Medsider: Learn from Medtech and Healthtech Founders and CEOs - How to Talk About a Technology No One’s Seen Before: Interview with Asensus Surgical CEO Anthony Fernando

Episode Date: July 1, 2025

In this episode of Medsider Radio, we sat down with Anthony Fernando, President and CEO of Asensus Surgical.Asensus is expanding the role of robotics in the OR with its performance-guided surgery platform — a digital-first, AI-enabled system designed to enhance precision and real-time decision-making. A mechanical engineer by training, Anthony has more than two decades of experience spanning medtech, robotics, and global operations. He joined Asensus in 2015 and previously served as Chief Operating Officer and Chief Technology Officer. Earlier in his career, Anthony held leadership roles at Stryker, Becton Dickinson, PerkinElmer, and Varian, where he focused on advancing automation and medical device innovation across international markets.In this interview, Anthony shares how the Durham, NC–based Asensus navigated uncharted regulatory territory for a first-of-its-kind technology and proactively made the case for acquisition — well before KARL STORZ came to the table.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 3 packages that will help you make use of our database of 750+ life science investors more efficiently for your fundraise and 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 VII. 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 Anthony Fernando.

It's really about trying to explain to the investors and make sure they understand the store. I mean, these investors, especially the institutions, they understand the space. They know MedTech, they know all of that. But again, we have to, you know, to my earlier comment, we need to help connect saying these are the similarities, these are the comps, this is how you should look at it. and then also kind of build credibility by establishing certain milestones and hitting those milestones. Hey, everyone, it's Scott. In this episode of MedSider, I sat down with Anthony Fernando, president and CEO of a census surgical, where he leads the company's efforts to transform surgery through digital innovation. A mechanical engineer by training, Anthony has more than two decades

of experience spanning med tech, robotics, and global operations. He joined a census in 2015 and previously served as C-O-O and C-T-O. Earlier in his career, Anthony held leadership roles at Stryker, Bechton Dickinson, Perkin Elmer, and Berion, where he focused on advancing automation and medical device innovation across international markets. Here are for you the key things that we discussed in this conversation. First, when building a new category of position novel technology within familiar frameworks, breakthrough products without clear competitors often face a credibility gap. A sense has encountered this in the 2017-2018 timeframe with its digital surgery platform the first of its kind. Instead of leading with futuristic features, they frame the innovation as an extension of trusted robotic systems,

making it feel like a logical next step. Second, help the FDA help you by speaking their language. Regulatory success with novel tech hinges on translating innovation into familiar terms. When a census sought approval for its AI-driven surgery platform, with no precedent, by the way, they avoided overwhelming FDA reviewers. Instead, they drew parallels to aviation and grounded their approach in well-established AI models. Third, don't wait for the acquirer to connect the dots, paint the picture yourself. When pursuing a strategic acquisition, the onus is on you to show how your technology

advances the buyer's vision. A census did just that proactively mapping out how its digital surgery platform could complement Carl Stores' portfolio and accelerate shared goals. That clarity helped drive the deal and pave the way for global scale backed by a world-class distribution network. All right, before we dive into this episode, I'm pumped to share that volume 7 of Medsider Mentors is now live. This latest edition highlights key takeaways from recent Medsider interviews with incredible entrepreneurs like Bill Hunter, CEO of Canary Medical, Brian Lord, CEO of Pristine Surgical, Don Crawford, co-founder of Safion and current CEO of Corvista Health, and other proven MedTech founders and CEOs.

Look, we get it. Keeping up with every MedSider interview isn't easy. That's why we created MedSider Mentors. These ebook volumes distill the best practices and insider secrets from top founders and CEOs, all in a downloadable, easy-to-digest format. To check the latest volume out, head over to Medsider Radio.com forward slash mentors. Premium members get free access to all past and future volumes, plus a treasured trove of other resources. If you're not a premium member yet, you should definitely consider

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forward slash mentors. All right, without further ado, let's dive in the interview. All right, Anthony, welcome to Medsider Radio. Appreciate you coming on. Thank you, Scott. Really looking forward to this. And you sound great despite the dentist appointment, right, earlier in the day. But joke aside, you've got a really impressive background, right?

