01:20   Lena' start in the world of medtech. A story about four students with a schnitzel ending up founding a medical devices company.

03:11 Lena discusses her background and how  someone without a medical background becomes a HealthTech entrepreneur?

04:38 Lena's experiences and lessoned learned from the PolyTouch acquisition?

06:54  How do you know in advance that the need is large? Was it clear from the PolyTouch product? 

08:25 In retrospect after 10 years, does Lena think the Polytech story was a success?

09:33 The story of Via Surgical.

11:42 Getting involved with surgeons and specialists in the development of the product itself.

12:58  Tips to companies that are thinking of getting KOLs on board.

14:12    How does Lena have input of what is happening in the market in terms of innovation. How is this factored in the evaluation of the market?

17:32 Lena expands on the difficulty in selling single product into the surgical market.

19:12   Lena shares a little bit about your experience selling in the US market with a product like yours.

22:05 What has Via Surgical done around online sales advertising in social networks.

23:36  How difficult is it to raise money for pure medical devices with Digital Health taking a portion of the funding and are you seeing a change in terms of who the investors are and what the focus is. 

26:08 The best tips to companies who are thinking about working with Israel's representative offices worldwide such as the office that supported your deal with Catcher out of Taiwan.

29:47 Lena's view of the unique challenges or different challenges that she faces being female CEO and entrepreneur.

34:19 Future directions of Via Surgical. What's next?

Lena Levin is the co-founder and Via Surgical. Her previous venture PolyTouch Medical was acquired back in 2011 She has managed to raise tens of millions of dollars over the years from private investors and Israel innovation. And in her not so free time, she mentors early-stage startups and different accelerators. Thank you, Lena, for joining us.

How do four students with a schnitzel end up founding medical devices company?

Lena Levin: We had this idea back in the university seeing for the first time, how the surgery is done and being exposed via YouTube to first minimal invasive surgeries. We saw a lot of opportunities on how we can improve it from the perspective, not a physician or a doctor, but from the perspective of the patient. We choose one of the most common surgeries done today, hernia repair. 20 million hernia repairs are done annually worldwide. So, it's one of the most common routine surgeries done today. Back several years ago a strong sentence was used, saying a routine surgery should have routine positive results. This is where we came in. We wanted to develop smart instruments for surgeons to make complex surgeries better, more accessible, and having patients back healthy and productive as they were before surgery and not suffering as a result of the lack of instruments.

You do not have a medical background. This is the most amazing thing. How did you come together to this wonderful world we live in?

Lena Levin: When I came from the USSR to Israel, I wanted to be an English teacher. I studied English and literature at Haifa University initially, but I was not a very good teacher so I became a serial entrepreneur. The passion was there and the whole innovation was oriented towards patients. I think this is the common between being a teacher and being entrepreneurial in health tech and med-tech, where you look at the patient and you innovate through their pain not than the other way around. I think it came from where we saw a strong need for more accessible instruments. We saw the struggle of surgeons in complex procedures and in simple procedures and it shouldn't be this way. So, this is where the innovation came from and the common background between being a teacher or being a physician or being an entrepreneur in this field of surgery.

We want to take you back to PloyTouch. PolyTouch was sold very quickly. We wanted maybe to hear from you, what you learned from that, what the experience was like and what you can share with listeners around the PolyTouch acquisition.

Lena Levin: So back then, we were still students me and my two co-founders, Ofek Levin and Arik Levy. During one of the workshops in the university, we always were thinking about making an impact, innovating and creating a company. The ideas varied from green technology to minimally invasive surgery. I think what really gave us a push to innovate was an entrepreneurial competition program in Technion-based tech. This is where we started. We were probably in the second around of this competition and we were given access to mentors, to physicians, to people who have done business. We won first place at the Technion competition and this is where it all started. The idea was simple. Let's create something that helped to spread the hernia mesh in a minimally invasive procedure. The design was more complex than the idea itself. I think we entered incubation right after we won the first prize. Within two years we sold the company just because the need was there and we were in the right place at the right time, innovating in the right direction, creating minimal invasive instruments exactly when the market was ready. So, it's the combination of luck and passion.

You're saying it was a lot of luck because it does sound to me and I'll give you a little more credit than that. It sounds like you're looking for a need before you decide where to go. Was it so clear to you when you set on your way around this PolyTouch product that the need was so large?

