Apollo Endosurgery (APEN) 10-K 22 Feb 22 2021 FY Annual report Financial data

Cover Page

Cover Page - USD ($)	12 Months Ended
	Dec. 31, 2021	Jan. 31, 2022	Jun. 30, 2021
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2021
Document Transition Report	false
Entity File Number	001-35706
Entity Registrant Name	APOLLO ENDOSURGERY, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	16-1630142
Entity Address, Address Line One	1120 S. Capital of Texas Highway
Entity Address, Address Line Two	Building 1, Suite #300
Entity Address, City or Town	Austin
Entity Address, State or Province	TX
Entity Address, Postal Zip Code	78746
City Area Code	512
Local Phone Number	279-5100
Title of 12(b) Security	Common Stock, $0.001 par value per share
Trading Symbol	APEN
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
ICFR Auditor Attestation Flag	false
Entity Public Float			$ 192,292,615
Entity Common Stock, Shares Outstanding		39,623,333
Documents Incorporated by Reference	DOCUMENTS INCORPORATED BY REFERENCE Portions of the Definitive Proxy Statement for the registrant’s 2022 Annual Meeting of Stockholders are incorporated by reference into Part III of this Annual Report on Form 10-K. The Definitive Proxy Statement will be filed no later than 120 days after the close of the registrant’s fiscal year ended December 31, 2021.
Entity Central Index Key	0001251769
Current Fiscal Year End Date	--12-31
Amendment Flag	false
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	FY

Audit Information

Audit Information	12 Months Ended
	Dec. 31, 2021
Audit Information [Abstract]
Auditor Firm ID	659
Auditor Name	Moss Adams LLP
Auditor Location	Dallas, Texas

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 90,691	$ 36,235
Accounts receivable, net of allowance for doubtful accounts of $330 and $634, respectively	10,078	8,218
Inventory	11,966	10,306
Prepaid expenses and other current assets	1,965	3,771
Total current assets	114,700	58,530
Restricted cash	1,121	965
Property, equipment and right-of-use assets, net	5,593	6,221
Goodwill	5,290	5,290
Intangible assets, net of accumulated amortization of $14,814 and $13,231, respectively	4,400	6,017
Other assets	424	414
Total assets	131,528	77,437
Current liabilities:
Accounts payable	4,584	3,675
Accrued expenses	9,902	7,357
Current portion of long-term debt	0	636
Total current liabilities	14,486	11,668
Long-term debt	33,473	37,192
Convertible debt	19,513	19,387
Long-term liabilities	2,819	2,439
Total liabilities	70,291	70,686
Commitments and contingencies
Stockholders’ equity:
Common stock; $0.001 par value; 100,000,000 shares authorized; 39,546,323 and 25,819,329 shares issued and outstanding at December 31, 2021 and 2020, respectively	40	26
Additional paid-in capital	356,516	276,569
Accumulated other comprehensive income	2,136	2,929
Accumulated deficit	(297,455)	(272,773)
Total stockholders’ equity	61,237	6,751
Total liabilities and stockholders’ equity	$ 131,528	$ 77,437

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 330	$ 634
Accumulated amortization, intangible assets	$ 14,814	$ 13,231
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)	39,546,323	25,819,329
Common stock, shares outstanding (in shares)	39,546,323	25,819,329

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Income Statement [Abstract]
Revenues	$ 62,989	$ 42,048
Cost of sales	28,030	19,806
Gross margin	34,959	22,242
Operating expenses:
Sales and marketing	24,311	17,355
General and administrative	18,448	11,062
Research and development	9,524	7,670
Amortization of intangible assets	1,875	1,949
Total operating expenses	54,158	38,036
Loss from operations	(19,199)	(15,794)
Other (income) expenses:
Interest expense, net	8,318	5,251
Gain on forgiveness of PPP loan	(2,852)	0
Other (income) expense, net	(139)	1,424
Net loss before income taxes	(24,526)	(22,469)
Income tax expense	156	142
Net loss	(24,682)	(22,611)
Other comprehensive (loss)/income:
Foreign currency translation	(793)	1,299
Comprehensive loss	$ (25,475)	$ (21,312)
Net loss per share, basic (USD per share)	$ (0.82)	$ (0.99)
Weighted Average Number of Shares Outstanding, Diluted	30,243,264	22,756,167
Shares used in computing net loss per share, basic (shares)	30,243,264	22,756,167
Shares used in computing net loss per share, diluted (shares)	$ (0.82)	$ (0.99)

Consolidated Statements of Chan

Consolidated Statements of Changes in Stockholders’ Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Income	Accumulated Deficit
Beginning balance (shares) at Dec. 31, 2019		20,951,963
Beginning balance at Dec. 31, 2019	$ 2,123	$ 21	$ 250,634	$ 1,630	$ (250,162)
Stockholders' Equity:
Exercise of common stock options (shares)		5,982
Exercise of common stock options	14		14
Exercise of common stock warrants (in shares)		2,105,836
Exercise of common stock warrants		$ 2	(2)
Issuance of restricted stock units (shares)		85,223
Issuance of common stock for convertible debt interest (in shares)		164,797
Issuance of common stock for convertible debt interest	467		467
Issuance of common stock, net of issuance costs (shares)		2,480,000
Issuance of common stock, net of issuance costs	23,262	$ 3	23,259
Conversion of convertible debt (in shares)		25,528
Conversion of convertible debt	83		83
Stock-based compensation	2,114		2,114
Foreign currency translation	1,299			1,299
Net loss	$ (22,611)				(22,611)
Ending balance (shares) at Dec. 31, 2020	25,819,329	25,819,329
Ending balance at Dec. 31, 2020	$ 6,751	$ 26	276,569	2,929	(272,773)
Stockholders' Equity:
Exercise of common stock options (shares)		698,070
Exercise of common stock options	2,488	$ 1	2,487
Exercise of common stock warrants (in shares)		2,668,247
Exercise of common stock warrants	2	$ 3	(1)
Issuance of restricted stock units (shares)		433,172
Issuance of common stock for convertible debt interest (in shares)		244,861
Issuance of common stock for convertible debt interest	1,229		1,229
Issuance of common stock, net of issuance costs (shares)		9,660,000
Issuance of common stock, net of issuance costs	69,782	$ 10	69,772
Conversion of convertible debt (in shares)		22,644
Conversion of convertible debt	74		74
Stock-based compensation	6,386		6,386
Foreign currency translation	(793)			(793)
Net loss	$ (24,682)				(24,682)
Ending balance (shares) at Dec. 31, 2021	39,546,323	39,546,323
Ending balance at Dec. 31, 2021	$ 61,237	$ 40	$ 356,516	$ 2,136	$ (297,455)

Consolidated Statements of Ch_2

Consolidated Statements of Changes in Stockholders’ Equity (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Statement of Stockholders' Equity [Abstract]
Stock issuance costs	$ 5,083	$ 1,721

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities:
Net loss	$ (24,682)	$ (22,611)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	3,232	3,730
Gain on forgiveness of PPP loan	(2,852)	0
Amortization of deferred financing costs	1,419	656
Non-cash interest	1,575	1,501
Provision for doubtful accounts receivable	152	52
Inventory impairment	50	50
Stock-based compensation	6,386	2,114
Unrealized foreign exchange on intercompany payables	(444)	1,208
Changes in operating assets and liabilities:
Accounts receivable	(2,332)	1,079
Inventory	(1,740)	(1,559)
Prepaid expenses and other assets	(1,251)	56
Accounts payable and accrued expenses	6,033	(7,088)
Net cash used in operating activities	(14,454)	(20,812)
Cash flows from investing activities:
Purchases of property and equipment	(1,195)	(486)
Purchases of intangibles and other assets	(261)	(144)
Proceeds from sale of equipment	17	0
Divestiture of Surgical product line	3,000	2,000
Net cash provided by investing activities	1,561	1,370
Cash flows from financing activities:
Proceeds from exercise of stock options	2,488	14
Proceeds from exercise of warrants	2	0
Proceeds from issuance of common stock	69,782	23,262
Proceeds from senior secured term loans	35,000	0
Proceeds from long-term debt	0	2,824
Payments of deferred financing costs	(1,540)	(487)
Repayments of senior secured notes	(38,150)	0
Net cash provided by financing activities	67,582	25,613
Effect of exchange rate changes on cash	(77)	108
Net increase in cash, cash equivalents and restricted cash	54,612	6,279
Cash, cash equivalents and restricted cash at beginning of year	37,200	30,921
Cash, cash equivalents and restricted cash at end of year	91,812	37,200
Supplemental disclosure of cash flow information:
Cash paid for interest	6,550	3,182
Cash paid for income taxes	272	192
Right-of-use assets recognized in exchange for lease obligations (non-cash)	(556)	1,146
Gain on forgiveness of PPP loan (non-cash)	2,852	0
Issuance of common stock for convertible debt interest (non-cash)	1,229	467
Issuance of common stock for conversion of convertible debt (non-cash)	$ 74	$ 83

