Asensus Surgical (TRXDW) 10-Q 13 Aug 24 2024 Q2 Quarterly report Financial data

Document And Entity Information

Document And Entity Information - shares	6 Months Ended
	Jun. 30, 2024	Aug. 06, 2024
Document Information [Line Items]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 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)		272,842,574
Entity Central Index Key	0000876378
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q2
Amendment Flag	false

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Revenue:
Revenue	$ 2,207	$ 1,081	$ 3,330	$ 2,057
Cost of revenue:
Cost of revenue	2,659	3,074	5,715	6,021
Gross loss	(452)	(1,993)	(2,385)	(3,964)
Operating Expenses:
Research and development	7,631	8,980	15,722	19,119
Sales and marketing	3,655	4,449	7,297	9,002
General and administrative	5,994	5,124	10,368	10,592
Amortization of intangible assets	110	114	224	226
Change in fair value of contingent consideration	5,700	203	12,180	308
Total operating expenses	23,090	18,870	45,791	39,247
Operating loss	(23,542)	(20,863)	(48,176)	(43,211)
Other (expenses) income, net
Change in fair value of warrant liabilities	(1,825)	0	291	0
Interest income	66	431	192	870
Interest expense	(321)	0	(321)	0
Other expense, net	(52)	(242)	(111)	(460)
Total other (expense) income, net	(2,132)	189	51	410
Loss before income taxes	(25,674)	(20,674)	(48,125)	(42,801)
Income tax (expense) benefit	(75)	12	(121)	(79)
Net loss	$ (25,749)	$ (20,662)	$ (48,246)	$ (42,880)
Net loss per common share attributable to common stockholders - basic and diluted (in dollars per share)	$ (0.09)	$ (0.09)	$ (0.18)	$ (0.18)
Weighted average number of shares used in computing net loss per common share - basic and diluted (in shares)	272,316	239,570	270,791	238,929
Comprehensive loss:
Net loss	$ (25,749)	$ (20,662)	$ (48,246)	$ (42,880)
Foreign currency translation (loss) gain	(174)	175	(668)	725
Unrealized gain on available-for-sale investments	1	99	9	406
Comprehensive loss	(25,922)	(20,388)	(48,905)	(41,749)
Product [Member]
Revenue:
Revenue	1,396	298	1,709	591
Cost of revenue:
Cost of revenue	1,155	1,612	2,836	2,837
Service [Member]
Revenue:
Revenue	236	289	521	484
Cost of revenue:
Cost of revenue	695	519	1,147	1,268
Lease [Member]
Revenue:
Revenue	575	494	1,100	982
Cost of revenue:
Cost of revenue	$ 809	$ 943	$ 1,732	$ 1,916

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Current Assets:
Cash and cash equivalents	$ 7,782	$ 17,096
Short-term investments, available-for-sale	0	3,971
Accounts receivable, net	406	3,508
Inventories	7,160	7,172
Prepaid expenses	2,729	3,143
Other current assets	1,364	1,496
Total Current Assets	19,441	36,386
Restricted cash	1,517	1,642
Inventories, net of current portion	2,516	4,043
Property and equipment, net	8,034	8,959
Intellectual property, net	1,012	1,237
Net deferred tax assets	34	44
Operating lease right-of-use assets, net	4,688	5,165
Other long-term assets	1,260	1,610
Total Assets	38,502	59,086
Current Liabilities:
Accounts payable	2,057	4,145
Accrued employee compensation and benefits	3,977	5,390
Accrued expenses and other current liabilities	2,611	1,636
Contingent consideration, current	14,400	0
Operating lease liabilities, current	1,070	1,036
Deferred revenue	496	421
Notes payable	15,309	0
Total Current Liabilities	39,920	12,628
Long-Term Liabilities:
Deferred revenue - less current portion	258	290
Contingent consideration	0	2,220
Warrant liabilities	5,597	5,888
Noncurrent operating lease liabilities	4,054	4,646
Total Liabilities	49,829	25,672
Commitments and Contingencies
Stockholders' Equity:
Common stock $0.001 par value, 750,000,000 shares authorized at June 30, 2024 and December 31, 2023; 272,616,330 and 264,921,526 issued and outstanding at June 30, 2024 and December 31, 2023, respectively	273	265
Preferred stock, $0.01 par value, 25,000,000 shares authorized, no shares issued and outstanding at June 30, 2024 and December 31, 2023	0	0
Additional paid-in capital	977,285	973,129
Accumulated deficit	(987,614)	(939,368)
Accumulated other comprehensive loss	(1,271)	(612)
Total Stockholders' Equity	(11,327)	33,414
Total Liabilities and Stockholders' Equity	38,502	59,086
Intellectual Property [Member]
Current Assets:
Intellectual property, net	$ 1,012	$ 1,237

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - $ / shares	Jun. 30, 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)	272,616,330	264,921,526
Common Stock, Shares, Issued (in shares)	272,616,330	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	$ 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)
Treasury Stock, Retired, Cost Method, Amount	0	(1)	0	0	0	1
Other comprehensive income	0	0	0	0	857	857
Net loss	$ 0	$ 0	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, 2022	236,895	0
Balance at Dec. 31, 2022	$ 237	$ 0	962,731	(860,935)	(2,388)	99,645
Net loss						(42,880)
Balance (in shares) at Jun. 30, 2023	239,970	0
Balance at Jun. 30, 2023	$ 240	$ 0	966,335	(903,815)	(1,257)	61,503
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
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	0
Issuance of common stock related to vesting of restricted stock units	$ 0	$ 0	0	0	0	0
Issuance of common stock, net of issuance costs (in shares)	355	0
Issuance of common stock, net of issuance costs	$ 1	$ 0	195	0	0	196
Other comprehensive income	0	0	0	0	274	274
Net loss	$ 0	$ 0	0	(20,662)	0	(20,662)
Exercise of stock options (in shares)	0	0
Exercise of stock options	$ 0	$ 0	0	0	0	0
Balance (in shares) at Jun. 30, 2023	239,970	0
Balance at Jun. 30, 2023	$ 240	$ 0	966,335	(903,815)	(1,257)	61,503
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)
Treasury Stock, Retired, Cost Method, Amount	$ 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
Balance (in shares) at Dec. 31, 2023	264,922	0
Balance at Dec. 31, 2023	$ 265	$ 0	973,129	(939,368)	(612)	33,414
Net loss						(48,246)
Balance (in shares) at Jun. 30, 2024	272,616	0
Balance at Jun. 30, 2024	$ 273	$ 0	977,285	(987,614)	(1,271)	(11,327)
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
Stock-based compensation	$ 0		1,528	0	0	1,528
Issuance of common stock related to vesting of restricted stock units (in shares)	630	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	163
Shares withheld related to net share settlement of equity awards	$ 0	$ 1	(43)	0	0	(42)
Cancellation of treasury stock (in shares)	0	(163)
Cancellation of treasury stock	$ 0	$ 1	0	0	0	(1)
Treasury Stock, Retired, Cost Method, Amount	0	$ (1)	0	0	0	1
Other comprehensive income	0			0	(173)	(173)
Net loss	$ 0			(25,749)	0	(25,749)
Refund of non-redeemed shares of non-accredited investors			85
Balance (in shares) at Jun. 30, 2024	272,616	0
Balance at Jun. 30, 2024	$ 273	$ 0	$ 977,285	$ (987,614)	$ (1,271)	$ (11,327)

