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Document and Entity Information Document and Entity Information - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Mar. 12, 2020	Jun. 30, 2019
_Document And Entity Information Abstract [Abstract]
Document Annual Report	true
Document Transition Report	false
Entity File Number	0-19437
Entity Address, Address Line One	635 Davis Drive
Entity Address, Address Line Two	Suite 300
Entity Address, City or Town	Morrisville
Entity Address, State or Province	NC
Entity Address, Postal Zip Code	27560
City Area Code	919
Local Phone Number	765-8400
Entity Incorporation, State or Country Code	DE
Title of 12(b) Security	Common Stock$0.001 par value per share
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	FY
Trading Symbol	TRXC
Entity Registrant Name	TRANSENTERIX, INC.
Entity Central Index Key	0000876378
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Voluntary Filers	No
Entity Filer Category	Accelerated Filer
Entity Shell Company	false
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		46,089,766
Entity Public Float			$ 244.9
Security Exchange Name	NYSEAMER
Entity Tax Identification Number	11-2962080

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Current Assets
Cash and cash equivalents	$ 9,598	$ 21,061
Short-term investments	0	51,790
Accounts receivable, net	620	8,560
Inventories	10,653	10,941
Interest receivable	0	26
Other current assets	7,084	9,205
Total Current Assets	27,955	101,583
Restricted cash	969	590
Inventories, net of current portion	7,594	0
Property and equipment, net	4,706	6,337
Goodwill	0	80,131
Other long term assets	2,489	203
Total Assets	74,779	239,307
Current Liabilities
Accounts payable	3,579	4,433
Accrued expenses	8,553	9,619
Deferred revenue – current portion	818	1,733
Contingent consideration – current portion	73	72
Deferred consideration - MST Acquisition	0	5,962
Total Current Liabilities	13,023	21,819
Long Term Liabilities
Deferred revenue – less current portion	27	109
Contingent consideration – less current portion	1,011	10,565
Notes payable, net of debt discount	0	28,937
Warrant liabilities	2,388	4,636
Net deferred tax liabilities	1,392	4,720
Other long term liabilities	1,403	0
Total Liabilities	19,244	70,786
Commitments and Contingencies (Note 21)
Stockholders’ Equity
Common stock $0.001 par value, 750,000,000 shares authorized at December 31, 2019 and December 31, 2018; 20,691,301 and 16,641,999 shares issued and outstanding at December 31, 2019 and December 31, 2018, respectively	21	17
Additional paid-in capital	720,484	676,572
Accumulated deficit	(663,600)	(509,406)
Accumulated other comprehensive (loss) income	(1,370)	1,338
Total Stockholders’ Equity	55,535	168,521
Total Liabilities and Stockholders’ Equity	74,779	239,307
Intellectual Property, Net
Current Assets
Intangible assets	28,596	39,716
In-Process Research and Development
Current Assets
Intangible assets	$ 2,470	$ 10,747

Consolidated Balance Sheets (Parenthetical) - $ / shares	Dec. 31, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	750,000,000	750,000,000
Common stock, shares issued	20,691,301	16,641,999
Common stock, shares outstanding (in shares)	20,691,301	16,641,999

Consolidated Statements of Operations and Comprehensive Loss - USD ($) shares in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Revenue	$ 8,531,000	$ 24,102,000
Cost of revenue	20,731,000	16,171,000
Gross (loss) profit	(12,200,000)	7,931,000
Operating Expenses (Income)
Research and development	22,468,000	21,823,000
Sales and marketing	28,014,000	25,736,000
General and administrative	18,758,000	13,854,000
Amortization of intangible assets	10,301,000	10,868,000
Change in fair value of contingent consideration	(9,553,000)	(1,011,000)
Restructuring and other charges	1,374,000	0
Goodwill impairment	78,969,000	0
In-process research and development impairment	7,912,000	0
Acquisition related costs	0	647,000
Reversal of transfer fee accrual	0	(2,994,000)
Total Operating Expenses	142,375,000	57,083,000
Operating Loss	(154,575,000)	(49,152,000)
Other Income (Expense)
Change in fair value of warrant liabilities	2,248,000	(14,320,000)
Interest income	582,000	1,400,000
Interest expense	(4,613,000)	(4,208,000)
Other (expense) income	(967,000)	1,126,000
Total Other Expense, net	(2,750,000)	(16,002,000)
Loss before income taxes	(157,325,000)	(65,154,000)
Income tax benefit	3,124,000	3,377,000
Net loss	(154,201,000)	(61,777,000)
Comprehensive loss
Foreign currency translation loss	(2,708,000)	(3,690,000)
Comprehensive loss	$ (156,909,000)	$ (65,467,000)
Net loss per share - basic and diluted (in dollars per share)	$ (8.69)	$ (3.88)
Weighted average number of shares used in computing net loss per common share - basic and diluted	17,737	15,938
Product
Revenue	$ 7,104,000	$ 23,268,000
Cost of revenue	16,439,000	14,162,000
Service
Revenue	1,427,000	834,000
Cost of revenue	4,292,000	2,009,000
SurgiBot System
Operating Expenses (Income)
Loss (gain) from sale of assets, net	97,000	(11,840,000)
AutoLap
Operating Expenses (Income)
Loss (gain) from sale of assets, net	$ (15,965,000)	$ 0

Consolidated Statements of Shareholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Treasury Stock	Additional Paid-in Capital	Accumulated Deficit	Accumulated Other Comprehensive (Loss) Income
Balance (in shares) at Dec. 31, 2017		15,329	0
Balance at Dec. 31, 2017	$ 178,850	$ 16	$ 0	$ 621,446	$ (447,640)	$ 5,028
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation	9,039			9,039
Issuance of common stock and warrants, net of issuance costs	279			279
Issuance of common stock for MST acquisition (in Shares)		242
Issuance of common stock for MST Acquisition	8,300	$ 0		8,300
Exercise of stock options and warrants (in Shares)		889
Exercise of stock options and warrants	36,172	$ 1		36,171
Award of restricted stock units (in Shares)		82
Award of restricted stock units	0	$ 0
Return of common stock to pay withholding taxes on restricted stock (in Shares)			(41)
Return of common stock to pay withholding taxes on restricted stock	(1,662)		$ 1	(1,663)
Cancellation of treasury stock (in Shares)			(41)
Cancellation of treasury stock	(1)		$ (1)
Issuance of common stock related to sale of SurgiBot assets, Shares		100
Issuance of common stock related to sale of SurgiBot assets	3,000	$ 0		3,000
Cumulative effect of change in accounting principle (Note 2)	11				11
Other comprehensive loss	(3,690)					(3,690)
Net loss	(61,777)				(61,777)
Balance (in shares) at Dec. 31, 2018		16,642	0
Balance at Dec. 31, 2018	168,521	$ 17	$ 0	676,572	(509,406)	1,338
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation	11,508			11,508
Issuance of common stock, net of issuance costs (in shares)		3,571
Issuance of common stock, net of issuance costs	25,777	$ 4		25,773
Issuance of common stock for MST acquisition (in Shares)		370
Issuance of common stock for MST Acquisition	6,599	$ 0		6,599
Exercise of stock options and warrants (in Shares)		38
Exercise of stock options and warrants	538	$ 0		538
Award of restricted stock units (in Shares)		70
Award of restricted stock units	0	$ 0
Return of common stock to pay withholding taxes on restricted stock (in Shares)			(15)
Return of common stock to pay withholding taxes on restricted stock	(499)		$ 0	(499)
Cancellation of treasury stock (in Shares)			(15)
Cancellation of treasury stock	0
Cumulative effect of change in accounting principle (Note 2)	0			(7)	7
Other comprehensive loss	(2,708)					(2,708)
Net loss	(154,201)				(154,201)
Balance (in shares) at Dec. 31, 2019		20,691	0
Balance at Dec. 31, 2019	$ 55,535	$ 21	$ 0	$ 720,484	$ (663,600)	$ (1,370)

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
Consolidated Statements of Cash Flows - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Operating Activities
Net loss	$ (154,201,000)	$ (61,777,000)
Adjustments to reconcile net loss to net cash and cash equivalents used in operating activities:
Goodwill and in-process research and development impairment	86,881,000	0
Depreciation		2,420,000
Amortization of intangible assets	10,301,000	10,868,000
Amortization of debt discount and debt issuance costs	1,513,000	725,000
Amortization of short-term investment discount	(327,000)	(351,000)
Stock-based compensation	11,508,000	9,039,000
Inventory write-down related to restructuring	7,408,000	0
Inventory write-down	1,523,000	0
Bad debt expense	1,634,000	0
Interest expense on deferred consideration - MST acquisition	756,000	0
Deferred tax benefit	(3,224,000)	(3,377,000)
Loss on extinguishment of debt	1,006,000	1,400,000
Change in fair value of warrant liabilities	(2,248,000)	14,320,000
Change in fair value of contingent consideration	(9,553,000)	(1,011,000)
Reversal of transfer fee accrual	0	(2,994,000)
Changes in operating assets and liabilities, net of effect of acquisition:
Accounts receivable	6,083,000	(7,225,000)
Interest receivable	26,000	54,000
Inventories	(16,404,000)	(2,145,000)
Other current and long term assets	(655,000)	(325,000)
Accounts payable	(668,000)	767,000
Accrued expenses	(1,180,000)	2,134,000
Deferred revenue	(959,000)	825,000
Other long term liabilities	998,000	0
Net cash and cash equivalents used in operating activities	(73,484,000)	(48,493,000)
Investing Activities
Purchase of short-term investments	(12,883,000)	(55,439,000)
Proceeds from maturities of short-term investments	65,000,000	4,000,000
Payment for acquisition of a business	0	(5,800,000)
Purchase of property and equipment	(437,000)	(770,000)
Proceeds from sale of property and equipment	0	32,000
Net cash and cash equivalents provided by (used in) investing activities	67,645,000	(53,481,000)
Financing Activities
Payment of notes payable	(31,425,000)	(15,305,000)
Proceeds from issuance of debt and warrants, net of issuance costs	0	28,507,000
Payment of contingent consideration	0	(770,000)
Proceeds from issuance of common stock and warrants, net of issuance costs	25,777,000	279,000
Taxes paid related to net share settlement of vesting of restricted stock units	(499,000)	(1,662,000)
Proceeds from issuance of common stock related to sale of SurgiBot assets	0	3,000,000
Proceeds from exercise of stock options and warrants	538,000	12,403,000
Net cash and cash equivalents (used in) provided by financing activities	(5,609,000)	26,452,000
Effect of exchange rate changes on cash and cash equivalents	364,000	(433,000)
Net (decrease) increase in cash, cash equivalents and restricted cash	(11,084,000)	(75,955,000)
Cash, cash equivalents and restricted cash, beginning of period	21,651,000	97,606,000
Cash, cash equivalents and restricted cash, end of period	10,567,000	21,651,000
Supplemental Disclosure for Cash Flow Information
Interest paid	2,187,000	1,730,000
Supplemental Schedule of Non-cash Investing and Financing Activities
Transfer of inventories to property and equipment	486,000	2,160,000
Transfer of property and equipment to inventories	323,000	637,000
Reclass of warrant liability to common stock and additional paid-in capital	0	23,774,000
Cashless exercise of warrants	0	4,272,000
Issuance of common stock related to MST acquisition		8,300,000
Proceeds from sale of AutoLap assets exchanged for settlement of Company obligations	1,000,000	0
Deferred consideration - MST acquisition	0	5,962,000
AutoLap
Adjustments to reconcile net loss to net cash and cash equivalents used in operating activities:
Loss (gain) from sale of assets, net	(15,965,000)	0
Investing Activities
Proceeds related to sale of assets, net	15,965,000	0
SurgiBot System
Adjustments to reconcile net loss to net cash and cash equivalents used in operating activities:
Loss (gain) from sale of assets, net	97,000	(11,840,000)
Inventory write-down	1,500,000	0
Investing Activities
Proceeds related to sale of assets, net	$ 0	$ 4,496,000

Organization and Capitalization

12 Months Ended

Dec. 31, 2019

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Organization and Capitalization

TransEnterix, Inc. (the "Company") is a medical device company that is digitizing the interface between the surgeon and the patient in laparoscopy to increase control and reduce surgical variability in today’s value-based healthcare environment. The Company is focused on the market development for and commercialization of the Senhance™ System, which digitizes laparoscopic minimally invasive surgery. The Senhance System allows for robotic precision, haptic feedback, surgeon camera control via eye sensing and improved ergonomics while offering responsible economics.

The Senhance System is available for sale in Europe, the United States, Japan, Taiwan and select other countries.


•	The Senhance System has a CE Mark in Europe for adult and pediatric laparoscopic abdominal and pelvic surgery, as well as limited thoracic surgeries excluding cardiac and vascular surgery.


•	In the United States, the Company has received 510(k) clearance from the FDA for use of the Senhance System in laparoscopic colorectal and gynecologic surgery in a total of 28 indicated procedures, including benign and oncologic procedures, laparoscopic inguinal hernia and laparoscopic cholecystectomy (gallbladder removal) surgery.


•	In Japan, the Company has received regulatory approval and reimbursement for 98 laparoscopic procedures.

