effectively. Technological advances or products developed by our competitors may render our technologies or products obsolete or less competitive.
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Our product development activities could be delayed or stopped.
We do not know whether our current product development activities will result in products that meet necessary standards and performance
criteria or whether the development will be completed on schedule. Delays could occur based on a number of issues that could arise. For example, should clinical trials be required, the commencement of clinical trials could be substantially delayed
or prevented by several factors, including:
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delay or failure to obtain sufficient supplies of the product for our clinical trials;
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limited number of, and competition for, suitable patients that meet the protocols inclusion criteria and do not meet any of the exclusion
criteria;
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limited number of, and competition for, suitable sites to conduct our clinical trials, and delay or failure to obtain FDA approval, if necessary, to
commence a clinical trial;
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requirements to provide the medical device required in our clinical trial at cost, which may require significant expenditures that we are unable or
unwilling to make;
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delay or failure to reach agreement on acceptable clinical trial agreement terms or clinical trial protocols with prospective sites or investigators;
and
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delay or failure to obtain IRB approval or renewal to conduct a clinical trial at a prospective or accruing site, respectively.
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The completion of our clinical trials could also be substantially delayed or prevented by several factors,
including:
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lack of efficacy evidenced during clinical trials;
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slower than expected rates of patient recruitment and enrollment;
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failure of patients to complete the clinical trial;
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unforeseen safety issues;
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termination of our clinical trials by one or more clinical trial sites;
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inability or unwillingness of patients or medical investigators to follow our clinical trial protocols or allocate sufficient resources to complete our
clinical trials; and
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inability to monitor patients adequately during or after treatment.
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Our clinical trials may be suspended or terminated at any time by us, the FDA, other
regulatory authorities or the IRB for any given site. Any failure or significant delay in completing clinical trials for our products could materially harm our financial results and the commercial prospects for our products.
In addition, other issues such as the need to investigate third party patents and potential infringement matters, although not currently
an issue, could arise, thereby delaying our development efforts.
The regulatory approval and clearance processes are expensive,
time-consuming and uncertain and may prevent us or our collaboration partners from obtaining approvals or clearances, as the case may be, for the commercialization of some or all of our products.
The product development and design, testing, manufacturing, labeling, approval, clearance, selling, marketing and distribution of medical
devices are subject to extensive regulation by the FDA and other non-U.S. regulatory authorities, which regulations differ from country to country. We are not permitted to market our products in the United States until we receive a clearance letter
under the 510(k) process or approval of a PMA from the FDA, depending on the nature of the device.
In the United States, a
company generally can obtain permission to distribute a new medical device in one of two ways. The first applies to any device that is substantially equivalent to a device first marketed prior to May 1976, or to another device marketed after that
date, but which was substantially equivalent to a pre-May 1976 device. These devices are either Class I or Class II devices. To obtain FDA clearance to distribute the medical device, a company generally must submit a Section 510(k) submission,
and receive an FDA order finding substantial equivalence to a predicate device (pre-May 1976 device or post-May 1976 device that was substantially equivalent to a pre-May 1976 device) and permitting commercial distribution of that medical device for
its intended use. A 510(k) submission must provide information supporting a claim of substantial equivalence to the predicate device. If clinical data from human experience are required to support the 510(k) submission, these data must be gathered
in compliance with investigational device exemption (IDE) regulations for investigations performed in the United States. The 510(k) process is normally used for products of the type that we are developing and propose to market and sell. The FDA
review process for premarket notifications submitted pursuant to Section 510(k) takes, on average, about ninety (90) days, but it can take substantially longer if the FDA has concerns regarding the application. It is possible for
Section 510(k) clearance procedures to take from six to twenty-four months, depending on the concerns raised by the FDA and the complexity of the device. There is no guarantee that the FDA will clear a medical device for marketing,
in which case the device cannot be distributed in the United States. There is also no guarantee that the FDA will deem the applicable device subject to the 510(k) process, as opposed to the more time-consuming, resource-intensive and problematic,
pre-market approval (PMA) process described below. In 2011, the FDA issued a series of draft guidance documents designed to reform the 510(k) clearance process. Similarly, the Medical Device User Fee Amendments of 2012 authorized the FDA to collect
user fees for the review of certain premarket submissions received on or after October 1, 2012, including 510(k) submissions. These fees are intended to improve the medical device review process, but the actual impact on the industry is still
unknown.
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The second, more comprehensive, approval process applies to a new device that is not
substantially equivalent to a pre-1976 product or that is to be used in supporting or sustaining life or preventing impairment. These devices are normally Class III devices. For example, most implantable devices are subject to the approval process.
Two steps of FDA approval are generally required before a company can market a product in the United States that is subject to approval, as opposed to clearance, as a Class III device. First, a company must comply with IDE regulations in connection
with any human clinical investigation of the device. These regulations permit a company to undertake a clinical study of a non-significant risk device without formal FDA approval. Prior express FDA approval is required if the device is a
significant risk device. Second, the FDA must review the companys PMA application, which contains, among other things, clinical information acquired under the IDE. Additionally, devices subject to PMA approval may be subject to a panel review
to obtain market approval and are required to pass a factory inspection in accordance with the current good manufacturing practices standards in order to obtain approval. The FDA will approve the PMA application if it finds there is
reasonable assurance that the device is safe and effective for its intended use. The PMA process takes substantially longer than the 510(k) process, approximately one to two years. However, in some instances the FDA may find that a device is new and
not substantially equivalent to a predicate device but is also not a high risk device as is generally the case with Class III PMA devices. In these instances FDA may allow a device to be down classified from Class III to Class I or II. The Food and
Drug Administration Modernization Act of 1997 (FDAMA) added the
de novo
classification option as an alternate pathway to classify novel devices of low to moderate risk that had automatically been placed in Class III after receiving a
not substantially equivalent (NSE) determination in response to a premarket notification 510(k) submission. Section 513(f)(2) of the FDCA was amended by section 607 of the Food and Drug Administration Safety and Innovation Act
(FDASIA), on July 9, 2012, to allow a sponsor to submit a
de novo
classification request to the FDA for novel low to moderate risk devices without first being required to submit a 510(k) application. These types of applications are
referred to as Evaluation of Automatic Class III Designation or
de novo
. In instances where a device is deemed not substantially equivalent to a Class II predicate device, the candidate device may be filed as a
de
novo
application which may lead to delays in regulatory decisions by the FDA. FDA review of a
de novo
application may lead the FDA to identify the device as either a Class I or II device and worthy of either an exempt or 510(k) regulatory
pathway.