Organization and Business Descr

Organization and Business Description	12 Months Ended
	Dec. 31, 2021
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 development of next-generation, less invasive medical devices to advance gastrointestinal therapeutic endoscopy. The Company develops and distributes devices that are used by surgeons and gastroenterologists for a variety of procedures related to gastrointestinal conditions including closure of gastrointestinal defects, managing gastrointestinal complications and the treatment of obesity. The Company’s core products include the OverStitch® Endoscopic Suturing System, X-Tack® Endoscopic HeliX Tacking System (collectively “ESS”) and the Orbera® Intragastric Balloon System (“IGB”). All devices are regulated by the U.S. Food and Drug Administration (the “FDA”) or an equivalent regulatory body outside the U.S.

Significant Accounting Policies

Significant Accounting Policies	12 Months Ended
	Dec. 31, 2021
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 assessment, useful lives of intangibles and long-lived assets, 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 four banks to secure obligations under lease agreements and performance based obligations. These letters of credit are secured by cash balances totaling $1,121 and $965 which are recorded in restricted cash on the consolidated balance sheet as of December 31, 2021 and 2020, 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 deemed uncollectible. Accounts receivable of $454 and $115 were written off during the years ended December 31, 2021 and 2020, respectively. (f) Inventory Inventory is stated at the lower of cost or net realizable value. Inventory costs include raw materials, inbound freight charges, warehousing costs, labor, and overhead expenses related to the Company’s manufacturing and processing facilities. Charges for excess and obsolete inventory are based on specific identification of obsolete inventory items and an analysis of inventory items approaching expiration date. The Company records 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, and restricted cash, 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 $35,000 and $41,100 at December 31, 2021 and 2020, respectively. The Company’s convertible debt is estimated by management to approximate $20,500 for both December 31, 2021 and 2020. 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) Leases Lease arrangements are generally recognized at lease commitment. Operating lease right-of-use assets and liabilities are recognized at commencement based on the present value of lease payments over the lease term, except for leases with an initial term of 12 months or less, for which lease expense is recognized as incurred over the lease term. Right-of-use assets represent the Company’s right to use an underlying asset during the reasonably certain lease term, and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Lease terms may include options to extend or terminate the lease when its reasonably certain that the Company will exercise that option. The Company primarily uses its incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. Operating lease right-of-use assets include any lease payments related to initial direct costs and prepayments and excludes lease incentives. Lease expense is recognized on a straight-line basis over the lease term. The Company has lease agreements with lease and non-lease components, which are generally accounted for separately. (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, 2021 and 2020 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, 2021 and 2020 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 the customer, in an amount that reflects the consideration expected to be entitled to in an exchange for 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. The Company’s 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 customers may receive volume rebates or discounts, which are accounted for as variable consideration. The Company estimates these amounts based on the expected amount to be provided to customers and reduces recognized revenues. The Company records 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. The assumptions used in estimating the fair value of stock-based compensation awards represent management’s estimate and involve inherent uncertainties and the application of management’s judgement. 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 $244 and $227 in advertising costs during the years ended December 31, 2021 and 2020, 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) Foreign 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. Exchange rate fluctuations on short-term intercompany loans are included in other expense in the consolidated statement of operations and comprehensive loss. (r) Recent Accounting Pronouncements In August 2020, Accounting Standards Update (“ASU”) No. 2020-06, Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity was issued, which simplifies the accounting for certain financial instruments with characteristics of liabilities and equity, including convertible instruments and contracts on an entity’s own equity. This ASU will become effective for the Company on January 1, 2024 and is not expected to have a material impact on the consolidated financial statements. In May 2021, ASU No. 2021-04, Issuer’s Accounting for Certain Modifications of Exchanges of Freestanding Equity-Classified Written Call Options was issued to clarify the accounting for modifications or exchanges of freestanding equity-classified written call options, such was warrants, that remain equity classified after modification or exchange. This ASU became effective for the Company on January 1, 2022 and is not expected to have a material impact on the consolidated financial statements.

Concentrations

Concentrations	12 Months Ended
	Dec. 31, 2021
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, 2021, the Company’s cash and cash equivalents and restricted cash are held in deposit accounts at four different banks totaling $91,812. 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 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 monitors the compliance of its customers with the Company’s payment terms, but generally requires no collateral. The Company had no concentrations greater than 10% of the Company’s net accounts receivable balance as of December 31, 2021 or 2020. The Company had no single customer that comprised more than 10% of the Company’s total revenues for the years ended December 31, 2021 and 2020.

Inventory

Inventory	12 Months Ended
	Dec. 31, 2021
Inventory Disclosure [Abstract]
Inventory	Inventory Inventory consists of the following as of December 31: 2021 2020 Raw materials $ 3,442 $ 2,344 Work in progress 965 558 Finished goods 7,559 7,404 Total inventory $ 11,966 $ 10,306 The Company recorded an inventory impairment charge of $50 for each of the years ended December 31, 2021 and 2020. Finished goods included $120 of inventory on consignment at customer locations at December 31, 2021.

Prepaid Expenses and Other Asse

Prepaid Expenses and Other Assets	12 Months Ended
	Dec. 31, 2021
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Prepaid Expenses and Other Assets	Prepaid Expenses and Other AssetsThe final installment of $3,000 from the sale of the surgical product line was received in December 2021. Imputed interest income on this receivable was $240 and $416 for the years ended December 31, 2021 and 2020, respectively, and is included within interest expense, net.

Property, Equipment and Right-o

Property, Equipment and Right-of-Use Assets	12 Months Ended
	Dec. 31, 2021
Property, Plant and Equipment [Abstract]
Property, Equipment and Right-of-Use Assets	Property, Equipment and Right-of-Use Assets Property and equipment consists of the following as of December 31: Depreciable Lives 2021 2020 Equipment 5 years $ 7,472 $ 7,452 Right-of-use assets 1 - 8 years 3,459 4,031 Furniture, fixtures and tooling 4 - 8 years 1,855 2,156 Computer hardware 3 - 5 years 1,444 1,244 Leasehold improvements 3 - 7 years 2,059 1,744 Construction in process 483 466 16,772 17,093 Less accumulated depreciation (11,179) (10,872) Property, equipment and right-of-use assets $ 5,593 $ 6,221 The Company recorded depreciation expense of $1,355 and $1,779 for the years ended December 31, 2021 and 2020, respectively. There were no impairment charges for the years ended December 31, 2021 or 2020. The Company disposed of $942 of fully depreciated property and equipment no longer being utilized during the year ended December 31, 2021. The Company has operating leases for office space in Texas, the United Kingdom, and Italy, and for the manufacturing facility in Costa Rica. The Company also has various operating lease agreements for vehicles. As of December 31, 2021, the maturities of the Company’s operating lease liabilities are as follows: 2022 $ 934 2023 555 2024 451 2025 404 2026 416 Thereafter 756 Total lease payments 3,516 Less imputed interest (926) Total operating lease liabilities $ 2,590 Operating lease liabilities of $587 and $2,003 are included in accrued expenses long-term liabilities

Intangible Assets

Intangible Assets	12 Months Ended
	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible Assets Intangible assets consist of the following as of December 31: Useful Life 2021 2020 Customer relationships 9 years $ 8,301 $ 8,301 Orbera technology 12 years 4,600 4,600 Trade names 10 years 1,700 1,700 Patents and trademarks 5 years 2,852 2,597 Capitalized software 1 - 5 years 1,438 2,050 18,891 19,248 Less accumulated amortization (14,491) (13,231) Intangible assets, net $ 4,400 $ 6,017 The Company recorded amortization expense of $1,877 and $1,951 during 2021 and 2020, respectively. Additionally, $256 and $144 related to the extension and renewal of patents and trademarks was capitalized during 2021 and 2020, respectively. Amortization for the next five years is as follows: 2022 $ 1,727 2023 959 2024 677 2025 615 2026 223 Thereafter 199 Total $ 4,400

