Colorectal Feb 2017 The company The laser The fiber Clinical Value Surgical Technique Overview Private company Headquarters and RampD in Israel Founded in 2012 20132014 20142015 20152016 CAGR 5060 ID: 908732
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Slide1
Business Plan July 2012
neoLaser -
Colorectal
Feb 2017
Slide2The companyThe laser
The fiberClinical ValueSurgical Technique
Overview
Slide3Private company
Headquarters and R&D in IsraelFounded in 20122013-2014, 2014-2015, 2015-2016 CAGR 50-60%> 30 distribution partners globally in North America, Europe, Asia, Pacific and South/Central America regions
Key areas of activity – EVLA, Colorectal, Spine, ENTLaser manufacturing in dedicated GMP compliant facility in IsraelCompatible Adler
Micromed Surgical Fibers Made in GermanyLaser and Fiber FDA Clearance in December 2015
The Company
neoLaser designs and manufactures top quality laser devices for the medical field
Slide4neoV
System Deployment Global
Current install rate of 150 systems per year globally
Key Markets: Germany, Netherlands, USA, Italy, Australia, Spain, France, UK, India
Slide5PrecisionUnique design
PortabilityQualityStabilityReliabilityUsability
The neoV1470
Slide6PORTABILITY
Proprietary cooling technology allows for much smaller unit, only 9”X9”X4”Only 8 pounds! Ffull
portability, special suitcaseQUALITY and RELIABILITYLaser engine – DILAS diode, #1 in the world in quality of laser diodes, Made in Germany, rated for 3,000 hours of laser on timeLaser touch screen – Made in Japan, Mitsubishi, super high brightness and resolution, wide viewing angles
Optics from Edmunds USAAll aluminum metal unitTop notch relability, over 300 units placed with <1% failure
USABILITY2 min setup from entering room to OR readyEasy and user friendly, all touch screen activated
Procedural presets
The neoV1470 – QUALITY FIRST
Slide7neoV
- Accessories
Interlock Plug
neoV
Laser
Power Cable
Power Supply
Goggles
Foot Pedal
User Manual
(inside top lid)
Slide8Laser ready room (warning sign, goggles, limited access)
No special electricity needsUnit is air cooledAmbient air temp <75FDo not block air inlet/outlet, do not put next to heat sourcesLower limit for unit temp (to turn on) is 50F. Do not store unit in freezing tempsHumidity limit is <80%
No ongoing maintenance/service needed. Check power once a yearAlways transport inside original suitcase
neoV – Unit Install Considerations
Slide9neoV
– Unit Front
Slide10neoV
– Unit Back
Power Cord
Interlock Plug
Foot Pedal
On/Off Switch
Slide11neoV
– User Interface
Very simple UI
Allows for storage of presets for specific application
Unit fully controlled through touch screen (can be used with surgical gloves)
Slide12neoV
– Setting Screen
Slide13Special Radial
emission for optimal energy deposition inside the fistula tractTop quality production (Fibers Made in Germany)Smooth atraumatic tip for direct insertion600um core, 1.8mm tip
Fully fused glass tip for extra safety
Adler Micromed Surgical Probe for Fistula
Slide14An anal fistula (also commonly called fistula-in-
ano) is frequently the result of a previous or current anal abscess. The fistula is the tunnel that forms under the skin and connects the clogged infected glands to an abscess. A fistula can be present with or without an abscess and may connect just to the skin of the buttocks near the anal opening.
No real solutions except for surgeryOpen surgery (opening and fixing the fistula) requires going through anal sphincter – very big long term risk of incontinence
Anal Fistula
No good sphincter saving options exist (success rates <50%)
The laser enables the first sphincter preserving option with 60-70% success rate
Prevalence ~8.6 per 100,000 so for
300M
people should be
~26K potential cases
. Assuming repeat in 20-30%,
~35K potential annual
cases. Very problematic cases for treatment
Slide15Pre Surgery
Blood thinner: DiscontinueBowel Prep: 2 evacs with Lecicarbon day of surgeryDuring SurgeryAnalysis: 3D Ultrasound
Antibiotics: Single Shot Cefuroxim + metrinozidolAnesthesia: General anesthesiaLocal Anesthesia: 3ml bupivacaine 0.5% with adrenaline 1:10,000
Laser and Probe: 1470nm, Fistula ProbeDosage: 10W, 3sec Pulse every 5mmKey points: Start at internal opening and trace back. Keep tip clean, push gently every few pulses to feel resistance. If big cavity, work in fan shape
Anal Fistula - Technique
Slide16Post Surgery
Slight pain and purulent discharge up to 6 weeks post opBandage: Shower with water 3 times a day and dexpanthenol ointment on a gauze compressSick note: 7 daysPain Killer: Ibuprofen 600 if necessary
Bowel movement: Psyllium (Plantago ovata) 5 gram after breakfast 3 weeks, not liquid bmSports: No heavy weights and contact sport for 3 weeks, no jogging or cycling for 1 week, no swimming in pools until wound closure
Anal Fistula - Continue
Slide17Italy (
Giamundo et al.)Long term results on 45 patients71% success rateOriginal technique – with flapDr. Zwiesigk, with
neoVExperience of >100 cases81% overall healing rateChanged technique – without flap, results for first treatment – 71% success
Second treatment always possibleAll patients save sphincterAnal Fistula - Results
Slide18Sinus cavity in lower back
Infected with hair and tissueIn the past, treatment involved open surgery to clean sinus and resolvePain and long downtime for patients, scar as wellLaser allows minimally invasive treatment without opening the skin
Pilonidal Sinus
Slide19Use of radial fiber
(Fistula Probe)Insertion through small opening, same general technique like FistulaProper cleaning of cavity before laser application1470nm, 10Watts, 3Sec pulses while retracting every 5mmTreatment of entire cavity
Pilonidal Sinus Technique
Slide20Pilonidal Sinus Technique
Pre SurgeryBlood thinner: Discontinue
During SurgeryAntibiotics: Not neccessaryAnesthesia: GeneralLocal Anesthesia: bupivacaine 0.5% with adrenaline 1:10,000 to broaden tissue thickness
Laser: 1470nm with Fistula ProbePower: 10Watts, 3sec pulseShots: 3sec pulse every 5mm. Start at one end of fistula tract, gently pull back until adherence loosens, clean tip during procedure to remove carbonization, then place back until feeling resistance. In case of wide cavity work in fan shape to reach every edge of cavity
Slide21Pilonidal Sinus Technique
After SurgeryPost op feeling: Low pain, low discharge and bleeding until 4 weeks
Bandage: compressing dressing immediately post op, no adhesive bandage after first changing of dressing, shower with water 3 times a day and PVP-iodine ointment on a gauze compressSick note: Rest for 3 daysPain killer: Ibuprofen 600 if necessary
Sports: No heavy weights and contact sport for 3 weeks, no jogging, cycling for 1 week, no swimming in pools until wound closureHair removal: No evidence of advantage of hair removal after complete healing, but necessary until wound closure
Slide22Based on 50 patients in Berlin (Dr. Zwiesigk)
Overall 83% success rateNo problem to repeat treatment if necessary81% forced wound management included
Pilonidal Sinus Results
Slide23Thank you
neoLaser
7
HaEshel St.Caesarea Industrial Park
ISRAEL 38900www.neo-laser.com
shapirag@neo-laser.com