FITM: The Extended Conversation with Doug Fairbanks

Doug Fairbanks left a robotics commercialization role at Johnson & Johnson to lead a deep tech startup most surgeons had never heard of. In this conversation, the president and CEO of VISIE Inc. explains why — and what their continuous anatomic auto tracking technology could mean for the future of robotic-assisted surgery.

VISIE started as Advanced Scanners, a company founded by optical physicist Aaron Bernstein to solve the problem of brain shift during cranial procedures. Fairbanks saw the technology's potential far beyond neuroscience and joined to steer the company toward orthopedics. The result is a 3D spatial computing platform that tracks anatomy in real time at 254-micron accuracy — without pins, arrays, or registration. Fairbanks walks through how VISIE built all its hardware and software in-house to push the limits of what's possible, why that Apollo 13 engineering mentality defines the company's culture, and what it took to go from four scans per second to over twenty-five.

This episode also covers the business side of deep tech innovation: how VISIE navigates the sub-component regulatory pathway, what partnership conversations with strategic companies actually sound like, how 16 patents in eight months shaped their IP strategy, and why the board in the other room still reads “patients treated: zero.” Whether you're a surgeon curious about pin-free tracking or a founder building something no one has built before, this is a candid look at what it takes to bring genuinely new technology to the operating room.

Learn more about VISIE at https://visievision.com

⏱️ Chapters:
00:00 From neuroscience startup to surgical vision company
03:55 Launching Velys robotics at DePuy Synthes
07:44 What is continuous anatomic auto tracking
11:07 Why VISIE builds all hardware and software in-house
13:54 Teaching robots to see what surgeons see
18:30 The hardest technical challenge at VISIE
21:00 Validating deep tech with the surgical market
25:42 Scaling a startup with contract manufacturing
28:09 Regulatory pathway as a sub-component device
32:00 Protecting innovation with an aggressive IP strategy
35:09 Future of pin-free tracking in hips and knees
37:29 Advice for surgeon innovators starting a company

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This podcast is intended for educational and informational purposes only.

The content discussed does not constitute medical advice and should not be used as a substitute for professional judgment. Clinicians should rely on their own training, experience, and clinical decision-making when applying information from this discussion.

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Transcript

Doug Fairbanks 0:27

My name is Doug Fairbanks. I'm the president, CEO, and board member at VISIE Inc.

Joseph M. Schwab 0:33

Hi, Doug. Thank you for joining us. Um, questions about VISIE. So I want you to take us back to the beginning. My understanding, this started with the co-founder Aaron Bernstein. Who is a, um, a PhD in optical Science and engineering, if I remember correctly. And there was a mission for this sort of technology in neuroscience. Tell me a little bit about that and tell me about how this work evolved into what VISIE is today.

Doug Fairbanks 1:05

Thank you for the question. So when we think about the history of VISIE really dates back to when the company was called Advanced Scanners. And uh, as you mentioned, Aaron Bernstein was one of the original founders of PhD, optical physicist, and somebody who, uh, was thinking very deeply about how do you use technology to solve the problems of, uh, really humanity, right? And, and he had some experience with, um, epilepsy and, and brain illnesses. Was saying, Hey, I wanna take my skillsets and, and use those to create a solution that can help others. Well, you know, VISIE was, was not born till after I joined the organization about three years ago, but I would finished up at grad school at the University of Texas here in Austin, and I was paying attention to different technologies and advanced scanners came across the desk and I said, wow, that is something really special. There is a group that's doing something really interesting. I wonder if the world knows how special they are. And so I was currently in a role at Johnson and Johnson and, and I was thinking about ways to impact patients and improve the way that we develop care. And I said, you know, this is really interesting. And the truth of the matter is I couldn't get the idea outta my head. Uh, Aaron and the group was currently working on, you know, brain shift. The idea that when you open up a, a cranial procedure, the brain floats and moves. And they were watching the ridges of the brain move and they were saying, Hey, we really want to be able to treat patients better. And I said, that application of that technology as it is today to be really meaningful, not just in neuro, but in spine and in orthopedics. I was really excited about off the bat, and so when I happened on these folks, I couldn't really get it outta my mind. As somebody who really believes in technology and was seeing this happen, I said, this is unbelievable. And I set out to say, Hey, can I introduce you to folks? And that relationship turned into Doug. Will you be a, an advisor of the company? And so I basically did some free work advising the company. And before you knew it, I couldn't shake that. I had to go be there, right? The ideas were so big, the goals of the company were ambitious, and they really needed somebody who could take the, the ideas and the skillsets and transform them into something that's a reality. And, and I think actually that lesson is really important when you think about surgeon innovators out there, because you can have an idea, but, but you can only take the ball so far, far right. And it's really about taking your idea and building a team and taking idea to the next level through getting people to invest themselves in it and to also believe in you. And it's that process of vetting idea that kind of starts the very early spark of a company to move from kind of zero to one, if that makes sense.

