Asensus Surgical (TRXDW) 10-Q 14 Nov 23 2023 Q3 Quarterly report Financial data

Document And Entity Information

Document And Entity Information - shares	9 Months Ended
	Sep. 30, 2023	Nov. 10, 2023
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	Q3
Document Fiscal Year Focus	2023
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
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
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Title of 12(b) Security	Common Stock $0.001 par value per share
Trading Symbol	ASXC
Security Exchange Name	NYSEAMER
Entity Common Stock, Shares Outstanding		264,316,749

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss (Unaudited) - USD ($) shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenue:
Revenue	$ 1,089,000	$ 2,563,000	$ 3,146,000	$ 4,623,000
Cost of revenue:
Cost of revenue	2,869,000	4,404,000	8,890,000	8,574,000
Gross loss	(1,780,000)	(1,841,000)	(5,744,000)	(3,951,000)
Operating expenses:
Research and development	9,290,000	6,741,000	28,409,000	20,422,000
Sales and marketing	4,138,000	3,615,000	13,140,000	10,936,000
General and administrative	4,571,000	4,853,000	15,163,000	15,378,000
Amortization of intangible assets	114,000	2,398,000	340,000	7,601,000
Change in fair value of contingent consideration	366,000	(416,000)	674,000	(1,168,000)
Impairment of property and equipment	0	0	0	432,000
Total operating expenses	18,479,000	17,191,000	57,726,000	53,601,000
Operating loss	(20,259,000)	(19,032,000)	(63,470,000)	(57,552,000)
Other income (expense), net
Change in fair value of warrant liabilities	2,278,000	0	2,278,000	0
Interest income	406,000	291,000	1,276,000	806,000
Interest expense	0	(99,000)	0	(440,000)
Other expense, net	(686,000)	(29,000)	(1,146,000)	(261,000)
Total other income, net	1,998,000	163,000	2,408,000	105,000
Loss before income taxes	(18,261,000)	(18,869,000)	(61,062,000)	(57,447,000)
Income tax expense	57,000	55,000	136,000	224,000
Net loss	$ (18,318,000)	$ (18,924,000)	$ (61,198,000)	$ (57,671,000)
Net loss per common share attributable to common stockholders - basic and diluted (in dollars per share)	$ (0.07)	$ (0.08)	$ (0.25)	$ (0.24)
Weighted average number of shares used in computing net loss per common share - basic and diluted (in shares)	256,184	236,713	244,744	236,373
Comprehensive loss:
Net loss	$ (18,318,000)	$ (18,924,000)	$ (61,198,000)	$ (57,671,000)
Foreign currency translation (loss) gain	(640,000)	(1,655,000)	84,000	(4,018,000)
Unrealized gain (loss) on available-for-sale investments	67,000	86,000	473,000	(610,000)
Comprehensive loss	(18,891,000)	(20,493,000)	(60,641,000)	(62,299,000)
Product [Member]
Revenue:
Revenue	301,000	1,964,000	892,000	2,565,000
Cost of revenue:
Cost of revenue	1,171,000	3,057,000	4,008,000	4,316,000
Service [Member]
Revenue:
Revenue	295,000	335,000	779,000	1,067,000
Cost of revenue:
Cost of revenue	581,000	365,000	1,849,000	1,506,000
Lease [Member]
Revenue:
Revenue	493,000	264,000	1,475,000	991,000
Cost of revenue:
Cost of revenue	$ 1,117,000	$ 982,000	$ 3,033,000	$ 2,752,000

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Current Assets:
Cash and cash equivalents	$ 21,669	$ 6,329
Short-term investments, available-for-sale	11,420	64,195
Accounts receivable, net	662	2,256
Inventory, net	6,683	8,284
Prepaid expenses	4,174	3,584
Employee retention tax credit receivable	0	554
Other current assets	1,324	1,671
Total Current Assets	45,932	86,873
Restricted cash	1,615	1,141
Long-term investments, available-for-sale	0	3,865
Inventory, net of current portion	5,640	5,469
Property and equipment, net	9,237	9,542
Intellectual property, net	1,278	1,576
Deferred tax assets, net	150	174
Operating lease right-of-use assets, net	5,004	4,950
Other noncurrent assets	1,871	2,463
Total Assets	70,727	116,053
Current Liabilities:
Accounts payable	4,526	3,348
Accrued employee compensation and benefits	4,967	4,508
Accrued expenses and other current liabilities	1,258	1,293
Operating lease liabilities, current	916	800
Deferred revenue	456	465
Total Current Liabilities	12,123	10,414
Long-Term Liabilities:
Warrant liabilities	4,842	0
Contingent consideration	1,930	1,256
Operating lease liabilities, noncurrent	4,579	4,738
Total Liabilities	23,474	16,408
Stockholders' Equity:
Common stock $0.001 par value, 750,000,000 shares authorized at September 30, 2023 and December 31, 2022; 264,111,257 and 236,895,440 issued and outstanding at September 30, 2023 and December 31, 2022, respectively	264	237
Preferred stock, $0.01 par value, 25,000,000 shares authorized, no shares issued and outstanding at September 30, 2023 and December 31, 2022	0	0
Additional paid-in capital	970,952	962,731
Accumulated deficit	(922,133)	(860,935)
Accumulated other comprehensive loss	(1,830)	(2,388)
Total Stockholders' Equity	47,253	99,645
Total Liabilities and Stockholders' Equity	70,727	116,053
Intellectual Property [Member]
Current Assets:
Intellectual property, net	$ 1,278	$ 1,576

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - $ / shares	Sep. 30, 2023	Dec. 31, 2022
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)	264,111,257	236,895,440
Common stock, shares outstanding (in shares)	264,111,257	236,895,440
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