During 2018 and 2019, the Company successfully obtained FDA clearance and CE Mark for the Company's 3 millimeter diameter instruments, Senhance ultrasonic system, 3 millimeter and 5 millimeter hooks, and the Senhance articulating system. The 3 millimeter instruments enable the Senhance System to be used for microlaparoscopic surgeries, allowing for tiny incisions. The ultrasonic system is an advanced energy device used to deliver controlled energy to ligate and divide tissue, while minimizing thermal injury to surrounding structures. The Senhance articulating system was launched in Europe in November 2019 and the Company is evaluating its pathway forward to launch such a system in the United States with a planned submission for U.S. clearance at the end of 2020.

The Senhance System is a multi-port robotic surgery system that allows multiple robotic arms to control instruments and a camera. The system features advanced technology to enable surgeons with haptic feedback and the ability to move the camera via eye movement.

On October 31, 2018, the Company acquired the assets, intellectual property and highly experienced multidisciplinary personnel of MST Medical Surgical Technologies, Inc., or MST, an Israeli-based medical technology company. Through this acquisition the Company acquired MST’s AutoLap™ assets and technology, one of the only image-guided robotic scope positioning systems with FDA clearance and CE Mark. The Company believes MST’s image analytics technology will accelerate and drive meaningful Senhance System developments, and allow the Company to expand the Senhance System to add augmented, intelligent vision capability. See Note 3 for a description of the acquisition transaction. The Company sold the AutoLap assets, while retaining the core technology, in October 2019. See Note 3 for a description of the asset sale. On January 14, 2020, the Company announced that it had filed a 510(k) submission with the U.S. Food and Drug Administration for its Intelligent Surgical Unit (ISU™) for use with the Senhance System. The Company believes it is the first such FDA submission seeking clearance for machine vision technology in abdominal robotic surgery. On March 13, 2020, the Company announced that it has received FDA clearance for the Intelligent Surgical Unit.

The Company has also developed the SurgiBot System, a single-port, robotically enhanced laparoscopic surgical platform. In December 2017, the Company entered into an agreement with Great Belief International Limited, or GBIL, to advance the SurgiBot System towards global commercialization. The agreement transferred ownership of the SurgiBot System assets to GBIL, while the Company retained the option to distribute or co-distribute the SurgiBot System outside of China. GBIL intends to manufacture the SurgiBot System in China, obtain Chinese regulatory clearance from the National Medical Products Administration ("NMPA"), and commercialize in the Chinese market. The agreement provides the Company with proceeds of at least $29.0 million, of which $15.0 million has been received to date. The remaining $14.0 million represents minimum royalties and will be paid beginning at the earlier of receipt of Chinese regulatory approval or March 2023. The Company recorded a gain during the year ended December 31, 2018 based on the cash proceeds (excluding future royalties) in excess of the carrying value of the assets sold.

On September 18, 2015, the Company entered into a Membership Interest Purchase Agreement, (the “Purchase Agreement”) with Sofar S.p.A., (“Sofar”) as seller, Vulcanos S.r.l. (“Vulcanos”), as the acquired company, and TransEnterix International, Inc.

(“TransEnterix International”), a direct, wholly owned subsidiary of the Company that was incorporated in September 2015, as buyer. The closing of the transactions occurred on September 21, 2015 (the “Closing Date”) pursuant to which the Company acquired all of the membership interests of Vulcanos from Sofar (now known as the “Senhance Acquisition”), and changed the name of Vulcanos to TransEnterix Italia S.r.l (“TransEnterix Italia”). The Senhance Acquisition included all of the assets, employees and contracts related to the Senhance System. See Note 3 for a description of the related transactions.

On September 3, 2013, TransEnterix Surgical, Inc. a Delaware corporation (“TransEnterix Surgical”), and SafeStitch Medical, Inc., a Delaware corporation (“SafeStitch”) consummated a merger transaction whereby TransEnterix Surgical merged with a merger subsidiary of SafeStitch, with TransEnterix Surgical as the surviving entity in the merger (the “Merger”). As a result of the Merger, TransEnterix Surgical became a wholly owned subsidiary of SafeStitch. On December 6, 2013, SafeStitch changed its name to TransEnterix, Inc. and increased the authorized shares of common stock from 225,000,000 to 750,000,000, and authorized 25,000,000 shares of preferred stock, par value $0.01 per share.

As used herein, the term “Company” refers to the combination of SafeStitch and TransEnterix Surgical after giving effect to the Merger, and includes TransEnterix Surgical, Inc., SafeStitch LLC, TransEnterix International, Inc.; TransEnterix Italia S.r.l.; TransEnterix Europe S.à.R.L; TransEnterix Asia Pte. Ltd.; TransEnterix Taiwan Ltd.; TransEnterix Japan KK; TransEnterix Israel Ltd. and TransEnterix Netherlands B.V.

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

Basis of Presentation

The accompanying Consolidated Financial Statements have been prepared in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) and include the accounts of the Company and its direct and indirect wholly owned subsidiaries, SafeStitch LLC, TransEnterix Surgical, Inc., TransEnterix International, Inc., TransEnterix Italia S.r.l., TransEnterix Europe S.à.R.L; TransEnterix Asia Pte. Ltd.; TransEnterix Taiwan Ltd.; TransEnterix Japan KK; TransEnterix Israel Ltd. and TransEnterix Netherlands B.V. All material inter-company accounts and transactions have been eliminated in consolidation.

On December 11, 2019, following receipt of approval from stockholders at a special meeting of stockholders held on the same day, the Company filed an amendment to our Amended and Restated Certificate of Incorporation to effect a reverse stock split of the Company’s common stock at a ratio of one-for-thirteen, or the Reverse Stock Split. The Company’s common stock began trading on a split-adjusted basis on NYSE American on the morning of December 12, 2019. No fractional shares were issued in connection with the Reverse Stock Split. Instead, the Company rounded up each fractional share resulting from the reverse stock split to the nearest whole share. As a result of the Reverse Stock Split, the Company’s outstanding common stock decreased from approximately 261.9 million shares to approximately 20.2 million shares (without giving effect to the rounding up for each fractional share).

Unless otherwise noted, all share and per share data referenced in the consolidated financial statements and the notes thereto have been retroactively adjusted to reflect the Reverse Stock Split. As a result of the Reverse Stock Split, certain amounts in the consolidated financial statements and the notes thereto may be slightly different than previously reported due to rounding of fractional shares, and certain amounts within the consolidated balance sheets were reclassified between common stock and additional paid-in capital.

Going Concern

The Company's consolidated financial statements are prepared using U.S. GAAP applicable to a going concern, which contemplate the realization of assets and liquidation of liabilities in the normal course of business. The Company had an accumulated deficit of $663.6 million as of December 31, 2019, and has working capital of $14.9 million as of December 31, 2019. The Company has not established sufficient sales revenues to cover its operating costs and requires additional capital to proceed with its operating plan. The ability of the Company to continue as a going concern is dependent on the Company obtaining adequate capital to fund operating losses until it becomes profitable. In order to continue as a going concern, the Company will need, among other things, additional capital resources.

Traditionally, the Company has raised additional capital through equity offerings. Management's plan to obtain such resources for the Company may include additional sales of equity, traditional financing, such as loans, entry into a strategic collaboration, entry into an out-licensing arrangement or provision of additional distribution rights in some or all of our markets. In addition, the Company may consider fundamental business combination transactions. If the Company is unable to obtain adequate capital through one of these methods, or if expected capital from existing agreements is not received when due, or at all, it would need to reduce its sales and marketing and administrative expenses and delay research and development projects, including the purchase of equipment and supplies, until it is able to obtain sufficient funds. If such sufficient funds are not received on a timely basis, the

Company would then need to pursue a plan to license or sell its assets, seek to be acquired by another entity, cease operations and/or seek bankruptcy protection. However, management cannot provide any assurance that the Company will be successful in accomplishing any or all of its plans. The ability to successfully resolve these factors raise substantial doubt about the Company’s ability to meet its existing obligations, and to continue as a going concern within one year from the date that these financial statements are issued. The consolidated financial statements of the Company do not include any adjustments that may result from the outcome of these aforementioned uncertainties.

Use of Estimates

The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Significant items subject to such estimates and assumptions include identifiable intangible assets and goodwill, contingent consideration, warrant liabilities, stock compensation expense, revenue recognition, accounts receivable reserves, excess and obsolete inventory reserves, inventory classification between current and non-current, and deferred tax asset valuation allowances.

Cash and Cash Equivalents and Restricted Cash

The Company considers all highly liquid investments with original maturities of 90 days or less at the time of purchase to be cash equivalents.

Restricted cash at December 31, 2019 and 2018 includes $1.0 million and $0.6 million, respectively, in cash accounts held as collateral primarily under the terms of an office operating lease, credit cards, automobile leases, and a performance guarantee required by the government of a country in which a Senhance System was sold in 2018.

Short-term Investments

Short-term investments are considered to be “held-to-maturity” and are carried at amortized cost using the effective interest method. As of December 31, 2018, short-term investments consisted of $51.8 million in U.S. government securities, all of which matured in less than a year. There were no short-term investments as of December 31, 2019.

The Company reassesses the appropriateness of the classification of its investments at the end of each reporting period. The Company determined that its debt securities should be classified as held-to-maturity as of December 31, 2018. The Company had no debt securities as of December 31, 2019. This classification as of December 31, 2018 was based upon management’s determination that it has the positive intent and ability to hold the securities until their maturity dates, as the investments mature within six months and the underlying cash invested in these securities is not required prior to the investments maturity. Due to the short-term maturities of these instruments, the amortized cost approximated the related fair values, which was based on level 1 inputs as defined in Note 5. As of December 31, 2018, the gross holding gains and losses were immaterial.

The Company reviews its short-term investments for other-than-temporary impairment if the cost exceeds the fair value. No such impairment was recorded during the years ended December 31, 2019 or 2018.

Concentrations and Credit Risk

The Company’s principal financial instruments subject to potential concentration of credit risk are cash and cash equivalents, including amounts held in money market accounts. The Company places cash deposits with a federally insured financial institution. The Company maintains its cash at banks and financial institutions it considers to be of high credit quality; however, the Company’s domestic cash deposits may at times exceed the Federal Deposit Insurance Corporation’s insured limit. Balances in excess of federally insured limitations may not be insured. The Company has not experienced losses on these accounts, and management believes that the Company is not exposed to significant risks on such accounts.

The Company’s accounts receivable are derived from sales to customers located throughout the world. The Company evaluates its customers’ financial condition and, generally, requires no collateral from its customers. The Company provides reserves for potential credit losses and recorded a bad debt charge totaling $1.6 million during the year ended December 31, 2019. The Company had eight customers who constituted 85% of the Company’s net accounts receivable at December 31, 2019. The Company had five customers who constituted 89% of the Company’s net accounts receivable at December 31, 2018. The Company had six customers who accounted for 82% of sales in 2019 and twelve customers who accounted for 89% of sales in 2018.

Accounts Receivable

Accounts receivable are recorded at net realizable value, which includes an allowance for estimated uncollectible accounts. The allowance for uncollectible accounts was determined on a customer specific basis based on deemed collectability.

Inventories

Inventories are stated at the lower of cost (determined on a first-in, first-out basis) or net realizable value. Inventory costs include direct materials, direct labor, and normal manufacturing overhead. The Company records reserves, when necessary, to reduce the carrying value of inventory to its net realizable value. Management considers forecast demand in relation to the inventory on hand, competitiveness of product offerings, market conditions and product life cycles when determining excess and obsolescence and net realizable value adjustments. At the point of loss recognition, a new, lower-cost basis for that inventory is established, and any subsequent improvements in facts and circumstances do not result in the restoration or increase in that newly established cost basis.

Any inventory on hand at the measurement date in excess of the Company's current requirements based on anticipated levels of sales is classified as long-term on the Company's consolidated balance sheets. The Company's classification of long-term inventory requires it to estimate the portion of on hand inventory that can be realized over the upcoming twelve months.

Identifiable Intangible Assets and Goodwill

Identifiable intangible assets are recorded at cost, or when acquired as part of a business acquisition, at estimated fair value. Certain intangible assets are amortized over 5 to 10 years. Similar to tangible personal property and equipment, the Company periodically evaluates identifiable intangible assets for impairment whenever events or changes in circumstances indicate that the carrying amount may not be recoverable.

Intellectual property consists of purchased patent rights and developed technology acquired as part of a business acquisition. Amortization of the patent rights is recorded using the straight-line method over the estimated useful life of the patents of 10 years. Amortization of the developed technology is recorded using the straight-line method over the estimated useful life of 5 to 7 years.

The Company continues to operate in one segment, which is considered to be the sole reporting unit and therefore, goodwill is tested for impairment at the enterprise level. Indefinite-lived intangible assets, such as goodwill, are not amortized.

The Company typically tests goodwill for impairment annually, however, market conditions as well as reduced forecasts required that the Company test its goodwill carrying value as of September 30, 2019.