While we have already received FDA clearance for the SPIDER System, we continue in discussions with the FDA
regarding the appropriate regulatory pathway for our SurgiBot System and our Gastroplasty Device. Obtaining approval of any PMA can be a lengthy, expensive and uncertain process. While the FDA normally reviews a premarket notification in ninety (90)
days, there is no guarantee that our future products will qualify for this more expeditious regulatory process, which is reserved for Class I and II devices, nor is there any assurance, even if a device is reviewed under the 510(k) premarket
notification process, that the FDA will review it expeditiously or determine that the device is substantially equivalent to a lawfully marketed non-PMA device. In the past the Company has been successful in receiving 510(k) clearance within the
90-day review period, but it can take longer (six to eighteen months) to obtain 510(k) clearance for a Class II device. If the FDA fails to provide clearance for a product candidate, such as the SurgiBot System, then we cannot market the device. In
lieu of acting on a premarket notification, the FDA may seek additional information or additional data which would further delay our ability to market the product.
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Regulatory approval of a PMA, PMA supplement or clearance pursuant to a 510(k) premarket
notification is not guaranteed, and the approval or clearance process, as the case may be, is expensive, uncertain and may, especially in the case of the PMA application, take several years. The FDA also has substantial discretion in the medical
device clearance process or approval process. Despite the time and expense exerted, failure can occur at any stage, and we could encounter problems that cause us to repeat or perform additional development, standardized testing, pre-clinical studies
and clinical trials. The number of pre-clinical studies and clinical trials that will be required for FDA clearance or approval varies depending on the medical device candidate, the disease or condition that the medical device candidate is designed
to address, and the regulations applicable to any particular medical device candidate. The FDA or other non-U.S. regulatory authorities can delay, limit or deny clearance or approval of a medical device candidate for many reasons, including:
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a medical device candidate may not be deemed safe or effective, in the case of a PMA application;
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a medical device candidate may not be deemed to be substantially equivalent to a device lawfully marketed either as a grandfathered device or one that
was cleared through the 510(k) premarket notification process;
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a medical device candidate may not be deemed to be in conformance with applicable standards and regulations;
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FDA or other regulatory officials may not find the data from pre-clinical studies and clinical trials sufficient;
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the FDA might not approve our processes or facilities or those of any of our third-party manufacturers for our Class III PMA devices;
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other non-U.S. regulatory authorities may not approve our processes or facilities or those of any of our third-party manufacturers, thereby restricting
export; or
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the FDA or other non-U.S. regulatory authorities may change clearance or approval policies or adopt new regulations.
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Even if we obtain regulatory clearances or approvals for our products, the terms thereof and ongoing regulation of our products may limit how we
manufacture and market our products, which could materially impair our ability to generate anticipated revenues.
Once
regulatory clearance or approval has been granted, the cleared or approved product and its manufacturer are subject to continual review. Any cleared or approved product may be promoted only for its indicated uses. In addition, if the FDA or other
non-U.S. regulatory authorities clear or approve any of our products, the labeling, packaging, adverse event reporting, storage, advertising and promotion for the product will be subject to extensive regulatory requirements. We and the manufacturers
of our products are also required to comply with the FDAs Quality System Regulation (QSR), which includes requirements relating to quality control and quality assurance, as well as the corresponding maintenance of records and
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documentation as well as other quality system requirements and regulations from non-U.S. regulatory authorities. Moreover, device manufacturers are required to report adverse events by filing
Medical Device Reports with the FDA, which are publicly available. Further, regulatory agencies must approve our manufacturing facilities for Class III devices before they can be used to manufacture our products, and all manufacturing facilities are
subject to ongoing regulatory inspection. If we fail to comply with the regulatory requirements of the FDA, either before or after clearance or approval, or other non-U.S. regulatory authorities, or if previously unknown problems with our products,
manufacturers or manufacturing processes are discovered, we could be subject to administrative or judicially imposed sanctions, including:
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restrictions on the products, manufacturers or manufacturing process;
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adverse inspectional observations (Form 483), warning letters, non-warning letters incorporating inspectional observations;
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civil or criminal penalties or fines;
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product seizures, detentions or import bans;
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voluntary or mandatory product recalls and publicity requirements;
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suspension or withdrawal of regulatory clearances or approvals;
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total or partial suspension of production;
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imposition of restrictions on operations, including costly new manufacturing requirements;
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refusal to clear or approve pending applications or premarket notifications; and
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import and export restrictions.
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In addition, the FDA and other non-U.S. regulatory authorities may change their policies and additional regulations may be enacted that could prevent or delay regulatory clearance or approval of our
products. We cannot predict the likelihood, nature or extent of government regulation that may arise from future legislation or administrative action, either in the United States or abroad. If we are not able to maintain regulatory compliance, we
would likely not be permitted to market our future products and we may not achieve or sustain profitability.
