Medsider: Learn from Medtech and Healthtech Founders and CEOs - Empathy-Driven Innovation: Interview with MOLLI Surgical CEO Ananth Ravi

Episode Date: February 14, 2024

In this episode of Medsider Radio, we had an engaging conversation with Ananth Ravi, CEO of MOLLI Surgical, a medtech startup that has developed an award-winning, wire-free soft tissue localization technology for breast cancer surgery.Growing up in Zambia, Ananth lost his best friend to treatable brain cancer, which ignited his passion for creating equitable and innovative cancer care solutions. Before founding MOLLI Surgical, he served as a medical physicist at Sunnybrook Odette Cancer Center and as clinical operations lead in brachytherapy. He held faculty appointments at Sunnybrook Research Institute, the University of Toronto, and Toronto Metropolitan University. He is also a co-inventor on numerous patents and holds several grants for medical devices. In this interview, Ananth unpacks his story, touching upon the benefits of being in close contact with a medical ecosystem, the importance of intuitive design, the ideal role of regulatory consultants, and the funding strategies he employs for MOLLI. 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 latest Medsider Mentors Volume V. 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 Ananth Ravi.

I think it is find a problem that matters. And it doesn't matter to you. So I'll be very clear. Like John and I built a lot of stuff. Like one of my most favorite things was like we made this little positron detector, those sophisticated piece of tech. We're really impressed with ourselves. Nobody cared.

So it's really find a problem that matters that matters to patients that makes significant impact. Welcome to Medsider, where you can learn from the bright 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. This episode of Med Sarai I sat down with Ananth Ravi, CEO of Molly Surgical. Growing up in Zambia, Ananth lost his best friend to treatable brain cancer, which ignited his passion for creating equitable and innovative of cancer care solutions. Before founding the company, he served as a medical physicist at

Sonnybrook, Odette, Cancer Center, and Clinical Operations Lead in Break of Therapy. Anant is a co-inventor on numerous patents and holds several grants for medical devices. Today, Anant is leading Mali, a med tech startup that has made significant strides, simplifying procedures in breast cancer surgery while dramatically improving patient comfort. Here for you the key things that we discussed in this conversation. First, immerse yourself in the environment where your product will be used. ensure that your innovation is driven by a real identifiable problem, then build products that minimize risk,

maximize patient benefit, have a low learning curve, and are user-friendly. Continue to stay engaged with your key stakeholders even after building your MVP. Second, be purposeful from the start. Actively work on expanding your network, raising awareness of your vision and understanding of the market. As you build and leverage consultants,

be sure your core team isn't overly reliant on any particular individuals or firms. Third, having a variety of funding sources is imperative for sustainable growth, especially as your company evolves through various stages. That said, it's important that you consistently communicate the impact, value, and significance of your company's work to your existing investors. This is key for peeling to both current and potential capital partners. All right, before we jump into this episode, I wanted to let you know that the latest edition of MedSider Mentors is now live. We just published Volume 5, which summarizes the key learnings from the most popular Medsider interviews over the last. the last several months with incredible entrepreneurs like Gabriel Jones, CEO of Proprio,

Kirsten Carroll, CEO of Can Do Health, Dr. David Alpert, founder of AliveCorp, Greg Bolinton, CEO of Magnolia Medical, and other leaders of some of the hottest startups in our space. Look, it's tough to listen or read every interview that comes out, even the best ones, but there are so many valuable lessons you can pick up 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. To check out the latest volume, head over to medsiderradio.com forward slash mentors. Premium members get free access to all past and future volumes.

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 that join our program. Whether you're looking to master capital fundraising, navigate early stage development, tackle regulatory challenges, understand reimbursement or positioning 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 MedsiderRadio.com forward slash mentors. All right, without further ado, let's jump into the interview. All right, Anant, welcome to Medsider Radio.

Appreciate coming on. Thank you. Thank you. Yeah, definitely looking forward to the conversation and learning a little bit more about not only your journey, right? coming out of kind of the world of academia into running Molly. But really kind of what you and your team have been building over the last several years and where you're your head and neck. So with that said, you're a physicist turned entrepreneur, as I just mentioned.

