Surgical Innovations Share Discussion Threads

[justiceforthemany] 01/3/2023 14:36

More than 1 million shares traded again. Has to be positive news or a takeover.

[buywell3] 01/3/2023 05:04

The size of the LiquibandFix8 market within the NHS ie 75,000 inguinal hernia operations per year

LiquiBand Fix8

LiquiBand Fix8 is supplied in boxes of 6. The version for laparoscopic procedures costs £1,199.94 and the version for open procedures costs £390.

Both are pre-assembled and terminally sterilised and do not require any additional consumable products.

A single laparoscopic Fix8 device contains 1.5 ml adhesive, enough for at least 40 applications of 12.5 mg adhesive each. The minimum number of 12.5 mg applications for the LiquiBand Fix8 open device is 45.



60,000 operations = 10,000 X £1,199.94 = £11,999,400 pounds


Both here in the UK as more hernia operations get carried out not only in the NHS but also by private healthcare which Elemental Healthcare supply --- Plus in the USA that 60,000 number of operations could get hit within 4 years of the AMS clinical study and US PMA

Giving a combined market of circa US $30 Million

Hence the second plastic injection molding machine requirement previously mentioned

happy days methinks

dyor

[buywell3] 28/2/2023 21:11

There is now an urgency within the NHS to reduce its carbon footprint to net zero by 2045

A large proportion of which comes from waste caused by single use surgical instruments within the operation room

‘In the US, it is estimated that 20% - 33% of all hospital waste is generated by the operating theatres and a single operation can generate more waste than a family of four produces in one week.’*

The NHS Supply Chain is now going down the path of achieving sustainability and waste reduction

New Surgical Instruments framework sees a focus on sustainable products

As part of its drive to help the NHS reach carbon net zero by 2045, NHS Supply Chain is working with suppliers to provide a range of sustainable surgical instruments that can be recycled, reused or repaired, decreasing the amount of waste going to landfill.



Elemental Healthcare are leading players within the NHS with the provision of such products many of which are made by Surgical Innovations under their 'Reposable' banner


Elemental Healthcare provide a portfolio of innovative products combining the highest quality with the best value.

We promote developments that will enable operating theatres to dramatically reduce their costs, yet retain the quality and operative experience for the Surgeon and Patient.

Looking at recent updates and RNS's such products and surgical instruments are set to grow very soon now as the demand for them is increasing in line with both the backlog of operations/waiting lists in all countries plus the need to reduce the carbon footprints of all healthcare providers






Surgical Innovations own 100% of Elemental Healthcare

dyor

justice

At the balance sheet date, the Group has unused tax losses of £23.5 million (2020: £23.4 million) available for offset against certain future profits.

This represents an unrecognised deferred tax asset of £5.66m (2020: £4.34m).

The timing differences has given rise to a deferred tax liability of £221,000 (2020 DTL: £115,000).

No deferred tax asset has been recognised in respect of the remaining £22.6 million (2020: £22.8 million) due to the future taxable losses expected by the Group.

The unused tax losses do not expire and can be carried forward indefinitely as long as trade continues

page 57

[justiceforthemany] 28/2/2023 15:45

Huge volume.
I think a takeover is coming.

[z1co] 28/2/2023 14:18

H2 revenue was really strong and was 10% more than H1.This strong momentum is likely to continue in the current year.

The company will provide more info at the time of it's full year results.

Share price is still rather subdued but will rebound as the year progresses.

[barrenwuffet2] 28/2/2023 13:27

It’s two years post Covid now. SUN should be showing double digit growth alongside all other medical companies

[justiceforthemany] 28/2/2023 13:26

Lots of big buys today
Reason?
Leaky ship.

[z1co] 28/2/2023 13:09

It looks like MM's are a bit short on the stock just 0.5m of buys and they have increased the share price by 6%.

With the full year results in a few weeks the shares are likely to rise a lot more.

[barrenwuffet2] 20/2/2023 10:07

1.5p
Ouch. It just doesn’t seem to get any better does it?

