Medsider: Learn from Medtech and Healthtech Founders and CEOs - Childlike Curiosity and the Scientific Approach to Medtech Startups: Interview with Levita Magnetics CEO Dr. Alberto Rodriguez-Navarro

Episode Date: November 3, 2023

In this episode of Medsider Radio, we had a chat with Dr. Alberto Rodriguez-Navarro, CEO of Levita Magnetics, a startup aiming to make surgical procedures as minimally invasive as possible with its advanced magnetic technology. Dr. Rodriguez-Navarro is not only a skilled surgeon but a medtech visionary with multiple patents to his name. Discover Alberto's journey spanning his childhood fascination with using magnets to clean the inside of his turtle tank to leveraging this concept into a cutting-edge magnetic surgery platform.  In this interview,  Dr. Rodriguez-Navarro discusses what to consider when starting a new business, how to hone your framework when transitioning from the clinic, and early-stage strategies to ease the road to FDA approval. Before we dive into the discussion, I wanted to mention a few things:First, if you’re into learning from medical device and health technology founders and CEOs, and want to know when new interviews are live, head over to Medsider.com and sign up for our free newsletter.Second, if you want to peek behind the curtain of the world's most successful startups, you should consider a Medsider premium membership. You’ll learn the strategies and tactics that founders and CEOs use to build and grow companies like Silk Road Medical, AliveCor, Shockwave Medical, and hundreds more!We recently introduced some fantastic additions exclusively for Medsider premium members, including playbooks, which are curated collections of our top Medsider interviews on key topics like capital fundraising and risk mitigation, and a curated investor database to help you discover your next medical device or health technology investor!In addition to the entire back catalog of Medsider interviews over the past decade, premium members also get a copy of every volume of Medsider Mentors at no additional cost, including the recently launched Medsider Mentors Volume IV. If you’re interested, go to medsider.com/subscribe to learn more.Lastly, if you'd rather read than listen, here's a link to the full interview with Dr. Rodriguez-Navarro.

We have a very scientific method approach. We have an hypothesis and with the team, we develop a way of testing our hypothesis in the most efficient way. I see how we can really focus in the core principal question that we want to answer and we set a plan how we can do it the fastest and with the less resources. We follow a lot of ethical guidelines, but we are very focused in terms of okay, how we can have the first in human. and we really are very close to the experience and we learn and iterate fast. Welcome to MedSider, where you can learn from the brightest founders and CEOs in medical devices and health technology.

Join tens of thousands of ambitious doers as we unpack the insights, tactics and secrets behind the most successful life science startups in the world. Now here's your host, Scott Nelson. Hey everyone, it's Scott. In this episode of MedSider, I sat down with Dr. Arberto Rodriguez Navarro, CEO of Levita Magnetics. Not only is he a skilled surgeon, but a med tech visionary with multiple patents to his name. Today, Dr. Arberto is the driving force behind Levita, a startup aiming to make surgical procedures as minimally invasive as possible with their advanced magnetic technology. Here are few of the key things that we discussed in this conversation. First, prioritize the scientific method from the beginning. Focus on effectively forming and testing

your hypotheses, begin with an MVP, gather real feedback. and then improve it in the most capital efficient way. Second, transitioning from clinician to a startup demands adopting a different mindset. Trust your abilities, but be receptive to feedback. Before delegating responsibility, dive into the roles yourself, as Dr. Rodriguez did by becoming Levita's first sales rep. Third, think like the FDA. Both the entrepreneur and the FDA share the same goal, creating and validating a safe and effective

product. Adopting this mindset will help you recognize the constraints of those on the other side of the regulatory table. Before we jump into this episode, I wanted to let you know that the latest edition of Medsider mentors is now live. Volume 4 summarizes the key learnings from the most popular Medsider interviews over the last several months with folks like Rob Ball, CEO of Shoulder Innovations, Kate Rumroll, CEO of Obelative Solutions, Dr. Christian Ramdo, CEO of Tempe Health, and other leaders of some of the hottest startups in the space. Look, it's tough to listen or read every Medsider

interview that comes out, even the best ones. But there are so many valuable lessons you can glean from the founders and CEOs that join our program. So that's why we decided to create Medsider mentors. It's the easiest way for you to learn from the world's best medical device and health technology entrepreneurs in one central place. If you're interested in learning more, head over to MedsiderRadio.com forward slash mentors. Premium members get free access to all past and future volumes. And if you're not a premium member yet, you should definitely consider signing up.