Subsequent to the adoption of Accounting Standards Update ("ASU") 2017-04 Intangibles - Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment , a company must record a goodwill impairment charge if a reporting unit’s carrying value exceeds its fair value. The Company generally determines the fair value of its reporting unit using two valuation methods: the “Income Approach — Discounted Cash Flow Analysis” method, and the “Market Approach — Guideline Public Company Method.”

Under the “Income Approach — Discounted Cash Flow Analysis” method the key assumptions consider projected sales, cost of sales, and operating expenses. These assumptions were determined by management utilizing the Company's internal operating plan, growth rates for revenues and operating expenses, and margin assumptions. An additional key assumption under this approach is the discount rate, which is determined by looking at current risk-free rates of capital, current market interest rates, and the evaluation of risk premium relevant to the business segment. If the Company's assumptions relative to growth rates were to change or were incorrect, the fair value calculation may change.

Under the “Market Approach — Guideline Public Company Method” the Company identified several publicly traded companies, which it believed had sufficiently relevant similarities. Similar to the income approach discussed above, sales, cost of sales, operating expenses, and their respective growth rates are key assumptions utilized. The market prices of the Company’s common stock and other guideline companies are additional key assumptions. If these market prices increase, the estimated market value would increase. If the market prices decrease, the estimated market value would decrease.

The results of these two methods were weighted based upon management’s evaluation of the relevance of the two approaches. In the 2019 evaluation, management determined that the income and market value approach should be weighted 50%-50%. In addition, management considered the decline in both the Company's stock price and market capitalization after the September 30, 2019 measurement date as relevant factors in the analysis.

The Company also performed a recoverability test on the intellectual property and concluded that there was no impairment as of September 30, 2019 or December 31, 2019.

During the third quarter of 2019, the Company determined that the goodwill associated with the business was impaired, and recorded impairment charges of $79.0 million. The impairment charge resulted from decreased sales and estimated cash flows and a significant decline in the Company's stock price. The Company also recognized a $7.9 million impairment charge to its IPR&D as it concluded that under the market value approach, the fair value of the IPR&D was lower than the carrying value.

No impairment existed at December 31, 2018.

In-Process Research and Development

In-process research and development (“IPR&D”) assets represent the fair value assigned to technologies that were acquired, which at the time of acquisition have not reached technological feasibility and have no alternative future use. IPR&D assets are considered to be indefinite-lived until the completion or abandonment of the associated research and development projects. During the period that the IPR&D assets are considered indefinite-lived, they are tested for impairment on an annual basis, or more frequently if the Company becomes aware of any events occurring or changes in circumstances that indicate that the fair value of the IPR&D assets are less than their carrying amounts. If and when development is complete, which generally occurs upon regulatory approval, and the Company is able to commercialize products associated with the IPR&D assets, these assets are then deemed definite-lived and are amortized based on their estimated useful lives at that point in time. If development is terminated or abandoned, the Company may have a full or partial impairment charge related to the IPR&D assets, calculated as the excess of carrying value of the IPR&D assets over fair value.

The IPR&D for the Senhance System was acquired on September 21, 2015. On October 13, 2017, upon receiving FDA clearance and the ability to commercialize the products associated with the IPR&D assets, the assets were deemed definite-lived, reclassified to intellectual property and are now amortized based on their estimated useful lives.

The IPR&D from MST was acquired on October 31, 2018.

The Company performed an impairment test of its IPR&D at the end of the third quarter 2019 as recent events and changes in market conditions indicated that the asset might be impaired.

The impairment test consisted of a comparison of the fair value of the IPR&D with its carrying amount. If the carrying amount of the IPR&D exceeds its fair value, an impairment loss is recognized in an amount equal to that excess.

Significant judgment is applied when testing for impairment. This judgment includes developing cash flow projections, selecting appropriate discount rates, identifying relevant market comparables, and incorporating general economic and market conditions.

During the third quarter of 2019, the Company concluded that the fair value determined by the market value approach, was lower than the carrying value. As a result, the Company recognized a $7.9 million impairment charge to its IPR&D. The company performed its annual impairment assessment at December 31, 2019 and no additional impairment was required.

Property and Equipment

Property and equipment consists primarily of machinery, manufacturing equipment, demonstration equipment, computer equipment, furniture, and leasehold improvements, which are recorded at cost.

Depreciation is recorded using the straight-line method over the estimated useful lives of the assets as follows:



Machinery, manufacturing and demonstration equipment	3-5 years
Computer equipment	3 years
Furniture	5 years
Leasehold improvements	Lesser of lease term or 3 to 10 years

Upon retirement or sale, the cost of assets disposed of and the related accumulated depreciation and amortization are removed from the accounts and any resulting gain or loss is credited or charged to operations. Repairs and maintenance costs are expensed as incurred.

Impairment of Long-Lived Assets

The Company reviews its long-lived assets for possible impairment whenever events or changes in circumstances indicate that the carrying amount of the assets may not be fully recoverable. To determine the recoverability of its long-lived assets, the Company

evaluates the probability that future estimated undiscounted net cash flows will be less than the carrying amount of the assets. If such estimated cash flows are less than the carrying amount of the long-lived assets, then such assets are written down to their fair value. The Company’s estimates of anticipated cash flows and the remaining estimated useful lives of long-lived assets could be reduced in the future, resulting in a reduction to the carrying amount of long-lived assets.

Contingent Consideration

Contingent consideration is recorded as a liability and is the estimate of the fair value of potential milestone payments related to business acquisitions. Contingent consideration is measured at fair value using a discounted cash flow model utilizing significant unobservable inputs including the probability of achieving each of the potential milestones, future Euro-to-USD exchange rates, and an estimated discount rate associated with the risks of the expected cash flows attributable to the various milestones. Significant increases or decreases in any of the probabilities of success or changes in expected achievement of any of these milestones would result in a significantly higher or lower fair value of these milestones, respectively, and commensurate changes to the associated liability. The contingent consideration is revalued at each reporting period and changes in fair value are recognized in the consolidated statements of operations and comprehensive loss.

Warrant Liabilities

The Company’s Series B Warrants (see Note 16) are measured at fair value using a simulation model which takes into account, as of the valuation date, factors including the current exercise price, the expected life of the warrant, the current price of the underlying stock, its expected volatility, holding cost and the risk-free interest rate for the term of the warrant (see Note 5). The warrant liability is revalued at each reporting period and changes in fair value are recognized in the consolidated statements of operations and comprehensive loss. The selection of the appropriate valuation model and the inputs and assumptions that are required to determine the valuation requires significant judgment and requires management to make estimates and assumptions that affect the reported amount of the related liability and reported amounts of the change in fair value. Actual results could differ from those estimates, and changes in these estimates are recorded when known. As the warrant liability is required to be measured at fair value at each reporting date, it is reasonably possible that these estimates and assumptions could change in the near term.

Translation of Foreign Currencies

The functional currency of the Company’s operational foreign subsidiaries is predominantly the Euro. The assets and liabilities of the Company’s foreign subsidiaries are translated into U.S. dollars at exchange rates in effect at the balance sheet date. Income and expense items are translated at the average exchange rates prevailing during the period. The cumulative translation effect for a subsidiary using a functional currency other than the U.S. dollar is included in accumulated other comprehensive income or loss as a separate component of stockholders’ equity.

The Company’s intercompany accounts are denominated in the functional currency of the foreign subsidiary. Gains and losses resulting from the remeasurement of intercompany receivables that the Company considers to be of a long-term investment nature are recorded as a cumulative translation adjustment in accumulated other comprehensive income or loss as a separate component of stockholders’ equity, while gains and losses resulting from the remeasurement of intercompany receivables from a foreign subsidiary for which the Company anticipates settlement in the foreseeable future are recorded in the consolidated statements of operations and comprehensive loss. The net gains and losses included in net loss in the consolidated statements of operations and comprehensive loss for the years ended December 31, 2019 and 2018 were not significant.

Business Acquisitions

Business acquisitions are accounted for using the acquisition method of accounting in accordance with ASC 805, “Business Combinations.” ASC 805 requires, among other things, that assets acquired and liabilities assumed be recognized at their fair values, as determined in accordance with ASC 820, “Fair Value Measurements,” as of the acquisition date. For certain assets and liabilities, book value approximates fair value. In addition, ASC 805 establishes that consideration transferred be measured at the closing date of the acquisition at the then-current market price. Under ASC 805, acquisition-related costs (i.e., advisory, legal, valuation and other professional fees) and certain acquisition-related restructuring charges impacting the target company are expensed in the period in which the costs are incurred. The application of the acquisition method of accounting requires the Company to make estimates and assumptions related to the estimated fair values of net assets acquired.

Significant judgments are used during this process, particularly with respect to intangible assets. Therefore, the purchase price allocation to intangible assets and goodwill has a significant impact on future operating results.

Risk and Uncertainties

The Company is subject to a number of risks similar to other similarly-sized companies in the medical device industry. These risks include, without limitation, the Company's ability to continue as a going concern, the historical lack of profitability; the Company’s ability to raise additional capital; the liquidity and capital resources of its partners; its ability to successfully develop, clinically test and commercialize its products; the timing and outcome of the regulatory review process for its products; changes in the health care and regulatory environments of the United States, the European Union, Japan, Taiwan and other countries in which the Company operates or intends to operate; its ability to attract and retain key management, marketing and scientific personnel; its ability to successfully prepare, file, prosecute, maintain, defend and enforce patent claims and other intellectual property rights; its ability to successfully transition from a research and development company to a marketing, sales and distribution concern; competition in the market for robotic surgical devices; and its ability to identify and pursue development of additional products.

Revenue Recognition

The Company adopted ASC Topic 606, Revenue from Contracts with Customers (the “New Revenue Standard”), on January 1, 2018. The Company’s revenue consists of product revenue resulting from the sale of systems, system components, instruments and accessories, and service revenue. The Company accounts for a contract with a customer when there is a legally enforceable contract between the Company and the customer, the rights of the parties are identified, the contract has commercial substance, and collectability of the contract consideration is probable. The Company's revenues are measured based on consideration specified in the contract with each customer, net of any sales incentives and taxes collected from customers that are remitted to government authorities.

The Company's system sale arrangements generally contain multiple products and services. For these bundled sale arrangements, the Company accounts for individual products and services as separate performance obligations if they are distinct, which is if a product or service is separately identifiable from other items in the bundled package, and if a customer can benefit from it on its own or with other resources that are readily available to the customer. The Company’s system sale arrangements include a combination of the following performance obligations: system(s), system components, instruments, accessories, and system service. The Company’s system sale arrangements generally include a five years period of service. The first year of service is generally free and included in the system sale arrangement and the remaining four years are generally included at a stated service price. The Company considers the service terms in the arrangements that are legally enforceable to be performance obligations. Other than service, the Company generally satisfies all of the performance obligations up-front. System components, system accessories, instruments, accessories, and service are also sold on a standalone basis.

The Company recognizes revenues as the performance obligations are satisfied by transferring control of the product or service to a customer. The Company generally recognizes revenue for the performance obligations as follows:

•

System sales. For systems and system components sold directly to end customers, revenue is recognized when the Company transfers control to the customer, which is generally at the point when acceptance occurs that indicates customer acknowledgment of delivery or installation, depending on the terms of the arrangement. For systems sold through distributors, for which distributors are responsible for installation, revenue is recognized generally at the time of shipment. The Company’s system arrangements generally do not provide a right of return. The systems are generally covered by a one-year warranty. Warranty costs were not material for the periods presented.

•

Instruments and accessories. Revenue from sales of instruments and accessories is recognized when control is transferred to the customers, which generally occurs at the time of shipment, but also occurs at the time of delivery depending on the customer arrangement. Accessory products include sterile drapes used to help ensure a sterile field during surgery, vision products such as replacement endoscopes, camera heads, light guides, and other items that facilitate use of the Senhance System.


•	Service. Service revenue is recognized ratably over the term of the service period as the customers benefit from the service throughout the service period. Revenue related to services performed on a time-and-materials basis is recognized when performed.

For multiple-element arrangements, revenue is allocated to each performance obligation based on its relative standalone selling price. Standalone selling prices are based on observable prices at which the Company separately sells the products or services. Due to limited sales to date, standalone selling prices are not directly observable. The Company estimates the standalone selling price using the market assessment approach considering market conditions and entity-specific factors including, but not limited to, features and functionality of the products and services, geographies, type of customer, and market conditions. The Company regularly reviews standalone selling prices and updates these estimates if necessary.

The following table presents revenue disaggregated by type and geography:



	Year Ended December 31,
	2019		2018
	(in thousands)
U.S.
Systems	$	90	$	2,556
Instruments and accessories	108		967
Services	338		255
Total U.S. revenue	536		3,778

Outside of U.S. ("OUS")
Systems	5,459		16,193
Instruments and accessories	1,447		3,552
Services	1,089		579
Total OUS revenue	7,995		20,324

Total
Systems	5,549		18,749
Instruments and accessories	1,555		4,519
Services	1,427		834
Total revenue	$	8,531	$	24,102

The Company recognizes sales by geographic area based on the country in which the customer is based.