[z1co] 23/1/2023 19:55

The strong UK sales growth highlighted in Q4 has continued into the current year, with new business wins contributing to year-on-year growth.

David Marsh, CEO of Surgical Innovations Group Plc said: "We are pleased with the 2022 performance achieving strong sales, led by the UK, and we have demonstrated that the Company has effectively managed the headwinds of the pandemic. The Company continues to win new accounts, with quality and sustainability the key catalyst for these hospital conversions. Internationally our sustainability messaging is beginning to resonate and 2023 will see the introduction of some important additions to our portfolio allowing a more complete offering for key markets. Our successful collaboration with OEM partners, especially in robotics, is a further exciting opportunity for the business to leverage our expertise in instrument design and be part of this growing development in surgery. We look forward to updating shareholders in March at the time of our final results."

[justiceforthemany] 23/1/2023 15:55

Equity ratio of >3 and debt to equity <1 with net cash

[z1co] 23/1/2023 08:31

After that solid trading update the share price has strong possibility of 50% upside from the current levels.

[justiceforthemany] 23/1/2023 08:23

Bought back in. Looking for 2.5p+.
May be taken over also.

[kenone] 23/1/2023 08:08

Woken up at last. Looks very cheap at these prices.

[mandate] 23/1/2023 07:39

Update looking positive

[buywell3] 19/10/2022 23:41

Surgical Innovations designed and manufacture the Liquiband Fix8 laparoscopic device for Advance Medical Solutions for use in MIS inguinal hernia operations

Surgical Innovations own the IP for this device and make it for AMS currently on a recent deal due to expire in a couple of years time

'In the final quarter of 2019, the Group concluded agreements to extend important contractual relationships, including the manufacture of the Fix-8 device for Advanced Medical Solutions plc until June 2024'

Advance Medical Solutions said this in September 2022:


Internal Fixation and Sealants

LiquiBandFix8® is used to fix hernia meshes placed inside the body with accurately delivered individual drops of cyanoacrylate adhesive, instead of traditional tacks and staples. Revenues increased by 37% on a reported basis to £1.6 million (2021 H1: £1.2 million) and 39% on a constant currency basis due to commercial progress, increasing volumes of hernia surgery and, to a lesser extent, the acquisition of AFS which increases the Group's end sales of the product. Encouraging growth has been seen in the UK following recommendation from the National Institute for Clinical Excellence (NICE) to consider the use of cyanoacrylate adhesives in place of invasive tackers.



The acquisition of AFS, who are specialist distributors of LiquiBandFix8®, will strengthen our ability to further penetrate into existing markets and will complement our existing sales expertise.



The US clinical trial for LiquiBandFix8 ® continues to progress well with completed patient procedure numbers on track to submit the clinical module of the Premarket Approval (PMA) filing in the second half of 2022, after the 12-month patient follow-up. AMS continues to be encouraged about the long-term prospects for the LiquiBandFix8® portfolio with entry into the US being a significant milestone for the Group.

Note

Generally the time for PMA is 180 days



NICE experts in july 2022 say:


Advice

Expert comments

Comments on this technology were invited from clinical experts working in the field. The comments received are individual opinions and do not represent NICE's view.

All 4 experts had used this technology before.

Level of innovation

One expert described mesh fixation using cyanoacrylate glue as a major innovation compared with tacking devices. Another described it as a novel approach that enables a move away from traumatic, mechanical mesh fixation methods. One expert felt it was only a minor variation, noting that different forms of glue (fibrin) have been used for many years. They explained that the operation and mesh remained the same, and that the difference was in the way that the mesh was fixed in place.

Potential patient impact
Experts advised that at least 70,000 inguinal hernia repairs are done in the UK each year, and most would be eligible for cyanoacrylate glue use. One expert estimated that less than 10% of NHS hospitals currently use cyanoacrylate glue for hernia mesh fixation.

