Document And Entity Information
Document And Entity Information - shares | 3 Months Ended | |
Mar. 31, 2024 | May 07, 2024 | |
Document Information [Line Items] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Mar. 31, 2024 | |
Document Transition Report | false | |
Entity File Number | 0-19437 | |
Entity Registrant Name | ASENSUS SURGICAL, INC. | |
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 | |
Trading Symbol | ASXC | |
Security Exchange Name | NYSE | |
Entity Common Stock, Shares Outstanding (in shares) | 272,331,675 | |
Entity Central Index Key | 0000876378 | |
Current Fiscal Year End Date | --12-31 | |
Document Fiscal Year Focus | 2024 | |
Document Fiscal Period Focus | Q1 | |
Amendment Flag | false |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Operations and Comprehensive Loss (Unaudited) - USD ($) shares in Thousands, $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Revenue: | ||
Revenue | $ 1,123 | $ 976 |
Cost of revenue: | ||
Cost of revenue | 3,056 | 2,947 |
Gross loss | (1,933) | (1,971) |
Operating Expenses: | ||
Research and development | 8,091 | 10,139 |
Sales and marketing | 3,642 | 4,553 |
General and administrative | 4,374 | 5,468 |
Amortization of intangible assets | 114 | 112 |
Change in fair value of contingent consideration | 6,480 | 105 |
Total operating expenses | 22,701 | 20,377 |
Operating loss | (24,634) | (22,348) |
Other income (expenses), net | ||
Change in fair value of warrant liabilities | 2,116 | 0 |
Interest income | 126 | 439 |
Other expense, net | (59) | (218) |
Total other income (expense), net | 2,183 | 221 |
Loss before income taxes | (22,451) | (22,127) |
Income tax expense | (46) | (91) |
Net loss | $ (22,497) | $ (22,218) |
Net loss per common share attributable to common stockholders - basic and diluted (in dollars per share) | $ (0.08) | $ (0.09) |
Weighted average number of shares used in computing net loss per common share - basic and diluted (in shares) | 269,265 | 238,280 |
Comprehensive loss: | ||
Net loss | $ (22,497) | $ (22,218) |
Foreign currency translation (loss) gain | (494) | 550 |
Unrealized gain on available-for-sale investments | 8 | 307 |
Comprehensive loss | (22,983) | (21,361) |
Product [Member] | ||
Revenue: | ||
Revenue | 313 | 293 |
Cost of revenue: | ||
Cost of revenue | 1,681 | 1,225 |
Service [Member] | ||
Revenue: | ||
Revenue | 285 | 195 |
Cost of revenue: | ||
Cost of revenue | 452 | 749 |
Lease [Member] | ||
Revenue: | ||
Revenue | 525 | 488 |
Cost of revenue: | ||
Cost of revenue | $ 923 | $ 973 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Current Assets: | ||
Cash and cash equivalents | $ 6,995 | $ 17,096 |
Short-term investments, available-for-sale | 994 | 3,971 |
Accounts receivable, net | 675 | 3,508 |
Inventories | 5,958 | 7,172 |
Prepaid expenses | 3,314 | 3,143 |
Other current assets | 1,312 | 1,496 |
Total Current Assets | 19,248 | 36,386 |
Restricted cash | 1,483 | 1,642 |
Inventories, net of current portion | 3,954 | 4,043 |
Property and equipment, net | 8,630 | 8,959 |
Intellectual property, net | 1,114 | 1,237 |
Net deferred tax assets | 37 | 44 |
Operating lease right-of-use assets, net | 4,926 | 5,165 |
Other long-term assets | 1,422 | 1,610 |
Total Assets | 40,814 | 59,086 |
Current Liabilities: | ||
Accounts payable | 4,036 | 4,145 |
Accrued employee compensation and benefits | 3,814 | 5,390 |
Accrued expenses and other current liabilities | 1,243 | 1,636 |
Contingent consideration, current | 8,700 | 0 |
Operating lease liabilities, current | 1,056 | 1,036 |
Deferred revenue | 439 | 421 |
Total Current Liabilities | 19,288 | 12,628 |
Long-Term Liabilities: | ||
Deferred revenue - less current portion | 330 | 290 |
Contingent consideration | 0 | 2,220 |
Warrant liabilities | 3,772 | 5,888 |
Noncurrent operating lease liabilities | 4,400 | 4,646 |
Total Liabilities | 27,790 | 25,672 |
Commitments and Contingencies | ||
Stockholders' Equity: | ||
Common stock $0.001 par value, 750,000,000 shares authorized at March 31, 2024 and December 31, 2023; 271,986,369 and 264,921,526 issued and outstanding at March 31, 2024 and December 31, 2023, respectively | 272 | 265 |
Preferred stock, $0.01 par value, 25,000,000 shares authorized, no shares issued and outstanding at March 31, 2024 and December 31, 2023 | 0 | 0 |
Additional paid-in capital | 975,715 | 973,129 |
Accumulated deficit | (961,865) | (939,368) |
Accumulated other comprehensive loss | (1,098) | (612) |
Total Stockholders' Equity | 13,024 | 33,414 |
Total Liabilities and Stockholders' Equity | 40,814 | 59,086 |
Intellectual Property [Member] | ||
Current Assets: | ||
Intellectual property, net | $ 1,114 | $ 1,237 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - $ / shares | Mar. 31, 2024 | Dec. 31, 2023 |
Common Stock, Par or Stated Value Per Share (in dollars per share) | $ 0.001 | $ 0.001 |
Common Stock, Shares Authorized (in shares) | 750,000,000 | 750,000,000 |
Common Stock, Shares, Outstanding (in shares) | 271,986,369 | 264,921,526 |
Common Stock, Shares, Issued (in shares) | 271,986,369 | 264,921,526 |
Preferred Stock, Par or Stated Value Per Share (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 ($) shares in Thousands, $ 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, 2022 | 236,895 | 0 | ||||
Balance at Dec. 31, 2022 | $ 237 | $ 0 | $ 962,731 | $ (860,935) | $ (2,388) | $ 99,645 |
Stock-based compensation | $ 0 | 1,916 | 0 | 0 | 1,916 | |
Issuance of common stock related to vesting of restricted stock units (in shares) | 2,434 | 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 | ||||
Shares withheld related to net share settlement of equity awards | $ 0 | $ 1 | (490) | 0 | 0 | (489) |
Cancellation of treasury stock (in shares) | 0 | (649) | ||||
Cancellation of treasury stock | $ 0 | $ 1 | 0 | 0 | 0 | (1) |
Cancellation of treasury stock | 0 | $ (1) | 0 | 0 | 0 | 1 |
Other comprehensive income | 0 | 0 | 857 | 857 | ||
Net loss | $ 0 | (22,218) | 0 | (22,218) | ||
Exercise of stock options (in shares) | 13 | 0 | ||||
Exercise of stock options | $ 0 | $ 0 | 5 | 0 | 0 | 5 |
Balance (in shares) at Mar. 31, 2023 | 239,342 | 0 | ||||
Balance at Mar. 31, 2023 | $ 239 | $ 0 | 964,162 | (883,153) | (1,531) | 79,717 |
Balance (in shares) at Dec. 31, 2023 | 264,922 | 0 | ||||
Balance at Dec. 31, 2023 | $ 265 | $ 0 | 973,129 | (939,368) | (612) | 33,414 |
Stock-based compensation | $ 0 | 1,745 | 0 | 0 | 1,745 | |
Issuance of common stock related to vesting of restricted stock units (in shares) | 4,012 | 0 | ||||
Issuance of common stock related to vesting of restricted stock units | $ 4 | $ 0 | 0 | 0 | 0 | 4 |
Shares withheld related to net share settlement of equity awards (in shares) | 0 | 640 | ||||
Shares withheld related to net share settlement of equity awards | $ 0 | $ 1 | (135) | 0 | 0 | (134) |
Cancellation of treasury stock (in shares) | 0 | (640) | ||||
Cancellation of treasury stock | $ 0 | $ 1 | 0 | 0 | 0 | (1) |
Cancellation of treasury stock | $ 0 | (1) | 0 | 0 | 0 | 1 |
Issuance of common stock, net of issuance costs (in shares) | 3,052 | |||||
Issuance of common stock, net of issuance costs | $ 3 | 976 | 979 | |||
Other comprehensive income | 0 | 0 | 0 | 0 | (486) | (486) |
Net loss | $ 0 | $ 0 | (22,497) | 0 | (22,497) | |
Balance (in shares) at Mar. 31, 2024 | 271,986 | 0 | ||||
Balance at Mar. 31, 2024 | $ 272 | $ 0 | $ 975,715 | $ (961,865) | $ (1,098) | $ 13,024 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Cash Flows from Operating Activities: | ||
Net loss | $ (22,497) | $ (22,218) |
Adjustments to reconcile net loss to net cash and cash equivalents used in operating activities: | ||
Depreciation | 841 | 813 |
Amortization of intangible assets | 114 | 112 |
Accretion of discounts and premiums on investments, net | (15) | (89) |
Stock-based compensation | 1,745 | 1,916 |
Deferred tax expense | 0 | 91 |
Bad debt expense | (2) | 0 |
Change in inventory reserves | 959 | (374) |
Change in fair value of warrant liabilities | (2,116) | 0 |
Change in fair value of contingent consideration | 6,480 | 105 |
Changes in operating assets and liabilities: | ||
Accounts receivable | 2,776 | 1,607 |
Inventories | (559) | 203 |
Operating lease right-of-use assets | 177 | 187 |
Prepaid expenses | (183) | 250 |
Other current and long-term assets | 313 | (27) |
Accounts payable | (74) | 1,608 |
Accrued employee compensation and benefits | (1,523) | (1,120) |
Accrued expenses and other current liabilities | (359) | (93) |
Deferred revenue | 73 | (13) |
Operating lease liabilities | (158) | (206) |
Net cash and cash equivalents used in operating activities | (14,008) | (17,248) |
Cash Flows from Investing Activities: | ||
Purchase of available-for-sale investments | 0 | (2,949) |
Proceeds from maturities of available-for-sale investments | 3,000 | 32,750 |
Purchase of property and equipment | 0 | (64) |
Net cash and cash equivalents provided by (used in) investing activities | 3,000 | 29,737 |
