Apollo Endosurgery (APEN) 10-K 18 Mar 19 2018 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2018	Feb. 28, 2019	Jun. 29, 2018
Document and Entity Information [Abstract]
Entity Registrant Name	Apollo Endosurgery, Inc.
Entity Central Index Key	0001251769
Document Type	10-K
Document Period End Date	Dec. 31, 2018
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Public Float			$ 98,996,893
Entity Common Stock, Shares Outstanding		21,913,243
Document Fiscal Year Focus	2018
Document Fiscal Period Focus	FY

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Current assets:
Cash and cash equivalents	$ 23,996	$ 30,513
Accounts receivable, net of allowance for doubtful accounts of $559 and $452, respectively	11,391	11,729
Inventory, net	9,932	14,343
Prepaid expenses and other current assets	2,801	1,015
Total current assets	48,120	57,600
Restricted cash	1,011	905
Property and equipment, net of accumulated depreciation of $6,692 and $6,658, respectively	5,897	6,885
Goodwill	5,290	6,828
Intangible assets, net of accumulated amortization of $9,455 and $28,415, respectively	9,859	36,421
Other assets	4,291	422
Total assets	74,468	109,061
Current liabilities:
Accounts payable	15,292	18,327
Accrued expenses	9,156	7,500
Total current liabilities	24,448	25,827
Long-term debt	21,190	33,321
Total liabilities	45,638	59,148
Commitments and contingencies
Stockholders' equity:
Common stock; $0.001 par value; 100,000,000 shares authorized; 21,899,522 and 17,291,209 shares issued and outstanding at December 31, 2018 and 2017, respectively	22	17
Additional paid-in capital	249,115	225,122
Accumulated other comprehensive income	2,501	1,795
Accumulated deficit	(222,808)	(177,021)
Total stockholders' equity	28,830	49,913
Total liabilities and stockholders' equity	$ 74,468	$ 109,061

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 559	$ 452
Accumulated depreciation, property and equipment	6,692	6,658
Accumulated amortization, intangible assets	$ 9,455	$ 28,415
Common stock, par value (USD per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, shares issued (in shares)	21,899,522	17,291,209
Common stock, shares outstanding (in shares)	21,899,522	17,291,209

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Income Statement [Abstract]
Revenues	$ 60,854	$ 64,310
Cost of sales	27,660	24,578
Gross margin	33,194	39,732
Operating expenses:
Sales and marketing	32,831	32,910
General and administrative	13,436	13,722
Research and development	12,176	8,299
Loss on divestiture	7,770	0
Amortization of intangible assets	7,074	7,240
Total operating expenses	73,287	62,171
Loss from operations	(40,093)	(22,439)
Other expenses:
Interest expense, net	4,063	4,508
Other expense	1,440	41
Net loss before income taxes	(45,596)	(26,988)
Income tax expense	191	304
Net loss	(45,787)	(27,292)
Other comprehensive income:
Foreign currency translation	706	324
Comprehensive loss	$ (45,081)	$ (26,968)
Net loss per share, basic and diluted (USD per share)	$ (2.31)	$ (2.01)
Shares used in computing net loss per share, basic and diluted (shares)	19,789,867	13,565,781

Consolidated Statements of Chan

Consolidated Statements of Changes in Stockholders’ Equity - USD ($) $ in Thousands	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Accumulated Other Comprehensive Income (Loss) [Member]	Accumulated Deficit [Member]
Beginning balance, shares at Dec. 31, 2016		10,688,992
Beginning balance at Dec. 31, 2016	$ 42,417	$ 11	$ 190,664	$ 1,471	$ (149,729)
Stockholders' Equity:
Exercise of common stock options, shares		59,764
Exercise of common stock options	119		119
Issuance of common stock, shares		6,542,453
Issuance of common stock	33,584	$ 6	33,578
Stock based compensation	761		761
Foreign currency translation	324			324
Net loss	(27,292)				(27,292)
Ending balance at Dec. 31, 2017	$ 49,913	$ 17	225,122	1,795	(177,021)
Ending balance, shares at Dec. 31, 2017	17,291,209	17,291,209
Stockholders' Equity:
Exercise of common stock options, shares		275,862
Exercise of common stock options	$ 738		738
Issuance of restricted stock units, shares		23,361
Issuance of common stock, shares		4,309,090
Issuance of common stock	21,857	$ 5	21,852
Stock based compensation	1,403		1,403
Foreign currency translation	706			706
Net loss	(45,787)				(45,787)
Ending balance at Dec. 31, 2018	$ 28,830	$ 22	$ 249,115	$ 2,501	$ (222,808)
Ending balance, shares at Dec. 31, 2018	21,899,522	21,899,522

Consolidated Statements of Ch_2

Consolidated Statements of Changes in Stockholders’ Equity (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Statement of Stockholders' Equity [Abstract]
Stock issuance costs	$ 1,843	$ 2,400

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Cash flows from operating activities:
Net loss	$ (45,787)	$ (27,292)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	9,292	9,717
Amortization of deferred financing costs	491	299
Non-cash interest expense	359	595
Provision for doubtful accounts receivable	186	180
Change in inventory reserve	387	692
Stock based compensation	1,403	761
Foreign exchange on short-term intercompany loans	1,161	(193)
Loss on divestiture	7,770	0
Changes in operating assets and liabilities:
Accounts receivable	(162)	(916)
Inventory	3,004	(2,850)
Prepaid expenses and other assets	41	948
Accounts payable and accrued expenses	(1,264)	4,739
Net cash used in operating activities	(23,119)	(13,320)
Cash flows from investing activities:
Purchases of property and equipment	(1,951)	(1,564)
Purchases of intangibles and other assets	(930)	(573)
Divestiture of Surgical product line	10,000	0
Net cash provided by/(used in) investing activities	7,119	(2,137)
Cash flows from financing activities:
Proceeds from exercise of stock options	738	119
Proceeds from issuance of common stock	21,857	33,584
Payments of deferred financing costs	(400)	0
Payment of debt	(12,500)	(7,000)
Net cash provided by financing activities	9,695	26,703
Effect of exchange rate changes on cash	(106)	131
Net increase (decrease) in cash, cash equivalents and restricted cash	(6,411)	11,377
Cash, cash equivalents and restricted cash at beginning of year	31,418	20,041
Cash, cash equivalents and restricted cash at end of year	25,007	31,418
Supplemental disclosure of cash flow information:
Cash paid for interest	3,775	3,775
Cash paid for income taxes	$ 98	$ 274

Organization and Business Descr

Organization and Business Description	12 Months Ended
	Dec. 31, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Business Description	Organization and Business Description Apollo Endosurgery, Inc. is a Delaware corporation with both domestic and foreign wholly-owned subsidiaries. Throughout these Notes "Apollo" and the "Company" refer to Apollo Endosurgery, Inc. and its consolidated subsidiaries. Apollo is a medical technology company primarily focused on the design, development, and commercialization of innovative medical devices. The Company's products are used by gastroenterologists and surgeons in a variety of settings to provide interventional therapy to patients who suffer from various gastrointestinal conditions including obesity and the many co-morbidities associated with obesity. The Company's core products include the OverStitch ™ Endoscopic Suturing System, the Orbera® Intragastric Balloon System, which together comprise the Company's Endo-bariatric products and the recently divested Lap-Band® adjustable gastric banding system ("Surgical" products). In the U.S., the Company offers Orbera® Coach, a digital and remotely delivered aftercare program. All devices are regulated by the U.S. Food and Drug Administration (the "FDA") or an equivalent regulatory body outside the U.S. The Company's products are sold throughout the world with direct sales markets in the U.S., Europe, Australia, Brazil and Canada. The Company also has a manufacturing facility located in Costa Rica. In December 2018, the Company completed an asset sale with ReShape Lifesciences, Inc ("ReShape") in which ReShape acquired substantially all of the assets exclusively related to the Surgical product line for $10,000 in cash at closing and future cash consideration. As additional consideration, the Company received from ReShape substantially all of ReShape's assets exclusively related to ReShape's intragastric balloon product line. Effective December 31, 2018, the Company ceased sales of ReShape's intragastric balloon system.