Accrued Expenses

Accrued Expenses	12 Months Ended
	Dec. 31, 2021
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses consists of the following as of December 31: 2021 2020 Accrued employee compensation and expenses $ 6,569 $ 3,946 Accrued professional service fees 656 358 Accrued interest 613 616 Lease liability 587 675 Accrued taxes 437 442 Accrued returns and rebates 106 129 Other 934 1,191 Total accrued expenses $ 9,902 $ 7,357

Long-Term Debt

Long-Term Debt	12 Months Ended
	Dec. 31, 2021
Debt Disclosure [Abstract]
Long-Term Debt	Long-Term Debt Long-term debt consists of the following as of December 31: 2021 2020 Term loan facility $ 35,000 $ 35,000 PPP loan — 2,824 Deferred interest 6 1,217 Deferred financing costs (1,533) (1,213) Less current portion — (636) Long-term debt $ 33,473 $ 37,192 Term Loan Facility In December 2021, the Company entered into a term loan facility agreement with Innovatus Capital Partners, LLC (“Innovatus”) to borrow up to $100,000 (the “Term Loans”) and drew the Term A Loan of $35,000. The Company is eligible to draw the Term B Loan of $15,000 between July 1, 2023 and December 31, 2023 and the Term C Loan of $25,000 between July 1, 2024 and December 31, 2024, in each case upon the achievement of certain minimum revenue thresholds. The Company is eligible to draw the Term D Loan of $25,000 to finance certain approved acquisitions between June 30, 2022 and June 30, 2024. The Term Loans mature on December 21, 2027, with principal payments beginning February 1, 2027, and bear interest at the greater of the Wall Street Journal Prime Rate or 3.25%, plus 4.0%. Principal payments are due on a straight-line basis after the interest-only period concludes. An additional 4.0% of the outstanding amount will be due at the end of the loan term. Prior to December 21, 2025, Innovatus will have the right to make a one-time election to convert up to 10.0% of the outstanding aggregate principal amount of the term loans into shares of common stock of the Company at a price per share equal to $11.50. The Term Loans include customary affirmative covenants and negative covenants. Additionally, it contains a minimum liquidity covenant, tested on a maintenance basis, and a minimum revenue covenant tested quarterly commencing the earlier of December 31, 2023 or the funding date of the Term B loan. The Company used $35,000 of the proceeds of the Term A Loan to repay the previous senior secured credit agreement in full, including interest. Final and prepayment fees of $3,150 were also paid in December 2021 and unamortized deferred financing costs of $938 were written off in December 2021 in connection with the repayment. Interest expense on the Company’s long-term debt was $7,137, including $2,044 of additional interest related to the prepayment and final fees repaid to the previous lender, and $4,212 for the years ended December 31, 2021 and 2020, respectively. Principal payments of the Company’s long-term debt are as follows: 2022 - 2026 $ — Thereafter 35,000 Total $ 35,000 PPP Loan In March 2020, the CARES Act was signed into law providing certain economic aid packages for qualified entities. In April 2020, the Company was granted a loan of $2,824 under the PPP established under the CARES Act. In June 2021, the Company received forgiveness for the full amount of the $2,852 loan, inclusive of interest, from the SBA.

Convertible Debt

Convertible Debt	12 Months Ended
	Dec. 31, 2021
Debt Disclosure [Abstract]
Convertible Debt	Convertible debt Convertible debt consists of the following as of December 31: 2021 2020 Convertible debt principal $ 20,446 $ 20,519 Deferred financing costs (933) (1,132) Convertible debt $ 19,513 $ 19,387 In August 2019, the Company issued $20,000 aggregate principal amount of 6.0% convertible senior debentures (the “Convertible Debt”), primarily to existing stockholders and officers of the Company. Interest on the Convertible Debt is payable semi-annually in shares of the Company’s common stock on January 1 and July 1 of each year, at a rate of 6.0% per year. The number of shares of common stock required to settle the amount of interest payable will be based on the volume-weighted average price (“VWAP”) of the Company’s common stock for the 10 consecutive trading days immediately preceding the applicable interest payment date. However, in the event that the trailing 10-trading day VWAP of the Company’s common stock is less than $2.50 per share, interest accrued and payable for the applicable interest payment period will accrete to the principal amount then outstanding. The Convertible Debt will mature on August 12, 2026, as amended in December 2020, unless earlier converted or repurchased in accordance with its terms. The Company issued 161,184 shares and 12,068 shares of the Company’s common stock to holders of the Convertible Debt in January 2021 and May 2021, respectively, in fulfillment of $616 of accrued interest as of December 31, 2020. In July 2021, the Company issued 71,609 additional shares of common stock for accrued interest as of June 30, 2021. In January 2022, the Company issued 75,780 shares of the Company’s common stock to holders of the Convertible Debt in fulfillment of $613 of accrued interest as of December 31, 2021. The Convertible Debt converts, at the option of the holders, into shares of the Company’s common stock at an initial conversion price of $3.25 per share, subject to adjustment. If the VWAP of the Company’s common stock has been at least $9.75 (subject to adjustment) for at least 20 trading days during any 30 consecutive trading day period, the Company may force the conversion of all or any part of the outstanding principal amount of the Convertible Debt, accrued and unpaid interest and any other amounts then owing, subject to certain conditions. In February 2021, $74 of the Convertible Debt, including interest, was converted into 22,644 shares of common stock. Interest expense on the Convertible Debt was $1,427 and $1,531 for the years ended December 31, 2021 and 2020, respectively.

Long-Term Liabilities

Long-Term Liabilities	12 Months Ended
	Dec. 31, 2021
Debt Disclosure [Abstract]
Long-Term Liabilities	Long-Term LiabilitiesIncluded in other long-term liabilities as of December 31, 2021 was $816 for the estimated non-current portion of the exit fee obligation to Solar Capital Ltd, which has been reclassified from long-term debt in December 2021. The Company remains obligated to pay $1,925 upon the earlier to occur of (i) certain exit events specified in the Solar Term Loan Facility, or (ii) the Company’s achievement of trailing twelve-month revenue of $100,000.

Stockholders' Equity

Stockholders' Equity	12 Months Ended
	Dec. 31, 2021
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, 2021: Warrant Expiration Date Number of shares Exercise price per share February 27, 2022 163,915 $21.29 Pre-funded - no expiration 13,744,504 $0.001 Total number of warrants outstanding 13,908,419 Weighted average exercise price of warrants outstanding $0.25 During the year ended December 31, 2021, 2,668,247 of pre-funded warrants were exercised into shares of common stock and 40,456 warrants expired.