Current legislation and
future legislative or regulatory reform of the health care system may affect our ability to sell our products profitably.
In the United States, there have been, and we expect there to continue to be, a number of legislative and regulatory initiatives, at both the federal and state government levels, to change the healthcare
system in ways that, if approved, could affect our ability to sell our products profitably. While many of the proposed policy changes require congressional approval to
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implement, we cannot be sure that reimbursement payments under governmental and private third-party payor programs to health care providers will remain at levels comparable to present levels or
will be sufficient to cover the costs allocable to patients eligible for reimbursement under these programs. Any changes that lower reimbursement rates under Medicare, Medicaid or private payor programs could negatively affect our business.
To the extent that any of our products are deemed to be durable medical equipment (DME), they may be subject to distribution
under Medicares Competitive Acquisition regulations, which could adversely affect the amount that we can seek from payors. Non-DME devices used in surgical procedures are normally paid directly by the hospital or health care provider and not
reimbursed separately by third-party payors. As a result, these types of devices are subject to intense price competition that can place a small manufacturer at a competitive disadvantage as hospitals and health care providers attempt to negotiate
lower prices for products such as the ones we develop and sell. Additionally, our business operations and activities may be directly, or indirectly, subject to various federal, state and local healthcare laws, including but not limited to, laws
prohibiting kickbacks and false claims.
Most significantly, in March 2010, President Obama signed into law both the Patient
Protection and Affordable Care Act (the Affordable Care Act) and the reconciliation law known as Health Care and Education Affordability Reconciliation Act (the Reconciliation Act, and, with the Affordable Care Act, the 2010 Health Care Reform
Legislation). The constitutionality of the 2010 Health Care Reform Legislation was confirmed on June 28, 2012 by the Supreme Court of the United States. Specifically, the Supreme Court upheld the individual mandate included changes regarding
the extension of medical benefits to those who currently lack insurance coverage. Thus, the 2010 Health Care Reform Legislation will change the existing state of the health care system by expanding coverage through voluntary state Medicaid
expansion, attracting previously uninsured persons through the new health care insurance exchanges and by modifying the methodology for reimbursing medical services, drugs and devices. These structural changes could entail modifications to the
existing system of third-party payors and government programs, such as Medicare and Medicaid, or some combination of both, as well as other changes.
Beyond coverage and reimbursement changes, the 2010 Health Care Reform Legislation subjects manufacturers of medical devices to an excise tax of 2.3% on certain U.S. sales of medical devices beginning in
January 2013. This excise tax will likely increase our expenses in the future.
Further, the 2010 Health Care Reform
Legislation includes the Physician Payments Sunshine Act, which, in conjunction with its implementing regulations, requires manufacturers of certain drugs, biologics, and devices that are reimbursable by Medicare, Medicaid and the Childrens
Health Insurance Program to report certain payments or transfers of value provided to physicians and teaching hospitals and to report ownership and investment interests held by physicians and their immediate family members during the
preceding calendar year. The Centers for Medicare & Medicaid Services, or CMS, issued its final rule implementing the Physician Payments Sunshine Act in February 2013, and required data collection commenced as of August 1, 2013.
Manufacturers must report aggregated data for August through December of 2013 to CMS in the first quarter of 2014 and more detailed information regarding the specific payments and transfers of value in the second quarter of 2014. CMS will release
the data on a public website by September 30, 2014. The Company is in the process of complying with its obligations
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under the Physician Payments Sunshine Act. The failure to report appropriate data could subject us to significant financial penalties. Other countries and several states currently have similar
laws and more may enact similar legislation.
Regulations under the 2010 Health Care Reform Legislation have been, and are
expected to continue to be, drafted, released and finalized throughout the next several years. The full impact of the 2010 Health Care Reform Legislation, as well as laws and other reform measures that may be proposed and adopted in the future,
remains uncertain, but may continue the downward pressure on medical device pricing, especially under the Medicare program, and may also increase our regulatory burdens and operating costs, which could have a material adverse effect on our business
operations.
Finally, we are unable to predict what additional legislation or regulation, if any, relating to the health care
industry or third-party coverage and reimbursement may be enacted in the future or what effect such legislation or regulation would have on our business. Any cost containment measures or other health care system reforms that are adopted could have a
material and adverse effect on our ability to commercialize our existing and future products successfully.
Even if we receive
regulatory clearance or approval to market our products, the market may not be receptive to our products, which could undermine our financial viability.
Even if our products obtain regulatory clearance or approval, resulting products may not gain market acceptance among physicians, patients, health care payors and/or the medical community. To date, we
have experienced minimal sales of the AMID HFD stapler and SPIDER System and have not made any sales of the SurgiBot System or the Gastroplasty Device. We have decided to focus our efforts on the development of the SurgiBot System and decreased and,
in some cases, stopped, commercializing our cleared products. We believe that the degree of market acceptance of a commercialized product will depend on a number of factors, including:
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timing of market introduction of competitive products;
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safety and efficacy of our products;
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physician training in the use of our products;
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prevalence and severity of any side effects;
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potential advantages or disadvantages over alternative treatments;
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strength of marketing and distribution support; and
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price of our future products, both in absolute terms and relative to alternative treatments.
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If applicable, for products such as the Gastroplasty Device, availability of coverage and reimbursement from government and other
third-party payors can also impact the acceptance of our product offerings.
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If our products fail to achieve market acceptance, we may not be able to generate significant
revenue or achieve or sustain profitability.