Significant Accounting Policies

Significant Accounting Policies	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Significant Accounting Policies	Significant Accounting Policies (a) Principles of Consolidation The consolidated financial statements include the accounts of the Company and all of its wholly-owned subsidiaries. All significant intercompany accounts and transactions have been eliminated. (b) Use of Estimates The preparation of consolidated financial statements in conformity with accounting principles generally accepted in the U.S. ("U.S. GAAP") requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting periods. Actual results are likely to differ from those estimates, and such differences may be material to the consolidated financial statements. Significant items subject to such estimates and assumptions include revenue recognition, going concern, financial projections, useful lives of intangibles and long-lived assets, stock compensation, deferred tax asset valuation, long-lived asset and goodwill impairment, allowance for doubtful accounts, and valuation of inventory. (c) Cash and Cash Equivalents The Company considers all highly liquid investments with a remaining maturity at date of purchase of three months or less to be cash equivalents. (d) Restricted Cash The Company entered into irrevocable letters of credit with three banks to secure obligations under lease agreements and performance based obligations. These letters of credit are secured by cash balances totaling $1,011 and $905 which are recorded in restricted cash on the balance sheet as of December 31, 2018 and 2017, respectively. (e) Accounts Receivable The Company generally extends credit to certain customers without requiring collateral. The Company provides an allowance for doubtful accounts based on management's evaluation of the collectability of accounts receivable. Accounts receivable are written off when it is determined amounts are uncollectible. The recorded allowance for doubtful accounts was $559 and $452 as of December 31, 2018 and 2017, respectively. Accounts receivable of $101 and $238 were written off during the years ended December 31, 2018 and 2017, respectively. (f) Inventory Inventory is stated at the lower of cost or net realizable value, net of any allowances. Charges for excess and obsolete inventory are based on specific identification of obsolete inventory items and an analysis of inventory items approaching expiration date. We record estimated excess and obsolescence charges to cost of sales. The Company's inventories are stated using the weighted average cost approach, which approximates actual costs. (g) Fair Value Measurements The carrying amounts of the Company's financial instruments, which primarily include cash and cash equivalents, accounts receivable, accounts payable and accrued expenses, approximate their fair values due to their short maturities. The fair value of the Company's long-term debt is estimated by management to approximate $21,935 at December 31, 2018 and $33,158 at December 31, 2017. Management's estimates are based on comparisons of the characteristics of the Company's obligations, comparable ranges of interest rates on recently issued debt, and maturity. Such valuation inputs are considered a Level 3 measurement in the fair value valuation hierarchy. The accounting guidance defines fair value, establishes a consistent framework for measuring fair value and expands disclosure for each major asset and liability category measured at fair value on either a recurring or nonrecurring basis. Fair value is defined as an exit price, representing the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. As such, fair value is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or liability. As a basis for considering such assumptions, the accounting guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows: Level 1: Observable inputs such as quoted prices in active markets; Level 2: Inputs, other than the quoted prices in active markets, that are observable either directly or indirectly; and Level 3: Unobservable inputs in which there is little or no market data, which require the reporting entity to develop its own assumptions. (h) Property and Equipment Property and equipment are carried at cost less accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the related assets, except for leasehold improvements, which are depreciated straight-line over the shorter of the estimated useful life or the life of the lease. Major renewals and betterments are capitalized. Validation costs (including materials and labor) that are required to bring machinery to working condition are capitalized. Expenditures for repairs and maintenance and minor replacements are charged to expense as incurred. (i) Purchase Accounting Business combinations must be evaluated to determine whether it meets the definition of a business or will be accounted for as an asset acquisition. A business consists of inputs and processes that have the ability to create outputs and are accounted for using the acquisition method of accounting. Using this method, the assets acquired and liabilities assumed are recorded at their fair value with any excess going to goodwill. When a business combination is considered an asset acquisition, the cost accumulation approach is used and the total consideration is allocated to the assets acquired and liabilities assumed on a relative fair value basis. (j) Goodwill and Other Intangible Assets Goodwill is not amortized but is tested annually for impairment or more frequently if impairment indicators exist. For annual and interim goodwill impairment tests, the Company first assesses qualitative factors before performing a quantitative assessment of the fair value of a reporting unit. If it is determined on the basis of qualitative factors that the fair value of the reporting unit is more likely than not less than the carrying amount, a quantitative impairment test is required. The Company's evaluation of goodwill completed on December 31, 2018 and 2017 resulted in no impairment losses. Definite-lived intangible assets consist of customer relationships, product technology, trade names, patents and trademarks and capitalized software which are amortized over their estimated useful lives. Costs to extend the lives of and renew patents and trademarks are capitalized when incurred. (k) Valuation of Long-Lived Assets Long-lived assets, including definite-lived intangible assets, are monitored and reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of any such asset may not be recoverable. The determination of recoverability is based on an estimate of undiscounted cash flows expected to result from the use of an asset and its eventual disposition. The estimate of undiscounted cash flows is based upon, among other things, certain assumptions about expected future operating performance. The Company's estimates of undiscounted cash flows may differ from actual cash flows. If the sum of the undiscounted cash flows is less than the carrying value of the asset, an impairment charge is recognized, measured as the amount by which the carrying value exceeds the fair value of the asset. The Company's evaluation of long-lived assets for the years ended December 31, 2018 and 2017 resulted in no impairment losses. (l) Revenue Recognition The Company's principal source of revenues is from the sale of its products. Revenue is recognized when control of the promised goods is transferred to our customers, in an amount that reflects the consideration we expect to be entitled to in an exchange or those goods. Generally, these are met under the Company's agreements with most customers upon product shipment. This includes sales to distributors, who sell the products to their customers, take title to the products and assume all risks of ownership at the time of shipment. Our distributors are obligated to pay within specified terms regardless of when, if ever, they sell the products. Customers and distributors generally have the right to return or exchange products purchased from the Company for up to thirty days from the date of product shipment. At the end of each period, the Company determines the extent to which its revenues need to be reduced to account for expected returns and exchanges. Certain customer may receive volume rebates or discounts, which are accounted for as variable consideration. We estimate these amounts based on the expected amount to be provided to customers and reduce revenues recognized. We record deferred revenues when cash payments are received in advance of the transfer of goods. The Company accounts for taxes collected from customers and remitted to governmental authorities on a net basis. Accordingly, such amounts are excluded from revenues. Amounts billed to customers related to shipping and handling are included in revenues. Shipping and handling costs related to revenue producing activities are included in cost of sales. (m) Research and Development Research and development costs are expensed as incurred. (n) Stock-based Compensation Plans The Company recognizes compensation costs for all stock-based awards based upon each award's estimated fair value as determined on the date of grant. The Company utilizes the Black-Scholes option-pricing model to determine the fair value of stock option awards. Compensation cost is recognized on a straight-line basis over the respective vesting period of the award. Adjustments for actual forfeitures are made in the period which they occur. (o) Advertising The Company expenses advertising costs as incurred. The Company incurred approximately $3,024 and $3,295 in advertising costs during the years ended December 31, 2018 and 2017, respectively. (p) Income Taxes The Company accounts for deferred income taxes using the asset and liability method. Under this method, deferred income taxes arise from temporary differences between the tax basis of assets and liabilities and their reported amounts in the financial statements, which will result in taxable or deductible amounts in the future. Temporary differences are then measured using the enacted tax rates and laws. Valuation allowances are established, when necessary, to reduce deferred tax assets to the amount that is more-likely than-not to be realized. Determining the appropriate amount of valuation allowance requires management to exercise judgment about future operations. In the ordinary course of business, there are many transactions for which the ultimate tax outcome is uncertain. The Company regularly assesses uncertain tax positions in each of the tax jurisdictions in which it has operations and accounts for the related consolidated financial statement implications. The amount of unrecognized tax benefits is adjusted when information becomes available or when an event occurs indicating a change is appropriate. The Company includes interest and penalties related to its uncertain tax positions as part of income tax expense. (q) Medical Device Excise Tax Effective as of January 1, 2013, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Affordability Reconciliation Act, imposed a medical device excise tax (MDET) of 2.3% on any entity that manufactures or imports certain medical devices offered for sale in the U.S. In December 2015, the medical device tax was suspended for two years and on January 22, 2018 the moratorium on this tax was extended through December 31, 2019. (r) Foreign Currency The Company is exposed to foreign currency exchange risk as foreign subsidiaries generally operate and utilize functional currencies in local currencies other than the U.S. Dollar, which is the Company's reporting currency. The Company translates foreign assets and liabilities at exchange rates in effect at the balance sheet dates, and the revenues and expenses using average rates during the year. The resulting foreign currency translation adjustments are recorded as a separate component of accumulated other comprehensive income in the accompanying consolidated balance sheets. The Company does not hedge foreign currency translation risk in the net assets and income it reports from these sources. Exchange rate fluctuations on short-term intercompany loans are included in other expense in the consolidated statement of operations and comprehensive loss. (s) Recent Accounting Pronouncements On January 1, 2018, the Company adopted the provisions of ASU 2014-09, Revenue from Contracts with Customers ("ASC 606"), which requires an entity to recognize revenue when it transfers control of promised goods or services to customers in an amount that reflects the consideration to which it expects to be entitled in exchange for those goods or services. The Company adopted this new standard using the modified retrospective method and applied this method only to contracts that were not completed as of January 1, 2018. Prior periods were not retrospectively adjusted. There was no material impact on the Company's financial statement upon adoption of the new revenue recognition standard. On January 1, 2018, the Company adopted the provisions of ASU 2017-01, Business Combinations: Clarifying the Definition of a Business ("ASU 2017-01") to clarify the definition of a business when evaluating whether transactions should be accounted for as acquisitions (or disposals) of assets or businesses. On January 1, 2019, the Company adopted the provisions of ASU 2016-02, Leases ("ASU 2016-02") which requires a lessee to recognize assets and liabilities for leases with a maximum possible term of more than 12 months. Upon adoption, the Company used the modified retrospective approach and chose not to adjust comparative periods. The Company elected the package of practical expedients permitted under the transition guidance within the new standard, which among other things, allowed us to carry forward the historical lease classification. The Company recognized a liability to make lease payments (the lease liability) and a right-of-use asset representing its right to use the leased asset (the underlying asset) for the lease term of $2,669 on the balance sheet, thereby increasing reported assets and liabilities. The cumulative-effect adjustment made to the opening balance of retained earnings as of January 1, 2019 did not have a material impact on the Company's financial statements. The income statement recognition of lease expense is similar to the Company's current methodology. In January 2017, the FASB issued ASU 2017-04, Intangibles - Goodwill and Other: Simplifying the Test for Goodwill Impairment (“ASU 2017-04”) to simplify the accounting for goodwill impairment. The guidance removes step two of the goodwill impairment test, which requires a hypothetical purchase price allocation. A goodwill impairment will now be the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the carrying amount of goodwill. Entities will continue to have the option to perform a qualitative assessment to determine if a quantitative impairment test is necessary.

Divestiture of Surgical Product

Divestiture of Surgical Product Line	12 Months Ended
	Dec. 31, 2018
Discontinued Operations and Disposal Groups [Abstract]
Divestiture of Surgical Product Line	Divestiture of Surgical Product Line On December 17, 2018, the Company entered into an Asset Purchase Agreement ("Purchase Agreement") with ReShape pursuant to which, ReShape acquired substantially all of the Company's assets exclusively related to our Surgical product line for $10,000 at the closing of the transaction and future payments of an additional $2,000 on each of the first and second anniversary of the closing date and $3,000 on the third anniversary of the closing date. As additional consideration, Apollo received ReShape's assets exclusively related to their intragastric balloon product. Legal fees associated with the divestiture were $498 and are also included in loss on divestiture. The $7,000 receivable from Reshape was discounted at 10% in order to determine the fair value for the consideration received. The current portion of this receivable is included in other current assets on the balance sheet with the long-term portion included in other assets. A summary of the consideration received from Reshape for the divestiture and the related Surgical assets that were divested is included below: Consideration received Cash $ 10,000 Receivable 5,725 Inventory 102 Intangible assets 1,781 Total consideration 17,608 Less: Assets divested Inventory (873) Property and equipment, net of accumulated depreciation (478) Intangible assets, net of accumulated amortization (21,186) Patents and trademarks, net of accumulated amortization (805) Goodwill (1,538) Total assets divested (24,880) Legal fees associated with divestiture (498) Loss on divestiture $ (7,770) The assets acquired from ReShape were accounted for as an asset acquisition. The Surgical product line was deemed to be a business, and thus goodwill was allocated to the Surgical product line and included in assets divested. Apollo and ReShape each made customary representations, warranties, covenants and indemnities in the Purchase Agreement. Subject to certain limitations, each party agreed to indemnify the other party for certain matters, including breaches of representations, warranties and covenants in the Purchase Agreement. The execution of the Purchase Agreement and the closing of the transaction occurred simultaneously on December 17, 2018. ReShape also granted the Company a security interest in substantially all of ReShape’s assets as security for the payment and performance when due of all of ReShape’s obligations under the Purchase Agreement, including the obligation to pay its remaining cash purchase price. In addition, the parties entered into a transition services agreement, supply agreement and distribution agreement pursuant to which, among other things, the Company will manufacture the Surgical product for ReShape for up to two one

Concentrations

Concentrations	12 Months Ended
	Dec. 31, 2018
Risks and Uncertainties [Abstract]
Concentrations	Concentrations Consolidated financial instruments that potentially subject the Company to a concentration of credit risk principally consist of cash and cash equivalents and accounts receivable. At December 31, 2018, the Company's cash and cash equivalents and restricted cash are held in deposit accounts at three different banks totaling $25,007. The Company has not experienced any losses in such accounts, and management does not believe the Company is exposed to any significant credit risk. Management further believes that the concentration of credit risk in the Company's accounts receivable is substantially mitigated by the Company's evaluation process, relatively short collection terms, and the high level of creditworthiness of its customers. The Company continually evaluates the status of each of its customers, but generally requires no collateral. The Company had no customers that comprised a concentration greater than 10% of the Company's total accounts receivable or revenues as of or for the years ended December 31, 2018 and 2017.

Inventory

Inventory	12 Months Ended
	Dec. 31, 2018
Inventory Disclosure [Abstract]
Inventory	Inventory Inventory consists of the following as of December 31: 2018 2017 Raw materials $ 3,806 $ 3,764 Work in progress 352 493 Finished goods 5,774 10,086 Total inventory $ 9,932 $ 14,343 The Company recorded an inventory impairment charge of $387 and $692 and for the year ended December 31, 2018 and 2017, respectively. For the year ended December 31, 2018, the Company disposed of $1,419 of expired product which was fully reserved. Finished goods included $328 of consigned inventory at December 31, 2018.