have been a census for now, almost a decade, right? But let's start there. I mean, if you can give us like a, I know it's kind of a tall order to summarize your journey in MedTac in a couple minutes, but let's start there. Give us kind of a high-level perspective from your side, right, on kind of what you've done leading up to now your CEO role at the company. Sure, sure. So I'm an engineer by training, you know, in graduate school, started building robots

funded by the U.S. Department of Energy Department of Defense. handling nuclear waste. So that's kind of got me into the automation side of things. And then lab automation was kind of a big thing back in the day. So kind of went into the life science side, you know, did a bunch of things on the pharmaceutical lab side of things and then, you know, kind of moved into different managerial roles, you know, IT operations, R&D, also got the opportunity to work in various geographies. It was based in Europe for a while, then based in Asia Pacific for a significant amount of time.

And that got me into MedTech, which I loved because there was so much purpose behind it and then stuck with it and been in kind of MedTech now, you know, 15 plus years just on the MedTech side and then kind of joined a census about 10 years back and wearing various hats and really enjoy the work. So still in MedTech and no plans to go anywhere else right now. It's funny.

I was actually on the guest side of a podcast earlier today. And we were talking about this topic where most, and I don't know why it kind of just hit me for maybe the first time. I was like, you know, most of the people I know in MedTech, they've always stayed with it, right, despite the fact that it's pretty hard to do. I mean, you're operating in some pretty significant regulatory constraints, you know, capital intensive, et cetera, et cetera.

But like, most of the people I know, like, just stay at it, right? Because I think in large part, because it is, it is very rewarding, right? I mean, it's one of that's very, very unique space to kind of, you know, spend a, spend a career in. Yeah. For sure. I think it's, you know, once you experience it, I think it's hard to explain to somebody. But once you experience it, you know, it really, it has, it really derives purpose. Yeah.

No longer a job. So it helps. Yeah, no doubt. No doubt. You spent roles at a census as a CTO, CEO, CFO, and now CEO of the company, but maybe frame up your answer, but give us a sense for kind of like what attracted you to the company, you know, almost a decade ago. And like what is like the big problem you're trying to solve here with the platform? The census, at the time I joined, they were working on a single port robotic platform.

They had a single port non-robotic version, but they were working on that. And the market continued to shift. You know, single port was an opportunity because, I mean, the census was kind of on the front end of this robotics evolution. However, the market shifted. So they were at a point back in 2014. The company had just listed in the NYAC. They were kind of trying to track the market, but they kind of saw the market was moving into more multiport robotics. So that's kind of when I got introduced to the company and having done some MNA in the past

and been in different geographies, kind of they had an opportunity to acquire a late stage prototype from a company in Italy. So that's kind of when I came in to do that MNA transaction and then took that product through the entire lifecycle as a Gen 1 product. But the real opportunity for me was, you know, given my engineering background, you know, and looking at trends generally in the world, you kind of see certain trends. Like, for example, when you employ automation or any kind of robotics or AI or anything for that matter, there are three things that are pretty certain. You know, cost go down, quality goes up or improves, and productivity improves. You see this in automotive industry, you see it in industrial sector, I mean, everywhere.

However, when you look at medical device or healthcare or surgical robotics, that was not true. So I was kind of thinking, saying, okay, why is that? And I even spoke with the company at the time before I joined saying, why is that? You know, why is that not the case? And then through that dialogue, I figured, okay, you know, they want to do this thing. to achieve that goal and realize the value of bringing robotics into surgery. So I was like, okay, if I think there's an alignment of what we need to create. So that was kind of the beginning of how I got into this.

And then since then being kind of the mission has not changed, still continuing to work on delivering that. Got it. Obviously the robotics kind of sector, if you will, I guess for lack of a better description category, you know, seemingly only increases, there's no increasing number of like, of players in the space, right? Yeah. You know, because forever, most people that are even loosely familiar with robotics, you know,

only thought of intuitive. So where does the census kind of, like what, you know, where does it stand out amongst others? Yeah. So if you know, when we got our FTA approval back in 2017, we were the second company to get an approval in the U.S. next to intuitive. So that was a big deal at that time. But I think at the same time, we got the approval.