Joseph M. Schwab 3:55

You, you mentioned your role at Johnson and Johnson, where I believe you were in charge of, uh, robotics commercialization for a period of time. Is that correct?

Doug Fairbanks 4:05

Yeah, I was at the Velys team. Uh, you know, I like to think that I was kind of a hired gun, right? I had, I just completed doing a business turnaround of a orthopedic medical technology outta Munich, Germany, and I came on the radar and they were saying, Hey, we were gonna launch a robot at, at DePuySynthes, Johnson and Johnson. Will you come over? I came into this role and before I got there, someone made a commitment, Hey, we're gonna go to the market in two years and we're gonna, we're gonna have commercialize a robot system. And I jumped in and, and, you know, we pushed like crazy and it was really exciting to do. We actually delivered that project on time, under budget. We did so halfway around the world during a global pandemic in a country that had closed borders and the details of which are really impressive and kind of interesting to play around with. But the truth of the matter is, is I was just responsible for executing this vision and there are some really impressive work that happened at the engineering at JJ Now, you know, look, we look at the spinoff of DePuy Synthes from j and j, but j and J tends to move really slow. It's a large organization. The, and the r and d groups at, at DePuy Synthes at the time, you know, led by, uh, Addie Harris, who actually came over and became a board board member here at VISIE, you know, led this group to deliver on a, a very, very ambitious product, and a time where, you know, not a lot of projects moved at that pace, and it was really impressive. And so it was a time where I realized, Hey, look, if you want something done, jump in. Apply yourself. Set very aggressive goals. And don't worry about the obstacles. And, and actually that's played, that's paid out dividends, not just at my time at j and j and others, but, but primarily here at VISIE.

Joseph M. Schwab 5:49

Were there other key lessons that you, um, experienced or learned at j and j that you've been able to, to bring over to the startup, uh, space at VISIE?

Doug Fairbanks 6:01

Uh, that's a, that's a fantastic question. When you think about lessons in big corporations, um, you know. There really is an idea that, hey, look, how do you innovate? Right? And, and we experience it sometimes today as we interact with larger organizations who wanna look at VISIE technology. You know, say, Hey look, we're so risk adverse. We have so many people that have to approve things. When I was in the Velys role and launching robotics at, uh, Johnson and Johnson, one of the things I said is, look, how much can I affect myself and how much can my team affect? And how do we rather than live into, Hey, look, there's not a possibility to change things to say you day, what can you change? And, and, you know, I was fortunate to have the, the support and, and the mandate to deliver on time, but. But that turned over to startup where you say, Hey look, you know, there's vast amounts of unknown that you jump into. And really in order to keep yourself sane and to keep the company moving forward, you have to set goals for yourself. Say, Hey, look, nobody's out there begging for my product. I have to get them to know what my product is. And in order to do that, I have to do something that's impressive. And so, you know, the lessons that I've learned along my career, and, and by the way, I spent some time at Zimmer, uh, Biomet, Zimmer at the time, and, and some other companies. But, but really the idea that, hey, look, you're gonna make the forward motion. You have to do that, that's delivered the, the success we've had at vi and it was a lesson that I've, that I've picked up along the way. But, but really what had honed in, in, as I, as I moved into the chief executive role here.

Joseph M. Schwab 7:45

Speaking of the technology that you're gonna have to showcase to people and, and, and make them understand. I've heard you talk about continuous anatomic auto tracking or CAAT, and I understand that's a concept that's really fundamental to the product that you offer, but you also feel that it's fundamental in how it redefines what robots can do during surgery. Can you tell me more about that?

