Document And Entity Information
Document And Entity Information - USD ($) | 12 Months Ended | ||
Dec. 31, 2022 | Feb. 24, 2023 | Jun. 30, 2022 | |
Document Information [Line Items] | |||
Entity Central Index Key | 0000876378 | ||
Entity Registrant Name | ASENSUS SURGICAL, INC. | ||
Amendment Flag | false | ||
Current Fiscal Year End Date | --12-31 | ||
Document Fiscal Period Focus | FY | ||
Document Fiscal Year Focus | 2022 | ||
Document Type | 10-K | ||
Document Annual Report | true | ||
Document Period End Date | Dec. 31, 2022 | ||
Document Transition Report | false | ||
Entity File Number | 0-19437 | ||
Entity Incorporation, State or Country Code | DE | ||
Entity Tax Identification Number | 11-2962080 | ||
Entity Address, Address Line One | 1 TW Alexander Drive, Suite 160 | ||
Entity Address, City or Town | Durham | ||
Entity Address, State or Province | NC | ||
Entity Address, Postal Zip Code | 27703 | ||
City Area Code | 919 | ||
Local Phone Number | 765-8400 | ||
Title of 12(b) Security | Common Stock $0.001 par value per share | ||
Trading Symbol | ASXC | ||
Security Exchange Name | NYSE | ||
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 | ||
ICFR Auditor Attestation Flag | false | ||
Entity Shell Company | false | ||
Entity Public Float | $ 93,100,000 | ||
Entity Common Stock, Shares Outstanding | 239,279,746 | ||
Auditor Name | BDO USA, LLP | ||
Auditor Location | Raleigh, NC | ||
Auditor Firm ID | 243 |
Consolidated Balance Sheets
Consolidated Balance Sheets - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Current Assets: | ||
Cash and cash equivalents | $ 6,329 | $ 18,129 |
Short-term investments, available-for-sale | 64,195 | 80,262 |
Accounts receivable, net | 2,256 | 749 |
Inventories | 8,284 | 8,634 |
Prepaid expenses | 3,584 | 3,255 |
Employee retention tax credit receivable | 554 | 1,311 |
Other current assets | 1,671 | 957 |
Total Current Assets | 86,873 | 113,297 |
Restricted cash | 1,141 | 1,154 |
Long-term investments, available-for-sale | 3,865 | 37,435 |
Inventories, net of current portion | 5,469 | 7,074 |
Property and equipment, net | 9,542 | 10,971 |
Intellectual property, net | 1,576 | 9,892 |
Net deferred tax assets | 174 | 288 |
Operating lease right-of-use assets, net | 4,950 | 5,348 |
Other long-term assets | 2,463 | 1,014 |
Total Assets | 116,053 | 186,473 |
Current Liabilities: | ||
Accounts payable | 3,348 | 3,448 |
Accrued employee compensation and benefits | 4,508 | 3,559 |
Accrued expenses and other current liabilities | 1,293 | 1,617 |
Operating lease liabilities - current portion | 800 | 683 |
Deferred revenue | 465 | 543 |
Total Current Liabilities | 10,414 | 9,850 |
Long-Term Liabilities: | ||
Contingent consideration | 1,256 | 2,371 |
Noncurrent operating lease liabilities | 4,738 | 5,006 |
Total Liabilities | 16,408 | 17,227 |
Commitments and Contingencies (Note 16) | ||
Stockholders' Equity: | ||
Common stock $0.001 par value, 750,000,000 shares authorized at December 31, 2022 and December 31, 2021; 236,895,440 and 235,218,552 shares issued and outstanding at December 31, 2022 and December 31, 2021, respectively | 237 | 235 |
Preferred stock, $0.01 par value, 25,000,000 shares authorized, no shares issued and outstanding at December 31, 2022 and December 31, 2021 | 0 | 0 |
Additional paid-in capital | 962,731 | 954,649 |
Accumulated deficit | (860,935) | (785,374) |
Accumulated other comprehensive loss | (2,388) | (264) |
Total Stockholders' Equity | 99,645 | 169,246 |
Total Liabilities and Stockholders' Equity | 116,053 | 186,473 |
Intellectual Property [Member] | ||
Current Assets: | ||
Intellectual property, net | $ 1,576 | $ 9,892 |
Consolidated Balance Sheets (Pa
Consolidated Balance Sheets (Parentheticals) - $ / shares | Dec. 31, 2022 | Dec. 31, 2021 |
Common stock, par value (in dollars per share) | $ 0.001 | $ 0.001 |
Common stock, shares authorized (in shares) | 750,000,000 | 750,000,000 |
Common stock, shares issued (in shares) | 236,895,440 | 235,218,552 |
Common stock, shares outstanding (in shares) | 236,895,440 | 235,218,552 |
Preferred stock, par value (in dollars per share) | $ 0.01 | $ 0.01 |
Preferred stock, shares authorized (in shares) | 25,000,000 | 25,000,000 |
Preferred stock, shares issued (in shares) | 0 | 0 |
Preferred stock, shares outstanding (in shares) | 0 | 0 |
Consolidated Statements of Oper
Consolidated Statements of Operations and Comprehensive Loss - USD ($) shares in Thousands, $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Revenue: | ||
Revenue | $ 7,087 | $ 8,232 |
Cost of revenue: | ||
Cost of revenue | 10,872 | 11,096 |
Gross loss | (3,785) | (2,864) |
Operating Expenses: | ||
Research and development | 28,942 | 19,348 |
Sales and marketing | 14,756 | 13,395 |
General and administrative | 20,172 | 19,323 |
Amortization of intangible assets | 7,708 | 11,254 |
Change in fair value of contingent consideration | (1,115) | (1,565) |
Property and equipment impairment | 1,431 | 0 |
Total Operating Expenses | 71,894 | 61,755 |
Operating Loss | (75,679) | (64,619) |
Other Income (Expense), net | ||
Gain on extinguishment of debt | 0 | 2,847 |
Change in fair value of warrant liabilities | 0 | (1,981) |
Interest income | 1,141 | 590 |
Interest expense | (410) | (370) |
Employee retention tax credit | 0 | 1,311 |
Other expense, net | (295) | (15) |
Total Other Income (Expense), net | 436 | 2,382 |
Loss before income taxes | (75,243) | (62,237) |
Income tax expense | (318) | (225) |
Net loss | (75,561) | (62,462) |
Comprehensive loss: | ||
Net loss | (75,561) | (62,462) |
Foreign currency translation loss | (1,867) | (2,985) |
Unrealized loss on available-for-sale investments | (257) | (247) |
Comprehensive loss | $ (77,685) | $ (65,694) |
Net loss per common share attributable to common stockholders - basic and diluted (in dollars per share) | $ (0.32) | $ (0.28) |
Weighted average number of shares used in computing net loss per common share - basic and diluted (in shares) | 236,492 | 226,960 |
Product [Member] | ||
Revenue: | ||
Revenue | $ 4,327 | $ 5,399 |
Cost of revenue: | ||
Cost of revenue | 5,303 | 5,741 |
Service [Member] | ||
Revenue: | ||
Revenue | 1,373 | 1,520 |
Cost of revenue: | ||
Cost of revenue | 2,174 | 1,799 |
Lease [Member] | ||
Revenue: | ||
Revenue | 1,387 | 1,313 |
Cost of revenue: | ||
Cost of revenue | $ 3,395 | $ 3,556 |
Consolidated Statements of Chan
Consolidated Statements of Changes in Stockholders' Equity - USD ($) $ in Thousands | Common Stock [Member] | Treasury Stock [Member] | Additional Paid-in Capital [Member] | Retained Earnings [Member] | AOCI Attributable to Parent [Member] | Total |
Balance (in shares) at Dec. 31, 2020 | 116,231,000 | 0 | ||||
Balance at Dec. 31, 2020 | $ 116 | $ 0 | $ 781,397 | $ (722,912) | $ 2,968 | $ 61,569 |
Stock-based compensation | $ 0 | 9,429 | 0 | 0 | 9,429 | |
Issuance of common stock, net of issuance costs (in shares) | 71,787,000 | 0 | ||||
Issuance of common stock, net of issuance costs | $ 72 | $ 0 | 131,857 | 0 | 0 | 131,929 |
Exercise of stock options and warrants (in shares) | 45,630,000 | 0 | ||||
Exercise of stock options and warrants | $ 46 | $ 0 | 33,029 | 0 | 0 | 33,075 |
Award of restricted stock units (in shares) | 1,571,000 | |||||
Award of restricted stock units | $ 1 | |||||
Return of common stock to pay withholding taxes on restricted stock (in shares) | 0 | 320,000 | ||||
Return of common stock to pay withholding taxes on restricted stock | $ 0 | $ 0 | (1,063) | 0 | 0 | (1,063) |
Cancellation of treasury stock (in shares) | 0 | (320,000) | ||||
Cancellation of treasury stock | $ 0 | $ 0 | 0 | 0 | 0 | 0 |
Other comprehensive loss | 0 | 0 | 0 | 0 | (3,232) | (3,232) |
Net loss | $ 0 | $ 0 | (62,462) | 0 | (62,462) | |
Balance (in shares) at Dec. 31, 2021 | 235,219,000 | 0 | ||||
Balance at Dec. 31, 2021 | $ 235 | $ 0 | 954,649 | (785,374) | (264) | 169,246 |
Stock-based compensation | $ 0 | 8,416 | 0 | 0 | 8,416 | |
Award of restricted stock units (in shares) | 1,633,000 | 0 | ||||
Award of restricted stock units | $ 2 | $ 0 | 0 | 0 | 0 | 2 |
Return of common stock to pay withholding taxes on restricted stock (in shares) | 0 | 443,000 | ||||
Return of common stock to pay withholding taxes on restricted stock | $ 0 | $ 0 | (352) | 0 | 0 | (352) |
Cancellation of treasury stock (in shares) | 0 | (443,000) | ||||
Cancellation of treasury stock | $ 0 | $ 0 | 0 | 0 | 0 | 0 |
Other comprehensive loss | 0 | 0 | (2,124) | (2,124) | ||
Net loss | $ 0 | (75,561) | 0 | $ (75,561) | ||
Exercise of stock options (in shares) | 43,000 | 0 | 43,453 | |||
Exercise of stock options | $ 0 | $ 0 | 18 | 0 | 0 | $ 18 |
Balance (in shares) at Dec. 31, 2022 | 236,895,000 | 0 | ||||
Balance at Dec. 31, 2022 | $ 237 | $ 0 | $ 962,731 | $ (860,935) | $ (2,388) | $ 99,645 |
Consolidated Statements of Cash
Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Operating Activities: | ||
Net loss | $ (75,561) | $ (62,462) |
Adjustments to reconcile net loss to net cash and cash equivalents used in operating activities: | ||
Depreciation | 3,368 | 2,857 |
Amortization of intangible assets | 7,708 | 11,254 |
Amortization of discounts and premiums on investments, net | 565 | 409 |
Stock-based compensation | 8,416 | 9,429 |
Gain on extinguishment of debt | 0 | (2,847) |
Deferred tax expense | 318 | 225 |
Change in inventory reserves | 620 | (492) |
Bad debt expense | 9 | 144 |
Property and equipment impairment | 1,431 | 0 |
Loss on disposal of property and equipment | 122 | 0 |
Change in fair value of warrant liabilities | 0 | 1,981 |
Change in fair value of contingent consideration | (1,115) | (1,565) |
Changes in operating assets and liabilities: | ||
Accounts receivable | (1,528) | 174 |
Inventories | (2,302) | (611) |
Operating lease right-of-use assets | 232 | (4,254) |
Prepaid expenses | (450) | 146 |
Employee retention tax credit receivable | 757 | (1,311) |
Other current and long-term assets | (2,101) | 902 |
Accounts payable | 35 | 1,614 |
Accrued employee compensation and benefits | 4,523 | (859) |
Accrued expenses | (3,955) | 384 |
Deferred revenue | (55) | (229) |
Operating lease liabilities | 26 | 4,452 |
Net cash and cash equivalents used in operating activities | (58,937) | (40,659) |
Investing Activities: | ||
Purchase of available-for-sale investments | (33,886) | (122,330) |
Proceeds from maturities of available-for-sale investments | 82,702 | 4,030 |
Purchase of property and equipment | (1,279) | (1,368) |
Net cash and cash equivalents provided by (used in) investing activities | 47,537 | (119,668) |
Financing Activities: | ||
Proceeds from issuance of common stock, net of issuance costs | 0 | 131,929 |
Taxes paid related to net share settlement of vesting of restricted stock units | (350) | (1,063) |
Proceeds from exercise of stock options and warrants | 18 | 30,839 |
Net cash and cash equivalents (used in) provided by financing activities | (332) | 161,705 |
Effect of exchange rate changes on cash and cash equivalents | (81) | 376 |
Net (decrease) increase in cash, cash equivalents and restricted cash | (11,813) | 1,754 |
Cash, cash equivalents and restricted cash, beginning of period | 19,283 | 17,529 |
Cash, cash equivalents and restricted cash, end of period | 7,470 | 19,283 |
Supplemental Disclosure for Cash Flow Information | ||
Cash paid for leases | 984 | 1,490 |
Cash paid for taxes | 165 | 170 |
Supplemental Schedule of Non-cash Investing and Financing Activities: | ||
Transfer of inventories to property and equipment | 2,693 | 3,244 |
Reclass of warrant liability to common stock and additional paid-in-capital | 0 | 2,236 |
Lease liabilities arising from obtaining right-of-use assets | $ 577 | $ 5,119 |
Note 1 - Description of the Bus
Note 1 - Description of the Business | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Organization, Consolidation, Basis of Presentation, Business Description and Accounting Policies [Text Block] | 1. Description of the Business Asensus Surgical, Inc. (formerly known as TransEnterix, Inc.) (the "Company") is a medical device company that is digitizing the interface between the surgeon and the patient to pioneer a new era of Performance-Guided Surgery™ by unlocking clinical intelligence for surgeons to enable consistently superior outcomes and a new standard of surgery. The Company is focused on the market development for and commercialization of the Senhance® Surgical System, which digitizes laparoscopic minimally invasive surgery, or MIS. The Senhance System is the first 3mm 5mm |
Note 2 - Summary of Significant
Note 2 - Summary of Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Significant Accounting Policies [Text Block] | 2. Summary of Significant Accounting Policies Basis of Presentation The accompanying consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) and include the accounts of the Company and its direct and indirect wholly owned subsidiaries. Going Concern The Company's consolidated financial statements are prepared using U.S. GAAP applicable to a going concern, which contemplate the realization of assets and liquidation of liabilities in the normal course of business. The Company had an accumulated deficit of $860.9 million and working capital of $76.5 million as of December 31, 2022. not The Company will need to obtain additional financing to proceed with its business plan. Management's plan to obtain additional resources for the Company may one not may Principles of Consolidation and Foreign Currency Considerations The accompanying consolidated financial statements include the accounts of the Company and its direct and indirect wholly owned subsidiaries, Asensus Surgical US, Inc., Asensus International, Inc., Asensus Surgical Italia S.r.l., Asensus Surgical Europe S.