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Cash Flows from Operating Activities:
Net loss	$ (48,246)	$ (42,880)
Adjustments to reconcile net loss to net cash and cash equivalents used in operating activities:
Depreciation	1,682	1,652
Amortization of intangible assets	224	226
Amortization (accretion) of discounts and premiums on investments, net	979	(298)
Stock-based compensation	3,273	3,894
Deferred tax expense	0	79
Bad debt expense	5	0
Change in inventory reserves	1,011	459
Change in fair value of warrant liabilities	(291)	0
Change in fair value of contingent consideration	12,180	308
Changes in operating assets and liabilities:
Accounts receivable	3,008	1,614
Inventories	(646)	(1,240)
Operating lease right-of-use assets	387	40
Prepaid expenses	391	409
Other current and long-term assets	350	340
Accounts payable	(2,040)	961
Accrued employee compensation and benefits	(1,319)	(577)
Accrued expenses and other current liabilities	912	(55)
Deferred revenue	62	(94)
Interest payable	309	0
Operating lease liabilities	(459)	(42)
Net cash and cash equivalents used in operating activities	(28,228)	(35,204)
Cash Flows from Investing Activities:
Purchase of available-for-sale investments	0	(12,268)
Proceeds from maturities of available-for-sale investments	3,000	48,735
Purchase of property and equipment	(111)	(166)
Net cash and cash equivalents provided by investing activities	2,889	36,301
Cash Flows from Financing Activities:
Proceeds from notes payable	15,000	0
Proceeds from issuance of common stock, net of issuance costs	982	196
Taxes paid related to net share settlement of vesting of restricted stock units	(176)	(490)
Proceeds from refund of non-redeemed shares of non-accredited investors	85	0
Proceeds from exercise of stock options	0	5
Net cash and cash equivalents provided by (used in) financing activities	15,891	(289)
Effect of exchange rate changes on cash and cash equivalents	9	751
Net (decrease) increase in cash, cash equivalents and restricted cash	(9,439)	1,559
Cash, cash equivalents and restricted cash, beginning of period	18,738	7,470
Cash, cash equivalents and restricted cash, end of period	9,299	9,029
Supplemental Disclosure for Cash Flow Information
Cash paid for leases	804	655
Cash paid for taxes	142	262
Supplemental Schedule of Non-cash Investing and Financing Activities:
Transfer of inventories to property and equipment	857	802
Lease liabilities arising from obtaining right-of-use assets	$ 112	$ 417

Note 1 - Description of Busines

Note 1 - Description of Business	6 Months Ended
	Jun. 30, 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	6 Months Ended
	Jun. 30, 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. Proposed Merger On June 6, 2024, the Company entered into an Agreement and Plan of Merger (the “Merger Agreement”), with KARL STORZ Endoscopy-America, Inc., a California corporation (“Parent”), and Karl Storz California Inc., a California corporation and a wholly owned subsidiary of Parent (“Merger Sub”). Pursuant to the terms of the Merger Agreement, Merger Sub will merge with and into the Company, with the Company continuing as the “surviving corporation” and becoming a wholly-owned subsidiary of Parent (the “Merger”). At the effective time of the Merger (the “Effective Time”), each share of common stock of the Company (the “Common Stock”) then outstanding will be converted into the right to receive $0.35 in cash, without interest, less any applicable withholding taxes (the “Merger Consideration”), other than those shares owned by Parent, Merger Sub or the Company (which will be cancelled without any consideration), and any shares of Common Stock as to which appraisal rights have been perfected (and not withdrawn or lost) in accordance with applicable law (which holder will be entitled to receive payment of the appraised value of such Common Stock held by him, her or it in accordance with Section 262 of the Delaware General Corporation Law). 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 $987.6 million as of June 30, 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 the proposed acquisition by Merger of the Company discussed below in Note 18 and, if that is not successful, a bankruptcy filing. The risk that the proposed Merger will not occur 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. Risks 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 obtain all necessary approvals to consummate the proposed Merger as described in Note 18; 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. In addition, the Company is subject to risks related to the proposed Merger described in Note 18, including, but not limited to the ability to meet expectations regarding the timing and completion of the Merger; the occurrence of any event, change or other circumstance that would give rise to the termination of the Merger Agreement; the fact that the Company’s stockholders may not approve the Merger Agreement and the Merger; the fact that certain terminations of the Merger Agreement require the Company to pay a termination fee of $3,600,000; the failure to satisfy each of the conditions to the consummation of the Merger; the disruption of management’s attention from ongoing business operations due to the Merger; the effect of the announcement or pendency of the Merger on the Company’s relationships with its customers, as well as its operating results and business generally; the outcome of any legal proceedings related to the Merger; retention of employees of the Company following the announcement of the Merger; the fact that the Company’s stock price may decline significantly if the Merger is not completed; the fact that the Company may be obligated to repay amounts advanced under the senior secured promissory note (the “Note”) issued to KARL STORZ SE & Co. KG (“KARL STORZ”) described in Note 11 under the circumstances described in the Note, whether the Company will be able to repay the Note if the Merger is not completed and the risk that if the Merger is not approved by stockholders, the Company expects to seek bankruptcy protection. 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	6 Months Ended
	Jun. 30, 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, Six Months Ended June 30, 2024 2023 2024 2023 (in thousands) U.S. Instruments and accessories $ 46 $ 38 97 98 Services 76 76 163 151 Leases 62 19 130 90 Total U.S. revenue 184 133 390 339 Outside of U.S. ("OUS") System 828 - 828 - Instruments and accessories 522 260 784 493 Services 160 213 358 333 Leases 513 475 970 892 Total OUS revenue 2,023 948 2,940 1,718 Total System 828 - 828 - Instruments and accessories 568 298 881 591 Services 236 289 521 484 Leases 575 494 1,100 982 Total revenue $ 2,207 $ 1,081 $ 3,330 $ 2,057 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 June 30, 2024 was $0.9 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 June 30, 2024 and 2023 that was included in the deferred revenue balance at the beginning of each reporting period was $0.1 million, which was included in the deferred revenue balance of $0.8 million and $0.5 million as of March 31, 2024 and 2023, respectively. Revenue recognized for the six months ended June 30, 2024 and 2023 that was included in the deferred revenue balance at the beginning of each reporting period was $0.3 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: June 30, 2024 December 31, 2023 (in thousands) Contract assets $ 70 $ 95 Deferred revenue $ 754 $ 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 and six months ended June 30, 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 June 30, 2024 and December 31, 2023. The Company recorded immaterial amounts for expected credit losses during the three and six months ended June 30, 2024 and 2023. The Company had three 26 13 11 one 83