Doug Fairbanks 8:13

Yeah. Uh, so when we think about CAAT and the development of CAAT, continuous anatomic auto tracking, uh, the basis or need for it actually came from the idea that. You know, are you identifying what. Is really important. And, and we talk about, they, uh, we won award, an anterior hip foundation that was really meaningful for several years ago. And, and Charlie DeCook gave a speech and it before and, and I don't remember the exact quote, but he said they, it's the on entrepreneurs, um, uh, plight to realize or appreciate what everybody ignores, right, is, you know, it's your goal to say, Hey, when there is a problem, that's not a problem. That's an opportunity. And for me, I was very fortunate in, in my career to have spent a lot of time during COVID. I talked to 400 orthopedic surgeons in one hour calls. It was, it was un unfettered access and has been, and, and was really insightful for me as I talked about robotics and technology. But before that, you know, I did, uh, 200 flights a year for close to 10 years visiting different hospitals and surgeons all through the country. And it was in those observations, right? Standing in ORs and interacting with surgeons that you understand, hey, what is the real problem here? And there are things that differ from one to the next, like philosophy. But then there are things like, Hey look, I don't want to put pins in the patient. You know, I put pins in the iliac wing to do navigation or robotics. That PIN site sometimes is more painful than the hip surgery itself, right? And so when we think about cat, we said, what is the opportunity? And when we looked at the technology, the, the IR tracking, stereo track, stereo graphic tracking that's used today is now over, we're 40 years old. And maybe the oldest piece of technology in your OR, and the truth is, is that there's a, there's a possibility for something better, less hold in the patient. Let's hassle for the surgeon and less time in surgery. We saw that as a win. And so when I came across advanced scanners, we said, okay, it's taking pictures of the patient and how do we get it to see the patient in real time? And the team got latched onto that and they wouldn't let it go. They just said, we're gonna deliver that, we're gonna deliver that. And the first time they did it kind of fast was four times a second. And by the way, if you see something at four times a second, it's. It's unbelievably still how four times the second is. But then they said, well, we can go faster. We can go faster. And before you know it, that the question of speed was no longer a thing. And we can see the patient and we can remove all this hassle to the procedure and we can really consider what is the impact on the surgeon and what is the impact on the patient and how do you deliver something better. And so we're excited about what CAAT has done.

Joseph M. Schwab 11:07

So one of the ways that you've been, you've enabled yourself at VISIE, it sounds like, in order to advance these, uh. Technologies as quickly as possible is you kind of create everything from the hardware to the software. It's sort of a, uh, an apple style, uh, philosophy, a built differently mindset, you might say. Um, I, I'm, I know you've been at companies that also source products, uh, in order to, to make their entire product. So why was an all in-house or mostly in-house, uh, process the right approach for VISIE.

Doug Fairbanks 11:44

Yeah. Uh, Joe, thank you for the question. The, the idea is that. Look, there is a lot of, there's a lot of innovation out there that is kind of a repackaging of other ideas and, uh, we consider ourselves at Vivi a d tech, meaning that we are attempting to do something that nobody has done before. And, and by the way, I think we're having some moderate success at it and getting better every day. But that being said is. Built differently means that, that the team here is highly engineering focused, right? I, I, I, and I'll have a partial engineering degree for an undergrad. Everybody in the building has an engineering degree, and it's part of the culture and the fabric. But the truth of the matter is, is that to solve the type of problem that we're solving, you actually have to go to a fundamental level. On every piece. Right? And, and I, once I once used the example, you know, like, Hey, we were getting fast, but the software and the equipment that we had made originally would only let us go so far. And I, the analogy was like the PLO 13, like when they're, I don't know if anybody knows Paul 13, but they're ripping all the, the, the seats out of the limb to make the, make it light enough so it gets back home, right. And, and what that's what we do here in the office is you gotta go unbolt the chairs. To say, can this thing go fast enough? And we have to know every component. Because if we're using something off the shelf, we can't get to the support, we can't get the answers, we can't push the edge of what's going on here. And so really it, it was part of what was going on at Advanced Scanners, and it was a really good pull through for us to say, Hey, look, we will examine every part of this problem at its fundamental level to be able to solve it. And the only other piece of that, and that'll tie back to building a good team and building a good organization is do the people in the building have the passion to do that? Are they, are they rewarded by solving hard problems? And luckily here we have really great people who say, look, I don't wanna solve it. If it's complex, I don't wanna, you know, I'm not gonna shy away from it and I'm not gonna find a way to say no. I'm gonna say yes, we'll do this because that's how we get stimulated.

Joseph M. Schwab 13:54

One of the ways that VISIE's robot or VISIE's technology has been described. Is teaching robots to see what the surgeons see. Now you've described this a little bit in the, uh, anatomic auto tracking. In practical terms in the operating room, what does that mean for the surgeon? And, and I'll just put in a plug here. I saw the demo at the AAOS, uh, the, the. Probably 50 second, uh, relatively viral video that went where the robots tracking literally the, the knee moving back and forth. And so I can see that from my perspective, what the technology is doing, what's the vision for what that's gonna look like and what that's gonna mean to surgeons in the or in one year, in five years.