à r.l., Asensus Surgical Taiwan Ltd., Asensus Surgical Japan K.K., Asensus Surgical Israel Ltd., Asensus Surgical Netherlands B.V., and Asensus Surgical Canada, Inc. All inter-company accounts and transactions have been eliminated in consolidation. The functional currency of the Company’s operational foreign subsidiaries is predominantly the Euro. The assets and liabilities of the Company’s foreign subsidiaries are translated into U.S. dollars at exchange rates in effect at the balance sheet date. Income and expense items are translated at the average exchange rates prevailing during the period. The cumulative translation effect for a subsidiary using a functional currency other than the U.S. dollar is included in accumulated other comprehensive loss as a separate component of stockholders’ equity. The Company’s intercompany accounts are denominated in the functional currency of the foreign subsidiary. Gains and losses resulting from the remeasurement of intercompany receivables that the Company considers to be of a long-term investment nature are recorded as a cumulative translation adjustment in accumulated other comprehensive loss as a separate component of stockholders’ equity, while gains and losses resulting from the remeasurement of intercompany receivables from a foreign subsidiary for which the Company anticipates settlement in the foreseeable future are recorded in the consolidated statements of operations and comprehensive loss. The net gains and losses included in net loss in the consolidated statements of operations and comprehensive loss for the years ended December 31, 2022 2021 not Reclassifications Certain amounts reported previously have been reclassified to conform to the current year presentation, with no December 31, 2021. December 31, 2021. Revision of Previously Disclosed Amounts During the course of preparing the Company’s unaudited consolidated financial statements as of and for the six June 30, 2022, December 31, 2021 7 December 31, 2021. no no Risk and Uncertainties The Company is subject to risks similar to other similarly sized companies in the medical device industry. These risks include, without limitation: negative impacts on the Company's operations caused by the COVID- 19 Use of Estimates The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Significant items subject to such estimates and assumptions include impairment considerations for long-lived assets, fair value estimates related to contingent consideration, stock compensation expense, revenue recognition, short-term and long-term investments, excess and obsolete inventory reserves, inventory classification between current and non-current, measurement of lease liabilities and corresponding right-of-use (“ROU”) assets, and deferred tax asset valuation allowances. Cash and Cash Equivalents, Restricted Cash, and Investments The Company considers all highly liquid investments with original maturities of 90 Restricted cash as of December 31, 2022 2021 The Company’s investments as of December 31, 2022 December 31, 2022. December 31, 2021. December 31, 2021. Investments with remaining maturities at date of purchase greater than 90 one one There have been no December 31, 2022 2021, no December 31, 2022. Fair Value Measurements The Company measures the fair value of money market funds, certain U.S. treasury securities, and equity investments with readily determinable value based on quoted prices in active markets for identical assets as Level 1 2 not third 2 3 Concentrations and Credit Risk The Company’s principal financial instruments subject to potential concentration of credit risk are cash and cash equivalents (including restricted cash), and investments, including amounts held in money market funds, commercial paper, and corporate bonds. The Company places cash deposits with a federally insured financial institution. The Company maintains its cash at banks and financial institutions it considers to be of high credit quality; however, the Company’s domestic cash deposits may may not not not The Company’s accounts receivable are derived from sales and leases to customers located throughout the world. The Company evaluates its customers’ financial condition and, generally, requires no one December 31, 2022. three December 31, 2021. 2022, two 2021, Accounts Receivable Accounts receivable are recorded at net realizable value, which includes an allowance for expected credit losses. The allowance for expected credit losses is based on the Company’s assessment of collectability of customer accounts. The Company regularly reviews the allowance by considering factors such as historical experience, credit quality, the age of the accounts receivable balances, and current economic conditions that may December 31, 2022, December 31, 2021, December 31, 2022 December 31, 2021. Inventories Inventories are stated at the lower of cost (determined on a first first not Any inventory on hand at the measurement date in excess of the Company's current requirements based on anticipated levels of sales is classified as long-term on the Company's consolidated balance sheets. The Company's classification of long-term inventory requires it to estimate the portion of on hand inventory that can be realized over the upcoming twelve Definite-Lived Intangible Assets - Intellectual Property Intellectual property consists of purchased patent rights and developed technology acquired as part of a business acquisition. Developed technology includes reclassified in-process research and development (“IPR&D”) assets related to (i) the Senhance System acquired in 2015 2017 2018 2020. The Company periodically evaluates intellectual property for impairment whenever events or changes in circumstances indicate that the carrying amount may not December 31, 2022 2021. Property and Equipment Property and equipment consists primarily of operating lease Senhance System assets, machinery, manufacturing equipment, demonstration equipment, computer equipment, furniture, and leasehold improvements, which are recorded at cost less accumulated depreciation. Depreciation is recorded using the straight-line method over the estimated useful lives of the assets as follows: Years Operating lease assets – Senhance System leasing 5 Machinery, manufacturing, and demonstration equipment 3 - 5 Computer equipment 3 Furniture 5 Leasehold improvements Lesser of lease term or 3 to 10 The Company reviews its property and equipment assets for possible impairment whenever events or changes in circumstances indicate that the carrying amount of the assets may not During the year ended December 31, 2022, not December 31, 2021. Operating Leases We have operating leases for our corporate office buildings, vehicles, and machinery and equipment. At inception, we determine whether an agreement represents a lease and, at commencement, we evaluate each lease agreement to determine whether the lease constitutes an operating or financing lease. The Company accounts for lease components and non-lease components as a single component. Non-lease components consist of common area maintenance payments for most real estate leases, which are determined based on costs incurred by the lessor. Many of the Company’s leases include base rental periods coupled with options to renew or terminate the lease, generally at the Company’s discretion. In evaluating the lease term, the Company considers whether renewal is reasonably certain. To the extent a significant economic incentive exists to renew the lease, the option is included within the lease term. Based on the Company’s leases, renewal options generally do not one ten may one six may one The interest rate implicit in our lease contracts is typically not Implementation Costs in a Cloud Computing Arrangement The Company capitalizes qualified implementation costs incurred in a hosting arrangement that is a service contract. These capitalized implementation costs are recorded within other current and long-term assets, and are generally amortized over the fixed, non-cancellable term of the associated hosting arrangement on a straight-line basis and included within operating expenses. Employee Retention Tax Credit Receivable The Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) included an Employee Retention Tax Credit (“ERTC”) provision designed to encourage employers to keep employees on their payroll. The ERTC is a refundable tax credit against certain payroll taxes paid by employers for eligible wages. During the year ended December 31, 2021, December 31, 2022. December 31, 2022. Notes Payable The Company’s policy is to account for forgivable loans received through the U.S. Small Business Administration (the “SBA”) under the CARES Act Payroll Protection Program (“PPP”), as debt in accordance with ASC 470, June 10, 2021, As of December 31, 2022, December 31, 2022. Contingent Consideration Contingent consideration is recorded as a liability and is the estimate of the fair value of potential milestone payments related to business acquisitions. Contingent consideration is measured at fair value using a Monte-Carlo simulation utilizing significant unobservable inputs including the probability of achieving each of the potential milestones, future Euro-to-USD exchange rates, revenue volatility and an estimated discount rate associated with the risks of the expected cash flows attributable to the various milestones. Significant increases or decreases in any of the probabilities of success or changes in expected achievement of any of these milestones would result in a significantly higher or lower fair value of these milestones, respectively, and commensurate changes to the associated liability. The contingent consideration is revalued at each reporting period and changes in fair value are recognized in the consolidated statements of operations and comprehensive loss. On September 21, 2015, 2016, December 31, 2022, €15.0 €25.0 2022, Warrant Liabilities The Company’s Series B Warrants were measured at fair value using a simulation model which considered, as of the valuation date, factors including the current exercise price, the expected life of the warrant, the current price of the underlying stock, its expected volatility, holding cost and the risk-free interest rate for the term of the warrant. The warrant liability was revalued at each reporting period and changes in fair value were recognized in the consolidated statements of operations and comprehensive loss. The selection of the appropriate valuation model and the inputs and assumptions that are required to determine the valuation requires significant judgment and requires management to make estimates and assumptions that affect the reported amount of the related liability and reported amounts of the change in fair value. Actual results could differ from those estimates, and changes in these estimates are recorded when known. All remaining outstanding Series B Warrants were exercised in the first 2021. Revenue Recognition The Company’s revenue consists of product revenue resulting from the sale of Senhance Systems, Senhance System components, and instruments and accessories. Service revenue consists of revenue related to Senhance System service agreements. Lease revenue consists of revenue generated from utilizing the Senhance System, instruments and accessories, and servicing of the Senhance System under operating lease agreements. The Company accounts for a contract with a customer when there is a legally enforceable contract between the Company and the customer, the rights of the parties are identified, the contract has commercial substance, and collectability of the contract consideration is probable. The Company's revenues are measured based on consideration specified in the contract with each customer, net of any sales incentives and taxes collected from customers that are remitted to government authorities. The Company’s Senhance System sale arrangements generally include a five first four The Company’s Senhance System sale arrangements generally contain multiple products and services. For these consolidated sale arrangements, the Company accounts for individual products and services as separate performance obligations if they are distinct, which is if a product or service is separately identifiable from other items in the consolidated package, and if a customer can benefit from it on its own or with other resources that are readily available to the customer. The Company’s Senhance System sale arrangements may For arrangements that contain multiple performance obligations, revenue is allocated to each performance obligation based on its relative estimated standalone selling price. When available, standalone selling prices are based on observable prices at which the Company separately sells the products or services; however due to limited sales to date, standalone selling prices generally are not not The Company recognizes revenues when or as the performance obligations are satisfied by transferring control of the product or service to a customer. The Company generally recognizes revenue for the performance obligations as follows: • System sales not one not • Instruments and accessories • Service The Company invoices its customers based on the billing schedules in its sales arrangements. Payments are generally due 30 60 In connection with assets recognized from the costs to obtain a contract with a customer, the Company determined that the sales incentive programs for its sales team do not not Senhance System Leasing The Company enters into lease arrangements with certain qualified customers. Revenue related to arrangements including lease elements are allocated to lease and non-lease elements based on their relative standalone selling prices. Lease elements generally include a Senhance System, while non-lease elements generally include instruments, accessories, and services. For some lease arrangements, the customers are provided with the right to purchase the leased Senhance System at some point during and/or at the end of the lease term. In some arrangements lease payments are based on the usage of the Senhance System. For the years ended December 31, 2022 2021, not In determining whether a transaction should be classified as a sales-type, operating, or direct financing lease, the Company considers the following terms at lease commencement: ( 1 2 3 4 5 no December 31, 2022 December 31, 2022 one three Cost of Revenue Cost of revenue consists of contract manufacturing, materials, labor and manufacturing overhead incurred internally to produce the products. Depreciation expense related to leased systems is included in the cost of revenue. Shipping and handling costs incurred by the Company are included in the cost of revenue. We expense all inventory obsolescence provisions as cost of revenue. Research and Development Costs Research and development expenses primarily consist of engineering, product development and regulatory expenses, incurred in the design, development, testing and enhancement of our products. Research and development costs are expensed as incurred. Stock-Based Compensation The Company recognizes expenses for share-based awards exchanged for services rendered equal to the estimated fair value of these awards over the requisite service period. The Company recognizes as expense, the grant-date fair value of stock options and other stock-based compensation issued to employees and non-employee directors over the requisite service periods, which are typically the vesting periods. The Company uses the Black-Scholes-Merton model to estimate the fair value of stock options. The volatility assumption used in the Black-Scholes-Merton model is based on the Company’s historical volatility. The expected term of options granted has been determined based upon the simplified method, because the Company does not not not The fair value of restricted stock units is determined by the market price of the Company’s common stock on the date of grant. See “Note 13 Income Taxes The Company accounts for income taxes using the asset and liability method, which requires the recognition of deferred tax assets or liabilities for the temporary differences between financial reporting and tax basis of the Company’s assets and liabilities, and for tax carryforwards at enacted statutory rates in effect for the years in which the asset or liability is expected to be realized. The effect on deferred taxes of a change in tax rates is recognized in income during the period that includes the enactment date. In addition, valuation allowances are established when necessary to reduce deferred tax assets and liabilities to the amounts expected to be realized. The Company has elected to account for global intangible low-taxed income (“GILTI”) as a period expense in the year the tax is incurred. The Company recognizes the financial statement benefit of an income tax position only after determining that the relevant taxing authority would more likely than not not 50% Tax regulations within each jurisdiction are subject to the interpretation of the related tax laws and regulations and require application of significant judgment. The Company is subject to U.S. federal and various state, local and foreign jurisdictions. Due to the Company’s net operating loss carryforwards, the Company may Comprehensive Loss Comprehensive loss is defined as the change in equity of a business enterprise during a period from transactions and other events and circumstances from non-owner sources. Segments The Company operates in one not Impact of Recently Issued Accounting Standards The Company has evaluated issued ASUs not not |