Note 4 - Fair Value Measurement

Note 4 - Fair Value Measurements	6 Months Ended
	Jun. 30, 2024
Notes to Financial Statements
Fair Value Disclosures [Text Block]	4. Fair Value Measurements As of June 30, 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 June 30, 2024 and December 31, 2023, the Company’s assets and liabilities measured at fair value on a recurring basis were as follows: June 30, 2024 Level 1 Level 2 Level 3 Total (in thousands) Assets: Cash and cash equivalents (1) $ 7,782 $ - $ - 7,782 Restricted cash 1,517 - - 1,517 Total assets $ 9,299 $ - $ - $ 9,299 Liabilities: Contingent consideration $ - $ - $ 14,400 $ 14,400 Warrant liabilities - - $ 5,597 $ 5,597 Total liabilities $ - $ - $ 19,997 $ 19,997 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 June 30, 2024: Fair value (in thousands) Balance at December 31, 2023 $ 5,888 Change in estimated fair value (291 ) Balance at June 30, 2024 $ 5,597 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 June 30, 2024 As of December 31, 2023 Expected volatility 108% 117% Risk-free interest rate 4.4% 3.8% Expected life (in years) 4.1 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. On June 6, 2024, the Company entered into the Merger Agreement, with Parent and Merger Sub, to be acquired by way of a cash-out merger. If the Merger is consummated, 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 Merger, assuming a 90% probability that the Merger 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 Merger 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 six months ended June 30, 2024 and 2023: Fair value (in thousands) Balance at December 31, 2022 $ 1,256 Change in estimated fair value 308 Balance at June 30, 2023 $ 1,564 Balance at December 31, 2023 $ 2,220 Change in estimated fair value 12,180 Balance at June 30, 2024 $ 14,400 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 proposed Merger and a Monte-Carlo simulation method as of June 30, 2024 and a Monte-Carlo simulation method as of December 31, 2023: Valuation Methodology Significant Unobservable Inputs June 30, 2024 December 31, 2023 Contingent consideration Probability weighted income approach Milestone date 2032 2032 Revenue discount rate 10.5% 10.0% Revenue volatility 35.0% 35.0% EUR-to-USD exchange rate 1.07 1.10 Probability of occurrence 90.0% - During the six months ended June 30, 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	6 Months Ended
	Jun. 30, 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: 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 June 30, 2024, there were no no

Note 6 - Inventories

Note 6 - Inventories	6 Months Ended
	Jun. 30, 2024
Notes to Financial Statements
Inventory Disclosure [Text Block]	6. Inventories The components of inventory are as follows: June 30, 2024 December 31, 2023 (in thousands) Finished goods $ 7,156 $ 9,200 Raw materials 2,520 2,015 Total inventories $ 9,676 $ 11,215 Current portion $ 7,160 $ 7,172 Long-term portion 2,516 4,043 Total inventories $ 9,676 $ 11,215

Note 7 - Intellectual Property

Note 7 - Intellectual Property	6 Months Ended
	Jun. 30, 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: June 30, 2024 Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount (in thousands) Developed technology $ 68,838 $ (67,072 ) $ (868 ) $ 898 Technology and patents purchased 400 (289 ) 3 114 Total intellectual property $ 69,238 $ (67,361 ) $ (865 ) $ 1,012 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	6 Months Ended
	Jun. 30, 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 June 30, Six Months Ended June 30, 2024 2023 2024 2023 (in thousands) Long-term operating $ 476 $ 479 $ 929 $ 930 Supplemental balance sheet information related to finance and operating leases was as follows: June 30, 2024 December 31, 2023 Weighted-average remaining lease term (in years) 5.6 5.7 Weighted-average discount rate 9.0 % 9.2 % Incremental borrowing rate 7.1% - 23.0% 7.1% - 23.0% Maturities of finance and operating lease obligations as of June 30, 2024 were as follows (in thousands): Fiscal Year Remainder of 2024 690 2025 1,387 2026 1,060 2027 1,005 2028 825 2029 and thereafter 1,406 Total minimum lease payments $ 6,373 Less: Amount of lease payments representing interest (1,249 ) Present value of future minimum lease payments $ 5,124

Note 9 - Accrued Expenses and O

Note 9 - Accrued Expenses and Other Current Liabilities	6 Months Ended
	Jun. 30, 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: June 30, 2024 December 31, 2023 (in thousands) Consulting and other vendors $ 112 $ 461 Royalties 122 9 Legal and professional fees 1,392 411 Taxes and other assessments 985 755 Total accrued expenses and other current liabilities $ 2,611 $ 1,636

Note 10 - Income Taxes

Note 10 - Income Taxes	6 Months Ended
	Jun. 30, 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 ( 0.2 0.3 0.1 0.3 0.2 The Company incurred losses for the three and six months ended June 30, 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 (benefit) during the three months ended June 30, 2024 and 2023, was an expense of approximately $0.07 million and a benefit of $0.01 million, respectively. The total tax expense during the six months ended June 30, 2024 and 2023, was $0.1 million. At June 30, 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 - Notes Payable

Note 11 - Notes Payable	6 Months Ended
	Jun. 30, 2024
Notes to Financial Statements
Debt Disclosure [Text Block]	11. Notes Payable On April 3, 2024, the Company issued the Note in favor of KARL STORZ in the principal amount of up to $20 million. The Note has provided bridge funding for the Company as it pursued the potential transaction with KARL STORZ. 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. As of June 30, 2024, the Company received $15 million under the Note. The maturity date of the Note is the earliest of (i) the date that is thirty days after the Merger Agreement is terminated in connection with (A) any breach of the Merger Agreement by the Company, (B) a change of recommendation or failure to publicly reconfirm the Company Board’s recommendation in favor of the Merger under the Merger Agreement by the Company Board, or (C) the Company enters into an Alternative Acquisition Agreement (as defined in the Merger Agreement), (ii) the date that is sixty days after the Merger Agreement is terminated under any other circumstances not set forth in the preceding subclause (i), and (iii) October 30, 2024. The Note bears interest at a rate of SOFR The principal amount of the Note may be repaid, in whole but not in part, together with all accrued but unpaid interest, at the option of the Company. Otherwise, the principal amount, and any accrued but unpaid interest shall be due on the applicable maturity date. The Note also contains certain customary triggering events which would accelerate the payment of the Note. In the event the Note is prepaid prior to its maturity date, a triggering event occurs, or upon repayments upon maturity under clauses (i), (ii) or (iii) of the immediately preceding paragraph, a prepayment premium equal to five percent of the then outstanding principal under the Note shall apply, in addition to repayment of outstanding principal and accrued but unpaid interest owed thereunder. June 30, 2024 (in thousands) Principal $ 15,000 Accrued interest payable 309 Total $ 15,309