Doug Fairbanks 14:41

Yeah, there, there, there's a lot to unpack in that question, right? Is, you know, what, what is a computer seeing like the surgeon mean? Right? So first of all, um, just as a base level. Computers actually don't see things well, right? Like, uh, the way that you put data into the computer. There's lots of ways to interface it, but it usually has to be pretty organized. And when you and I look at a table, we, you know, we know what the things are. We know the cup cup of coffee is that big and that far away. All these things are things that our brain does really easily and does it very quickly. You know, we use, you know, a form of stereo. Stereotography is two cameras. Our eyes use, you know, a thing called binocular disparity, where they compare two images and do it very quickly and do it very well to tell us how far away things and how big they are. Thing is computers, don't you point a camera at something. They don't know if it's flat or if it's around or how far away it is. And, and there's a couple different ways that you get to 3D imagery. Now, what we did was we essentially built at the idea that we are gonna say we're gonna do 3D scanning. We're gonna do it in high, high accuracy. So, you know, every one, every one of these different modalities has different accuracy. We're gonna do it in high accuracy, but then we have to do it very fast, which is challenging, right? So if, if you're doing something for the FDA, you really gotta, you know, say, Hey, something's below two millimeters. We are looking at things regularly. Something like 254 micron level, right? A tiny, tiny, tiny, tiny measurements. A human, a couple of human error is 200 microns, right? And so we're looking at things very accurately, but we're producing a ton of data. Then we gotta process the data and the problem. The problem in all of that is, is that you have to process it faster than the person that you're working with can realize it's changing. So I'm gonna draw back to computers. Computers have a hard time seeing things. We have this technology that, from the ground up is built in, in the house, the hardware, endless software, and it essentially says I can measure everything in the field. I can tell you how big it is, and I can tell you how far away it is. And that's important because in surgery I wanna tell the surgeon where the anatomy is, because that's the whole question. Now, to draw back to your example of the demo, that's actually really hard for us because seeing things, you and I are seeing things, but is there any indication we're seeing things? No, it's actually kind of, it should be a silent problem, right? It it, you know, oh, we saw things, we, we acknowledged it. So we put the robot, we put the, the device on the end of the robot. Because it was a really good demonstration that, hey, it is tracking this femur and it is doing it at at a speed that is, that is so fast that you don't realize that it's changing and doing it. So in that demo, the 3D scanner that we built is looking at the anatomy, it's measuring it, it's adding up a bunch of pictures to be very accurate. It's saying where it is in space. It's saying go to that place while being mounted to something. While also watching something that moves and, and the problem is actually really hard. And the analogy I'll use, and I'm, and people are probably tired of hearing it, but it's like, uh, videotaping a race car while driving a race car, hanging out the window with a camera and taking a picture of the, of the other race car. So, uh, the demo was really great. I think it got our, our, our use case across. But the truth of the matter is, is that when, when VISIE goes to market, you should actually never even think about us. We, we should just give, fight to your system. It's to say that's bone, that's ligament, that's fat, that's tendon, that's the patella tendon. That's, you know, that's a greater tr We know all these things. We see'em and we got a database of, of understanding, of, of anatomy that can tell us these are important structures for use surgeon so that when you operate it's seamless.

Joseph M. Schwab 18:30

Was that demo the hardest technical challenge that VISIE has faced so far? And if not, what has been?

Doug Fairbanks 18:39

I have three young kids and. You know, I watched my partner give birth to three kids, and it was, that's a terribly hard thing to do. And then after your, apparently the brain releases chemicals and you forget how hard it is. So a lot of the really hard challenges, the analogy is, is that a lot of the really hard challenges of fear at VISIE are like giving birth. It was so hard. There was no light in the tunnel, and then it was over, and then we celebrated, right? So the demo, the demo actually was a celebration for the organization because. It was a really cool way to do it. And by the way, in startup it's, it's really tough because we don't get a regular customer interaction. Like we're not making revenue. We're not somehow bolstered by what the market is doing. We have these handful of time inflection points when we come up for air and we hope that the world can see and appreciate what we do. So it was a particularly a great moment when he got a response at Ortho View. At Ortho at ortho pitch. To, to say, Hey, look, we like what you're doing. We like what, what is going on here? We think this is an exciting technology. Now, when we, when we back up, that pedal back is the, the really hard part to the company, one of the hardest achievements that I believe we made and, and we're working on a couple things that are really interesting right now. Very challenging, but, but to go from essentially four to, to over 25 hertz was a huge leap. And you know, from the technology standpoint, four, like we said, is, is is slow. You watch something, do something four times a second. You're surprised how slow that does. Human perception. Typical humans are seeing between 20 and 24 hertz, so 20 or 24 times a second, and your brain kind of smooth things out. Professional video gamers can see it like 30 because they're used to tracking things very fast. But to go from from four to 24. That was a huge milestone. And by the way, it wasn't, it wasn't just, oh, we got a little bit better. We turned a bunch of, uh, a little screws and it happened. It was, it required that we rethink from the ground up how we do this. And, and fortunate for us, we had done all the things from the ground up. So going back to it wasn't super challenging. So that was a milestone and an achievement. I think it was really a great accomplishment. The demo, I think, was rewarding for us to see. So, uh, great question.