Transaction price allocated to remaining performance obligations relates to amounts allocated to products and services for which the revenue has not yet been recognized. A significant portion of this amount relates to service obligations performed under the Company's system sales contracts that will be invoiced and recognized as revenue in future periods. Transaction price allocated to remaining performance obligations was approximately $3.7 million as of December 31, 2019.

The Company invoices its customers based on the billing schedules in its sales arrangements. Contract assets for the periods presented primarily represent the difference between the revenue that was recognized based on the relative selling price of the related performance obligations and the contractual billing terms in the arrangements. Contract assets are included in accounts receivable and totaled $0.2 million and $0.2 million as of December 31, 2019 and 2018, respectively. Deferred revenue for the periods presented was primarily related to service obligations, for which the service fees are billed up-front, generally annually. The associated deferred revenue is generally recognized ratably over the service period. The Company did not have any significant impairment losses on its contract assets for the periods presented. Revenue recognized from deferred revenue attributable to warranty and maintenance agreements totaled $1.0 million for the year ended December 31, 2019. The Company also recognized $1.3 million during the year ended December 31, 2019, half of which was deferred at December 31, 2018, related to a 2017 system sale where revenue was deferred until its first clinical use, which occurred in the second quarter of 2019. Revenue recognized from deferred revenue for the year ended December 31, 2018 totaled $0.4 million.

In connection with assets recognized from the costs to obtain a contract with a customer, the Company determined that the sales incentive programs for its sales team do not meet the requirements to be capitalized as the Company does not expect to generate future economic benefits from the related revenue from the initial sales transaction.

Cost of Revenue

Cost of revenue consists of contract manufacturing, materials, labor and manufacturing overhead incurred internally to produce the products. Shipping and handling costs incurred by the Company are included in cost of revenue. During the year ended December 31, 2019, the Company recorded a $7.4 million inventory write-down as part of a restructuring plan and a $1.5 million charge for inventory obsolescence related to certain system components.

Research and Development Costs

Research and development expenses primarily consist of engineering, product development and regulatory expenses, incurred in the design, development, testing and enhancement of our products. Research and development costs are expensed as incurred.

Reversal of Transfer Fee Accrual

In connection with the Senhance acquisition, the Company recorded an accrual of $3.0 million in the 2015 third quarter for the potential assessment of additional transfer fees that could be assessed during a three year period. In September 2018, the Company determined that the accrual was no longer required and reversed the accrual.

Stock-Based Compensation

The Company follows ASC 718 “Stock Compensation”, which provides guidance in accounting for share-based awards exchanged for services rendered and requires companies to expense the estimated fair value of these awards over the requisite service period.

The Company recognizes compensation expense for stock-based awards based on estimated fair values on the date of grant for awards. The Company uses the Black-Scholes-Merton option pricing model to determine the fair value of stock options. The fair value of restricted stock units is determined by the market price of the Company’s common stock on the date of grant. The expense associated with stock-based compensation is recognized on a straight-line basis over the requisite service period of each award.

The Company records as expense the fair value of stock-based compensation awards, including stock options and restricted stock units. Compensation expense for stock-based compensation was approximately $11,508,000 and $9,039,000 for the years ended December 31, 2019 and 2018, respectively.

Income Taxes

The Company accounts for income taxes using the asset and liability method, which requires the recognition of deferred tax assets or liabilities for the temporary differences between financial reporting and tax basis of the Company’s assets and liabilities, and for tax carryforwards at enacted statutory rates in effect for the years in which the asset or liability is expected to be realized. The effect on deferred taxes of a change in tax rates is recognized in income during the period that includes the enactment date. In addition, valuation allowances are established when necessary to reduce deferred tax assets and liabilities to the amounts expected to be realized.

On December 22, 2017, the Tax Cuts and Jobs Act (“Tax Legislation”) was enacted into law, which reduced the U.S. federal corporate income tax rate to 21% for tax years beginning after December 31, 2018. As a result of the newly enacted tax rate, the Company adjusted its U.S. deferred tax assets as of December 31, 2018, by applying the new 21% rate, which resulted in a decrease to the deferred tax assets and a corresponding decrease to the valuation allowance of approximately $36.1 million, resulting in no impact to the consolidated statement of operations and comprehensive loss.

The Tax Legislation also implements a territorial tax system. Under the territorial tax system, in general, the Company's foreign earnings will no longer be subject to tax in the U.S. As part of transition to the territorial tax system the Tax Legislation includes a mandatory deemed repatriation of all undistributed foreign earnings that are subject to a U.S. income tax. The Company has determined that the deemed repatriation applicable to the year ended December 31, 2018 did not result in an additional U.S. income tax liability as it has no undistributed foreign earnings.

The FASB Staff Q&A, Topic 740, No. 5, Accounting for Global Intangible Low-Taxed Income (“GILTI”), states that an entity can make an accounting policy election to either recognize deferred taxes for temporary basis differences expected to reverse as GILTI in future years or to provide for the tax expense related to GILTI in the year the tax is incurred as a period expense only. The Company has elected to account for GILTI as a period expense in the year the tax is incurred.

In a referendum held on May, 19 2019, Swiss voters adopted the Federal Act on Tax Reform and AVS Financing (TRAF). TRAF introduces major changes in the Swiss tax system by abolishing certain current preferential tax regimes and replacing them with new measures that are in line with international standards. The referendum did not have a material impact on the Company’s 2019 tax provision. The Company will continue to evaluate the impact of these provisions in future periods as the enactment process in completed.

Comprehensive Loss

Comprehensive loss is defined as the change in equity of a business enterprise during a period from transactions and other events and circumstances from non-owner sources.

Segments

The Company operates in one business segment—the research, development and sale of medical device robotics to improve minimally invasive surgery. The Company’s chief operating decision maker (determined to be the Chief Executive Officer) does not manage any part of the Company separately, and the allocation of resources and assessment of performance are based on the

Company’s consolidated operating results. Approximately 19% and 54% of the Company’s total consolidated assets are located within the U.S. as of December 31, 2019 and 2018, respectively. The remaining assets are mostly located in Europe and are primarily related to the Company’s facility in Italy, and include goodwill (as of December 2018 only), intellectual property, in-process research and development, other current assets, property and equipment, cash, accounts receivable, other long-term assets and inventory of $60.5 million and $111.0 million at December 31, 2019 and 2018. Total assets outside of the U.S. excluding goodwill amounted to 81% and 34% of total consolidated assets at December 31, 2019 and 2018, respectively. The Company recognizes sales by geographic area based on the country in which the customer is based. For the years ended December 31, 2019 and 2018, 6% and 16%, respectively, of net revenue were generated in the United States; 39% and 78% were generated in Europe; and 55% and 6% were generated in Asia.

Impact of Recently Issued Accounting Standards

In August 2018, the FASB issued ASU 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework—Changes to the Disclosure Requirements for Fair Value Measurement. This ASU eliminates, adds and modifies certain disclosure requirements for fair value measurements as part of its disclosure framework project. The standard is effective for all entities for financial statements issued for fiscal years beginning after December 15, 2019, and interim periods within those fiscal years. Early adoption is permitted. The adoption of this ASU should not have a material impact on the consolidated financial statements.

In June 2018, the FASB issued ASU 2018-07, Compensation-Stock Compensation (Topic 718), Improvements to Nonemployee Share-based Payments. This ASU expands the scope of Topic 718 to include share-based payment transactions for acquiring goods and services from non-employees. The Company adopted ASU 2018-07 on January 1, 2019, whereby the accounting for share-based payments for non-employees and employees will be substantially the same. With the adoption of ASU 2018-07, the Company recorded a charge to accumulated deficit of $7 thousand.

In July 2017, the FASB issued ASU 2017-11, Earnings Per Share (Topic 260); Distinguishing Liabilities from Equity (Topic 480); Derivatives and Hedging (Topic 815): (Part I) Accounting for Certain Financial Instruments with Down Round Features, (Part II) Replacement of the Indefinite Deferral for Mandatorily Redeemable Financial Instruments of Certain Nonpublic Entities and Certain Mandatorily Redeemable Noncontrolling Interests with a Scope Exception. The amendments in this update are intended to simplify the accounting for certain equity-linked financial instruments and embedded features with down round features that result in the strike price being reduced on the basis of the pricing of future equity offerings. Under the new guidance, a down round feature will no longer need to be considered when determining whether certain financial instruments or embedded features should be classified as liabilities or equity instruments. That is, a down round feature will no longer preclude equity classification when assessing whether an instrument or embedded feature is indexed to an entity's own stock. In addition, the amendments clarify existing disclosure requirements for equity-classified instruments. These amendments are effective for fiscal years, and interim periods within those years, beginning after December 15, 2018, with early adoption permitted. The adoption of this ASU did not have a material impact on the consolidated financial statements.

In February 2016, the FASB issued ASU 2016-02, Leases (Topic (842), which establishes a right-of-use (ROU) model that requires a lessee to record a ROU asset and a lease liability on the balance sheet for most leases. In July 2018, the FASB issued ASU 2018-11, Leases (Topic 842), Targeted Improvements, which amends the guidance to add a method of adoption whereby the issuer may elect to recognize a cumulative effect adjustment at the beginning of the period of adoption. ASU 2018-11 Leases (Topic 842), Targeted Improvements, does not require comparative period financial information to be adjusted. Leases will be classified as either finance or operating, with classification affecting the pattern of expense recognition in the income statement.

ASU 2016-02 defines a lease as a contract, or part of a contract, that conveys the right to control the use of identified property, plant or equipment for a period of time in exchange for consideration. To determine whether a contract conveys the right to control the use of the identified asset for a period of time, the customer has to have both (i)the right to obtain substantially all of the economic benefits from the use of the identified asset and (ii)the right to direct the use of the identified asset. A contract does not contain an identified asset if the supplier has a substantive right to substitute such asset ("the leasing criteria"). As part of the adoption of ASC 842, the Company performed an assessment of the impact that the new lease recognition standard will have on its consolidated financial statements. The Company’s leases relate to office equipment, company owned vehicles and corporate offices, all of which are classified as operating leases and include fixed payments. The Company does not have any material leases, individually or in the aggregate, classified as a finance leasing arrangement under the new lease recognition standard.

On January 1, 2019, the Company adopted ASU No. 2016-02, applying the package of practical expedients to leases that commenced before the effective date whereby the Company elected to not reassess the following: (i) whether any expired or existing contracts contain leases; (ii) the lease classification for any expired or existing leases; and (iii) initial direct costs for any existing leases. The Company also elected, for all classes of underlying assets, to not separate non-lease components from lease components and instead to account for them as a single component. The Company elected to apply the transition provisions as of January 1, 2019, the date of adoption, using the effective date approach, and recorded lease ROU assets and related liabilities on its balance sheet

without restating prior periods. Many of the Company’s leases include base rental periods coupled with options to renew or terminate the lease, generally at the Company’s discretion. In evaluating the lease term, the Company considers whether renewal is reasonably certain. To the extent a significant economic incentive exists to renew the lease, the option is included within the lease term. Based on the Company’s leases, renewal options generally do not provide a significant economic incentive and are therefore excluded from the lease term. The ROU asset is included in other long-term assets on the consolidated balance sheets. The current portion of operating lease liabilities are presented within accrued liabilities while the non-current portion of operating lease liabilities are presented within other long term liabilities on the consolidated balance sheets and represents the present value of the remaining lease payments, discounted using the Company’s incremental borrowing rate, which ranges between 6.1% and 8.5% based on the terms of the lease. The weighted average discount rate as of December 31, 2019 was 7.8%. As a result of the adoption of ASU 2016-02, other long-term assets increased by $1.8 million, accrued expenses increased by $0.5 million, and other long-term liabilities increased by $1.2 million. There was no change to the Company’s consolidated statements of operations and comprehensive loss or cash flows as a result of the adoption of ASU 2016-02.

As of December 31, 2019, the right-of-use asset totaled $2.3 million and is included within other long term assets on the consolidated balance sheet and the lease liability totaled $2.5 million, of which $1.1 million is classified as current within accrued expenses and $1.4 million is classified as non-current and makes up the full balance of other long term liabilities on the consolidated balance sheet. Operating lease costs for the year ended December 31, 2019 totaled $1.4 million and are included within operating expenses in the consolidated statement of operations and comprehensive loss. Rent expense for the year ended December 31, 2018 was approximately $1.2 million. The weighted average remaining lease term for operating leases as of December 31, 2019 was 2.6 years. Total cash paid for operating leases during the year ended December 31, 2019 was $1.7 million and is included within cash flows from operating activities within the consolidated statement of cash flows.