All 4 experts agreed that there would be a reduced risk of complications compared with mechanical mesh fixation methods. Three of the experts noted the reduced risk of chronic pain, with 2 commenting that the incidence of nerve damage would be reduced. One also mentioned that immediate postoperative pain was likely to be reduced. Two experts advised that the risk of hernia recurrence is reduced when using glue; 1 explained that it is possible to extend the mesh across a wider area in laparoscopic transabdominal preperitoneal (TAPP) and extraperitoneal (TEP) inguinal hernia repairs. The other expert suggested that chronic pain is a greater concern than hernia recurrence because it is possible to carry out another hernia repair, but not always to resolve chronic pain. One expert thought that thin people who have a low body mass index may particularly benefit from glue use, because they have a greater risk of nerve damage from mechanical mesh fixation methods. Another expert commented that young people tend to have a higher rate of chronic pain, and probably have more chance of benefit from cyanoacrylate glue use.

One of the experts noted that evidence suggests that improved clinical outcomes associated with cyanoacrylate glue may lead to a shortened length of hospital stay, and a quicker return to normal activities. Two experts commented that avoiding complications such as pain and recurrence could reduce the need for further management, avoiding visits to primary and secondary care, potential reoperation and absences from the workplace.

Potential system impact

All 4 experts agreed that adopting cyanoacrylate glue has little impact on staff resources, equipment or care setting. Applicator devices were considered by 2 experts to be simple to use for mesh fixation (1 said that peritoneal closure using glue can be technically challenging in TAPP repairs). All experts agreed that minimal training is needed. One said that this can be achieved on the job. One said 20 cases or less would be needed to get the required experience but another believed that up to 50 cases may be needed before the operator can apply the glue efficiently. One expert emphasised that nurses also need minimal training to understand how to prepare the device for use.

Two experts indicated that the length of procedure may be shortened if glue is used for both mesh fixation and peritoneal closure. Lessening the need for ongoing management of complications, and avoiding recurrence, could slightly reduce the overall burden on the healthcare system.

All experts indicated that cyanoacrylate glue has the potential to replace the routine use of tacks and other mechanical fixation devices. The potential economic impact depends very much on the standard care comparator. As highlighted by 1 of the experts, cyanoacrylate glue would inevitably cost more than no mesh fixation. Another advised that cyanoacrylate glue costs substantially less than fibrin glue. Two experts believed that cyanoacrylate glue is likely to cost about the same as current standard care, when the whole care pathway is taken into consideration. One expert suggested that cyanoacrylate glue may ultimately prove less costly than tacks because of reduced long-term resource use. One expert commented that cyanoacrylate glue products are easy to store and do not require refrigeration; another suggested that shelf life should be taken into consideration.

General comments

The experts confirmed that a variety of mesh fixation methods are commonly used in the NHS. The decision on which 1 to use is likely influenced by the procedural approach and which technologies are available locally. Three experts described using tacks for laparoscopic procedures, and 2 referred to using sutures for open surgery. One of the experts routinely used fibrin glue.

In hernia repair procedures, cyanoacrylate glue can be used for both mesh fixation and for peritoneal closure. One expert believed that the glue's main advantages (such as speed of use) are most evident when used for these 2 purposes within a single procedure. One expert was uncertain about the relative effectiveness of mesh fixation with cyanoacrylate glue when compared with self-gripping mesh (which similarly has the benefit of avoiding tissue trauma). However, when self-gripping mesh is used, it takes more time to suture the peritoneum (than when the peritoneum is glued).

Although not reported in the included studies, anecdotal evidence from 1 expert suggests that some clinicians are reluctant to use cyanoacrylate glue because they are not sure whether the fixation is as strong as with tacks, and are concerned about the risk of hernia recurrence.