Joseph M. Schwab 20:59

Moments like that demo, whether they're a, a reward for the team or not, um, they certainly catch the industry's attention. What does a moment like that teach you about how people, how surgeons, how industry perceive what VISIE's doing?

Doug Fairbanks 21:18

So much of what we do here is an effort to help the market understand what our value proposition is because, you know, in a deep tech, you're working on a hard problem for a very long time. By the way, working on anything costs money. And so you gotta say, Hey, did we do something tangible? And by the way, could you get to the end of doing all this work? And it, and the thing you create, even though you're excited about it, may not mean much to other folks. And so how do you essentially call out? This is so, so for us, it became important for us to have a regular check in with the market to be able to. Drive some understanding of the technology. You know, we said we think that solving pins and arrays and registration is an important solution, but we're not surgeons, so we need to go out and talk to folks that are, luckily when we talk to surgeons, we're like. Please, please, please solve this problem. And actually one of the first great validations we had was this, uh, shark Tank at Anterior Hip Foundation, where, where even the judges are like, okay, this is cool. Like this is not one other thing that, you know, this is not one other thing that we solve for other times. And there's six out out there. They said, this is cool. So doing these pitch competitions actually were a form of validation and, and anterior hip foundation being so surgeon focused was really nice for us. That being said, we, we have to come up for error once in a while and say, did we do something that was right? And does that achievement mean something to folks? Because, you know, the end of the road is, Hey, if we don't want it, we're not gonna buy it. Now the other huge lift in all this, and, and it's important to think about, um. This as you do any startup, is to say, is the juice worth the squeeze? Now is what you, is what you do is all the work you put into this gonna produce some outcome that that will benefit the investors importantly as a startup, but will then invent, will, will benefit. Healthcare is really critical as a mandate that all healthcare companies should have and I think that that is, uh, where we land as we think about validation of anything is to say. Did we, did we achieve what we wanted as we thought about the end user?

Joseph M. Schwab 23:35

How do you ensure, um, you touched on this a little bit, but how do you ensure VISIE, which is a tech company, uh, really essentially stays surgeon centric in what it offers rather than tech for tech's sake.

Doug Fairbanks 23:51

Uh, great question. How, how do you ensure. That technology serves its end goal, especially in healthcare. You know, by the way, that, that pulls back to a core principle of ours, right. Which is we believe insurgents. Right. You know, there's a lot of talk about automation these days and, and you know, automation can come from different levels and you can have tasks taken over by others. That's fine. But, but really for us, the critical element in all of this is that. That a surgeon has bought in on an idea or bought in on the, the solution helps them do their job better, right? Surgery is done by surgeons. For us, we're not a, we're not a company that, that moves away from that. So when I think about, about the audience and, and the group at Anterior Foundation, you say, look, I'm in a unique position because the things that I experience in my or are actually things that others may experience as well. And it, it is, it is again, the entrepreneur's plight to say, I can identify a problem as an opportunity. Now the next big piece in all of that, as you go to form a company or to create a startup or to create a solution, is to say, okay, do I believe so strongly in that solution that I'm willing to go out and do it? And by the way, doing is a big deal and, and that I'm willing to put my name on the line and to, to go hire people and to get behind this in a way that adds the thrust. There are lots of ideas. I would argue that execution. Is, is way underrated as a critical element for anything, right? We, like I talked about earlier in the speech setting a milestone, setting a goal and going after it and, and putting your resources and putting your time into it is important. And I idea alone will not make a success.

Joseph M. Schwab 25:43

Let's talk about your next milestone, because even without a product on the market yet, uh, VISIE obviously is gonna be looking towards putting a product on the market. And from your perspective, from the business side of things, what does building for scale look like in a company like yours?