Note 3 - Revenue Recognition
Note 3 - Revenue Recognition | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Revenue from Contract with Customer [Text Block] | 3. Revenue Recognition The following table presents revenue disaggregated by type and geography: Years Ended December 31, 2022 2021 (in thousands) U.S. Systems $ - $ - Instruments and accessories 211 273 Services 300 383 Leases 256 377 Total U.S. revenue 767 1,033 Outside of U.S. ("OUS") Systems 2,551 3,286 Instruments and accessories 1,565 1,840 Services 1,073 1,137 Leases 1,131 936 Total OUS revenue 6,320 7,199 Total Systems 2,551 3,286 Instruments and accessories 1,776 2,113 Services 1,373 1,520 Leases 1,387 1,313 Total revenue $ 7,087 $ 8,232 Remaining Performance Obligations The transaction price allocated to remaining performance obligations relates to amounts allocated to products and services for which the revenue has not December 31, 2022 one four Contract Assets and Liabilities Deferred revenue for the periods presented was primarily related to service obligations, for which the service fees are billed up-front, generally annually. The associated deferred revenue is generally recognized ratably over the service period. The Company did not December 31, 2022 2021 The following information summarizes the Company’s contract assets and liabilities: December 31, 2022 December 31, 2021 (in thousands) Contract Assets $ 116 $ 91 Deferred Revenue $ 465 $ 543 |
Note 4 - Cash, Cash Equivalents
Note 4 - Cash, Cash Equivalents, and Restricted Cash | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Cash, Cash Equivalents, and Restricted Cash Disclosure [Text Block] | 4. Cash, Cash Equivalents, and Restricted Cash Cash, cash equivalents and restricted cash consist of the following: December 31, December 31, 2022 2021 (in thousands) Cash $ 3,473 $ 8,343 Money Market 2,856 5,287 Commerical Paper - 4,499 Total cash and cash equivalents $ 6,329 $ 18,129 Restricted Cash 1,141 1,154 Total $ 7,470 $ 19,283 Restricted cash at December 31, 2022 2021 2018. |
Note 5 - Investments, Available
Note 5 - Investments, Available-for-sale | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block] | 5. Investments, available-for-sale The aggregate fair values of investment securities along with cumulative unrealized gains and losses determined on an individual investment security basis and included in other comprehensive loss are as follows: December 31, 2022 (in thousands) Amortized Cost Unrealized Gain Unrealized Loss Fair Value Short-term investments Long-term investments Commercial Paper $ 12,364 $ - $ (49 ) $ 12,315 $ 12,315 $ - Corporate Bonds 55,201 - (447 ) 54,754 50,889 3,865 U.S. Government Agencies 999 - (8 ) 991 991 - Total Investments $ 68,564 $ - $ (504 ) $ 68,060 $ 64,195 $ 3,865 December 31, 2021 (in thousands) Amortized Cost Unrealized Gain Unrealized Loss Fair Value Short-term investments Long-term investments Commercial Paper $ 50,705 $ - $ (46 ) $ 50,659 $ 50,660 $ - Corporate Bonds 67,239 1 (202 ) 67,038 29,602 37,435 Total Investments $ 117,944 $ 1 $ (248 ) $ 117,697 $ 80,262 $ 37,435 The following table summarizes the contractual maturities of the Company’s available-for-sale investments: December 31, 2022 (in thousands) Amortized Cost Fair Value Mature in less than one year $ 64,662 $ 64,195 Mature in one to two years 3,902 3,865 Total $ 68,564 $ 68,060 Actual maturities may no December 31, 2022 2021, December 31, 2022. December 31, 2021 |
Note 6 - Fair Value
Note 6 - Fair Value | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Fair Value Disclosures [Text Block] | 6. Fair Value The following are categories of assets and liabilities measured at fair value on a recurring basis using quoted prices in active markets for identical assets (Level 1 2 3 December 31, 2022 (in thousands) Description Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total Assets measured at fair value Cash and cash equivalents (1) $ 6,329 $ - $ - $ 6,329 Restricted cash 1,141 - - 1,141 Short-term investments - 64,195 - 64,195 Long-term investments - 3,865 - 3,865 Total assets measured at fair value $ 7,470 $ 68,060 $ - $ 75,530 Liabilities measured at fair value Contingent consideration $ - $ - $ 1,256 $ 1,256 Total liabilities measured at fair value $ - $ - $ 1,256 $ 1,256 ( 1 90 December 31, 2021 (in thousands) Description Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total Assets measured at fair value Cash and cash equivalents (1) $ 18,129 $ - $ - $ 18,129 Restricted cash 1,154 - - 1,154 Short-term investments - 80,262 - 80,262 Long-term investments - 37,435 - 37,435 Total assets measured at fair value $ 19,283 $ 117,697 $ - $ 136,980 Liabilities measured at fair value Contingent consideration $ - $ - $ 2,371 $ 2,371 Total liabilities measured at fair value $ - $ - $ 2,371 $ 2,371 ( 1 90 The carrying values of accounts receivable, prepaid expenses, employee retention tax credit receivables, other current assets, accounts payable, accrued employee compensation and benefits, accrued expenses, deferred revenue, and other current liabilities as of December 31, 2022, December 31, 2021, The Company’s financial liabilities consisted of contingent consideration payable to Three Heads Investment S.r.l., related to the Company’s 2015 The following table presents quantitative information about the inputs and valuation methodologies used for the Company’s fair value measurements for contingent consideration utilizing a Monte-Carlo simulation as of December 31, 2022 December 31, 2021: Valuation Methodology Significant Unobservable Input December 31, 2022 December 31, 2021 Contingent consideration Probability weighted income approach Milestone dates 2032 2031 Discount rate 16.5% 9.5% Revenue volatility 45.0% 39.0% EUR-to-USD exchange rate 1.07 1.14 The following table presents the current and long-term portion of the contingent consideration for the year ended December 31, 2022 3 December 31, 2022 2021: Fair Value Measurement at Reporting Date (Level 3) (in thousands) Contingent consideration Balance at December 31, 2020 $ 3,936 Change in fair value (1,565 ) Balance at December 31, 2021 $ 2,371 Change in fair value (1,115 ) Balance at December 31, 2022 $ 1,256 Current portion $ - Long-term portion 1,256 Balance at December 31, 2022 $ 1,256 |
Note 7 - Inventories
Note 7 - Inventories | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Inventory Disclosure [Text Block] | 7. Inventories The components of inventories are as follows: December 31, 2022 (in thousands) Gross Carrying Amount Reserve Balance Net Carrying Amount Finished goods $ 15,337 $ (4,129 ) $ 11,208 Raw materials 4,718 (2,173 ) 2,545 Total inventories $ 20,055 $ (6,302 ) $ 13,753 Current Portion $ 9,399 $ (1,115 ) $ 8,284 Long-term portion 10,656 (5,187 ) 5,469 Total inventories $ 20,055 $ (6,302 ) $ 13,753 December 31, 2021 (in thousands) Gross Carrying Amount Reserve Balance Net Carrying Amount Finished goods $ 13,066 $ (2,987 ) $ 10,079 Raw materials 8,324 (2,695 ) 5,629 Total inventories $ 21,390 $ (5,682 ) $ 15,708 Current Portion $ 9,931 $ (1,297 ) $ 8,634 Long-term portion 11,459 (4,385 ) 7,074 Total inventories $ 21,390 $ (5,682 ) $ 15,708 |
Note 8 - Property and Equipment
Note 8 - Property and Equipment | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Property, Plant and Equipment Disclosure [Text Block] | 8. Property and Equipment Property and equipment consisted of the following: December 31, 2022 December 31, 2021 (In thousands) Machinery, manufacturing, and demonstration equipment $ 8,450 $ 8,289 Operating lease assets - Senhance System leasing 10,251 10,143 Computer equipment 600 325 Furniture 831 644 Leasehold improvements 1,654 1,259 Construction in process 436 ‑ Total property and equipment 22,222 20,660 Accumulated depreciation and amortization (12,680 ) (9,689 ) Property and equipment, net $ 9,542 $ 10,971 Depreciation expense was approximately $3.4 million and $2.9 million for the years ended December 31, 2022 2021, |
Note 9 - Intellectual Property
Note 9 - Intellectual Property | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Intangible Assets Disclosure [Text Block] | 9. Intellectual Property The components of gross intellectual property, accumulated amortization, and net intellectual property are as follows: December 31, 2022 (in thousands) Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount Developed technology $ 68,838 $ (66,562 ) $ (874 ) $ 1,402 Technology and patents purchased 400 (239 ) 13 174 Total intellectual property $ 69,238 $ (66,801 ) $ (861 ) $ 1,576 December 31, 2021 (in thousands) Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount Developed technology $ 68,838 $ (58,912 ) $ (262 ) $ 9,664 Technology and patents purchased 400 (199 ) 27 228 Total intellectual property $ 69,238 $ (59,111 ) $ (235 ) $ 9,892 The weighted average remaining useful life of the developed technology and technology and patents purchased was 4.2 years and 4.3 years, respectively, as of December 31, 2022. December 31, 2021. The estimated future amortization expense of intellectual property as of December 31, 2022 Year Ending December 31, 2022 2023 $ 377 2024 377 2025 377 2026 377 2027 68 Total $ 1,576 |
Note 10 - Leases
Note 10 - Leases | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Lessee, Operating Leases [Text Block] | 10. Leases Lessee Information Components of operating lease expense are primarily recorded in general and administrative on the consolidated statements of operations and comprehensive loss were as follows: Years Ended December 31, 2022 2021 (in thousands) Long-term Operating $ 1,557 $ 1,826 Short-term Operating - - Total Operating lease expense $ 1,557 $ 1,826 Supplemental balance sheet information related to operating leases was as follows: December 31, 2022 December 31, 2021 Weighted-average remaining lease term (in years) 6.8 7.8 Weighted-average discount rate 8.4% 7.8% Incremental borrowing rate 6.1% - 14.5% 6.1% - 8.5% Maturities of operating lease obligations as of December 31, 2022 Fiscal Year 2023 $ 1,222 2024 1,136 2025 1,058 2026 837 2027 775 Thereafter 2,195 Total minimum lease payments $ 7,223 Less: Amount of lease payments representing interest (1,685 ) Present value of future minimum lease payments $ 5,538 |
Note 11 - Accrued Expenses
Note 11 - Accrued Expenses | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Accrued Liabilities [Text Block] | 11. Accrued Expenses The following table presents the components of accrued expenses: December 31, 2022 December 31, 2021 (In thousands) Consulting and other vendors $ 155 $ 128 Other — 124 Royalties 24 247 Legal and professional fees 275 503 Taxes and other assessments 839 615 Total $ 1,293 $ 1,617 |
Note 12 - Income Taxes
Note 12 - Income Taxes | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Income Tax Disclosure [Text Block] | 12. Income Taxes The components for the income tax expense are as follows for the years ended December 31 2022 2021 Current income taxes Federal $ - $ - State - - Foreign 239 232 Deferred income taxes Federal - - State - - Foreign 79 (7 ) Total income tax expense $ 318 $ 225 The United States and foreign components of loss from operations before taxes are as follows for the years ended December 31 2022 2021 United States $ (44,802 ) $ (32,094 ) Foreign (30,441 ) (30,143 ) Total loss from operations before taxes $ (75,243 ) $ (62,237 ) Significant components of the Company’s deferred tax assets consist of the following at December 31 2022 2021 Deferred Tax assets: Stock-based compensation $ 2,840 $ 2,440 Accrued expenses and other 2,538 2,423 Research credit carryforward 1,341 564 Fixed Assets 162 101 Capitalized start-up costs and other intangibles 921 1,109 Capitalized research costs 4,382 - Net operating loss carryforwards 83,908 75,237 96,092 81,874 Valuation Allowance (94,704 ) (78,294 ) Net deferred tax asset 1,388 3,580 Deferred tax liabilities Fixed assets and other (1,214 ) (1,176 ) Purchase accounting intangibles - (2,116 ) Net deferred tax liability (1,214 ) (3,292 ) Net deferred tax asset (liability) $ 174 $ 288 During 2021, 382 383 382, 2020. 382 383 382 At December 31, 2022 2021, not not. December 31, 2022, 382 382 2027, December 31, 2022, 382. 382 2022, December 31, 2022, 2027. 383, At December 31, 2022, 2034; 2023, 2040. The Company has evaluated its tax positions to consider whether it has any unrecognized tax benefits. As of December 31, 2022, none not twelve not The following is a tabular reconciliation of the Company’s change in gross unrecognized tax positions at December 31 2022 2021 Beginning balance $ 141 $ - Gross increases for tax positions related to current periods 194 141 Gross decreases related to 382 limitations - - Ending balance $ 335 $ 141 The Company recognizes interest and penalties related to uncertain tax positions in the provision for income taxes. As of December 31, 2022 2021, The Company has analyzed its filing positions in all significant federal, state, and foreign jurisdictions where it is required to file income tax returns, as well as open tax years in these jurisdictions. With few exceptions, the Company is no 2019, 2019 may No Taxes computed at the then-current statutory federal income tax rate of 21% are reconciled to the provision for income taxes as follows for the years ended December 31: 2022 2021 Amount Percent of Pretax Earnings Amount Percent of Pretax Earnings United States federal tax at statutory rate $ (15,801 ) 21.0 % $ (13,070 ) 21.0 % State taxes (net of deferred benefit) (2,912 ) 3.9 % (2,205 ) 3.5 % Nondeductible expenses 1,077 (1.4% ) (440 ) 0.7 % Change in fair market value of contingent consideration (283 ) 0.4 % (397 ) 0.6 % Warrant remeasurment and financing costs - - 502 (0.8% ) Research & Development (970 ) 1.3 % (705 ) 1.1 % Change in unrecognized tax benefits 194 (0.3% ) 141 (0.2% ) Foreign tax rate differential 2,676 (3.6% ) 1,911 (3.1% ) True-up to Stock Compensation - Cancellations 49 (0.1% ) 2,832 (4.6% ) Change in enacted tax rates and other, net (96 ) 0.2 % 731 (1.0% ) Change in valuation allowance 16,384 (21.8% ) 10,925 (17.6% ) Income tax expense (benefit) $ 318 (0.4% ) $ 225 (0.4% ) |