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Changes in Stockholders' Equity (Unaudited) - USD ($) $ in Thousands	Common Stock [Member]	Treasury Stock, Common [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	AOCI Attributable to Parent [Member]	Total
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	$ 0	2,245	0	0	2,245
Exercise of stock options (in shares)	30,000	0
Exercise of stock options	$ 0	$ 0	12	0	0	12
Issuance of common stock related to vesting of restricted stock units (in shares)	1,166,000	0
Issuance of common stock related to vesting of restricted stock units	$ 1	$ 0	0	0	0	1
Shares withheld related to net share settlement of equity awards (in shares)	0	436,000
Shares withheld related to net share settlement of equity awards	$ 0	$ 0	(349)	0	0	(349)
Cancellation of treasury stock (in shares)	0	(436,000)
Cancellation of treasury stock	$ 0	$ 0	0	0	0	0
Other comprehensive income (loss)	0	0	0	0	(1,202)	(1,202)
Net loss	0	0	0	(19,128)	0	(19,128)
cancellation of treasury stock	$ 0	$ 0	0	0	0	0
Balance (in shares) at Mar. 31, 2022	236,415,000	0
Balance at Mar. 31, 2022	$ 236	$ 0	956,557	(804,502)	(1,466)	150,825
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
Net loss						(57,671)
Balance (in shares) at Sep. 30, 2022	236,783,000	0
Balance at Sep. 30, 2022	$ 237	$ 0	960,676	(843,045)	(4,892)	112,976
Balance (in shares) at Mar. 31, 2022	236,415,000	0
Balance at Mar. 31, 2022	$ 236	$ 0	956,557	(804,502)	(1,466)	150,825
Stock-based compensation	$ 0	$ 0	2,083	0	0	2,083
Exercise of stock options (in shares)	13,000	0
Exercise of stock options	$ 0	$ 0	6	0	0	6
Issuance of common stock related to vesting of restricted stock units (in shares)	192,000	0
Issuance of common stock related to vesting of restricted stock units	$ 1	$ 0	0	0	0	1
Other comprehensive income (loss)	0	0		0	(1,857)	(1,857)
Net loss	$ 0	$ 0	0	(19,619)	0	(19,619)
Balance (in shares) at Jun. 30, 2022	236,620,000	0
Balance at Jun. 30, 2022	$ 237	$ 0	958,646	(824,121)	(3,323)	131,439
Stock-based compensation	$ 0	$ 0	2,033	0	0	2,033
Issuance of common stock related to vesting of restricted stock units (in shares)	163,000	0
Issuance of common stock related to vesting of restricted stock units	$ 0	$ 0	0	0	0	0
Shares withheld related to net share settlement of equity awards (in shares)	0	7,000
Shares withheld related to net share settlement of equity awards	$ 0	$ 0	(3)	0	0	(3)
Cancellation of treasury stock (in shares)	0	(7,000)
Cancellation of treasury stock	$ 0	$ 0	0	0	0	0
Other comprehensive income (loss)	0	0	0	0	(1,569)	(1,569)
Net loss	0	0	0	(18,924)	0	(18,924)
cancellation of treasury stock	$ 0	$ 0	0	0	0	0
Balance (in shares) at Sep. 30, 2022	236,783,000	0
Balance at Sep. 30, 2022	$ 237	$ 0	960,676	(843,045)	(4,892)	112,976
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
Stock-based compensation	$ 0	$ 0	1,916	0	0	1,916
Exercise of stock options (in shares)	13,000	0
Exercise of stock options	$ 0	$ 0	5	0	0	5
Issuance of common stock related to vesting of restricted stock units (in shares)	2,434,000	0
Issuance of common stock related to vesting of restricted stock units	$ 2	$ 0	0	0	0	2
Shares withheld related to net share settlement of equity awards (in shares)	0	649,000
Shares withheld related to net share settlement of equity awards	$ 0	$ 1	(490)	0	0	(489)
Cancellation of treasury stock (in shares)	0	(649,000)
Cancellation of treasury stock	$ 0	$ (1)	0	0	0	(1)
Other comprehensive income (loss)	0	0	0	0	857	857
Net loss	0	0		(22,218)	0	(22,218)
cancellation of treasury stock	$ 0	$ 1	0	0	0	1
Balance (in shares) at Mar. 31, 2023	239,342,000	0
Balance at Mar. 31, 2023	$ 239	$ 0	964,162	(883,153)	(1,531)	79,717
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
Exercise of stock options (in shares)						13,300
Net loss						$ (61,198)
Balance (in shares) at Sep. 30, 2023	264,111,000	0
Balance at Sep. 30, 2023	$ 264	$ 0	970,952	(922,133)	(1,830)	47,253
Balance (in shares) at Mar. 31, 2023	239,342,000	0
Balance at Mar. 31, 2023	$ 239	$ 0	964,162	(883,153)	(1,531)	79,717
Stock-based compensation	$ 0	$ 0	1,978	0	0	1,978
Issuance of common stock related to vesting of restricted stock units (in shares)	273,000	0
Issuance of common stock related to vesting of restricted stock units	$ 0	$ 0	0	0	0	0
Other comprehensive income (loss)	0	0	0	0	274	274
Net loss	$ 0	$ 0	0	(20,662)	0	(20,662)
Issuance of common stock, net of issuance costs (in shares)	355,000	0
Issuance of common stock, net of issuance costs	$ 1	$ 0	195	0	0	196
Balance (in shares) at Jun. 30, 2023	239,970,000	0
Balance at Jun. 30, 2023	$ 240	$ 0	966,335	(903,815)	(1,257)	61,503
Stock-based compensation	$ 0	$ 0	2,019	0	0	2,019
Issuance of common stock related to vesting of restricted stock units (in shares)	253,000	0
Issuance of common stock related to vesting of restricted stock units	$ 0	$ 0	0	0	0	0
Shares withheld related to net share settlement of equity awards (in shares)	0	8,000
Shares withheld related to net share settlement of equity awards	$ 0	$ 0	(7)	0	0	0
Cancellation of treasury stock (in shares)	0	(8,000)
Cancellation of treasury stock	$ 0	$ 0	0	0	0	0
Other comprehensive income (loss)	0	0	0	0	(573)	(573)
Net loss	$ 0	$ 0	0	(18,318)	0	(18,318)
Issuance of common stock, net of issuance costs (in shares)	23,888,000	0
Issuance of common stock, net of issuance costs	$ 24	$ 0	2,598	0	0	2,622
cancellation of treasury stock	$ 0	$ 0	0	0	0	0
Balance (in shares) at Sep. 30, 2023	264,111,000	0
Balance at Sep. 30, 2023	$ 264	$ 0	$ 970,952	$ (922,133)	$ (1,830)	$ 47,253

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Cash Flows from Operating Activities:
Net loss	$ (61,198)	$ (57,671)
Adjustments to reconcile net loss to net cash and cash equivalents used in operating activities:
Depreciation	2,405	2,481
Amortization of intangible assets	340	7,601
Amortization of discounts and premiums on investments, net	(454)	556
Stock-based compensation	5,913	6,361
Deferred tax expense	136	224
Bad debt expense		9
Change in inventory reserves	297	386
Property and equipment impairment	0	432
Loss on disposal of property and equipment		97
Change in fair value of warrant liabilities	(2,278)	0
Change in fair value of contingent consideration	674	(1,168)
Changes in operating assets and liabilities:
Accounts receivable	1,587	(1,735)
Inventory	536	(535)
Operating lease right-of-use assets	(142)	237
Prepaid expenses	(590)	(693)
Employee retention tax credit receivable	554	164
Other current and long-term assets	310	(2,123)
Accounts payable	1,236	449
Accrued employee compensation and benefits	566	236
Accrued expenses and other current liabilities	(97)	0
Deferred revenue	(5)	(139)
Operating lease liabilities	(43)	(53)
Net cash and cash equivalents used in operating activities	(50,253)	(44,884)
Cash Flows from Investing Activities:
Purchase of available-for-sale investments	(12,268)	(25,588)
Proceeds from maturities of available-for-sale investments	69,835	67,702
Purchase of property and equipment	(488)	(904)
Net cash and cash equivalents provided by investing activities	57,079	41,210
Cash Flows from Financing Activities:
Proceeds from issuance of common stock and warrants, net of issuance costs	9,946	0
Taxes paid related to net share settlement of vesting of restricted stock units	(497)	(350)
Proceeds from exercise of stock options	5	18
Net cash and cash equivalents provided by (used in) financing activities	9,454	(332)
Effect of exchange rate changes on cash and cash equivalents	(466)	(300)
Net increase (decrease) in cash, cash equivalents and restricted cash	15,814	(4,306)
Cash, cash equivalents and restricted cash, beginning of period	7,470	19,283
Cash, cash equivalents and restricted cash, end of period	23,284	14,977
Supplemental Disclosure for Cash Flow Information
Cash paid for leases	1,067	729
Cash paid for taxes	230	79
Supplemental Schedule of Non-cash Investing and Financing Activities:
Transfer of inventory to property and equipment	2,227	1,293
Lease liabilities arising from obtaining right-of-use assets	$ 796	$ 316

Note 1 - Description of Busines

Note 1 - Description of Business	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Organization, Consolidation, Basis of Presentation, Business Description and Accounting Policies [Text Block]	1. Description of Business Asensus Surgical, 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. Based upon the foundations of digital laparoscopy and the Senhance® Surgical System, the Company is developing the LUNA™ Surgical System, a next generation robotic and instrument system as a foundation of its digital surgery solution. These systems will be powered by the Intelligent Surgical Unit™ (ISU™) to increase surgeon’s control and reduce variability of surgical outcomes. With the addition of machine vision, augmented intelligence, and deep learning capabilities throughout the surgical experience, the Company intends to holistically address the current clinical, cognitive, and economic shortcomings that drive surgical outcomes and value-based healthcare. The Company continues market development for and commercialization of the Senhance 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	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Significant Accounting Policies [Text Block]	2. Summary of Significant Accounting Policies Basis of Presentation The accompanying unaudited interim condensed 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. All inter-company accounts and transactions have been eliminated in consolidation. The results reported in these unaudited interim condensed consolidated financial statements should not may 2022 10 Going Concern The Company's condensed consolidated financial statements are prepared using U.S. GAAP applicable to a going concern basis of accounting, which contemplates the realization of assets and liquidation of liabilities in the normal course of business. The Company had an accumulated deficit of $922.1 million and working capital of $33.8 million as of September 30, 2023. not The Company will need to obtain additional financing to execute its business plan. Management's plans to obtain additional resources for the Company may one not may Principles of Consolidation The accompanying condensed 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. 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: the historical lack of profitability; the Company’s ability to raise additional capital; its ability to successfully develop, clinically test, obtain regulatory clearance for and commercialize its products and products in development; negative impacts on the Company's operations caused by the hostilities in the Middle East, 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-based 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, measurement of warrant liabilities and deferred tax asset valuation allowances. Significant Accounting Policies With the exception of the Company’s warrant policy (please see next section), there have been no 2022 10 Warrant Liabilities The Company’s warrants (see Note 12 4 Impact of Recently Issued Accounting Standards The Company has evaluated issued Accounting Standards Updates (“ASUs”) not not