Stock Option Plans

Stock Option Plans	12 Months Ended
	Dec. 31, 2021
Share-based Payment Arrangement [Abstract]
Stock Option Plans	Stock Option Plans Plans 2017 Plan The Company’s 2017 Equity Incentive Plan (the “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. Certain of the outstanding options were granted under prior equity incentive plans which are no longer in effect. As of December 31, 2021, the Company has 799,630 shares of common stock reserved for issuance under the 2017 Plan. 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, 2021 is presented below. Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Aggregate Intrinsic Value Options outstanding, December 31, 2020 2,921,946 $3.86 7.6 years $1,664 Options granted 1,507,872 $6.36 Options exercised (698,070) $3.57 Options forfeited (248,865) $3.27 Options outstanding, vested and expected to vest, December 31, 2021 3,482,883 $5.04 8.0 years $12,307 Options exercisable 1,484,884 $4.60 6.7 years $6,148 The fair value for options under the Equity Plans was estimated at the date of grant using the Black-Scholes option pricing model. 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: 2021 2020 Risk free interest rate 1.0% 0.4% Expected dividend yield —% —% Estimated volatility 81.1% 73.8% Expected life 6.1 years 5.8 years Additional information regarding options is as follows: 2021 2020 Stock-based compensation cost $6,386 $2,114 Weighted-average grant date fair value of options granted during the period $4.40 $1.31 Aggregate intrinsic value of options exercised during the period $3,494 $8 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, 2021 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, 2021 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. In March 2021, the Company awarded 848,733 stock options to the Company’s chief executive officer in connection with the commencement of his employment. In August 2021, the Company awarded 150,000 stock options to the Company’s chief financial officer in connection with the commencement of his employment. The option grant will vest over a period of four years, with one-quarter of the shares underlying the option vesting on the first anniversary of the grant date and the remainder vesting in equal monthly installments thereafter. In connection with the departure of two executive officers, the terms for the stock option vesting period and exercise period were modified which resulted in additional stock-based compensation of $222 for the year ended December 31, 2021. Unrecognized compensation expense related to unvested options was approximately $6,034 at December 31, 2021, with a weighted-average remaining amortization period of less than 2.9 years. A summary of the restricted stock unit activity, including performance-based stock units, under the Company’s Equity Plans as of December 31, 2021 is presented below: Units Weighted Average Grant Date Fair Value Aggregate Intrinsic Value Restricted stock units outstanding, December 31, 2020 664,666 $2.55 $2,260 Restricted stock units granted 1,111,437 $6.53 Restricted stock units released (433,172) $3.97 Restricted stock units forfeited (148,499) $3.08 Restricted stock units outstanding, December 31, 2021 1,194,432 $5.67 $10,069 In March 2021, the Company awarded 707,278 performance-based restricted stock units to the Company’s chief executive officer in connection with the commencement of his employment. The performance-based restricted stock units vest in four equal tranches upon the achievement of revenue for the trailing four quarters equal to $50,000, $65,000, $80,000, and $95,000. The revenue milestone for the first tranche was achieved as of June 30, 2021. In August 2021, the Company awarded 80,000 time-based restricted stock units and 120,000 performance-based restricted stock units to the Company’s chief financial officer in connection with the commencement of his employment. The time-based restricted stock units vest in four equal tranches upon completion of each year of employment. The performance-based restricted stock units vest in three equal tranches upon the achievement of revenue for the trailing four quarters equal to $70,000, $90,000, and $110,000. In connection with the departure of an executive officer, the vesting terms for restricted stock units outstanding were modified which resulted in additional stock-based compensation of $76 for the year ended December 31, 2021. Unrecognized compensation expense related to unvested restricted stock units and performance-based stock units was approximately $1,988 and $2,284, respectively, at December 31, 2021, with a remaining weighted-average amortization period of 1.6 years.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies (a) 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. (b) 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 three (c) 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.

Defined Contribution Plan

Defined Contribution Plan	12 Months Ended
	Dec. 31, 2021
Retirement Benefits [Abstract]
Defined Contribution Plan	Defined Contribution PlanThe Company sponsors defined contribution plans for employees in the U.S. and Europe. The cost of these plans, including employer contributions, was $729 and $581 for the years ended December 31, 2021 and 2020 respectively.

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes Income tax expense of $156 and $142 for the years ended December 31, 2021 and 2020, respectively is composed of foreign income taxes on earnings generated by 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: 2021 2020 Deferred tax assets: Capitalized transaction costs $ 250 $ 279 Intangible assets 1,205 1,100 Inventory valuation 43 28 Research and development credit 4,005 4,123 Interest expense carryforward 4,980 3,121 Foreign timing differences 624 578 Depreciable assets 53 — Other 1,871 1,095 Net operating loss carryforwards 57,739 53,666 70,770 63,990 Deferred tax liabilities: Unremitted foreign earnings (448) (463) Depreciable assets — (93) (448) (556) Total net deferred tax assets 70,322 63,434 Less valuation allowance (70,055) (63,243) Net deferred tax assets (included in other assets) $ 267 $ 191 The Company has established a valuation allowance 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 $6,812 during the year ended December 31, 2021, primarily as a result of changes in net operating loss. As of December 31, 2021, 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% to income before income taxes as a result of the following: 2021 2020 Tax at U.S. statutory rate $ (5,150) $ (4,719) State taxes, net of deferred benefit (783) (536) Foreign tax rate differential (260) (327) Foreign taxes (169) (13) Permanent differences (231) 702 Research and development tax credit — (313) Other (124) 365 Deferred tax adjustment (43) 756 Unremitted foreign earnings 27 33 Valuation allowance - current year 6,889 4,194 Income tax expense $ 156 $ 142 Income tax expense consists of the following: 2021 2020 Current taxes: U.S. state $ 2 $ 11 International 239 279 Total current income tax expense 241 290 Deferred taxes: International (85) (148) Total deferred income tax expense (85) (148) Income tax expense $ 156 $ 142 As of December 31, 2021, the Company had U.S. federal net operating loss carryforwards of approximately $239,847, of which $96,010 has an unlimited life and the remaining amount 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, 2021 were $139,022. However, the Company’s deferred tax asset value for this section 382 reduction is not reflected in the table above until written off in a future tax return. There have been no additional section 382 reductions through December 31, 2021. The deferred tax asset associated with net operating loss carryforwards has been 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 $119,712 which will begin to expire in varying amounts beginning in 2022, if not utilized. The Company had foreign net operating losses of approximately $2,403 which do not expire.

Net Loss Per Share

Net Loss Per Share	12 Months Ended
	Dec. 31, 2021
Earnings Per Share [Abstract]
Net Loss Per Share	Net Loss Per ShareThe 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, convertible debt, restricted stock units, including performance-based 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 on a weighted average basis): Year Ended December 31 2021 2020 Warrants for common stock 13,908,419 8,068,615 Convertible debt 6,310,235 6,310,621 Common stock options 3,094,197 2,520,029 Restricted stock units 920,066 487,636 24,232,917 17,386,901

Segment and Geographic Informat

Segment and Geographic Information	12 Months Ended
	Dec. 31, 2021
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. 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, 2021 Year Ended December 31, 2020 U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 25,917 $ 14,048 $ 39,965 63.4 % $ 15,774 $ 9,955 $ 25,729 61.2 % IGB 7,193 14,904 22,097 35.1 % 5,045 9,739 14,784 35.2 % Other 894 33 927 1.5 % 1,453 82 1,535 3.6 % Total revenues $ 34,004 $ 28,985 $ 62,989 100.0 % $ 22,272 $ 19,776 $ 42,048 100.0 % % Total revenues 54.0 % 46.0 % 53.0 % 47.0 % Total distributor sales were 44.3% and 35.2% of total OUS revenues for the years ended December 31, 2021 and 2020, respectively. Sales in the next largest individual country outside the U.S. were 6.3% and 7.6% for the years ended December 31, 2021 and 2020, respectively. The following table represents property, equipment and right-of-use assets based on the physical location of the asset: 2021 2020 U.S. $ 1,855 $ 2,149 Costa Rica 3,436 3,641 Other 302 431 Total property, equipment and right-of-use assets, net $ 5,593 $ 6,221

Significant Accounting Polici_2

Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Principles of Consolidation	Principles of ConsolidationThe 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 EstimatesThe 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 assessment, useful lives of intangibles and long-lived assets, long-lived asset and goodwill impairment, allowance for doubtful accounts, and valuation of inventory.
Cash and Cash Equivalents	Cash and Cash EquivalentsThe 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 CashThe Company entered into irrevocable letters of credit with four banks to secure obligations under lease agreements and performance based obligations.
Accounts Receivable	Accounts ReceivableThe 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 deemed uncollectible.
Inventory	InventoryInventory is stated at the lower of cost or net realizable value. Inventory costs include raw materials, inbound freight charges, warehousing costs, labor, and overhead expenses related to the Company’s manufacturing and processing facilities. Charges for excess and obsolete inventory are based on specific identification of obsolete inventory items and an analysis of inventory items approaching expiration date. The Company records 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, and restricted cash, 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 $35,000 and $41,100 at December 31, 2021 and 2020, respectively. The Company’s convertible debt is estimated by management to approximate $20,500 for both December 31, 2021 and 2020. 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 EquipmentProperty 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.
Leases	LeasesLease arrangements are generally recognized at lease commitment. Operating lease right-of-use assets and liabilities are recognized at commencement based on the present value of lease payments over the lease term, except for leases with an initial term of 12 months or less, for which lease expense is recognized as incurred over the lease term. Right-of-use assets represent the Company’s right to use an underlying asset during the reasonably certain lease term, and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Lease terms may include options to extend or terminate the lease when its reasonably certain that the Company will exercise that option. The Company primarily uses its incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. Operating lease right-of-use assets include any lease payments related to initial direct costs and prepayments and excludes lease incentives. Lease expense is recognized on a straight-line basis over the lease term. The Company has lease agreements with lease and non-lease components, which are generally accounted for separately.
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, 2021 and 2020 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 AssetsLong-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 the customer, in an amount that reflects the consideration expected to be entitled to in an exchange for 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. The Company’s 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 customers may receive volume rebates or discounts, which are accounted for as variable consideration. The Company estimates these amounts based on the expected amount to be provided to customers and reduces recognized revenues. The Company records 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 DevelopmentResearch and development costs are expensed as incurred.
Stock-based Compensation Plans	Stock-based Compensation PlansThe 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. The assumptions used in estimating the fair value of stock-based compensation awards represent management’s estimate and involve inherent uncertainties and the application of management’s judgement. 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	AdvertisingThe Company expenses advertising costs as incurred.
Income Taxes	Income TaxesThe 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.
Foreign Currency	Foreign CurrencyThe 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. 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 In August 2020, Accounting Standards Update (“ASU”) No. 2020-06, Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity was issued, which simplifies the accounting for certain financial instruments with characteristics of liabilities and equity, including convertible instruments and contracts on an entity’s own equity. This ASU will become effective for the Company on January 1, 2024 and is not expected to have a material impact on the consolidated financial statements. In May 2021, ASU No. 2021-04, Issuer’s Accounting for Certain Modifications of Exchanges of Freestanding Equity-Classified Written Call Options was issued to clarify the accounting for modifications or exchanges of freestanding equity-classified written call options, such was warrants, that remain equity classified after modification or exchange. This ASU became effective for the Company on January 1, 2022 and is not expected to have a material impact on the consolidated financial statements.
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, convertible debt, restricted stock units, including performance-based 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.