We knew there were probably a handful of other companies developing robots. And if you fast forward to today, I would say there are over 50 companies in the world building robots. So we kind of had an idea that this trend was going in that direction. So back in 2018, 2017, 2018 timeframe along getting our first product through the FDA, we realized that, you know, if you look at, again, if you go look at automotive or industrial, you know, robotics was commoditized. So we said, hey, you know, it's a matter of time before robotics gets commoditized. So what do we do? And at the time I was in my role as CTO, so I said, okay, we need to do something different, something that will create value in the future.

because these things take, you know, 10 years to build and the entire world changes in that kind of time. So we said, okay, we are going to work on robotics, but we are going to digitize robotics. We are going to work on digitizing the interface between the surgeon and the patient and focus on delivering value through digital technology rather than robotic technology. So we started pivoting to becoming more of a digital surgery company. since 2018. And that's kind of what we are delivering today. Yes, we have a robot, but the real value driver, the value delivery mechanism is really

on the digital front. Got it. That's kind of who we are. So we are very differentiated from the robotics category. We are adjacent to the robotics surgery category, but we are more on the digital surgery, or we call it performance-guided surgery. Got it. Which is our own category that we pioneered and we created.

I like that. I like performance-guided surgery. I was going to say, would you consider a sentence as almost like a digitally native, right, robotics company? That's kind of what comes to mind as I was hearing you kind of describe the company's kind of journey. You were, I mean, gosh, you guys were early in that trend, for sure. I mean, although from my perspective, 2017, 18 doesn't seem that long ago, but that was a while

ago, right? I mean, yeah, so. That was. I mean, it was and we were, I would say, one of the first to get AI-driven digital technology through the FTA. And we got it approved in early 2000, not early 2000, early 2020, you know, when we got it approved and we were one of the first to do it. So we were, we are still in the front, front seat there. And even today, we remain the only company that offers real-time intraoperative surgical intelligence. Got it. So that's, I think, a nice category to be. And then you hit the nail on the head when you said digitally native.

That's exactly how we explain to the outside world that we are truly digitally native. Yeah, which is important, right? I mean, because like so many robotics companies are sort of almost, I'm not, I wouldn't consider robotics like my wheelhouse. whatsoever, but almost kind of retrofitting their platform, right, for a digital AI kind of play. And oftentimes, as you and I both know, that doesn't work out sometimes, right? Or it's kind of clunky, comes together kind of clunky, right? So I can see how maybe that trend that you spotted early on and building the platform, kind of with that, you know, digitally native or AI native kind of approach probably has paid off

in spades. With that said, I'm on the website, asensis.com. For everyone listening, if you don't get to the full write-up on MedSider, it's A-S-E-N-S-U-S-U-S-U-S-com, of census.com, kind of just as it sounds. Very cool website. You can definitely check out the technology in more detail. But Anthony, give us a sense for kind of, we're recording this in late Q2 of 25. If someone's listened to this, maybe three, four, five months down the road,

what are the big kind of initiatives, kind of activities going on with the census today? Yeah, so currently we have our Gen 1 product on the market. We've done about over, you know, 15,000 cases. globally, you know, 40-50 systems out there, honor plus surgeons. And that was more of a market development platform. That was our intent. We collected a ton of data.

We learned about what's working, what's not working, you know, preferences. Every geography has their preferences. So we've understood all of that. And then probably around four years ago, we kicked off our Gen 2 development, which we are calling the lunar platform. So that's really some of the key activities that are ongoing. We have probably, you know, we've stated this publicly.