The following table presents the minimum lease payments as of December 31, 2019 (in thousands):



January 1, 2020 to December 31, 2020	$	1,372
January 1, 2021 to December 31, 2021	716
January 1, 2022 to December 31, 2022	454
January 1, 2023 to December 31, 2023	207
January 1, 2024 to December 31, 2024	28
Thereafter	—
Total minimum lease payments	$	2,778
Less: Amount of lease payments representing interest	(266		)
Present value of future minimum lease payments	$	2,512

The following table presents the minimum lease payments as of December 31, 2018 (in thousands):



January 1, 2019 to December 31, 2019	$	929
January 1, 2020 to December 31, 2020	399
January 1, 2021 to December 31, 2021	385
January 1, 2022 to December 31, 2022	175
January 1, 2023 to December 31, 2023	38
Thereafter	—
Total minimum lease payments	$	1,926

Acquisitions

12 Months Ended

Dec. 31, 2019

Business Combinations [Abstract]

Acquisitions

MST Medical Surgery Technologies Ltd. Acquisition

On September 23, 2018, the Company entered into an Asset Purchase Agreement (the “MST Purchase Agreement”) with MST Medical Surgery Technologies Ltd., an Israeli private company (the “Seller”), and two of the Company’s wholly owned subsidiaries, as purchasers of the assets of the Seller, (collectively, the “Buyers”). The closing of the transactions occurred on October 31, 2018, pursuant to which the Company acquired the Seller’s assets consisting of intellectual property and tangible assets related to surgical analytics with its core image analytics technology designed to empower and automate the surgical environment, with a focus on medical robotics and computer-assisted surgery. The core technology acquired under the MST Purchase Agreement is a software-

based image analytics information platform powered by advanced visualization, scene recognition, artificial intelligence, machine learning and data analytics.

Under the terms of the MST Purchase Agreement, at the closing the Buyers purchased substantially all of the assets of the Seller. The acquisition price consisted of two tranches. At or prior to the closing of the transaction the Buyers paid $5.8 million in cash and the Company issued approximately 242,310 shares of the Company’s common stock (the "Initial Shares"). A second tranche of $6.6 million in additional consideration was payable in cash, stock or cash and stock, at the discretion of the Company, within one year after the closing date. On August 7, 2019, the Company notified MST that the Company would satisfy the additional consideration payment of $6.6 million by issuing shares of TransEnterix common stock. The number of shares issued to MST was 370,423 (the “Additional Consideration Shares” and, together with the Initial Shares, the “Securities Consideration”).

The MST Purchase Agreement contains customary representations and warranties of the parties and the parties have customary indemnification obligations, which are subject to certain limitations described further in the MST Purchase Agreement.

In connection with the closing under the MST Purchase Agreement (the “MST Acquisition”), the Company and the Seller entered into a Lock-Up Agreement, dated October 31, 2018, pursuant to which the Seller agreed, subject to certain exceptions, not to sell, transfer or otherwise convey any of the Initial Shares for six months following the Closing Date. As of the date of this report, 75% of the Initial Shares are free from the lock-up restrictions. For the remaining 25% of the Initial Shares, the Lock-Up Agreement provides that all of the Initial Shares will be released from the lock-up restrictions on May 1, 2020, or earlier upon certain other conditions. The Additional Consideration Shares were released from the lock-up restrictions on February 7, 2020.

In connection with the MST Acquisition, the Company also entered into a Registration Rights Agreement, dated as of October 31, 2018, with MST, pursuant to which the Company agreed to register the Securities Consideration such that such Securities Consideration is eligible for resale following the end of the lock-up periods described above. All of the Securities Consideration is eligible to be sold by the holders without restriction under Rule 144, therefore the Registration Rights Agreement has expired. The MST Purchase Agreement was accounted for as a business combination utilizing the methodology prescribed in ASC 805. The purchase price for the acquisition was allocated to the assets acquired and liabilities assumed based on their estimated fair values.

The following table summarizes the acquisition date fair value of the consideration (in thousands).



Stock consideration	$	8,300
Cash consideration	5,800
Present value of deferred consideration	5,900
Other consideration	314
Total consideration	$	20,314

The value of the stock consideration was determined based on the fair value of the stock on the closing date, adjusted for a lack of marketability discount related to the Lock-Up Agreement. The value of the deferred consideration was determined based on the present value of the future payment using a market interest rate.

The following table summarizes the estimated fair values of the assets acquired and liabilities assumed on October 31, 2018, the date of acquisition (in thousands):



Property and equipment	$	43
In-process research and development	10,633
Goodwill	9,638
Net assets acquired	$	20,314

The Company allocated $10.6 million of the purchase price to identifiable intangible assets of in-process research and development that met the separability and contractual legal criterion of ASC 805. IPR&D is principally the estimated fair value of the MST technology which had not reached commercial technological feasibility nor had alternative future use at the time of the acquisition and therefore the Company considered IPR&D, with assigned values to be allocated to the IPR&D assets acquired.

Goodwill is calculated as the difference between the acquisition-date fair value of the consideration transferred and the fair values of the assets acquired and liabilities assumed. The goodwill resulting from this acquisition arises largely from synergies expected

from combining the intellectual property acquired from MST with the Company’s existing intellectual property as well as acquired employees. The goodwill is deductible for income tax purposes.

The following unaudited pro forma information presents the combined results of operations for the year ended December 31, 2018, as if the Company had completed the MST Acquisition at the beginning of fiscal 2018. The pro forma financial information is provided for comparative purposes only and is not necessarily indicative of what actual results would have been had the acquisition occurred on the date indicated, nor does it give effect to synergies, cost savings, fair market value adjustments, and other changes expected to result from the acquisition. Accordingly, the pro forma financial results do not purport to be indicative of consolidated results of operations as of the date hereof, for any period ended on the date hereof, or for any other future date or period. The pro forma consolidated financial information has been calculated after applying the Company’s accounting policies and includes adjustments for transaction-related costs.



	Year Ended December 31,
	2018
	(In thousands except per share amounts) (unaudited)
Revenue	$	24,170
Net loss	(64,365		)
Net loss per share	$	(0.31	)

During the year ended December 31, 2018 no revenue and a net loss of $0.4 million associated with MST’s operations are included in the consolidated financial statements.

On July 3, 2019 the Company entered into a System Sale Agreement with GBIL to sell certain assets related to the AutoLap technology. On October 15, 2019, the Company amended the prior AutoLap Sale Agreement with GBIL. Pursuant to the amended agreement the Company sold the AutoLap laparoscopic vision system, or AutoLap, and related assets to GBIL. The assets include inventory, spare parts, production equipment, testing equipment and certain intellectual property specifically related to the AutoLap. The purchase price was $17.0 million, all of which was received in 2019 in the form of $16 million in cash and a commitment by GBIL to pay $1.0 million to settle certain Company obligations in China. GBIL subsequently paid the obligation. Under the amended AutoLap Agreement, the Company entered into a cross‑license agreement with GBIL to retain rights to use any AutoLap-related intellectual property sold to GBIL, and to non-exclusively license additional intellectual property to GBIL. The Company recorded a $16.0 million gain on the sale of the AutoLap assets during the year ended December 31, 2019, which represented the proceeds received in excess of the carrying value of the assets, less contract costs.

Senhance Surgical Robotic System

On September 21, 2015, the Company completed the strategic acquisition, through its wholly owned subsidiary TransEnterix International, from Sofar, of all of the assets, employees and contracts related to the advanced robotic system for minimally invasive laparoscopic surgery now known as the Senhance System.

Under the terms of the Purchase Agreement, the consideration consisted of the issuance of (i) 1,195,647 shares of the Company’s common stock (the “Securities Consideration”) and (ii) approximately $25.0 million U.S. Dollars and €27.5 million Euro in cash consideration (the “Cash Consideration”).

On December 30, 2016, the Company and Sofar entered into an Amendment to the Purchase Agreement (the “Amendment”) to restructure the terms of the second tranche of the Cash Consideration (the “Second Tranche”). The initial Securities Consideration was issued in full at the closing of the Senhance Acquisition; under the Amendment, the Second Tranche of the Cash Consideration was restructured, and an additional issuance of 286,360 shares of the Company’s common stock with an aggregate fair market value of €5.0 million occurred in January 2017. Following the Amendment, the total Cash Consideration was $25.0 million U.S. Dollars and approximately €22.5 million Euro, of which all but €15.1 million Euro has been paid as of December 31, 2019. The majority of the remaining Cash Consideration to be paid is the third tranche of the Cash Consideration (the “Third Tranche”) of €15.0 million which shall be payable upon achievement of trailing revenues from sales or services contracts of the Senhance System of at least €25.0 million over a calendar quarter.

The fourth tranche of the Cash Consideration of €2.5 million was payable in installments by December 31 of each year as reimbursement for certain debt payments made by Sofar under an existing Sofar loan agreement in such year, with payments beginning as of December 31, 2017. As of December 31, 2019, the Company had paid €2.4 million of the fourth tranche.

The Third Tranche payments will be accelerated in the event that (i) the Company or TransEnterix International is acquired, (ii) the Company significantly reduces or suspends selling efforts of the Senhance System, or (iii) the Company acquires a business that offers alternative products that are directly competitive with the Senhance System. The remaining amounts due to Sofar are included in contingent consideration as of December 31, 2019 and 2018.

The Purchase Agreement contains customary representations and warranties of the parties and the parties have customary indemnification obligations, which are subject to certain limitations described further in the Purchase Agreement.

Cash, Cash Equivalents, and Restricted Cash

12 Months Ended

Dec. 31, 2019

Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents [Abstract]

Cash, Cash Equivalents, and Restricted Cash

Cash, cash equivalents and restricted cash consist of the following:



	December 31, 2019		December 31, 2018
	(In thousands)
Cash	$	9,596	$	1,485
Money market	2		19,576
Total cash and cash equivalents	$	9,598	$	21,061
Restricted cash	969		590
Total	$	10,567	$	21,651

Fair Value

12 Months Ended

Dec. 31, 2019

Fair Value Disclosures [Abstract]

Fair Value

The Company held certain assets and liabilities that are required to be measured at fair value on a recurring basis. These assets and liabilities include cash and cash equivalents, restricted cash, contingent consideration and warrant liabilities. ASC 820-10 (“Fair Value Measurement Disclosure”) requires the valuation using a three-tiered approach, which requires that fair value measurements be classified and disclosed in one of three tiers. These tiers are: Level 1, defined as quoted prices in active markets for identical assets or liabilities; Level 2, defined as valuations based on observable inputs other than those included in Level 1, such as quoted prices for similar assets and liabilities in active markets, or other inputs that are observable or can be corroborated by observable input data; and Level 3, defined as valuations based on unobservable inputs reflecting the Company’s own assumptions, consistent with reasonably available assumptions made by other market participants. The Company did not have any transfers of assets and liabilities between Level 1, Level 2, and Level 3 of the fair value hierarchy during the years ended December 31, 2019 and 2018.

For assets and liabilities recorded at fair value, it is the Company’s policy to maximize the use of observable inputs and minimize the use of unobservable inputs when developing fair value measurements, in accordance with the fair value hierarchy. Fair value measurements for assets and liabilities where there exists limited or no observable market data and therefore, are based primarily upon estimates, are often calculated based on the economic and competitive environment, the characteristics of the asset or liability and other factors. Therefore, the results cannot be determined with precision and may not be realized in an actual sale or immediate settlement of the asset or liability. Additionally, there may be inherent weaknesses in any calculation technique, and changes in the underlying assumptions used, including discount rates and estimates of future cash flows, could significantly affect the results of current or future values. The Company utilizes fair value measurements to record fair value adjustments to certain assets and liabilities and to determine fair value disclosures.

As prescribed by U.S. GAAP, the Company groups assets and liabilities at fair value in three levels, based on the markets in which the assets and liabilities are traded and the reliability of the assumptions used to determine fair value. An adjustment to the pricing method used within either Level 1 or Level 2 inputs could generate a fair value measurement that effectively falls in a lower level in the hierarchy.

The determination of where an asset or liability falls in the hierarchy requires significant judgment. The Company evaluates its hierarchy disclosures and based on various factors, it is possible that an asset or liability may be classified differently from period to period. However, the Company expects changes in classifications between levels will be rare.

The carrying values of accounts receivable, short-term investments, interest receivable, accounts payable, and certain accrued expenses at December 31, 2019 and 2018, approximate their fair values due to the short-term nature of these items. The Company’s notes payable balance also approximates fair value as of December 31, 2018, as the interest rate on the notes payable approximates the rates available to the Company as of this date.

The following are the major categories of assets and liabilities measured at fair value on a recurring basis as of December 31, 2019 and 2018, using quoted prices in active markets for identical assets (Level 1); significant other observable inputs (Level 2); and significant unobservable inputs (Level 3):



	December 31, 2019
	(In thousands) (unaudited)
Description	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Total
Assets measured at fair value
Cash and cash equivalents	$	9,598	$	—	$	—	$	9,598
Restricted cash	969		—		—		969
Total Assets measured at fair value	$	10,567	$	—	$	—	$	10,567
Liabilities measured at fair value
Contingent consideration	$	—	$	—	$	1,084	$	1,084
Warrant liabilities	—		—		2,388		2,388
Total liabilities measured at fair value	$	—	$	—	$	3,472	$	3,472



	December 31, 2018
	(In thousands)
Description	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Total
Assets measured at fair value
Cash and cash equivalents	$	21,061	$	—	$	—	$	21,061
Restricted cash	590		—		—		590
Total Assets measured at fair value	$	21,651	$	—	$	—	$	21,651
Liabilities measured at fair value
Contingent consideration	$	—	$	—	$	10,637	$	10,637
Warrant liabilities	—		—		4,636		4,636
Total liabilities measured at fair value	$	—	$	—	$	15,273	$	15,273

The Company’s financial liabilities consisted of contingent consideration potentially payable to Sofar related to the Senhance Acquisition in September 2015 (Note 3). This liability is reported as Level 3 as estimated fair value of the contingent consideration related to the acquisition requires significant management judgment or estimation and is calculated using the income approach, using various revenue and cost assumptions and applying a probability to each outcome. The decrease in fair value of the contingent consideration of $9.6 million for the year ended December 31, 2019 was primarily due to a change in the Company's long-term forecast. The decrease in fair value of the contingent consideration of $1.0 million for the year ended December 31, 2018 was primarily due to the impact of foreign currency exchange rates and changes in the Company's long-range forecast. Adjustments associated with the change in fair value of contingent consideration are included in the Company’s consolidated statements of operations and comprehensive loss.