Inventory (Tables)

Inventory (Tables)	12 Months Ended
	Dec. 31, 2021
Inventory Disclosure [Abstract]
Schedule of Inventory	Inventory consists of the following as of December 31: 2021 2020 Raw materials $ 3,442 $ 2,344 Work in progress 965 558 Finished goods 7,559 7,404 Total inventory $ 11,966 $ 10,306

Property, Equipment and Right_2

Property, Equipment and Right-of-Use Assets (Tables)	12 Months Ended
	Dec. 31, 2021
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment	Property and equipment consists of the following as of December 31: Depreciable Lives 2021 2020 Equipment 5 years $ 7,472 $ 7,452 Right-of-use assets 1 - 8 years 3,459 4,031 Furniture, fixtures and tooling 4 - 8 years 1,855 2,156 Computer hardware 3 - 5 years 1,444 1,244 Leasehold improvements 3 - 7 years 2,059 1,744 Construction in process 483 466 16,772 17,093 Less accumulated depreciation (11,179) (10,872) Property, equipment and right-of-use assets $ 5,593 $ 6,221
Schedule of Lease Maturity	As of December 31, 2021, the maturities of the Company’s operating lease liabilities are as follows: 2022 $ 934 2023 555 2024 451 2025 404 2026 416 Thereafter 756 Total lease payments 3,516 Less imputed interest (926) Total operating lease liabilities $ 2,590

Intangible Assets (Tables)

Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	Intangible assets consist of the following as of December 31: Useful Life 2021 2020 Customer relationships 9 years $ 8,301 $ 8,301 Orbera technology 12 years 4,600 4,600 Trade names 10 years 1,700 1,700 Patents and trademarks 5 years 2,852 2,597 Capitalized software 1 - 5 years 1,438 2,050 18,891 19,248 Less accumulated amortization (14,491) (13,231) Intangible assets, net $ 4,400 $ 6,017
Schedule of Amortization Expense	Amortization for the next five years is as follows: 2022 $ 1,727 2023 959 2024 677 2025 615 2026 223 Thereafter 199 Total $ 4,400

Accrued Expenses (Tables)

Accrued Expenses (Tables)	12 Months Ended
	Dec. 31, 2021
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses consists of the following as of December 31: 2021 2020 Accrued employee compensation and expenses $ 6,569 $ 3,946 Accrued professional service fees 656 358 Accrued interest 613 616 Lease liability 587 675 Accrued taxes 437 442 Accrued returns and rebates 106 129 Other 934 1,191 Total accrued expenses $ 9,902 $ 7,357

Long-Term Debt (Tables)

Long-Term Debt (Tables)	12 Months Ended
	Dec. 31, 2021
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Long-term debt consists of the following as of December 31: 2021 2020 Term loan facility $ 35,000 $ 35,000 PPP loan — 2,824 Deferred interest 6 1,217 Deferred financing costs (1,533) (1,213) Less current portion — (636) Long-term debt $ 33,473 $ 37,192
Schedule of Maturities of Long-term Debt	Principal payments of the Company’s long-term debt are as follows: 2022 - 2026 $ — Thereafter 35,000 Total $ 35,000

Convertible Debt (Tables)

Convertible Debt (Tables)	12 Months Ended
	Dec. 31, 2021
Debt Disclosure [Abstract]
Convertible Debt	Convertible debt consists of the following as of December 31: 2021 2020 Convertible debt principal $ 20,446 $ 20,519 Deferred financing costs (933) (1,132) Convertible debt $ 19,513 $ 19,387

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	12 Months Ended
	Dec. 31, 2021
Equity [Abstract]
Schedule of Warrants	Warrants consist of the following as of December 31, 2021: Warrant Expiration Date Number of shares Exercise price per share February 27, 2022 163,915 $21.29 Pre-funded - no expiration 13,744,504 $0.001 Total number of warrants outstanding 13,908,419 Weighted average exercise price of warrants outstanding $0.25

Stock Option Plans (Tables)

Stock Option Plans (Tables)	12 Months Ended
	Dec. 31, 2021
Share-based Payment Arrangement [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, 2021 is presented below. Options Weighted Average Exercise Price Weighted Average Remaining Contractual Term Aggregate Intrinsic Value Options outstanding, December 31, 2020 2,921,946 $3.86 7.6 years $1,664 Options granted 1,507,872 $6.36 Options exercised (698,070) $3.57 Options forfeited (248,865) $3.27 Options outstanding, vested and expected to vest, December 31, 2021 3,482,883 $5.04 8.0 years $12,307 Options exercisable 1,484,884 $4.60 6.7 years $6,148
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: 2021 2020 Risk free interest rate 1.0% 0.4% Expected dividend yield —% —% Estimated volatility 81.1% 73.8% Expected life 6.1 years 5.8 years
Schedule of Other Stock Option Information	Additional information regarding options is as follows: 2021 2020 Stock-based compensation cost $6,386 $2,114 Weighted-average grant date fair value of options granted during the period $4.40 $1.31 Aggregate intrinsic value of options exercised during the period $3,494 $8
Schedule of Restricted Stock Unit Activity	A summary of the restricted stock unit activity, including performance-based stock units, under the Company’s Equity Plans as of December 31, 2021 is presented below: Units Weighted Average Grant Date Fair Value Aggregate Intrinsic Value Restricted stock units outstanding, December 31, 2020 664,666 $2.55 $2,260 Restricted stock units granted 1,111,437 $6.53 Restricted stock units released (433,172) $3.97 Restricted stock units forfeited (148,499) $3.08 Restricted stock units outstanding, December 31, 2021 1,194,432 $5.67 $10,069

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2021
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: 2021 2020 Deferred tax assets: Capitalized transaction costs $ 250 $ 279 Intangible assets 1,205 1,100 Inventory valuation 43 28 Research and development credit 4,005 4,123 Interest expense carryforward 4,980 3,121 Foreign timing differences 624 578 Depreciable assets 53 — Other 1,871 1,095 Net operating loss carryforwards 57,739 53,666 70,770 63,990 Deferred tax liabilities: Unremitted foreign earnings (448) (463) Depreciable assets — (93) (448) (556) Total net deferred tax assets 70,322 63,434 Less valuation allowance (70,055) (63,243) Net deferred tax assets (included in other assets) $ 267 $ 191
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% to income before income taxes as a result of the following: 2021 2020 Tax at U.S. statutory rate $ (5,150) $ (4,719) State taxes, net of deferred benefit (783) (536) Foreign tax rate differential (260) (327) Foreign taxes (169) (13) Permanent differences (231) 702 Research and development tax credit — (313) Other (124) 365 Deferred tax adjustment (43) 756 Unremitted foreign earnings 27 33 Valuation allowance - current year 6,889 4,194 Income tax expense $ 156 $ 142
Schedule of Components of Income Tax Expense (Benefit)	Income tax expense consists of the following: 2021 2020 Current taxes: U.S. state $ 2 $ 11 International 239 279 Total current income tax expense 241 290 Deferred taxes: International (85) (148) Total deferred income tax expense (85) (148) Income tax expense $ 156 $ 142