There is significant uncertainty related to the third-party coverage and
reimbursement of newly cleared or approved medical devices. Normally, surgical devices are not directly covered; instead, the procedure using the device is subject to a coverage determination by the insurer. We believe that hospitals and ambulatory
surgery centers will be our direct customers for our product candidates, and that our revenue is not dependent upon the receipt of reimbursement codes or reimbursement coverage by payors. However, the commercial success of our existing and future
products in both domestic and international markets may depend in part on the availability of coverage and adequate reimbursement from third-party payors, including government payors, such as the Medicare and Medicaid programs, managed care
organizations and other third-party payors. Government and other third-party payors are increasingly attempting to contain health care costs by limiting both coverage and the level of reimbursement for new products and, as a result, they may not
cover or provide adequate payment for our existing and future products. These payors may conclude that our products are not as safe or effective as existing devices or that procedures using our devices are not as safe or effective as the existing
procedures using other devices. These payors may also conclude that the overall cost of the procedure using one of our devices exceeds the overall cost of the competing procedure using another type of device, and third-party payors may not approve
our products for coverage and adequate reimbursement. The failure to obtain coverage and adequate reimbursement for our existing and future products or health care cost containment initiatives that limit or restrict reimbursement for our existing
and future products may reduce any future product revenue.
If we fail to attract and retain key management and scientific personnel, we
may be unable to successfully develop or commercialize our products.
We will need to effectively manage our
managerial, operational, financial, development, marketing and other resources in order to successfully pursue our research, development and commercialization efforts for our existing and future products. Our success depends on our continued ability
to attract, retain and motivate highly qualified management and pre-clinical and clinical personnel. The loss of the services of any of our senior management, particularly Todd M. Pope, Richard M. Mueller and Joseph P. Slattery, could delay or
prevent the development or commercialization of our products. We do not maintain key man insurance policies on the lives of these individuals or the lives of any of our other employees. We employ these individuals on an at-will basis and
their employment can be terminated by us or them at any time, for any reason and with or without notice. We will need to hire additional personnel as we continue to expand our research and development activities and build a sales and marketing
organization.
We may not be able to attract or retain qualified management and scientific personnel in the future due to the
intense competition for qualified personnel among medical device and other businesses. If we are not able to attract and retain the necessary personnel to accomplish our business objectives, we may experience constraints that will impede
significantly the achievement of our research and development objectives, our ability to raise additional capital and our ability to implement our business strategy. In particular, if we lose any members of our senior management team, we may not be
able to find suitable replacements in a timely fashion or at all and our business may be harmed as a result.
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We have not sought an advisory stockholder vote to approve the compensation of our named executive
officers.
Rule 14a-21 under the Exchange Act requires us to seek a separate stockholder advisory vote at our annual
meeting at which directors are elected to approve the compensation of our named executive officers, not less frequently than once every three years (say-on-pay vote), and, at least once every six years, to seek a separate stockholder advisory vote
on the frequency with which we will submit advisory say-on-pay votes to our stockholders (say-on-frequency vote). In 2013, the year in which Rule 14a-21 became applicable to smaller reporting companies, we did not submit to our stockholders a
say-on-pay vote to approve an advisory resolution regarding our compensation program for our named executive officers, or a say-on-frequency vote. Consequently, the Board of Directors has not considered the outcome of our say-on-pay vote results
when determining future compensation policies and pay levels for our named executive officers. At our 2014 annual meeting of stockholders, we will be asking our stockholders to vote on a proposal to approve an advisory resolution regarding our
compensation program for our named executive officers, and presenting a separate say-on-frequency vote. Following such annual meeting, the Board will consider the outcome of our say-on-pay vote results when determining future compensation policies
and pay levels for our named executive officers, and will report on the results of the say-on-pay vote and the say-on-frequency vote as required by applicable SEC rules. In our Annual Report on Form 10-K, we disclosed that our disclosure controls
and procedures did not lead to our identification of the requirement to provide these advisory
say-on-pay
and say-on-frequency votes, and we adjusted our disclosure
controls and procedures processes accordingly.
Because our manufacturing capabilities are limited, we may rely on third parties to
manufacture and supply some of our products. An inability to find additional or alternate sources for these products could materially and adversely affect our financial condition and results of operations.
In 2013 we operated manufacturing facilities for production of the SPIDER System and maintained manufacturing facilities for the AMID HFD
product. In the future, we may choose to use a third-party manufacturer for our other products. In addition, certain of our SPIDER System product component parts come from third-party suppliers. If these manufacturing partners are unable to produce
our products or component parts in the amounts that we require, we may not be able to establish a contract and obtain a sufficient alternative supply from another supplier on a timely basis and in the quantities we require.
Our products require precise, high quality manufacturing. We and our contract manufacturers will be subject to ongoing periodic
unannounced inspection by the FDA and non-U.S. regulatory authorities to ensure strict compliance with QSR, current good manufacturing practices and other applicable government regulations and corresponding standards. If we or our
contract manufacturers fail to achieve and maintain high manufacturing standards in compliance with QSR, we may experience manufacturing errors resulting in patient injury or death, product recalls or withdrawals, delays or interruptions of
production or failures in product testing or delivery, delay or prevention of filing or approval of marketing applications for our products, cost overruns or other problems that could seriously harm our business.
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Any performance failure by us or on the part of our contract manufacturers could delay
product development or regulatory clearance or approval of our products, or commercialization of our products and future products, depriving us of potential product revenue and resulting in additional losses. In addition, our dependence on any third
party for manufacturing could adversely affect our future profit margins. Our ability to replace any then-existing manufacturer may be difficult because the number of potential manufacturers is limited and, in the case of Class III devices, the FDA
must approve any replacement manufacturer before manufacturing can begin. It may be difficult or impossible for us to identify and engage a replacement manufacturer on acceptable terms in a timely manner, or at all.