Lena Levin: Actually. I consider myself lucky and PolyTouch was a lucky project in a way in a a niche market. We were never backed up by VCs in PolyTouch Medical because we addressed a very small market with existential needs but still, the numbers of volumes are small compared to other markets. Let's say, general surgery or orthopedics, or plastic surgery. We focused more on a need of a patient rather than a market size. So, that's why I call it luck. Despite all the theoretical backgrounds about exits and how you choose the correct project, we went with our hearts to what we thought was essential.

In a Failcon Conference, and you talked about the PolyTouch experience. In retrospect after 10 years, do you think it was a success?

Lena Levin: I think it was a success. I definitely think it was a breakthrough because then I saw a wave of innovation in this field of minimally invasive surgery. It's amazing we started in 2000 and surgery is one of the fields. If we look on other fields like semiconductors, like cell phones, even our computers, everything is changing so rapidly. But in surgery, it occurs very, very slow. So I'm happy to be at the beginning of this revolution where suddenly robotic surgery occurs and suddenly novel instruments and improved cameras and improvements occur. I was there at the very beginning so in retrospect I think it was a success.

Even though the product did not hit the market you are here. You sold the company, you learned a lot along the way, and you founded Via Surgical so I think now's the time to tell us what Via Surgical does.

Lena Levin: Via Surgical was an organic development out of PolyTouch. We sold PolyTouch Medical, and we were two years in this field. We learned a lot from observing surgical procedures and we saw a bigger need than just spreading the mesh. Basically, suturing in minimally invasive surgery does not exist or didn't exist up until Via Surgical. The way a surgeon could suture in open surgeries traditionally does not exist in this field. So, all the discrete or standalone sutures were replaced with screws, anchors, all kinds of alternatives that can replace sutures just because there were no ways to deliver the suture in a minimally invasive way. We took it as a challenge. We thought it would take two years R&D. It took us almost seven. Why not deliver a suture in a consistent, accurate, stable way via port of two or five millimeters, whatever is required for a specific surgery? We started from hernia repair, but the vision was much larger because if you look at all soft tissue repair, you can see that screws are used in cardiovascular surgeries, in orthopedics for soft tissue repair, where it's so natural and so instinctive that you know that soft tissue repair needs something more delicate and more suture-like rather than a screw-like.

In seven years of R&D you really have to be very much collaborating with your users. Surgeons in this case. How involved were surgeons and specialists in the development of the product itself? How how much did you go and test all the time with what was happening in the surgical theater to make sure that what you were developing was something that could be used?

Lena Levin: This starts from the very beginning. When we have an idea and if I hear from surgeons that only 80% or 50% love it, we don't start the project. So, we really need an idea where a surgeon says, almost everyone, 99% say okay, I need it. This was the case with suturing in minimally invasive surgery. All surgeons said we need the suturing there as well as we had previously in open surgery.

What tips can you give to the listeners, to companies that are thinking of getting KOLs on board and having them committed to the company for years? What exactly should they be focusing on?

Lena Levin: We have a very large board of key opinion leaders at our medical advisory board from the Past President of the American Hernia Society, Dr. Karl LeBlanc to the very young and very ambitious surgeons. What is common about them is their passion to innovate. The only criteria I have for surgeons is that they have a passion for innovation. They want to change the way it is done traditionally. It's very important. Maybe it sounds trivial but it's so important because the way a surgeon is trained, they do hours over hours over hours of repetition until it became automatic. In order to change it, you really need willpower and collaboration on a high level of surgeons to do it.

You're right that the innovation in this space is coming slowly. But we are seeing robotics and we are seeing more and more virtual reality and augmented reality and all sorts of digital innovations coming into the surgical theater. As a CEO, how do you manage to have the input of what is happening in the market in terms of innovation, and how do you factor that in, in your kind daily or maybe quarterly evaluation of the market?

Lena Levin: If we look at the top level, I'm very excited that robotics is entering the field of surgery. It gives the surgeons additional instruments and tools to perform surgery better, to make better outcomes, and patients feel better. For me, I want to be there as an accessory. I want to be the first suture and accessory for the robotic arm. For example, the da Vinci robot is used in hernia repairs. You still need to suture by hand manually which is strange. You have this huge machine, half of the OR room is occupied and you don't have accessory to perform minimally invasive soft tissue surgery. So, I want to be there with my next phase product, to be an enabling technology for robotic surgery as well. We explore our platform to other procedures where we want to replace metal screw-like invasive and painful fixation to delicate soft tissue fixation that is based on suture on a closed-loop design.

The more robotic platform will enter the market, the more surgeons will get to use it. The more the need for accessorizing, the robotic platform will be required, and we are ready to be there with a fixation device.