Cash Flows from Financing Activities: | ||
Proceeds from issuance of common stock, net of issuance costs | 982 | 0 |
Taxes paid related to net share settlement of vesting of restricted stock units | (171) | (488) |
Proceeds from exercise of stock options | 0 | 5 |
Net cash and cash equivalents provided by (used in) financing activities | 811 | (483) |
Effect of exchange rate changes on cash and cash equivalents | (63) | 403 |
Net (decrease) increase in cash, cash equivalents and restricted cash | (10,260) | 12,409 |
Cash, cash equivalents and restricted cash, beginning of period | 18,738 | 7,470 |
Cash, cash equivalents and restricted cash, end of period | 8,478 | 19,879 |
Supplemental Disclosure for Cash Flow Information | ||
Cash paid for leases | 351 | 330 |
Cash paid for taxes | 87 | 190 |
Supplemental Schedule of Non-cash Investing and Financing Activities: | ||
Transfer of inventory to property and equipment | 630 | 112 |
Lease liabilities arising from obtaining right-of-use assets | $ 72 | $ 45 |
Note 1 - Description of the Bus
Note 1 - Description of the Business | 3 Months Ended |
Mar. 31, 2024 | |
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, we intend 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 and only digital, multi-port laparoscopic platform designed to maintain laparoscopic MIS standards while providing digital benefits such as haptic feedback, robotic precision, comfortable ergonomics, advanced instrumentation including 3mm microlaparoscopic instruments, 5mm articulating instruments, eye-sensing camera control and fully reusable standard instruments to help maintain per-procedure costs similar to traditional laparoscopy. |
Note 2 - Summary of Significant
Note 2 - Summary of Significant Accounting Policies | 3 Months Ended |
Mar. 31, 2024 | |
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 be regarded as necessarily indicative of results that may be expected for any subsequent period or for the entire year. These unaudited condensed consolidated financial statements and notes thereto should be read in conjunction with the Company’s audited consolidated financial statements and the notes thereto included in the Fiscal Year 2023 Form 10-K. Certain information and footnote disclosures normally included in the annual consolidated financial statements prepared in accordance with U.S. GAAP have been condensed or omitted in the accompanying interim condensed consolidated financial statements. In the opinion of the Company’s management, the accompanying unaudited condensed consolidated financial statements contain all adjustments, consisting only of normal recurring adjustments, except as otherwise indicated, necessary for a fair statement of its financial position, results of operations, and cash flows of the Company for all periods presented. Going Concern The Company's condensed consolidated financial statements are prepared using U.S. GAAP applicable to a going concern basis of accounting, which contemplate the realization of assets and liquidation of liabilities in the normal course of business. The Company had an accumulated deficit of $961.9 million as of March 31, 2024. The Company has not established sufficient sales revenues to cover its operating costs and requires additional capital to proceed with its operating plan. The ability of the Company to continue as a going concern is dependent on the Company obtaining adequate capital to fund operating losses until it becomes profitable. The Company will need to obtain additional financing to execute its business plan. Management's plan to obtain additional resources for the Company includes a potential sale of the Company and, if that is not successful, additional sales of equity, traditional financing, such as loans, entry into strategic collaborations, entry into an out-licensing arrangement or provision of additional distribution rights in some or all of its markets, or, if all such alternatives are not successful, a bankruptcy filing. However, management cannot provide any assurance that the Company will be successful in accomplishing any or all of its plans. The ability to successfully resolve these factors raises substantial doubt about the Company’s ability to meet its existing obligations, and to continue as a going concern within one year from the date that these financial statements are issued. The condensed consolidated financial statements of the Company do not include any adjustments that may result from the outcome of these aforementioned uncertainties. 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 risk that the Company will not be able to successfully negotiate a definitive merger agreement with from KARL STORZ SE & Co. KG (“KARL STORZ”) or, if such definitive agreement is executed, successfully obtain all necessary approvals to consummate the possible transaction described in Note 17; the Company’s ability to raise additional capital; its ability to successfully develop, clinically test and commercialize its products and products in development; negative impacts on the Company's operations caused by the hostilities in the Middle East and other geopolitical factors; the success of its market development efforts; the timing and outcome of the regulatory review process for its products; changes in the healthcare regulatory environments of the United States, the European Union, Japan, Taiwan, and other countries in which the Company operates or intends to operate; its ability to attract and retain key management, marketing and scientific personnel; its ability to successfully prepare, file, prosecute, maintain, defend and enforce patent claims and other intellectual property rights; its ability to successfully transition from a research and development company to a marketing, sales and distribution company; competition in the market for robotic surgical devices; and its ability to identify and pursue development of additional products. 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 investments, fair value estimates related to warrant liabilities, changes in 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. Significant Accounting Policies There have been no new or material changes to the significant accounting policies discussed in the Company’s audited financial statements and the notes thereto included in the Fiscal Year 2023 Form 10-K. Impact of Recently Issued Accounting Standards In November 2023, the FASB issued Accounting Standards Update, or ASU, No. 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures The ASU is to be applied retrospectively to all prior periods presented in the financial statements with an effective date for all public entities for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The Company is currently evaluating the impact of this ASU. In December 2023, the FASB issues ASU No. 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures This ASU is to be applied on a prospective basis with an effective date for all public entities for annual periods beginning after December 15, 2024. Early adoption is permitted. The Company is currently evaluating the impact of this ASU. |
Note 3 - Revenue Recognition
Note 3 - Revenue Recognition | 3 Months Ended |
Mar. 31, 2024 | |
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 March 31, 2024 2023 (in thousands) U.S. Instruments and accessories $ 51 $ 60 Services 87 75 Leases 68 71 Total U.S. revenue 206 206 Outside of U.S. ("OUS") Instruments and accessories 262 233 Services 198 120 Leases 457 417 Total OUS revenue 917 770 Total Instruments and accessories 313 293 Services 285 195 Leases 525 488 Total revenue $ 1,123 $ 976 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 yet been recognized. A significant portion of this amount relates to service obligations performed under the Company's system sales contracts that will be invoiced and recognized as revenue in future periods. The transaction price allocated to remaining performance obligations as of March 31, 2024 was $0.8 million, which is expected to be recognized over 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 have any significant impairment losses on its contract assets (included in accounts receivable, net in the consolidated balance sheets) for the periods presented. Revenue recognized for the three months ended March 31, 2024 and 2023 that was included in the deferred revenue balance at the beginning of each reporting period was $0.2 million, which was included in the deferred revenue balance of $0.7 million and $0.5 million as of December 31, 2023, and 2022, respectively. The following information summarizes the Company’s contract assets and liabilities: March 31, 2024 December 31, 2023 (in thousands) Contract assets $ 74 $ 95 Deferred revenue $ 769 $ 711 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 months ended March 31, 2024, and 2023, variable lease revenue related to usage-based arrangements was not material. 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 affect a customer’s ability to pay. The allowance for expected credit losses was $1.6 million as of March 31, 2024 and December 31, 2023. The Company recorded immaterial amounts for expected credit losses during the three months ended March 31, 2024 and 2023. The Company had three 23 15 12 one 83 |