We may become subject to potential product liability claims, and we may be required to pay damages that exceed our insurance coverage.
Our business exposes us to potential product liability claims that are inherent in the design, testing, manufacture,
sale and distribution of our products and each of our product candidates that we are seeking to introduce to the market. Surgical medical devices involve significant risks of serious complications, including bleeding, nerve injury, paralysis,
infection, and even death. Any product liability claim brought against us, with or without merit, could result in the increase of our product liability insurance rates or in our inability to secure coverage in the future on commercially reasonable
terms, if at all. In addition, if our product liability insurance proves to be inadequate to pay a damage award, we may have to pay the excess of this award out of our cash reserves, which could significantly harm our financial condition. If
longer-term patient results and experience indicate that our products or any component of a product causes tissue damage, motor impairment or other adverse effects, we could be subject to significant liability. A product liability claim, even one
without merit, could harm our reputation in the industry, lead to significant legal fees, and result in the diversion of managements attention from managing our business.
We currently have a limited sales, marketing and distribution organization. If we are unable to develop our sales, marketing and distribution capability on our own or through collaborations with
marketing partners, we will not be successful in commercializing our products.
We currently have limited
marketing, sales and distribution capabilities, including a limited number of direct sales representatives. We intend to distribute our products through direct sales and independent contractor and distribution agreements with companies possessing
established sales and marketing operations in the medical device industry, but there can be no assurance that we will be successful. To the extent that we enter into co-promotion or other arrangements, our product revenue is likely to be lower than
if we directly market or sell our products. In addition, any revenue we receive will depend in whole or in part upon the efforts of such third parties, which may not be successful and are generally not within our control. If we are unable to enter
into such arrangements on acceptable terms or at all, we may not be able to successfully commercialize our products. If we are not successful in commercializing our existing and future products, either on our own or through collaborations with one
or more third parties, our future product revenue will suffer and we may incur significant additional losses.
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For our Gastroplasty Device, we rely on our license with Creighton, and any loss of our rights
under such license agreement, or failure to properly maintain or enforce the patent applications underlying such license agreement, could materially adversely affect our business prospects for the Gastroplasty Device.
The patents and patent applications in our patent portfolio related to the Gastroplasty Device are not owned by us, but are licensed from
Creighton University. Presently, we rely on such licensed technology for our Gastroplasty Device and relied on it in developing the SMART Dilator and bite blocks products and may license additional technology from other third parties in the future.
The Creighton Agreement gives us rights for the commercial exploitation of the patents resulting from the patent applications, subject to certain provisions of the license agreement. Failure to comply with these provisions could result in the loss
of our rights under the Creighton agreement. Our inability to rely on these patents and patent applications which are the basis of certain aspects of our Gastroplasty Device technology would have an adverse effect on our business.
Further, our success will depend in part on the ability of us, Creighton and other third-party licensors to obtain, maintain and enforce
patent protection for our licensed intellectual property and, in particular, those patents to which we have secured exclusive rights. We, Creighton or other third-party licensors may not successfully prosecute the patent applications which are
licensed to us, may fail to maintain these patents, may determine not to pursue litigation against other companies that are infringing these patents, or may pursue such litigation less aggressively than necessary to obtain an acceptable outcome from
any such litigation. Without protection for the intellectual property we have licensed, other companies might be able to offer substantially identical products for sale, which could materially adversely affect our competitive business position,
business prospects and results of operations.
If we or our licensors are unable to obtain and enforce patent protection for our
products, our business could be materially harmed.
Our success depends, in part, on our ability to protect
proprietary methods and technologies that we develop or license under the patent and other intellectual property laws of the United States and other countries, so that we can prevent others from unlawfully using our inventions and proprietary
information. However, we may not hold proprietary rights to some patents required for us to commercialize our proposed products. We have numerous patent applications that are in process. For example, with respect to the SPIDER System and the
SurgiBot System, we have two issued patents and we have filed over 30 patent applications in the United States and abroad. To our knowledge, none of the technology we have licensed has been patented in the U.S. Because certain U.S. patent
applications are confidential until patents issue, such as applications filed prior to November 29, 2000, or applications filed after such date which will not be filed in foreign countries, third parties may have filed patent applications for
technology covered by our pending patent applications without our being aware of those applications, and our patent applications may not have priority over those applications. For this and other reasons, we or our third-party collaborators may be
unable to secure desired patent
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rights, thereby losing desired exclusivity. If licenses are not available to us on acceptable terms, we will not be able to market the affected products or conduct the desired activities, unless
we challenge the validity, enforceability or infringement of the third-party patent or otherwise circumvent the third-party patent.
Our strategy depends on our ability to promptly identify and seek patent protection for our discoveries. In addition, we will rely on third-party collaborators to file patent applications relating to
proprietary technology that we develop jointly during certain collaborations. The process of obtaining patent protection is expensive and time-consuming. If our present or future collaborators fail to file and prosecute all necessary and desirable
patent applications at a reasonable cost and in a timely manner, our business will be adversely affected. Despite our efforts and the efforts of our collaborators to protect our proprietary rights, unauthorized parties may be able to develop and use
information that we regard as proprietary.
The issuance of a patent provides a presumption, but does not guarantee that it is
valid. Any patents we have obtained, or obtain in the future, may be challenged or potentially circumvented. Moreover, the United States Patent and Trademark Office (the USPTO) may commence interference proceedings involving our patents or patent
applications. Any such challenge to our patents or patent applications would be costly, would require significant time and attention of our management and could have a material adverse effect on our business. In addition, future court decisions may
introduce uncertainty in the enforceability or scope of any patent, including those owned by medical device companies.