Note 12 - Stock-based Compensat

Note 12 - Stock-based Compensation	6 Months Ended
	Jun. 30, 2024
Notes to Financial Statements
Share-Based Payment Arrangement [Text Block]	12. 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 June 30, 2024, as well as activity, including grants to non-employees, for the six months ended June 30, 2024: Number of Shares Weighted- Average Exercise Price Weighted-Average Remaining Contractual Term (Years) Aggregate Intrinsic Value (thousands) Outstanding at December 31, 2023 10,444,679 $ 3.20 4.80 Granted 5,552,790 0.26 Cancelled (110,980 ) 15.61 Outstanding at June 30, 2024 15,886,489 $ 2.07 5.14 $ 389 Vested or expected to vest at June 30, 2024 14,894,960 $ 2.18 5.06 $ 334 Exercisable at June 30, 2024 7,919,713 $ 3.74 4.04 $ - The fair value of options granted were estimated using the Black-Scholes-Merton option pricing model based on the assumptions in the table below: Six Months Ended June 30, 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 % Restricted Stock Units The following table summarizes information about restricted stock units outstanding as of June 30, 2024, as well as activity, including performance restricted stock units, granted, vested and forfeited, for the six months ended June 30, 2024: Number of Shares Weighted-Average Grant Date Fair Value Unvested at December 31, 2023 12,326,177 $ 0.81 Granted 14,953,974 $ 0.26 Vested (5,455,413 ) $ 0.91 Forfeited (1,396,905 ) $ 0.66 Unvested at June 30, 2024 20,427,833 $ 0.39 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 and six months ended June 30, 2024 and 2023: Three Months Ended June 30, Six Months Ended June 30, 2024 2023 2024 2023 (in thousands) Stock options $ 341 $ 591 $ 766 $ 1,256 Restricted stock units 844 977 1,800 1,836 Performance restricted stock units 343 410 707 802 $ 1,528 $ 1,978 $ 3,273 $ 3,894 As of June 30, 2024, the unrecognized stock-based compensation expense related to stock options was approximately $2.1 million, which is expected to be recognized over a weighted average period of 2.1 years. As of June 30, 2024, the unrecognized stock-based compensation expense related to unvested restricted stock units and performance restricted stock units was approximately $5.6 million, which is expected to be recognized over a weighted average period of 1.7 years.

Note 13 - Equity Offering

Note 13 - Equity Offering	6 Months Ended
	Jun. 30, 2024
Notes to Financial Statements
Equity [Text Block]	13. Equity Offering 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): Six Months Ended 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 14 - Basic and Diluted Net

Note 14 - Basic and Diluted Net Loss Per Share	6 Months Ended
	Jun. 30, 2024
Notes to Financial Statements
Earnings Per Share [Text Block]	14. 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: June 30, 2024 2023 Stock options 15,886,489 10,602,414 Nonvested restricted stock units 20,427,833 12,938,688 Stock warrants 24,830,500 1,021,076 Total 61,144,822 24,562,178

Note 15 - Commitments and Conti

Note 15 - Commitments and Contingencies	6 Months Ended
	Jun. 30, 2024
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	15. 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 16 - Segments and Geograph

Note 16 - Segments and Geographic Areas	6 Months Ended
	Jun. 30, 2024
Notes to Financial Statements
Segment Reporting Disclosure [Text Block]	16. 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: June 30, 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 June 30, Six Months Ended June 30, 2024 2023 2024 2023 US 8 % 12 % 12 % 16 % EMEA 84 % 67 % 77 % 62 % Asia 8 % 21 % 11 % 22 % Total 100 % 100 % 100 % 100 % For the three months ended June 30, 2024, the Company had two one no

Note 17 - Related Party Transac

Note 17 - Related Party Transactions	6 Months Ended
	Jun. 30, 2024
Notes to Financial Statements
Related Party Transactions Disclosure [Text Block]	17. 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 18 - Subsequent Events

Note 18 - Subsequent Events	6 Months Ended
	Jun. 30, 2024
Notes to Financial Statements
Subsequent Events [Text Block]	18. Subsequent Events On July 5, 2024, the Company filed a definitive proxy statement and called for a special meeting of its stockholders (the “Special Meeting”) to be held on August 7, 2024, subject to adjournment, to seek stockholder approval of the Merger Agreement and Merger. Under the Delaware General Corporation Law, the approval of the Merger Agreement and Merger requires the affirmative vote of a majority of the issued and outstanding shares of the Company’s common stock as of the record date of June 28, 2024. The definitive proxy statement included a proposal to approve one or more adjournments of the Special Meeting to a later date or dates if necessary or appropriate to solicit additional proxies if there are insufficient votes to approve the Merger Agreement at the time of the Special Meeting. In July 2024, the Company received an additional $5 million in interim funding under the Note bringing the total to $20.0 million as it pursues approval of the Merger by its stockholders. The Special Meeting was adjourned on August 7, 2024 for thirteen days to August 20, 2024 in order to allow the Company to solicit additional proxies because there were insufficient votes to approve the Merger Agreement and the Merger proposal as of August 6, 2024.