Note 13 - Stock-based Compensat
Note 13 - Stock-based Compensation | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Share-Based Payment Arrangement [Text Block] | 13. Stock-Based Compensation Overview On July 22, 2021, 2021 December 31, 2022, Under the Plan, which is administered by the Compensation Committee, the Company may may not no may ten Stock Options The following table summarizes the Company’s stock option activity, including grants to non-employees, for the year ended December 31, 2022: Number of Shares Weighted- Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Balance at December 31, 2021 4,640,660 $ 6.64 5.66 Granted 3,153,881 0.70 Forfeited (129,134 ) 1.60 Cancelled (36,987 ) 21.11 Exercised (43,453 ) 0.41 Balance at December 31, 2022 7,584,967 $ 4.22 5.31 The aggregate intrinsic value of stock options exercised under the Company’s stock plans was not December 31, 2022. The following table summarizes information about stock options outstanding at December 31, 2022: Number of Shares Weighted- Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Aggregate Intrinsic Value (Millions) Exercisable at December 31, 2022 3,524,473 $ 7.40 4.75 $ - Vested or expected to vest at December 31, 2022 7,350,141 $ 4.32 5.28 $ - The fair value of options granted were estimated using the Black-Scholes-Merton option pricing model based on the assumptions in the table below: Years Ended December 31, 2022 2021 Expected dividend yield 0% 0% Expected volatility 126% - 133% 118% - 139% Risk-free interest rate 1.25% - 4.40% 0.33% - 1.11% Expected life (in years) 3.8 - 4.5 3.8 - 4.5 Restricted Stock Units The following is a summary of the restricted stock units activity, including performance restricted stock units, for the year ended December 31, 2022: Number of Restricted Stock Units Outstanding Weighted- Average Grant Date Fair Value Unvested December 31, 2021 3,839,030 $ 2.36 Granted 6,996,822 0.71 Vested (2,076,663 ) 2.34 Forfeited (275,698 ) 1.19 Unvested December 31, 2022 8,483,491 $ 1.04 Performance Restricted Stock Units In 2022 2021, October 1, 2023 October 1, 2022, 2022 2021 2022 2021, three Stock-based Compensation Expense The following table summarizes non-cash stock-based compensation expense by award type for the years ended December 31, 2022, 2021: Years Ended December 31, 2022 2021 (in thousands) Stock options $ 3,654 $ 4,535 Restricted stock units 3,319 3,954 Performance restricted stock units 1,443 940 $ 8,416 $ 9,429 As of December 31, 2022, December 31, 2022, |
Note 14 - Equity Offerings
Note 14 - Equity Offerings | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Stockholders' Equity Note Disclosure [Text Block] | 14. Equity Offerings Equity financing transactions for the years ended December 31, 2022 2021, 2020 October 9, 2020, “2020 January 2021. January 2021 January 29, 2021, February 1, 2021, January 2021 January 12, 2021, 2021 May 19, 2021, SM “2021 Sales during the year ended December 31, 2021, 2021 2020 Year Ended December 31, 2021 Total shares of common stock sold 20,237,045 Average price per share $ 1.53 Gross proceeds $ 30,943 Commisssion earned by Sales Agents $ 928 Net proceeds $ 30,015 2021 December 31, 2021, 2022 March 18, 2022, “2022 “2022 2022 December 31, 2022. |
Note 15 - Basic and Diluted Net
Note 15 - Basic and Diluted Net Loss Per Share | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Earnings Per Share [Text Block] | 15. Basic and Diluted Net Loss per Share Basic net loss per common share is computed by dividing net loss attributable to common stockholders by the weighted average number of common shares outstanding during the period. Diluted net loss per common share is computed giving effect to all potential dilutive common shares that were outstanding during the period when the effect is dilutive. Potential dilutive common shares consist of incremental shares issuable upon exercise of stock options, restricted stock units, and warrants. No December 31, 2022 2021 Potential common shares not December 31, 2022 2021 Stock options 7,584,967 4,640,660 Stock warrants 1,021,076 1,120,300 Nonvested restricted stock units 8,483,491 3,839,030 Total 17,089,534 9,599,990 |
Note 16 - Commitments and Conti
Note 16 - Commitments and Contingencies | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Commitments and Contingencies Disclosure [Text Block] | 16. Commitments and Contingencies License and Supply Agreements As part of the Company’s acquisition of the Senhance System in 2015, Fiscal Year 2023 $ 5,976 2024 407 2025 313 2026 303 Total commitments $ 6,999 |
Note 17 - Segments and Geograph
Note 17 - Segments and Geographic Areas | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Segment Reporting Disclosure [Text Block] | 17. Segments and Geographic Areas The following table presents consolidated assets and long-lived assets by geographic area, which includes property and equipment, intellectual property, and operating lease assets: December 31, 2022 Long-Lived Assets Total Assets U.S. 35 % 72 % EMEA Switzerland 46 % 24 % Italy 8 % 2 % Other 8 % 1 % Total EMEA 62 % 27 % Asia 3 % 1 % Total 100 % 100 % December 31, 2021 Long-Lived Assets Total Assets U.S. 26 % 77 % EMEA Switzerland 34 % 16 % Italy 36 % 5 % Other 4 % 1 % Total EMEA 74 % 22 % Asia 0 % 1 % Total 100 % 100 % The following table presents sales by geographic area based on the country in which the customer is based. Years Ended December 31, 2022 2021 US 11 % 13 % EMEA 77 % 62 % Asia 12 % 25 % Total 100 % 100 % |
Note 18 - Related Party Transac
Note 18 - Related Party Transactions | 12 Months Ended |
Dec. 31, 2022 | |
Notes to Financial Statements | |
Related Party Transactions Disclosure [Text Block] | 18. Related Party Transactions In March 2018, 1 1 December 31, 2022 2021, |
Significant Accounting Policies
Significant Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2022 | |
Accounting Policies [Abstract] | |
Basis of Accounting, Policy [Policy Text Block] | Basis of Presentation The accompanying consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) and include the accounts of the Company and its direct and indirect wholly owned subsidiaries. |
Substantial Doubt about Going Concern [Policy Text Block] | Going Concern The Company's consolidated financial statements are prepared using U.S. GAAP applicable to a going concern, which contemplate the realization of assets and liquidation of liabilities in the normal course of business. The Company had an accumulated deficit of $860.9 million and working capital of $76.5 million as of December 31, 2022. not The Company will need to obtain additional financing to proceed with its business plan. Management's plan to obtain additional resources for the Company may one not may |
Consolidation, Policy [Policy Text Block] | Principles of Consolidation and Foreign Currency Considerations The accompanying consolidated financial statements include the accounts of the Company and its direct and indirect wholly owned subsidiaries, Asensus Surgical US, Inc., Asensus International, Inc., Asensus Surgical Italia S.r.l., Asensus Surgical Europe S.à r.l., Asensus Surgical Taiwan Ltd., Asensus Surgical Japan K.K., Asensus Surgical Israel Ltd., Asensus Surgical Netherlands B.V., and Asensus Surgical Canada, Inc. All inter-company accounts and transactions have been eliminated in consolidation. The functional currency of the Company’s operational foreign subsidiaries is predominantly the Euro. The assets and liabilities of the Company’s foreign subsidiaries are translated into U.S. dollars at exchange rates in effect at the balance sheet date. Income and expense items are translated at the average exchange rates prevailing during the period. The cumulative translation effect for a subsidiary using a functional currency other than the U.S. dollar is included in accumulated other comprehensive loss as a separate component of stockholders’ equity. The Company’s intercompany accounts are denominated in the functional currency of the foreign subsidiary. Gains and losses resulting from the remeasurement of intercompany receivables that the Company considers to be of a long-term investment nature are recorded as a cumulative translation adjustment in accumulated other comprehensive loss as a separate component of stockholders’ equity, while gains and losses resulting from the remeasurement of intercompany receivables from a foreign subsidiary for which the Company anticipates settlement in the foreseeable future are recorded in the consolidated statements of operations and comprehensive loss. The net gains and losses included in net loss in the consolidated statements of operations and comprehensive loss for the years ended December 31, 2022 2021 not |
Reclassification, Comparability Adjustment [Policy Text Block] | Reclassifications Certain amounts reported previously have been reclassified to conform to the current year presentation, with no December 31, 2021. December 31, 2021. |
Error Correction and Revisions [Policy Text Block] | Revision of Previously Disclosed Amounts During the course of preparing the Company’s unaudited consolidated financial statements as of and for the six June 30, 2022, December 31, 2021 7 December 31, 2021. no no |
Risk And Uncertainties, Policy [Policy Text Block] | Risk and Uncertainties The Company is subject to risks similar to other similarly sized companies in the medical device industry. These risks include, without limitation: negative impacts on the Company's operations caused by the COVID- 19 |
Use of Estimates, Policy [Policy Text Block] | Use of Estimates The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Significant items subject to such estimates and assumptions include impairment considerations for long-lived assets, fair value estimates related to contingent consideration, stock compensation expense, revenue recognition, short-term and long-term investments, excess and obsolete inventory reserves, inventory classification between current and non-current, measurement of lease liabilities and corresponding right-of-use (“ROU”) assets, and deferred tax asset valuation allowances. |
Cash and Cash Equivalents, Restricted Cash, and Investments, Policy [Policy Text Block] | Cash and Cash Equivalents, Restricted Cash, and Investments The Company considers all highly liquid investments with original maturities of 90 Restricted cash as of December 31, 2022 2021 The Company’s investments as of December 31, 2022 December 31, 2022. December 31, 2021. December 31, 2021. Investments with remaining maturities at date of purchase greater than 90 one one There have been no December 31, 2022 2021, no December 31, 2022. |
Fair Value Measurement, Policy [Policy Text Block] | Fair Value Measurements The Company measures the fair value of money market funds, certain U.S. treasury securities, and equity investments with readily determinable value based on quoted prices in active markets for identical assets as Level 1 2 not third 2 3 |
Concentration Risk, Credit Risk, Policy [Policy Text Block] | Concentrations and Credit Risk The Company’s principal financial instruments subject to potential concentration of credit risk are cash and cash equivalents (including restricted cash), and investments, including amounts held in money market funds, commercial paper, and corporate bonds. The Company places cash deposits with a federally insured financial institution. The Company maintains its cash at banks and financial institutions it considers to be of high credit quality; however, the Company’s domestic cash deposits may may not not not The Company’s accounts receivable are derived from sales and leases to customers located throughout the world. The Company evaluates its customers’ financial condition and, generally, requires no one December 31, 2022. three December 31, 2021. 2022, two 2021, |
Receivable [Policy Text Block] | Accounts Receivable Accounts receivable are recorded at net realizable value, which includes an allowance for expected credit losses. The allowance for expected credit losses is based on the Company’s assessment of collectability of customer accounts. The Company regularly reviews the allowance by considering factors such as historical experience, credit quality, the age of the accounts receivable balances, and current economic conditions that may December 31, 2022, December 31, 2021, December 31, 2022 December 31, 2021. |
Inventory, Policy [Policy Text Block] | Inventories Inventories are stated at the lower of cost (determined on a first first not Any inventory on hand at the measurement date in excess of the Company's current requirements based on anticipated levels of sales is classified as long-term on the Company's consolidated balance sheets. The Company's classification of long-term inventory requires it to estimate the portion of on hand inventory that can be realized over the upcoming twelve |
Goodwill and Intangible Assets, Policy [Policy Text Block] | Definite-Lived Intangible Assets - Intellectual Property Intellectual property consists of purchased patent rights and developed technology acquired as part of a business acquisition. Developed technology includes reclassified in-process research and development (“IPR&D”) assets related to (i) the Senhance System acquired in 2015 2017 2018 2020. The Company periodically evaluates intellectual property for impairment whenever events or changes in circumstances indicate that the carrying amount may not December 31, 2022 2021. |
Property, Plant and Equipment, Policy [Policy Text Block] | Property and Equipment Property and equipment consists primarily of operating lease Senhance System assets, machinery, manufacturing equipment, demonstration equipment, computer equipment, furniture, and leasehold improvements, which are recorded at cost less accumulated depreciation. Depreciation is recorded using the straight-line method over the estimated useful lives of the assets as follows: Years Operating lease assets – Senhance System leasing 5 Machinery, manufacturing, and demonstration equipment 3 - 5 Computer equipment 3 Furniture 5 Leasehold improvements Lesser of lease term or 3 to 10 The Company reviews its property and equipment assets for possible impairment whenever events or changes in circumstances indicate that the carrying amount of the assets may not During the year ended December 31, 2022, not December 31, 2021. |