Note 4 - Fair Value Measurement
Note 4 - Fair Value Measurements | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Fair Value Disclosures [Text Block] | 4. Fair Value Measurements As of March 31, 2024 and December 31, 2023, carrying amounts reported on the Company’s balance sheet for cash and cash equivalents, restricted cash, accounts receivable, prepaid expenses, other current assets, accounts payable, employee-related liabilities, accrued expenses and other current liabilities, and deferred revenue approximate their respective fair value due to liquidity and short-term nature of these items. The Company records certain assets and liabilities at fair value. ASC 820 – Fair Value Measurement states that fair value is the price that would be received to sell an asset, or paid to transfer a liability, in an orderly transaction between market participants at the measurement date. As such, the fair value is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or a liability. The three-tiered fair value hierarchy that prioritizes the inputs used in measuring fair value, is comprised of: Level 1 – Unadjusted quoted prices in active markets for identical assets or liabilities; Level 2 – Inputs other than quoted prices included within Level 1 that are either directly or indirectly observable through correlation with market data; and Level 3 – Unobservable inputs that are supported by little or no market data, which require the reporting entity to develop its own assumptions. As of March 31, 2024 and December 31, 2023, the Company’s assets and liabilities measured at fair value on a recurring basis were as follows: March 31, 2024 Level 1 Level 2 Level 3 Total (in thousands) Assets: Cash and cash equivalents (1) $ 6,995 $ - $ - 6,995 Restricted cash 1,483 - - 1,483 Short-term investments - 994 - 994 Total assets $ 8,478 $ 994 $ - $ 9,472 Liabilities: Contingent consideration $ - $ - $ 8,700 $ 8,700 Warrant liabilities $ 3,772 $ 3,772 Total liabilities $ - $ - $ 12,472 $ 12,472 December 31, 2023 Level 1 Level 2 Level 3 Total (in thousands) Assets: Cash and cash equivalents (1) $ 17,096 $ - $ - $ 17,096 Restricted cash 1,642 - - 1,642 Short-term investments - 3,971 - 3,971 Total assets $ 18,738 $ 3,971 $ - $ 22,709 Liabilities: Contingent consideration $ - $ - $ 2,220 $ 2,220 Warrant liabilities - - 5,888 5,888 Total liabilities $ - $ - $ 8,108 $ 8,108 (1) Includes investments that are readily convertible to cash with original maturities of 90 days or less. Warrant Liabilities Warrant liabilities was recorded at its initial estimated fair value. Adjustments associated with changes in fair value of 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 as of March 31, 2024: Fair value (in thousands) Balance at December 31, 2023 $ 5,888 Change in estimated fair value (2,116 ) Balance at March 31, 2024 $ 3,772 The fair value of the warrant liabilities was estimated using the Black-Scholes option pricing model, which is based on unobservable inputs and is designated as Level 3 in the fair value hierarchy. The following table summarizes the assumptions used in determining fair value of warrant liabilities: As of March 31, 2024 As of December 31, 2023 Expected volatility 116% 117% Risk-free interest rate 4.2% 3.8% Expected life (in years) 4.3 4.6 Expected dividend yield 0.0% 0.0% Contingent Consideration Contingent consideration represents a liability related to the Company’s 2015 acquisition of the Senhance System (the “Senhance Acquisition”). Adjustments associated with changes in fair value of contingent consideration are included in the Company’s condensed consolidated statements of operations and comprehensive loss. The fair value of contingent consideration is related to a milestone of €15.0 million which shall be payable upon achievement of trailing revenues from sales or services contracts of the Senhance System of at least €25.0 million over a calendar quarter or in the event that (i) the Company is acquired, (ii) the Company significantly reduces or suspends selling efforts of the Senhance System, or (iii) the Company acquires a business that offers alternative products that are directly competitive with the Senhance System. On March 28, 2024, the Company entered into a non-binding letter of intent with KARL STORZ for a potential acquisition of the Company by KARL STORZ (the “Potential Acquisition”). If the Potential Acquisition is successfully negotiated, a definitive agreement is signed, and the Potential Acquisition is approved by all necessary parties, including the Company’s stockholders, the contingent consideration becomes immediately payable. Our valuation of the contingent consideration is management’s best estimate of the probability-weighted fair value of the consideration under the Potential Acquisition, assuming a 50% probability that the Potential Acquisition would occur and the timing of achievement of trailing revenue of at least €25.0 million over a calendar quarter. If the facts or circumstances should change regarding the assumption of the probability of the Potential Acquisition occurring, this could have a material impact on the fair value of the contingent consideration. The following table summarizes changes in estimated fair value of the contingent consideration for the three months ended March 31, 2024 and 2023: Fair value (in thousands) Balance at December 31, 2022 $ 1,256 Change in estimated fair value 105 Balance at March 31, 2023 $ 1,361 Balance at December 31, 2023 $ 2,220 Change in estimated fair value 6,480 Balance at March 31, 2024 $ 8,700 The following table presents quantitative information about the inputs and valuation methodologies used for fair value measurement of contingent consideration liability utilizing a probability of occurrence related to the Potential Acquisition and a Monte-Carlo simulation method as of March 31, 2024 and a Monte-Carlo simulation method as of December 31, 2023: Valuation Methodology Significant Unobservable Inputs March 31, 2024 December 31, 2023 Contingent consideration Probability weighted income approach Milestone date 2032 2032 Revenue discount rate 10.0% 10.0% Revenue volatility 32.5% 35.0% EUR-to-USD exchange rate 1.08 1.10 Probability of occurrence 50.0% - During the three months ended March 31, 2024, there were no transfers of assets or liabilities between Level 1, Level 2, or Level 3 of fair value categories. |
Note 5 - Investments, Available
Note 5 - Investments, Available-for-sale | 3 Months Ended |
Mar. 31, 2024 | |
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 consolidated balance sheets are as follows: March 31, 2024 Balance Sheet Classification Amortized Cost Unrealized Gain Unrealized Loss Fair Value Short-term investments (in thousands) Corporate bonds $ 995 $ - $ (1 ) $ 994 $ 994 Total investments $ 995 $ - $ (1 ) $ 994 $ 994 December 31, 2023 Balance Sheet Classification Amortized Cost Unrealized Gain Unrealized Loss Fair Value Short-term investments (in thousands) Corporate bonds $ 3,981 $ - $ (10 ) $ 3,971 $ 3,971 Total investments $ 3,981 $ - $ (10 ) $ 3,971 $ 3,971 As of March 31, 2024, contractual maturities of available-for-sale investments were one year or less. Actual maturities may differ from contractual maturities because certain borrowers have the right to call or prepay certain obligations. There were no |
Note 6 - Inventories
Note 6 - Inventories | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Inventory Disclosure [Text Block] | 6. Inventories The components of inventory are as follows: March 31, 2024 December 31, 2023 (in thousands) Finished goods $ 7,422 $ 9,200 Raw materials 2,490 2,015 Total inventories $ 9,912 $ 11,215 Current portion $ 5,958 $ 7,172 Long-term portion 3,954 4,043 Total inventories $ 9,912 $ 11,215 |
Note 7 - Intellectual Property
Note 7 - Intellectual Property | 3 Months Ended |
Mar. 31, 2024 | |
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: March 31, 2024 Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount (in thousands) Developed technology $ 68,838 $ (66,988 ) $ (861 ) $ 989 Technology and patents purchased 400 (289 ) 14 125 Total intellectual property $ 69,238 $ (67,277 ) $ (847 ) $ 1,114 December 31, 2023 Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount (in thousands) Developed technology $ 68,838 $ (66,902 ) $ (837 ) $ 1,099 Technology and patents purchased 400 (279 ) 17 138 Total intellectual property $ 69,238 $ (67,181 ) $ (820 ) $ 1,237 |
Note 8 - Leases
Note 8 - Leases | 3 Months Ended |
Mar. 31, 2024 | |