Insider Trading Arrangements

Insider Trading Arrangements	6 Months Ended
	Jun. 30, 2024
Insider Trading Arr Line Items
Material Terms of Trading Arrangement [Text Block]	Other Information. During the three months ended June 30, 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)	6 Months Ended
	Jun. 30, 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.
Business Combinations Policy [Policy Text Block]	Proposed Merger On June 6, 2024, the Company entered into an Agreement and Plan of Merger (the “Merger Agreement”), with KARL STORZ Endoscopy-America, Inc., a California corporation (“Parent”), and Karl Storz California Inc., a California corporation and a wholly owned subsidiary of Parent (“Merger Sub”). Pursuant to the terms of the Merger Agreement, Merger Sub will merge with and into the Company, with the Company continuing as the “surviving corporation” and becoming a wholly-owned subsidiary of Parent (the “Merger”). At the effective time of the Merger (the “Effective Time”), each share of common stock of the Company (the “Common Stock”) then outstanding will be converted into the right to receive $0.35 in cash, without interest, less any applicable withholding taxes (the “Merger Consideration”), other than those shares owned by Parent, Merger Sub or the Company (which will be cancelled without any consideration), and any shares of Common Stock as to which appraisal rights have been perfected (and not withdrawn or lost) in accordance with applicable law (which holder will be entitled to receive payment of the appraised value of such Common Stock held by him, her or it in accordance with Section 262 of the Delaware General Corporation Law).
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 $987.6 million as of June 30, 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 the proposed acquisition by Merger of the Company discussed below in Note 18 and, if that is not successful, a bankruptcy filing. The risk that the proposed Merger will not occur 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]	Risks 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 obtain all necessary approvals to consummate the proposed Merger as described in Note 18; 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. In addition, the Company is subject to risks related to the proposed Merger described in Note 18, including, but not limited to the ability to meet expectations regarding the timing and completion of the Merger; the occurrence of any event, change or other circumstance that would give rise to the termination of the Merger Agreement; the fact that the Company’s stockholders may not approve the Merger Agreement and the Merger; the fact that certain terminations of the Merger Agreement require the Company to pay a termination fee of $3,600,000; the failure to satisfy each of the conditions to the consummation of the Merger; the disruption of management’s attention from ongoing business operations due to the Merger; the effect of the announcement or pendency of the Merger on the Company’s relationships with its customers, as well as its operating results and business generally; the outcome of any legal proceedings related to the Merger; retention of employees of the Company following the announcement of the Merger; the fact that the Company’s stock price may decline significantly if the Merger is not completed; the fact that the Company may be obligated to repay amounts advanced under the senior secured promissory note (the “Note”) issued to KARL STORZ SE & Co. KG (“KARL STORZ”) described in Note 11 under the circumstances described in the Note, whether the Company will be able to repay the Note if the Merger is not completed and the risk that if the Merger is not approved by stockholders, the Company expects to seek bankruptcy protection.
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)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Disaggregation of Revenue [Table Text Block]	Three Months Ended March 31, Six Months Ended June 30, 2024 2023 2024 2023 (in thousands) U.S. Instruments and accessories $ 46 $ 38 97 98 Services 76 76 163 151 Leases 62 19 130 90 Total U.S. revenue 184 133 390 339 Outside of U.S. ("OUS") System 828 - 828 - Instruments and accessories 522 260 784 493 Services 160 213 358 333 Leases 513 475 970 892 Total OUS revenue 2,023 948 2,940 1,718 Total System 828 - 828 - Instruments and accessories 568 298 881 591 Services 236 289 521 484 Leases 575 494 1,100 982 Total revenue $ 2,207 $ 1,081 $ 3,330 $ 2,057
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Table Text Block]	June 30, 2024 December 31, 2023 (in thousands) Contract assets $ 70 $ 95 Deferred revenue $ 754 $ 711

Note 4 - Fair Value Measureme_2

Note 4 - Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Fair Value, Assets Measured on Recurring Basis [Table Text Block]	June 30, 2024 Level 1 Level 2 Level 3 Total (in thousands) Assets: Cash and cash equivalents (1) $ 7,782 $ - $ - 7,782 Restricted cash 1,517 - - 1,517 Total assets $ 9,299 $ - $ - $ 9,299 Liabilities: Contingent consideration $ - $ - $ 14,400 $ 14,400 Warrant liabilities - - $ 5,597 $ 5,597 Total liabilities $ - $ - $ 19,997 $ 19,997 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 (291 ) Balance at June 30, 2024 $ 5,597
Fair Value Measurement Inputs and Valuation Techniques [Table Text Block]	As of June 30, 2024 As of December 31, 2023 Expected volatility 108% 117% Risk-free interest rate 4.4% 3.8% Expected life (in years) 4.1 4.6 Expected dividend yield 0.0% 0.0% Valuation Methodology Significant Unobservable Inputs June 30, 2024 December 31, 2023 Contingent consideration Probability weighted income approach Milestone date 2032 2032 Revenue discount rate 10.5% 10.0% Revenue volatility 35.0% 35.0% EUR-to-USD exchange rate 1.07 1.10 Probability of occurrence 90.0% -
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 308 Balance at June 30, 2023 $ 1,564 Balance at December 31, 2023 $ 2,220 Change in estimated fair value 12,180 Balance at June 30, 2024 $ 14,400

Note 5 - Investments, Availab_2

Note 5 - Investments, Available-for-sale (Tables)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Debt Securities, Available-for-Sale [Table Text Block]	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)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Schedule of Inventory, Current [Table Text Block]	June 30, 2024 December 31, 2023 (in thousands) Finished goods $ 7,156 $ 9,200 Raw materials 2,520 2,015 Total inventories $ 9,676 $ 11,215 Current portion $ 7,160 $ 7,172 Long-term portion 2,516 4,043 Total inventories $ 9,676 $ 11,215

Note 7 - Intellectual Property

Note 7 - Intellectual Property (Tables)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Schedule of Finite-Lived Intangible Assets [Table Text Block]	June 30, 2024 Gross Carrying Amount Accumulated Amortization Foreign Currency Translation Impact Net Carrying Amount (in thousands) Developed technology $ 68,838 $ (67,072 ) $ (868 ) $ 898 Technology and patents purchased 400 (289 ) 3 114 Total intellectual property $ 69,238 $ (67,361 ) $ (865 ) $ 1,012 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)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Lease, Cost [Table Text Block]	Three Months Ended June 30, Six Months Ended June 30, 2024 2023 2024 2023 (in thousands) Long-term operating $ 476 $ 479 $ 929 $ 930
Lessee, Operating Lease, Disclosure [Table Text Block]	June 30, 2024 December 31, 2023 Weighted-average remaining lease term (in years) 5.6 5.7 Weighted-average discount rate 9.0 % 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 690 2025 1,387 2026 1,060 2027 1,005 2028 825 2029 and thereafter 1,406 Total minimum lease payments $ 6,373 Less: Amount of lease payments representing interest (1,249 ) Present value of future minimum lease payments $ 5,124

Note 9 - Accrued Expenses and_2

Note 9 - Accrued Expenses and Other Current Liabilities (Tables)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Schedule of Accrued Liabilities [Table Text Block]	June 30, 2024 December 31, 2023 (in thousands) Consulting and other vendors $ 112 $ 461 Royalties 122 9 Legal and professional fees 1,392 411 Taxes and other assessments 985 755 Total accrued expenses and other current liabilities $ 2,611 $ 1,636

Note 11 - Notes Payable (Tables

Note 11 - Notes Payable (Tables)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Schedule of Short-Term Debt [Table Text Block]	June 30, 2024 (in thousands) Principal $ 15,000 Accrued interest payable 309 Total $ 15,309