Doug Fairbanks 26:03

Yeah. Um, VISIE is not waiting to go to market. VISIE is going to market and, and as fast as I can, as fast as I can, right? We are, it is a core mandate for us. It's a critical, critical path element to say, how do we get to market now? Luckily, uh, the ecosystem is set up in a way that kind of supports this, right? So, uh, you, you know, if you can, if you can get to a good idea and to get to a fundamentally strong, competent build in the technology, you can actually engage in contract manufacturers. We'll build a thing as you describe it, and actually we'll do some refinement along the way. VISIE is, is actively engaged with contract manufacturers. We are not gonna build scanners here in this building, you know, in the, in the hundreds that are, are kind of sitting on the verge of, of moving into, into, you know, our production and into the world. We can't, we can handle the volume. And by the way, it's just a bunch of engineers anyway, right? So, um, we, we look at the, there is resource and there is an environment that once you have. Landed on something that you think does what you want it to do and accomplishes goal and meets, its kind of, um, verification of its design requirements. You know, those things can then be handed off to contract manufacturer. So. Um, I, I, I will, I think it's good for education of, of surgeons say, look, you're not gonna have to set up a whole factory if you make something. If you get to a place, there are good resources that can, can turn your product into something and make it a sellable product. Right? So, um, that, that is, that is the, the good point. Now, I'll leave you also with the idea that as you run a business or, or take a product, you, you have to. You have to have good practice in, in acquiring things, right? You gotta interview lots of parties that do this because in doing so, you learn more and you're able to execute, right? So you say, Hey, look, I learned this from the other interview, and I should go back to my vendor and ask them about this, and, and I've hired somebody who knows something about this. Looking at one person is really ever the good idea for, for getting a, a good competitive good result.

Joseph M. Schwab 28:09

Because your technology, VISIE's technology is designed to integrate with an existing robot rather than, um, necessarily to replace a robot. I'm assuming once it's integrated into, um, uh, another manufacturer or another vendor's product, another company's product that it will have to go through FDA clearance. And so can you talk a little bit about how different or more complex, or less complex is that process for a company like VISIE compared to trying to clear a standalone device?

Doug Fairbanks 28:42

This is a, this, you know, regulatory is, is a super complicated, uh, thing because it, because it needs to be, it needs to be that companies are producing safe products to be used on patient now, on patients now, um. If you think about it right now, something like 80% of robotic and navigation companies use a single vendor for their stereo cameras, and that vendor provides something like 48,000 cameras to the market is the footprint, is pretty, pretty dramatic. And if you walk around one of these trade zones, you can see a lot of these cameras are the same cameras. So our, our regulatory, uh, uh, our regulatory guidelines have us pursuing a sub-component classification, which means that we have to design to certain engineering standards. Uh, ISO 13 4 85, uh, there's a safety, there's electrical safety 6 0 6 0 1. There's software 6 2 3 0 4. There's a bunch of these, essentially standards that we built to. But our regulatory Subcomponent classification says we designed to these engineering standards. We manufacture those standards, we turn over our device, and our device gets then embedded in a device that goes and goes through five 10 K or, or through regulatory clearance itself. So this is a well-worn path. The camera company that's doing it now for most, for most systems on the market. Got, has been, has been making these cameras for about 40 years and has a ton deployed to the field and, and it's kind of a known way of pursuing things and, and we, we intend fully to comply to those standards.

Joseph M. Schwab 30:19

How do you approach your conversation with potential partners and. Have you received any pushback or feedback or anything surprising regarding a partnership model with VISIE's technology?

Doug Fairbanks 30:33

Y yeah, the, the. This model for going to market as a sub-component is, is different than most and, and probably only fits a handful of styles of products. Ours was the luckily fits in there. It has its benefits and its drawbacks. Uh, but, but as you think about this, uh, approach for the strategics, the challenge in everything is, is something new gonna play out. And so the two conversations that we have is. Hey, does it work? Will be real, which is es essentially challenging the premise of what we do, which, which you should do when you, when you look at a partnership is the, is is typically the first question. The second question is usually. Can we get it exclusively right? So they're kind of at odds with each other, which is, I, I don't know that I believe that this is real, but if it was real, I'm wanna be the only one who owns it, right? So, um, you know, we are embarrassing st various stages of having those discussions with a lot of folks, you know, really drawing the vision. We won ortho pitch at, at AAOS and then we went to acus and, and we showed something that kind of the execution of the device as a follow up. And, and we were, we were surprised that we still had some of these Oh wow. Moments. In fact, uh, we, the team writes down their notes after, and, and the, and a handful of people said, audible Wow. At the end of presentation, like, great, it feels good for us. And so that's nice.

Joseph M. Schwab 31:59

Um, a little bit on intellectual property. You guys have been very busy in the intellectual property space, uh, obtaining 16 or so patents in the last eight months, which is super impressive. Um, can you tell me a little bit about protecting your innovation, protecting your intellectual property, and how does that shape your confidence as you move towards commercialization?