Note 3 - Revenue Recognition

Note 3 - Revenue Recognition	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Revenue from Contract with Customer [Text Block]	3. Revenue Recognition The following table presents revenue disaggregated by type and geography: Three Months Ended September 30, Nine Months Ended September 30, (In thousands) 2023 2022 2023 2022 U.S. Systems $ - $ - $ - $ - Instruments and accessories 71 60 169 142 Services 77 75 228 225 Leases 40 46 130 211 Total U.S. revenue 188 181 527 578 Outside of U.S. ("OUS") Systems - 1,227 - 1,228 Instruments and accessories 230 677 723 1,195 Services 218 260 551 842 Leases 453 218 1,345 780 Total OUS revenue 901 2,382 2,619 4,045 Total Systems - 1,227 - 1,228 Instruments and accessories 301 737 892 1,337 Services 295 335 779 1,067 Leases 493 264 1,475 991 Total revenue $ 1,089 $ 2,563 $ 3,146 $ 4,623 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 September 30, 2023 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 Revenue recognized for the three September 30, 2023 2022 nine September 30, 2023 2022 The following information summarizes the Company’s contract assets and liabilities: September 30, 2023 December 31, 2022 December 31, 2021 (In thousands) Contract Assets $ 54 $ 116 $ 91 Deferred Revenue $ 456 $ 465 $ 543 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 three nine September 30, 2023, 2022, not 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 the 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 September 30, 2023 December 31, 2022. three nine September 30, 2023 2022. The Company had four customers that accounted for 18%, 16%, 15% and 14%, respectively, of the Company’s net accounts receivable as of September 30, 2023. December 31, 2022.

Note 4 - Fair Value Measurement

Note 4 - Fair Value Measurements	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Fair Value Disclosures [Text Block]	4. Fair Value Measurements The Company records certain assets and liabilities at fair value. Accounting Standards Codification (“ASC”) 820 three Level 1 Level 2 1, Level 3 no As of September 30, 2023 December 31, 2022, September 30, 2023 (In thousands) Level 1 Level 2 Level 3 Total Assets: Cash and cash equivalents (1) $ 21,669 $ - $ - $ 21,669 Restricted cash 1,615 - - 1,615 Short-term investments - 11,420 - 11,420 Total assets $ 23,284 $ 11,420 $ - $ 34,704 Liabilities: Contingent consideration $ - $ - $ 1,930 $ 1,930 Warrant liabilities - - 4,842 4,842 Total liabilities $ - $ - $ 6,772 $ 6,772 ( 1 90 December 31, 2022 (In thousands) Level 1 Level 2 Level 3 Total Assets: 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 $ 7,470 $ 68,060 $ - $ 75,530 Liabilities: Contingent consideration $ - $ - $ 1,256 $ 1,256 Total liabilities $ - $ - $ 1,256 $ 1,256 ( 1 90 As of September 30, 2023 December 31, 2022, At September 30, 2023, Contingent Consideration Contingent consideration represents a liability related to the Company’s 2015 nine September 30, 2023: (In thousands) Fair Value Balance at December 31, 2022 $ 1,256 Change in fair value 105 Balance at March 31, 2023 1,361 Change in fair value 203 Balance at June 30, 2023 1,564 Change in fair value 366 Balance at September 30, 2023 $ 1,930 The following table presents quantitative information about the inputs and valuation methodologies used for fair value measurement of contingent consideration liability utilizing a Monte-Carlo simulation method as of September 30, 2023 December 31, 2022: Valuation Methodology Significant Unobservable Inputs September 30, 2023 December 31, 2022 Contingent consideration Probability weighted income approach Milestone date 2032 2032 Revenue discount rate 11.0% 16.5% Revenue volatility 37.5% 45.0% EUR-to-USD exchange rate 1.06 1.07 Warrant Liabilities During the three September 30, 2023, July 2023 ( 12 Warrant liabilities were recorded at their initial estimated fair value. Adjustments associated with changes in fair value of the warrant liabilities are included in the Company’s condensed consolidated statements of operations and comprehensive loss. The following table summarizes changes in estimated fair value of the warrant liabilities for the warrants issued in July 2023 September 30, 2023: (In thousands) Fair Value Balance at June 30, 2023 $ - Issuance of warrants 7,120 Change in fair value (2,278 ) Balance at September 30, 2023 $ 4,842 The fair value of the warrant liabilities were estimated using the Black-Scholes option pricing model, which is based on unobservable inputs and is designated as Level 3 As of July 31, 2023 As of September 30, 2023 Expected volatility 115 % 115 % Risk-free interest rate 4.2 % 4.6 % Expected life (in years) 5.0 4.8 Expected dividend yield 0 % 0 % During the nine September 30, 2023, no 1, 2, 3

Note 5 - Investments, Available

Note 5 - Investments, Available-for-sale	9 Months Ended
	Sep. 30, 2023
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 accumulated other comprehensive loss in the condensed consolidated balance sheets are as follows: September 30, 2023 Balance Sheet Classification (In thousands) Amortized Cost Unrealized Gain Unrealized Loss Fair Value Short-term investments Long-term investments Commercial Paper $ - $ - $ - $ - $ - $ - Corporate Bonds 4,960 - (28 ) 4,932 4,932 - US Treasuries 5,491 - - 5,491 5,491 - U.S. Government Agencies 1,000 - (3 ) 997 997 - Total Investments $ 11,451 $ - $ (31 ) $ 11,420 $ 11,420 $ - December 31, 2022 Balance Sheet Classification (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 As of September 30, 2023, one may three nine September 30, 2023 2022.

Note 6 - Inventory

Note 6 - Inventory	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Inventory Disclosure [Text Block]	6. Inventory The components of inventory are as follows: September 30, 2023 (In thousands) Gross Carrying Amount Reserve Balance Net Carrying Amount Finished goods $ 11,750 $ (2,324 ) $ 9,426 Raw materials 5,308 (2,411 ) 2,897 Total inventories $ 17,058 $ (4,735 ) $ 12,323 Current portion $ 7,380 $ (697 ) $ 6,683 Long-term portion 9,678 (4,038 ) 5,640 Total inventories $ 17,058 $ (4,735 ) $ 12,323 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 inventory $ 20,055 $ (6,302 ) $ 13,753 Current portion $ 9,399 $ (1,115 ) $ 8,284 Long-term portion 10,656 (5,187 ) 5,469 Total inventory $ 20,055 $ (6,302 ) $ 13,753

Note 7 - Intellectual Property

Note 7 - Intellectual Property	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Intangible Assets Disclosure [Text Block]	7. Intellectual Property The components of gross intellectual property, accumulated amortization, and net intellectual property are as follows: September 30, 2023 (In thousands) Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount Developed technology $ 68,838 $ (66,872 ) $ (830 ) $ 1,136 Technology and patents purchased 400 (269 ) 11 142 Total intellectual property $ 69,238 $ (67,141 ) $ (819 ) $ 1,278 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 The weighted average remaining useful life of the developed technology and technology and patents purchased was 3.4 years and 3.6 years, respectively, as of September 30, 2023. December 31, 2022.