Note 12 - Stock-based Compens_2

Note 12 - Stock-based Compensation (Tables)	6 Months Ended
	Jun. 30, 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 (thousands) Outstanding at December 31, 2023 10,444,679 $ 3.20 4.80 Granted 5,552,790 0.26 Cancelled (110,980 ) 15.61 Outstanding at June 30, 2024 15,886,489 $ 2.07 5.14 $ 389 Vested or expected to vest at June 30, 2024 14,894,960 $ 2.18 5.06 $ 334 Exercisable at June 30, 2024 7,919,713 $ 3.74 4.04 $ -
Schedule of Share-Based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]	Six Months Ended June 30, 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 %
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 14,953,974 $ 0.26 Vested (5,455,413 ) $ 0.91 Forfeited (1,396,905 ) $ 0.66 Unvested at June 30, 2024 20,427,833 $ 0.39
Share-Based Payment Arrangement, Cost by Plan [Table Text Block]	Three Months Ended June 30, Six Months Ended June 30, 2024 2023 2024 2023 (in thousands) Stock options $ 341 $ 591 $ 766 $ 1,256 Restricted stock units 844 977 1,800 1,836 Performance restricted stock units 343 410 707 802 $ 1,528 $ 1,978 $ 3,273 $ 3,894

Note 13 - Equity Offering (Tabl

Note 13 - Equity Offering (Tables)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Schedule of Common Stock Outstanding Roll Forward [Table Text Block]	Six Months Ended 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 14 - Basic and Diluted N_2

Note 14 - Basic and Diluted Net Loss Per Share (Tables)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share [Table Text Block]	June 30, 2024 2023 Stock options 15,886,489 10,602,414 Nonvested restricted stock units 20,427,833 12,938,688 Stock warrants 24,830,500 1,021,076 Total 61,144,822 24,562,178

Note 15 - Commitments and Con_2

Note 15 - Commitments and Contingencies (Tables)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Contractual Obligation, Fiscal Year Maturity [Table Text Block]	Fiscal Year 2025 $ 300 2026 300 Total commitments $ 600

Note 16 - Segments and Geogra_2

Note 16 - Segments and Geographic Areas (Tables)	6 Months Ended
	Jun. 30, 2024
Notes Tables
Long-Lived Assets by Geographic Areas [Table Text Block]	June 30, 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 June 30, Six Months Ended June 30, 2024 2023 2024 2023 US 8 % 12 % 12 % 16 % EMEA 84 % 67 % 77 % 62 % Asia 8 % 21 % 11 % 22 % Total 100 % 100 % 100 % 100 %

Note 2 - Summary of Significa_2

Note 2 - Summary of Significant Accounting Policies (Details Textual) - USD ($)	Jun. 30, 2024	Jun. 06, 2024	Dec. 31, 2023
Retained Earnings (Accumulated Deficit)	$ (987,614,000)		$ (939,368,000)
Merger Agreement [Member]
Business Acquisition, Termination Fee		$ 3,600,000
Common Stock [Member] | Merger Arrangement [Member]
Right to Receive, Price Per Share (in dollars per share)		$ 0.35

Note 3 - Revenue Recognition 1

Note 3 - Revenue Recognition 1 (Details Textual) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Dec. 31, 2023	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2022
Contract with Customer, Liability, Revenue Recognized	$ 100	$ 100	$ 300	$ 300
Contract with Customer, Liability	754		754		$ 711	$ 800	$ 500	$ 500
Accounts Receivable, Allowance for Credit Loss	$ 1,600		$ 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			0.26%
Accounts Receivable [Member] | Customer Concentration Risk [Member] | Customer Two [Member]
Concentration Risk, Percentage			0.13%
Accounts Receivable [Member] | Customer Concentration Risk [Member] | Customer Three [Member]
Concentration Risk, Percentage			0.11%
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	Jun. 30, 2024 USD ($)
Revenue, Remaining Performance Obligation, Amount	$ 0.9
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		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Revenue	$ 2,207	$ 1,081	$ 3,330	$ 2,057
UNITED STATES
Revenue	184	133	390	339
Non-US [Member]
Revenue	2,023	948	2,940	1,718
Instruments and Accessories [Member]
Revenue	568	298	881	591
Instruments and Accessories [Member] | UNITED STATES
Revenue	46	38	97	98
Instruments and Accessories [Member] | Non-US [Member]
Revenue	522	260	784	493
Service [Member]
Revenue	236	289	521	484
Service [Member] | UNITED STATES
Revenue	76	76	163	151
Service [Member] | Non-US [Member]
Revenue	160	213	358	333
Lease [Member]
Revenue	575	494	1,100	982
Lease [Member] | UNITED STATES
Revenue	62	19	130	90
Lease [Member] | Non-US [Member]
Revenue	513	475	970	892
Systems [Member]
Revenue	828	0	828	0
Systems [Member] | Non-US [Member]
Revenue	$ 828	$ 0	$ 828	$ 0

Note 3 - Revenue Recognition _2

Note 3 - Revenue Recognition - Contract Assets and Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Mar. 31, 2024	Dec. 31, 2023	Mar. 31, 2023	Dec. 31, 2022
Contract assets	$ 70		$ 95
Deferred revenue	$ 754	$ 800	$ 711	$ 500	$ 500

Note 4 - Fair Value Measureme_3

Note 4 - Fair Value Measurements (Details Textual) € in Millions, $ in Millions	6 Months Ended
	Jun. 30, 2024 USD ($)	Jun. 30, 2024 EUR (€)
Senhance Surgical Robotic System Acquisition[Member] | Minimum [Member]
Business Combination Contingent Consideration Arrangements Target Revenue | $	$ 25
Merger Agreement [Member]
Business Combination, Contingent Consideration Arrangements, Assumed Percentage Probability	90%	90%
Merger Agreement [Member] | 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		Jun. 30, 2024	Dec. 31, 2023
Cash and cash equivalents (1)	[1]	$ 7,782	$ 17,096
Restricted cash		1,517	1,642
Total assets		9,299	22,709
Short-term investments		0	3,971
Contingent consideration		14,400	2,220
Warrant liabilities		5,597	5,888
Total liabilities		19,997	8,108
Fair Value, Inputs, Level 1 [Member]
Cash and cash equivalents (1)	[1]	7,782	17,096
Restricted cash		1,517	1,642
Total assets		9,299	18,738
Short-term investments			0
Contingent consideration		0	0
Warrant liabilities		0	0
Total liabilities		0	0
Fair Value, Inputs, Level 2 [Member]
Cash and cash equivalents (1)	[1]	0	0
Restricted cash		0	0
Total assets		0	3,971
Short-term investments			3,971
Contingent consideration		0	0
Warrant liabilities		0	0
Total liabilities		0	0
Fair Value, Inputs, Level 3 [Member]
Cash and cash equivalents (1)	[1]	0	0
Restricted cash		0	0
Total assets		0	0
Short-term investments			0
Contingent consideration		14,400	2,220
Warrant liabilities		5,597	5,888
Total liabilities		$ 19,997	$ 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	6 Months Ended
	Jun. 30, 2024 USD ($)
Balance at December 31, 2023	$ 5,888
Change in estimated fair value	(291)
Balance at June 30, 2024	$ 5,597