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	12 Months Ended
	Dec. 31, 2021
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 on a weighted average basis): Year Ended December 31 2021 2020 Warrants for common stock 13,908,419 8,068,615 Convertible debt 6,310,235 6,310,621 Common stock options 3,094,197 2,520,029 Restricted stock units 920,066 487,636 24,232,917 17,386,901

Segment and Geographic Inform_2

Segment and Geographic Information (Tables)	12 Months Ended
	Dec. 31, 2021
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, 2021 Year Ended December 31, 2020 U.S. OUS Total Revenues % Total Revenues U.S. OUS Total Revenues % Total Revenues ESS $ 25,917 $ 14,048 $ 39,965 63.4 % $ 15,774 $ 9,955 $ 25,729 61.2 % IGB 7,193 14,904 22,097 35.1 % 5,045 9,739 14,784 35.2 % Other 894 33 927 1.5 % 1,453 82 1,535 3.6 % Total revenues $ 34,004 $ 28,985 $ 62,989 100.0 % $ 22,272 $ 19,776 $ 42,048 100.0 % % Total revenues 54.0 % 46.0 % 53.0 % 47.0 %
Schedule of Long-Lived Assets by Geographic Area	The following table represents property, equipment and right-of-use assets based on the physical location of the asset: 2021 2020 U.S. $ 1,855 $ 2,149 Costa Rica 3,436 3,641 Other 302 431 Total property, equipment and right-of-use assets, net $ 5,593 $ 6,221

Significant Accounting Polici_3

Significant Accounting Policies (Narrative) (Details)	12 Months Ended
	Dec. 31, 2021USD ($)bank	Dec. 31, 2020USD ($)
Restricted Cash
Number of banks | bank	4
Restricted cash	$ 1,121,000	$ 965,000
Accounts Receivable
Accounts receivable write-offs	454,000	115,000
Fair Value Measurements
Long-term debt, fair value	35,000,000	41,100,000
Goodwill and Other Intangible Assets
Goodwill impairment loss	0	0
Valuation of Long-Lived Assets
Impairment of long-lived assets	$ 0	0
Advertising Expense
Return period	30 days
Advertising costs	$ 244,000	227,000
Convertible debt
Fair Value Measurements
Convertible debt, fair value	$ 20,500,000	$ 20,500,000

Concentrations (Details)

Concentrations (Details) $ in Thousands	Dec. 31, 2021USD ($)bank
Risks and Uncertainties [Abstract]
Number of banks | bank	4
Cash and cash equivalents and restricted cash | $	$ 91,812

Inventory (Details)

Inventory (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Raw materials	$ 3,442	$ 2,344
Work in progress	965	558
Finished goods	7,559	7,404
Total inventory, net	11,966	10,306
Inventory impairment	50	$ 50
Consigned inventory	$ 120

Prepaid Expenses and Other As_2

Prepaid Expenses and Other Assets (Details) - USD ($) $ in Thousands	1 Months Ended	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2020
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Final installment from divestiture		$ 3,000	$ 2,000
Surgical Product Line | Disposal
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Final installment from divestiture	$ 3
Interest income		$ 240	$ 416

Property, Equipment and Right_3

Property, Equipment and Right-of-Use Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Right-of-use assets	$ 3,459	$ 4,031
Property and equipment, gross	16,772	17,093
Less accumulated depreciation	(11,179)	(10,872)
Property, equipment and right-of-use assets	$ 5,593	6,221
Minimum
Property, Plant and Equipment [Line Items]
Depreciable Lives	1 year
Maximum
Property, Plant and Equipment [Line Items]
Depreciable Lives	8 years
Equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 7,472	7,452
Depreciable lives	5 years
Furniture, fixtures and tooling
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 1,855	2,156
Furniture, fixtures and tooling | Minimum
Property, Plant and Equipment [Line Items]
Depreciable lives	4 years
Furniture, fixtures and tooling | Maximum
Property, Plant and Equipment [Line Items]
Depreciable lives	8 years
Computer hardware
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 1,444	1,244
Computer hardware | Minimum
Property, Plant and Equipment [Line Items]
Depreciable lives	3 years
Computer hardware | Maximum
Property, Plant and Equipment [Line Items]
Depreciable lives	5 years
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 2,059	1,744
Leasehold improvements | Minimum
Property, Plant and Equipment [Line Items]
Depreciable lives	3 years
Leasehold improvements | Maximum
Property, Plant and Equipment [Line Items]
Depreciable lives	7 years
Construction in process
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 483	$ 466

Property, Equipment and Right_4

Property, Equipment and Right-of-Use Assets (Lease Narrative) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Jun. 30, 2021
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 1,355,000	$ 1,779,000
Impairment charge	0	0
Disposal of property and equipment	942,000
Lease liability	$ 587,000	$ 675,000
Lease liability extensible list	Accrued expenses	Accrued expenses
Operating lease, liability, noncurrent	$ 2,003,000
Operating lease, liability, noncurrent extensible list	Other Liabilities, Noncurrent
Operating lease, payments	$ 1,109,000	$ 1,156,000
Operating lease, weighted average remaining lease term	4 years 10 months 24 days
Operating lease, weighted average discount rate	8.70%
Renewal term			1 year

Property, Equipment and Right_5

Property, Equipment and Right-of-Use Assets (Lease Maturity) (Details) $ in Thousands	Dec. 31, 2021USD ($)
Property, Plant and Equipment [Abstract]
2022	$ 934
2023	555
2024	451
2025	404
2026	416
Thereafter	756
Total lease payments	3,516
Less imputed interest	(926)
Total operating lease liabilities	$ 2,590

Intangible Assets (Other Intang

Intangible Assets (Other Intangible Assets) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Intangible assets, gross	$ 18,891	$ 19,248
Less accumulated amortization	(14,491)	(13,231)
Total	4,400	6,017
Amortization of intangible assets	$ 1,877	1,951
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Useful life	9 years
Intangible assets, gross	$ 8,301	8,301
Orbera technology
Finite-Lived Intangible Assets [Line Items]
Useful life	12 years
Intangible assets, gross	$ 4,600	4,600
Trade names
Finite-Lived Intangible Assets [Line Items]
Useful life	10 years
Intangible assets, gross	$ 1,700	1,700
Patents and trademarks
Finite-Lived Intangible Assets [Line Items]
Useful life	5 years
Intangible assets, gross	$ 2,852	2,597
Cost incurred to extend and renew patents and trademarks	256	144
Capitalized software
Finite-Lived Intangible Assets [Line Items]
Intangible assets, gross	$ 1,438	$ 2,050
Capitalized software | Minimum
Finite-Lived Intangible Assets [Line Items]
Useful life	1 year
Capitalized software | Maximum
Finite-Lived Intangible Assets [Line Items]
Useful life	5 years

Intangible Assets (Amortization

Intangible Assets (Amortization Expense) (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
2022	$ 1,727
2023	959
2024	677
2025	615
2026	223
Thereafter	199
Total	$ 4,400	$ 6,017

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Payables and Accruals [Abstract]
Accrued employee compensation and expenses	$ 6,569	$ 3,946
Accrued professional service fees	656	358
Accrued interest	613	616
Lease liability	587	675
Accrued taxes	437	442
Accrued returns and rebates	106	129
Other	934	1,191
Total accrued expenses	$ 9,902	$ 7,357

Long-Term Debt (Schedule of Lon

Long-Term Debt (Schedule of Long-term Debt) (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Apr. 30, 2020
Debt Instrument [Line Items]
Deferred financing costs	$ (1,533)	$ (1,213)
Less current portion	0	(636)
Long-term debt	33,473	37,192
Deferred interest
Debt Instrument [Line Items]
Long-term debt, gross	6	1,217
PPP loan
Debt Instrument [Line Items]
Long-term debt, gross	0	2,824	$ 2,824
Line of Credit | Term loan facility
Debt Instrument [Line Items]
Long-term debt, gross	$ 35,000	$ 35,000