You know, our goal is to try to get this into the FDA sometime in 2026. So the second half of this year is a very critical year for us in making sure that we buttoned everything up. So what's to come is trying to really, you know, give a. time for the surgeons to really evaluate the system. That's what we are currently working on. So I think we begin to see some surgeon feedback and things of the sort where they'll get the first real test drive of the system, you know, doing pre-clinical work in the second half of this year. So really excited and looking forward to seeing that come to life. Yeah, I can imagine the sheer amounts of activity leading up to, you know, a potential

FDA submission, right, on the, you know, fairly near-term horizon. Yeah, that's a, that's, that's, that's, that's, that's, that's, that's, that's, that's, that's, that's, that's, that's, got it. Okay. Very helpful. With that said, um, let's, let's, let's transition to a few, um, kind of cross-functional topics, if you will, right? And I'd love to start out with, um, early stage development, which is obviously in your wheelhouse having spent, you know, not only as, you know, time is the CTO of a census, but he's, you know, even, you know, prior, right? You came up through kind of the R&D ranks. And when you think about, whether it's within kind of the context of joining a census or just other experiences in general,

like what are you, like if you coach up another, another technical founder, right, and another med tech startup, you know, typically those are the hardest times, right, when you're, you're trying to iterate on a device with limited resources in most cases, right? But you have to move quickly, make iterations, et cetera. What do you think either are the biggest mistakes most CEOs founders make or flip that, you know, what's your kind of key, key advice, right, for MedTech founders, CEOs that are trying to, try to move fast with limited resources in those early stages? So I think, you know, even for my self, Scott, you know, I had an assumption that I made wrongly

thinking that, okay, if you have some good technology, that it's going to shut, you know, it's going to, you know, survive, it's going to do great things. But I think what I realize, very quickly is sometimes new technology or futuristic technology too early is it doesn't work. I mean, personally, it took a lot back in, you know, 2017, 2018 to convince the company, the board and management at the time to say we need to move into digital because digital is a future, but it didn't exist. Nobody had it. Yeah, I mean, we were used to all the everyday digital technologies that we use as consumers, but in the surgical space, it didn't exist. So it was hard to say this is what it's going to be because there were no comps. There was nothing to compare to.

It was more saying, hey, this is going to be the thing you got to believe me and you got to fund it. So that was kind of a tough thing to do internally and then also externally at the time of a public company and we can easily impress the investors and the banker saying, wow, this looks really cool. But then they ask the question, like, you know, how are going to make money? You know, how are going to sell this thing? And it's like, you don't quite know that yet. So that was kind of a tough thing. So I think you kind of have to mix it, I think, with saying, hey, this is what we know.

Robotics is something we know. You see how other companies have been successful. there is a robotic platform, so that's what's going to make money. And then, oh, by the way, there's all this other technology that could, even though you kind of have an idea, that might be the lead actor in the future, but you kind of have to position it differently depending on where you're at, because the audience can't receive it yet. Yeah. I mean, we're kind of laughing about it, but I can't imagine how probably difficult that was, right? because whether you're trying to pitch an investor, right, to infuse capital to the company, or maybe it's bankers on the street, right, if you're publicly traded, you know, they're all,

they all want a pattern match, right? Like, what's the most comparable thing that I can use as a baseline reference? And don't get me wrong, like, they're not the only ones do that. I do that, right? And so I think everyone wants to, wants to use something as a comparison, but you guys obviously made a call of, like, you know, taking a pretty, seemingly what was a pretty big swing and a pretty big, a pretty big risk. And connecting that to just the capital intensive nature, right, of medical device companies, it's like, you know, these aren't like one, one or two year projects. They're five to 10 year projects. You know what I mean? And so like, how do you, I guess if I'm a new, a new founder or CEO and I feel, you know, I have conviction around kind of the direction, you know,

that we need to go. How do you, how do you balance that against some of maybe the naysayers or, right, or the people that are kind of critiquing, critiquing that decision? I think some have done it quite well. There are several companies that I'm aware of on a very low burn. They, you know, worked with maybe one hospital and run certain number of patients through and gotten a couple of publications to just show, hey, here's a head-to-head comparison of existing technology and the new technology. So at least now, you know, you exponentially increase your credibility to try.

try to go have this conversation saying because now you don't have to address the question of is it viable? You have to address the question of is it scalable. But at least you answered one question, which kind of gets you in the door, having another discussion. And I think basically you're reducing the risk, investment risk for anybody who's looking at that point in time. That's such a good point.