Our
pending patent applications may not result in issued patents. The patent position of medical device companies, including ours, is generally uncertain and involves complex legal and factual considerations. The standards that the USPTO and its foreign
counterparts use to grant patents are not always applied predictably or uniformly and can change. There is also no uniform, worldwide policy regarding the subject matter and scope of claims granted or allowable in medical device patents.
Accordingly, we do not know the degree of future protection for our proprietary rights or the breadth of claims that will be allowed in any patents issued to us or to others. The legal systems of certain countries do not favor the aggressive
enforcement of patents, and the laws of foreign countries may not protect our rights to the same extent as the laws of the United States. Therefore, the enforceability or scope of our owned or licensed patents in the United States or in foreign
countries cannot be predicted with certainty, and, as a result, any patents that we own or license may not provide sufficient protection against competitors. We may not be able to obtain or maintain patent protection for our pending patent
applications, those we may file in the future, or those we may license from third parties, including Creighton.
We cannot
assure you that any patents that will issue, that may issue or that may be licensed to us will be enforceable or valid or will not expire prior to the commercialization of our products, thus allowing others to more effectively compete with us.
Therefore, any patents that we own or license may not adequately protect our future products.
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If we or our licensors are unable to protect the confidentiality of our proprietary information
and know-how, the value of our technology and products could be adversely affected.
In addition to patent protection,
we also rely on other proprietary rights, including protection of trade secrets, know-how and confidential and proprietary information. To maintain the confidentiality of trade secrets and proprietary information, we will seek to enter into
confidentiality agreements with our employees, consultants and collaborators upon the commencement of their relationships with us. These agreements generally require that all confidential information developed by the individual or made known to the
individual by us during the course of the individuals relationship with us be kept confidential and not disclosed to third parties. Our agreements with employees also generally provide and will generally provide that any inventions conceived
by the individual in the course of rendering services to us shall be our exclusive property. However, we may not obtain these agreements in all circumstances, and individuals with whom we have these agreements may not comply with their terms. In the
event of unauthorized use or disclosure of our trade secrets or proprietary information, these agreements, even if obtained, may not provide meaningful protection, particularly for our trade secrets or other confidential information. To the extent
that our employees, consultants or contractors use technology or know-how owned by third parties in their work for us, disputes may arise between us and those third parties as to the rights in related inventions. Adequate remedies may not exist in
the event of unauthorized use or disclosure of our confidential information. The disclosure of our trade secrets would impair our competitive position and may materially harm our business, financial condition and results of operations.
Our commercial success depends significantly on our ability to operate without infringing the patents and other proprietary rights of third
parties.
Other entities may have or obtain patents or proprietary rights that could limit our ability to manufacture,
use, sell, offer for sale or import products or impair our competitive position. In addition, to the extent that a third party develops new technology that covers our products, we may be required to obtain licenses to that technology, which licenses
may not be available or may not be available on commercially reasonable terms, if at all. If licenses are not available to us on acceptable terms, we will not be able to market the affected products or conduct the desired activities, unless we
challenge the validity, enforceability or infringement of the third-party patent or circumvent the third-party patent, which would be costly and would require significant time and attention of our management. Third parties may have or obtain valid
and enforceable patents or proprietary rights that could block us from developing products using our technology. Our failure to obtain a license to any technology that we require may materially harm our business, financial condition and results of
operations.
If we become involved in patent litigation or other proceedings related to a determination of rights, we could incur
substantial costs and expenses, substantial liability for damages or be required to stop our product development and commercialization efforts, any of which could materially adversely affect our liquidity, business prospects and results of
operations.
Third parties may sue us for infringing their patent rights. Likewise, we may need to resort to
litigation to enforce a patent issued or licensed to us or to determine the scope and validity of proprietary rights of others. In addition, a third party may claim that we have
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improperly obtained or used its confidential or proprietary information. Furthermore, in connection with our third-party license agreements, we generally have agreed to indemnify the licensor for
costs incurred in connection with litigation relating to intellectual property rights. The cost to us of any litigation or other proceeding relating to intellectual property rights, even if resolved in our favor, could be substantial, and the
litigation would divert our managements efforts. Some of our competitors may be able to sustain the costs of complex patent litigation more effectively than we can because they have substantially greater resources. Uncertainties resulting from
the initiation and continuation of any litigation could limit our ability to continue our operations.
If any parties
successfully claim that our creation or use of proprietary technologies infringes upon their intellectual property rights, we might be forced to pay damages, potentially including treble damages, if we are found to have willfully infringed on such
parties patent rights. In addition to any damages we might have to pay, a court could require us to stop the infringing activity or obtain a license. Any license required under any patent may not be made available on commercially acceptable
terms, if at all. In addition, such licenses are likely to be non-exclusive and, therefore, our competitors may have access to the same technology licensed to us. If we fail to obtain a required license and are unable to design around a patent, we
may be unable to effectively market some of our technology and products, which could limit our ability to generate revenues or achieve profitability and possibly prevent us from generating revenue sufficient to sustain our operations.
Our business may become subject to economic, political, regulatory and other risks associated with domestic and international operations.
Our business is subject to risks associated with conducting business domestically and internationally, in part due to
some of our suppliers being located outside the U.S. Accordingly, our future results could be harmed by a variety of factors, including:
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difficulties in compliance with U.S. and non-U.S. laws and regulations;
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changes in U.S. and non-U.S. regulations and customs;
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changes in non-U.S. currency exchange rates and currency controls;
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changes in a specific countrys or regions political or economic environment;
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trade protection measures, import or export licensing requirements or other restrictive actions by U.S. or non-U.S. governments;
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negative consequences from changes in tax laws; and
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difficulties associated with staffing and managing foreign operations, including differing labor relations.