Note 8 - Leases

Note 8 - Leases	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Lessee, Operating Leases [Text Block]	8. Leases Lessee Information Components of operating lease expense recorded in general and administrative expense in the condensed consolidated statements of operations and comprehensive loss were as follows (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Long-term Operating $ 494 $ 408 $ 1,424 $ 1,192 Supplemental balance sheet information related to operating leases was as follows: September 30, 2023 December 31, 2022 Weighted-average remaining lease term (in years) 6.1 6.8 Weighted-average discount rate 8.4 % 8.4 % Maturities of operating lease obligations as of September 30, 2023 Fiscal Year Remainder of 2023 $ 309 2024 1,329 2025 1,251 2026 936 2027 954 2028 and thereafter 2,227 Total minimum lease payments $ 7,006 Less: Amount of lease payments representing interest (1,511 ) Present value of future minimum lease payments $ 5,495

Note 9 - Accrued Expenses and O

Note 9 - Accrued Expenses and Other Current Liabilities	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Accrued Liabilities [Text Block]	9. Accrued Expenses and Other Current Liabilities Accrued expenses and other current liabilities consisted of the following: (In thousands) September 30, 2023 December 31, 2022 Income and other taxes payable $ 694 $ 839 Legal and professional fees 374 275 Royalties 23 24 Consulting services 167 155 Total accrued expenses and other current liabilities $ 1,258 $ 1,293

Note 10 - Income Taxes

Note 10 - Income Taxes	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Income Tax Disclosure [Text Block]	10. Income Taxes Income taxes have been accounted for using the asset and liability method in accordance with ASC 740 December 31, 2023. not three September 30, 2023 2022 nine September 30, 2023 2022 The Company incurred losses for the three nine September 30, 2023, December 31, 2023. not The total tax expense during the three September 30, 2023 2022 nine September 30, 2023 2022 At September 30, 2023 The Financial Accounting Standards Board (“FASB”) Staff Q&A, Topic 740, No. 5, not 2023; nine September 30, 2023 2022,

Note 11 - Stock-based Compensat

Note 11 - Stock-based Compensation	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Share-Based Payment Arrangement [Text Block]	11. Stock-Based Compensation Incentive Compensation Plan Information On June 6, 2023, 2023 Stock Options The following table summarizes options outstanding as of September 30, 2023, nine September 30, 2023: Number of Shares Weighted-Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Aggregate Intrinsic Value (Millions) Outstanding at December 31, 2022 7,584,967 $ 4.22 5.31 Granted 3,047,615 $ 0.71 Exercised (13,300 ) $ 0.38 Cancelled (21,116 ) $ 25.79 Forfeited (106 ) $ 15.86 Outstanding at September 30, 2023 10,598,060 $ 3.17 5.10 $ - Vested or expected to vest at September 30, 2023 10,132,754 $ 3.29 5.05 $ - Exercisable at September 30, 2023 5,591,291 $ 5.15 4.37 $ - The fair value of options granted were estimated using the Black-Scholes-Merton option pricing model based on the assumptions in the table below: Nine Months Ended September 30, 2023 2022 Expected volatility 124% - 130% 128% - 133% Risk-free interest rate 3.53% - 4.14% 1.25% - 2.98% Expected life (in years) 3.8 - 4.5 3.8 - 4.5 Expected dividend yield 0% 0% Weighted average grant date fair value $0.59 $0.60 Restricted Stock Units The following table summarizes information about restricted stock units outstanding as of September 30, 2023, nine September 30, 2023: Number of Shares Weighted-Average Grant Date Fair Value Outstanding at December 31, 2022 8,483,491 $ 1.04 Granted 8,482,315 $ 0.71 Vested (3,623,411 ) $ 1.14 Forfeited (539,448 ) $ 0.76 Outstanding at September 30, 2023 12,802,947 $ 0.82 Performance-Based Restricted Stock Units In 2023 2022, 2023 2022 December 31, 2023 October 1, 2023, 2022, 2022 three not 2023. Stock-Based Compensation Expense The following table summarizes non-cash stock-based compensation expense by award type for the three nine September 30, 2023 2022: Three Months Ended September 30, Nine Months Ended September 30, (In thousands) 2023 2022 2023 2022 Stock options $ 552 $ 913 $ 1,808 $ 2,812 Restricted stock units 1,037 772 2,873 2,480 Performance restricted stock units 430 348 1,232 1,069 $ 2,019 $ 2,033 $ 5,913 $ 6,361 As of September 30, 2023, September 30, 2023,

Note 12 - Equity Offerings

Note 12 - Equity Offerings	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Equity Offerings [Text Block]	12. Equity Offerings 2022 On March 18, 2022 , 2022 2022 The following table presents details about common stock issued pursuant to the 2022 Three Months Ended September 30, 2023 Nine Months Ended September 30, 2023 Shares of common stock issued 78,600 433,672 Average price per share $ 0.31 $ 0.52 Gross proceeds $ 25 $ 227 Commission paid to Agents $ (1 ) $ (7 ) Net proceeds $ 24 $ 220 2023 On July 27, 2023, five 480 815 not 4 The Company allocated $7.1 million of the aggregate proceeds to warrants based on their estimated fair value, with the residual amount of $2.9 million allocated to common stock. Offering related issuance costs were approximately $1.0 million and consisted primarily of placement agent’s fees and legal expenses. Issuance costs were allocated to common stock and warrant liability proportionally to the allocation of the purchase price. For the three nine September 30, 2023, O

Note 13 - Basic and Diluted Net

Note 13 - Basic and Diluted Net Loss Per Share	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Earnings Per Share [Text Block]	13. 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. Potential dilutive common shares consist of incremental shares issuable upon exercise of stock options, restricted stock units, and warrants. No three nine September 30, 2023 2022 Potential common shares not September 30, 2023 2022 Stock options 10,598,060 7,404,858 Nonvested restricted stock units 12,802,947 8,038,575 Stock warrants 24,830,500 1,021,076 Total 48,231,507 16,464,509

Note 14 - Commitments and Conti

Note 14 - Commitments and Contingencies	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	14. Commitments and Contingencies License and Supply Agreements The Company has purchase orders with various suppliers for certain tooling, supplies, contract engineering and research services. Commitments related to these agreements and purchase orders are as follows (in thousands): Fiscal Year 2023 (remaining three months) $ 4,223 2024 1,543 2025 314 2026 303 Total commitments $ 6,383

Note 15 - Segments and Geograph

Note 15 - Segments and Geographic Areas	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Segment Reporting Disclosure [Text Block]	15. Segments and Geographic Areas The Company operates in one business segment—the research, development, and sale of medical devices to improve minimally invasive surgery. The Company’s chief operating decision maker (determined to be the Chief Executive Officer) does not The following table presents long-lived assets (which include property and equipment and operating lease assets) by geographic area: September 30, 2023 December 31, 2022 U.S. 37 % 39 % EMEA 57 % 57 % Asia 6 % 4 % Total 100 % 100 % The following table presents revenue by geographic area based on the country in which the customer is based: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 US 17 % 7 % 17 % 13 % EMEA 64 % 86 % 62 % 72 % Asia 19 % 7 % 21 % 15 % Total 100 % 100 % 100 % 100 % For the three September 30, 2023, nine September 30, 2023, 10% three nine September 30, 2022,

Note 16 - Related Party Transac

Note 16 - Related Party Transactions	9 Months Ended
	Sep. 30, 2023
Notes to Financial Statements
Related Party Transactions Disclosure [Text Block]	16. Related Party Transactions In March 2018, 1 1 three September 30, 2023 2022, nine September 30, 2023 2022,