In addition to every volume of Medsider mentors, you'll get full access to the entire library of interviews dating back to 2010. You'll also be able to see all of our playbooks, which are handpicked collections of the most insightful interviews with the brightest founders and CEOs. Whether you're looking to master capital fundraising, navigate early stage development, tackle regulatory challenges, understand reimbursement, or position your venture for a meaningful exit, MedSider Playbooks have you covered. And last, considering that fundraising can be one of the most daunting tasks for any startup, we created a meticulous database of investors right at your fingertips. Explore a wealth of VC funds, private equity firms, angel groups, and more, all eager

to invest in medical device and health technology startups. Access to this database is a premium member exclusive, so don't miss out. Learn more about MedSider Mentors and our premium memberships by visiting Medsider Radio.com forward slash mentors. Again, that's Medsider Radio.com forward slash mentors. All right, without further ado, let's jump right into the interview. All right, Dr. Alberto, welcome to Medsider Radio. I appreciate you. coming on. Thank you very much for having me here. Yeah, and I know you're a full on MD, but for the sake of the conversation to keep this informal, I'll call you Alberto throughout the rest of the interview here. That's okay with you. Yeah, I prefer that. I prefer that.

All right, sounds good. Well, I recorded a bio for the listeners kind of at the outside of this episode. Let's start with kind of your elevator pitch for your professional journey leading up to, you know, founding, operating Livia as the CEO. Yeah. Well, I am a Minervative surgeon, turn entrepreneur. I worked almost 10 years in the clinical practice. I was the chief of the ambulatory surgical unit of my hospital. And also I've been involving research, mostly pain research. So that's what's my previous past before I decided to stop my clinical practice, move to the Bay Area, and start Levita.

Okay, got it. And we're recording this in Q3 of 2023. And it looks like you started Levita about a lot. a little over 10 years ago now? Is that about right? Yeah. Yeah. Almost 10 years.

I mean, the first years, I still was kind of like in the clinical practice and also starting the company. All in in the company, I would say like around like eight, nine years. Got it. Got it. Okay. Very good. Let's call it just for the sake of rounding purpose, almost a decade in at this point.

And I think you're recently announced a 510K clearance. So congrats on that. And certainly we'll get into that in more detail here throughout the rest of the conversation. Begin a little bit, set the stage, I guess, not go too far into the weeds, but give us kind of an overview of the technology and sort of how the origin story, I guess, and how it sort of came to be. Yeah. I mean, we have a very unique and disruptive approach.

We're combining magnets and now, I mean, we started developing dynamic magnetic retraction that is a fundamental technology in order to make surgery less invasive. That is mostly using magnets in order to do the procedures. And now we combine that with machines in order to, always bring more value, how we can make the surgeons more effective, more and more efficient in terms of providing better surgeries and for more patients. Our technology is aimed to bring benefits to the patient in terms of less pain, faster recovery, like a less invasive procedure, less scars. Also bringing benefit to the surgeon to give it more control. If you have more control,

better visualization, you can be more effective in terms of doing the procedure because you are in control and also for for us it's important to bring value to the providers to the to the hospitals to the surgical centers because we reduce the the need of so many people in the OR so we bring savings in that way and also we provide a better patient experience because it's less invasive less pain so it's a very kind of compelling value proposition for for these three stakeholders got it got it and i'm on your site now levita dot com if you're following along and don't get to the summary write-up for this particular conversation. It's L-E-V-I-T-A-com. You can learn a little bit more about the system that Alberta just described. But if I'm understanding this right, you've got sort of