Long-Term Debt (Narrative) (Det

Long-Term Debt (Narrative) (Details) - USD ($) $ / shares in Units, $ in Thousands	1 Months Ended	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2020	Jun. 30, 2021	Apr. 30, 2020
Debt Instrument [Line Items]
Line of credit	$ 35,000	$ 35,000
Interest expense		7,137	$ 4,212
Prepayment and final fees		2,044
PPP loan
Debt Instrument [Line Items]
Long-term debt, gross	$ 0	$ 0	2,824		$ 2,824
SBA Loan
Debt Instrument [Line Items]
Long-term debt, gross				$ 2,852
Line of Credit
Debt Instrument [Line Items]
Percent of instrument converted	10.00%	10.00%
Conversion price (USD per share)	$ 11.50	$ 11.50
Line of Credit | Term loan facility
Debt Instrument [Line Items]
Maximum borrowing capacity	$ 100,000	$ 100,000
Interest rate	3.25%	3.25%
Percent of outstanding amount		4.00%
Long-term debt, gross	$ 35,000	$ 35,000	$ 35,000
Line of Credit | Term loan facility | Prime Rate
Debt Instrument [Line Items]
Basis spread on variable rate		4.00%
Line of Credit | Term A Loan
Debt Instrument [Line Items]
Proceeds from term loan	35,000
Line of Credit | Term B Loan
Debt Instrument [Line Items]
Line of credit	15,000	$ 15,000
Line of Credit | Term C Loan
Debt Instrument [Line Items]
Line of credit	25,000	25,000
Line of Credit | Term D Loan
Debt Instrument [Line Items]
Line of credit	25	$ 25
Line of Credit | Senior Secured Credit Facility
Debt Instrument [Line Items]
Loss on debt prepayment	3,150
Unamortized deferred financing costs	$ 938

Long-Term Debt (Schedule of Mat

Long-Term Debt (Schedule of Maturity of Long-term Debt) (Details) $ in Thousands	Dec. 31, 2021USD ($)
Debt Disclosure [Abstract]
2022 - 2026	$ 0
Thereafter	35,000
Total	$ 35,000

Convertible Debt (Schedule of C

Convertible Debt (Schedule of Convertible Debt) (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Deferred financing costs	$ (1,533)	$ (1,213)
Long-term debt	33,473	37,192
Convertible debt
Debt Instrument [Line Items]
Convertible debt principal	20,446	20,519
Deferred financing costs	(933)	(1,132)
Long-term debt	$ 19,513	$ 19,387

Convertible Debt (Narrative) (D

Convertible Debt (Narrative) (Details) $ / shares in Units, $ in Thousands	1 Months Ended						12 Months Ended
	Jan. 31, 2022shares	Jul. 31, 2021shares	May 31, 2021shares	Feb. 28, 2021USD ($)shares	Jan. 31, 2021shares	Aug. 31, 2019USD ($)d$ / shares	Dec. 31, 2021USD ($)shares	Dec. 31, 2020USD ($)shares
Debt Instrument [Line Items]
Proceeds from senior secured term loans							$ 35,000	$ 0
Convertible securities (shares) | shares			12,068
Accrued interest							613	616
Issuance of common stock for convertible debt interest (in shares) | shares		71,609
Conversion of convertible debt				$ 74			74	83
Interest expense							$ 7,137	$ 4,212
Common Stock
Debt Instrument [Line Items]
Convertible securities (shares) | shares				22,644			22,644	25,528
Issuance of common stock for convertible debt interest (in shares) | shares							244,861	164,797
Convertible debt
Debt Instrument [Line Items]
Proceeds from senior secured term loans						$ 20,000
Interest rate						6.00%
Share price (in dollars per share) | $ / shares						$ 2.50
Convertible securities (shares) | shares					161,184
Accrued interest							$ 613
Interest expense							$ 1,427	$ 1,531
Convertible debt | Subsequent Event
Debt Instrument [Line Items]
Convertible securities (shares) | shares	75,780
Convertible debt | Conversion Ratio Less Than 2.50
Debt Instrument [Line Items]
Consecutive trading days | d						10
Convertible debt | Conversion Ratio Of 3.25
Debt Instrument [Line Items]
Consecutive trading days | d						30
Conversion price (USD per share) | $ / shares						$ 3.25
Stock price trigger (USD per share) | $ / shares						$ 9.75
Threshold trading days | d						20

Long-Term Liabilities (Details)

Long-Term Liabilities (Details) $ in Thousands	Dec. 31, 2021USD ($)
Debt Instrument [Line Items]
Exit fee liability, noncurrent	$ 816
Solar Term Loan Facility
Debt Instrument [Line Items]
Liabilities, noncurrent	1,925
Trailing twelve month revenue	$ 100,000

Stockholders' Equity (Authorize

Stockholders' Equity (Authorized Stock) (Details) - $ / shares	Dec. 31, 2021	Dec. 31, 2020
Equity [Abstract]
Preferred and common stock, shares authorized (in shares)	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 (in shares)	15,000,000
Preferred stock, par value (USD per share)	$ 0.001

Stockholders' Equity (Warrants)

Stockholders' Equity (Warrants) (Details)	Dec. 31, 2021$ / sharesshares
Class of Warrant or Right [Line Items]
Total number of warrants outstanding (shares)	13,908,419
Exercise price (USD per share) | $ / shares	$ 0.25
Warrants to purchase (shares)	2,668,247
Expired (in shares)	40,456
February 27, 2022
Class of Warrant or Right [Line Items]
Total number of warrants outstanding (shares)	163,915
Exercise price (USD per share) | $ / shares	$ 21.29
Pre-funded - no expiration
Class of Warrant or Right [Line Items]
Total number of warrants outstanding (shares)	13,744,504
Exercise price (USD per share) | $ / shares	$ 0.001

Stock Option Plans (Plans) (Det

Stock Option Plans (Plans) (Details) - 2017 Plan	12 Months Ended
	Dec. 31, 2021shares
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%
Annual increase in reserve, active term	10 years
Common stock reserved for issuance (in shares)	799,630

Stock Option Plans (Stock Optio

Stock Option Plans (Stock Option Activity) (Details) - Equity Plans - Stock Option - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Options
Options outstanding, beginning balance (in shares)	2,921,946
Options granted (in shares)	1,507,872
Options exercised (in shares)	(698,070)
Options forfeited (in shares)	(248,865)
Options outstanding, ending balance (in shares)	3,482,883	2,921,946
Options exercisable (in shares)	1,484,884
Weighted Average Exercise Price
Weighted average exercise price, beginning balance (in USD per share)	$ 3.86
Options granted (in USD per share)	6.36
Options exercised (in USD per share)	3.57
Options forfeited (in USD per share)	3.27
Weighted average exercise price, ending balance (in USD per share)	5.04	$ 3.86
Options exercisable (in USD per share)	$ 4.60
Weighted Average Remaining Contractual Term
Weighted average remaining contractual term	8 years	7 years 7 months 6 days
Options exercisable	6 years 8 months 12 days
Aggregate Intrinsic Value
Aggregate intrinsic value	$ 12,307	$ 1,664
Options exercisable	$ 6,148

Stock Option Plans (Fair Value

Stock Option Plans (Fair Value of Stock Options) (Details) - Stock Option	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk free interest rate	1.00%	0.40%
Expected dividend yield	0.00%	0.00%
Estimated volatility	81.10%	73.80%
Expected life	6 years 1 month 6 days	5 years 9 months 18 days