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We may be required to recognize impairment charges for our goodwill and other intangible assets.
As of December 31, 2013, the net carrying value of our goodwill and other intangible assets totaled
approximately $93.8 million. In accordance with generally accepted accounting principles, we periodically assess these assets to determine if they are impaired. Significant negative industry or economic trends, disruptions to our business, inability
to effectively integrate acquired businesses, unexpected significant changes or planned changes in use of the assets, divestitures and market capitalization declines may impair our goodwill and other intangible assets. Any charges relating to such
impairments would adversely affect our results of operations in the periods recognized.
In connection with the Merger, we entered into
a voting and lock-up agreement with certain of our stockholders pursuant to which such stockholders agreed to vote to approve certain corporate actions following the Merger.
In connection with the Merger Agreement and the Private Placement, the Investors and a majority of SafeStitchs and TransEnterix
Surgicals former stockholders, including the largest stockholders of each of SafeStitch and TransEnterix Surgical prior to the Merger comprising, in the aggregate, 93% of our stock on the effective date of the Merger, and members of our Board
of Directors, agreed to enter into lock-up and voting agreements (each, a Voting Agreement), pursuant to which such persons agreed, subject to certain exceptions, not to sell, transfer or otherwise convey any of the Companys securities held by
them (collectively, Covered Securities) for one year following the Merger closing date. The Voting Agreements provide that such persons may sell, transfer or convey: (i) up to 50% of their respective Covered Securities during the period
commencing on the one-year anniversary of the Merger closing date and ending on the eighteen-month anniversary of the Merger closing date; and (ii) up to an aggregate of 75% of their respective Covered Securities during the period commencing on
the eighteen-month anniversary of the Merger closing date and ending on the two-year anniversary of the Merger closing date. The restrictions on transfer contained in the Voting Agreements cease to apply to the Covered Securities following the
second anniversary of the Merger closing date.
Additionally, pursuant to the Voting Agreements, each Investor party thereto
has agreed, for the period commencing on the Merger closing date and ending on the one-year anniversary of the Merger closing date, to vote all of such persons Covered Securities in favor of: (i) amending the Companys Amended and
Restated Certificate of Incorporation to change the legal name of the Company to TransEnterix, Inc.; (ii) effecting a reverse stock split of the common stock on terms approved by the Companys Board of Directors; and
(iii) amending the Companys 2007 Incentive Compensation Plan in order to increase the number of shares of common stock available for issuance thereunder. Each of these identified events were approved by majority consent of our
stockholders prior to the filing of this prospectus.
The Voting Agreement had the effect of securing the approval, by a
majority of our stockholders, of the designated corporate actions. The corporate actions described in (i) and (iii) above were approved by stockholders and effected on December 6, 2013. The corporate action described in
(ii) above was approved by a majority of our stockholders on February 12, 2014. Therefore, all voting requirements under the Voting Agreement have been completed. The
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Voting Agreement continues to limit the ability of our principal stockholders to transfer shares of our common stock for a significant period after the Merger consummation. These limitations may
add to the low volume of shares of our common stock that trade on the OTCBB during the time period described.
Risks Related
to Offerings under this Prospectus and our Common Stock
The market price of our common stock has been, and may continue to be,
highly volatile, and such volatility could cause the market price of our common stock to decrease and could cause you to lose some or all of your investment in our common stock.
During the two years ended December 31, 2013, the market price of our common stock fluctuated from a high of $1.78 per share to a
low of $0.21 per share, and our stock price continues to fluctuate. The market price of our common stock may continue to fluctuate significantly in response to numerous factors, some of which are beyond our control, such as:
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the announcement of new products or product enhancements by us or our competitors;
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developments concerning intellectual property rights and regulatory approvals;
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variations in our and our competitors results of operations;
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changes in earnings estimates or recommendations by securities analysts, if our common stock is covered by analysts;
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developments in the medical device industry;
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the results of product liability or intellectual property lawsuits;
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future issuances of common stock or other securities;
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the addition or departure of key personnel;
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announcements by us or our competitors of acquisitions, investments or strategic alliances; and
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general market conditions and other factors, including factors unrelated to our operating performance.
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Further, the stock market in general, and the market for medical device companies in particular, has recently experienced extreme price
and volume fluctuations. The volatility of our common stock is further exacerbated due to its low trading volume. Continued market fluctuations could result in extreme volatility in the price of our common stock, which could cause a decline in the
value of our common stock and the loss of some or all of your investment.
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We intend to effect a reverse stock split of our common stock, which could result in increased
volatility in the price and trading volume of our common stock and cause a decline in the value of our common stock.
On February 12, 2014, the holders of approximately 66% of our voting securities authorized a Certificate of Amendment to the
Companys Amended and Restated Certificate of Incorporation to effect a reverse stock split in the rage of one-for-two to one-for-ten, with the actual ratio to be determined by the Board of Directors in its sole discretion, within such range.
The Company does not currently know the final ratio that will be selected. The proposed reverse stock split is contemplated in connection with our pending application to list our common stock for trading on the NYSE MKT. The Company believes that it
meets the objective criteria necessary for listing on the NYSE MKT.
While there will not be any change in a
stockholders economic interest in the Company as a result of such a reverse stock split, stockholders may not view such a reverse stock split in a favorable manner. If such a reverse stock split is not viewed favorably by stockholders, this
could result in increased volatility in the price and trading volume of our common stock, which could also cause a decline in the value of our common stock. There can be no assurance that the per share market price of our common stock following the
reverse stock split will increase and be maintained in proportion to the reduction in the number of shares of our common stock outstanding before the reverse stock split.