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2018
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consists of the following as of December 31: Depreciable Lives 2018 2017 Equipment 5 years $ 7,510 $ 5,501 Furniture, fixtures and tooling 4 - 8 years 2,223 3,524 Computer hardware 3 - 5 years 1,326 1,223 Leasehold improvements 3 - 5 years 1,400 1,424 Construction in process 130 1,871 12,589 13,543 Less accumulated depreciation (6,692) (6,658) Property and equipment, net $ 5,897 $ 6,885 The Company recorded depreciation expense of $2,024 and $2,250 for the years ended December 31, 2018 and 2017, respectively. There were no impairment charges for the years ended December 31, 2018 or 2017. The Company disposed of $1,861 of gross property and equipment with accumulated depreciation of $1,383 related to the disposition of the Surgical product line (see Note 3) and also disposed of $608 which was fully depreciated as of December 31, 2018 and no longer being utilized by the Company.

Goodwill and Other Intangible A

Goodwill and Other Intangible Assets	12 Months Ended
	Dec. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Other Intangible Assets	Goodwill and Other Intangible Assets The following table reflects the changes in goodwill for the years ended December 31, 2018 and 2017: December 31, 2016 $ 6,828 December 31, 2017 $ 6,828 Goodwill associated with divestiture of Surgical product line (see Note 3) (1,538) December 31, 2018 $ 5,290 Other intangible assets consist of the following as of December 31: Useful Life 2018 2017 Customer relationships 9 years $ 8,301 $ 30,300 Lap-Band technology 10 years — 15,500 Orbera technology 12 years 4,600 4,600 Trade names 10 years 1,700 7,900 Patents and trademarks 5 years 2,292 4,579 Other 1 - 5 years 2,421 1,957 19,314 64,836 Less accumulated amortization (9,455) (28,415) Intangible assets, net $ 9,859 $ 36,421 In connection with the Purchase Agreement (see Note 3), the Company divested of the intangibles related to the Surgical product line. Additionally, the Company obtained an independent third-party valuation to determine the value of the customer relationships purchased of $1,781. Amortization expense related to the above intangible assets was $7,268 and $7,467 during 2018 and 2017, respectively. Additionally, we capitalized $416 and $401 related to the extension and renewal of our patents and trademarks during 2018 and 2017, respectively. Amortization for the next five years is as follows: 2019 $ 2,181 2020 1,909 2021 1,786 2022 1,612 2023 845 Thereafter 1,526 Total $ 9,859

Accrued Expenses

Accrued Expenses	12 Months Ended
	Dec. 31, 2018
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses consist of the following as of December 31: 2018 2017 Accrued employee compensation and expenses $ 3,804 $ 4,243 Accrued professional service fees (including clinical trials) 2,983 522 Accrued returns and rebates 331 438 Accrued insurance and taxes 625 527 Other 1,413 1,770 Total accrued expenses $ 9,156 $ 7,500

Long-Term Debt

Long-Term Debt	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Long-Term Debt	Long-Term Debt Long-term debt consists of the following as of December 31: 2018 2017 Senior secured credit facility $ 19,500 $ 32,000 Payment-in-kind interest 2,142 2,223 Discount on long-term debt (175) (534) Deferred financing costs (277) (368) Long-term debt $ 21,190 $ 33,321 In February 2015, the Company entered into a senior secured credit facility (the "Credit Agreement") with Athyrium Opportunities II Acquisition LP ("Athyrium") to borrow $50,000 which is payable in a lump sum on February 27, 2020. The Credit Agreement is secured by all of the Company's assets and has priority over all other debt. The Credit Agreement bears interest at 10.5% per annum. In the first year, 7% cash interest was paid quarterly and 3.5% of payment-in-kind was added to the outstanding debt. After March 15, 2016, 10.5% of interest became payable in cash on a quarterly basis. An additional 2% of the outstanding amount will be due at end of the loan term. The Company is accruing this additional payment-in-kind interest as interest expense using the effective interest rate method. The Company used $39,500 of these proceeds in 2015 to pay off the previous outstanding long-term debt. In October 2016, the Company issued a warrant to purchase 163,915 shares of common stock with an exercise price of $21.29 per share. These warrants remain outstanding and are included in Note 10. The Credit Agreement includes covenants and terms that place certain restrictions on the Company's ability to incur additional debt, incur additional liens, make investments, effect mergers, declare or pay dividends, sell assets, engage in transactions with affiliates, or make capital expenditures. The Credit Agreement also includes financial covenants including minimum consolidated quarterly revenue requirements and a consolidated debt to revenue ratio and provides certain limited cure provisions in the event these requirements are not met. In February 2018, the Company entered into a Sixth Amendment to the Credit Agreement with Athyrium which removed the minimum quarterly revenue requirement and increased the maximum debt-to-revenue ratio to 0.54 from 0.49 with the maximum debt-to-revenue ratio declining gradually each quarter over the remaining term of the facility. In July 2018, the Company entered into a waiver with Athyrium that increased the maximum debt-to-revenue ratio for the second quarter of 2018 to 0.56 from 0.53, waived the existing default under such ratio and prepaid $1,500 of the principal amount outstanding, together with accrued interest and certain fees and expenses. In September 2018, the Company made an additional $1,000 voluntary principal payment to the lender and in November, 2018, the Company entered into a Seventh Amendment to the Credit Agreement and Waiver with Athyrium which granted a waiver for the noncompliance of the debt-to-revenue ratio for the third quarter 2018. In addition, the amendment removed the cure right provision. In December 2018, the Company entered into an Eighth Amendment to the Credit Agreement with Athyrium which amended, among other things (i) the covenants under the Credit Agreement with Athyrium to permit the transactions contemplated by the Asset Purchase Agreement with ReShape Lifesciences Inc.; (ii) modified the mandatory prepayment provisions and required the Company to pay Athyrium the additional cash consideration received from ReShape on the first, second and third anniversaries of the closing date, so long as the Credit Agreement remains outstanding; and (iii) required the Company to pay Athyrium the initial $10,000 received from ReShape plus accrued interest due under the Credit Agreement and certain fees and expenses. In March 2019, the Company entered into a Term Loan Facility with Solar Capital Partners to borrow $35,000 of which $22,372 of the proceeds were used to repay our Senior Secured Credit Facility. See Note 19 for further details.

Stockholders' Equity

Stockholders' Equity	12 Months Ended
	Dec. 31, 2018
Equity [Abstract]
Stockholders' Equity	Stockholders' Equity (a) Authorized Stock The Company’s amended and restated certificate of incorporation, authorizes the Company to issue 115,000,000 shares of common and preferred stock, consisting of 100,000,000 shares of common stock with $0.001 par value and 15,000,000 shares of preferred stock with $0.001 par value. The Company has reserved common shares for issuance upon the exercise of the authorized and issued common stock options and warrants. (b) Warrants Warrants consist of the following as of December 31, 2018: Warrant Expiration Date Number of shares Exercise price per share September 25, 2019 46,818 $ 258.72 December 29, 2021 40,456 $ 13.70 February 27, 2022 163,915 $ 21.29 Total number of warrants outstanding 251,189 Weighted average exercise price of warrants outstanding $ 64.32

Stock Option Plans

Stock Option Plans	12 Months Ended
	Dec. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock Option Plans	Stock Option Plans (a) Plans 2006 Plan The Company's 2006 Equity Incentive Plan (the "2006 Plan") covers employees, consultants, and nonemployee directors of the Company and provides for the grant of incentive stock options or nonqualified stock options to purchase shares of the Company's common stock. Options to date have been granted to employees at 100% of the fair value at the date of the grant. The fair value, vesting period, and expiration dates of the options granted were determined by the Board of Directors at the time of grant. The maximum term of options granted under the 2006 Plan is 10 years from the date of grant. Options generally vest over a period of time, typically not more than 5 years. Under certain circumstances, the Company may repurchase previously granted options or shares issued upon the exercise of a previously granted option. The 2006 Plan expired in May 2016. 2016 Plan The Company's 2016 Equity Incentive Plan (the "2016 Plan") covers employees, consultants, and nonemployee directors of the Company and provides for the grant of incentive stock options, nonstatutory stock options, stock appreciation rights, restricted stock awards, restricted stock units and other stock awards to purchase shares of the Company's common stock. Options to date have been granted to employees at 100% of the fair value at the date of the grant. The fair value, vesting period, and expiration dates of the options granted are determined by the Board of Directors at the time of grant. The maximum term of options granted under the 2016 Plan is 10 years from the date of grant. Options generally vest over a period of time, typically not more than 5 years. The 2016 Plan was replaced by the 2017 Plan. 2017 Plan The Company's 2017 Equity Incentive Plan ("2017 Plan") was approved in June 2017 by the Company's stockholders. The 2017 plan covers employees, consultants, and nonemployee directors of the Company and provides for the grant of incentive stock options, nonstatutory stock options, stock appreciation rights, restricted stock awards, restricted stock units, performance stock awards, performance cash awards, and other stock awards to purchase shares of the Company's common stock. Options to date have been granted to employees at 100% of the fair value at the date of the grant. The fair value, vesting period, and expiration dates of the options granted are determined by the Board of Directors at the time of grant. The maximum term of options granted under the 2017 Plan is 10 years from the date of grant. Options generally vest over a period of time, typically not more than 5 years. The plan's reserve is automatically increased by 4% of the total number of shares outstanding at the prior year end for a period of ten years. Shares subject to awards granted under the 2017 Plan which expire, are repurchased, or are canceled or forfeited will again become available for issuance under the 2017 Plan. The shares available will not be reduced by awards settled in cash or by shares withheld to satisfy tax withholding obligations. Only the net number of shares issued upon the exercise of stock appreciation rights or options exercised by means of a net exercise will be deducted from the shares available under the 2017 Plan. The 2017 Plan replaced the Company's 2016 Plan, which was the successor to the 2006 Plan, and the Lpath Plan (collectively, the Lpath Plan, with the 2016 Plan and the 2006 Plan, the "Prior Plans"). Grants will no longer be made under the Prior Plans, but the awards that remain outstanding will continue to be governed by the terms of the applicable Prior Plan and the applicable award agreement. As of December 31, 2018, the Company has 974,056 shares of common stock reserved for issuance under the 2017 Plan. (b) Stock Option Activity A summary of the stock option activity under the Company's 2017 Plan and Prior Plans (collectively, the "Equity Plans") as of December 31, 2018 is presented below. Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Aggregate Intrinsic Value Options outstanding, December 31, 2017 1,390,428 $4.64 7.0 years $2,432 Options granted 681,403 $6.72 Options exercised (275,862) $2.68 Options forfeited (293,213) $6.24 Options outstanding, December 31, 2018 1,502,756 $5.63 7.7 years $217 Options vested and expected to vest 1,502,756 $5.63 7.7 years $217 Options exercisable 725,972 $4.53 6.5 years $174 The fair value for options under the Equity Plans was estimated at the date of grant using the Black-Scholes option pricing model in valuing the stock awards. Prior to December 2016, the value of the Company's common stock was determined by an independent valuation firm using a blend of an income approach, market approach and cost approach. The Black-Scholes model requires estimating dividend yield, volatility, risk-free rate of return during the service period and the expected term of the award. The expected dividend yield assumption is based on the Company’s expectation of zero future dividend payouts. The volatility assumption is based on the historical volatilities of the Company’s common stock and of comparable public companies. The risk free rate of return assumption utilizes yields on U.S. treasury zero-coupon bonds with maturity that is commensurate with the expected term for awards issued to employees and the contractual term for awards issued to non-employees. The expected term is derived using the simplified method and represents the weighted average period that the stock awards are expected to remain outstanding. The fair value of stock option grants has been estimated at the date of grant using the Black-Scholes option pricing model with the following weighted average assumptions for the years ended December 31: 2018 2017 Risk free interest rate 2.7% 1.9% Expected dividend yield —% —% Estimated volatility 63.3% 61.7% Expected life 5.8 years 5.4 years Additional information regarding options is as follows: 2018 2017 Stock compensation cost $ 1,403 $ 761 Weighted-average grant date fair value of options granted during the period $ 3.95 $ 3.75 Aggregate intrinsic value of options exercised during the period $ 921 $ 231 The aggregate intrinsic value in the table above represents the total pre-tax value of the options shown, calculated as the difference between the Company’s closing stock price on December 31, 2018 and the exercise prices of the options shown, multiplied by the number of in-the money options. This is the aggregate amount that would have been received by the option holders if they had all exercised their options on December 31, 2018 and sold the shares thereby received at the closing price of the Company’s stock on that date. This amount changes based on the closing price of the Company’s stock. Annually the Company grants options that would vest only upon the Company's achievement of certain global revenue and EBITDA targets and in 2018, 37,500 options were determined to have met the underlying conditions. The remaining performance shares were forfeited. Unrecognized compensation expense related to unvested options was approximately $2,579 at December 31, 2018, with a remaining amortization period of less than 2.6 years. A summary of the restricted stock unit activity under the Company's Equity Plans as of December 31, 2018 is presented below: Units Weighted Average Grant Date Fair Value Aggregate Intrinsic Value Unvested units, December 31, 2017 61,198 $5.60 $343 Restricted stock units granted 61,220 $6.63 Restricted stock units vested (23,361) $5.64 Restricted stock units forfeited (4,117) $6.53 Unvested units, December 31, 2018 94,940 $6.21 $328 Unrecognized compensation expense related to unvested restricted stock units was approximately $438 at December 31, 2018, with a remaining amortization period of 2.6 years.