Significant Accounting Policies

Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Basis of Accounting, Policy [Policy Text Block]	Basis of Presentation The accompanying unaudited interim condensed 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. All inter-company accounts and transactions have been eliminated in consolidation. The results reported in these unaudited interim condensed consolidated financial statements should not may 2022 10
Substantial Doubt about Going Concern [Policy Text Block]	Going Concern The Company's condensed consolidated financial statements are prepared using U.S. GAAP applicable to a going concern basis of accounting, which contemplates the realization of assets and liquidation of liabilities in the normal course of business. The Company had an accumulated deficit of $922.1 million and working capital of $33.8 million as of September 30, 2023. not The Company will need to obtain additional financing to execute its business plan. Management's plans to obtain additional resources for the Company may one not may
Consolidation, Policy [Policy Text Block]	Principles of Consolidation The accompanying condensed 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.
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: the historical lack of profitability; the Company’s ability to raise additional capital; its ability to successfully develop, clinically test, obtain regulatory clearance for and commercialize its products and products in development; negative impacts on the Company's operations caused by the hostilities in the Middle East, 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-based 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, measurement of warrant liabilities and deferred tax asset valuation allowances.
Warrant Liabilities [Policy Text Block]	Warrant Liabilities The Company’s warrants (see Note 12 4
New Accounting Pronouncements, Policy [Policy Text Block]	Impact of Recently Issued Accounting Standards The Company has evaluated issued Accounting Standards Updates (“ASUs”) not not

Note 3 - Revenue Recognition (T

Note 3 - Revenue Recognition (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Disaggregation of Revenue [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, (In thousands) 2023 2022 2023 2022 U.S. Systems $ - $ - $ - $ - Instruments and accessories 71 60 169 142 Services 77 75 228 225 Leases 40 46 130 211 Total U.S. revenue 188 181 527 578 Outside of U.S. ("OUS") Systems - 1,227 - 1,228 Instruments and accessories 230 677 723 1,195 Services 218 260 551 842 Leases 453 218 1,345 780 Total OUS revenue 901 2,382 2,619 4,045 Total Systems - 1,227 - 1,228 Instruments and accessories 301 737 892 1,337 Services 295 335 779 1,067 Leases 493 264 1,475 991 Total revenue $ 1,089 $ 2,563 $ 3,146 $ 4,623
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Table Text Block]	September 30, 2023 December 31, 2022 December 31, 2021 (In thousands) Contract Assets $ 54 $ 116 $ 91 Deferred Revenue $ 456 $ 465 $ 543

Note 4 - Fair Value Measureme_2

Note 4 - Fair Value Measurements (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Fair Value, Assets Measured on Recurring Basis [Table Text Block]	September 30, 2023 (In thousands) Level 1 Level 2 Level 3 Total Assets: Cash and cash equivalents (1) $ 21,669 $ - $ - $ 21,669 Restricted cash 1,615 - - 1,615 Short-term investments - 11,420 - 11,420 Total assets $ 23,284 $ 11,420 $ - $ 34,704 Liabilities: Contingent consideration $ - $ - $ 1,930 $ 1,930 Warrant liabilities - - 4,842 4,842 Total liabilities $ - $ - $ 6,772 $ 6,772 December 31, 2022 (In thousands) Level 1 Level 2 Level 3 Total Assets: 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 $ 7,470 $ 68,060 $ - $ 75,530 Liabilities: Contingent consideration $ - $ - $ 1,256 $ 1,256 Total liabilities $ - $ - $ 1,256 $ 1,256
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Table Text Block]	(In thousands) Fair Value Balance at December 31, 2022 $ 1,256 Change in fair value 105 Balance at March 31, 2023 1,361 Change in fair value 203 Balance at June 30, 2023 1,564 Change in fair value 366 Balance at September 30, 2023 $ 1,930
Fair Value Measurement Inputs and Valuation Techniques [Table Text Block]	Valuation Methodology Significant Unobservable Inputs September 30, 2023 December 31, 2022 Contingent consideration Probability weighted income approach Milestone date 2032 2032 Revenue discount rate 11.0% 16.5% Revenue volatility 37.5% 45.0% EUR-to-USD exchange rate 1.06 1.07 As of July 31, 2023 As of September 30, 2023 Expected volatility 115 % 115 % Risk-free interest rate 4.2 % 4.6 % Expected life (in years) 5.0 4.8 Expected dividend yield 0 % 0 %
Fair Value, Liabilities Measured on Recurring Basis [Table Text Block]	(In thousands) Fair Value Balance at June 30, 2023 $ - Issuance of warrants 7,120 Change in fair value (2,278 ) Balance at September 30, 2023 $ 4,842

Note 5 - Investments, Availab_2

Note 5 - Investments, Available-for-sale (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Debt Securities, Available-for-Sale [Table Text Block]	September 30, 2023 Balance Sheet Classification (In thousands) Amortized Cost Unrealized Gain Unrealized Loss Fair Value Short-term investments Long-term investments Commercial Paper $ - $ - $ - $ - $ - $ - Corporate Bonds 4,960 - (28 ) 4,932 4,932 - US Treasuries 5,491 - - 5,491 5,491 - U.S. Government Agencies 1,000 - (3 ) 997 997 - Total Investments $ 11,451 $ - $ (31 ) $ 11,420 $ 11,420 $ - December 31, 2022 Balance Sheet Classification (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

Note 6 - Inventory (Tables)

Note 6 - Inventory (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Schedule of Inventory, Current [Table Text Block]	September 30, 2023 (In thousands) Gross Carrying Amount Reserve Balance Net Carrying Amount Finished goods $ 11,750 $ (2,324 ) $ 9,426 Raw materials 5,308 (2,411 ) 2,897 Total inventories $ 17,058 $ (4,735 ) $ 12,323 Current portion $ 7,380 $ (697 ) $ 6,683 Long-term portion 9,678 (4,038 ) 5,640 Total inventories $ 17,058 $ (4,735 ) $ 12,323 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 inventory $ 20,055 $ (6,302 ) $ 13,753 Current portion $ 9,399 $ (1,115 ) $ 8,284 Long-term portion 10,656 (5,187 ) 5,469 Total inventory $ 20,055 $ (6,302 ) $ 13,753

Note 7 - Intellectual Property

Note 7 - Intellectual Property (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Schedule of Finite-Lived Intangible Assets [Table Text Block]	September 30, 2023 (In thousands) Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount Developed technology $ 68,838 $ (66,872 ) $ (830 ) $ 1,136 Technology and patents purchased 400 (269 ) 11 142 Total intellectual property $ 69,238 $ (67,141 ) $ (819 ) $ 1,278 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

Note 8 - Leases (Tables)

Note 8 - Leases (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Lease, Cost [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 Long-term Operating $ 494 $ 408 $ 1,424 $ 1,192
Lessee, Operating Lease, Disclosure [Table Text Block]	September 30, 2023 December 31, 2022 Weighted-average remaining lease term (in years) 6.1 6.8 Weighted-average discount rate 8.4 % 8.4 %
Lessee, Operating Lease, Liability, to be Paid, Maturity [Table Text Block]	Fiscal Year Remainder of 2023 $ 309 2024 1,329 2025 1,251 2026 936 2027 954 2028 and thereafter 2,227 Total minimum lease payments $ 7,006 Less: Amount of lease payments representing interest (1,511 ) Present value of future minimum lease payments $ 5,495

Note 9 - Accrued Expenses and_2

Note 9 - Accrued Expenses and Other Current Liabilities (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Schedule of Accrued Liabilities [Table Text Block]	(In thousands) September 30, 2023 December 31, 2022 Income and other taxes payable $ 694 $ 839 Legal and professional fees 374 275 Royalties 23 24 Consulting services 167 155 Total accrued expenses and other current liabilities $ 1,258 $ 1,293