Your product is an amazing feat of engineering. I don't think that people realize how difficult it is to use a regular tack-like gun but to close the loop so it will look like and seem like a suture. How difficult is it for you when you come and you try to sell this single product (an accessory) into the market? Especially when there are large companies in the laparoscopy space selling complete solutions with tacks?

Lena Levin: Before this stage of marketing, we worried about it but that's why I start at the very beginning and I choose a project where 100% or 99% of surgeons say yes. In a way, they were ready for sutures to be introduced to laparoscopic surgery. The concept is very intuitive, not only for surgeons but also for patients. The marketing is challenging but I see the reaction of surgeons and I see how it's expanding. It's challenging in a way that it occurs slowly. You have to gain your reputation. You have to show clinical data and everything takes time. So, we approach it in a very responsible way where we have baby steps, but every time we measure the reaction of surgeons and it is very positive.

I love hearing how connected you are to your users. I think that's super important and a really important takeaway from this conversation. But they actually don't pay for this. At the end, someone else is paying for these. I know you've started selling in the US. Can you share a little bit about how you're doing that, what your takeaways are from entering the US market with a product like yours?

Lena Levin: When you talk about paying, then they are paying with their health and their productivity and the days they are staying at home. We can measure payment in a different way, the quality of life, the production before and after the surgery, the chronic pain. The hernia recurrence today is between 5% to 20%. So, my vision is to reduce it to 0% in the long-term, and in a way, that's why it was designed and so complex as it was. I see it as a state-of-art and Chen maybe knew, because I talked to him about it in the past: How difficult it was to design the closed-loop that closes consistently every time in every procedure, in every patient. The combination of this design specific that is more beneficial for the patient together with the excitement of surgeons to have a suture back in a minimally invasive way. That helps a lot.

We operate in the US. This is our first market and also in Israel through independent reps and through distribution. In a way, I cannot really innovate the way it is done. So, it is done the traditional way. You go to a hospital, you have an evaluation, you have feedback from several surgeons and if it is positive you are in. We see gradual growth. So, we have a 50% retention rate from evaluation to enter the hospital and zero drop. As soon as hospitals start ordering, they order again and again. For me, it's a positive sign and we combine the innovation and startup nation methods with the traditional way the marketing in surgical places are done. We can measure major KPIs and I see the retention rate and I see the satisfaction of the surgeons and I see zero drop off. So, for me, it is a successful entrance.

I know that you started doing some work online. Medical device companies are a little bit careful when it comes to these newer platforms. What can you tell us about what you've done? How it's going?

Lena Levin: When the COVID breakout pandemic occurred, we didn't have any other choice. So, we basically used the online platform as a training tool and incorporate it in a very traditional space as surgery. So, we train all our reps and even surgeons online during this period and it gave us better feedback because we can measure every step where there was a problem, so we can react more quickly. We are in Israel, in the bubble of all tech AI and that helps a lot to incorporate and think as an entrepreneur, although we're still in a very traditional and heavily regulated space.

Let's talk a little bit about funding. In a world where digital health is now the trend and AI and machine learning. How difficult is it to raise money for pure medical devices and are you seeing a change in terms of who the investors are? Do you go to the same groups? Are you seeing missing funding for medical devices?

Lena Levin: Our major investor today is Olive Tree Venture Capital, which is also investing in digital health heavily. In the end with all the digital health progress which helps us a lot also developments in robotics, someone has to do the surgery. Someone has to close the hole. I want to be the end of the robotic arm. The more digital health is developing the better for me. The patients are more educated, but in the end, surgery is something that is done by hand. Unfortunately, up until now, there is no alternative to surgery. All over the period, I was heavily supported by angels especially at the very beginning, but now we're already at the step of strategic where we have strategic investments with people who are focused on this field and are dedicated to this field. That helps a lot.

This is actually really good news because the feedback that I've been hearing sometimes is that investors are a lot more careful when it comes to let's say, pure-play medical devices that do not connect to something. But as you pointed out, you're working with Olive Tree Ventures with Amir Lahat and they're an amazing group of investments. I'm sure they're extremely supportive. I saw that you recently added Catcher Technology to your partners and investors which is really exciting. I understand the deal combines investment with manufacturing and distribution. Could you talk about that and maybe more specifically? The Israeli Foreign Trade Administration brokered the deal. What tips can you give to companies who are thinking about working with Israel's representative offices worldwide?