Commitments

Commitments	12 Months Ended
	Dec. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Commitments	Commitments (a) Lease Commitments The Company has entered into various lease agreements for its office space in Texas, California, the United Kingdom, Australia, Italy, and Brazil, and for the manufacturing facility located in Costa Rica. The Company also has various lease agreements for equipment and vehicles. Lease expense for the years ended December 31, 2018 and 2017 was $1,290 and $1,769, respectively. Certain of these leases contain scheduled rent increases which are included in lease expense and recognized using the straight-line method over the term of the leases. At December 31, 2018, minimum rental commitments under non-cancellable operating leases payable over the next five years are as follows: 2019 $ 1,174 2020 965 2021 764 2022 84 2023 84 Thereafter 49 Total $ 3,120 (b) Risk Management The Company maintains various forms of insurance that the Company's management believes are adequate to reduce the exposure to these risks to an acceptable level. (c) Employment Agreements Certain executive officers are entitled to payments if they are terminated without cause or as a result of a change in control. Upon termination without cause, and not as a result of death or disability, each of such officers is entitled to receive a payment of base salary for three to twelve months following termination of employment and such officer will be entitled to continue to receive coverage under medical and dental benefit plans for three to twelve months or until such officer is covered under a separate plan from another employer. Upon a termination other than for cause or for good reason within twelve months following a change in control, each of such officers will be entitled to the same benefits as upon termination without cause and will also be entitled to certain acceleration of such officer's outstanding unvested options at the time of such termination. (d) Litigation Management believes there are no claims or actions pending or threatened against the Company, the ultimate disposition of which would have a material impact on the Company's consolidated financial position, results of operations or cash flows.

Contingencies

Contingencies	12 Months Ended
	Dec. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Contingencies	Contingencies Accounts payable includes $8,505 related to inventory and transition services provided during 2015 and 2016. The payment of these charges is contingent upon resolution of audit findings related to the transition agreements in connection with a dispute with Allergan. As the dispute has not yet been resolved with Allergan, the timing and terms of final amounts payable remain uncertain.

Defined Contribution Plan

Defined Contribution Plan	12 Months Ended
	Dec. 31, 2018
Retirement Benefits [Abstract]
Defined Contribution Plan	Defined Contribution Plan The Company sponsors defined contribution plans for employees in the U.S. and Europe. The cost of these plans, including employer contributions, was $731 and $645 for the years ended December 31, 2018 and 2017 respectively.

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes Income tax expense of $191 and $304 for the years ended December 31, 2018 and 2017, respectively is composed of foreign income taxes on earnings generated in the foreign subsidiaries. Deferred income taxes reflect the net effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes. Significant components of the Company's deferred taxes at December 31 are as follows: 2018 2017 Deferred tax assets: Capitalized transaction costs $ 385 $ 415 Intangible assets 1,321 2,418 Inventory valuation 255 506 Research and development credit 3,597 3,241 Foreign timing differences 187 (17) Other 1,942 952 Net operating loss carryforwards 45,067 34,887 52,754 42,402 Deferred tax liabilities: Unremitted foreign earnings (461) (438) Depreciable assets (64) (47) (525) (485) Total net deferred tax assets 52,229 41,917 Less valuation allowance (52,229) (41,917) Net deferred tax assets (liabilities) $ — $ — The Company has established a valuation allowance equal to the total net deferred tax asset due to uncertainties regarding the realization of deferred tax assets based on the Company's lack of earnings history and potential limitations pursuant to changes in ownership under Internal Revenue Code Section 382. The valuation allowance increased by $10,312 during the year ended December 31, 2018, primarily as a result of changes in net operating loss. As of December 31, 2018, the Company has no unrecognized tax benefits or accrued interest or penalties associated with uncertain tax positions. The Company's provision for income taxes differs from the expected tax expense amount computed by applying the statutory federal income tax rate of 21% for 2018 and 35% for 2017 to income before income taxes as a result of the following: 2018 2017 Tax at U.S. statutory rate $ (9,575) $ (9,176) State taxes, net of deferred benefit (2,017) (866) Foreign tax rate differential (92) (451) Foreign taxes (88) — Permanent differences 993 726 Research and development tax credit (362) (444) Other 211 1,045 Deferred tax adjustment 796 — Unremitted foreign earnings 13 (757) Valuation allowance - current year 10,312 9,332 Change in valuation allowance - rate change — (20,199) Federal tax rate change — 21,094 Income tax expense $ 191 $ 304 As of December 31, 2018, the Company had federal net operating loss carryforwards of approximately $186,866 which will expire in varying amounts beginning in 2025 if not utilized. The Company’s July 2017 stock offering qualified as an ownership change under section 382 which resulted in a reduction of $100,825 in the Company’s U.S. federal net operating losses that will not be utilizable in the future, thus federal net operating loss carryforwards available to the Company as of December 31, 2018 were $86,041. In June 2018, the Company had an additional stock offering that could potentially have triggered an additional ownership change and is still being assessed. The deferred tax asset associated with net operating loss carryforwards has been fully offset by a valuation allowance due to the uncertainty that the Company will achieve taxable income necessary to utilize the net operating loss carryforward in the future. The Company had state net operating loss carryforwards of approximately $104,818 which will begin to expire in varying amounts beginning in 2019. The Company had foreign net operating losses of approximately $3,817 which begin to expire in varying amounts beginning in 2020, if not utilized. New Tax Legislation On December 22, 2017, the U.S. enacted the Tax Cuts and Jobs Act ("Tax Act") which makes significant changes in the U.S. tax law including a reduction in the corporate tax rates from 35% to 21%. Because the Company previously established a valuation allowance equal to its total U.S. net deferred tax assets, the enactment of the new tax law also reduced its valuation allowance and had no net impact on earnings. This adjustment was recorded in the Company's December 31, 2017 consolidated financial statements. On December 22, 2017, Staff Accounting Bulletin No. 118 was issued to address the implication of U.S. GAAP in situations when the Company does not have the necessary information available, prepared, or analyzed in reasonable detail to complete the accounting for certain income tax effects of the Tax Act and provided a one-year measurement period to complete the accounting required under ASC 740. Due to this significant tax law change, the Company recorded provisional estimates within the tax provision based on the best information available as of the filing of the financial statements ending December 31, 2017. During the fourth quarter of 2018, the Company finalized these estimates. As of the fourth quarter of 2018, there are no material impacts on tax expense with respect to the finalization of tax positions taken due to Tax Reform Legislation.

Net Loss Per Share

Net Loss Per Share	12 Months Ended
	Dec. 31, 2018
Earnings Per Share [Abstract]
Net Loss Per Share	Net Loss Per Share The basic and diluted net loss per common share presented in the consolidated statement of operations and comprehensive loss is calculated by dividing net loss by the weighted-average number of common shares outstanding during the period, without consideration for common stock equivalents. Potentially dilutive shares, which include warrants for the purchase of common stock, restricted stock units, and options outstanding under the Company's equity incentive plans, are considered to be common stock equivalents and are only included in the calculation of diluted net loss per share when their effect is dilutive. Potentially dilutive securities not included in the calculation of diluted net loss per share attributable to common stockholders because to do so would be anti-dilutive are as follows (in common stock equivalent shares): Year Ended December 31 2018 2017 Warrants for common stock 251,189 251,891 Common stock options 1,382,512 1,390,428 Restricted stock units 84,183 61,198 1,717,884 1,703,517

Liquidity and Capital Resources

Liquidity and Capital Resources	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Liquidity and Capital Resources	Liquidity and Capital Resources The Company has experienced operating losses since inception and occasional debt covenant violations and has an accumulated deficit of $222,808 as of December 31, 2018. To date, the Company has funded its operating losses and acquisitions through equity offerings and the issuance of debt instruments. The Company's ability to fund future operations and meet debt covenant requirements will depend upon the level of future operating cash flow and our ability to access additional funding through either equity offerings, issuances of debt instruments or both. Management believes its existing cash and cash equivalents and product revenues, along with the additional cash received with the refinancing, will be sufficient to meet liquidity and capital requirements for at least the next twelve months, although there can be no assurances that the Company will be able to do so. The Company periodically evaluates its liquidity requirements, alternative uses of capital, capital needs and available resources. As a result of this process, the Company has in the past, and may in the future, explore alternatives to finance its business plan, including, but not limited to, a public offering of its common stock, private equity or debt financings, reduction of planned expenditures, or other sources. In July 2017, the Company completed a public offering selling 6,542,453 shares at a price of $5.50 per share, including 853,363 shares sold to the underwriters upon the full exercise of their option to purchase additional shares, before the underwriting discount. The public offering generated net proceeds of approximately $33,584, after deducting the underwriting discount and related offering expenses. In December 2017, the Company filed a shelf registration statement on Form S-3 with the Securities and Exchange Commission ("SEC"), which permits the offering, issuance and sale by it of up to $50,000 of its common stock. At that time the Company also entered into a sales agreement with Cantor Fitzgerald & Co. for the sale and issuance of shares of its common stock of up to $16,000 from time to time in an "at-the-market" program. In June 2018, the Company completed a public offering selling 4,309,090 shares of common stock at a price of $5.50 per share, including 562,055 shares pursuant to the exercise in full of the underwriters' option to purchase additional shares of common stock resulting in net proceeds of approximately $21,857, after deducting underwriting discounts and expenses. Following the closing of this transaction, the December 2017 "at-the-market" program was terminated but the sales agreement remains in effect. In December 2018, the Company divested its Surgical product line and received $10,000 in cash on closing which was used to repay debt principal outstanding.