On April 28, 2017, the Company sold 24.9 million units (the “Units”), each consisting of approximately 0.077 shares of the Company's Common Stock, a Series A warrant to purchase approximately 0.077 shares of Common Stock with an exercise price of $13.00 per share (the “Series A Warrants”), and a Series B warrant to purchase approximately 0.058 shares of Common Stock with an exercise price of $13.00 per share (the “Series B Warrants,” together with the Series A Warrants, the “Warrants”), at an offering price of $1.00 per Unit. Each Series A Warrant was exercisable at any time beginning on the date of issuance, and from time to time thereafter, through and including the first anniversary of the issuance date, unless terminated earlier as provided in the Series A Warrant. Receipt of 510(k) clearance for the Senhance System on October 13, 2017 triggered the acceleration of the expiration date of the Series A Warrants to October 31, 2017 (see Note 16). As such, all of the Series A Warrants were exercised

prior to the expiration date. Each Series B Warrant may be exercised at any time beginning on the date of issuance and from time to time thereafter through and including the fifth anniversary of the issuance date.

The fair value of the Series A Warrants of $2.5 million at the date of issuance was estimated using the Black-Scholes Merton model which used the following inputs: term of 1 year, risk free rate of 1.07%, no dividends, volatility of 73.14%, and share price of $8.45 per share based on the trading price of the Company’s Common Stock. All Series A Warrants were exercised as of October 31, 2017.

The exercise prices and the number of shares issuable upon exercise of each of the Series B Warrants are subject to adjustment upon the occurrence of certain events, including, but not limited to, stock splits or dividends, business combinations, sale of assets, similar recapitalization transactions, or other similar transactions. The Series B warrants contain provisions, often referred to as “down-round protection,” that leads to adjustment of the exercise price and number of underlying warrant shares if the Company issues securities, including its common stock or convertible securities or debt securities, in the future at sale prices below the then-current exercise price. As a result of this adjustment feature and after giving effect to the Company’s reverse stock split at a ratio of one-for-thirteen shares effective December 11, 2019, or the Reverse Stock Split, the exercise price of all outstanding Series B Warrants has been adjusted to $1.39 per share and the number of shares of common stock reserved for and issuable upon the exercise of outstanding Series B Warrants has been adjusted to 1,963,451 warrant shares as of December 31, 2019.

The change in fair value of all outstanding Series B warrants for the years ended December 31, 2019 and 2018 of a decrease of $2.2 million and an increase of $14.3 million, respectively, was included in the Company’s consolidated statements of operations and comprehensive loss. The following table presents the inputs and valuation methodologies used for the Company’s fair value of the Series B warrants:



Series B	December 31, 2019	December 31, 2018
Fair value	$2.4 million	$4.6 million
Valuation methodology	Monte Carlo	Monte Carlo
Term	2.32 years	3.32 years
Risk free rate	1.59%	2.47%
Dividends	—	—
Volatility	109.80%	87.60%
Share price	$1.47	$29.38
Probability of additional financing	100% in 2020	100% in 2019

The following table presents quantitative information about the inputs and valuation methodologies used for the Company’s fair value measurements for contingent consideration as of December 31, 2019 and 2018:



	Valuation Methodology	Significant Unobservable Input	Weighted Average (range, if applicable)
			December 31, 2019	December 31, 2018
Contingent consideration	Probability weighted income approach	Milestone dates	2020 to 2024	2019 to 2022
		Discount rate	10% to 11%	11.5% to 12%

The following table summarizes the change in fair value, as determined by Level 3 inputs for the warrants and the contingent consideration for the years ended December 31, 2019 and 2018:



	Fair Value Measurement at Reporting Date (Level 3)
	(In thousands)
	Common stock warrants			Contingent consideration
Balance at December 31, 2017	$	14,090		$	12,418
Payment for contingent consideration	—			(770		)
Exercise of warrants	(23,774		)	—
Change in fair value	14,320			(1,011		)
Balance at December 31, 2018	4,636			10,637
Change in fair value	(2,248		)	(9,553		)
Balance at December 31, 2019	2,388			1,084
Current portion	—			73
Long-term portion	2,388			1,011
Balance at December 31, 2019	$	2,388		$	1,084

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

Accounts Receivable, Net

12 Months Ended

Dec. 31, 2019

Receivables [Abstract]

Accounts Receivable, Net

The following table presents the components of accounts receivable:



	December 31, 2019			December 31, 2018
	(In thousands)
Gross accounts receivable	$	2,274		$	8,640
Allowance for uncollectible accounts	(1,654		)	(80		)
Total accounts receivable, net	$	620		$	8,560

The Company recorded $1.6 million in bad debt expense during the year ended December 31, 2019.

- Definition

The entire disclosure for claims held for amounts due a entity, excluding financing receivables. Examples include, but are not limited to, trade accounts receivables, notes receivables, loans receivables. Includes disclosure for allowance for credit losses.

+ References + Details

Inventories

12 Months Ended

Dec. 31, 2019

Inventory Disclosure [Abstract]

Inventories

The components of inventories are as follows:



	December 31, 2019		December 31, 2018
	(In thousands)
Finished goods	$	9,737	$	5,439
Raw materials	8,510		5,502
Total inventories	$	18,247	$	10,941

Current Portion	$	10,653	$	10,941
Long-term portion	7,594		—
Total inventories	$	18,247	$	10,941

The Company recorded a write-down of obsolete inventory for the year-ended December 31, 2019 totaling $7.4 million as part of a restructuring plan and a $1.5 million charge for inventory obsolescence related to certain system components. There were no such write-downs or charges for the year ended December 31, 2018.

Other Current Assets

12 Months Ended

Dec. 31, 2019

Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]

Other Current Assets

The following table presents the components of other current assets:



	December 31, 2019		December 31, 2018
	(In thousands)
Advances to vendors	$	2,534	$	5,427
Prepaid expenses	1,834		1,443
VAT receivable	2,716		2,335
Total	$	7,084	$	9,205

Property and Equipment

12 Months Ended

Dec. 31, 2019

Property, Plant and Equipment [Abstract]

Property and Equipment

Property and equipment consisted of the following:



	December 31, 2019			December 31, 2018
	(In thousands)
Machinery, manufacturing and demonstration equipment	$	10,421		$	12,320
Computer equipment	2,321			2,260
Furniture	637			639
Leasehold improvements	2,295			2,280
Total property and equipment	15,674			17,499
Accumulated depreciation and amortization	(10,968		)	(11,162		)
Property and equipment, net	$	4,706		$	6,337

Depreciation expense was approximately $2.2 million and $2.4 million for the years ended December 31, 2019 and 2018, respectively.

Goodwill, In-Process Research and Development and Intellectual Property

12 Months Ended

Dec. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill, In-Process Research and Development and Intellectual Property

Goodwill

Goodwill of $93.8 million was recorded in connection with the Merger, as described in Note 1, goodwill of $38.3 million was recorded in connection with the Senhance Acquisition, as described in Note 3, and goodwill of $9.6 million was recorded in connection with the MST Acquisition, as described in Note 3. The carrying value of goodwill and the change in the balance for the years ended December 31, 2019 and 2018 is as follows:



	Goodwill
	(In thousands)
Balance at December 31, 2017	71,368
Additions	9,638
Foreign currency translation impact	(875		)
Balance at December 31, 2018	$	80,131
Foreign currency translation impact	(1,162		)
Impairment	(78,969		)
Balance at December 31, 2019	$	—

Accumulated impairment of goodwill as of December 31, 2019 and 2018 was $140.8 million and $61.8 million, respectively.

The Company performs an annual impairment test of goodwill at December 31, or more frequently if events or changes in circumstances indicate that the carrying value of the Company’s one reporting unit may not be recoverable. As of December 31, 2018, the Company calculated the fair value of the Company’s sole reporting unit, based on the Company’s market capitalization, which exceeded the carrying amount. Accordingly, no charge for goodwill impairment was required as of December 31, 2018. During the third quarter of 2019, the Company's stock price declined significantly as a result of decreased sales. As of September 30, 2019, goodwill was deemed to be fully impaired, and the Company recorded an impairment charge of $79.0 million.

In-Process Research and Development

As described in Note 3, on October 31, 2018, the Company acquired the MST assets, technology and business from MST and recorded $10.6 million of IPR&D. The estimated fair value of the IPR&D was determined using a probability-weighted income approach, which discounts expected future cash flows to present value. The projected cash flows were based on certain key assumptions, including estimates of future revenue and expenses, taking into account the stage of development of the technology at the acquisition date and the time and resources needed to complete development. The Company used a discount rate of 15% and cash flows that have been probability adjusted to reflect the risks of product integration, which the Company believes are appropriate and representative of market participant assumptions.

The Company performed an impairment test of its IPR&D at the end of the third quarter 2019 as recent events and changes in market conditions indicated that the asset might be impaired. The impairment test consisted of a comparison of the fair value of the IPR&D with its carrying amount. If the carrying amount of the IPR&D exceeds its fair value, an impairment loss is recognized in an amount equal to that excess. Significant judgment is applied when testing for impairment. This judgment includes developing cash flow projections, selecting appropriate discount rates, identifying relevant market comparables, and incorporating general economic and market conditions. During the third quarter of 2019, the Company concluded that the fair value determined by the market value approach was lower than the carrying value. As a result, the Company recognized a $7.9 million impairment charge to its IPR&D. The company performed its annual impairment assessment at December 31, 2019 and no additional impairment was required.

The carrying value of the Company’s IPR&D assets and the change in the balance for the years ended December 31, 2018 and 2019 is as follows:



	In-Process Research and Development
	(In thousands)
Balance at December 31, 2017	$	—
Additions	10,633
Foreign currency translation impact	114
Balance at December 31, 2018	10,747
Impairment	(7,912		)
Foreign currency translation impact	(365		)
Balance at December 31, 2019	$	2,470

Intellectual Property

As described in Note 3, on September 21, 2015, the Company acquired all of the assets related to the Senhance System and recorded $17.1 million of IPR&D. The estimated fair value of the IPR&D was determined using a probability-weighted income approach, which discounts expected future cash flows to present value. The projected cash flows were based on certain key assumptions, including estimates of future revenue and expenses, taking into account the stage of development of the technology at the acquisition date and the time and resources needed to complete development. The Company used a discount rate of 45% and cash flows that have been probability adjusted to reflect the risks of product commercialization, which the Company believes are appropriate and representative of market participant assumptions. On October 13, 2017, upon regulatory approval and the ability to commercialize the products associated with the IPR&D assets, the assets were deemed definite-lived, reclassified to intellectual property and are now being amortized based on their estimated useful lives.

The components of gross intellectual property, accumulated amortization, and net intellectual property as of December 31, 2019 and 2018 are as follows:



	December 31, 2019										December 31, 2018
	(In thousands)										(In thousands)
	Gross Carrying Amount		Accumulated Amortization			Foreign currency translation impact			Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization			Foreign currency translation impact		Net Carrying Amount
Developed technology	$	66,413	$	(36,918	)	$	(1,208	)	$	28,287	$	66,413	$	(27,174	)	$	119	$	39,358
Technology and patents purchased	400		(112		)	21			309		400		(72		)	30		358
Total intellectual property	$	66,813	$	(37,030	)	$	(1,187	)	$	28,596	$	66,813	$	(27,246	)	$	149	$	39,716

The weighted average remaining useful life of the developed technology and technology and patents purchased was 2.8 years and 7.3 years, respectively as of December 31, 2019.