Lessee, Leases [Policy Text Block] | Operating Leases We have operating leases for our corporate office buildings, vehicles, and machinery and equipment. At inception, we determine whether an agreement represents a lease and, at commencement, we evaluate each lease agreement to determine whether the lease constitutes an operating or financing lease. The Company accounts for lease components and non-lease components as a single component. Non-lease components consist of common area maintenance payments for most real estate leases, which are determined based on costs incurred by the lessor. Many of the Company’s leases include base rental periods coupled with options to renew or terminate the lease, generally at the Company’s discretion. In evaluating the lease term, the Company considers whether renewal is reasonably certain. To the extent a significant economic incentive exists to renew the lease, the option is included within the lease term. Based on the Company’s leases, renewal options generally do not one ten may one six may one The interest rate implicit in our lease contracts is typically not |
Capitalization of Internal Costs, Policy [Policy Text Block] | Implementation Costs in a Cloud Computing Arrangement The Company capitalizes qualified implementation costs incurred in a hosting arrangement that is a service contract. These capitalized implementation costs are recorded within other current and long-term assets, and are generally amortized over the fixed, non-cancellable term of the associated hosting arrangement on a straight-line basis and included within operating expenses. |
Employer Retention Tax Credit, Policy [Policy Text Block] | Employee Retention Tax Credit Receivable The Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) included an Employee Retention Tax Credit (“ERTC”) provision designed to encourage employers to keep employees on their payroll. The ERTC is a refundable tax credit against certain payroll taxes paid by employers for eligible wages. During the year ended December 31, 2021, December 31, 2022. December 31, 2022. |
Debt, Policy [Policy Text Block] | Notes Payable The Company’s policy is to account for forgivable loans received through the U.S. Small Business Administration (the “SBA”) under the CARES Act Payroll Protection Program (“PPP”), as debt in accordance with ASC 470, June 10, 2021, As of December 31, 2022, December 31, 2022. |
Contingent Consideration [Policy Text Block] | Contingent Consideration Contingent consideration is recorded as a liability and is the estimate of the fair value of potential milestone payments related to business acquisitions. Contingent consideration is measured at fair value using a Monte-Carlo simulation utilizing significant unobservable inputs including the probability of achieving each of the potential milestones, future Euro-to-USD exchange rates, revenue volatility and an estimated discount rate associated with the risks of the expected cash flows attributable to the various milestones. Significant increases or decreases in any of the probabilities of success or changes in expected achievement of any of these milestones would result in a significantly higher or lower fair value of these milestones, respectively, and commensurate changes to the associated liability. The contingent consideration is revalued at each reporting period and changes in fair value are recognized in the consolidated statements of operations and comprehensive loss. On September 21, 2015, 2016, December 31, 2022, €15.0 €25.0 2022, |
Warrant Liabilities [Policy Text Block] | Warrant Liabilities The Company’s Series B Warrants were measured at fair value using a simulation model which considered, as of the valuation date, factors including the current exercise price, the expected life of the warrant, the current price of the underlying stock, its expected volatility, holding cost and the risk-free interest rate for the term of the warrant. The warrant liability was revalued at each reporting period and changes in fair value were recognized in the consolidated statements of operations and comprehensive loss. The selection of the appropriate valuation model and the inputs and assumptions that are required to determine the valuation requires significant judgment and requires management to make estimates and assumptions that affect the reported amount of the related liability and reported amounts of the change in fair value. Actual results could differ from those estimates, and changes in these estimates are recorded when known. All remaining outstanding Series B Warrants were exercised in the first 2021. |
Revenue [Policy Text Block] | Revenue Recognition The Company’s revenue consists of product revenue resulting from the sale of Senhance Systems, Senhance System components, and instruments and accessories. Service revenue consists of revenue related to Senhance System service agreements. Lease revenue consists of revenue generated from utilizing the Senhance System, instruments and accessories, and servicing of the Senhance System under operating lease agreements. The Company accounts for a contract with a customer when there is a legally enforceable contract between the Company and the customer, the rights of the parties are identified, the contract has commercial substance, and collectability of the contract consideration is probable. The Company's revenues are measured based on consideration specified in the contract with each customer, net of any sales incentives and taxes collected from customers that are remitted to government authorities. The Company’s Senhance System sale arrangements generally include a five first four The Company’s Senhance System sale arrangements generally contain multiple products and services. For these consolidated sale arrangements, the Company accounts for individual products and services as separate performance obligations if they are distinct, which is if a product or service is separately identifiable from other items in the consolidated package, and if a customer can benefit from it on its own or with other resources that are readily available to the customer. The Company’s Senhance System sale arrangements may For arrangements that contain multiple performance obligations, revenue is allocated to each performance obligation based on its relative estimated standalone selling price. When available, standalone selling prices are based on observable prices at which the Company separately sells the products or services; however due to limited sales to date, standalone selling prices generally are not not The Company recognizes revenues when or as the performance obligations are satisfied by transferring control of the product or service to a customer. The Company generally recognizes revenue for the performance obligations as follows: • System sales not one not • Instruments and accessories • Service The Company invoices its customers based on the billing schedules in its sales arrangements. Payments are generally due 30 60 In connection with assets recognized from the costs to obtain a contract with a customer, the Company determined that the sales incentive programs for its sales team do not not |
Lessor, Leases [Policy Text Block] | Senhance System Leasing The Company enters into lease arrangements with certain qualified customers. Revenue related to arrangements including lease elements are allocated to lease and non-lease elements based on their relative standalone selling prices. Lease elements generally include a Senhance System, while non-lease elements generally include instruments, accessories, and services. For some lease arrangements, the customers are provided with the right to purchase the leased Senhance System at some point during and/or at the end of the lease term. In some arrangements lease payments are based on the usage of the Senhance System. For the years ended December 31, 2022 2021, not In determining whether a transaction should be classified as a sales-type, operating, or direct financing lease, the Company considers the following terms at lease commencement: ( 1 2 3 4 5 no December 31, 2022 December 31, 2022 one three |
Cost of Goods and Service [Policy Text Block] | Cost of Revenue Cost of revenue consists of contract manufacturing, materials, labor and manufacturing overhead incurred internally to produce the products. Depreciation expense related to leased systems is included in the cost of revenue. Shipping and handling costs incurred by the Company are included in the cost of revenue. We expense all inventory obsolescence provisions as cost of revenue. |
Research and Development Expense, Policy [Policy Text Block] | Research and Development Costs Research and development expenses primarily consist of engineering, product development and regulatory expenses, incurred in the design, development, testing and enhancement of our products. Research and development costs are expensed as incurred. |
Share-Based Payment Arrangement [Policy Text Block] | Stock-Based Compensation The Company recognizes expenses for share-based awards exchanged for services rendered equal to the estimated fair value of these awards over the requisite service period. The Company recognizes as expense, the grant-date fair value of stock options and other stock-based compensation issued to employees and non-employee directors over the requisite service periods, which are typically the vesting periods. The Company uses the Black-Scholes-Merton model to estimate the fair value of stock options. The volatility assumption used in the Black-Scholes-Merton model is based on the Company’s historical volatility. The expected term of options granted has been determined based upon the simplified method, because the Company does not not not The fair value of restricted stock units is determined by the market price of the Company’s common stock on the date of grant. See “Note 13 |
Income Tax, Policy [Policy Text Block] | Income Taxes The Company accounts for income taxes using the asset and liability method, which requires the recognition of deferred tax assets or liabilities for the temporary differences between financial reporting and tax basis of the Company’s assets and liabilities, and for tax carryforwards at enacted statutory rates in effect for the years in which the asset or liability is expected to be realized. The effect on deferred taxes of a change in tax rates is recognized in income during the period that includes the enactment date. In addition, valuation allowances are established when necessary to reduce deferred tax assets and liabilities to the amounts expected to be realized. The Company has elected to account for global intangible low-taxed income (“GILTI”) as a period expense in the year the tax is incurred. The Company recognizes the financial statement benefit of an income tax position only after determining that the relevant taxing authority would more likely than not not 50% Tax regulations within each jurisdiction are subject to the interpretation of the related tax laws and regulations and require application of significant judgment. The Company is subject to U.S. federal and various state, local and foreign jurisdictions. Due to the Company’s net operating loss carryforwards, the Company may |
Comprehensive Income, Policy [Policy Text Block] | Comprehensive Loss Comprehensive loss is defined as the change in equity of a business enterprise during a period from transactions and other events and circumstances from non-owner sources. |
Segment Reporting, Policy [Policy Text Block] | Segments The Company operates in one not |
New Accounting Pronouncements, Policy [Policy Text Block] | Impact of Recently Issued Accounting Standards The Company has evaluated issued ASUs not not |
Note 2 - Summary of Significa_2
Note 2 - Summary of Significant Accounting Policies (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Schedule of Property Plant and Equipment Useful Life [Table Text Block] | Years Operating lease assets – Senhance System leasing 5 Machinery, manufacturing, and demonstration equipment 3 - 5 Computer equipment 3 Furniture 5 Leasehold improvements Lesser of lease term or 3 to 10 |
Note 3 - Revenue Recognition (T
Note 3 - Revenue Recognition (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Disaggregation of Revenue [Table Text Block] | Years Ended December 31, 2022 2021 (in thousands) U.S. Systems $ - $ - Instruments and accessories 211 273 Services 300 383 Leases 256 377 Total U.S. revenue 767 1,033 Outside of U.S. ("OUS") Systems 2,551 3,286 Instruments and accessories 1,565 1,840 Services 1,073 1,137 Leases 1,131 936 Total OUS revenue 6,320 7,199 Total Systems 2,551 3,286 Instruments and accessories 1,776 2,113 Services 1,373 1,520 Leases 1,387 1,313 Total revenue $ 7,087 $ 8,232 |
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Table Text Block] | December 31, 2022 December 31, 2021 (in thousands) Contract Assets $ 116 $ 91 Deferred Revenue $ 465 $ 543 |
Note 4 - Cash, Cash Equivalen_2
Note 4 - Cash, Cash Equivalents, and Restricted Cash (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Schedule of Cash, Cash Equivalents, and Restricted Cash [Table Text Block] | December 31, December 31, 2022 2021 (in thousands) Cash $ 3,473 $ 8,343 Money Market 2,856 5,287 Commerical Paper - 4,499 Total cash and cash equivalents $ 6,329 $ 18,129 Restricted Cash 1,141 1,154 Total $ 7,470 $ 19,283 |
Note 5 - Investments, Availab_2
Note 5 - Investments, Available-for-sale (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Debt Securities, Available-for-Sale [Table Text Block] | December 31, 2022 (in thousands) Amortized Cost Unrealized Gain Unrealized Loss Fair Value Short-term investments Long-term investments Commercial Paper $ 12,364 $ - $ (49 ) $ 12,315 $ 12,315 $ - Corporate Bonds 55,201 - (447 ) 54,754 50,889 3,865 U.S. Government Agencies 999 - (8 ) 991 991 - Total Investments $ 68,564 $ - $ (504 ) $ 68,060 $ 64,195 $ 3,865 December 31, 2021 (in thousands) Amortized Cost Unrealized Gain Unrealized Loss Fair Value Short-term investments Long-term investments Commercial Paper $ 50,705 $ - $ (46 ) $ 50,659 $ 50,660 $ - Corporate Bonds 67,239 1 (202 ) 67,038 29,602 37,435 Total Investments $ 117,944 $ 1 $ (248 ) $ 117,697 $ 80,262 $ 37,435 |
Investments Classified by Contractual Maturity Date [Table Text Block] | December 31, 2022 (in thousands) Amortized Cost Fair Value Mature in less than one year $ 64,662 $ 64,195 Mature in one to two years 3,902 3,865 Total $ 68,564 $ 68,060 |