Segment and Geographic Informat

Segment and Geographic Information	12 Months Ended
	Dec. 31, 2018
Segment Reporting [Abstract]
Segment and Geographic Information	Segment and Geographic Information Operating segments are defined as components of an enterprise for which separate financial information is available and evaluated regularly by the chief operating decision maker, or decision-making group, in deciding how to allocate resources and in assessing performance. The Company globally manages the business within one reportable segment. Segment information is consistent with how management reviews the business, makes investing and resource allocation decisions and assesses operating performance. The Company’s products are principally sold in the U.S. No other countries are individually significant. Product sales by product group and geographic market, based on the location of the customer, whether the U.S. or outside the U.S. ("OUS") for the periods shown were as follows: Year Ended December 31, 2018 Year Ended December 31, 2017 U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 11,016 $ 12,364 $ 23,380 38.4 % $ 8,019 $ 8,462 $ 16,481 25.6 % IGB 5,400 12,339 17,739 29.2 % 6,301 13,141 19,442 30.3 % Endo-bariatric 16,416 24,703 41,119 67.6 % 14,320 21,603 35,923 55.9 % Surgical 10,795 7,913 18,708 30.7 % 17,366 10,227 27,593 42.9 % Other 995 32 1,027 1.7 % 766 28 794 1.2 % Total revenues $ 28,206 $ 32,648 $ 60,854 100.0 % $ 32,452 $ 31,858 $ 64,310 100.0 % % Total revenues 46.4 % 53.6 % 50.5 % 49.5 % ---------------------- Endoscopic Suturing System ("ESS") and Intragastric Balloon ("IGB") Total distributor sales were 24.8% of total OUS revenues for both the year ended December 31, 2018 and 2017. Sales in the next largest individual country outside the U.S. were 7.6% and 8.2% for the year ended December 31, 2018 and 2017, respectively. The following table represents property and equipment, net based on the physical geographic location of the asset: 2018 2017 U.S. $ 2,337 $ 2,855 Costa Rica 3,347 3,748 Other 213 282 Total property and equipment, net $ 5,897 $ 6,885

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2018
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events  In March 2019, the Company entered into a Term Loan Facility (the "Facility") with Solar Capital Ltd. ("Solar") to borrow  $35,000. The Facility is due on September 1, 2023 and bears interest at LIBOR plus 7.5%. Interest only is payable in arrears until March 1, 2021 (or September 1, 2021 if certain revenue milestones are achieved). Principal payments are due on a straight-line basis after the interest-only period concludes. The Facility may provide an additional $15,000 upon the Company's request subject to further credit approval. The Facility includes the customary affirmative covenants, negative covenants and financial covenants, including a minimum liquidity of $10,000 and minimum product revenues. We used $22,372 of the proceeds of the Facility to repay our senior secured credit facility, in full. Closing fees of $263 were paid on the closing date.

Significant Accounting Polici_2

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2018
Accounting Policies [Abstract]
Principles of Consolidation	Principles of Consolidation The consolidated financial statements include the accounts of the Company and all of its wholly-owned subsidiaries. All significant intercompany accounts and transactions have been eliminated.
Use of Estimates	Use of Estimates The preparation of consolidated financial statements in conformity with accounting principles generally accepted in the U.S. ("U.S. GAAP") requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting periods. Actual results are likely to differ from those estimates, and such differences may be material to the consolidated financial statements. Significant items subject to such estimates and assumptions include revenue recognition, going concern, financial projections, useful lives of intangibles and long-lived assets, stock compensation, deferred tax asset valuation, long-lived asset and goodwill impairment, allowance for doubtful accounts, and valuation of inventory.
Cash and Cash Equivalents	Cash and Cash Equivalents The Company considers all highly liquid investments with a remaining maturity at date of purchase of three months or less to be cash equivalents.
Restricted Cash	Restricted Cash The Company entered into irrevocable letters of credit with three banks to secure obligations under lease agreements and performance based obligations.
Accounts Receivable	Accounts Receivable The Company generally extends credit to certain customers without requiring collateral. The Company provides an allowance for doubtful accounts based on management's evaluation of the collectability of accounts receivable. Accounts receivable are written off when it is determined amounts are uncollectible.
Inventory	Inventory Inventory is stated at the lower of cost or net realizable value, net of any allowances. Charges for excess and obsolete inventory are based on specific identification of obsolete inventory items and an analysis of inventory items approaching expiration date. We record estimated excess and obsolescence charges to cost of sales. The Company's inventories are stated using the weighted average cost approach, which approximates actual costs.
Fair Value Measurements	Fair Value Measurements The carrying amounts of the Company's financial instruments, which primarily include cash and cash equivalents, accounts receivable, accounts payable and accrued expenses, approximate their fair values due to their short maturities. The fair value of the Company's long-term debt is estimated by management to approximate $21,935 at December 31, 2018 and $33,158 at December 31, 2017. Management's estimates are based on comparisons of the characteristics of the Company's obligations, comparable ranges of interest rates on recently issued debt, and maturity. Such valuation inputs are considered a Level 3 measurement in the fair value valuation hierarchy. The accounting guidance defines fair value, establishes a consistent framework for measuring fair value and expands disclosure for each major asset and liability category measured at fair value on either a recurring or nonrecurring basis. Fair value is defined as an exit price, representing the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. As such, fair value is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or liability. As a basis for considering such assumptions, the accounting guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows: Level 1: Observable inputs such as quoted prices in active markets; Level 2: Inputs, other than the quoted prices in active markets, that are observable either directly or indirectly; and Level 3: Unobservable inputs in which there is little or no market data, which require the reporting entity to develop its own assumptions.
Property and Equipment	Property and Equipment Property and equipment are carried at cost less accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the related assets, except for leasehold improvements, which are depreciated straight-line over the shorter of the estimated useful life or the life of the lease. Major renewals and betterments are capitalized. Validation costs (including materials and labor) that are required to bring machinery to working condition are capitalized. Expenditures for repairs and maintenance and minor replacements are charged to expense as incurred.
Purchase Accounting	Purchase Accounting Business combinations must be evaluated to determine whether it meets the definition of a business or will be accounted for as an asset acquisition. A business consists of inputs and processes that have the ability to create outputs and are accounted for using the acquisition method of accounting. Using this method, the assets acquired and liabilities assumed are recorded at their fair value with any excess going to goodwill. When a business combination is considered an asset acquisition, the cost accumulation approach is used and the total consideration is allocated to the assets acquired and liabilities assumed on a relative fair value basis.
Goodwill and Other Intangible Assets	Goodwill and Other Intangible Assets Goodwill is not amortized but is tested annually for impairment or more frequently if impairment indicators exist. For annual and interim goodwill impairment tests, the Company first assesses qualitative factors before performing a quantitative assessment of the fair value of a reporting unit. If it is determined on the basis of qualitative factors that the fair value of the reporting unit is more likely than not less than the carrying amount, a quantitative impairment test is required. The Company's evaluation of goodwill completed on December 31, 2018 and 2017 resulted in no impairment losses. Definite-lived intangible assets consist of customer relationships, product technology, trade names, patents and trademarks and capitalized software which are amortized over their estimated useful lives. Costs to extend the lives of and renew patents and trademarks are capitalized when incurred.
Valuation of Long-Lived Assets	Valuation of Long-Lived Assets Long-lived assets, including definite-lived intangible assets, are monitored and reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of any such asset may not be recoverable. The determination of recoverability is based on an estimate of undiscounted cash flows expected to result from the use of an asset and its eventual disposition. The estimate of undiscounted cash flows is based upon, among other things, certain assumptions about expected future operating performance. The Company's estimates of undiscounted cash flows may differ from actual cash flows. If the sum of the undiscounted cash flows is less than the carrying value of the asset, an impairment charge is recognized, measured as the amount by which the carrying value exceeds the fair value of the asset.
Revenue Recognition	Revenue Recognition The Company's principal source of revenues is from the sale of its products. Revenue is recognized when control of the promised goods is transferred to our customers, in an amount that reflects the consideration we expect to be entitled to in an exchange or those goods. Generally, these are met under the Company's agreements with most customers upon product shipment. This includes sales to distributors, who sell the products to their customers, take title to the products and assume all risks of ownership at the time of shipment. Our distributors are obligated to pay within specified terms regardless of when, if ever, they sell the products. Customers and distributors generally have the right to return or exchange products purchased from the Company for up to thirty days from the date of product shipment. At the end of each period, the Company determines the extent to which its revenues need to be reduced to account for expected returns and exchanges. Certain customer may receive volume rebates or discounts, which are accounted for as variable consideration. We estimate these amounts based on the expected amount to be provided to customers and reduce revenues recognized. We record deferred revenues when cash payments are received in advance of the transfer of goods. The Company accounts for taxes collected from customers and remitted to governmental authorities on a net basis. Accordingly, such amounts are excluded from revenues. Amounts billed to customers related to shipping and handling are included in revenues. Shipping and handling costs related to revenue producing activities are included in cost of sales.
Research and Development	Research and Development Research and development costs are expensed as incurred.
Stock-based Compensation Plans	Stock-based Compensation Plans The Company recognizes compensation costs for all stock-based awards based upon each award's estimated fair value as determined on the date of grant. The Company utilizes the Black-Scholes option-pricing model to determine the fair value of stock option awards. Compensation cost is recognized on a straight-line basis over the respective vesting period of the award. Adjustments for actual forfeitures are made in the period which they occur.
Advertising	Advertising The Company expenses advertising costs as incurred.
Income Taxes	Income Taxes The Company accounts for deferred income taxes using the asset and liability method. Under this method, deferred income taxes arise from temporary differences between the tax basis of assets and liabilities and their reported amounts in the financial statements, which will result in taxable or deductible amounts in the future. Temporary differences are then measured using the enacted tax rates and laws. Valuation allowances are established, when necessary, to reduce deferred tax assets to the amount that is more-likely than-not to be realized. Determining the appropriate amount of valuation allowance requires management to exercise judgment about future operations. In the ordinary course of business, there are many transactions for which the ultimate tax outcome is uncertain. The Company regularly assesses uncertain tax positions in each of the tax jurisdictions in which it has operations and accounts for the related consolidated financial statement implications. The amount of unrecognized tax benefits is adjusted when information becomes available or when an event occurs indicating a change is appropriate. The Company includes interest and penalties related to its uncertain tax positions as part of income tax expense.
Medical Device Excise Tax	Medical Device Excise Tax Effective as of January 1, 2013, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Affordability Reconciliation Act, imposed a medical device excise tax (MDET) of 2.3% on any entity that manufactures or imports certain medical devices offered for sale in the U.S. In December 2015, the medical device tax was suspended for two years and on January 22, 2018 the moratorium on this tax was extended through December 31, 2019.
Foreign Currency	Foreign Currency The Company is exposed to foreign currency exchange risk as foreign subsidiaries generally operate and utilize functional currencies in local currencies other than the U.S. Dollar, which is the Company's reporting currency. The Company translates foreign assets and liabilities at exchange rates in effect at the balance sheet dates, and the revenues and expenses using average rates during the year. The resulting foreign currency translation adjustments are recorded as a separate component of accumulated other comprehensive income in the accompanying consolidated balance sheets. The Company does not hedge foreign currency translation risk in the net assets and income it reports from these sources. Exchange rate fluctuations on short-term intercompany loans are included in other expense in the consolidated statement of operations and comprehensive loss.
Recent Accounting Pronouncements	Recent Accounting Pronouncements On January 1, 2018, the Company adopted the provisions of ASU 2014-09, Revenue from Contracts with Customers ("ASC 606"), which requires an entity to recognize revenue when it transfers control of promised goods or services to customers in an amount that reflects the consideration to which it expects to be entitled in exchange for those goods or services. The Company adopted this new standard using the modified retrospective method and applied this method only to contracts that were not completed as of January 1, 2018. Prior periods were not retrospectively adjusted. There was no material impact on the Company's financial statement upon adoption of the new revenue recognition standard. On January 1, 2018, the Company adopted the provisions of ASU 2017-01, Business Combinations: Clarifying the Definition of a Business ("ASU 2017-01") to clarify the definition of a business when evaluating whether transactions should be accounted for as acquisitions (or disposals) of assets or businesses. On January 1, 2019, the Company adopted the provisions of ASU 2016-02, Leases ("ASU 2016-02") which requires a lessee to recognize assets and liabilities for leases with a maximum possible term of more than 12 months. Upon adoption, the Company used the modified retrospective approach and chose not to adjust comparative periods. The Company elected the package of practical expedients permitted under the transition guidance within the new standard, which among other things, allowed us to carry forward the historical lease classification. The Company recognized a liability to make lease payments (the lease liability) and a right-of-use asset representing its right to use the leased asset (the underlying asset) for the lease term of $2,669 on the balance sheet, thereby increasing reported assets and liabilities. The cumulative-effect adjustment made to the opening balance of retained earnings as of January 1, 2019 did not have a material impact on the Company's financial statements. The income statement recognition of lease expense is similar to the Company's current methodology. In January 2017, the FASB issued ASU 2017-04, Intangibles - Goodwill and Other: Simplifying the Test for Goodwill Impairment (“ASU 2017-04”) to simplify the accounting for goodwill impairment. The guidance removes step two of the goodwill impairment test, which requires a hypothetical purchase price allocation. A goodwill impairment will now be the amount by which a reporting unit’s carrying value exceeds its fair value, not to exceed the carrying amount of goodwill. Entities will continue to have the option to perform a qualitative assessment to determine if a quantitative impairment test is necessary.
Net Loss Per Share	The basic and diluted net loss per common share presented in the consolidated statement of operations and comprehensive loss is calculated by dividing net loss by the weighted-average number of common shares outstanding during the period, without consideration for common stock equivalents. Potentially dilutive shares, which include warrants for the purchase of common stock, restricted stock units, and options outstanding under the Company's equity incentive plans, are considered to be common stock equivalents and are only included in the calculation of diluted net loss per share when their effect is dilutive.