I recorded kind of a very brief bio at the outset of this particular episode. Let's start there. Tell us a bit more about your professional background leading up to your current role as CEO of Molly Surgical. Sure. Yeah, I'm a medical physicist by trade. You know, when you say your medical physics, people's eyes kind of gloss over and I think Big Bang Theory and that kind of thing. But it's, you know, it's one of those careers that I was very fortunate to get into coming out of undergrad and the co-op term and got exposed to the world of, you know, technology and physics and how it's applied into clinical practice

to ensure safe, effective outcomes for patients that are undergoing radiation. treatment for for for cancers of all sorts and variety so very early I was hooked in this aspect of applying really cool technology and engineering and physics principles to have an impact that was very profound it was really profound on like an individual person patient perspective so I love that career and then that kind of set myself up to create all sorts new technologies and ended up, you know, leading Molly. Got it. And that, I'm looking at your LinkedIn profile right now, which will, which will link to in the full write-up on Medsider for this particular, for this particular

discussion. But you, you joined Molly back in, let's see here, mid-2018. Does that sound about right? So you've been at it five and a half years or so, considering when recording this in the very latter part of 2023. When you think about, the technology, right? Your, you know, your, you're, you're, you're, your, you're, your, you're, you're, kind of foundational technology. Give us an overview of maybe a, let's start first with like what, what it does. And then if you can kind of tell us a little bit more about the, the origin stories,

considering you came into Molly first as a, as sort of the chief, I think, chief, CTO or chief science officer. Yeah. So give us a sense for like kind of where the, not only what, what it does, what you're working on, but, you know, we're the, we're the, kind of the origin story of the technology itself. Maybe I'll put it around. I'll talk about the origin story that kind of lends itself.

way until like what it does quite nicely. Like so before, before 2018, I was clinical physicist. If you told me I was going to head up a medical device company out of it. That's not, that's definitely not me. But thank you for thinking of me that way.

It's not going to happen. And I was responsible for radiation oncology treatments for really prostate cancer patients, gynecological cancer and breast cancer patients. And one day, a breast surgeon by the name of Nicole, look home at Sunny Prokospo, came to me and said, you know, our patient cohort that have breast-conserving surgery

really want a different way of being treated. And at the time, we're using this wire-based approach of treating breast cancer. And at the time, you're suggesting, you know, instead of these wires, you want to implant radioactive seeds and you're responsible

for radiation safety and the radiation aspects of radiation ecology. Could you help us build out this program? And I immediately, it was like, well, we use this to treat patients not to find a spot that's not, that's a lot of administrative burden. Are you sure you want to do this? And I was really trying to detract her from this entire endeavor.

And then, you know, fortuitously, she said that there's a patient family advisory committee meeting where patients are going to talk about the experience. Why don't you go ahead and listen? So I listened and it was profound. I still remember this woman coming in saying she had amazing care, but the one that's thing that stuck with her was this wire-based procedure. She talked about it like it happened to her just an hour ago. So she came in, she had these wires that looked like fishing hooks.

She was in hospital for six hours and she was in pain and discomfort. And she talked about how the team was amazing, but the experience just stuck with her long after she got treated. And so that's sort of like, okay, we do need to do something way better than this. And we recognize that implanting these radioactive pods is a solution, but not the best solution. And this is where my chief technology officer and co-founder, who was actually my first student at the time, John Dillon, we kind of started iterating solutions along with Nicole to try and come up with something, where you could mark the spot, but really make sure it's as minimally painful as possible.

So we implant a tiny little permanent magnet the size of a sesame seed. and it's called it in Pure Goals so it's completely safe for the patient. This can be done at the 30 days prior to the surgery. So the patient does this as a five-minute procedure. It's not any more painful than like your flu shot, for example. And then they go home. They live their life,

and then they have surgery on a separate day on their schedule, both completely autonomously. And then the surgeon, instead of kind of palpating for this wire, now uses a wand and a tablet, and they can tell them the three-dimensional position of this marker in space. So it gives them far more precision that allow the surgeon now to plan out their surgical

plan with really looking at an aesthetic cure. So trying to hide the scar so that there's absolutely no trace behind for the patient. So it started there, it started off as a very research project within the hospital. And it's one of those things where John and I would build all sorts of. of stuff that were very dedicated patient care within the confines of Sunnybrook but this was the first time we started having like people started to find out and we got inbound from u.s sites and from sites across canada saying like we'd love to participate is this available like we'd love a solution and oh there's something here um so then we went through the standard ecosystem within sunnybrook and

University of Toronto and commercialized, found some cornerstone investors that were really well aligned with our vision. And at the time, when we first started up, Molly, I was still working at Sunnybrook because, you know, we wanted to make sure that we could iterate and answer the right questions and make a device that was absolutely the right fit and was really well designed to present the right amount of information at the right time. And so it took a little bit of me being in there and reiterating the design while we were building it up commercially and then kind of switched over and then commercialized after we got FDA clearance and haven't been haven't looked back since. God, that's a great.