The estimated future amortization expense of intangible assets as of December 31, 2019 is as follows:



	Year ending December 31, 2019
	(In thousands)
2020	$	10,328
2021	10,328
2022	7,757
2023	42
2024	42
Thereafter	99
Total	$	28,596

Income Taxes

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Income Taxes

The components for the income tax expense (benefit) are as follows for the years ended December 31 (in thousands):



	2019			2018
Current income taxes
Federal	$	—		$	—
State	—			—
Foreign	100			—
Deferred income taxes
Federal	—			—
State	—			—
Foreign	(3,224		)	(3,377		)
Total income tax benefit	$	(3,124	)	$	(3,377	)

The United States and foreign components of loss from operations before taxes are as follows for the years ended December 31 (in thousands):



	2019			2018
United States	$	(91,935	)	$	(44,744	)
Foreign	(65,390		)	(20,410		)
Total loss from operations before taxes	$	(157,325	)	$	(65,154	)

Significant components of the Company’s deferred tax assets consist of the following at December 31 (in thousands):



	2019			2018
Noncurrent deferred tax assets:
Stock-based compensation	$	3,665		$	2,281
Accrued expenses and other	1,007			795
Research credit carryforward	6,776			6,182
Fixed assets	345			392
Capitalized start-up costs and other intangibles	3,618			1,859
Net operating loss carryforwards	113,410			74,566
	128,821			86,075
Valuation allowance	(123,108)			(81,337		)
Net noncurrent deferred tax asset	5,713			4,738
Noncurrent deferred tax liabilities
Fixed assets and other	(1,445		)	(686		)
Purchase accounting intangibles	(5,660		)	(8,772		)
Net noncurrent deferred tax liability	(7,105		)	(9,458		)
Net deferred tax liability	$	(1,392	)	$	(4,720	)

At December 31, 2019 and 2018, the Company has provided a full valuation allowance against its net deferred tax assets in the U.S., Luxembourg, Swiss, and Asian tax jurisdictions, since realization of these benefits is not more likely than not. The valuation allowance increased approximately $41.8 million from the prior year. At December 31, 2019, the Company had U.S. federal net operating loss carryforwards of $337.6 million. Of this amount, $254.5 million begin to expire in 2027, while the remaining $83.1 million carry forward indefinitely. At December 31, 2019, the Company had U.S. state net operating loss carryforwards of $287.5 million. Of this amount, $282.8 million begin to expire in 2022, while the remaining $4.7 million carry forward indefinitely. At December 31, 2019, the Company had federal research credit carryforwards in the amount of $6.8 million. These carryforwards begin to expire in 2027. The utilization of the federal net operating loss carryforwards and credit carryforwards will depend on the Company’s ability to generate sufficient taxable income prior to the expiration of the carryforwards. In addition, the maximum annual use of net operating loss and research credit carryforwards is limited in certain situations where changes occur in stock ownership.

At December 31, 2019, the Company had foreign operating loss carryforwards in Italy of approximately $23.1 million, which can be carried forward indefinitely; foreign operating loss carryforwards in Luxembourg of approximately $95.1 million, which will begin to expire in 2035; foreign operating loss carryforwards in Switzerland of approximately $42.3 million, which begin to expire in 2023; and foreign operating loss carryforwards in Japan of approximately $2.0 million, which begin to expire in 2028.

The Company has evaluated its tax positions to consider whether it has any unrecognized tax benefits. As of December 31, 2019, the Company had gross unrecognized tax benefits of approximately $1.5 million. Of the total, none would reduce the Company’s effective tax rate if recognized. The Company does not anticipate a significant change in total unrecognized tax benefits or the Company’s effective tax rate due to the settlement of audits or the expiration of statutes of limitations within the next twelve months. Furthermore, the Company does not expect any cash settlement with the taxing authorities as a result of these unrecognized tax benefits as the Company has sufficient unutilized carryforward attributes to offset the tax impact of these adjustments.

The following is a tabular reconciliation of the Company’s change in gross unrecognized tax positions at December 31 (in thousands):



	2019		2018
Beginning balance	$	1,363	$	1,202
Gross increases for tax positions related to current periods	149		161
Gross increases for tax positions related to prior periods	—		—
Ending balance	$	1,512	$	1,363

The Company recognizes interest and penalties related to uncertain tax positions in the provision for income taxes. As of December 31, 2019 and 2018, the Company had no accrued interest or penalties related to uncertain tax positions.

The Company has analyzed its filing positions in all significant federal, state, and foreign jurisdictions where it is required to file income tax returns, as well as open tax years in these jurisdictions. With few exceptions, the Company is no longer subject to United States Federal, state, and local tax examinations by tax authorities for years before 2016, although carryforward attributes that were generated prior to 2016 may still be adjusted upon examination by the taxing authorities if they either have been or will be used in a future period. No income tax returns are currently under examination by taxing authorities.

Taxes computed at the then-current statutory federal income tax rate of 21% are reconciled to the provision for income taxes as follows for the years ended December 31:



	2019					2018
	Amount			% of Pretax Earnings		Amount			% of Pretax Earnings
United States federal tax at statutory rate	$	(33,038	)	21.0	%	$	(13,682	)	21.0	%
State taxes (net of deferred benefit)	(4,778		)	3.0	%	(1,080		)	1.7	%
Nondeductible expenses	709			(0.5	)%	(1,320		)	2.0	%
Change in fair market value of contingent consideration	(2,342		)	1.5	%	(256		)	0.4	%
Warrant remeasurement and financing costs	(551		)	0.4	%	3,630			(5.6	)%
Research & Development credits	(743		)	0.5	%	(803		)	1.2	%
Change in unrecognized tax benefits	149			(0.1	)%	161			(0.2	)%
Foreign tax rate differential	2,590			(1.6	)%	(96		)	0.1	%
Goodwill impairment	(6,638		)	4.2	%	—			—
Change in enacted tax rates and other, net	(253		)	0.2	%	252			(0.3	)%
Change in valuation allowance	41,771			(26.6	)%	9,817			(15.1	)%
Income tax benefit	$	(3,124	)	2.0	%	$	(3,377	)	5.2	%

U.S. shareholders are subject to tax on global intangible low-taxed income (GILTI) earned by certain foreign subsidiaries. The FASB Staff Q&A, Topic 740, No. 5, Accounting for Global Intangible Low-Taxed Income, states that an entity can make an accounting policy election to either recognize deferred taxes for temporary basis differences expected to reverse as GILTI in future years or to provide for the tax expense related to GILTI in the year the tax is incurred as a period expense only. The Company has elected to account for GILTI in the year the tax is incurred. As of December 31, 2019, no GILTI tax has been recorded.

Accrued Expenses

12 Months Ended

Dec. 31, 2019

Accrued Liabilities, Current [Abstract]

Accrued Expenses

The following table presents the components of accrued expenses:



	December 31, 2019		December 31, 2018
	(In thousands)
Compensation and benefits	$	5,061	$	6,243
Restructuring costs	882		—
Consulting and other vendors	308		895
Other	242		539
Lease Liability	1,112		—
Royalties	148		498
Legal and professional fees	474		432
Deferred rent	—		391
Taxes and other assessments	326		365
Interest	—		256
Total	$	8,553	$	9,619

Notes Payable	12 Months Ended
Notes Payable	Dec. 31, 2019
Debt Disclosure [Abstract]
Notes Payable	Notes Payable On May 23, 2018, the Company and its domestic subsidiaries, as co-borrowers, entered into a Loan and Security Agreement (the “Hercules Loan Agreement”) with several banks and other financial institutions or entities from time to time party to the Loan Agreement (collectively, the “Lender”) and Hercules Capital, Inc., as administrative agent and collateral agent (the “Agent”). Under the Hercules Loan Agreement, the Lender agreed to make certain term loans to the Company in the aggregate principal amount of up to $40.0 million. Funding of the first $20.0 million tranche occurred on May 23, 2018 (the “Initial Funding Date”). On October 23, 2018, the Lender funded the second tranche of $10.0 million under the Hercules Loan Agreement. The Company was entitled to make interest-only payments until December 1, 2020, and at the end of the interest-only period, the Company would have been required to repay the term loans over an eighteen-month period based on an eighteen-month amortization schedule, with a final maturity date of June 1, 2022. The term loans were required to be repaid if the term loans were accelerated following an event of default. Effective April 30, 2019, the Hercules Loan Agreement was amended (the “Hercules Amendment”) to eliminate the availability of the Tranche III Loan facility, add a new Tranche IV Loan facility of up to $20.0 million, revise certain financial covenants and make other changes. The availability of advances under the Tranche IV Loan was not milestone-based, rather the Company could request advances in minimum $5.0 million increments at any time during the period from July 1, 2019 through December 31, 2020, subject to the funding discretion of the Lender. The monthly trailing six month net revenue financial covenant was amended to be tested quarterly and to change the projected net revenue percentage to be met for the six months ending on the last day of each fiscal quarter. If such quarterly financial covenant was not achieved as of the last day of any fiscal quarter, as tested on the thirtieth day after quarter end, the Company must have complied with the waiver conditions in the Hercules Amendment from such test date until the next quarterly test date. The Hercules Amendment was executed by the parties on May 7, 2019. The Amendment was treated as a debt modification for accounting purposes. In connection with the entry into the AutoLap Sale Agreement with respect to the AutoLap assets, the Company commenced discussions with the Agent in order to obtain the required consent of the Agent and the Lender with respect to the sale of the AutoLap assets. In connection with obtaining such consent, the Company entered into the Consent and Second Amendment to the Loan and Security Agreement on July 10, 2019 (the “Hercules Second Amendment”). Under the Hercules Second Amendment, in consideration for the consent to the sale of, and the release of the Lender’s security interest on, the AutoLap assets, the Company reduced its indebtedness under the Hercules Loan Agreement by repaying $15.0 million of the $30.0 million of outstanding indebtedness thereunder, without any prepayment penalties, amendment fee or acceleration of the end of term charges, and received adjustments to the quarterly financial covenants and related waiver conditions to reflect the decreased outstanding indebtedness. The Amendment was treated as a debt modification for accounting purposes. Under the Hercules Second Amendment, the applicable waiver condition for fiscal year 2019 was changed to maintenance of unrestricted cash equal to $7.0 million. The term loans bore interest at a rate equal to the greater of (i) 9.55% per annum (the “Fixed Rate”) and (ii) the Fixed Rate plus the prime rate (as reported in The Wall Street Journal) minus 5.00%. On the Initial Funding Date, the Company was obligated to pay a facility fee of $0.4 million, recorded as a debt discount. The Company also incurred other debt issuance costs totaling $1.1 million in conjunction with its entry into the Hercules Loan Agreement. In addition, the Company was permitted to prepay the term loans in full at any time, with a prepayment fee of 3.0% of the outstanding principal amount of the loan in the first year after the Initial Funding Date, 2.0% if the prepayment occurred in the second year after the Initial Funding Date and 1.0% thereafter. Upon prepayment of the term loans in full or repayment of the terms loans at the maturity date or upon acceleration, the Company was required to pay a final fee of 6.95% of the aggregate principal amount of term loans funded. The final payment fee was accreted to interest expense over the life of the term loan and included within notes payable on the consolidated balance sheet. The Company’s obligations under the Hercules Loan Agreement were guaranteed by all current and future material foreign subsidiaries of the Company and were secured by a security interest in all of the assets of the Company and their current and future domestic subsidiaries and all of the assets of their current and future material foreign subsidiaries, including a security interest in the intellectual property. The Hercules Loan Agreement contained customary representations and covenants that, subject to exceptions, restricted the Company’s and its subsidiaries’ ability to do the following, among other things: declare dividends or redeem or repurchase equity interests; incur additional indebtedness and liens; make loans and investments; engage in mergers, acquisitions, and asset sales; transact with affiliates; undergo a change in control; add or change business locations; and engage in businesses that were not related to its existing business. Under the terms of the Hercules Loan Agreement, the Company was required to maintain cash and/or investment property in accounts which perfected the Agent’s first priority security interest in such accounts in an amount equal to the lesser of (i) (x) 120% of the then-outstanding principal balance of the term loans, including accrued interest and any other fees payable under the agreement to the extent accrued and payable plus (y) an amount equal to the then-outstanding accounts payable of the Company on a consolidated basis that were more than 90 days past due and (ii) 80% of the aggregate cash of the Company and its consolidated subsidiaries. The Agent was granted the option to invest up to $2.0 million in any future equity offering broadly marketed by the Company to investors on the same terms as the offering to other investors. On November 4, 2019, the Company entered into a payoff letter with the Agent pursuant to which the Company terminated the Hercules Loan Agreement, as amended. The Company determined it was in the best interests of the Company to pay down the debt and terminate the Hercules Agreement to simplify the Company's balance sheet and provide additional flexibility as the Board of Directors continues to explore strategic and financial alternatives for the Company. Under the payoff letter, the Company repaid all amounts owed under the Hercules Loan Agreement totaling approximately $16.4 million, which included end of term fees of $1.4 million, and Hercules released all security interests held on the assets of the Company and its subsidiaries, including, without limitation, on the intellectual property assets of the Company. The Company recognized a loss of $1.0 million on the extinguishment of notes payable, which is included in interest expense on the consolidated statement of operations and comprehensive loss for the year ended December 31, 2019. In connection with its entrance into the Hercules Loan Agreement, the Company repaid its existing loan and security agreement (the “Innovatus Loan Agreement”) with Innovatus Life Sciences Lending Fund I, LP (“Innovatus”). The Company recognized a loss of $1.4 million on the extinguishment of notes payable which was included in interest expense on the consolidated statements of operations and comprehensive loss for the year ended December 31, 2018. The Company paid $0.7 million in final payment obligations and $0.3 million in prepayment fees under the Innovatus Loan Agreement upon repayment. Under the Innovatus Loan Agreement, entered into on May 10, 2017, Innovatus agreed to make certain term loans in the aggregate principal amount of up to $17.0 million. Funding of the first $14.0 million tranche occurred on May 10, 2017. The Innovatus Loan Agreement allowed for interest-only payments for up to twenty-four months at a fixed rate equal to 11% per annum, of which 2.5% could be paid in-kind and added to the outstanding principal amount of the term loans until the earlier of (i) the first anniversary following the funding date and (ii) the Company’s failure to achieve an Interest-Only Milestone. At the end of the interest-only period, the Company would be required to repay the term loans over a two-year period, based on a twenty-four (24) month amortization schedule, with a final maturity date of May 10, 2021. In connection with the Innovatus funding, the Company paid a facility fee of $0.2 million on the date of funding of the first tranche and incurred additional debt issuance costs of approximately $1.2 million, recorded as a debt discount. In addition, the Company issued warrants to Innovatus to purchase shares of the Company’s common stock that will expire five years from such issue date. The warrants issued in connection with funding of the first tranche entitle Innovatus to purchase up to 95,750 shares of the Company’s common stock at an exercise price of $13.00 per share. The Company estimated the fair value of the warrants to be $0.3 million. The value of the warrants was classified as equity and recorded as a discount to the loan. The debt discount was amortized as interest expense using the effective interest method over the life of the loan. As of December 31, 2018, the unamortized debt discount was $0.