like this idea of magnetic surgery, which I'd love to learn a little bit more about because it seems super interesting. But are you, if I understand this right, are you combining that with almost like a robotics platform to them? Yeah. I mean, the first we developed the magnetic component. The story is very interesting because the origin is based on these magnets that you use for cleaning the kind of water tanks. When as a kid, I have like a turtle, this kind of like sea turtles, and we have a magnet that you put inside and another magnet that you put outside of the glass and you kind of clean it. So the basic component is that.

It's kind of how you can do something inside of the cavity without damaging the wall. So that's how it started. And we developed the first product. We create a new category in the FDA. we launched that product. We realized that we bring the clinical benefit mostly by the reduction of incisions, because incisions are the ones who are mostly related to pain after the procedure. So you reduce the incisions, you reduce pain, you reduce the use of pain medications,

as opioids, and all the side effects. So it's a much better post-operatory time for the patient. And in this first launching of the product, we figured it out that if we combine these, with machines, with kind of arms that can be moved by the surgeon, you can start bringing more value. It's a better way of moving the magnets. You can also add visualization to control the visualization, and you realize that you start going in that way,

and you give control to the surgeon, and you reduce the need of an assistant. So that's why we got the idea of developing the full Mars platform. And also I can tell you that this is another stepping stone. We have a very strong pipeline of new products. that we are developing, also based in the same concept. So this is just another step in our journey. Got it, got it.

That's super helpful. And Mars stands for magnetic-assisted robotic surgery. Is that the acronym? Yeah, we want to bring some new stuff. We have the trademark Mars. We want to probably make some tweaks about it. Got it, got it. Okay, so you got, yeah, stay tuned.

You got more coming is kind of what it sounds like. So if you can, let's pretend I'm, you know, a ninth grader, you know, a freshman in high school. Can you give me like a high level or a basic understanding of how magnets actually like help, help prevent, you know, trauma to the vessel wall? Yeah. Yeah. I mean, when you do the surgery, the basic concept, if you need kind of like traction, contra traction, and then kind of like being able to see and do the procedures, it's kind of a mechanical process. So for that, you have to get access to the abdominal. cavity. In the early developments of surgery, what we did is like a big incision and you have kind of direct access to the organs with your hands. You save the patient, but with a very high metabolic cost in terms of the damage that you are making in order to get to the organ. This evolves in the

80s in laparoscopic surgery that actually they changed that big incision for mostly four or five incisions where you put a camera, you put different instruments, kind of like your two hands of the surgeon, kind of like a little bit of like a folk and a knife, and also some instruments just to create the surgical field. It's very well documented that this less damage in the abdominal wall is the big benefit of laparoscopic surgery. So in that trend, the idea is reducing even more the damage that you're producing the patient, the incisions. But there's a point that you start compromising the capability of the surgeon to do the movement. And that's where a magnet are a very transformational solution,

are a very elegant way that if you deploy one instrument inside of the cavity and then you can move it with an external magnet, you can create very effective movements that enable the surgeon to perform the procedure without compromising the capability of movement, you see? Got it, got it. I see. I'm starting to understand. Yeah, so that's where you're kind of able to tell the story

around less incisions, right? And less trauma inside the sort of the, the body cavity is being able to manipulate sort of the mechanical movement of those instruments with the magnets. Okay, got it, got it. Okay. That's super helpful. Yeah, and actually with the first product, we have clinical data. I mean, there's a very nice study well conducted by Duke University that demonstrate that reducing the number of incisions in bariatric procedures actually is linked to less pain, shorter length of stay, and also there's a trend of less use of opioids. So we have data to back up what we are saying.

Got it. Okay. Levita, were you the first company to kind of pioneer this movement in magnetic surgery? Yes. Got it. Okay. Very cool. Very cool.