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 March 31, 2024 2023 (in thousands) Long-term operating $ 453 $ 451 Supplemental balance sheet information related to finance and operating leases was as follows: March 31, 2024 December 31, 2023 Weighted-average remaining lease term (in years) 5.5 5.7 Weighted-average discount rate 9.1% 9.2% Incremental borrowing rate 7.1% - 23.0% 7.1% - 23.0% Maturities of finance and operating lease obligations as of March 31, 2024 were as follows (in thousands): Fiscal Year Remainder of 2024 1,144 2025 1,386 2026 1,051 2027 1,003 2028 827 2029 and thereafter 1,406 Total minimum lease payments $ 6,817 Less: Amount of lease payments representing interest (1,361 ) Present value of future minimum lease payments $ 5,456 |
Note 9 - Accrued Expenses and O
Note 9 - Accrued Expenses and Other Current Liabilities | 3 Months Ended |
Mar. 31, 2024 | |
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: March 31, 2024 December 31, 2023 (in thousands) Consulting and other vendors $ 145 $ 461 Royalties 50 9 Legal and professional fees 132 411 Taxes and other assessments 916 755 Total accrued expenses and other current liabilities $ 1,243 $ 1,636 |
Note 10 - Income Taxes
Note 10 - Income Taxes | 3 Months Ended |
Mar. 31, 2024 | |
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 “Income Taxes”. The Company computes its interim provision for income taxes by applying the estimated annual effective tax rate method. The Company estimates an annual effective tax rate of ( 0.3 0.2 0.4 The Company incurred losses for the three months ended March 31, 2024, and is forecasting additional losses through the year, resulting in an estimated net loss for both financial statement and tax purposes for the year ending December 31, 2024. Due to the Company’s history of losses, there is not sufficient evidence to record a net deferred tax asset associated with the U.S., Luxembourg, Swiss, Italian, Taiwanese, and Canadian operations. Accordingly, a full valuation allowance has been recorded related to the net deferred tax assets in those jurisdictions. The total tax expense during the three months ended March 31, 2024 and 2023, was a benefit of approximately $0.05 million and of $0.09 million, respectively. At March 31, 2024, the Company had no The FASB Staff Q&A, Topic 740, No. 5, Accounting for Global Intangible Low-Taxed Income (“GILTI”), states that an entity can make an accounting policy election to either recognize deferred taxes for temporary basis differences expected to reverse as GILTI in future years or to provide for the tax expense related to GILTI in the year the tax is incurred as a period expense only. The Company has elected to account for GILTI as a period expense in the year the tax is incurred. The Company does not expect a GILTI inclusion for 2024; no |
Note 11 - Stock-based Compensat
Note 11 - Stock-based Compensation | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Share-Based Payment Arrangement [Text Block] | 11. Stock-Based Compensation Incentive Compensation Plan Information On June 6, 2023, at the 2023 Annual Meeting of Stockholders, the Company’s stockholders voted to approve an amendment and restatement of the Company’s Incentive Compensation Plan (“the Plan”) to increase the number of shares reserved for issuance under the Plan by 22,000,000 shares. As a result of this amendment, shares authorized for issuance under the Plan increased to 54,072,307 shares. Stock Options The following table summarizes options outstanding as of March 31, 2024, as well as activity, including grants to non-employees, for the three months ended March 31, 2024: Number of Shares Weighted-Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Aggregate Intrinsic Value (Millions) Outstanding at December 31, 2023 10,444,679 $ 3.20 4.80 Granted 5,552,790 0.26 Cancelled (36,406 ) 10.24 Outstanding at March 31, 2024 15,961,063 $ 2.16 5.37 $ - Vested or expected to vest at March 31, 2024 14,795,731 $ 2.30 5.27 $ - Exercisable at March 31, 2024 7,862,867 $ 3.97 4.25 $ - The fair value of options granted were estimated using the Black-Scholes-Merton option pricing model based on the assumptions in the table below: Three Months Ended March 31, 2024 2023 Expected volatility 126% - 127% 124% - 126% Risk-free interest rate 4.06% - 4.07% 3.73% - 4.14% Expected life (in years) 4.3 - 4.5 4.3 - 4.5 Expected dividend yield 0% 0% Weighted average grant date fair value $0.22 $0.60 Restricted Stock Units The following table summarizes information about restricted stock units outstanding as of March 31, 2024, as well as activity, including performance restricted stock units, granted, vested and forfeited, for the three months ended March 31, 2024: Number of Shares Weighted-Average Grant Date Fair Value Unvested at December 31, 2023 12,326,177 $ 0.81 Granted 14,647,450 $ 0.26 Vested (4,655,843 ) $ 0.97 Forfeited (1,358,970 ) $ 0.67 Unvested at March 31, 2024 20,958,814 $ 0.40 Vesting of Performance-Based Restricted Stock Units In 2024 and 2023, the Company granted performance-based restricted stock units (“PRSUs”). The number of shares earnable under the 2023 awards were based on achieving certain operational targets by December 31, 2023 (for the PRSUs granted in 2023). In February 2024, the Board determined that the operational targets for PRSU awards granted in 2023 were 50% achieved and as a result, the 2023 PRSUs were 50% earned and remain subject to three Stock-Based Compensation Expense The following table summarizes non-cash stock-based compensation expense by award type for the three months ended March 31, 2024 and 2023: Three Months Ended March 31, 2024 2023 (in thousands) Stock options $ 425 $ 665 Restricted stock units 956 859 Performance restricted stock units 364 392 $ 1,745 $ 1,916 As of March 31, 2024, the unrecognized stock-based compensation expense related to stock options was approximately $2.4 million, which is expected to be recognized over a weighted average period of 2.3 years. As of March 31, 2024, the unrecognized stock-based compensation expense related to unvested restricted stock units and performance restricted stock units was approximately $6.8 million, which is expected to be recognized over a weighted average period of 1.8 years. |
Note 12 - Shareholders' Equity
Note 12 - Shareholders' Equity | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Equity [Text Block] | 12. Shareholder s Equity 2022 At-The Market Offering On March 18, 2022 , 3.0 The following table presents details about common stock issued pursuant to the 2022 ATM Offering (in thousands, except share and per share amounts): Three Months Ended March 31, 2024 Shares of common stock issued 3,051,837 Average price per share $ 0.33 Gross proceeds $ 1,009 Commission paid to agents $ (30 ) Net proceeds $ 979 |
Note 13 - Basic and Diluted Net
Note 13 - Basic and Diluted Net Loss Per Share | 3 Months Ended |
Mar. 31, 2024 | |
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 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 Potential common shares not included in the computation of diluted net loss per share are as follows: March 31, 2024 2023 Stock options 15,961,063 10,319,169 Nonvested restricted stock units 20,958,814 12,657,094 Stock warrants 24,830,500 1,021,076 Total 61,750,377 23,997,339 |
Note 14 - Commitments and Conti
Note 14 - Commitments and Contingencies | 3 Months Ended |
Mar. 31, 2024 | |
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 2025 $ 300 2026 300 Total commitments $ 600 |
Note 15 - Segments and Geograph
Note 15 - Segments and Geographic Areas | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Segment Reporting Disclosure [Text Block] | 15. Segments and Geographic Areas The Company operates in one The following table presents long-lived assets (which include property and equipment and operating lease assets) by geographic area: March 31, 2024 December 31, 2023 U.S. 28 % 29 % EMEA 70 % 68 % Asia 2 % 3 % Total 100 % 100 % The following table presents revenue by geographic area based on the country in which the customer is based: Three Months Ended March 31, 2024 2023 US 18 % 21 % EMEA 66 % 58 % Asia 16 % 21 % Total 100 % 100 % For the three months ended March 31, 2024, the Company had no two |
Note 16 - Related Party Transac
Note 16 - Related Party Transactions | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Related Party Transactions Disclosure [Text Block] | 16. Related Party Transactions In March 2018, Asensus Surgical Europe S.à r.l entered into a Service Supply Agreement with 1 Med S.A. for certain regulatory consulting services. Andrea Biffi, a current member of the Company’s Board of Directors, owns a non-controlling interest in and is President of the board of 1 Med S.A. Expenses under the Service Supply Agreement were approximately zero |
Note 17 - Subsequent Events
Note 17 - Subsequent Events | 3 Months Ended |
Mar. 31, 2024 | |
Notes to Financial Statements | |