Note 6 - Fair Value (Tables)
Note 6 - Fair Value (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Fair Value, Assets Measured on Recurring Basis [Table Text Block] | December 31, 2022 (in thousands) Description Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total Assets measured at fair value Cash and cash equivalents (1) $ 6,329 $ - $ - $ 6,329 Restricted cash 1,141 - - 1,141 Short-term investments - 64,195 - 64,195 Long-term investments - 3,865 - 3,865 Total assets measured at fair value $ 7,470 $ 68,060 $ - $ 75,530 Liabilities measured at fair value Contingent consideration $ - $ - $ 1,256 $ 1,256 Total liabilities measured at fair value $ - $ - $ 1,256 $ 1,256 December 31, 2021 (in thousands) Description Quoted Prices in Active Markets for Identical Assets (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) Total Assets measured at fair value Cash and cash equivalents (1) $ 18,129 $ - $ - $ 18,129 Restricted cash 1,154 - - 1,154 Short-term investments - 80,262 - 80,262 Long-term investments - 37,435 - 37,435 Total assets measured at fair value $ 19,283 $ 117,697 $ - $ 136,980 Liabilities measured at fair value Contingent consideration $ - $ - $ 2,371 $ 2,371 Total liabilities measured at fair value $ - $ - $ 2,371 $ 2,371 |
Fair Value Measurement Inputs and Valuation Techniques [Table Text Block] | Valuation Methodology Significant Unobservable Input December 31, 2022 December 31, 2021 Contingent consideration Probability weighted income approach Milestone dates 2032 2031 Discount rate 16.5% 9.5% Revenue volatility 45.0% 39.0% EUR-to-USD exchange rate 1.07 1.14 |
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Table Text Block] | Fair Value Measurement at Reporting Date (Level 3) (in thousands) Contingent consideration Balance at December 31, 2020 $ 3,936 Change in fair value (1,565 ) Balance at December 31, 2021 $ 2,371 Change in fair value (1,115 ) Balance at December 31, 2022 $ 1,256 Current portion $ - Long-term portion 1,256 Balance at December 31, 2022 $ 1,256 |
Note 7 - Inventories (Tables)
Note 7 - Inventories (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Schedule of Inventory, Current [Table Text Block] | December 31, 2022 (in thousands) Gross Carrying Amount Reserve Balance Net Carrying Amount Finished goods $ 15,337 $ (4,129 ) $ 11,208 Raw materials 4,718 (2,173 ) 2,545 Total inventories $ 20,055 $ (6,302 ) $ 13,753 Current Portion $ 9,399 $ (1,115 ) $ 8,284 Long-term portion 10,656 (5,187 ) 5,469 Total inventories $ 20,055 $ (6,302 ) $ 13,753 December 31, 2021 (in thousands) Gross Carrying Amount Reserve Balance Net Carrying Amount Finished goods $ 13,066 $ (2,987 ) $ 10,079 Raw materials 8,324 (2,695 ) 5,629 Total inventories $ 21,390 $ (5,682 ) $ 15,708 Current Portion $ 9,931 $ (1,297 ) $ 8,634 Long-term portion 11,459 (4,385 ) 7,074 Total inventories $ 21,390 $ (5,682 ) $ 15,708 |
Note 8 - Property and Equipme_2
Note 8 - Property and Equipment (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Property, Plant and Equipment [Table Text Block] | December 31, 2022 December 31, 2021 (In thousands) Machinery, manufacturing, and demonstration equipment $ 8,450 $ 8,289 Operating lease assets - Senhance System leasing 10,251 10,143 Computer equipment 600 325 Furniture 831 644 Leasehold improvements 1,654 1,259 Construction in process 436 ‑ Total property and equipment 22,222 20,660 Accumulated depreciation and amortization (12,680 ) (9,689 ) Property and equipment, net $ 9,542 $ 10,971 |
Note 9 - Intellectual Property
Note 9 - Intellectual Property (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Schedule of Finite-Lived Intangible Assets [Table Text Block] | December 31, 2022 (in thousands) Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount Developed technology $ 68,838 $ (66,562 ) $ (874 ) $ 1,402 Technology and patents purchased 400 (239 ) 13 174 Total intellectual property $ 69,238 $ (66,801 ) $ (861 ) $ 1,576 December 31, 2021 (in thousands) Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount Developed technology $ 68,838 $ (58,912 ) $ (262 ) $ 9,664 Technology and patents purchased 400 (199 ) 27 228 Total intellectual property $ 69,238 $ (59,111 ) $ (235 ) $ 9,892 |
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block] | Year Ending December 31, 2022 2023 $ 377 2024 377 2025 377 2026 377 2027 68 Total $ 1,576 |
Note 10 - Leases (Tables)
Note 10 - Leases (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Lease, Cost [Table Text Block] | Years Ended December 31, 2022 2021 (in thousands) Long-term Operating $ 1,557 $ 1,826 Short-term Operating - - Total Operating lease expense $ 1,557 $ 1,826 |
Lessee, Operating Lease, Disclosure [Table Text Block] | December 31, 2022 December 31, 2021 Weighted-average remaining lease term (in years) 6.8 7.8 Weighted-average discount rate 8.4% 7.8% Incremental borrowing rate 6.1% - 14.5% 6.1% - 8.5% |
Lessee, Operating Lease, Liability, Maturity [Table Text Block] | Fiscal Year 2023 $ 1,222 2024 1,136 2025 1,058 2026 837 2027 775 Thereafter 2,195 Total minimum lease payments $ 7,223 Less: Amount of lease payments representing interest (1,685 ) Present value of future minimum lease payments $ 5,538 |
Note 11 - Accrued Expenses (Tab
Note 11 - Accrued Expenses (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Schedule of Accrued Liabilities [Table Text Block] | December 31, 2022 December 31, 2021 (In thousands) Consulting and other vendors $ 155 $ 128 Other — 124 Royalties 24 247 Legal and professional fees 275 503 Taxes and other assessments 839 615 Total $ 1,293 $ 1,617 |
Note 12 - Income Taxes (Tables)
Note 12 - Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Schedule of Components of Income Tax Expense (Benefit) [Table Text Block] | 2022 2021 Current income taxes Federal $ - $ - State - - Foreign 239 232 Deferred income taxes Federal - - State - - Foreign 79 (7 ) Total income tax expense $ 318 $ 225 |
Schedule of Income before Income Tax, Domestic and Foreign [Table Text Block] | 2022 2021 United States $ (44,802 ) $ (32,094 ) Foreign (30,441 ) (30,143 ) Total loss from operations before taxes $ (75,243 ) $ (62,237 ) |
Schedule of Deferred Tax Assets and Liabilities [Table Text Block] | 2022 2021 Deferred Tax assets: Stock-based compensation $ 2,840 $ 2,440 Accrued expenses and other 2,538 2,423 Research credit carryforward 1,341 564 Fixed Assets 162 101 Capitalized start-up costs and other intangibles 921 1,109 Capitalized research costs 4,382 - Net operating loss carryforwards 83,908 75,237 96,092 81,874 Valuation Allowance (94,704 ) (78,294 ) Net deferred tax asset 1,388 3,580 Deferred tax liabilities Fixed assets and other (1,214 ) (1,176 ) Purchase accounting intangibles - (2,116 ) Net deferred tax liability (1,214 ) (3,292 ) Net deferred tax asset (liability) $ 174 $ 288 |
Schedule of Unrecognized Tax Benefits Roll Forward [Table Text Block] | 2022 2021 Beginning balance $ 141 $ - Gross increases for tax positions related to current periods 194 141 Gross decreases related to 382 limitations - - Ending balance $ 335 $ 141 |
Schedule of Effective Income Tax Rate Reconciliation [Table Text Block] | 2022 2021 Amount Percent of Pretax Earnings Amount Percent of Pretax Earnings United States federal tax at statutory rate $ (15,801 ) 21.0 % $ (13,070 ) 21.0 % State taxes (net of deferred benefit) (2,912 ) 3.9 % (2,205 ) 3.5 % Nondeductible expenses 1,077 (1.4% ) (440 ) 0.7 % Change in fair market value of contingent consideration (283 ) 0.4 % (397 ) 0.6 % Warrant remeasurment and financing costs - - 502 (0.8% ) Research & Development (970 ) 1.3 % (705 ) 1.1 % Change in unrecognized tax benefits 194 (0.3% ) 141 (0.2% ) Foreign tax rate differential 2,676 (3.6% ) 1,911 (3.1% ) True-up to Stock Compensation - Cancellations 49 (0.1% ) 2,832 (4.6% ) Change in enacted tax rates and other, net (96 ) 0.2 % 731 (1.0% ) Change in valuation allowance 16,384 (21.8% ) 10,925 (17.6% ) Income tax expense (benefit) $ 318 (0.4% ) $ 225 (0.4% ) |
Note 13 - Stock-based Compens_2
Note 13 - Stock-based Compensation (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Share-Based Payment Arrangement, Option, Activity [Table Text Block] | Number of Shares Weighted- Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Balance at December 31, 2021 4,640,660 $ 6.64 5.66 Granted 3,153,881 0.70 Forfeited (129,134 ) 1.60 Cancelled (36,987 ) 21.11 Exercised (43,453 ) 0.41 Balance at December 31, 2022 7,584,967 $ 4.22 5.31 |
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Vested and Expected to Vest, Exercisable [Table Text Block] | Number of Shares Weighted- Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Aggregate Intrinsic Value (Millions) Exercisable at December 31, 2022 3,524,473 $ 7.40 4.75 $ - Vested or expected to vest at December 31, 2022 7,350,141 $ 4.32 5.28 $ - |
Schedule of Share-Based Payment Award, Stock Options, Valuation Assumptions [Table Text Block] | Years Ended December 31, 2022 2021 Expected dividend yield 0% 0% Expected volatility 126% - 133% 118% - 139% Risk-free interest rate 1.25% - 4.40% 0.33% - 1.11% Expected life (in years) 3.8 - 4.5 3.8 - 4.5 |
Share-Based Payment Arrangement, Restricted Stock Unit, Activity [Table Text Block] | Number of Restricted Stock Units Outstanding Weighted- Average Grant Date Fair Value Unvested December 31, 2021 3,839,030 $ 2.36 Granted 6,996,822 0.71 Vested (2,076,663 ) 2.34 Forfeited (275,698 ) 1.19 Unvested December 31, 2022 8,483,491 $ 1.04 |
Share-Based Payment Arrangement, Cost by Plan [Table Text Block] | Years Ended December 31, 2022 2021 (in thousands) Stock options $ 3,654 $ 4,535 Restricted stock units 3,319 3,954 Performance restricted stock units 1,443 940 $ 8,416 $ 9,429 |
Note 14 - Equity Offerings (Tab
Note 14 - Equity Offerings (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Schedule of Sales Under Sales Agency Agreement [Table Text Block] | Year Ended December 31, 2021 Total shares of common stock sold 20,237,045 Average price per share $ 1.53 Gross proceeds $ 30,943 Commisssion earned by Sales Agents $ 928 Net proceeds $ 30,015 |
Note 15 - Basic and Diluted N_2
Note 15 - Basic and Diluted Net Loss Per Share (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share [Table Text Block] | December 31, 2022 2021 Stock options 7,584,967 4,640,660 Stock warrants 1,021,076 1,120,300 Nonvested restricted stock units 8,483,491 3,839,030 Total 17,089,534 9,599,990 |
Note 16 - Commitments and Con_2
Note 16 - Commitments and Contingencies (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Contractual Obligation, Fiscal Year Maturity [Table Text Block] | Fiscal Year 2023 $ 5,976 2024 407 2025 313 2026 303 Total commitments $ 6,999 |
Note 17 - Segments and Geogra_2
Note 17 - Segments and Geographic Areas (Tables) | 12 Months Ended |
Dec. 31, 2022 | |
Notes Tables | |
Long-Lived Assets by Geographic Areas [Table Text Block] | December 31, 2022 Long-Lived Assets Total Assets U.S. 35 % 72 % EMEA Switzerland 46 % 24 % Italy 8 % 2 % Other 8 % 1 % Total EMEA 62 % 27 % Asia 3 % 1 % Total 100 % 100 % December 31, 2021 Long-Lived Assets Total Assets U.S. 26 % 77 % EMEA Switzerland 34 % 16 % Italy 36 % 5 % Other 4 % 1 % Total EMEA 74 % 22 % Asia 0 % 1 % Total 100 % 100 % |
Revenue from External Customers by Geographic Areas [Table Text Block] | Years Ended December 31, 2022 2021 US 11 % 13 % EMEA 77 % 62 % Asia 12 % 25 % Total 100 % 100 % |
Note 2 - Summary of Significa_3
Note 2 - Summary of Significant Accounting Policies (Details Textual) $ in Thousands, € in Millions | 12 Months Ended | |||
Jun. 10, 2021 USD ($) | Dec. 31, 2022 USD ($) | Dec. 31, 2022 EUR (€) | Dec. 31, 2021 USD ($) | |
Retained Earnings (Accumulated Deficit), Total | $ (860,935) | $ (785,374) | ||
Working Capital | 76,500 | |||
Overstated Raw Materials, Amount | 2,500 | |||
Restricted Cash, Total | 1,100 | 1,100 | ||
Debt Securities, Available-for-Sale, Realized Gain (Loss), Total | 0 | 0 | ||
Accounts Receivable, Allowance for Credit Loss, Ending Balance | 1,600 | 1,700 | ||
Accounts Receivable, Credit Loss Expense (Reversal) | 9 | 144 | ||
Property, Plant and Equipment, Including Purchased Software, Impairment Charges | 1,400 | 0 | ||
Other Income, Employer Retention Tax Credit | 0 | 1,311 | ||
Proceeds From Employee Retention Tax Credit | 700 | |||
Employer Retention Tax Credit Receivable | 554 | 1,311 | ||
Letters of Credit Outstanding, Amount | 0 | |||
Business Combination, Contingent Consideration, Liability, Total | $ 1,256 | $ 2,371 | ||
Period Of Service Sale Arrangement (Year) | 5 years | 5 years | ||
Period of Service Sale Arrangement at Stated Service Price (Year) | 4 years | 4 years | ||
Lessor, Operating Lease, Payments to be Received, Total | $ 2,200 | |||
Number of Operating Segments | 1 | 1 | ||
Senhance Surgical Robotic System Acquisition[Member] | ||||
Business Combination, Contingent Consideration, Liability, Total | $ 1,300 | |||
Business Combination, Contingent Consideration, Liability, Related Milestone | € | € 15 | |||
Letter of Credit [Member] | ||||
Line of Credit Facility, Remaining Borrowing Capacity | $ 600 | |||
Paycheck Protection Program CARES Act [Member] | ||||
Debt Instrument, Decrease, Forgiveness | $ 2,800 | |||
Minimum [Member] | ||||
Lessee, Operating Lease, Term of Contract (Year) | 1 year | |||
Lessee, Operating Lease, Renewal Term (Year) | 1 year | |||
Minimum [Member] | Senhance Surgical Robotic System Acquisition[Member] | ||||
Business Combination Contingent Consideration Arrangements Target Revenue | € | € 25 | |||
Maximum [Member] | ||||
Lessee, Operating Lease, Term of Contract (Year) | 10 years | |||
Lessee, Operating Lease, Renewal Term (Year) | 6 years | |||
Patents [Member] | ||||
Finite-Lived Intangible Asset, Useful Life (Year) | 10 years | 10 years | ||
Developed Technology Rights [Member] | Minimum [Member] | ||||
Finite-Lived Intangible Asset, Useful Life (Year) | 5 years | 5 years | ||
Developed Technology Rights [Member] | Maximum [Member] | ||||
Finite-Lived Intangible Asset, Useful Life (Year) | 7 years | 7 years | ||
Intellectual Property [Member] | ||||
Impairment of Intangible Assets, Finite-lived | $ 0 | |||
Accounts Receivable [Member] | Customer Concentration Risk [Member] | One Customer [Member] | ||||
Number of Major Customers | 1 | 1 | ||
Concentration Risk, Percentage | 69% | 69% | ||
Accounts Receivable [Member] | Customer Concentration Risk [Member] | Three Customers [Member] | ||||
Number of Major Customers | 3 | |||
Accounts Receivable [Member] | Customer Concentration Risk [Member] | Customer One [Member] | ||||
Concentration Risk, Percentage | 26% | |||
Accounts Receivable [Member] | Customer Concentration Risk [Member] | Customer Two [Member] | ||||
Concentration Risk, Percentage | 20% | |||
Accounts Receivable [Member] | Customer Concentration Risk [Member] | Customer Three [Member] | ||||
Concentration Risk, Percentage | 14% | |||