Divestiture of Surgical Produ_2

Divestiture of Surgical Product Line (Tables)	12 Months Ended
	Dec. 31, 2018
Discontinued Operations and Disposal Groups [Abstract]
Divestiture Schedule	A summary of the consideration received from Reshape for the divestiture and the related Surgical assets that were divested is included below: Consideration received Cash $ 10,000 Receivable 5,725 Inventory 102 Intangible assets 1,781 Total consideration 17,608 Less: Assets divested Inventory (873) Property and equipment, net of accumulated depreciation (478) Intangible assets, net of accumulated amortization (21,186) Patents and trademarks, net of accumulated amortization (805) Goodwill (1,538) Total assets divested (24,880) Legal fees associated with divestiture (498) Loss on divestiture $ (7,770)

Inventory (Tables)

Inventory (Tables)	12 Months Ended
	Dec. 31, 2018
Inventory Disclosure [Abstract]
Schedule of Inventory	Inventory consists of the following as of December 31: 2018 2017 Raw materials $ 3,806 $ 3,764 Work in progress 352 493 Finished goods 5,774 10,086 Total inventory $ 9,932 $ 14,343

Property and Equipment (Tables)

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2018
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment	Property and equipment consists of the following as of December 31: Depreciable Lives 2018 2017 Equipment 5 years $ 7,510 $ 5,501 Furniture, fixtures and tooling 4 - 8 years 2,223 3,524 Computer hardware 3 - 5 years 1,326 1,223 Leasehold improvements 3 - 5 years 1,400 1,424 Construction in process 130 1,871 12,589 13,543 Less accumulated depreciation (6,692) (6,658) Property and equipment, net $ 5,897 $ 6,885

Goodwill and Other Intangible_2

Goodwill and Other Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The following table reflects the changes in goodwill for the years ended December 31, 2018 and 2017: December 31, 2016 $ 6,828 December 31, 2017 $ 6,828 Goodwill associated with divestiture of Surgical product line (see Note 3) (1,538) December 31, 2018 $ 5,290
Schedule of Intangible Assets	Other intangible assets consist of the following as of December 31: Useful Life 2018 2017 Customer relationships 9 years $ 8,301 $ 30,300 Lap-Band technology 10 years — 15,500 Orbera technology 12 years 4,600 4,600 Trade names 10 years 1,700 7,900 Patents and trademarks 5 years 2,292 4,579 Other 1 - 5 years 2,421 1,957 19,314 64,836 Less accumulated amortization (9,455) (28,415) Intangible assets, net $ 9,859 $ 36,421
Schedule of Amortization Expense	Amortization for the next five years is as follows: 2019 $ 2,181 2020 1,909 2021 1,786 2022 1,612 2023 845 Thereafter 1,526 Total $ 9,859

Accrued Expenses (Tables)

Accrued Expenses (Tables)	12 Months Ended
	Dec. 31, 2018
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses consist of the following as of December 31: 2018 2017 Accrued employee compensation and expenses $ 3,804 $ 4,243 Accrued professional service fees (including clinical trials) 2,983 522 Accrued returns and rebates 331 438 Accrued insurance and taxes 625 527 Other 1,413 1,770 Total accrued expenses $ 9,156 $ 7,500

Long-Term Debt (Tables)

Long-Term Debt (Tables)	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Long-term debt consists of the following as of December 31: 2018 2017 Senior secured credit facility $ 19,500 $ 32,000 Payment-in-kind interest 2,142 2,223 Discount on long-term debt (175) (534) Deferred financing costs (277) (368) Long-term debt $ 21,190 $ 33,321

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	12 Months Ended
	Dec. 31, 2018
Equity [Abstract]
Schedule of Warrants	Warrants consist of the following as of December 31, 2018: Warrant Expiration Date Number of shares Exercise price per share September 25, 2019 46,818 $ 258.72 December 29, 2021 40,456 $ 13.70 February 27, 2022 163,915 $ 21.29 Total number of warrants outstanding 251,189 Weighted average exercise price of warrants outstanding $ 64.32

Stock Option Plans (Tables)

Stock Option Plans (Tables)	12 Months Ended
	Dec. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Schedule of Stock Option Activity	A summary of the stock option activity under the Company's 2017 Plan and Prior Plans (collectively, the "Equity Plans") as of December 31, 2018 is presented below. Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Aggregate Intrinsic Value Options outstanding, December 31, 2017 1,390,428 $4.64 7.0 years $2,432 Options granted 681,403 $6.72 Options exercised (275,862) $2.68 Options forfeited (293,213) $6.24 Options outstanding, December 31, 2018 1,502,756 $5.63 7.7 years $217 Options vested and expected to vest 1,502,756 $5.63 7.7 years $217 Options exercisable 725,972 $4.53 6.5 years $174
Schedule of Fair Value of Stock Options	The fair value of stock option grants has been estimated at the date of grant using the Black-Scholes option pricing model with the following weighted average assumptions for the years ended December 31: 2018 2017 Risk free interest rate 2.7% 1.9% Expected dividend yield —% —% Estimated volatility 63.3% 61.7% Expected life 5.8 years 5.4 years
Schedule of Other Stock Option Information	Additional information regarding options is as follows: 2018 2017 Stock compensation cost $ 1,403 $ 761 Weighted-average grant date fair value of options granted during the period $ 3.95 $ 3.75 Aggregate intrinsic value of options exercised during the period $ 921 $ 231
Schedule of Restricted Stock Unit Activity	A summary of the restricted stock unit activity under the Company's Equity Plans as of December 31, 2018 is presented below: Units Weighted Average Grant Date Fair Value Aggregate Intrinsic Value Unvested units, December 31, 2017 61,198 $5.60 $343 Restricted stock units granted 61,220 $6.63 Restricted stock units vested (23,361) $5.64 Restricted stock units forfeited (4,117) $6.53 Unvested units, December 31, 2018 94,940 $6.21 $328

Commitments (Tables)

Commitments (Tables)	12 Months Ended
	Dec. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Schedule of Future Minimum Rental Commitments	At December 31, 2018, minimum rental commitments under non-cancellable operating leases payable over the next five years are as follows: 2019 $ 1,174 2020 965 2021 764 2022 84 2023 84 Thereafter 49 Total $ 3,120

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Schedule of Deferred Tax Assets and Liabilities	Significant components of the Company's deferred taxes at December 31 are as follows: 2018 2017 Deferred tax assets: Capitalized transaction costs $ 385 $ 415 Intangible assets 1,321 2,418 Inventory valuation 255 506 Research and development credit 3,597 3,241 Foreign timing differences 187 (17) Other 1,942 952 Net operating loss carryforwards 45,067 34,887 52,754 42,402 Deferred tax liabilities: Unremitted foreign earnings (461) (438) Depreciable assets (64) (47) (525) (485) Total net deferred tax assets 52,229 41,917 Less valuation allowance (52,229) (41,917) Net deferred tax assets (liabilities) $ — $ —
Schedule of Effective Income Tax Rate	The Company's provision for income taxes differs from the expected tax expense amount computed by applying the statutory federal income tax rate of 21% for 2018 and 35% for 2017 to income before income taxes as a result of the following: 2018 2017 Tax at U.S. statutory rate $ (9,575) $ (9,176) State taxes, net of deferred benefit (2,017) (866) Foreign tax rate differential (92) (451) Foreign taxes (88) — Permanent differences 993 726 Research and development tax credit (362) (444) Other 211 1,045 Deferred tax adjustment 796 — Unremitted foreign earnings 13 (757) Valuation allowance - current year 10,312 9,332 Change in valuation allowance - rate change — (20,199) Federal tax rate change — 21,094 Income tax expense $ 191 $ 304

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	12 Months Ended
	Dec. 31, 2018
Earnings Per Share [Abstract]
Schedule of Antidilutive Securities Excluded from Computation of Diluted Loss Per Share	Potentially dilutive securities not included in the calculation of diluted net loss per share attributable to common stockholders because to do so would be anti-dilutive are as follows (in common stock equivalent shares): Year Ended December 31 2018 2017 Warrants for common stock 251,189 251,891 Common stock options 1,382,512 1,390,428 Restricted stock units 84,183 61,198 1,717,884 1,703,517

Segment and Geographic Inform_2

Segment and Geographic Information (Tables)	12 Months Ended
	Dec. 31, 2018
Segment Reporting [Abstract]
Schedule of Product Sales by Product Group and Geographic Market	Product sales by product group and geographic market, based on the location of the customer, whether the U.S. or outside the U.S. ("OUS") for the periods shown were as follows: Year Ended December 31, 2018 Year Ended December 31, 2017 U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 11,016 $ 12,364 $ 23,380 38.4 % $ 8,019 $ 8,462 $ 16,481 25.6 % IGB 5,400 12,339 17,739 29.2 % 6,301 13,141 19,442 30.3 % Endo-bariatric 16,416 24,703 41,119 67.6 % 14,320 21,603 35,923 55.9 % Surgical 10,795 7,913 18,708 30.7 % 17,366 10,227 27,593 42.9 % Other 995 32 1,027 1.7 % 766 28 794 1.2 % Total revenues $ 28,206 $ 32,648 $ 60,854 100.0 % $ 32,452 $ 31,858 $ 64,310 100.0 % % Total revenues 46.4 % 53.6 % 50.5 % 49.5 % ---------------------- Endoscopic Suturing System ("ESS") and Intragastric Balloon ("IGB")
Schedule of Long-Lived Assets by Geographic Area	The following table represents property and equipment, net based on the physical geographic location of the asset: 2018 2017 U.S. $ 2,337 $ 2,855 Costa Rica 3,347 3,748 Other 213 282 Total property and equipment, net $ 5,897 $ 6,885