Subsequent Events [Text Block] | 17. Subsequent Events On March 28, 2024, the Company agreed to and accepted a non-binding letter of intent (the “letter of intent”) from KARL STORZ to engage in diligence and negotiations regarding the terms of a proposed acquisition of the Company by KARL STORZ (the “Potential Acquisition”). KARL STORZ proposed to acquire 100% of the Company's outstanding shares for $0.35 per share in cash. The letter of intent provides an exclusivity period that began on March 28, 2024, and extended for one week. KARL STORZ has the right to extend the exclusivity period in one-week increments, up to a total of ten weeks (the “Exclusivity Period”); provided that KARL STORZ makes the weekly payments under the Note described below. During the Exclusivity Period, the Company will not engage in negotiations for alternative transactions, KARL STORZ will be conducting diligence and the parties will be negotiating a definitive merger agreement. KARL STORZ has the right to elect not to extend the Exclusivity Period on a weekly basis. On April 3, 2024, the Company issued a promissory note in favor of KARL STORZ in the principal amount of up to $20 million (the “Note”). The Note provides bridge funding for the Company as it pursues a potential transaction with KARL STORZ. Under the Note, KARL STORZ provides $1 million of funding to the Company for each week the Exclusivity Period is extended. The first payment under the Note occurred on April 3, covering the first week of the Exclusivity Period. As of the date of this filing, KARL STORZ has extended the Exclusivity Period six times, paying $1 million each week. The Exclusivity Period will currently end on May 15, 2024, if not extended. If a definitive merger agreement for the Potential Acquisition is executed by the parties, the Company will have the option to secure two $5 million payments under the Note as it seeks to secure stockholder approval for the Proposed Acquisition. The Note is secured by a first priority security interest on all tangible and intangible assets of the Company and each of its direct and indirect subsidiaries. Each of its subsidiaries also serves as a guarantor under the Note. The Note bears interest at a rate of SOFR In addition, on April 3, 2024, each of the Company and its subsidiaries Asensus Surgical US, Inc., Asensus Surgical Europe S.à r.l. and Asensus Surgical Italia S.r.l. entered into an Intellectual Property Security Agreement as grantors to secure the obligations under the Note with a security interest in the U.S. patents held by such grantors. |
Insider Trading Arrangements
Insider Trading Arrangements | 3 Months Ended |
Mar. 31, 2024 | |
Insider Trading Arr Line Items | |
Material Terms of Trading Arrangement [Text Block] | Other Information. During the three months ended March 31, 2024, none |
Rule 10b5-1 Arrangement Adopted [Flag] | false |
Rule 10b5-1 Arrangement Terminated [Flag] | false |
Non-Rule 10b5-1 Arrangement Adopted [Flag] | false |
Non-Rule 10b5-1 Arrangement Terminated [Flag] | false |
Significant Accounting Policies
Significant Accounting Policies (Policies) | 3 Months Ended |
Mar. 31, 2024 | |
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 be regarded as necessarily indicative of results that may be expected for any subsequent period or for the entire year. These unaudited condensed consolidated financial statements and notes thereto should be read in conjunction with the Company’s audited consolidated financial statements and the notes thereto included in the Fiscal Year 2023 Form 10-K. Certain information and footnote disclosures normally included in the annual consolidated financial statements prepared in accordance with U.S. GAAP have been condensed or omitted in the accompanying interim condensed consolidated financial statements. In the opinion of the Company’s management, the accompanying unaudited condensed consolidated financial statements contain all adjustments, consisting only of normal recurring adjustments, except as otherwise indicated, necessary for a fair statement of its financial position, results of operations, and cash flows of the Company for all periods presented. |
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 contemplate the realization of assets and liquidation of liabilities in the normal course of business. The Company had an accumulated deficit of $961.9 million as of March 31, 2024. The Company has not established sufficient sales revenues to cover its operating costs and requires additional capital to proceed with its operating plan. The ability of the Company to continue as a going concern is dependent on the Company obtaining adequate capital to fund operating losses until it becomes profitable. The Company will need to obtain additional financing to execute its business plan. Management's plan to obtain additional resources for the Company includes a potential sale of the Company and, if that is not successful, additional sales of equity, traditional financing, such as loans, entry into strategic collaborations, entry into an out-licensing arrangement or provision of additional distribution rights in some or all of its markets, or, if all such alternatives are not successful, a bankruptcy filing. However, management cannot provide any assurance that the Company will be successful in accomplishing any or all of its plans. The ability to successfully resolve these factors raises substantial doubt about the Company’s ability to meet its existing obligations, and to continue as a going concern within one year from the date that these financial statements are issued. The condensed consolidated financial statements of the Company do not include any adjustments that may result from the outcome of these aforementioned uncertainties. |
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 risk that the Company will not be able to successfully negotiate a definitive merger agreement with from KARL STORZ SE & Co. KG (“KARL STORZ”) or, if such definitive agreement is executed, successfully obtain all necessary approvals to consummate the possible transaction described in Note 17; the Company’s ability to raise additional capital; its ability to successfully develop, clinically test and commercialize its products and products in development; negative impacts on the Company's operations caused by the hostilities in the Middle East and other geopolitical factors; the success of its market development efforts; the timing and outcome of the regulatory review process for its products; changes in the healthcare regulatory environments of the United States, the European Union, Japan, Taiwan, and other countries in which the Company operates or intends to operate; its ability to attract and retain key management, marketing and scientific personnel; its ability to successfully prepare, file, prosecute, maintain, defend and enforce patent claims and other intellectual property rights; its ability to successfully transition from a research and development company to a marketing, sales and distribution company; competition in the market for robotic surgical devices; and its ability to identify and pursue development of additional products. |
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 investments, fair value estimates related to warrant liabilities, changes in 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. |
New Accounting Pronouncements, Policy [Policy Text Block] | Impact of Recently Issued Accounting Standards In November 2023, the FASB issued Accounting Standards Update, or ASU, No. 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures The ASU is to be applied retrospectively to all prior periods presented in the financial statements with an effective date for all public entities for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The Company is currently evaluating the impact of this ASU. In December 2023, the FASB issues ASU No. 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures This ASU is to be applied on a prospective basis with an effective date for all public entities for annual periods beginning after December 15, 2024. Early adoption is permitted. The Company is currently evaluating the impact of this ASU. |
Note 3 - Revenue Recognition (T
Note 3 - Revenue Recognition (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Disaggregation of Revenue [Table Text Block] | Three Months Ended March 31, 2024 2023 (in thousands) U.S. Instruments and accessories $ 51 $ 60 Services 87 75 Leases 68 71 Total U.S. revenue 206 206 Outside of U.S. ("OUS") Instruments and accessories 262 233 Services 198 120 Leases 457 417 Total OUS revenue 917 770 Total Instruments and accessories 313 293 Services 285 195 Leases 525 488 Total revenue $ 1,123 $ 976 |
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Table Text Block] | March 31, 2024 December 31, 2023 (in thousands) Contract assets $ 74 $ 95 Deferred revenue $ 769 $ 711 |