Note 11 - Stock-based Compens_2

Note 11 - Stock-based Compensation (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Share-Based Payment Arrangement, Option, Activity [Table Text Block]	Number of Shares Weighted-Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Aggregate Intrinsic Value (Millions) Outstanding at December 31, 2022 7,584,967 $ 4.22 5.31 Granted 3,047,615 $ 0.71 Exercised (13,300 ) $ 0.38 Cancelled (21,116 ) $ 25.79 Forfeited (106 ) $ 15.86 Outstanding at September 30, 2023 10,598,060 $ 3.17 5.10 $ - Vested or expected to vest at September 30, 2023 10,132,754 $ 3.29 5.05 $ - Exercisable at September 30, 2023 5,591,291 $ 5.15 4.37 $ -
Schedule of Share-Based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	Nine Months Ended September 30, 2023 2022 Expected volatility 124% - 130% 128% - 133% Risk-free interest rate 3.53% - 4.14% 1.25% - 2.98% Expected life (in years) 3.8 - 4.5 3.8 - 4.5 Expected dividend yield 0% 0% Weighted average grant date fair value $0.59 $0.60
Share-Based Payment Arrangement, Restricted Stock Unit, Activity [Table Text Block]	Number of Shares Weighted-Average Grant Date Fair Value Outstanding at December 31, 2022 8,483,491 $ 1.04 Granted 8,482,315 $ 0.71 Vested (3,623,411 ) $ 1.14 Forfeited (539,448 ) $ 0.76 Outstanding at September 30, 2023 12,802,947 $ 0.82
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, (In thousands) 2023 2022 2023 2022 Stock options $ 552 $ 913 $ 1,808 $ 2,812 Restricted stock units 1,037 772 2,873 2,480 Performance restricted stock units 430 348 1,232 1,069 $ 2,019 $ 2,033 $ 5,913 $ 6,361

Note 12 - Equity Offerings (Tab

Note 12 - Equity Offerings (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Schedule of Common Stock Outstanding Roll Forward [Table Text Block]	Three Months Ended September 30, 2023 Nine Months Ended September 30, 2023 Shares of common stock issued 78,600 433,672 Average price per share $ 0.31 $ 0.52 Gross proceeds $ 25 $ 227 Commission paid to Agents $ (1 ) $ (7 ) Net proceeds $ 24 $ 220

Note 13 - Basic and Diluted N_2

Note 13 - Basic and Diluted Net Loss Per Share (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share [Table Text Block]	September 30, 2023 2022 Stock options 10,598,060 7,404,858 Nonvested restricted stock units 12,802,947 8,038,575 Stock warrants 24,830,500 1,021,076 Total 48,231,507 16,464,509

Note 14 - Commitments and Con_2

Note 14 - Commitments and Contingencies (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Contractual Obligation, Fiscal Year Maturity [Table Text Block]	Fiscal Year 2023 (remaining three months) $ 4,223 2024 1,543 2025 314 2026 303 Total commitments $ 6,383

Note 15 - Segments and Geogra_2

Note 15 - Segments and Geographic Areas (Tables)	9 Months Ended
	Sep. 30, 2023
Notes Tables
Long-Lived Assets by Geographic Areas [Table Text Block]	September 30, 2023 December 31, 2022 U.S. 37 % 39 % EMEA 57 % 57 % Asia 6 % 4 % Total 100 % 100 %
Revenue from External Customers by Geographic Areas [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 US 17 % 7 % 17 % 13 % EMEA 64 % 86 % 62 % 72 % Asia 19 % 7 % 21 % 15 % Total 100 % 100 % 100 % 100 %

Note 2 - Summary of Significa_2

Note 2 - Summary of Significant Accounting Policies (Details Textual) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Retained Earnings (Accumulated Deficit)	$ (922,133)	$ (860,935)
Working Capital	$ 33,800

Note 3 - Revenue Recognition 1

Note 3 - Revenue Recognition 1 (Details Textual) $ in Millions	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)
Contract with Customer, Liability, Revenue Recognized	$ 0.2	$ 0.2	$ 0.5	$ 0.7
Accounts Receivable, Allowance for Credit Loss	$ 1.6		$ 1.6		$ 1.6
Customer Concentration Risk [Member] | Accounts Receivable [Member]
Number of Major Customers			4		1
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer One [Member]
Concentration Risk, Percentage			18%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer Two [Member]
Concentration Risk, Percentage			16%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer Three [Member]
Concentration Risk, Percentage			15%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | Customer Four [Member]
Concentration Risk, Percentage			14%
Customer Concentration Risk [Member] | Accounts Receivable [Member] | One Customer [Member]
Concentration Risk, Percentage					69%

Note 3 - Revenue Recognition 2

Note 3 - Revenue Recognition 2 (Details Textual) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-10-01 - USD ($) $ in Millions	Sep. 30, 2023	Jun. 30, 2023
Revenue, Remaining Performance Obligation, Amount	$ 0.7
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	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenue	$ 1,089	$ 2,563	$ 3,146	$ 4,623
UNITED STATES
Revenue	188	181	527	578
Non-US [Member]
Revenue	901	2,382	2,619	4,045
Systems [Member]
Revenue	0	1,227	0	1,228
Systems [Member] | UNITED STATES
Revenue	0	0	0	0
Systems [Member] | Non-US [Member]
Revenue	0	1,227	0	1,228
Instruments and Accessories [Member]
Revenue	301	737	892	1,337
Instruments and Accessories [Member] | UNITED STATES
Revenue	71	60	169	142
Instruments and Accessories [Member] | Non-US [Member]
Revenue	230	677	723	1,195
Service [Member]
Revenue	295	335	779	1,067
Service [Member] | UNITED STATES
Revenue	77	75	228	225
Service [Member] | Non-US [Member]
Revenue	218	260	551	842
Lease [Member]
Revenue	493	264	1,475	991
Lease [Member] | UNITED STATES
Revenue	40	46	130	211
Lease [Member] | Non-US [Member]
Revenue	$ 453	$ 218	$ 1,345	$ 780

Note 3 - Revenue Recognition _2

Note 3 - Revenue Recognition - Contract Assets and Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022	Dec. 31, 2021
Contract Assets	$ 54	$ 116	$ 91
Deferred Revenue	$ 456	$ 465	$ 543

Note 4 - Fair Value Measureme_3

Note 4 - Fair Value Measurements - Summary of Assets and Liabilities Measured at Fair Value on Recurring Basis (Details) - USD ($) $ in Thousands		Sep. 30, 2023	Dec. 31, 2022
Cash and cash equivalents	[1]	$ 21,669	$ 6,329
Restricted cash		1,615	1,141
Short-term investments		11,420	64,195
Total assets		34,704	75,530
Contingent consideration		1,930	1,256
Warrant liabilities		4,842	0
Total liabilities		6,772	1,256
Long-term investments		0	3,865
Fair Value, Inputs, Level 1 [Member]
Cash and cash equivalents	[1]	21,669	6,329
Restricted cash		1,615	1,141
Short-term investments		0	0
Total assets		23,284	7,470
Contingent consideration		0	0
Warrant liabilities		0
Total liabilities		0	0
Long-term investments			0
Fair Value, Inputs, Level 2 [Member]
Cash and cash equivalents	[1]	0	0
Restricted cash		0	0
Short-term investments		11,420	64,195
Total assets		11,420	68,060
Contingent consideration		0	0
Warrant liabilities		0
Total liabilities		0	0
Long-term investments			3,865
Fair Value, Inputs, Level 3 [Member]
Cash and cash equivalents	[1]	0	0
Restricted cash		0	0
Short-term investments		0	0
Total assets		0	0
Contingent consideration		1,930	1,256
Warrant liabilities		4,842
Total liabilities		$ 6,772	1,256
Long-term investments			$ 0
[1]Includes investments that are readily convertible to cash with original maturities of 90 days or less.