Lena Levin: With Catcher it was a surprise for us as well. Catcher is a well-known, publicly-traded Taiwanese giant. The majority of the focus is Apple. Everything that we have in Apple, not everything, but at least some part of Apple hardware came from Catcher. From my perspective, I remember I actually got called from the representative of the economy department of the government asking if I would consider a strategic investment from this Taiwanese giant. Again, when we talk about luck, I think we were lucky because we were chosen by Catcher, out of a list of a lot of companies. At the corporate level catcher received a decision to enter the medical device market and we were one of their first investments into the medical device field, which came through very high levels. Saying that I'm happy that Via Surgical is visible on the industrial field, then the technologist recognized. For us, it's pure luck to have a partner such as Catcher.

I want to hear a little bit more about working with the Israeli government and the different representatives. They came to you but still, are there ways that you can leverage that as a startup generally?.

Lena Levin: This specific department of the Minister of Economy that helps startups. They approached us and it was not a passive role. In a way, they were very helpful mostly when acting as a VC in a way that they helped us to go through the due diligence. It was through the very challenging time of COVID outbreaks all over the world where borders are closed. The quarantine is all over. They did do diligence on behalf of Catcher on our facilities and clean room. They were very, very active, which is usually not something that we think about when we talk about government or governmental grants. It usually comes as a passive grant but here they were very active, very supportive, and I'm very, very grateful for this specific division that facilitates and helped us secure the investment.

That's amazing. One question we always ask our female CEOs who we interview about the landscape at the moment is that the majority of CEOs in the med-tech space are men. How do you see the unique challenges or different challenges that you face being female CEO and entrepreneur?

Lena Levin: Well yes it is because I am a woman, meaning I am not only the CEO, I'm also a mother of three children. I grew up in a family where women were very strong. My grandmother was the CEO, my mother owned her own business. I inherited this model of independent, strong women and it helped me a lot. At the very beginning, I think I was the only woman in this world, but through time you see that a lot of women are entrepreneurs, especially in the med-tech space. For me, sometimes I always got support from females or males from my surroundings. I never felt that it is something different. I think it was my attitude that if you do your work professionally it doesn't matter. But in a certain way, it was unaware of males versus females about our obstacles.

For example, when my kids were small and I needed a private space to nurse. It was the most lucrative law firm, and there were no nursing rooms. While they have a 50% of employees, female. So, these are things that are slowly changing and it came from unawareness or indifference because male CEOs have different problems from female CEOs. So, we still want to be also mothers and having a balance between family and career. Usually successful male CEOs have a woman who doesn't work. Maybe she's fully dedicated to the family so he can go and do his career. In a female situation, it's usually different. You have to find this balance. I had full support from my co-founders and from employees, which also for me was a revelation because when I looked at the R&D department, I saw two years ago, it was 80% men. Today it's 50%, female and male. So this awareness has also something that I think female entrepreneurs or female CEOs has to take into account as well. I had a case where we developed the product. It was on a pilot. It was in evaluation study and suddenly I figured out that we made the handle suitable for a male’s hand. A female surgeon said, well, it's too big. I cannot use it this way. This was embarrassing because I am the CEO. I am female, I have a smaller hand and it didn't occur to me up until this evaluation stage. So, I think awareness is the biggest step. The more we talk about it, the more we share, the more support we receive, and the more we collaborate.

If you look at the statistics during the COVID period, you see that majority of unemployment occurs in the female sector. Women gave up their careers to take care of family. So, we not only didn't fire any women during this period, we took two more females on board.

Where is Via Surgical going next? What are the next five years going to look like from your perspective?

Lena Levin: Oh, we have very grandiose plans. I cannot reveal it unfortunately because I am bounded. We have exciting news and I hope till the end of the year, we will do a very large announcement. As I said, laparoscopy, it's only the beginning and we do not stop there. We want to be the first soft tissue fixation for any soft tissue fixation surgery that involves today metal tacks or screw-like staplers.

Thank you very much for the time you spent with us. I was lucky enough to work with you guys. As I pointed out, the first time I saw this closed-loop suture I said, you know, it's basically a piece of plastic what is the big deal? But then we went and we needed it. We decided that we want to shoot it, film it to see how it closed and is it reproducible. We had to get a camera that is able to capture 15,000 frames a second or something crazy like that, just to see the motion and the fact that it's reproducible. It happens every single time is truly amazing. Hats off.

Lena Levin: Yes. Thank you. This work was amazing while we were working with you and with Yoram Reshef and the shooting the product at 15,000 frames a second it was a masterpiece.

Lena Levin's profile on LinkedIn

Via Surgical's website

Catch Group's website

Olive Tree Ventures' website

Amir Lahat's Profile on LinkedIn