and obviously it worked out well, right? You went from CTO to, you know, CO then CEO, right? So obviously the decisions paid off. But I hear this, I still hear this a fair amount, right, from people in MedTech that, you know, they look at maybe at software entrepreneurs, right, and say, look, you guys can build an MVP and minimum viable product. It's so easy, right? That doesn't work in MetTech. And I mean, to a certain extent that's true, but I totally agree with your point. There's usually things that you can do to either de-risk, right, to answer that question around viability. or just that would lead to signals, right, that you are on the right path. And, I mean, it sounds like the example that you just brought up of, like, getting to a point

where maybe you can test it in a hospital or tested in a preclinical lab and begin to sort of help connect the dots, right, for, you know, your audience, whether that's investors or whether that's other stakeholders. That's so, so crucial. And I think those are almost, regardless of the scenario, those are almost always there, right, those sort of points that you can kind of get to, those inflection points that you can get to, you know, to your point to further de-risk, right, the approach. Yeah. I mean, that's important because you have to focus on kind of your strengths, right? I mean, you

understand the technology, you see the need, then you need to kind of connect those two dots and kind of show everybody that, hey, there's viability here. Yeah. And how do we move to the next phase? Yeah, exactly. Yeah. Let's transition and talk a little bit about regulatory and clinical. And I want to touch on something you mentioned earlier, right? Since this was the first company to really get approval with FDA for like this kind of digital first, you know, kind of robotics platform, I don't not want to underappreciate probably the challenges that you, that you faced and really kind of getting buy-in, right, with a bunch of reviewers at FDA for the first time. And so when you think about, you know, maybe frame up your answer kind of like sort of being a kind of a first mover, right,

in this new category, creating this kind of this new category, what's your kind of, you know, words of wisdom, right, to others that are maybe faced with the same type of challenge, right? where they're working on something pretty novel, something pretty differentiated. And you've got a group of people at FDA that mean well, but they have just no idea, right, what this is. And you try to kind of help them overcome sort of the inherent kind of skepticism that comes with something new. I know overall, we've had a very successful relationship with the FDA.

And I think there is somewhat of a misconception that many folks have with the FDA thinking that they're this, you know, unapproachable kind of an outfit, which is not the case. I mean, we've found the FDA to have, you know, some very, very smart, talented people. They actually understand all of this stuff, everything from physics to engineering to clinical. They actually understand. We've had some very deep conversations with these reviewers, and they're very approachable. you know, when we submitted our AI digital platform, you know, there were questions that through multiple dialogue sessions, you know, we knew they didn't understand either. And, you know, they were

trying to figure out, they were asking us questions like, where else is this technology use? Is it used in another regulated environment, you know, like aviation or whatever other industries so that we could draw some parallel and, you know, basically we had to help them help us by trying to fully understand where they are coming from, which they were very open to, to share, saying, hey, these are the regs, this is what, this is kind of the burden of proof that you need to show us that these things. And then some things when they don't exist, it fell back on us saying, here's the rationale. here's the logic and here's why we think this is sufficient because we have seen these in these

other industries successfully used. I mean, some of the AI models that we picked had had been used in other industries and had a very nice literature backing. So we said, we kind of had to compare and said, hey, we are using this model that was very well established by these two companies and and have been used. And they're like, oh, great. Yeah, we are familiar with that one technology and that framework. And I'm glad to see you guys using that model. So things like that.

I think it's important to have a good relationship, an open relationship with the agency to be able to have a two-way dialogue. Because at the end of the day, they are looking to help all the U.S. companies. And they are also looking out to make sure that these technologies and solutions get to the U.S. healthcare system in the safest and fastest way possible. I mean, that's our approach. That's always been our approach. And as a result, we've been very fortunate to have an extremely close relationship with the agency over the years.

Yeah, so obviously, you've been doing something right. 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. Here's why. First, Medsider Premium members get access to every single interview dating back to 2010. That's over 200 episodes packed with expert insights from proven founders and CEOs. Second, premium members also get free access to Medsider Playbooks. These are thematic collections of hard-won insights covering topics like fundraising, risk management, regulatory, reimbursement,

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