Note 4 - Fair Value Measureme_2
Note 4 - Fair Value Measurements (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Fair Value, Assets Measured on Recurring Basis [Table Text Block] | March 31, 2024 Level 1 Level 2 Level 3 Total (in thousands) Assets: Cash and cash equivalents (1) $ 6,995 $ - $ - 6,995 Restricted cash 1,483 - - 1,483 Short-term investments - 994 - 994 Total assets $ 8,478 $ 994 $ - $ 9,472 Liabilities: Contingent consideration $ - $ - $ 8,700 $ 8,700 Warrant liabilities $ 3,772 $ 3,772 Total liabilities $ - $ - $ 12,472 $ 12,472 December 31, 2023 Level 1 Level 2 Level 3 Total (in thousands) Assets: Cash and cash equivalents (1) $ 17,096 $ - $ - $ 17,096 Restricted cash 1,642 - - 1,642 Short-term investments - 3,971 - 3,971 Total assets $ 18,738 $ 3,971 $ - $ 22,709 Liabilities: Contingent consideration $ - $ - $ 2,220 $ 2,220 Warrant liabilities - - 5,888 5,888 Total liabilities $ - $ - $ 8,108 $ 8,108 |
Fair Value, Liabilities Measured on Recurring Basis [Table Text Block] | Fair value (in thousands) Balance at December 31, 2023 $ 5,888 Change in estimated fair value (2,116 ) Balance at March 31, 2024 $ 3,772 |
Fair Value Measurement Inputs and Valuation Techniques [Table Text Block] | As of March 31, 2024 As of December 31, 2023 Expected volatility 116% 117% Risk-free interest rate 4.2% 3.8% Expected life (in years) 4.3 4.6 Expected dividend yield 0.0% 0.0% Valuation Methodology Significant Unobservable Inputs March 31, 2024 December 31, 2023 Contingent consideration Probability weighted income approach Milestone date 2032 2032 Revenue discount rate 10.0% 10.0% Revenue volatility 32.5% 35.0% EUR-to-USD exchange rate 1.08 1.10 Probability of occurrence 50.0% - |
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Table Text Block] | Fair value (in thousands) Balance at December 31, 2022 $ 1,256 Change in estimated fair value 105 Balance at March 31, 2023 $ 1,361 Balance at December 31, 2023 $ 2,220 Change in estimated fair value 6,480 Balance at March 31, 2024 $ 8,700 |
Note 5 - Investments, Availab_2
Note 5 - Investments, Available-for-sale (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Debt Securities, Available-for-Sale [Table Text Block] | March 31, 2024 Balance Sheet Classification Amortized Cost Unrealized Gain Unrealized Loss Fair Value Short-term investments (in thousands) Corporate bonds $ 995 $ - $ (1 ) $ 994 $ 994 Total investments $ 995 $ - $ (1 ) $ 994 $ 994 December 31, 2023 Balance Sheet Classification Amortized Cost Unrealized Gain Unrealized Loss Fair Value Short-term investments (in thousands) Corporate bonds $ 3,981 $ - $ (10 ) $ 3,971 $ 3,971 Total investments $ 3,981 $ - $ (10 ) $ 3,971 $ 3,971 |
Note 6 - Inventories (Tables)
Note 6 - Inventories (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Inventory, Current [Table Text Block] | March 31, 2024 December 31, 2023 (in thousands) Finished goods $ 7,422 $ 9,200 Raw materials 2,490 2,015 Total inventories $ 9,912 $ 11,215 Current portion $ 5,958 $ 7,172 Long-term portion 3,954 4,043 Total inventories $ 9,912 $ 11,215 |
Note 7 - Intellectual Property
Note 7 - Intellectual Property (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Finite-Lived Intangible Assets [Table Text Block] | March 31, 2024 Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount (in thousands) Developed technology $ 68,838 $ (66,988 ) $ (861 ) $ 989 Technology and patents purchased 400 (289 ) 14 125 Total intellectual property $ 69,238 $ (67,277 ) $ (847 ) $ 1,114 December 31, 2023 Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount (in thousands) Developed technology $ 68,838 $ (66,902 ) $ (837 ) $ 1,099 Technology and patents purchased 400 (279 ) 17 138 Total intellectual property $ 69,238 $ (67,181 ) $ (820 ) $ 1,237 |
Note 8 - Leases (Tables)
Note 8 - Leases (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Lease, Cost [Table Text Block] | Three Months Ended March 31, 2024 2023 (in thousands) Long-term operating $ 453 $ 451 |
Lessee, Operating Lease, Disclosure [Table Text Block] | March 31, 2024 December 31, 2023 Weighted-average remaining lease term (in years) 5.5 5.7 Weighted-average discount rate 9.1% 9.2% Incremental borrowing rate 7.1% - 23.0% 7.1% - 23.0% |
Lessee, Operating Lease, Liability, to be Paid, Maturity [Table Text Block] | Fiscal Year Remainder of 2024 1,144 2025 1,386 2026 1,051 2027 1,003 2028 827 2029 and thereafter 1,406 Total minimum lease payments $ 6,817 Less: Amount of lease payments representing interest (1,361 ) Present value of future minimum lease payments $ 5,456 |
Note 9 - Accrued Expenses and_2
Note 9 - Accrued Expenses and Other Current Liabilities (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Accrued Liabilities [Table Text Block] | March 31, 2024 December 31, 2023 (in thousands) Consulting and other vendors $ 145 $ 461 Royalties 50 9 Legal and professional fees 132 411 Taxes and other assessments 916 755 Total accrued expenses and other current liabilities $ 1,243 $ 1,636 |
Note 11 - Stock-based Compens_2
Note 11 - Stock-based Compensation (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
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, 2023 10,444,679 $ 3.20 4.80 Granted 5,552,790 0.26 Cancelled (36,406 ) 10.24 Outstanding at March 31, 2024 15,961,063 $ 2.16 5.37 $ - Vested or expected to vest at March 31, 2024 14,795,731 $ 2.30 5.27 $ - Exercisable at March 31, 2024 7,862,867 $ 3.97 4.25 $ - |
Schedule of Share-Based Payment Award, Stock Options, Valuation Assumptions [Table Text Block] | Three Months Ended March 31, 2024 2023 Expected volatility 126% - 127% 124% - 126% Risk-free interest rate 4.06% - 4.07% 3.73% - 4.14% Expected life (in years) 4.3 - 4.5 4.3 - 4.5 Expected dividend yield 0% 0% Weighted average grant date fair value $0.22 $0.60 |
Share-Based Payment Arrangement, Restricted Stock Unit, Activity [Table Text Block] | Number of Shares Weighted-Average Grant Date Fair Value Unvested at December 31, 2023 12,326,177 $ 0.81 Granted 14,647,450 $ 0.26 Vested (4,655,843 ) $ 0.97 Forfeited (1,358,970 ) $ 0.67 Unvested at March 31, 2024 20,958,814 $ 0.40 |
Share-Based Payment Arrangement, Cost by Plan [Table Text Block] | Three Months Ended March 31, 2024 2023 (in thousands) Stock options $ 425 $ 665 Restricted stock units 956 859 Performance restricted stock units 364 392 $ 1,745 $ 1,916 |
Note 12 - Shareholders' Equity
Note 12 - Shareholders' Equity (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Common Stock Outstanding Roll Forward [Table Text Block] | Three Months Ended March 31, 2024 Shares of common stock issued 3,051,837 Average price per share $ 0.33 Gross proceeds $ 1,009 Commission paid to agents $ (30 ) Net proceeds $ 979 |
Note 13 - Basic and Diluted N_2
Note 13 - Basic and Diluted Net Loss Per Share (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share [Table Text Block] | March 31, 2024 2023 Stock options 15,961,063 10,319,169 Nonvested restricted stock units 20,958,814 12,657,094 Stock warrants 24,830,500 1,021,076 Total 61,750,377 23,997,339 |
Note 14 - Commitments and Con_2
Note 14 - Commitments and Contingencies (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Contractual Obligation, Fiscal Year Maturity [Table Text Block] | Fiscal Year 2025 $ 300 2026 300 Total commitments $ 600 |
Note 15 - Segments and Geogra_2
Note 15 - Segments and Geographic Areas (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Notes Tables | |
Long-Lived Assets by Geographic Areas [Table Text Block] | March 31, 2024 December 31, 2023 U.S. 28 % 29 % EMEA 70 % 68 % Asia 2 % 3 % Total 100 % 100 % |
Revenue from External Customers by Geographic Areas [Table Text Block] | Three Months Ended March 31, 2024 2023 US 18 % 21 % EMEA 66 % 58 % Asia 16 % 21 % Total 100 % 100 % |
Note 2 - Summary of Significa_2
Note 2 - Summary of Significant Accounting Policies (Details Textual) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Retained Earnings (Accumulated Deficit) | $ (961,865) | $ (939,368) |
Note 3 - Revenue Recognition 1
Note 3 - Revenue Recognition 1 (Details Textual) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | ||
Mar. 31, 2024 | Mar. 31, 2023 | Dec. 31, 2023 | Dec. 31, 2022 | |
Contract with Customer, Liability, Revenue Recognized | $ 200 | $ 200 | ||
Contract with Customer, Liability | 769 | $ 711 | $ 500 | |
Accounts Receivable, Allowance for Credit Loss | $ 1,600 | $ 1,600 | ||
Accounts Receivable [Member] | Customer Concentration Risk [Member] | ||||
Number of Major Customers | 3 | 1 | ||
Accounts Receivable [Member] | Customer Concentration Risk [Member] | Customer One [Member] | ||||
Concentration Risk, Percentage | 0.23% | |||
Accounts Receivable [Member] | Customer Concentration Risk [Member] | Customer Two [Member] | ||||
Concentration Risk, Percentage | 0.15% | |||
Accounts Receivable [Member] | Customer Concentration Risk [Member] | Customer Three [Member] | ||||