Stock Option Plans (Additional

Stock Option Plans (Additional Information) (Details) $ / shares in Units, $ in Thousands	1 Months Ended		12 Months Ended
	Aug. 31, 2021USD ($)trancheshares	Mar. 31, 2021USD ($)trancheshares	Dec. 31, 2021USD ($)officer$ / sharesshares	Dec. 31, 2020USD ($)$ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation			$ 6,386	$ 2,114
Number of executive officers departed | officer			2
Employee benefits and share-based compensation			$ 222
Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation			$ 6,386	$ 2,114
Weighted-average grant date fair value of options granted during the period (USD per share) | $ / shares			$ 4.40	$ 1.31
Aggregate intrinsic value of options exercised during the period			$ 3,494	$ 8
Unrecognized compensation expense related to unvested options			$ 6,034
Remaining amortization period, less then			2 years 10 months 24 days
Stock Option | Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted (in shares) | shares		848,733
Stock Option | Chief Financial Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Options granted (in shares) | shares	150,000
Vesting period	4 years
Award vesting rights, percentage	25.00%
Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Compensation not yet recognized			$ 2,284
Restricted Stock Units (RSUs) And Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Employee benefits and share-based compensation			$ 76
Restricted Stock Units (RSUs) And Performance Shares | Chief Executive Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted stock units granted (in shares) | shares		707,278
Number of tranches | tranche		4
Restricted Stock Units (RSUs) And Performance Shares | Chief Executive Officer | Share-based Payment Arrangement, Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Amount vested		$ 50,000
Restricted Stock Units (RSUs) And Performance Shares | Chief Executive Officer | Share-based Payment Arrangement, Tranche Two
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Amount vested		65,000
Restricted Stock Units (RSUs) And Performance Shares | Chief Executive Officer | Share-based Payment Arrangement, Tranche Three
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Amount vested		80,000
Restricted Stock Units (RSUs) And Performance Shares | Chief Executive Officer | Share-Based Payment Arrangement, Tranche Four
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Amount vested		$ 95,000
Restricted Stock Units (RSUs) And Performance Shares | Chief Financial Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted stock units granted (in shares) | shares	120,000
Number of tranches | tranche	3
Restricted Stock Units (RSUs) And Performance Shares | Chief Financial Officer | Share-based Payment Arrangement, Tranche One
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Amount vested	$ 70,000
Restricted Stock Units (RSUs) And Performance Shares | Chief Financial Officer | Share-based Payment Arrangement, Tranche Two
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Amount vested	90,000
Restricted Stock Units (RSUs) And Performance Shares | Chief Financial Officer | Share-based Payment Arrangement, Tranche Three
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Amount vested	$ 110,000
Restricted Stock Units (RSUs) And Time-based Shares | Chief Financial Officer
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted stock units granted (in shares) | shares	80,000
Number of tranches | tranche	4
Restricted stock units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Remaining amortization period, less then			1 year 7 months 6 days
Restricted stock units granted (in shares) | shares			1,111,437
Compensation not yet recognized			$ 1,988

Stock Option Plans (Restricted

Stock Option Plans (Restricted Stock Units Activity) (Details) - Restricted stock units - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Units
Shares outstanding beginning balance (in shares)	664,666
Restricted stock units granted (in shares)	1,111,437
Restricted stock units vested (in shares)	(433,172)
Restricted stock units forfeited (in shares)	(148,499)
Shares outstanding ending balance (in shares)	1,194,432
Weighted-Average Grant Date Fair Value
Units outstanding beginning balance (in USD per share)	$ 2.55
Restricted stock units granted (in USD per share)	6.53
Restricted stock units vested (in USD per share)	3.97
Restricted stock units forfeited (in USD per share)	3.08
Units outstanding ending balance (in USD per share)	$ 5.67
Intrinsic value	$ 10,069	$ 2,260

Commitments and Contingencies (

Commitments and Contingencies (Employment Agreements) (Details)	12 Months Ended
	Dec. 31, 2021
Minimum
Other Commitments [Line Items]
Period for salary and benefits payment	3 months
Maximum
Other Commitments [Line Items]
Period for salary and benefits payment	12 months
Executive Officer
Other Commitments [Line Items]
Period following change in control	12 months
Executive Officer | Minimum
Other Commitments [Line Items]
Period for salary and benefits payment	3 months
Executive Officer | Maximum
Other Commitments [Line Items]
Period for salary and benefits payment	24 months

Defined Contribution Plan (Deta

Defined Contribution Plan (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Retirement Benefits [Abstract]
Cost of defined contribution plan	$ 729	$ 581

Income Taxes (Narrative) (Detai

Income Taxes (Narrative) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Operating Loss Carryforwards [Line Items]
Income tax expense	$ 156,000	$ 142,000
Valuation allowance, increase (decrease)	6,812,000
Unrecognized tax benefits	0
Domestic Tax Authority
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	239,847,000
Operating loss carryforwards, unlimited life	96,010,000
Operating loss carryforwards, reduction due to ownership change	100,825,000
Operating loss carryforwards, net	139,022,000
State and Local Jurisdiction
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	119,712,000
Foreign Tax Authority
Operating Loss Carryforwards [Line Items]
Operating loss carryforwards	$ 2,403,000

Income Taxes (Deferred Tax Asse

Income Taxes (Deferred Tax Assets Liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred tax assets:
Capitalized transaction costs	$ 250	$ 279
Intangible assets	1,205	1,100
Inventory valuation	43	28
Research and development credit	4,005	4,123
Interest expense carryforward	4,980	3,121
Foreign timing differences	624	578
Depreciable assets	53	0
Other	1,871	1,095
Net operating loss carryforwards	57,739	53,666
Deferred tax assets, gross	70,770	63,990
Deferred tax liabilities:
Unremitted foreign earnings	(448)	(463)
Depreciable assets	0	(93)
Total deferred tax liabilities	(448)	(556)
Total net deferred tax assets	70,322	63,434
Less valuation allowance	(70,055)	(63,243)
Net deferred tax assets (included in other assets)	$ 267	$ 191

Income Taxes (Effective Income

Income Taxes (Effective Income Tax Rate) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Tax at U.S. statutory rate	$ (5,150)	$ (4,719)
State taxes, net of deferred benefit	(783)	(536)
Foreign tax rate differential	(260)	(327)
Foreign taxes	(169)	(13)
Permanent differences	(231)	702
Research and development tax credit	0	(313)
Other	(124)	365
Deferred tax adjustment	(43)	756
Unremitted foreign earnings	27	33
Valuation allowance - current year	6,889	4,194
Income tax expense	$ 156	$ 142

Income Taxes (Income Tax Expens

Income Taxes (Income Tax Expense) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Current taxes:
U.S. state	$ 2	$ 11
International	239	279
Total current income tax expense	241	290
Deferred taxes:
International	(85)	(148)
Total deferred income tax expense	(85)	(148)
Income tax expense	$ 156	$ 142

Net Loss Per Share (Details)

Net Loss Per Share (Details) - shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	24,232,917	17,386,901
Warrants for common stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	13,908,419	8,068,615
Convertible debt
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	6,310,235	6,310,621
Common stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	3,094,197	2,520,029
Restricted stock units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities excluded from computation of diluted loss per share	920,066	487,636

Segment and Geographic Inform_3

Segment and Geographic Information (Segment Information) (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2021USD ($)segment	Dec. 31, 2020USD ($)
Revenue, Major Customer [Line Items]
Number of reportable segments | segment	1
Revenues	$ 62,989	$ 42,048
U.S.
Revenue, Major Customer [Line Items]
Revenues	34,004	22,272
Other
Revenue, Major Customer [Line Items]
Revenues	$ 28,985	$ 19,776
Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of total revenue	100.00%	100.00%
Revenue | Product Risk | U.S.
Revenue, Major Customer [Line Items]
Percentage of total revenue	54.00%	53.00%
Revenue | Product Risk | Other
Revenue, Major Customer [Line Items]
Percentage of total revenue	46.00%	47.00%
Distributor Sales | Product Risk | Other
Revenue, Major Customer [Line Items]
Percentage of total revenue	44.30%	35.20%
Distributor Sales | Product Risk | Non US Next Largest Single Country
Revenue, Major Customer [Line Items]
Percentage of total revenue	6.30%	7.60%
ESS
Revenue, Major Customer [Line Items]
Revenues	$ 39,965	$ 25,729
ESS | U.S.
Revenue, Major Customer [Line Items]
Revenues	25,917	15,774
ESS | Other
Revenue, Major Customer [Line Items]
Revenues	$ 14,048	$ 9,955
ESS | Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of total revenue	63.40%	61.20%
IGB
Revenue, Major Customer [Line Items]
Revenues	$ 22,097	$ 14,784
IGB | U.S.
Revenue, Major Customer [Line Items]
Revenues	7,193	5,045
IGB | Other
Revenue, Major Customer [Line Items]
Revenues	$ 14,904	$ 9,739
IGB | Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of total revenue	35.10%	35.20%
Other
Revenue, Major Customer [Line Items]
Revenues	$ 927	$ 1,535
Other | U.S.
Revenue, Major Customer [Line Items]
Revenues	894	1,453
Other | Other
Revenue, Major Customer [Line Items]
Revenues	$ 33	$ 82
Other | Revenue | Product Risk
Revenue, Major Customer [Line Items]
Percentage of total revenue	1.50%	3.60%

Segment and Geographic Inform_4

Segment and Geographic Information (Long-Lived Assets by Geographic Area) (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	$ 5,593	$ 6,221
U.S.
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	1,855	2,149
Costa Rica
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	3,436	3,641
Other
Revenues from External Customers and Long-Lived Assets [Line Items]
Total property and equipment, net	$ 302	$ 431