Yeah, because this is a domain that I'm not overly familiar with. So research leading up to this conversation, kind of hearing about it for the first time. But you guys are the kind of the leaders in the space. Yes. Yes. We're the first company in the world. We create the new category in the FDA. So, yeah, we own the trademark magnetic surgery.

So, yeah, we are the first ones. Got it. Cool. Very good. And I mentioned the recent 510K clearance for the Mars platform. So are you actively commercializing the system now? Where's the company at in terms of development? It sounds like you've got a lot more in the pipeline and on the development roadmap. But are you commercializing the platform now? We just got the FDA clearance a couple of days ago. So we're in the process of, yes, preparing everything. We're preparing the first cases here in the U.S. So stay tuned. Stay tuned. Stay tuned.

Okay, got it, got it. Yeah. Well, we'll definitely link to Levita site in the full summary write-up on MedSider for this conversation. So you can find it there. But if you don't make it to that write-up, it's levita.com, L-E-V-I-T-A-C-A-com, and you can learn a little bit more about the technology and follow along, you know, in terms of what's next for the company's journey. Yeah, the name is coming from levitation. I mean, actually, if you can really balance the magnetic forces, you can make levitate the

instrument. That is very cool. So that's the name where it's come from. Got it. Very cool. Yeah. Yeah, it's always fun to hear about some of these origin stories, not just about the technology, but the also the naming of the company and the particular product. So with that said, let's go back in time and learn a little bit more about not really the journey, right, building and getting elevated to this far, but also kind of just some key lessons that you've learned along the way. And so with that said, you kind of walked us through sort of the evolution, right, starting with the introduction of magnetic surgery, now to the full on Mars platform. When you think about like the early days, right, I'm sure, you know, you know, the Mars system looks vastly different now versus what it did, you know, even probably, you know, three, four, five years ago. What do you think are some of the biggest lessons that you learned about, you know, trying to be as capital efficient as possible in those early development life cycles of your company? Yeah, that's a very good question. And I will say

that how we approach it here in the company, we have a very kind of like scientific method approach. We have an hypothesis and with the team, we develop a way of testing our hypothesis in the most efficient way. I see how we can really focus in the core principal question that we want to answer and we set a plan in order how we can do it the fastest and with the less resources. So that's how we approach everything. We have also a model that we conduct human clinical, kind of like clinical cases early on. I mean, we follow a lot of ethical guidelines, but we

are very focused in terms how we can have the first in human and we really are very close to the experience and we learn and iterate fast. So I would say that that's a kind of approach be very focused in just the key questions, the key fundamentals that we want

to answer and we are kind of like laser focus because it's very easy to try to add more things and we keep the team very focusing what we want to answer. And develop experience and then we improve in terms of the experience that we are getting. Got it. That approach to trying to sort of fast track towards first in human works, right? I think most entrepreneurs, life science, kind of med tech entrepreneurs that are listening

to this understand the business rationale, right? That's a clear value inflection point for any startup to get to that point. But it sounds like, yes, you understood that, but you also wanted to sort of validate the technology as well as early as possible in an actual. patient or in human data. Was that kind of the case? Yeah. Okay. Yeah, I mean, that's correct.

I mean, what drivers are in Levita is bringing value. And how we see business is that you charge some amount of money lower than the value that you bring. So, I mean, while you bring more value, you charge more. That's kind of like the basic understanding of what we're doing. So for us, it's the value creation is our driver. As you might also be aware, many things that works in the preclinical studies when you use it in patients, it doesn't work. That doesn't translate well, especially in surgery.

There's many things that you can test in preclinical models when you really want to use it in a real OR environment. It's different. They didn't perform well. So that's why we have a very kind of like focused plan in order to get to first in human and conduct a lot of clinical experience. And because the idea is developed a safe product that works. And the only way that you can really test that is in clinical experience. Got it. Super helpful.