Concentration Risk, Percentage | 0.12% | |||
Accounts Receivable [Member] | Customer Concentration Risk [Member] | One Customer [Member] | ||||
Concentration Risk, Percentage | 0.83% |
Note 3 - Revenue Recognition 2
Note 3 - Revenue Recognition 2 (Details Textual) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01 $ in Millions | Mar. 31, 2024 USD ($) |
Revenue, Remaining Performance Obligation, Amount | $ 0.8 |
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 | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Revenue | $ 1,123 | $ 976 |
UNITED STATES | ||
Revenue | 206 | 206 |
Non-US [Member] | ||
Revenue | 917 | 770 |
Instruments and Accessories [Member] | ||
Revenue | 313 | 293 |
Instruments and Accessories [Member] | UNITED STATES | ||
Revenue | 51 | 60 |
Instruments and Accessories [Member] | Non-US [Member] | ||
Revenue | 262 | 233 |
Service [Member] | ||
Revenue | 285 | 195 |
Service [Member] | UNITED STATES | ||
Revenue | 87 | 75 |
Service [Member] | Non-US [Member] | ||
Revenue | 198 | 120 |
Lease [Member] | ||
Revenue | 525 | 488 |
Lease [Member] | UNITED STATES | ||
Revenue | 68 | 71 |
Lease [Member] | Non-US [Member] | ||
Revenue | $ 457 | $ 417 |
Note 3 - Revenue Recognition _2
Note 3 - Revenue Recognition - Contract Assets and Liabilities (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 | Dec. 31, 2022 |
Contract assets | $ 74 | $ 95 | |
Deferred revenue | $ 769 | $ 711 | $ 500 |
Note 4 - Fair Value Measureme_3
Note 4 - Fair Value Measurements (Details Textual) - Senhance Surgical Robotic System Acquisition[Member] € in Millions | 3 Months Ended |
Mar. 31, 2024 EUR (€) | |
Business Combination, Contingent Consideration Arrangements, Assumed Percentage Probability | 50% |
Minimum [Member] | |
Business Combination Contingent Consideration Arrangements Target Revenue | € 25 |
Note 4 - Fair Value Measureme_4
Note 4 - Fair Value Measurements - Summary of Assets and Liabilities Measured at Fair Value on Recurring Basis (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 | |
Cash and cash equivalents (1) | [1] | $ 6,995 | $ 17,096 |
Restricted cash | 1,483 | 1,642 | |
Short-term investments | 994 | 3,971 | |
Total assets | 9,472 | 22,709 | |
Contingent consideration | 8,700 | 2,220 | |
Warrant liabilities | 3,772 | 5,888 | |
Total liabilities | 12,472 | 8,108 | |
Fair Value, Inputs, Level 1 [Member] | |||
Cash and cash equivalents (1) | [1] | 6,995 | 17,096 |
Restricted cash | 1,483 | 1,642 | |
Short-term investments | 0 | 0 | |
Total assets | 8,478 | 18,738 | |
Contingent consideration | 0 | 0 | |
Warrant liabilities | 0 | ||
Total liabilities | 0 | 0 | |
Fair Value, Inputs, Level 2 [Member] | |||
Cash and cash equivalents (1) | [1] | 0 | 0 |
Restricted cash | 0 | 0 | |
Short-term investments | 994 | 3,971 | |
Total assets | 994 | 3,971 | |
Contingent consideration | 0 | 0 | |
Warrant liabilities | 0 | ||
Total liabilities | 0 | 0 | |
Fair Value, Inputs, Level 3 [Member] | |||
Cash and cash equivalents (1) | [1] | 0 | 0 |
Restricted cash | 0 | 0 | |
Short-term investments | 0 | 0 | |
Total assets | 0 | 0 | |
Contingent consideration | 8,700 | 2,220 | |
Warrant liabilities | 3,772 | 5,888 | |
Total liabilities | $ 12,472 | $ 8,108 | |
[1]Includes investments that are readily convertible to cash with original maturities of 90 days or less. |
Note 4 - Fair Value Measureme_5
Note 4 - Fair Value Measurements - Summary of Change in Fair Value for Warrants (Details) - Warrant [Member] $ in Thousands | 3 Months Ended |
Mar. 31, 2024 USD ($) | |
Balance at December 31, 2023 | $ 5,888 |
Change in estimated fair value | (2,116) |
Balance at March 31, 2024 | $ 3,772 |
Note 4 - Fair Value Measureme_6
Note 4 - Fair Value Measurements - Quantitative Information about Inputs and Valuation Methodologies - Warrants (Details) | Mar. 31, 2024 | Dec. 31, 2023 |
Measurement Input, Price Volatility [Member] | Senhance Surgical Robotic System Acquisition[Member] | Fair Value, Inputs, Level 3 [Member] | ||
Measurement Input | 0.325 | 0.35 |
Measurement Input, Price Volatility [Member] | Warrant [Member] | ||
Measurement Input | 1.16 | 1.17 |
Measurement Input, Risk Free Interest Rate [Member] | Warrant [Member] | ||
Measurement Input | 0.042 | 0.038 |
Measurement Input, Discount Rate [Member] | Senhance Surgical Robotic System Acquisition[Member] | Fair Value, Inputs, Level 3 [Member] | ||
Measurement Input | 0.10 | 0.10 |
Measurement Input, Expected Term [Member] | Warrant [Member] | ||
Measurement Input | 4.3 | 4.6 |
Measurement Input, Currency Exchange Rate [Member] | Senhance Surgical Robotic System Acquisition[Member] | Fair Value, Inputs, Level 3 [Member] | ||
Measurement Input | 1.08 | 1.1 |
Measurement Input, Expected Dividend Rate [Member] | Warrant [Member] | ||
Measurement Input | 0 | 0 |
Measurement Input, Probability Rate [Member] | Senhance Surgical Robotic System Acquisition[Member] | Fair Value, Inputs, Level 3 [Member] | ||
Measurement Input | 0.50 |
Note 4 - Fair Value Measureme_7
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 | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Balance at December 31, 2023 | $ 2,220 | $ 1,256 |
Change in estimated fair value | 6,480 | 105 |
Balance at March 31, 2024 | $ 8,700 | $ 1,361 |
Note 5 - Investments, Availab_3
Note 5 - Investments, Available-for-sale (Details Textual) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Debt Securities, Available-for-Sale, Realized Gain (Loss) | $ 0 | $ 0 |
Proceeds from Sale of Debt Securities, Available-for-Sale | $ 0 | $ 0 |
Note 5 - Investments, Availab_4
Note 5 - Investments, Available-for-sale - Summary of Investment Securities (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Amortized Cost | $ 995 | $ 3,981 |
Unrealized Gain | 0 | 0 |
Unrealized Loss | (1) | (10) |
Fair Value | 994 | 3,971 |
Short-term investments | 994 | 3,971 |
Corporate Debt Securities [Member] | ||
Amortized Cost | 995 | 3,981 |
Unrealized Gain | 0 | 0 |
Unrealized Loss | (1) | (10) |
Fair Value | 994 | 3,971 |
Short-term investments | $ 994 | $ 3,971 |
Note 6 - Inventories - Componen
Note 6 - Inventories - Components of Inventories (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Finished goods, gross | $ 7,422 | $ 9,200 |
Raw materials, gross | 2,490 | 2,015 |
Total inventories, gross | 9,912 | 11,215 |
Current Portion, gross | 5,958 | 7,172 |
Long-term portion, gross | $ 3,954 | $ 4,043 |
Note 7 - Intellectual Propert_2
Note 7 - Intellectual Property - Intellectual Property (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Finite-Lived Intangible Assets, Gross | $ 69,238 | $ 69,238 |
Finite-Lived Intangible Assets, Accumulated Amortization | (67,277) | (67,181) |
Finite-Lived Intangible Assets, Foreign Currency Translation Impact | (847) | (820) |
Intellectual property, net | 1,114 | 1,237 |
Developed Technology Rights [Member] | ||
Finite-Lived Intangible Assets, Gross | 68,838 | 68,838 |
Finite-Lived Intangible Assets, Accumulated Amortization | (66,988) | (66,902) |
Finite-Lived Intangible Assets, Foreign Currency Translation Impact | (861) | (837) |
Intellectual property, net | 989 | 1,099 |
Technology-Based Intangible Assets [Member] | ||
Finite-Lived Intangible Assets, Gross | 400 | 400 |
Finite-Lived Intangible Assets, Accumulated Amortization | (289) | (279) |
Finite-Lived Intangible Assets, Foreign Currency Translation Impact | 14 | 17 |
Intellectual property, net | $ 125 | $ 138 |
Note 8 - Leases - Components of
Note 8 - Leases - Components of Operating Lease Expense (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
General and Administrative Expense [Member] | ||
Long-term Operating | $ 453 | $ 451 |
Note 8 - Leases -Supplemental B
Note 8 - Leases -Supplemental Balance Sheet Information (Details) | Mar. 31, 2024 | Dec. 31, 2023 |
Weighted-average remaining lease term (in years) (Year) | 5 years 6 months | 5 years 8 months 12 days |
Weighted-average discount rate | 9.10% | 9.20% |
Minimum [Member] | ||
Incremental borrowing rate | 7.10% | 7.10% |
Maximum [Member] | ||
Incremental borrowing rate | 23% | 23% |
Note 8 - Leases - Minimum Lease
Note 8 - Leases - Minimum Lease Payments (Details) $ in Thousands | Mar. 31, 2024 USD ($) |
2024 | $ 1,144 |
2025 | 1,386 |
2026 | 1,051 |
2027 | 1,003 |
2028 | 827 |
Thereafter | 1,406 |
Total minimum lease payments | 6,817 |
Less: Amount of lease payments representing interest | (1,361) |
Present value of future minimum lease payments | $ 5,456 |
Note 9 - Accrued Expenses and_3
Note 9 - Accrued Expenses and Other Current Liabilities - Components of Accrued Expenses (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Consulting and other vendors | $ 145 | $ 461 |
Royalties | 50 | 9 |
Legal and professional fees | 132 | 411 |
Taxes and other assessments | 916 | 755 |
Total | $ 1,243 | $ 1,636 |
Note 10 - Income Taxes (Details
Note 10 - Income Taxes (Details Textual) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | Dec. 31, 2024 | |