Note 4 - Fair Value Measureme_6

Note 4 - Fair Value Measurements - Quantitative Information about Inputs and Valuation Methodologies - Warrants (Details)	Jun. 30, 2024	Dec. 31, 2023
Measurement Input, Price Volatility [Member] | Senhance Surgical Robotic System Acquisition[Member] | Fair Value, Inputs, Level 3 [Member]
Measurement Input	0.35	0.35
Measurement Input, Price Volatility [Member] | Warrant [Member]
Measurement Input	1.08	1.17
Measurement Input, Discount Rate [Member] | Senhance Surgical Robotic System Acquisition[Member] | Fair Value, Inputs, Level 3 [Member]
Measurement Input	0.105	0.10
Measurement Input, Risk Free Interest Rate [Member] | Warrant [Member]
Measurement Input	0.044	0.038
Measurement Input, Currency Exchange Rate [Member] | Senhance Surgical Robotic System Acquisition[Member] | Fair Value, Inputs, Level 3 [Member]
Measurement Input	1.07	1.1
Measurement Input, Probability Rate [Member] | Senhance Surgical Robotic System Acquisition[Member] | Fair Value, Inputs, Level 3 [Member]
Measurement Input	0.90
Measurement Input, Expected Term [Member] | Warrant [Member]
Measurement Input	4.1	4.6
Measurement Input, Expected Dividend Rate [Member] | Warrant [Member]
Measurement Input	0	0

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	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Balance at December 31, 2023	$ 2,220	$ 1,256
Change in estimated fair value	12,180	308
Balance at June 30, 2024	$ 14,400	$ 1,564

Note 5 - Investments, Availab_3

Note 5 - Investments, Available-for-sale (Details Textual) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Dec. 31, 2023
Debt Securities, Available-for-Sale	$ 0		$ 0		$ 3,971
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	Jun. 30, 2024	Dec. 31, 2023
Amortized Cost		$ 3,981
Unrealized Gain		0
Unrealized Loss		(10)
Fair Value	$ 0	3,971
Short-term investments	$ 0	3,971
Corporate Debt Securities [Member]
Amortized Cost		3,981
Unrealized Gain		0
Unrealized Loss		(10)
Fair Value		3,971
Short-term investments		$ 3,971

Note 6 - Inventories - Componen

Note 6 - Inventories - Components of Inventories (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Finished goods, gross	$ 7,156	$ 9,200
Raw materials, gross	2,520	2,015
Total inventories, gross	9,676	11,215
Current Portion, gross	7,160	7,172
Long-term portion, gross	$ 2,516	$ 4,043

Note 7 - Intellectual Propert_2

Note 7 - Intellectual Property - Intellectual Property (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Finite-Lived Intangible Assets, Gross	$ 69,238	$ 69,238
Finite-Lived Intangible Assets, Accumulated Amortization	(67,361)	(67,181)
Finite-Lived Intangible Assets, Foreign Currency Translation Impact	(865)	(820)
Intellectual property, net	1,012	1,237
Developed Technology Rights [Member]
Finite-Lived Intangible Assets, Gross	68,838	68,838
Finite-Lived Intangible Assets, Accumulated Amortization	(67,072)	(66,902)
Finite-Lived Intangible Assets, Foreign Currency Translation Impact	(868)	(837)
Intellectual property, net	898	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	3	17
Intellectual property, net	$ 114	$ 138

Note 8 - Leases - Components of

Note 8 - Leases - Components of Operating Lease Expense (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
General and Administrative Expense [Member]
Long-term operating	$ 476	$ 479	$ 929	$ 930

Note 8 - Leases - Supplemental

Note 8 - Leases - Supplemental Balance Sheet Information (Details)	Jun. 30, 2024	Dec. 31, 2023
Weighted-average remaining lease term (in years) (Year)	5 years 7 months 6 days	5 years 8 months 12 days
Weighted-average discount rate	9%	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	Jun. 30, 2024 USD ($)
Remainder of 2024	$ 690
2025	1,387
2026	1,060
2027	1,005
2028	825
2029 and thereafter	1,406
Total minimum lease payments	6,373
Less: Amount of lease payments representing interest	(1,249)
Present value of future minimum lease payments	$ 5,124

Note 9 - Accrued Expenses and_3

Note 9 - Accrued Expenses and Other Current Liabilities - Components of Accrued Expenses (Details) - USD ($) $ in Thousands	Jun. 30, 2024	Dec. 31, 2023
Consulting and other vendors	$ 112	$ 461
Royalties	122	9
Legal and professional fees	1,392	411
Taxes and other assessments	985	755
Total accrued expenses and other current liabilities	$ 2,611	$ 1,636

Note 10 - Income Taxes (Details

Note 10 - Income Taxes (Details Textual) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Dec. 31, 2024
Effective Income Tax Rate Reconciliation, Percent	(0.003%)	0.001%	(0.002%)	(0.002%)
Income Tax Expense (Benefit)	$ 75	$ (12)	$ 121	$ 79
Unrecognized Tax Benefits, Income Tax Penalties and Interest Accrued	$ 0		0
Effective Income Tax Rate Reconciliation, GILTI, Amount			$ 0	$ 0
Forecast [Member]
Effective Income Tax Rate Reconciliation, Percent					(0.20%)

Note 11 - Notes Payable (Detail

Note 11 - Notes Payable (Details Textual) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Apr. 03, 2024	Jun. 30, 2024	Jun. 30, 2023
Proceeds from Notes Payable		$ 15,000	$ 0
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]	us-gaap:SecuredOvernightFinancingRateSofrMember
Promissory Note [Member]
Debt Instrument, Face Amount		$ 15,000
KARL STORZ [Member] | Promissory Note [Member]
Debt Instrument, Basis Spread on Variable Rate		10%
KARL STORZ [Member] | Merger Agreement [Member] | Promissory Note [Member]
Proceeds from Notes Payable		$ 15,000
KARL STORZ [Member] | Maximum [Member] | Merger Agreement [Member] | Promissory Note [Member]
Debt Instrument, Face Amount	$ 20,000

Note 11 - Notes Payable - Sched

Note 11 - Notes Payable - Schedule of Short Term Debt (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Dec. 31, 2023
Total	$ 15,309	$ 0
Promissory Note [Member]
Principal	15,000
Accrued interest payable	309
Total	$ 15,309