While the Board of Directors believes that a higher stock price per share, and a lower number of outstanding shares may help generate investor interest, there can be no assurance that the reverse stock
split will result in a per-share price that will attract institutional investors or investment funds or that such share price will satisfy the investing guidelines of institutional investors or investment funds. As a result, the trading liquidity of
our common stock may not necessarily improve.
Trading of our common stock is limited, and trading restrictions imposed on us by
applicable regulations may further reduce trading in our common stock, making it difficult for our stockholders to sell their shares; and future sales of common stock could reduce our stock price.
Trading of our common stock is currently conducted on the OTCBB. The liquidity of our common stock is limited, not only in terms of the
number of shares that can be bought and sold at a given price, but also as it may be adversely affected by delays in the timing of transactions and reduction in security analysts and the medias coverage of us, if at all. As of
immediately following the consummation of the Merger and the Private Placement, approximately 65% of the issued and outstanding shares of our common stock were held by officers, directors and beneficial owners of at least 10% of our outstanding
shares. These holders are subject to certain restrictions, including transfer restrictions set forth in the Voting Agreement, and restrictions imposed by the Securities Act with regard to trading our common stock. These factors may result in
different prices for our common stock than might otherwise be obtained in a more liquid market and could also result in a larger spread between the bid and asked prices for our common stock. In addition, without a large public float, our common
stock is less liquid than the stock of companies with broader public ownership, and, as a result, the trading prices of our common
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stock may be more volatile. In the absence of an active public trading market, an investor may be unable to liquidate his investment in our common stock. Trading of a relatively small volume of
our common stock may have a greater impact on the trading price of our stock than would be the case if our public float were larger. We cannot predict the prices at which our common stock will trade in the future, if at all.
Sales by stockholders of substantial amounts of our shares of common stock, the issuance of new shares of common stock by us or the
perception that these sales may occur in the future could materially and adversely affect the market price of our common stock, and you may lose all or a portion of your investment in our common stock.
Because our common stock may be a penny stock, it may be more difficult for investors to sell shares of our common stock, and the
market price of our common stock may be adversely affected.
Our common stock may be a penny stock if,
among other things, the stock price is below $5.00 per share, it is not listed on a national securities exchange or approved for quotation on the Nasdaq Stock Market or any other national stock exchange or it has not met certain net tangible asset
or average revenue requirements. Broker-dealers who sell penny stocks must provide purchasers of these stocks with a standardized risk-disclosure document prepared by the SEC. This risk-disclosure document provides information about penny stocks and
the nature and level of risks involved in investing in the penny-stock market. A broker must also give a purchaser, orally or in writing, bid and offer quotations and information regarding broker and salesperson compensation, make a written
determination that the penny stock is a suitable investment for the purchaser and obtain the purchasers written agreement to the purchase. Broker-dealers must also provide customers that hold penny stock in their accounts with such
broker-dealer a monthly statement containing price and market information relating to the penny stock. If a penny stock is sold to an investor in violation of the penny stock rules, the investor may be able to cancel its purchase and get its money
back.
If applicable, the penny stock rules may make it difficult for investors to sell their shares of our common stock.
Because of the rules and restrictions applicable to a penny stock, there is less trading in penny stocks and the market price of our common stock may be adversely affected. Also, many brokers choose not to participate in penny stock transactions.
Accordingly, investors may not always be able to resell their shares of our common stock publicly at times and prices that they feel are appropriate.
Directors, executive officers, principal stockholders and affiliated entities own a significant percentage of our capital stock, and they may make decisions that you do not consider to be in the
best interests of our stockholders.
Our directors, executive officers, principal stockholders and affiliated entities
beneficially owned, in the aggregate, approximately 65% of our outstanding voting securities as of immediately following the consummation of the Merger and the Private Placement financing, and continue to hold such beneficial ownership. As a result,
if some or all of them acted together, they would have the ability to exert substantial influence over the election of our Board of Directors and the outcome of issues requiring approval by our stockholders. This
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concentration of ownership may also have the effect of delaying or preventing a change in control of the Company that may be favored by other stockholders. This could prevent transactions in
which stockholders might otherwise recover a premium for their shares over current market prices.
Our management will have broad
discretion as to the use of the proceeds of offerings under this prospectus.
We have not designated the amount of net
proceeds we will receive from an offering under this prospectus for any particular purpose. Accordingly, our management will have broad discretion as to the application of net proceeds. Our stockholders may not agree with the manner in which our
management chooses to allocate and spend the net proceeds.
We may issue preferred stock in the future, and the terms of the preferred
stock may reduce the value of our common stock.
We are authorized to issue shares of preferred stock in one or more
series. Our Board of Directors may determine the terms of future preferred stock offerings without further action by our stockholders. If we issue preferred stock, it could affect your rights or reduce the value of our outstanding common stock. In
particular, specific rights granted to future holders of preferred stock may include voting rights, preferences as to dividends and liquidation, conversion and redemption rights, sinking fund provisions, and restrictions on our ability to merge with
or sell our assets to a third party.
We do not expect to pay any cash dividends on our common stock.
We have not declared or paid any cash dividends on our common stock or other securities, and we currently do not anticipate paying any
cash dividends in the foreseeable future. Because we do not anticipate paying cash dividends for the foreseeable future, our stockholders will not realize a return on their investment in our common stock except to the extent of any appreciation in
the value of our common stock. Our common stock may not appreciate in value, or may decline in value.