When you think about, you know, we talked a little bit, you know, you hinted at this robust kind of pipeline inside the company. When you think about the next development program for Levita, is there anything that you do differently, I guess, you know, now versus maybe, you know, five to 10 years ago when you first started the company? Yeah. I mean, what we do now is we take the time. before really kind of putting too much resources in the huge kind of pipeline that we have.

We put the kind of basic technology. We see this as our minimum viable kind of product in hands of surgeons, and we stay very close to them. We really challenge our ideas. We are very eager for asking for real feedback. We tell them, don't show what the thing. We tell the truth, what we can do better, because at the end, as I mentioned, our mission is how we can make the surgeons be better.

I mean, how they can do more, how they can do better. And the only way that you can really understand that is giving them a minimum viable product that is safe, that works, and then understanding what are their needs and then figure it out in our pipeline what fulfilled that need. And one of the things that we've talked about quite a bit on this program with other med tech founders and CEOs is this idea of creating an MVP, right, a minimum viable product that's good enough and able to, so you're able to kind of demonstrate that or at least get it in the hands of your end users. From your perspective, how have you kind of balance that,

right? The idea of having something that's, maybe doesn't look the prettiest, but it accomplishes kind of what you need at this particular stage versus something that, you know, that maybe would, I guess, give you sort of either a false positive or a false negative, right? Because, you know, the system, you know, just isn't where it's at before, you know, getting in the hands of you know, of surgeons or physicians. Yeah, that's a wonderful question. And I would say that I have two advices. Well, the first one, we work with early adopters.

We people who understand that this is now, but this is how we will look in the future. And the other trick that we do is we do a lot of like 3D animations, kind of like very nice and foliage animations that we play a little bit like, okay, yeah, it looks like this now, but look how we will look in the future kind of like. We don't expect that they imagine it. We kind of give them a little bit of a visual for the future. So that also helps to say, okay, yeah, I know that it looks ugly, but it will look like that in the future. Yeah, that's great stuff.

I mean, we're laughing about it, but those are really, that's really great advice, right? And I think your first answer about just making sure that you're working with, you know, early adopters, physicians that hopefully understand that. They've been around, they've worked with enough, you know, early stage startups to understand like, hey, they can sort of overcome sort of that maybe the appearance or kind of, look and feel in order to kind of like best answer, you know, what you're trying to, the questions you're trying to solve for now. But I love that. I love the fact about like, hey, you can follow that up with a nice looking render, right, to showcase kind of, hey,

this is the direction, this is the vision. Give us, you know, another six months, another year or whatever. It's going to look like this. But hey, we want your feedback on this, this kind of alpha version right now. Yeah. Yeah. Yeah. And also I'm going to the back to the topic of the early adopters. It's also, it's very common that sometimes you talk with an investor and they say, hey, you know, my auntie is a pediatric surgeon, and she's an 80 years old, and I ask her about your technology, and she has some questions. So, I mean, be careful with kind of really say, okay, it's good that your aunties, I don't know, 80 years old, great, but let's focus on the early adopters,

because they are really ones who can see where this technology is going. So that's also another advice that be careful to fall in the trap that they bring you some kind of third parties that are not really people who have the vision to see where you are going. Yeah, yeah. No, that's really good stuff. Let's transition a little bit. It's kind of like, I guess maybe the opposite side of the coin here in that 10 years, right, you know, practicing medicine and then transition to, you know, med tech entrepreneur. There's a lot of, you know, not only physicians, but also, you know, PhDs too, coming out of kind of the world of academia that want to take a swing at a startup that are likely listening to, likely listening to this conversation.

when you think about that transition, anything stand out that worked either really well for you in that transition or, you know, alternatively, you know, anything that you maybe you do differently, you know, if you had to reset the clock. Yeah. Yeah, that's a very good question too. And I would say that the first advice is you have to leave your ego behind. I'm talking as a surgeon, and you know that surgeon has a very big ego. Because, I mean, you need it in order to, you have the responsibility of taking someone's life in your hands when you're doing a surgeon. so you have to be really confident in yourself. But I mean, when you are entering in this stage of being an entrepreneur,

you really are a lot of things that you don't know. So you really need to leave your ego behind and have like a position that you have to be constantly learning. In my case, I would say one of the most difficult things that I have to understand is that sales is really difficult. I mean, you as a surgeon, you are always with the rep in the science, and you're kind of like, it's not really that you really understand.