That's a great origin story. And I'm looking at the website right now, which is mollysurgical.com, M-O-L-L-I-Surgical.com, Mollysurgical. We'll link to it again in the full write-up on MedSider for this particular discussion with, nonth. But so if I understand that correctly, the sort of the Mali system, if you want to think about like that way, comes with that marker, right, that allows, allows, you know, a physician to sort of precisely kind of map out, you know, where they want to surgically, you know, intervene. Then you've got the tablet, which I think is probably used for visual enhancement. And then the wand, which I presume detects the marker. Is that, am I understanding that, correct?

Yeah, so basically, like, that's what you used to find it with precision. And then on screen, it gives you kind of like a GPS guidance as to where it is in relation to the tip of that one. Then the surgeon knows exactly where the marker is and they can plan out how much tissue to remove. The other device we recently came out with was something called a remarkable tool that was launched this year as well. And that was, again, in response to being very clinically aware asking what is important

from the surgical community and the radiological community. So we find out that these markers are being placed in depends. patients, but sometimes they're placed suboptimally or they wish they could place them a little bit more accurately in the center. Historically, there's nothing you can do about that. Like with a lot of the competitive technologies, there's nothing you can do to move it. You have to just go in and surgically take it out with that level of placement. With remarkable now, we can percutaneously using a needle very similar to the one that you used to put in, actually take out the marker from the patient.

and then you can re-optimized as as required. So that was something that we recently launched this year in addition to Molly, too. Got it. Sounds like a fairly remarkable tool, right? Funful and genius. The tongue-in-cheek puns are endless with that. That's right. That's right.

You know, I'm a father of five, so I try to work in some dad jokes along the way, right? So I mentioned this earlier, but, you know, you're, you know, let's call it five and a half, six years in to Molly. It sounds like I'm not entirely sure when, without pulling my notes here, when you received 510K clearance for the system, you recently launched remarkable. Give us a high level sense, I guess, where the company's at. Are you in full-on kind of commercial mode right now? And maybe what geographies are you focused on? Great question.

So we got FDA cleared around the middle of 2021. So we've really been ramping up commercialization. over this last year. So it's been really a little year and a half of full out commercialization. But that being said, like our company is well positioned to continuously innovate. I think that's part of the core. A real reason for why we created mall in the first place and why I left clinical practice to do this is to be able to pay innovations, scale it up and have impact. That's not just confined to a single institution. And so the way we've structured our company is we're in heavy commercialization, but we have half of our company that's,

actually still R&D in development. So we're continuously coming up with new things. I think we have a cadence of really significant new product introductions every year to year and a half. Coming up with something new that is very original and impactful is kind of fore to what we do. So in addition to achieving commercial success, we're really aiming at constantly coming up with something new. Got it. Got it. Super helpful. So I think that serves as a nice kind of transition point to sort of go back in time and learn a little bit more about sort of the journey of Molly, maybe on a kind of a functional basis, if you will, kind of looking at development and Rayclin, et cetera. And so again, for everyone listening, if you don't get a chance to get

to the full write-up on Medsider that accompanies this particular audio episode, Molly's surgical is the website, M-O-L-L-I-Surgical.com. You can learn a little bit more about the technology, the company, the team behind the technology. as well. So with that said, Anand, let's start with product development, right? And you kind of hinted at this that, you know, when you've, this first started out very much like a research project, right? You didn't intend to sort of, you know, become the CEO of a device company. And I'm sure your early prototypes, right, of the, the, the, the, the, the, the, the, the, the, the, the, the system looks like now. So when you kind of think back on those early years of, of trying to sort of rapidly iterate, you know, with, with likely probably limited capital. Are there a few things that come to mind that either were really helpful that you

did right or maybe, you know, alternatively, you know, if you had the chance to kind of go back in time, which maybe you did a little bit differently. Yeah. I mean, I think the one thing that we were really fortunate to have was the ecosystem in which we came out of. I think having clinical and John also being part of the study broke, like we were very embedded in patient care. And I can't stress that enough because it puts your priorities in the right spot. Like I've been part of delivering care using technologies in exact designs that resulted in treatment errors. And then I've personally had to have those challenging conversations of patients and families