Note 4 - Fair Value Measureme_4

Note 4 - Fair Value Measurements - Summary of Change in Fair Value for Contingent Consideration (Details) - The 2015 Senhance Acquisition [Member] - USD ($) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2023
Balance	$ 1,564	$ 1,361	$ 1,256	$ 1,256
Change in fair value	366	203	105
Balance	$ 1,930	$ 1,564	$ 1,361	$ 1,930

Note 4 - Fair Value Measureme_5

Note 4 - Fair Value Measurements - Quantitative Information about Inputs and Valuation Methodologies Used for Fair Value Measurements Classification (Details)	Sep. 30, 2023	Jul. 31, 2023	Dec. 31, 2022
Measurement Input, Price Volatility [Member] | Warrant [Member]
Measurement Input	1.15	1.15
Measurement Input, Risk Free Interest Rate [Member] | Warrant [Member]
Measurement Input	0.046	0.042
Measurement Input, Expected Term [Member] | Warrant [Member]
Measurement Input	4.8	5
Measurement Input, Expected Dividend Rate [Member] | Warrant [Member]
Measurement Input	0	0
The 2015 Senhance Acquisition [Member] | Fair Value, Inputs, Level 3 [Member] | Milestone Date, Year [Member]
Contingent consideration milestone dates	Dec. 31, 2032		Dec. 31, 2032
The 2015 Senhance Acquisition [Member] | Fair Value, Inputs, Level 3 [Member] | Measurement Input, Price Volatility [Member]
Contingent consideration, measurement input	0.375		0.45
The 2015 Senhance Acquisition [Member] | Fair Value, Inputs, Level 3 [Member] | Measurement Input, Discount Rate [Member]
Contingent consideration, measurement input	0.11		0.165
The 2015 Senhance Acquisition [Member] | Fair Value, Inputs, Level 3 [Member] | Measurement Input, Currency Exchange Rate [Member]
Contingent consideration, measurement input	1.06		1.07

Note 4 - Fair Value Measureme_6

Note 4 - Fair Value Measurements - Summary of Change in Fair Value for Warrants (Details) - Warrant [Member] $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Balance	$ 0
Issuance of warrants	7,120
Change in fair value	(2,278)
Balance	$ 4,842

Note 5 - Investments, Availab_3

Note 5 - Investments, Available-for-sale (Details Textual) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Proceeds from Sale of Debt Securities, Available-for-Sale	$ 0	$ 0	$ 0	$ 0

Note 5 - Investments, Availab_4

Note 5 - Investments, Available-for-sale - Summary of Investment Securities (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Amortized Cost	$ 11,451	$ 68,564
Unrealized Gain	0	0
Unrealized Loss	(31)	(504)
Fair Value	11,420	68,060
Short-term investments	11,420	64,195
Long-term investments	0	3,865
Commercial Paper [Member]
Amortized Cost	0	12,364
Unrealized Gain	0	0
Unrealized Loss	0	(49)
Fair Value	0	12,315
Short-term investments	0	12,315
Long-term investments	0	0
Corporate Debt Securities [Member]
Amortized Cost	4,960	55,201
Unrealized Gain	0	0
Unrealized Loss	(28)	(447)
Fair Value	4,932	54,754
Short-term investments	4,932	50,889
Long-term investments	0	3,865
US Treasury Securities [Member]
Amortized Cost	5,491
Unrealized Gain	0
Unrealized Loss	0
Fair Value	5,491
Short-term investments	5,491
Long-term investments	0
US Government Agencies Debt Securities [Member]
Amortized Cost	1,000	999
Unrealized Gain	0	0
Unrealized Loss	(3)	(8)
Fair Value	997	991
Short-term investments	997	991
Long-term investments	$ 0	$ 0

Note 6 - Inventory - Components

Note 6 - Inventory - Components of Inventories (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Finished goods, gross	$ 11,750	$ 15,337
Finished goods, reserve	(2,324)	(4,129)
Finished goods, net	9,426	11,208
Raw materials, gross	5,308	4,718
Raw materials, reserve	(2,411)	(2,173)
Raw materials, net	2,897	2,545
Total inventories, gross	17,058	20,055
Total inventories, reserve	(4,735)	(6,302)
Total inventories, net	12,323	13,753
Current Portion, gross	7,380	9,399
Current Portion, reserve	(697)	(1,115)
Inventory, net	6,683	8,284
Long-term portion, gross	9,678	10,656
Long-term portion, reserve	(4,038)	(5,187)
Inventory, net of current portion	$ 5,640	$ 5,469

Note 7 - Intellectual Propert_2

Note 7 - Intellectual Property (Details Textual) - Weighted Average [Member]	Sep. 30, 2023	Dec. 31, 2022
Developed Technology Rights [Member]
Finite-Lived Intangible Assets, Remaining Amortization Period (Year)	3 years 4 months 24 days	4 years 2 months 12 days
Technology-Based Intangible Assets [Member]
Finite-Lived Intangible Assets, Remaining Amortization Period (Year)	3 years 7 months 6 days	4 years 3 months 18 days

Note 7 - Intellectual Propert_3

Note 7 - Intellectual Property - Intellectual Property (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets, Gross	$ 69,238	$ 69,238
Finite-Lived Intangible Assets, Accumulated Amortization	(67,141)	(66,801)
Finite-Lived Intangible Assets, Foreign Currency Translation Impact	(819)	(861)
Intellectual property, net	1,278	1,576
Developed Technology Rights [Member]
Finite-Lived Intangible Assets, Gross	68,838	68,838
Finite-Lived Intangible Assets, Accumulated Amortization	(66,872)	(66,562)
Finite-Lived Intangible Assets, Foreign Currency Translation Impact	(830)	(874)
Intellectual property, net	1,136	1,402
Technology-Based Intangible Assets [Member]
Finite-Lived Intangible Assets, Gross	400	400
Finite-Lived Intangible Assets, Accumulated Amortization	(269)	(239)
Finite-Lived Intangible Assets, Foreign Currency Translation Impact	11	13
Intellectual property, net	$ 142	$ 174

Note 8 - Leases - Components of

Note 8 - Leases - Components of Operating Lease Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
General and Administrative Expense [Member]
Long-term Operating	$ 494	$ 408	$ 1,424	$ 1,192

Note 8 - Leases -Supplemental B

Note 8 - Leases -Supplemental Balance Sheet Information (Details)	Sep. 30, 2023	Dec. 31, 2022
Weighted-average remaining lease term (in years) (Year)	6 years 1 month 6 days	6 years 9 months 18 days
Weighted-average discount rate	8.40%	8.40%

Note 8 - Leases - Minimum Lease

Note 8 - Leases - Minimum Lease Payments (Details) $ in Thousands	Sep. 30, 2023 USD ($)
Remainder of 2023	$ 309
2024	1,329
2025	1,251
2026	936
2027	954
2028 and thereafter	2,227
Total minimum lease payments	7,006
Less: Amount of lease payments representing interest	(1,511)
Present value of future minimum lease payments	$ 5,495

Note 9 - Accrued Expenses and_3

Note 9 - Accrued Expenses and Other Current Liabilities - Components of Accrued Expenses (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Income and other taxes payable	$ 694	$ 839
Legal and professional fees	374	275
Royalties	23	24
Consulting services	167	155
Total accrued expenses and other current liabilities	$ 1,258	$ 1,293

Note 10 - Income Taxes (Details

Note 10 - Income Taxes (Details Textual) - USD ($)	3 Months Ended			9 Months Ended
	Dec. 31, 2023	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Effective Income Tax Rate Reconciliation, Percent		(0.30%)	(0.30%)	(0.20%)	(0.40%)
Income Tax Expense (Benefit)		$ 57,000	$ 55,000	$ 136,000	$ 224,000
Unrecognized Tax Benefits, Income Tax Penalties and Interest Accrued, Total		$ 0		0
Effective Income Tax Rate Reconciliation, GILTI, Amount				$ 0	$ 0
Forecast [Member]
Effective Income Tax Rate Reconciliation, Percent	(0.30%)

Note 11 - Stock-based Compens_3

Note 11 - Stock-based Compensation (Details Textual) - USD ($) $ in Millions		9 Months Ended
	Jun. 06, 2023	Sep. 30, 2023
Share-Based Payment Arrangement, Option [Member]
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount		$ 2.2
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)		1 year 8 months 12 days
Restricted Stock Units (RSUs) [Member]
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount		$ 6
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)		1 year 4 months 24 days
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)	54,072,307