Doug Fairbanks 32:24

I, the, on the subject of ip, this is, this is critically important. And, and even more so as you, as you work into y you know, long development pathway, uh, products, which are anything in, in healthcare. Um, lucky for us, we started with kind of a, an IP approach that was, you know, throw everything against the wall. What sticks, what sticks. But you know, a couple years back we went and hired the, a chief IP officer who previously was at NuVasive, and he, he had the mandate to professionalize their portfolio. And, uh, it's a gentleman named Jonathan Spengler is, he's a fantastic contributor to organization. But, but our challenge is that on a lot of things, we're out front, like we're inventing how to do this the first time. And, and so we, we can't then go tell the world about it without saying, oh wait, we need to own this and we need to own our space. So a lot of things we're out front and this is it. CR creates this very delicate ance of what are you gonna tell today? And has that been cleared? And by the way, there's some really cool stuff on the other side of this wall that I love to tell the world about, but I can't make a public disclosure on something that's really awesome just yet. Uh, we, we continue to file. We are very active on filing and my advice is. To, to surgeon entrepreneurs and, and to those in healthcare is that, that you, that you carefully vet your IP person and, and by the way, you can get somebody, by the way, you need anybody who will go file for you and somebody will go file a ton. In fact, we may have, may or may have not run into that pitfall, which is everything you bring to me, I'm happy to put on file. Uh, bills are billable hours. The lawyers are happy to create billable hours. But the answer is, is that, hey look, are we gonna commercially sell this thing? Is it realistic? Are you doing this test of. Hey, can we, can we sell this to somebody for money and will it be a real product? And, and you really need to start by asking those questions and not let them, you know, give you the, you know, you can't just give away the, the car keys and let someone say, run, unfollow everything you want. You gotta be thinking about commercial. And a good IP partner will say, Hey, are we actually gonna sell this? Or do we just like this idea? And, and by the way, I'll tell you that. With engineers, there's a point of pride of filing IP and, and you gotta walk delicate, um, on the idea that, Hey, look, why I love your idea, why I think it's a novel intervention invention that may not be something that is real useful for us to put forth a bunch of cash on, and we need to maybe hold it off for now or till later and to think about that. So there is some steps to, to doing this right. We are filing, but I think we're filing in a sweet spot of things that have not been done yet and are exciting for the future.

Joseph M. Schwab 35:10

Just a few more questions. Looking ahead, where do you see VISIE's technology going both within orthopedics and given that you started outside of orthopedics? I'm assuming the goal is to move beyond it at some point as well.

Doug Fairbanks 35:25

Yeah, Joe, the, the goal is ortho is really exciting to us. You can, you can affect the lives of a lot of people. You know, I started in pancreatic cancer, drug development, and it was hard as a young guy, you know, I was in my twenties and I was, and everybody was meeting was ending up, you know, passing away and it was really hard work. And I went to orthopedics as a way of saying, Hey, look in, in ortho you fix people and they're better. And, and there is a need, a real need. To, to advance orthopedics and there is an appetite in orthopedics for technology. So we aren't, we are not looking outside orthopedics for anything to run to. We are excited about things that are happening. Neuro is really exciting for us because, you know, a problem gets a little bit easier and, and neuro treatments are advancing and, and we have some passion in the organization working with the brain. So there are, there are spaces that we continue to push on. We, we really like knees. We really are eager to spend more time in hips. We think that there's some value. You think about the challenges in the hips in orthopedics, you know, the hips tend to do really well. Hitting the limbic safe, safe zone is really challenging for surgeons. And how do you advance and improve that? And then if you think about it, leg length discrepancy is, is among, or the most litigious aspect of doing any orthopedic procedure, whether it's trauma, hip, knee, shoulder, whatever, and getting leg lengths, right, just right. We do fantastic on the, on the femur side to be able to see the femur anatomy and to be able to give you some insights about it. That's a really, a strong suit for busy and we're excited about taking the technology and, and kind of proliferating it there because putting a raise and rotating the leg out to, to do all that RMA roll is a huge challenge for surgeon. I think there's an opportunity to, to provide some really good insights there. So while we say, Hey, look, neuro is cool, spine is interesting to us. Ortho has the ability to have an outside impact on healthcare and on people humanity. And we are really excited to continue to push that. We see hip and shoulder as being really exciting areas for growth after we clear this kind of hip, this knee area.