Effective Income Tax Rate Reconciliation, Percent | (0.20%) | (0.40%) | |
Income Tax Expense (Benefit) | $ 46 | $ 91 | |
Unrecognized Tax Benefits, Income Tax Penalties and Interest Accrued | 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 | 1 Months Ended | 3 Months Ended | |
Jun. 06, 2023 | Feb. 28, 2024 | Mar. 31, 2024 | |
Performance Restricted Stock Unit [Member] | Granted in 2023 [Member] | |||
Share-Based Compensation Arrangement by Share-Based Payment Award, Percentage of Operation Targets Achieved | 50% | ||
Share-Based Compensation Arrangement by Share-Based Payment Award, Percentage of Operation, Earned | 50% | ||
Share-Based Compensation Arrangement by Share-Based Payment Award, Award Vesting Period | 3 years | ||
Share-Based Compensation Arrangement by Share-Based Payment Award, Percentage of Award Forfeited | 50% | ||
Share-Based Payment Arrangement, Option [Member] | |||
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount | $ 2.4 | ||
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year) | 2 years 3 months 18 days | ||
Restricted Stock Units (RSUs) [Member] | |||
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount | $ 6.8 | ||
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year) | 1 year 9 months 18 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) | 54,072,307 |
Note 11 - Stock-based Compens_4
Note 11 - Stock-based Compensation - Stock Option Activity (Details) - USD ($) | 3 Months Ended | 12 Months Ended |
Mar. 31, 2024 | Dec. 31, 2023 | |
Options, Outstanding, Number of Shares (in shares) | 10,444,679 | |
Options, Outstanding, Weighted Average Exercise Price (in dollars per share) | $ 3.2 | |
Options, Outstanding, Weighted Average Remaining Contractual Term (Year) | 5 years 4 months 13 days | 4 years 9 months 18 days |
Options, Granted, Number of Shares (in shares) | 5,552,790 | |
Options, Grants in Period, Weighted Average Exercise Price (in dollars per share) | $ 0.26 | |
Options, Cancelled, Number of Shares (in shares) | (36,406) | |
Options, Expirations in Period, Weighted Average Exercise Price (in dollars per share) | $ 10.24 | |
Outstanding at March 31, 2024 (in shares) | 15,961,063 | 10,444,679 |
Outstanding at March 31, 2024 (in dollars per share) | $ 2.16 | $ 3.2 |
Outstanding at March 31, 2024 | $ 0 | |
Vested or expected to vest at March 31, 2024 (in shares) | 14,795,731 | |
Vested or expected to vest at March 31, 2024 (in dollars per share) | $ 2.3 | |
Vested or expected to vest at March 31, 2024 (Year) | 5 years 3 months 7 days | |
Vested or expected to vest at March 31, 2024 | $ 0 | |
Exercisable at March 31, 2024 (in shares) | 7,862,867 | |
Exercisable at March 31, 2024 (in dollars per share) | $ 3.97 | |
Exercisable at March 31, 2024 (Year) | 4 years 3 months | |
Exercisable at March 31, 2024 | $ 0 |
Note 11 - Stock-based Compens_5
Note 11 - Stock-based Compensation - Stock Option Valuation Assumptions (Details) - $ / shares | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Expected dividend yield | 0% | 0% |
Weighted average grant date fair value (in dollars per share) | $ 0.22 | $ 0.6 |
Minimum [Member] | ||
Expected volatility | 126% | 124% |
Risk-free interest rate | 4.06% | 3.73% |
Maximum [Member] | ||
Expected volatility | 127% | 126% |
Risk-free interest rate | 4.07% | 4.14% |
Note 11 - Stock-based Compens_6
Note 11 - Stock-based Compensation - RSU Activity (Details) - Restricted Stock Units (RSUs) [Member] | 3 Months Ended |
Mar. 31, 2024 $ / shares shares | |
Beginning of period, Restricted stock units, Unvested (in shares) | shares | 12,326,177 |
Beginning of period, Restricted stock units, Unvested, weighted average grant date fair value (in dollars per share) | $ / shares | $ 0.81 |
Restricted stock units, Granted (in shares) | shares | 14,647,450 |
Restricted stock units, Granted, weighted average grant date fair value (in dollars per share) | $ / shares | $ 0.26 |
Restricted stock units, Vested (in shares) | shares | (4,655,843) |
Restricted stock units, Vested, weighted average grant date fair value (in dollars per share) | $ / shares | $ 0.97 |
Restricted stock units, Forfeited (in shares) | shares | (1,358,970) |
Restricted stock units, Forfeited, weighted average grant date fair value (in dollars per share) | $ / shares | $ 0.67 |
Unvested (in shares) | shares | 20,958,814 |
Unvested December 31, 2022 (in dollars per share) | $ / shares | $ 0.4 |
Note 11 - Stock-based Compens_7
Note 11 - Stock-based Compensation - Non-cash Share-based Compensation Expense (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Share-based compensation | $ 1,745 | $ 1,916 |
Share-Based Payment Arrangement, Option [Member] | ||
Share-based compensation | 425 | 665 |
Restricted Stock Units (RSUs) [Member] | ||
Share-based compensation | 956 | 859 |
Performance Restricted Stock Unit [Member] | ||
Share-based compensation | $ 364 | $ 392 |
Note 12 - Shareholders' Equit_2
Note 12 - Shareholders' Equity (Details Textual) - The 2022 ATM Offering [Member] $ in Billions | Mar. 18, 2022 USD ($) |
Stock Offering Agreement, Maximum Share Value | $ 0.1 |
Stock Offering Agreement, Commission, Percent | 3% |
Note 12 - Shareholders' Equit_3
Note 12 - Shareholders' Equity - Summary of Sales Under Offering (Details) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Net proceeds | $ 982 | $ 0 |
The 2022 ATM Offering [Member] | ||
Shares of common stock issued (in shares) | 3,051,837 | |
Gross proceeds | $ 1,009 | |
Commission paid to agents | (30) | |
Net proceeds | $ 979 | |
The 2022 ATM Offering [Member] | Arithmetic Average [Member] | ||
Average price per share (in dollars per share) | $ 0.33 |
Note 13 - Basic and Diluted N_3
Note 13 - Basic and Diluted Net Loss Per Share (Details Textual) - shares shares in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Weighted Average Number of Shares Outstanding, Diluted, Adjustment | 0 | 0 |
Note 13 - Basic and Diluted N_4
Note 13 - Basic and Diluted Net Loss Per Share - Antidilutive Securities Excluded from Computation of Earnings Per Share (Details) - shares | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares) | 61,750,377 | 23,997,339 |
Share-Based Payment Arrangement, Option [Member] | ||
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares) | 15,961,063 | 10,319,169 |
Restricted Stock Units (RSUs) [Member] | ||
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares) | 20,958,814 | 12,657,094 |
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] - Senhance Surgical Robotic System Acquisition[Member] $ in Millions | Mar. 31, 2024 USD ($) |
2025 | $ 0.3 |
2026 | 0.3 |
Total commitments | $ 0.6 |
Note 15 - Segments and Geogra_3
Note 15 - Segments and Geographic Areas (Details Textual) | 3 Months Ended | 12 Months Ended |
Mar. 31, 2024 | Dec. 31, 2023 | |
Number of Operating Segments | 1 | |
Revenue Benchmark [Member] | Customer Concentration Risk [Member] | ||
Number of Major Customers | 0 | 2 |
Revenue Benchmark [Member] | Customer Concentration Risk [Member] | Customer One [Member] | ||
Concentration Risk, Percentage | 13% | |
Revenue Benchmark [Member] | Customer Concentration Risk [Member] | Customer Two [Member] | ||
Concentration Risk, Percentage | 11% |
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] - Assets, Total [Member] | 3 Months Ended | 12 Months Ended |
Mar. 31, 2024 | Dec. 31, 2023 | |
UNITED STATES | ||
Percentage | 28% | 29% |
Europe, Middle East, and Africa [Member] | ||
Percentage | 70% | 68% |
Asia [Member] | ||
Percentage | 2% | 3% |
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 | |
Mar. 31, 2024 | Mar. 31, 2023 | |
UNITED STATES | ||
Percentage | 18% | 21% |
EMEA [Member] | ||
Percentage | 66% | 58% |
Asia [Member] | ||
Percentage | 16% | 21% |
All Countries [Member] | ||
Percentage | 100% | 100% |
Note 16 - Related Party Trans_2
Note 16 - Related Party Transactions (Details Textual) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Asensus Surgical Europe S.à.R.L [Member] | 1 Med S.A. [Member] | Service Supply Agreement [Member] | ||
Operating Costs and Expenses | $ 0 | $ 20 |
Note 17 - Subsequent Events (De
Note 17 - Subsequent Events (Details Textual) - USD ($) $ / shares in Units, $ in Millions | 3 Months Ended | ||
Apr. 03, 2024 | Mar. 31, 2024 | Mar. 28, 2024 | |
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration] | us-gaap:SecuredOvernightFinancingRateSofrMember | ||
Subsequent Event [Member] | KARL STORZ [Member] | |||
Debt Instrument, Exclusivity Period Extended, Funding Per Week | $ 1 | ||
Debt Instrument, Merger Approved, Option Amount | $ 5 | ||
Debt Instrument, Basis Spread on Variable Rate | 10% | ||
Subsequent Event [Member] | KARL STORZ [Member] | Maximum [Member] | |||
Debt Instrument, Face Amount | $ 20 | ||
KARL STORZ [Member] | Asensus Surgical [Member] | |||
Business Acquisition, Percentage of Voting Interests Acquired | 100% | ||
Business Acquisition, Share Price | $ 0.35 |