One expert considered that the evidence could be strengthened by additional high-quality randomised controlled trials comparing recurrence rates. Another suggested further research comparing cyanoacrylate with more established glues. Three experts noted that the length of study follow up should extend to at least 1 year after the procedure (to evaluate prevalence of chronic pain). One expert suggested that longer studies (up to 10 years) are needed for a better understanding of relative rates of recurrence. One of the experts considered the design of the applicator device to be 'key', and implied that a comparative evaluation of device functioning would be helpful. Three experts emphasised that applicators must be easy to use; 1 provided a further explanation that this could affect how quickly the operation could be done (and so the number of procedures that could be completed in a day). Cost comparisons should consider the frequency of applicator device malfunctioning, which can result if glue is not loaded correctly or a blockage occurs. Three experts reported that they sometimes needed to replace LiquiBand Fix8 devices because of problems with glue delivery; this adds to the cost and can add a few extra minutes to the length of the procedure.

One of the experts commented that their experience and research (based on the laparoscopic LiquiBand Fix8 device) had led to them to no longer using tacks in TAPP repairs and laparoscopic intraperitoneal onlay mesh (IPOM) repairs. Another expert noted that all of the procedures they had carried out using Histoacryl had been day cases, with no reports of chronic pain.


There is currently a clinical trial taking place in America:

A Clinical Study to Evaluate the Clinical Performance and Safety of LiquiBand FIX8® Versus AbsorbaTack™ for Hernia Mesh Fixation and Peritoneal Closure in Groin Hernia Repair
A Multi-center, Randomized, Controlled, Single Blinded, Parallel-group Study Evaluating the Clinical Performance and Safety of LiquiBand FIX8® Versus Control for Hernia Mesh Fixation and Peritoneal Closure in Groin Hernia Repair


Advanced Medical Solutions state:

The US clinical trial for LiquiBandFix8 ® continues to progress well with completed patient procedure numbers on track to submit the clinical module of the Premarket Approval (PMA) filing in the second half of 2022, after the 12-month patient follow-up. AMS continues to be encouraged about the long-term prospects for the LiquiBandFix8® portfolio with entry into the US being a significant milestone for the Group.


If the US clinical trial results support the use of the Liquiband Fix8 device then US approval of Liquiband Fix8 should follow and then US sales of Liquiband Fix8 in 2023 commence.

The market for Liquiband Fix8 in America is huge compared to the UK

Advanced Medical Solutions have spent millions on this clinical trial and are obviously excited about what is happening --- note ref the US clinical trial

Primary Completion Date 2022-07-01

And in sept 2022 AMS said:
The US clinical trial for LiquiBandFix8 ® continues to progress well with completed patient procedure numbers on track to submit the clinical module of the Premarket Approval (PMA) filing in the second half of 2022.


It might be worth considering to what extent the Liquiband Fix8 device ( as used in laparoscopic hernia operations -- NOT the open device) -- will figure going forwards for both companies




Regarding the NHS and NICE and Liquiband Fix8 sales

NICE have said this


At present only 10% of lNHS UK aparoscopic hernia operations are carried out presently using glue

IMO --- NICE are wanting more clinical evidence before giving a direct recommendation for glue over tackers or staplers

Will the US clinical trial results be enough to convince NICE to do so ?

There are a number of other clinical trials in progress as well as the Advanced Medical Solutions trial in the US which gets mentioned.



So UK sales of laparoscopic hernia glue- based repair imo looks set to rise from the present low level of 10% of operations

When or if NICE makes the recommendation UK sales could easily rise imo by a significant multiple

However:

Since there are 800.000 inguinal hernia operations in the USA every year that market is around 11 times the size of the UK market at circa 70,000 operations a year





Thus what happens in the USA next year is very very important for both companies



imo dyor

[kenone] 21/9/2022 08:25

Jam tomorrow again. Still looking good going forward .Just have to wait a bit longer .

[mandate] 15/8/2022 16:10

.... if there was more of an information flow then the share price would probably be a little more robust

[mandate] 15/8/2022 15:57

Probably just the shorters buying back in ....

[kenone] 15/8/2022 14:32

Decent bit of buying today . Some good news in the offing at last ?

[barrenwuffet2] 11/8/2022 21:37

1.4p today. That’s as bad as it’s been in a long time. Maybe an opportunity?

[barrenwuffet2] 30/7/2022 21:11

Any idea why Buywell has deleted all of their posts on this thread?