And for example, with the first product, I was the first rep of the company. So Duke was our first customer. So I moved to North Carolina. And in purpose, I was the first rep of the company. It's super hard. They treat you very, very harsh,

and you really have to develop sales mindset. And I would say that probably, I mean, talking with other entrepreneurs, kind of like the sales mentality, is the one that is harder to, develop. That's that's really that's really good good good point yeah because there's a lot of a lot of you know other founders and CEOs they often come from more of a scientific kind of engineering yes background a clinical background right and don't you know that that sort of the uh

the salesmanship right um not only convincing stakeholders but also you know convincing investors convincing other people to kind of join join your mission it's it's uh it's sort of all salesmanship at the end of the day you know yeah and at the end sales you see it's like communicating kind of like it's how you make someone make something because you provide some information or some some benefits for them in the future so i will recommend to everybody who really want to take this seriously to to sell to sell the products i mean go there talk with the customers and do their exercise because it's hard i mean convincing people of especially of new things it's difficult but i mean it's i will say it's key in our in our in our

in our industry. You have no doubt. And you mentioned kind of leaving your ego, you go behind. You know, one of the, one of the physicians that we work with that fast wave and are fortunate to have on our advisor team is Dr. Peter Schneider, a vascular surgeon. Still practices to this day, but it's kind of a serial, serial entrepreneur. He was a founder of intact vascular, which sold to Phillips. Another founder of Cajian vascular. He's got another startup, I think, that he's working on. But anyway, he's like super experienced, right, has a ton of, really really phenomenal track record, a ton of domain expertise, et cetera,

but it's like one of the most humble guys that I know, right? And I got to think that, you know, maybe that's, maybe that's, you know, a little bit more his character anyway. But I'm sure that's, you know, that's worked extremely well for him, right? Over the, over the course of his career is, you know, is kind of taking on a little bit more of a humble sort of attitude as he approaches, you know, projects to work on. So, yeah, see, the trick is that you have to really believe in you.

You have to be really kind of like trust. what your evaluation of the market, of the new approach, it's feasible and will work. But in the flip side, you don't have to leave your ego kind of blog you of feedback. So it's a fine balance that you have to trust in yourself, but not permanent to new comments or how to improve it. Yeah. Yeah. And I love the fact that you brought up that you were the first sales rep, right?

For the company. Yes. You know, position, started the company, founded the company, CEO, but still kind of, you know, served as the first, you know, salesperson too. And some of the best entrepreneurs that I know kind of operate under that framework that regardless of sort of the role, they want to be the first one to do it. Right. So they understand all of the dynamics at play. What pushback they're going to get, what works well, what doesn't, et cetera, before they begin to hand off, you know, some of those aspects. And again, not possible in every scenario, but usually a pretty good sort of operating framework

is, you know, to your point of like, yeah, no, I'm not going to go higher the first rep. I'm going to be the first rep and really get into the trenches, you know? And actually for us was critical because that's the way that we developed first, the first system kind of for go blood surgery. But in the use, we figured out that obesity was our kind of like beachhead to the market. And also in these first cases, we conducted some of the cases using also the Davinci. So that's where we start figuring out that if we combine this with other technologies, it has much more bigger value proposition,

but all that knowledge has been on the field. So you have to be, that's why I'm saying that you have to be very close to the users, challenged ideas, ask for honest feedback because most of the people say, oh, this is wonderful because you're the founders. I'm like, no, no, no, no. Tell me when it works, why you are not using it every day, how we can do it better. Yeah, yeah, good stuff.

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