because of those. And so that just puts an additional kind of burden when you're making your own devices now to make sure that design is top and foremost and risk mitigation is. really what you're thinking about all the time because you know you're not using somebody else that's yours and i think that was that environment really set that priority up front and also you recognize from that environment like robustness and reliability are key and the easier something is to use is absolutely paramount it doesn't decrease from the appeal it actually increases the appeal of the technology by making it just really easy to introduce because staff is so overburdened

and overwhelmed. So really exposure to the environment and the users and understanding not just like, okay, this is my device and this is how it's going to be used, but the entire treatment landscape and how you can make their lives easier and that of the patient's experience of treatment better is absolutely critical in the early days. I think we did that really, really well. The thing that I think we could have done a little bit better was we, so in the Canadian ecosystem, it's all about trying to prove things out.

So before we even start to get commercial and create molly, we already get a phase one clinical trial. So I think we were fairly late in the commercialization process compared to others in the space. So I think there is value to starting a lot of that commercial in parallel with like your early pilot testing and getting a little bit more traction on understanding what the market looks like and using that to drive, you know, what your commercial launch would look like a little bit further. So if we pulled that up a little bit earlier, I think that would have benefited us in terms of like the speed and focusing on the right things at the right time from a commercial aspect. From the clinical aspect, I think just the ecosystem, as long as you can be embedded in the ecosystem in which your patients and clinical teams are that we did quite well. And I'm trying to emulate that. Now that I'm out of that atmosphere, how do we maintain that level engagement and really make sure we were building devices that understand that clinical lead exquisitely? That's the trick when you kind of are separated from that ecosystem.

That's interesting, the point you brought up about kind of continuing to remain entrenched in the ecosystem. I was having a conversation last week with one of our KOLs for Fastwave. And he mentioned that the, and I'm not going to, I won't name the name, but this is a large strategic that he previously worked with. I mean, a billion dollar publicly traded company. And the CEO made it, made a commitment almost, I think if I remember correctly, on a monthly basis to go out and be in cases, right? And this is a, you know, this is a billion dollar, you know, a company with a billion dollar market cap, you know, hundreds and hundreds of maybe not thousands of employees still on a monthly basis going out and embedding himself kind of in the trenches, right? Seeing cases, going to see follow up, you know, patients in clinic, et cetera. And I think that really stood out to me.

And I think to your point, it's really, really important, especially as the company kind of evolves and scales commercially. I do think I very much am at least. I would argue probably in cases at least once a month myself. But it gives you a very, and there's absolutely our team is amazing and they'll relay information really well, but there's something about seeing it with your own eyes that is, you know, it's an intangible quality. You know, you have a different lens than others. And so bringing that lens to what you see versus just, you know, having it that relayed

is often, it's often very, very insightful. Yeah. Yeah, yeah, no doubt. A couple other follow-up, I guess, comments slash questions I had for you and that kind of stood out as I listed in kind of your response. One is that your comment around simplicity of design and making sure that the learning curve is as low as possible, right, in terms of adoption with the end users. That's so important because I, and I'm sure you do. You have a network of entrepreneurs, founders, CEOs. And it's so, the trade-off between adding additional features or optimizing for a certain benefit, but layering,

laying that up against kind of what that learning curve will be. And oftentimes, if there's going to be too much friction, right, with the end user, and it's just a little bit too complicated, that oftentimes far outweighs any sort of benefit. And I think it's just a really good point to be mindful of, you know, if you're listening to this and you're kind of in those early phases of either developing your initial system or maybe a follow-up product like remarkable, you know, just to really keep that in mind. mind. I think you're nail it right on.

It's just one of those things where, for us, it was when you do something, make sure it's very purpose-driven, you solve the essential problem and you do it exceedingly well. And then if you want to layer on things later, that's fine. But like, make sure that the actual problem you're trying to solve is done so that someone picking it up can just immediately use it. And that was the goal with Molly and it still remains the goal for this. say with everything we build is things should be self-explanatory. It's just like, you know, your phones, they make it so you pick it up, you turn it on,

and you don't have to have an IFU to teach you how to use it. I think that's what we want with all of our medical devices. It should be so intuitive and risk-reduced that anybody can just plug it in and go and be able to like do high-quality care with them. Yeah, that's a good framework, honestly. Is like, is my device out of the box? Is it so easy to use that, you know, you would, even necessarily need to pull an IFU, right? It's a really, really good, really good kind of

framework to start with. The other question I had for you, kind of around your point related to sort of thinking about commercialization earlier in the process, pragmatically, are you kind of referring to, you know, as you think about, you know, your clinical work, ensuring that you're engaging with the right physicians that can obviously help you with your clinical efforts, but that that also sets you up for kind of those early, early soft launches. Is that sort of what are you referring to? It's really around soft launches. Exactly.