Organization and Business Des_2

Organization and Business Description (Details) - USD ($) $ in Thousands	Dec. 17, 2018	Dec. 31, 2018	Dec. 31, 2017
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sale of assets		$ 10,000	$ 0
Surgical Product Line [Member] | Disposal [Member]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sale of assets	$ 10

Significant Accounting Polici_3

Significant Accounting Policies (Narrative) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Jan. 01, 2019
Restricted Cash
Restricted cash	$ 1,011,000	$ 905,000
Accounts Receivable
Allowance for doubtful accounts	559,000	452,000
Accounts receivable write-offs	101,000	238,000
Fair Value Measurements
Long-term debt, fair value	21,935,000	33,158,000
Goodwill and Other Intangible Assets
Goodwill impairment loss	0	0
Valuation of Long-Lived Assets
Impairment of long-lived assets		0
Advertising Expense
Advertising costs	$ 3,024,000	$ 3,295,000
ASU 2016-02 [Member] | Subsequent Event [Member]
Recent Accounting Pronouncements
Right-of-use asset			$ 2,669,000
Lease liability			$ 2,669,000

Divestiture of Surgical Produ_3

Divestiture of Surgical Product Line (Narrative) (Details) - Surgical Product Line [Member] - Disposal [Member] - USD ($) $ in Thousands	Dec. 21, 2021	Dec. 17, 2020	Dec. 17, 2019	Dec. 17, 2018	Dec. 31, 2018
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Divestiture of Surgical product line				$ 10
Legal fees				498
Notes receivable				$ 7
Product manufacture period					2 years
Distributor period					1 year
Discount Rate [Member]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Discount rate				10.00%
Forecast [Member]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Divestiture of Surgical product line	$ 3	$ 2	$ 2

Divestiture of Surgical Produ_4

Divestiture of Surgical Product Line (Schedule of Divestiture) (Details) - USD ($) $ in Thousands	Dec. 17, 2018	Dec. 31, 2018	Dec. 31, 2017
Less: Assets divested
Loss on divestiture		$ (7,770)	$ 0
Surgical Product Line [Member] | Disposal [Member]
Consideration received
Cash		$ 10,000
Receivable	$ 5,725
Inventory	102
Intangible assets	1,781
Total consideration	17,608
Less: Assets divested
Inventory	(873)
Property and equipment, net of accumulated depreciation	(478)
Intangible assets, net of accumulated amortization	(21,186)
Goodwill	(1,538)
Total assets divested	(24,880)
Legal fees associated with divestiture	(498)
Loss on divestiture	(7,770)
Surgical Product Line [Member] | Disposal [Member] | Patents and Trademarks [Member]
Less: Assets divested
Intangible assets, net of accumulated amortization	$ (805)

Concentrations (Details)

Concentrations (Details) $ in Thousands	Dec. 31, 2018USD ($)bank
Risks and Uncertainties [Abstract]
Number of banks | bank	3
Cash and cash equivalents and restricted cash | $	$ 25,007

Inventory (Details)

Inventory (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Inventory Disclosure [Abstract]
Raw materials	$ 3,806	$ 3,764
Work in progress	352	493
Finished goods	5,774	10,086
Total inventory, net	9,932	14,343
Change in inventory reserve	387	$ 692
Disposal of expired product	1,419
Consigned inventory	$ 328

Property and Equipment (Details

Property and Equipment (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 12,589,000	$ 13,543,000
Less accumulated depreciation	(6,692,000)	(6,658,000)
Property and equipment, net	5,897,000	6,885,000
Depreciation expense	2,024,000	2,250,000
Impairment charge	0	0
Disposal of property and equipment	608,000
Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 7,510,000	5,501,000
Depreciable lives	5 years
Furniture, Fixtures and Tooling [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 2,223,000	3,524,000
Furniture, Fixtures and Tooling [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Depreciable lives	4 years
Furniture, Fixtures and Tooling [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Depreciable lives	8 years
Computer Hardware [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 1,326,000	1,223,000
Computer Hardware [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Depreciable lives	3 years
Computer Hardware [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Depreciable lives	5 years
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 1,400,000	1,424,000
Leasehold Improvements [Member] | Minimum [Member]
Property, Plant and Equipment [Line Items]
Depreciable lives	3 years
Leasehold Improvements [Member] | Maximum [Member]
Property, Plant and Equipment [Line Items]
Depreciable lives	5 years
Construction in Progress [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 130,000	$ 1,871,000
Surgical Product Line [Member] | Disposal [Member]
Property, Plant and Equipment [Line Items]
Accumulated depreciation from disposition of the Surgical product line	1,383,000
Disposal of property and equipment	$ 1,861,000

Goodwill and Other Intangible_3

Goodwill and Other Intangible Assets (Goodwill) (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2018USD ($)
Goodwill
Beginning balance	$ 6,828
Goodwill associated with divestiture of Surgical product line	(1,538)
Ending balance	$ 5,290

Goodwill and Other Intangible_4

Goodwill and Other Intangible Assets (Other Intangible Assets) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Finite-Lived Intangible Assets [Line Items]
Intangible assets, gross	$ 19,314	$ 64,836
Less accumulated amortization	(9,455)	(28,415)
Total	9,859	36,421
Amortization of intangible assets	$ 7,268	7,467
Lap-Band [Member]
Finite-Lived Intangible Assets [Line Items]
Useful life	10 years
Intangible assets, gross	$ 0	15,500
Orbera [Member]
Finite-Lived Intangible Assets [Line Items]
Useful life	12 years
Intangible assets, gross	$ 4,600	4,600
Customer Relationships [Member]
Finite-Lived Intangible Assets [Line Items]
Useful life	9 years
Intangible assets, gross	$ 8,301	30,300
Customer Relationships [Member] | Surgical Product Line [Member] | Disposal [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible assets, gross	$ 1,781
Trade Names [Member]
Finite-Lived Intangible Assets [Line Items]
Useful life	10 years
Intangible assets, gross	$ 1,700	7,900
Patents and Trademarks [Member]
Finite-Lived Intangible Assets [Line Items]
Useful life	5 years
Intangible assets, gross	$ 2,292	4,579
Cost incurred to extend and renew patents and trademarks	416	401
Other [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible assets, gross	$ 2,421	$ 1,957
Other [Member] | Minimum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful life	1 year
Other [Member] | Maximum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful life	5 years

Goodwill and Other Intangible_5

Goodwill and Other Intangible Assets (Amortization Expense) (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
2019	$ 2,181
2020	1,909
2021	1,786
2022	1,612
2023	845
Thereafter	1,526
Total	$ 9,859	$ 36,421

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Payables and Accruals [Abstract]
Accrued employee compensation and expenses	$ 3,804	$ 4,243
Accrued professional service fees (including clinical trials)	2,983	522
Accrued returns and rebates	331	438
Accrued insurance and taxes	625	527
Other	1,413	1,770
Total accrued expenses	$ 9,156	$ 7,500

Long-Term Debt (Schedule of Lon

Long-Term Debt (Schedule of Long-term Debt) (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Discount on long-term debt	$ (175)	$ (534)
Deferred financing costs	(277)	(368)
Long-term debt	21,190	33,321
Payment in Kind Interest [Member]
Debt Instrument [Line Items]
Long-term debt, gross	2,142	2,223
Line of Credit [Member] | Secured Debt [Member] | Credit Facility [Member]
Debt Instrument [Line Items]
Long-term debt, gross	$ 19,500	$ 32,000

Long-Term Debt (Narrative) (Det

Long-Term Debt (Narrative) (Details)	Mar. 15, 2016	Mar. 18, 2019USD ($)	Sep. 30, 2018USD ($)	Jul. 31, 2018USD ($)	Feb. 28, 2018	Jun. 30, 2018	Dec. 31, 2018USD ($)$ / shares	Dec. 31, 2017shares	Dec. 31, 2015USD ($)	Oct. 31, 2016$ / sharesshares	Feb. 27, 2015USD ($)
Debt Instrument [Line Items]
Expired warrants (shares) | shares								702
Exercise price (USD per share) | $ / shares							$ 64.32
Common Stock [Member] | Warrant [Member]
Debt Instrument [Line Items]
Expired warrants (shares) | shares										163,915
Exercise price (USD per share) | $ / shares										$ 21.29
Notes Payable [Member] | Consortium Loan [Member]
Debt Instrument [Line Items]
Repayments of debt									$ 39,500,000
Line of Credit [Member] | Term Loan Facility [Member] | Subsequent Event [Member]
Debt Instrument [Line Items]
Line of credit		$ 35,000,000
Line of Credit [Member] | Senior Secured Credit Facility [Member] | Subsequent Event [Member]
Debt Instrument [Line Items]
Repayments of debt		$ 22,372,000
Line of Credit [Member] | Secured Debt [Member] | Credit Facility [Member]
Debt Instrument [Line Items]
Maximum borrowing capacity											$ 50,000,000
Interest rate											10.50%
Cash interest quarterly											7.00%
Payment-in-kind interest											3.50%
Percent of outstanding due at end of loan	2.00%
Line of Credit [Member] | Secured Debt [Member] | Credit Facility Sixth Amendment [Member]
Debt Instrument [Line Items]
Minimum debt to revenue ratio					0.49			0.54
Line of Credit [Member] | Secured Debt [Member] | Athyrium Agreement [Member]
Debt Instrument [Line Items]
Repayments of debt				$ 1,500,000
Minimum debt to revenue ratio				0.53		0.56
Principal payment			$ 1,000
Line of Credit [Member] | Secured Debt [Member] | Credit Facility Eighth Amendment [Member]
Debt Instrument [Line Items]
Repayments of debt							$ 10,000

Stockholders' Equity (Authorize

Stockholders' Equity (Authorized Stock) (Details) - $ / shares	Dec. 31, 2018	Dec. 31, 2017
Equity [Abstract]
Preferred and common stock, shares authorized	115,000,000
Common stock, shares authorized (in shares)	100,000,000	100,000,000
Common stock, par value (USD per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized	15,000,000
Preferred stock, par value (USD per share)	$ 0.001

Stockholders' Equity (Warrants)

Stockholders' Equity (Warrants) (Details) - $ / shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Class of Warrant or Right [Line Items]
Total number of warrants outstanding (shares)	251,189
Exercise price (USD per share)	$ 64.32
Exercise of stock warrants (in shares)	0
Warrants to purchase (shares)		702
September 25, 2019 [Member]
Class of Warrant or Right [Line Items]
Total number of warrants outstanding (shares)	46,818
Exercise price (USD per share)	$ 258.72
December 29, 2021 [Member]
Class of Warrant or Right [Line Items]
Total number of warrants outstanding (shares)	40,456
Exercise price (USD per share)	$ 13.70
February 27, 2022 [Member]
Class of Warrant or Right [Line Items]
Total number of warrants outstanding (shares)	163,915
Exercise price (USD per share)	$ 21.29

Stock Option Plans (Plans) (Det

Stock Option Plans (Plans) (Details) - shares	5 Months Ended	12 Months Ended
	May 31, 2016	Dec. 31, 2018
2006 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of fair value	100.00%
Maximum term of options granted	10 years
2006 Plan [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period	5 years
2016 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of fair value		100.00%
Maximum term of options granted		10 years
Vesting period		5 years
2017 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of fair value		100.00%
Maximum term of options granted		10 years
Vesting period		5 years
Percentage of outstanding stock		4.00%
Common stock reserved for issuance (in shares)		974,056