Revenue Benchmark [Member] | Customer Concentration Risk [Member] | One Customer [Member] | ||||
Number of Major Customers | 1 | 1 | ||
Concentration Risk, Percentage | 47% | 47% | ||
Revenue Benchmark [Member] | Customer Concentration Risk [Member] | Customer One [Member] | ||||
Concentration Risk, Percentage | 36% | |||
Revenue Benchmark [Member] | Customer Concentration Risk [Member] | Customer Two [Member] | ||||
Concentration Risk, Percentage | 16% | |||
Revenue Benchmark [Member] | Customer Concentration Risk [Member] | Two Customers [Member] | ||||
Number of Major Customers | 2 |
Note 2 - Summary of Significa_4
Note 2 - Summary of Significant Accounting Policies - Estimated Useful Lives of Assets (Details) | 12 Months Ended |
Dec. 31, 2022 | |
Operating Lease Assets [Member] | |
Property and equipment, estimated useful lives (Year) | 5 years |
Machinery, Manufacturing and Demonstration Equipment [Member] | Minimum [Member] | |
Property and equipment, estimated useful lives (Year) | 3 years |
Machinery, Manufacturing and Demonstration Equipment [Member] | Maximum [Member] | |
Property and equipment, estimated useful lives (Year) | 5 years |
Computer Equipment [Member] | |
Property and equipment, estimated useful lives (Year) | 3 years |
Furniture and Fixtures [Member] | |
Property and equipment, estimated useful lives (Year) | 5 years |
Leasehold Improvements [Member] | Minimum [Member] | |
Property and equipment, estimated useful lives (Year) | 3 years |
Leasehold Improvements [Member] | Maximum [Member] | |
Property and equipment, estimated useful lives (Year) | 10 years |
Note 3 - Revenue Recognition 1
Note 3 - Revenue Recognition 1 (Details Textual) - USD ($) $ in Millions | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Contract with Customer, Liability, Revenue Recognized | $ 0.5 | $ 0.6 |
Note 3 - Revenue Recognition 2
Note 3 - Revenue Recognition 2 (Details Textual) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01 $ in Millions | Dec. 31, 2022 USD ($) |
Revenue, Remaining Performance Obligation, Amount | $ 1.1 |
Minimum [Member] | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Period (Year) | 1 year |
Maximum [Member] | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Period (Year) | 4 years |
Note 3 - Revenue Recognition -
Note 3 - Revenue Recognition - Disaggregation of Revenue (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Revenue | $ 7,087 | $ 8,232 |
UNITED STATES | ||
Revenue | 767 | 1,033 |
Non-US [Member] | ||
Revenue | 6,320 | 7,199 |
Systems [Member] | ||
Revenue | 2,551 | 3,286 |
Systems [Member] | UNITED STATES | ||
Revenue | 0 | 0 |
Systems [Member] | Non-US [Member] | ||
Revenue | 2,551 | 3,286 |
Instruments and Accessories [Member] | ||
Revenue | 1,776 | 2,113 |
Instruments and Accessories [Member] | UNITED STATES | ||
Revenue | 211 | 273 |
Instruments and Accessories [Member] | Non-US [Member] | ||
Revenue | 1,565 | 1,840 |
Service [Member] | ||
Revenue | 1,373 | 1,520 |
Service [Member] | UNITED STATES | ||
Revenue | 300 | 383 |
Service [Member] | Non-US [Member] | ||
Revenue | 1,073 | 1,137 |
Lease [Member] | ||
Revenue | 1,387 | 1,313 |
Lease [Member] | UNITED STATES | ||
Revenue | 256 | 377 |
Lease [Member] | Non-US [Member] | ||
Revenue | $ 1,131 | $ 936 |
Note 3 - Revenue Recognition _2
Note 3 - Revenue Recognition - Contract Assets and Liabilities (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Contract Assets | $ 116 | $ 91 |
Deferred Revenue | $ 465 | $ 543 |
Note 4 - Cash, Cash Equivalen_3
Note 4 - Cash, Cash Equivalents, and Restricted Cash (Details Textual) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Restricted Cash and Cash Equivalents, Noncurrent, Total | $ 1,141 | $ 1,154 |
Note 4 - Cash, Cash Equivalen_4
Note 4 - Cash, Cash Equivalents, and Restricted Cash - Cash, Cash Equivalents, and Restricted Cash (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Cash | $ 3,473 | $ 8,343 |
Money Market | 2,856 | 5,287 |
Commerical Paper | 0 | 4,499 |
Total cash and cash equivalents | 6,329 | 18,129 |
Restricted Cash and Cash Equivalents, Noncurrent, Total | 1,141 | 1,154 |
Total | $ 7,470 | $ 19,283 |
Note 5 - Investments, Availab_3
Note 5 - Investments, Available-for-sale (Details Textual) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Proceeds from Sale of Debt Securities, Available-for-Sale | $ 0 | $ 0 |
Debt Securities, Available-for-Sale, Realized Gain (Loss), Total | $ 0 | $ 0 |
Note 5 - Investments, Availab_4
Note 5 - Investments, Available-for-sale - Summary of Investment Securities (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Amortized Cost | $ 68,564 | $ 117,944 |
Unrealized Gain | 0 | 1 |
Unrealized Loss | (504) | (248) |
Fair Value | 68,060 | 117,697 |
Short-term investments | 64,195 | 80,262 |
Long-term investments | 3,865 | 37,435 |
Commercial Paper [Member] | ||
Amortized Cost | 12,364 | 50,705 |
Unrealized Gain | 0 | 0 |
Unrealized Loss | (49) | (46) |
Fair Value | 12,315 | 50,659 |
Short-term investments | 12,315 | 50,660 |
Long-term investments | 0 | 0 |
Corporate Debt Securities [Member] | ||
Amortized Cost | 55,201 | 67,239 |
Unrealized Gain | 0 | 1 |
Unrealized Loss | (447) | (202) |
Fair Value | 54,754 | 67,038 |
Short-term investments | 50,889 | 29,602 |
Long-term investments | 3,865 | $ 37,435 |
US Government Agencies Debt Securities [Member] | ||
Amortized Cost | 999 | |
Unrealized Gain | 0 | |
Unrealized Loss | (8) | |
Fair Value | 991 | |
Short-term investments | 991 | |
Long-term investments | $ 0 |
Note 5 - Investments, Availab_5
Note 5 - Investments, Available-for-sale - Contractual Maturities (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Mature in less than one year, amortized cost | $ 64,662 | |
Mature in less than one year, fair value | 64,195 | |
Mature in one to two years, amortized cost | 3,902 | |
Mature in one to two years, fair value | 3,865 | |
Total, amortized cost | 68,564 | $ 117,944 |
Total, fair value | $ 68,060 | $ 117,697 |
Note 6 - Fair Value - Summary o
Note 6 - Fair Value - Summary of Assets and Liabilities Measured at Fair Value on Recurring Basis (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 | |
Cash and cash equivalents | [1] | $ 6,329 | $ 18,129 |
Restricted cash | 1,141 | 1,154 | |
Short-term investments | 64,195 | 80,262 | |
Long-term investments | 3,865 | 37,435 | |
Total assets measured at fair value | 75,530 | 136,980 | |
Contingent consideration | 1,256 | 2,371 | |
Total liabilities measured at fair value | 1,256 | 2,371 | |
Fair Value, Inputs, Level 1 [Member] | |||
Cash and cash equivalents | [1] | 6,329 | 18,129 |
Restricted cash | 1,141 | 1,154 | |
Short-term investments | 0 | 0 | |
Long-term investments | 0 | 0 | |
Total assets measured at fair value | 7,470 | 19,283 | |
Contingent consideration | 0 | 0 | |
Total liabilities measured at fair value | 0 | 0 | |
Fair Value, Inputs, Level 2 [Member] | |||
Cash and cash equivalents | [1] | 0 | 0 |
Restricted cash | 0 | 0 | |
Short-term investments | 64,195 | 80,262 | |
Long-term investments | 3,865 | 37,435 | |
Total assets measured at fair value | 68,060 | 117,697 | |
Contingent consideration | 0 | 0 | |
Total liabilities measured at fair value | 0 | 0 | |
Fair Value, Inputs, Level 3 [Member] | |||
Cash and cash equivalents | [1] | 0 | 0 |
Restricted cash | 0 | 0 | |
Short-term investments | 0 | 0 | |
Long-term investments | 0 | 0 | |
Total assets measured at fair value | 0 | 0 | |
Contingent consideration | 1,256 | 2,371 | |
Total liabilities measured at fair value | $ 1,256 | $ 2,371 | |
[1]Includes investments that are readily convertible to cash with original maturities of 90 days or less. |
Note 6 - Fair Value - Quantitat
Note 6 - Fair Value - Quantitative Information about Inputs and Valuation Methodologies Used for Fair Value Measurements Classification (Details) - Senhance Surgical Robotic System Acquisition[Member] - Fair Value, Inputs, Level 3 [Member] | Dec. 31, 2022 | Dec. 31, 2021 |
Measurement Input, Discount Rate [Member] | ||
Contingent consideration, measurement input | 0.165 | 0.095 |
Measurement Input, Price Volatility [Member] | ||
Contingent consideration, measurement input | 0.450 | 0.390 |
Measurement Input, Currency Exchange Rate [Member] | ||
Contingent consideration, measurement input | 1.07 | 1.14 |
Note 6 - Fair Value - Summary_2
Note 6 - Fair Value - Summary of Change in Fair Value for Warrants and Contingent Consideration (Details) - Warrant [Member] - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Balance | $ 2,371 | $ 3,936 |
Change in fair value | (1,115) | (1,565) |
Balance | 1,256 | $ 2,371 |
Current portion | 0 | |
Long-term portion | $ 1,256 |
Note 7 - Inventories - Componen
Note 7 - Inventories - Components of Inventories (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Finished goods, gross | $ 15,337 | $ 13,066 |
Finished goods, reserve | (4,129) | (2,987) |
Finished goods, net | 11,208 | 10,079 |
Raw materials, gross | 4,718 | 8,324 |
Raw materials, reserve | (2,173) | (2,695) |
Raw materials, net | 2,545 | 5,629 |
Total inventories, gross | 20,055 | 21,390 |
Total inventories, reserve | (6,302) | (5,682) |
Total inventories, net | 13,753 | 15,708 |
Current Portion, gross | 9,399 | 9,931 |
Current Portion, reserve | (1,115) | (1,297) |
Inventories | 8,284 | 8,634 |
Long-term portion, gross | 10,656 | 11,459 |
Long-term portion, reserve | (5,187) | (4,385) |
Inventories, net of current portion | $ 5,469 | $ 7,074 |
Note 8 - Property and Equipme_3
Note 8 - Property and Equipment (Details Textual) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Depreciation, Total | $ 3,368 | $ 2,857 |
Note 8 - Property and Equipme_4
Note 8 - Property and Equipment - Summary of Property and Equipment (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Property, plant and equipment, gross | $ 22,222 | $ 20,660 |
Accumulated depreciation and amortization | (12,680) | (9,689) |
Property and equipment, net | 9,542 | 10,971 |
Machinery, Manufacturing and Demonstration Equipment [Member] | ||
Property, plant and equipment, gross | 8,450 | 8,289 |
Operating Lease Assets [Member] | ||
Property, plant and equipment, gross | 10,251 | 10,143 |
Computer Equipment [Member] | ||
Property, plant and equipment, gross | 600 | 325 |
Furniture and Fixtures [Member] | ||
Property, plant and equipment, gross | 831 | 644 |
Leasehold Improvements [Member] | ||
Property, plant and equipment, gross | 1,654 | 1,259 |
Construction in Progress [Member] | ||
Property, plant and equipment, gross | $ 436 |
Note 9 - Intellectual Propert_2
Note 9 - Intellectual Property (Details Textual) - Weighted Average [Member] | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Developed Technology Rights [Member] | ||
Finite-Lived Intangible Assets, Remaining Amortization Period (Year) | 4 years 2 months 12 days | 1 year 7 months 6 days |
Technology-Based Intangible Assets [Member] | ||
Finite-Lived Intangible Assets, Remaining Amortization Period (Year) | 4 years 3 months 18 days | 5 years 3 months 18 days |
Note 9 - Intellectual Propert_3
Note 9 - Intellectual Property - Intellectual Property (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Finite-Lived Intangible Assets, Gross | $ 69,238 | $ 69,238 |
Finite-Lived Intangible Assets, Accumulated Amortization | (66,801) | (59,111) |
Finite-Lived Intangible Assets, Foreign Currency Translation Impact | (861) | (235) |
Intellectual property, net | 1,576 | 9,892 |
Developed Technology Rights [Member] | ||
Finite-Lived Intangible Assets, Gross | 68,838 | 68,838 |
Finite-Lived Intangible Assets, Accumulated Amortization | (66,562) | (58,912) |
Finite-Lived Intangible Assets, Foreign Currency Translation Impact | (874) | (262) |
Intellectual property, net | 1,402 | 9,664 |
Technology-Based Intangible Assets [Member] | ||
Finite-Lived Intangible Assets, Gross | 400 | 400 |
Finite-Lived Intangible Assets, Accumulated Amortization | (239) | (199) |
Finite-Lived Intangible Assets, Foreign Currency Translation Impact | 13 | 27 |
Intellectual property, net | $ 174 | $ 228 |
Note 9 - Intellectual Propert_4
Note 9 - Intellectual Property - Amortization Expense of Intangible Assets (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Total | $ 1,576 | $ 9,892 |
Intellectual Property [Member] | ||
2023 | 377 | |
2024 | 377 | |
2025 | 377 | |
2026 | 377 | |
2027 | 68 | |
Total | $ 1,576 | $ 9,892 |
Note 10 - Leases - Components o
Note 10 - Leases - Components of Operating Lease Expense (Details) - General and Administrative Expense [Member] - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Long-term Operating | $ 1,557 | $ 1,826 |
Short-term Operating | 0 | 0 |
Total Operating lease expense | $ 1,557 | $ 1,826 |
Note 10 - Leases -Supplemental
Note 10 - Leases -Supplemental Balance Sheet Information (Details) | Dec. 31, 2022 | Dec. 31, 2021 |
Weighted-average remaining lease term (in years) (Year) | 6 years 9 months 18 days | 7 years 9 months 18 days |
Weighted-average discount rate | 8.40% | 7.80% |
Minimum [Member] | ||
Incremental borrowing rate | 6.10% | 6.10% |
Maximum [Member] | ||
Incremental borrowing rate | 14.50% | 8.50% |
Note 10 - Leases - Minimum Leas
Note 10 - Leases - Minimum Lease Payments (Details) $ in Thousands | Dec. 31, 2022 USD ($) |
2023 | $ 1,222 |
2024 | 1,136 |
2025 | 1,058 |
2026 | 837 |
2027 | 775 |
Thereafter | 2,195 |
Total minimum lease payments | 7,223 |
Less: Amount of lease payments representing interest | (1,685) |
Present value of future minimum lease payments | $ 5,538 |
Note 11 - Accrued Expenses - Co
Note 11 - Accrued Expenses - Components of Accrued Expenses (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Consulting and other vendors | $ 155 | $ 128 |
Other | 0 | 124 |
Royalties | 24 | 247 |
Legal and professional fees | 275 | 503 |
Taxes and other assessments | 839 | 615 |
Total | $ 1,293 | $ 1,617 |
Note 12 - Income Taxes (Details
Note 12 - Income Taxes (Details Textual) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Valuation Allowance, Deferred Tax Asset, Increase (Decrease), Amount | $ 16,400 | ||
Unrecognized Tax Benefits, Ending Balance | 335 | $ 141 | $ 0 |
Unrecognized Tax Benefits, Income Tax Penalties and Interest Accrued, Total | $ 0 | $ 0 | |
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent | 21% | 21% | |
Domestic Tax Authority [Member] | |||
Increase (Decrease) in Operating Loss Carryforwards | $ (253,000) | ||
Operating Loss Carryforwards | 419,400 | ||
Operating Loss Carryforwards, Subject to Expiration | 254,500 | ||
Operating Loss Carryforwards, Not Subject to Expiration | 164,900 | ||
Domestic Tax Authority [Member] | Research Tax Credit Carryforward [Member] | |||
Tax Credit Carryforward, Amount | 10,200 | ||
Increase (Decrease) in Tax Credit Carryforward | (8,800) | ||
Domestic Tax Authority [Member] | Impact of 382 Ownership Changes [Member] | |||
Increase (Decrease) in Operating Loss Carryforwards | (253,000) | ||