Note 11 - Stock-based Compens_4

Note 11 - Stock-based Compensation - Stock Option Activity (Details) - USD ($) $ / shares in Units, $ in Millions	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Options, Outstanding, Number of Shares (in shares)	7,584,967
Options, Outstanding, Weighted Average Exercise Price (in dollars per share)	$ 4.22
Options, Outstanding, Weighted Average Remaining Contractual Term (Year)	5 years 1 month 6 days	5 years 3 months 21 days
Options, Granted, Number of Shares (in shares)	3,047,615
Options, Grants in Period, Weighted Average Exercise Price (in dollars per share)	$ 0.71
Options, Exercised, Number of Shares (in shares)	(13,300)
Options, Exercises in Period, Weighted Average Exercise Price (in dollars per share)	$ 0.38
Options, Cancelled, Number of Shares (in shares)	(21,116)
Options, Expirations in Period, Weighted Average Exercise Price (in dollars per share)	$ 25.79
Options, Forfeited, Number of Shares (in shares)	(106)
Options, Forfeitures in Period, Weighted Average Exercise Price (in dollars per share)	$ 15.86
Options, Outstanding, Number of Shares (in shares)	10,598,060	7,584,967
Outstanding at September 30, 2023 (in dollars per share)	$ 3.17	$ 4.22
Options, Outstanding, Aggregate Intrinsic Value	$ 0
Options, Vested and Expected to Vest, Exercisable, Number of Shares (in shares)	10,132,754
Options, Vested and Expected to Vest, Exercisable, Weighted Average Exercise Price (in dollars per share)	$ 3.29
Options, Vested and Expected to Vest, Exercisable, Weighted Average Remaining Contractual Term (Year)	5 years 18 days
Options, Vested or Expected to Vest, Aggregate Intrinsic Value	$ 0
Options, Exercisable, Number of Shares (in shares)	5,591,291
Options, Exercisable, Weighted Average Exercise Price (in dollars per share)	$ 5.15
Options, Exercisable, Weighted Average Remaining Contractual Term (Year)	4 years 4 months 13 days
Options, Exercisable, Aggregate Intrinsic Value	$ 0

Note 11 - Stock-based Compens_5

Note 11 - Stock-based Compensation - Stock Option Valuation Assumptions (Details) - $ / shares	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Expected dividend yield	0%	0%
Weighted average grant date fair value (in dollars per share)	$ 0.59	$ 0.6
Minimum [Member]
Expected volatility	124%	128%
Risk-free interest rate	3.53%	1.25%
Expected life (in years) (Year)	3 years 9 months 18 days	3 years 9 months 18 days
Maximum [Member]
Expected volatility	130%	133%
Risk-free interest rate	4.14%	2.98%
Expected life (in years) (Year)	4 years 6 months	4 years 6 months

Note 11 - Stock-based Compens_6

Note 11 - Stock-based Compensation - RSU Activity (Details) - Restricted Stock Units (RSUs) [Member]	9 Months Ended
	Sep. 30, 2023 $ / shares shares
Beginning of period, Restricted stock units, Unvested (in shares) | shares	8,483,491
Beginning of period, Restricted stock units, Unvested, weighted average grant date fair value (in dollars per share) | $ / shares	$ 1.04
Restricted stock units, Granted (in shares) | shares	8,482,315
Restricted stock units, Granted, weighted average grant date fair value (in dollars per share) | $ / shares	$ 0.71
Restricted stock units, Vested (in shares) | shares	(3,623,411)
Restricted stock units, Vested, weighted average grant date fair value (in dollars per share) | $ / shares	$ 1.14
Restricted stock units, Forfeited (in shares) | shares	(539,448)
Restricted stock units, Forfeited, weighted average grant date fair value (in dollars per share) | $ / shares	$ 0.76
Beginning of period, Restricted stock units, Unvested (in shares) | shares	12,802,947
Beginning of period, Restricted stock units, Unvested, weighted average grant date fair value (in dollars per share) | $ / shares	$ 0.82

Note 11 - Stock-based Compens_7

Note 11 - Stock-based Compensation - Non-cash Share-based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Share-based compensation	$ 2,019	$ 2,033	$ 5,913	$ 6,361
Share-Based Payment Arrangement, Option [Member]
Share-based compensation	552	913	1,808	2,812
Restricted Stock Units (RSUs) [Member]
Share-based compensation	1,037	772	2,873	2,480
Performance Restricted Stock Unit [Member]
Share-based compensation	$ 430	$ 348	$ 1,232	$ 1,069

Note 12 - Equity Offerings (Det

Note 12 - Equity Offerings (Details Textual) - USD ($) $ / shares in Units, $ in Thousands		3 Months Ended	9 Months Ended
	Jul. 23, 2023	Sep. 30, 2023	Sep. 30, 2023	Mar. 18, 2022
Warrants Issued in Registered Direct Offering [Member]
Other Nonoperating Expense		$ 700	$ 700
Warrants Issued in Registered Direct Offering [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)	23,809,524
Class of Warrant or Right, Exercise Price of Warrants or Rights (in dollars per share)	$ 0.42
Warrants and Rights Outstanding, Term (Year)	5 years
Proceeds from Issuance of Common Stock	$ 2,900
The 2022 ATM Offering [Member]
Stock Offering Agreement, Maximum Share Value				$ 100,000
Stock Offering Agreement, Commission, Percent				3%
Stock Issued During Period, Shares, New Issues (in shares)		78,600	433,672
Proceeds from Issuance of Common Stock		$ 25	$ 227
Common Stock Issued in Registered Direct Offering [Member]
Stock Issued During Period, Shares, New Issues (in shares)	23,809,524
Proceeds from Issuance or Sale of Equity	$ 10,000
Proceeds from Issuance of Warrants	7,100
Adjustments to Additional Paid in Capital, Stock Issued, Issuance Costs	$ 1,000

Note 12 - Equity Offerings - Su

Note 12 - Equity Offerings - Summary of Sales Under Offering (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2023	Sep. 30, 2022
Net proceeds		$ 9,946	$ 0
The 2022 ATM Offering [Member]
Shares of common stock issued (in shares)	78,600	433,672
Gross proceeds	$ 25	$ 227
Commission paid to Agents	1	7
Net proceeds	$ 24	$ 220
The 2022 ATM Offering [Member] | Arithmetic Average [Member]
Average price per share (in dollars per share)	$ 0.31	$ 0.52

Note 13 - Basic and Diluted N_3

Note 13 - Basic and Diluted Net Loss Per Share - Antidilutive Securities Excluded from Computation of Earnings Per Share (Details) - shares	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	48,231,507	16,464,509
Share-Based Payment Arrangement, Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	10,598,060	7,404,858
Restricted Stock Units (RSUs) [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	12,802,947	8,038,575
Warrant [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	24,830,500	1,021,076

Note 14 - Commitments and Con_3

Note 14 - Commitments and Contingencies - Purchase Orders Commitments (Details) - License and Supply Agreement [Member] $ in Thousands	Sep. 30, 2023 USD ($)
2023 (remaining three months)	$ 4,223
2024	1,543
2025	314
2026	303
Total commitments	$ 6,383

Note 15 - Segments and Geogra_3

Note 15 - Segments and Geographic Areas (Details Textual)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Number of Operating Segments			1
Revenue Benchmark [Member] | Customer Concentration Risk [Member]
Number of Major Customers	1	1	0	1
Revenue Benchmark [Member] | Customer Concentration Risk [Member] | One Customer [Member]
Concentration Risk, Percentage	10%	10%		10%

Note 15 - Segments and Geogra_4

Note 15 - Segments and Geographic Areas - Consolidated Assets and Long Lived Assets by Geographic Area (Details) - Geographic Concentration Risk [Member] - Long-lived Assets [Member]	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
UNITED STATES
Percentage	37%	39%
EMEA [Member]
Percentage	57%	57%
Asia [Member]
Percentage	6%	4%
All Countries [Member]
Percentage	100%	100%

Note 15 - Segments and Geogra_5

Note 15 - Segments and Geographic Areas - Sales by Geographic Area (Details) - Revenue Benchmark [Member] - Geographic Concentration Risk [Member]	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
UNITED STATES
Concentration risk, percent	17%	7%	17%	13%
EMEA [Member]
Concentration risk, percent	64%	86%	62%	72%
Asia [Member]
Concentration risk, percent	19%	7%	21%	15%
All Countries [Member]
Concentration risk, percent	100%	100%	100%	100%

Note 16 - Related Party Trans_2

Note 16 - Related Party Transactions (Details Textual) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Asensus Surgical Europe S.à.R.L [Member] | 1 Med S.A. [Member] | Service Supply Agreement [Member]
Operating Costs and Expenses	$ 2,000	$ 67,000	$ 73,000	$ 208,000