Because for us, it's really in order for us to commercialize and get to a particular scale. They were very much contained, proving that this technology works and it's very effective. And then we were able to take that step to create an entity that then could go outside the confines or not the walls of Sunnybrook to other institutions and explore, explore opportunities outside. I think exploring those outside opportunities early is absolutely something that I would

encourage a little bit more of. And really, like, if this is, you know, looking backwards. Initially, we were literally like, this was just an academic. This was like, we were going to help the patience of Sunnybrook, and we would be very content with that. It's only after we started getting all these inbounds that we realized, oh, there's something more here. And so it was very organic, which is also good.

But I think if you have, if you're purposeful in how you do things and if this is something that you want to do, I'm right out of the gate, then I would be very purposeful about like going as far and creating an network as quickly as possible, recognizing that you will, you're onto something and you'll figure it out as you kind of go through the iterations of development. Yeah, yeah, it's such a really good point. I was actually recording a kind of a mini podcast. actually with someone else in the space earlier today.

And we were talking about this very same thing of, you know, when you're building a startup, should you kind of operate in the stealth mode or begin to kind of tell your story publicly? And I'm a big believer in the latter, right? The more you can raise awareness for kind of your vision and what you're building, et cetera, the better, because it allows you to begin to foster this community, right?

And just engage with more, more end users, more physicians, more stakeholders that even if they're not, even if there's not like a tangible next step with this kind of cohort of people, maybe there will be six, nine, 12 months down the road. So I think it's a really, really good point. I mean, to your point, like doing the startup is incredibly hard, incredibly hard. And people don't, because it's so hard, don't want to pay the attention to you when you're so early because the chances of you're failing is like almost guaranteed.

So people will start paying attention when you start to like actually. create revenue and you have something going. But until then, it completely, the risk benefit to like reaching out and telling your story and building awareness is fully on the side of like build as much awareness as possible. Because, you know, people will love to hear the story, but they really don't count you existing until you actually show up. Yeah. Yeah.

And so the more you can kind of tell your version of the world, of the world that you want to exist, right? with the products you're building, the more that gives you a chance, right, to get the attention of whether it's physicians, investors, payers, whoever, they at least know something about what you're trying to do. So I think it's a really, really good point. And to your, you know, your comment around, you know, building startups is so hard. I mean, it is. It's just like you're pushing a boulder up a hill and trying to balance all of these different considerations. And it's very, very difficult. But like, that's a really, really good point to be mindful of, you know,

even in the earliest stages of, okay, let's, after we get through, you know, this clinical work and you're trying to peek around the corner, you know, trying to ensure that you, you're thinking about the commercial aspects

as early as possible, the better. So let's use that as a little bit of a transition point to, to talking about, you know, Flynn Reg and in general. And you mentioned this earlier, that you were highly focused on,

on achieving these clinical milestones, right, out of the gate. And this whole topic can be really kind of hard to navigate, right? especially if, you know, if your technology is fairly novel like it is at Molly. And so when you, when you think about how you approached it, not only your clinical work, but how that kind of ladders up to achieving regulatory milestones, were there a couple things that kind of come to

mind that you think would be good, good tips or good pieces of advice for other, you know, founders or CEOs that are that are kind of in the trenches, kind of working on their, their own kind of roadmap. Hey there, it's Scott. And thanks for listening in so far. The rest of this conversation, is only available via our private podcast for MedSider Premium Members. If you're not a premium member yet, you should definitely consider signing up. You'll get full access to the entire library of interviews dating back to 2010. This includes conversations with experts like Renee Ryan, CEO of Cala Health,

Nadine Miarid CEO of CVRX, and so many others. As a premium member, you'll get to join live interviews with these incredible medical device and health technology entrepreneurs. In addition, you'll get a copy of every volume of MedSider mentors at no additional. cost. To learn more, head over to medsiderradio.com forward slash premium. Again, that's medsiderradio.com forward slash premium.