State and Local Jurisdiction [Member] | |||
Operating Loss Carryforwards | 328,900 | ||
Operating Loss Carryforwards, Subject to Expiration | 317,400 | ||
Operating Loss Carryforwards, Not Subject to Expiration | 11,500 | ||
State and Local Jurisdiction [Member] | Impact of 382 Ownership Changes [Member] | |||
Increase (Decrease) in Operating Loss Carryforwards | (204,000) | ||
Foreign Tax Authority [Member] | Ministry of Economic Affairs and Finance, Italy [Member] | |||
Operating Loss Carryforwards | 24,600 | ||
Foreign Tax Authority [Member] | Luxembourg Inland Revenue [Member] | |||
Operating Loss Carryforwards, Subject to Expiration | 95,900 | ||
Foreign Tax Authority [Member] | Swiss Federal Tax Administration (FTA) [Member] | |||
Operating Loss Carryforwards, Subject to Expiration | 116,500 | ||
Foreign Tax Authority [Member] | Canada Revenue Agency [Member] | |||
Operating Loss Carryforwards, Subject to Expiration | $ 900 |
Note 12 - Income Taxes - Income
Note 12 - Income Taxes - Income Tax Expense (Benefit) (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Federal | $ 0 | $ 0 |
State | 0 | 0 |
Foreign | 239 | 232 |
Federal | 0 | 0 |
State | 0 | 0 |
Foreign | 79 | (7) |
Total income tax expense | $ 318 | $ 225 |
Note 12 - Income Taxes - Domest
Note 12 - Income Taxes - Domestic and Foreign Components of Loss from Operations (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
United States | $ (44,802) | $ (32,094) |
Foreign | (30,441) | (30,143) |
Loss before income taxes | $ (75,243) | $ (62,237) |
Note 12 - Income Taxes - Deferr
Note 12 - Income Taxes - Deferred Tax Assets (Details) - USD ($) $ in Thousands | Dec. 31, 2022 | Dec. 31, 2021 |
Stock-based compensation | $ 2,840 | $ 2,440 |
Accrued expenses and other | 2,538 | 2,423 |
Research credit carryforward | 1,341 | 564 |
Fixed Assets | 162 | 101 |
Net operating loss carryforwards | 83,908 | 75,237 |
Deferred Tax Assets, Gross, Total | 96,092 | 81,874 |
Valuation Allowance | (94,704) | (78,294) |
Net deferred tax asset | 1,388 | 3,580 |
Fixed assets and other | (1,214) | (1,176) |
Purchase accounting intangibles | 0 | (2,116) |
Net deferred tax liability | (1,214) | (3,292) |
Net deferred tax asset (liability) | 174 | 288 |
Start-up Costs and Other Intangibles [Member] | ||
Capitalized costs | 921 | 1,109 |
Research Tax Credit Carryforward [Member] | ||
Capitalized costs | $ 4,382 | $ 0 |
Note 12 - Income Taxes - Unreco
Note 12 - Income Taxes - Unrecognized Tax Positions (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Beginning balance | $ 141 | $ 0 |
Gross increases for tax positions related to current periods | 194 | 141 |
Gross decreases related to 382 limitations | 0 | 0 |
Ending balance | $ 335 | $ 141 |
Note 12 - Income Taxes - Effect
Note 12 - Income Taxes - Effective Income Tax Reconciliation (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
United States federal tax at statutory rate, amount | $ (15,801) | $ (13,070) |
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent | 21% | 21% |
State taxes (net of deferred benefit), amount | $ (2,912) | $ (2,205) |
State taxes (net of deferred benefit), percent | 3.90% | 3.50% |
Nondeductible expenses, amount | $ 1,077 | $ (440) |
Nondeductible expenses, percent | (1.40%) | 0.70% |
Change in fair market value of contingent consideration, amount | $ (283) | $ (397) |
Change in fair market value of contingent consideration, percent | 0.40% | 0.60% |
Warrant remeasurment and financing costs, amount | $ 0 | $ 502 |
Warrant remeasurment and financing costs, percent | 0% | (0.80%) |
Research & Development, amount | $ (970) | $ (705) |
Research & Development, percent | 1.30% | 1.10% |
Change in unrecognized tax benefits, amount | $ 194 | $ 141 |
Change in unrecognized tax benefits, percent | (0.30%) | (0.20%) |
Foreign tax rate differential, amount | $ 2,676 | $ 1,911 |
Foreign tax rate differential, percent | (3.60%) | (3.10%) |
True-up to Stock Compensation - Cancellations, amount | $ 49 | $ 2,832 |
True-up to Stock Compensation - Cancellations, percent | (0.10%) | (4.60%) |
Change in enacted tax rates and other, net, amount | $ (96) | $ 731 |
Change in enacted tax rates and other, net, percent | 0.20% | (1.00%) |
Change in valuation allowance, amount | $ 16,384 | $ 10,925 |
Change in valuation allowance, percent | (21.80%) | (17.60%) |
Total income tax expense | $ 318 | $ 225 |
Income tax expense (benefit), percent | (0.40%) | (0.40%) |
Note 13 - Stock-based Compens_3
Note 13 - Stock-based Compensation (Details Textual) - USD ($) $ in Millions | 12 Months Ended | |
Jul. 22, 2021 | Dec. 31, 2022 | |
Share-Based Payment Arrangement, Option [Member] | ||
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount, Total | $ 2.1 | |
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year) | 1 year 6 months | |
Restricted Stock Units (RSUs) [Member] | ||
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount, Total | $ 4.2 | |
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year) | 1 year 4 months 24 days | |
Asensus Surgical, Inc. Amended and Restated Incentive Compensation Plan [Member] | ||
Share-Based Compensation Arrangement by Share-Based Payment Award, Number of Additional Shares Authorized (in shares) | 22,000,000 | |
Share-Based Compensation Arrangement by Share-Based Payment Award, Number of Shares Authorized (in shares) | 32,072,308 | |
Share-Based Compensation Arrangement by Share-Based Payment Award, Number of Shares Available for Grant (in shares) | 11,038,824 | |
Share-Based Compensation Arrangement by Share-Based Payment Award, Expiration Period (Year) | 10 years |
Note 13 - Stock-based Compens_4
Note 13 - Stock-based Compensation - Stock Option Activity (Details) - $ / shares | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Options, Outstanding, Number of Shares (in shares) | 4,640,660 | |
Options, Outstanding, Weighted Average Exercise Price (in dollars per share) | $ 6.64 | |
Options, Outstanding, Weighted Average Remaining Contractual Term (Year) | 5 years 3 months 21 days | 5 years 7 months 28 days |
Options, Granted, Number of Shares (in shares) | 3,153,881 | |
Options, Grants in Period, Weighted Average Exercise Price (in dollars per share) | $ 0.70 | |
Options, Forfeited, Number of Shares (in shares) | (129,134) | |
Options, Forfeitures in Period, Weighted Average Exercise Price (in dollars per share) | $ 1.60 | |
Options, Cancelled, Number of Shares (in shares) | (36,987) | |
Options, Expirations in Period, Weighted Average Exercise Price (in dollars per share) | $ 21.11 | |
Options, Exercised, Number of Shares (in shares) | (43,453) | |
Options, Exercises in Period, Weighted Average Exercise Price (in dollars per share) | $ 0.41 | |
Options, Outstanding, Number of Shares (in shares) | 7,584,967 | 4,640,660 |
Options, Outstanding, Weighted Average Exercise Price (in dollars per share) | $ 4.22 | $ 6.64 |
Note 13 - Stock-based Compens_5
Note 13 - Stock-based Compensation - Stock Options Outstanding (Details) $ / shares in Units, $ in Millions | 12 Months Ended |
Dec. 31, 2022 USD ($) $ / shares shares | |
Options, Exercisable, Number of Shares (in shares) | shares | 3,524,473 |
Options, Exercisable, Weighted Average Exercise Price (in dollars per share) | $ / shares (in dollars per share) | $ / shares | $ 7.40 |
Options, Exercisable, Weighted Average Remaining Contractual Term (Year) | 4 years 9 months |
Options, Exercisable, Aggregate Intrinsic Value | $ | $ 0 |
Options, Vested and Expected to Vest, Exercisable, Number of Shares (in shares) | shares | 7,350,141 |
Options, Vested and Expected to Vest, Exercisable, Weighted Average Exercise Price (in dollars per share) | $ / shares | $ 4.32 |
Options, Vested and Expected to Vest, Exercisable, Weighted Average Remaining Contractual Term (Year) | 5 years 3 months 10 days |
Options, Vested or Expected to Vest, Aggregate Intrinsic Value | $ | $ 0 |
Note 13 - Stock-based Compens_6
Note 13 - Stock-based Compensation - Stock Option Valuation Assumptions (Details) | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Expected dividend yield | 0% | 0% |
Minimum [Member] | ||
Expected volatility | 126% | 118% |
Risk-free interest rate | 1.25% | 0.33% |
Expected life (in years) (Year) | 3 years 9 months 18 days | 3 years 9 months 18 days |
Maximum [Member] | ||
Expected volatility | 133% | 139% |
Risk-free interest rate | 4.40% | 1.11% |
Expected life (in years) (Year) | 4 years 6 months | 4 years 6 months |
Note 13 - Stock-based Compens_7
Note 13 - Stock-based Compensation - RSU Activity (Details) - Restricted Stock Units (RSUs) [Member] | 12 Months Ended |
Dec. 31, 2022 $ / shares shares | |
Beginning of period, Restricted stock units, Unvested (in shares) | shares | 3,839,030 |
Beginning of period, Restricted stock units, Unvested, weighted average grant date fair value (in dollars per share) | $ / shares | $ 2.36 |
Restricted stock units, Granted (in shares) | shares | 6,996,822 |
Restricted stock units, Granted, weighted average grant date fair value (in dollars per share) | $ / shares | $ 0.71 |
Restricted stock units, Vested (in shares) | shares | (2,076,663) |
Restricted stock units, Vested, weighted average grant date fair value (in dollars per share) | $ / shares | $ 2.34 |
Restricted stock units, Forfeited (in shares) | shares | (275,698) |
Restricted stock units, Forfeited, weighted average grant date fair value (in dollars per share) | $ / shares | $ 1.19 |
Unvested (in shares) | shares | 8,483,491 |
Unvested December 31, 2022 (in dollars per share) | $ / shares | $ 1.04 |
Note 13 - Stock-based Compens_8
Note 13 - Stock-based Compensation - Non-cash Share-based Compensation Expense (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Share-based compensation | $ 8,416 | $ 9,429 |
Share-Based Payment Arrangement, Option [Member] | ||
Share-based compensation | 3,654 | 4,535 |
Restricted Stock Units (RSUs) [Member] | ||
Share-based compensation | 3,319 | 3,954 |
Performance Restricted Stock Unit [Member] | ||
Share-based compensation | $ 1,443 | $ 940 |
Note 14 - Equity Offerings (Det
Note 14 - Equity Offerings (Details Textual) - USD ($) | 12 Months Ended | ||||||
Jan. 29, 2021 | Jan. 12, 2021 | Dec. 31, 2022 | Dec. 31, 2021 | Mar. 18, 2022 | May 19, 2021 | Oct. 09, 2020 | |
Proceeds from Issuance of Common Stock, Net | $ 0 | $ 131,929,000 | |||||
Proceeds from Warrant Exercises | $ 30,600,000 | ||||||
The 2020 ATM Offering [Member] | |||||||
Stock Offering Agreement, Maximum Share Value | $ 40,000,000 | ||||||
Public Offering [Member] | |||||||
Stock Issued During Period, Shares, New Issues (in shares) | 26,545,832 | ||||||
Shares Issued, Price Per Share (in dollars per share) | $ 3 | ||||||
Proceeds from Issuance of Common Stock, Net | $ 73,400,000 | ||||||
Registered Direct Offering [Member] | |||||||
Stock Issued During Period, Shares, New Issues (in shares) | 25,000,000 | ||||||
Shares Issued, Price Per Share (in dollars per share) | $ 1.25 | ||||||
Proceeds from Issuance of Common Stock, Net | $ 28,600,000 | ||||||
The 2021 ATM Offering [Member] | |||||||
Stock Offering Agreement, Maximum Share Value | $ 100,000,000 | ||||||
The 2022 ATM Offering [Member] | |||||||
Stock Offering Agreement, Maximum Share Value | $ 100,000,000 | ||||||
Stock Issued During Period, Shares, New Issues (in shares) | 0 |
Note 14 - Equity Offerings - Su
Note 14 - Equity Offerings - Summary of Sales Under Offering (Details) - The 2021 and 2020 ATM Offering [Member] $ / shares in Units, $ in Thousands | 12 Months Ended |
Dec. 31, 2021 USD ($) $ / shares shares | |
Total shares of common stock sold (in shares) | shares | 20,237,045 |
Average price per share (in dollars per share) | $ / shares | $ 1.53 |
Gross proceeds | $ 30,943 |
Commisssion earned by Sales Agents | 928 |
Net proceeds | $ 30,015 |
Note 15 - Basic and Diluted N_3
Note 15 - Basic and Diluted Net Loss Per Share - Antidilutive Securities Excluded from Computation of Earnings Per Share (Details) - shares | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares) | 17,089,534 | 9,599,990 |
Share-Based Payment Arrangement, Option [Member] | ||
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares) | 7,584,967 | 4,640,660 |
Warrant [Member] | ||
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares) | 1,021,076 | 1,120,300 |
Restricted Stock Units (RSUs) [Member] | ||
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares) | 8,483,491 | 3,839,030 |
Note 16 - Commitments and Con_3
Note 16 - Commitments and Contingencies - Purchase Orders Commitments (Details) - License and Supply Agreement [Member] - Senhance Surgical Robotic System Acquisition[Member] $ in Thousands | Dec. 31, 2022 USD ($) |
2023 | $ 5,976 |
2024 | 407 |
2025 | 313 |
2026 | 303 |
Total commitments | $ 6,999 |
Note 17 - Segments and Geogra_3
Note 17 - Segments and Geographic Areas - Consolidated Assets and Long Lived Assets by Geographic Area (Details) - Geographic Concentration Risk [Member] | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Long-lived Assets [Member] | UNITED STATES | ||
Percentage | 35% | 26% |
Long-lived Assets [Member] | SWITZERLAND | ||
Percentage | 46% | 34% |
Long-lived Assets [Member] | ITALY | ||
Percentage | 8% | 36% |
Long-lived Assets [Member] | Other Countries in EMEA [Member] | ||
Percentage | 8% | 4% |
Long-lived Assets [Member] | Europe, Middle East, and Africa [Member] | ||
Percentage | 62% | 74% |
Long-lived Assets [Member] | Asia [Member] | ||
Percentage | 3% | 0% |
Long-lived Assets [Member] | All Countries [Member] | ||
Percentage | 100% | 100% |
Assets, Total [Member] | UNITED STATES | ||
Percentage | 72% | 77% |
Assets, Total [Member] | SWITZERLAND | ||
Percentage | 24% | 16% |
Assets, Total [Member] | ITALY | ||
Percentage | 2% | 5% |
Assets, Total [Member] | Other Countries in EMEA [Member] | ||
Percentage | 1% | 1% |
Assets, Total [Member] | Europe, Middle East, and Africa [Member] | ||
Percentage | 27% | 22% |
Assets, Total [Member] | Asia [Member] | ||
Percentage | 1% | 1% |
Assets, Total [Member] | All Countries [Member] | ||
Percentage | 100% | 100% |
Note 17 - Segments and Geogra_4
Note 17 - Segments and Geographic Areas - Sales by Geographic Area (Details) - Revenue Benchmark [Member] - Geographic Concentration Risk [Member] | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
UNITED STATES | ||
Concentration risk, percent | 11% | 13% |
EMEA [Member] | ||
Concentration risk, percent | 77% | 62% |
Asia [Member] | ||
Concentration risk, percent | 12% | 25% |
All Countries [Member] | ||
Concentration risk, percent | 100% | 100% |
Note 18 - Related Party Trans_2
Note 18 - Related Party Transactions (Details Textual) - USD ($) | 12 Months Ended | |
Dec. 31, 2022 | Dec. 31, 2021 | |
Asensus Surgical Europe S.à.R.L [Member] | 1 Med S.A. [Member] | Service Supply Agreement [Member] | ||
Related Party Transaction, Expenses from Transactions with Related Party | $ 290,000 | $ 186,000 |