Note 12 - Stock-based Compens_3

Note 12 - Stock-based Compensation (Details Textual) - USD ($) $ in Millions		1 Months Ended	6 Months Ended
	Jun. 06, 2023	Feb. 28, 2024	Jun. 30, 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			$ 2.1
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)			2 years 1 month 6 days
Restricted Stock Units (RSUs) [Member]
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount			$ 5.6
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)			1 year 8 months 12 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 12 - Stock-based Compens_4

Note 12 - Stock-based Compensation - Stock Option Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 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 1 month 20 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)	(110,980)
Options, Expirations in Period, Weighted Average Exercise Price (in dollars per share)	$ 15.61
Options, Outstanding, Number of Shares (in shares)	15,886,489
Options, Outstanding, Weighted Average Exercise Price (in dollars per share)	$ 2.07
Options, Outstanding, Aggregate Intrinsic Value	$ 389
Options, Vested and Expected to Vest, Number of Shares (in shares)	14,894,960
Options, Vested and Expected to Vest, Weighted Average Exercise Price (in dollars per share)	$ 2.18
Options, Vested and Expected to Vest, Weighted Average Remaining Contractual Term (Year)	5 years 21 days
Options, Vested and Expected to Vest, Aggregate Intrinsic Value	$ 334
Options, Exercisable, Number of Shares (in shares)	7,919,713
Options, Exercisable, Weighted Average Exercise Price (in dollars per share)	$ 3.74
Options, Exercisable, Weighted Average Remaining Contractual Term (Year)	4 years 14 days
Options, Exercisable, Aggregate Intrinsic Value	$ 0

Note 12 - Stock-based Compens_5

Note 12 - Stock-based Compensation - Stock Option Valuation Assumptions (Details)	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Expected dividend yield	0%	0%
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 12 - Stock-based Compens_6

Note 12 - Stock-based Compensation - RSU Activity (Details) - Restricted Stock Units (RSUs) [Member]	6 Months Ended
	Jun. 30, 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	14,953,974
Restricted stock units, Granted, weighted average grant date fair value (in dollars per share) | $ / shares	$ 0.26
Restricted stock units, Vested (in shares) | shares	(5,455,413)
Restricted stock units, Vested, weighted average grant date fair value (in dollars per share) | $ / shares	$ 0.91
Restricted stock units, Forfeited (in shares) | shares	(1,396,905)
Restricted stock units, Forfeited, weighted average grant date fair value (in dollars per share) | $ / shares	$ 0.66
End of period, Restricted stock units, Unvested (in shares) | shares	20,427,833
End of period, Restricted stock units, Unvested, weighted average grant date fair value (in dollars per share) | $ / shares	$ 0.39

Note 12 - Stock-based Compens_7

Note 12 - Stock-based Compensation - Non-cash Share-based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Share-based compensation	$ 1,528	$ 1,978	$ 3,273	$ 3,894
Share-Based Payment Arrangement, Option [Member]
Share-based compensation	341	591	766	1,256
Restricted Stock Units (RSUs) [Member]
Share-based compensation	844	977	1,800	1,836
Performance Restricted Stock Unit [Member]
Share-based compensation	$ 343	$ 410	$ 707	$ 802

Note 13 - Equity Offering (Deta

Note 13 - Equity Offering (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 13 - Equity Offering - Sum

Note 13 - Equity Offering - Summary of Sales Under Offering (Details) - USD ($) $ / shares in Units, $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Net proceeds	$ 982	$ 196
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 14 - Basic and Diluted N_3

Note 14 - Basic and Diluted Net Loss Per Share (Details Textual) - shares shares in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Weighted Average Number of Shares Outstanding, Diluted, Adjustment	0	0	0	0

Note 14 - Basic and Diluted N_4

Note 14 - Basic and Diluted Net Loss Per Share - Antidilutive Securities Excluded from Computation of Earnings Per Share (Details) - shares	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	61,144,822	24,562,178
Share-Based Payment Arrangement, Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	15,886,489	10,602,414
Restricted Stock Units (RSUs) [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	20,427,833	12,938,688
Warrant [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	24,830,500	1,021,076

Note 15 - Commitments and Con_3

Note 15 - Commitments and Contingencies - Purchase Orders Commitments (Details) - License and Supply Agreement [Member] - Senhance Surgical Robotic System Acquisition[Member] $ in Millions	Jun. 30, 2024 USD ($)
2025	$ 0.3
2026	0.3
Total commitments	$ 0.6

Note 16 - Segments and Geogra_3

Note 16 - Segments and Geographic Areas (Details Textual)	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024
Number of Operating Segments			1
Revenue Benchmark [Member] | Customer Concentration Risk [Member]
Number of Major Customers	2	0	1
Revenue Benchmark [Member] | Customer Concentration Risk [Member] | Customer One [Member]
Concentration Risk, Percentage	43%
Revenue Benchmark [Member] | Customer Concentration Risk [Member] | Customer Two [Member]
Concentration Risk, Percentage	11%
Revenue Benchmark [Member] | Customer Concentration Risk [Member] | One Customer [Member]
Concentration Risk, Percentage			28%

Note 16 - Segments and Geogra_4

Note 16 - Segments and Geographic Areas - Consolidated Assets and Long Lived Assets by Geographic Area (Details) - Geographic Concentration Risk [Member] - Assets, Total [Member]	6 Months Ended	12 Months Ended
	Jun. 30, 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 16 - Segments and Geogra_5

Note 16 - Segments and Geographic Areas - Sales by Geographic Area (Details) - Revenue Benchmark [Member] - Geographic Concentration Risk [Member]	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
UNITED STATES
Percentage	8%	12%	12%	16%
EMEA [Member]
Percentage	84%	67%	77%	62%
Asia [Member]
Percentage	8%	21%	11%	22%
All Countries [Member]
Percentage	100%	100%	100%	100%

Note 17 - Related Party Trans_2

Note 17 - Related Party Transactions (Details Textual) - USD ($) $ in Thousands	3 Months Ended
	Jun. 30, 2024	Jun. 30, 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 18 - Subsequent Events (De

Note 18 - Subsequent Events (Details Textual) - Promissory Note [Member] - USD ($) $ in Millions	Jul. 31, 2024	Jun. 30, 2024	Apr. 03, 2024
Debt Instrument, Face Amount		$ 15
KARL STORZ [Member] | Merger Agreement [Member] | Maximum [Member]
Debt Instrument, Face Amount			$ 20
KARL STORZ [Member] | Subsequent Event [Member] | Merger Agreement [Member]
Debt Instrument, Merger, Additional Funding	$ 5
KARL STORZ [Member] | Subsequent Event [Member] | Merger Agreement [Member] | Maximum [Member]
Debt Instrument, Face Amount	$ 20