Stock Option Plans (Stock Optio

Stock Option Plans (Stock Option Activity) (Details) - Equity Plans [Member] - Stock Option [Member] - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Options
Options outstanding, beginning balance (in shares)	1,390,428
Options granted (in shares)	681,403
Options exercised (in shares)	(275,862)
Options forfeited (in shares)	(293,213)
Options outstanding, ending balance (in shares)	1,502,756	1,390,428
Options vested and expected to vest (in shares)	1,502,756
Options exercisable (in shares)	725,972
Weighted Average Exercise Price
Weighted average exercise price, beginning balance (in USD per share)	$ 4.64
Options granted (in USD per share)	6.72
Options exercised (in USD per share)	2.68
Options forfeited (in USD per share)	6.24
Weighted average exercise price, ending balance (in USD per share)	5.63	$ 4.64
Options vested and expected to vest (in USD per share)	5.63
Options exercisable (in USD per share)	$ 4.53
Weighted Average Remaining Contractual Term
Weighted average remaining contractual term	7 years 8 months 12 days	7 years
Options vested and expected to vest	7 years 8 months 12 days
Options exercisable	6 years 6 months
Aggregate Intrinsic Value
Aggregate intrinsic value	$ 217	$ 2,432
Options vested and expected to vest	217
Options exercisable	$ 174

Stock Option Plans (Fair Value

Stock Option Plans (Fair Value of Stock Options) (Details) - Stock Option [Member]	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk free interest rate	2.70%	1.90%
Expected dividend yield	0.00%	0.00%
Estimated volatility	63.30%	61.70%
Expected life	5 years 9 months 18 days	5 years 4 months 24 days

Stock Option Plans (Additional

Stock Option Plans (Additional Information) (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock based compensation	$ 1,403	$ 761
Stock Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock based compensation	$ 1,403	$ 761
Weighted-average grant date fair value of options granted during the period (USD per share)	$ 3.95	$ 3.75
Aggregate intrinsic value of options exercised during the period	$ 921	$ 231
Unrecognized compensation expense related to unvested options	$ 2,579
Remaining amortization period, less then	2 years 7 months 6 days
Performance Shares [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted (in shares)	37,500

Stock Option Plans (Restricted

Stock Option Plans (Restricted Stock Units Activity) (Details) - Restricted stock units [Member] - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Units
Shares outstanding beginning balance (in shares)	61,198
Restricted stock units granted (in shares)	61,220
Restricted stock units vested (in shares)	(23,361)
Restricted stock units forfeited (in shares)	(4,117)
Shares outstanding ending balance (in shares)	94,940
Weighted-Average Grant Date Fair Value
Units outstanding beginning balance (in USD per share)	$ 5.60
Restricted stock units granted (in USD per share)	6.63
Restricted stock units vested (in USD per share)	5.64
Restricted stock units forfeited (in USD per share)	6.53
Units outstanding ending balance (in USD per share)	$ 6.21
Intrinsic value	$ 328	$ 343
Compensation not yet recognized	$ 438
Remaining amortization period, less then	2 years 7 months 6 days

Commitments (Lease Commitments)

Commitments (Lease Commitments) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Commitments and Contingencies Disclosure [Abstract]
Lease expense	$ 1,290	$ 1,769
Minimum Rental Commitments
2019	1,174
2020	965
2021	764
2022	84
2023	84
Thereafter	49
Total	$ 3,120

Commitments (Employment Agreeme

Commitments (Employment Agreements) (Details) - Executive Officer [Member]	12 Months Ended
	Dec. 31, 2018
Other Commitments [Line Items]
Period following change in control	12 months
Minimum [Member]
Other Commitments [Line Items]
Period for salary and benefits payment	3 months
Maximum [Member]
Other Commitments [Line Items]
Period for salary and benefits payment	12 months

Contingencies (Details)

Contingencies (Details) - USD ($) $ in Thousands	Dec. 31, 2016	Dec. 31, 2015
Transitional Services [Member]
Related Party Transaction [Line Items]
Accounts payable, related parties	$ 8,505	$ 8,505

Defined Contribution Plan (Deta

Defined Contribution Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Retirement Benefits [Abstract]
Cost of defined contribution plan	$ 731	$ 645

Income Taxes (Narrative) (Detai

Income Taxes (Narrative) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Operating Loss Carryforwards [Line Items]
Income tax expense	$ 191,000	$ 304,000
Valuation allowance - current year	10,312,000	$ 9,332,000
Unrecognized tax benefits	0
Operating loss carryforwards	86,041,000
Accrued interest	0
Tax penalties	0
Domestic Tax Authority [Member]
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	186,866,000
Decrease in operating loss carryforwards	100,825,000
State and Local Jurisdiction [Member]
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	104,818,000
Foreign Tax Authority [Member]
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	$ 3,817,000

Income Taxes (Deferred Tax Asse

Income Taxes (Deferred Tax Assets Liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Deferred tax assets:
Capitalized transaction costs	$ 385	$ 415
Intangible assets	1,321	2,418
Inventory valuation	255	506
Research and development credit	3,597	3,241
Foreign timing differences	187	(17)
Other	1,942	952
Net operating loss carryforwards	45,067	34,887
Deferred tax assets, gross	52,754	42,402
Deferred tax liabilities:
Unremitted foreign earnings	(461)	(438)
Depreciable assets	(64)	(47)
Total deferred tax liabilities	(525)	(485)
Total net deferred tax assets	52,229	41,917
Less valuation allowance	(52,229)	(41,917)
Net deferred tax assets (liabilities)	$ 0	$ 0

Income Taxes (Effective Income

Income Taxes (Effective Income Tax Rate) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Tax at U.S. statutory rate	$ (9,575)	$ (9,176)
State taxes, net of deferred benefit	(2,017)	(866)
Foreign tax rate differential	(92)	(451)
Foreign taxes	(88)	0
Permanent differences	993	726
Research and development tax credit	(362)	(444)
Other	211	1,045
Unremitted foreign earnings	13	(757)
Deferred tax adjustment	796	0
Valuation allowance - current year	10,312	9,332
Change in valuation allowance - rate change	0	(20,199)
Federal tax rate change	0	21,094
Income tax expense	$ 191	$ 304

Net Loss Per Share (Details)

Net Loss Per Share (Details) - shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	1,717,884	1,703,517
Warrants for common and preferred stock [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	251,189	251,891
Common stock options [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	1,382,512	1,390,428
Restricted stock units [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	84,183	61,198

Liquidity and Capital Resourc_2

Liquidity and Capital Resources (Details) - USD ($)	Jul. 25, 2017	Mar. 18, 2019	Jun. 30, 2018	Dec. 31, 2017	Dec. 31, 2018
Debt Disclosure [Abstract]
Accumulated deficit				$ (177,021,000)	$ (222,808,000)
Subsidiary, Sale of Stock [Line Items]
Net proceeds	$ 33,584,000
Senior Secured Credit Facility [Member] | Line of Credit [Member] | Subsequent Event [Member]
Subsidiary, Sale of Stock [Line Items]
Repayments of debt		$ 22,372,000
Term Loan Facility [Member] | Line of Credit [Member] | Subsequent Event [Member]
Subsidiary, Sale of Stock [Line Items]
Line of credit		35,000,000
Minimum cash balance required		$ 10,000,000
Minimum product revenues required, as percentage of planned revenues		85.00%
Public Stock Offering [Member]
Subsidiary, Sale of Stock [Line Items]
Number of shares issued in transaction (in shares)	6,542,453		4,309,090
Sale of stock, price per share (USD per share)	$ 5.50		$ 5.50
Over-Allotment Option [Member]
Subsidiary, Sale of Stock [Line Items]
Number of shares issued in transaction (in shares)	853,363		562,055
Shelf Registration [Member]
Subsidiary, Sale of Stock [Line Items]
Authorized amount				16,000
Shelf Registration [Member] | Common Stock [Member]
Subsidiary, Sale of Stock [Line Items]
Authorized amount				$ 50,000

Segment and Geographic Inform_3

Segment and Geographic Information (Segment Information) (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2018USD ($)segment	Dec. 31, 2017USD ($)
Revenue, Major Customer [Line Items]
Number of reportable segments | segment	1
Revenues	$ 60,854	$ 64,310
U.S [Member]
Revenue, Major Customer [Line Items]
Revenues	28,206	32,452
Outside of US [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 32,648	$ 31,858
Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of total revenue	100.00%	100.00%
Revenue [Member] | Product Risk [Member] | U.S [Member]
Revenue, Major Customer [Line Items]
Percentage of total revenue	46.40%	50.50%
Revenue [Member] | Product Risk [Member] | Outside of US [Member]
Revenue, Major Customer [Line Items]
Percentage of total revenue	53.60%	49.50%
Distributor Sales [Member] | Product Risk [Member] | Outside of US [Member]
Revenue, Major Customer [Line Items]
Percentage of total revenue	24.80%	24.80%
Distributor Sales [Member] | Product Risk [Member] | Non US Next Largest Single Country [Member]
Revenue, Major Customer [Line Items]
Percentage of total revenue	7.60%	8.20%
ESS [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 23,380	$ 16,481
ESS [Member] | U.S [Member]
Revenue, Major Customer [Line Items]
Revenues	11,016	8,019
ESS [Member] | Outside of US [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 12,364	$ 8,462
ESS [Member] | Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of total revenue	38.40%	25.60%
IGB [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 17,739	$ 19,442
IGB [Member] | U.S [Member]
Revenue, Major Customer [Line Items]
Revenues	5,400	6,301
IGB [Member] | Outside of US [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 12,339	$ 13,141
IGB [Member] | Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of total revenue	29.20%	30.30%
Endo-Bariatric [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 41,119	$ 35,923
Endo-Bariatric [Member] | U.S [Member]
Revenue, Major Customer [Line Items]
Revenues	16,416	14,320
Endo-Bariatric [Member] | Outside of US [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 24,703	$ 21,603
Endo-Bariatric [Member] | Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of total revenue	67.60%	55.90%
Surgical [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 18,708	$ 27,593
Surgical [Member] | U.S [Member]
Revenue, Major Customer [Line Items]
Revenues	10,795	17,366
Surgical [Member] | Outside of US [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 7,913	$ 10,227
Surgical [Member] | Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of total revenue	30.70%	42.90%
Other [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 1,027	$ 794
Other [Member] | U.S [Member]
Revenue, Major Customer [Line Items]
Revenues	995	766
Other [Member] | Outside of US [Member]
Revenue, Major Customer [Line Items]
Revenues	$ 32	$ 28
Other [Member] | Revenue [Member] | Product Risk [Member]
Revenue, Major Customer [Line Items]
Percentage of total revenue	1.70%	1.20%

Segment and Geographic Inform_4

Segment and Geographic Information (Long-Lived Assets by Geographic Area) (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	$ 5,897	$ 6,885
U.S [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	2,337	2,855
Costa Rica [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	3,347	3,748
Outside of US [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	$ 213	$ 282

Subsequent Events (Details)

Subsequent Events (Details) - Line of Credit [Member] - Subsequent Event [Member]	1 Months Ended
	Mar. 18, 2019USD ($)
Term Loan Facility [Member]
Subsequent Event [Line Items]
Line of credit	$ 35,000,000
Additional borrowing capacity	15,000,000
Minimum liquidity	10,000,000
Closing fees	$ 263,000
Term Loan Facility [Member] | LIBOR [Member]
Subsequent Event [Line Items]
Basis spread on variable rate	7.50%
Senior Secured Credit Facility [Member]
Subsequent Event [Line Items]
Repayments of debt	$ 22,372,000