Joseph M. Schwab 37:29

For surgeons or engineers who are listening who have an idea but don't know where to start, if you could give them your single best piece of advice from that perspective, what would you say?

Doug Fairbanks 37:46

Uh, for surgeons and engineer and engineers who have an idea that are looking to say the next step, I think the the first thing you have to do is you, you have to really humble yourself and say, okay. You, you know, I have this idea. I think it's great, but, but do other thing. People think it's great. And most importantly are the people who use it, gonna think it's great, right? And so. You know, I would, I, I always say that finding the problem is really the, if you get latched on the problem or latched on the problem here, but when you get latched on the problem, that really solves a lot of the other things if other people can see your problem. And so what I would recommend in anybody is to say, Hey, are you capable of taking your ideas and telling people that you trust and like, and having them and, and being confident that they may give you feedback that you might not like. Right. And, and. Say can, can I honestly receive that? And if you can't honestly receive that, then somebody, you know, take the idea and give it to somebody else and then get the feedback and then give it to you. Right? Is there something, so always vetting your ideas, spending your time, and, and I attribute my success on, on, on finding, hey, look, pins are pain in the neck. That was just, that was the result of me talking to hundreds and hundreds of surgeons. All over the world. And, and for that insight, that insight just bubble up to the top and, and create a thing. So really vetting your idea is the, is the critical first step because we can see technologies, and by the way, it's really easy to get fascinated by technology. And you're like, oh, that's really cool, but, but, but what does it solve? And does it do something that's, you know, how do you walk this fine line between gimmicky. And real use cases that are gonna mean something to somebody. And, and that's where we read zero in. So if I give advice to new engineers and surgeons is go out and talk to your friends and say it's somebody else's idea. Say, I, I heard this idea. What do you think about it? So that they feel comfortable giving you the honest feedback. That's the dumbest thing I've ever heard. Move on. You go, oh, that hurts my feelings, but at least I'm not, uh, seven years in and$20 million in this. And then someone tells me it's terrible. Right. You know, that's better to know early. So.

Joseph M. Schwab 39:55

So our series is titled From Idea to Market and, um, you've been kind enough to share your, your thoughts with us here today. Um, if you were to take that phrase from Idea to Market. And apply it to the stage you're at in VISIE's journey. What, if anything, does that mean to you personally, or, or, um, what would you think about that?

Doug Fairbanks 40:21

Yeah. The, the term idea to market, uh, I think is one that resonates well with me, right? Because that, in this interview I talked about, you know, the various achievements of the company and meeting milestones and accomplishing things. And by the way, it, it, if you, if you say that from idea to market is a journey, it, it actually is important to treat it as such as the new. When you win Anterior Hip foundation, when you win ortho pitch, when you're a finalist at South by Southwest Health, and when you, when you have these accomplishments along the way, it's important to say, oh, I feel good about that. I've done something. I've advanced, I've moved forward, and I've somehow somewhat validated the ideas and things that I'm pursuing, which are good because you'll need fuel on a journey to keep going. Now, it also ties back to the other concept, which is, hey. You know, there's not a whole lot to celebrate in the grand scheme of things here, because market to market is the end goal. VISIE still on the other, in the other room, we have a board that says, number of patients treated zero. You know, we haven't accomplished our goal. We haven't set out, we said, we will get to market, we will treat patients, we will advance healthcare, and, and you gotta stay locked on. While it feels good to have these steps along the way. Still is the goal. You gotta get to the finish line. The finish line is get it to market and treat patients and, and do the good that you promised because you can get caught up. There's lots of people who get caught up in startup and just spend a lot of time going to networking events and ha happy hours and, and doing the contest, but the contest is not the answer. You gotta be mindful about goals and so there's two pieces to this. One is when you need to enjoy the journey, celebrate the wind because they can sustain you. The second is. The job is not done till the job is done, and it's our goal to deliver for patients, and that's what, that's what we intend to do.

Joseph M. Schwab 42:20

Thank you so much and thank you for talking with me today. If there's anything that you wanted to say that you didn't get a chance to with the questions. You've been more than generous with your time.

Doug Fairbanks 42:30

I really appreciate the time, Joe, and, and thank you for taking the time to, to think about innovation. You know, we talk about casting a vision into the world, and, and it takes, it takes folks on the other side to hear and be interested. In a better way for us to survive. Right. We, we have to say to somebody and, and it's nice when we see surgeons and, and organizations like Anterior Hip Foundation saying, we're gonna dedicate, dedicate time to innovation and to embracing and learning about what's new because it may help us do this thing better. And I'm excited about that. We really do appreciate Anterior Hip Foundation and you taking the time to chat with us.