Stock-Based Compensation

12 Months Ended

Dec. 31, 2019

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Stock-Based Compensation

The Company’s stock-based compensation plans include the TransEnterix, Inc. Amended and Restated Incentive Compensation Plan, previously named the TransEnterix, Inc. 2007 Incentive Compensation Plan, or the Plan, as well as options outstanding under the TransEnterix, Inc. Stock Option Plan, or the 2006 Plan. As part of the Merger, options outstanding, whether vested or unvested, under the 2006 Plan were adjusted by the Exchange Ratio of approximately 0.0887, and assumed by the Company concurrent with the closing of the Merger.

The Plan was initially approved by the majority of the stockholders on November 13, 2007. The Plan was amended on June 19, 2012 to increase the number of shares of common stock available for issuance to 76,923 and was amended on October 29, 2013 to (a) increase the number of shares of common stock authorized for issuance under the Plan from 76,923 shares of common stock to 380,000 shares of common stock, (b) increase the per-person award limitations for options or stock appreciation rights from 15,385 to 76,923 shares and for restricted stock, deferred stock, performance shares and/or other stock-based awards from 7,692 to 38,462 shares, and (c) change the name of the Plan to reflect the Merger-related change. The Plan was again amended on May 7, 2015 to (i) increase the number of shares reserved for issuance under the Plan to 918,462 shares; (ii) extend the term of the Plan until May 7, 2025; and (iii) make other changes and updates to the Plan and was further amended in October 2015 to add French Sub-Plan amendments applicable to awards made to France-based employees. The Plan was further amended on June 8, 2016 to (a) approve an increase in the number of shares reserved for issuance under the Plan to 1,456,923 shares and (b) establish maximum equity award limits for initial awards and annual awards to non-employee directors. The Plan was subsequently amended as of May 25, 2017, increasing the number of shares of Common Stock authorized under the Plan to 1,995,385. The Plan was again amended on May 24, 2018, increasing the number of shares of Common Stock authorized under the Plan to 3,149,231. The Plan was again amended in October 2018 to add an Israeli Sub-Plan applicable to awards made to Israel-based employees. The Plan was again amended on April 24, 2019, to increase the number of shares of Common Stock authorized under the Plan to 4,072,308 and to make other changes.

The October 2013, May 2015, June 2016, May 2017, May 2018, and April 2019 amendments were approved by the Board of Directors and stockholders; the French Sub-Plan and Israeli Sub-Plan were approved by the Board of Directors. Under the Plan, which is administered by the Compensation Committee, the Company may grant stock options, stock appreciation rights, restricted stock and/or deferred stock to employees, officers, directors, consultants and vendors. The exercise price of stock options or stock appreciation rights may not be less than the fair market value of the Company’s shares at the date of grant. Additionally, no stock options or stock appreciation rights granted under the Plan may have a term exceeding ten years.

The 2006 Plan was adopted and approved by stockholders in September 2006 and provided for the granting of up to 6,154 stock options to employees, directors, and consultants. Under the 2006 Plan, both employees and non-employees were eligible for such stock options. In 2009, the 2006 Plan was amended to increase the total options pool to 85,389. In 2011, the 2006 Plan was amended to increase the total options pool to 259,861. The amendments were approved by the Board of Directors and stockholders. The Board of Directors had the authority to administer the plan and determine, among other things, the exercise price, term and dates of the exercise of all options at their grant date. Under the 2006 Plan, options become vested generally over four years, and expire not more than 10 years after the date of grant. As part of the Merger, options outstanding under the 2006 Plan were adjusted by the Conversion Ratio, and remain in existence as options of TransEnterix.

During the years ended December 31, 2019 and 2018, the Company recognized approximately $11.5 million and $9.0 million, respectively, of stock-based compensation expense, including stock options and restricted stock units.

The Company recognizes as expense, the grant-date fair value of stock options and other stock based compensation issued to employees and non-employee directors over the requisite service periods, which are typically the vesting periods. The Company uses the Black-Scholes-Merton model to estimate the fair value of its stock-based payments. The volatility assumption used in the Black-Scholes-Merton model is based on the calculated historical volatility based on an analysis of reported data for a peer group of companies as well as the Company’s historical volatility. The expected term of options granted by the Company has been determined based upon the simplified method, because the Company does not have sufficient historical information regarding its options to derive the expected term. Under this approach, the expected term is the mid-point between the weighted average of vesting period and the contractual term. The risk-free interest rate is based on U.S. Treasury rates whose term is consistent with the expected life of the stock options. The Company has not paid and does not anticipate paying cash dividends on its shares of common stock; therefore, the expected dividend yield is assumed to be zero. The Company estimates forfeitures based on the historical experience of the Company and adjusts the estimated forfeiture rate based upon actual experience.

The fair value of options granted were estimated using the Black-Scholes-Merton option pricing model based on the assumptions in the table below:



	Year ended December 31,
	2019	2018
Expected dividend yield	0%	0%
Expected volatility	81% - 92%	73% - 75%
Risk-free interest rate	1.39% - 2.66%	2.35% - 3.02%
Expected life (in years)	5.5 - 6.1	5.5 - 6.1

The following table summarizes the Company’s stock option activity, including grants to non-employees, for the year ended December 31, 2019:



	Number of Shares		Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term (Years)
Options outstanding at December 31, 2018	1,529,964		$	31.45	7.82
Granted	623,272		29.79
Forfeited	(248,834	)	33.13
Cancelled	(43,525	)	38.67
Exercised	(29,919	)	18.00
Options Outstanding December 31, 2019	1,830,958		$	30.71	7.36

The following table summarizes information about stock options outstanding at December 31, 2019:



	Number of Shares	Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)
Exercisable at December 31, 2019	926,498	$	32.48	6.14
Vested or expected to vest at December 31, 2019	1,763,300	$	30.75	7.28

Stock options outstanding, exercisable, and vested or expected to vest at December 31, 2019 had no intrinsic value based on the closing market price of the Company’s common stock at December 31, 2019.

The total intrinsic value of options exercised during 2019 and 2018 was approximately $0.2 million and $9.3 million, respectively. Proceeds from options exercised during 2019 and 2018 were approximately $0.5 million and $7.1 million, respectively.

The Company granted 623,272 and 669,662 options to employees and non-employees during the years ended December 31, 2019 and 2018, respectively, with a weighted-average grant date fair value of $21.23 and $20.67, respectively.

As of December 31, 2019, the Company had future employee stock-based compensation expense of approximately $19.6 million related to unvested share awards, which is expected to be recognized over an estimated weighted-average period of 2.5 years.

Restricted Stock Units

12 Months Ended

Dec. 31, 2019

Equity [Abstract]

Restricted Stock Units

In 2018 and 2019, the Company issued Restricted Stock Units (“RSUs”) to certain employees which vest over three years. The RSUs vest on defined vesting dates, subject to the continuous service with the Company at the applicable vesting event. Vesting can be accelerated upon a change in control under the Plan if the RSUs are not assumed by the successor company, and will be accelerated for certain executive officers under existing employment agreements if any such executive officer has a termination of employment in connection with a change in control event. When vested, the RSUs represent the right to be issued the number of shares of the Company’s common stock that is equal to the number of RSUs granted. The fair value of each RSU is estimated based upon the closing price of the Company’s common stock on the grant date. Share-based compensation expense related to RSUs is recognized over the requisite service period as adjusted for estimated forfeitures.

The following is a summary of the RSU activity for the years ended December 31, 2019 and 2018:



	Number of Restricted Stock Units Outstanding		Weighted Average Grant Date Fair Value
Unvested December 31, 2017	338,055		$	14.95
Granted	170,403		28.66
Vested	(123,539	)	17.44
Forfeited	(2,821	)	17.71
Unvested December 31, 2018	382,098		$	20.24
Granted	192,987		31.42
Vested	(85,153	)	25.98
Forfeited	(46,005	)	21.38
Unvested December 31, 2019	443,927		$	23.88

As of December 31, 2019 and 2018, the Company recorded approximately $3.2 million and $2.9 million, respectively, in compensation expense for the RSUs. As of December 31, 2019, the unrecognized stock-based compensation expense related to unvested RSUs was approximately $5.5 million, which is expected to be recognized over a weighted average period of approximately 1.4 years.

Warrants

12 Months Ended

Dec. 31, 2019

Warrants and Rights Note Disclosure [Abstract]

Warrants

On March 22, 2013, SafeStitch entered into a stock purchase agreement with approximately 17 investors (the “2013 PIPE Investors”) pursuant to which the 2013 PIPE Investors purchased an aggregate of approximately 186,092 shares of common stock at a price of $16.25 per share for aggregate consideration of approximately $3.0 million. Included in this private placement was the issuance of warrants to purchase approximately 93,046 common shares, representing one warrant for every two common shares purchased, with an exercise price of $21.45 per share and five years expiration. Among the 2013 PIPE Investors purchasing shares were related parties who purchased 98,462 shares and received 49,231 warrants. There were approximately 92,277 warrants outstanding that were assumed as of the Merger. During the years ended December 31, 2018 and 2017, 61,538 and 18,462, respectively of these warrants were exercised. During the year ended December 31, 2018, the remaining 7,354 warrants expired.

On January 17, 2012, TransEnterix Surgical entered into an original Loan Agreement with Silicon Valley Bank ("SVB") and Oxford Financial LLC (the "Prior Lenders"). Pursuant to such agreement, TransEnterix Surgical issued preferred stock warrants to the Prior Lenders on January 17, 2012 and December 21, 2012, respectively, to purchase shares of TransEnterix Surgical preferred stock. The preferred stock warrants expire ten years from the issue date. The preferred stock warrants were remeasured immediately prior to the Merger. As of the Merger, the preferred stock warrants converted to common stock warrants, adjusted based on a Merger exchange ratio of approximately 0.0887, and the preferred stock warrant liability was reclassified to additional paid-in capital. These warrants are exercisable for an aggregate of approximately 21,506 shares of common stock, with an exercise price of $18.85 per share. During the year ended December 31, 2013, 10,753 of these warrants were exercised in a cashless transaction for 8,674 shares of common stock. During the year ended December 31, 2018, the remaining 10,753 of these warrants were exercised in a cashless transaction for 8,065 shares of common stock.

On September 26, 2014, the Company entered into an amendment to the SVB Loan Agreement with the Prior Lenders. In connection with the first tranche borrowings under such amendment, the Company issued 2,948 common stock warrants to the Prior Lenders to purchase shares of the Company’s common stock, with an exercise price of $52.20 per share. The warrants expire seven years from their respective issue date. The Company concluded that the warrants are considered equity instruments. The warrants were recognized at the relative fair value on the issuance date as a debt discount and were amortized using the effective interest method from issuance to the maturity of the term loans. None of these warrants were exercised during the years ended December 31, 2019. During the year ended December 31, 2018, 2,145 of these warrants were exercised in a cashless transaction for 660 shares of common stock.

On August 14, 2015, in connection with an amendment to the SVB Loan Agreement and first tranche borrowings thereunder, the Company issued 8,684 common stock warrants to the Prior Lenders to purchase shares of the Company’s common stock, with an exercise price of $40.30 per share. The warrants expire seven years from their respective issue date. The Company concluded that the warrants are considered equity instruments. The warrants were recognized at the relative fair value on the issuance date as a debt discount and were amortized using the effective interest method from issuance to the maturity of the note. None of these warrants were exercised during the years ended December 31, 2019. During the year ended December 31, 2018, 5,211 of these warrants were exercised in a cashless transaction for 2,426 shares of common stock.

On April 28, 2017, the Company sold 24.9 million Units, each consisting of approximately 0.077 shares of the Company's Common Stock, a Series A Warrant to purchase approximately 0.077 shares of Common Stock with an exercise price of $13.00 per share, and a Series B Warrant to purchase approximately 0.058 shares of Common Stock with an exercise price of $13.00 per share at an offering price of $1.00 per Unit. Each Series A Warrant was exercisable at any time beginning on the date of issuance, and from time to time thereafter, through and including the first anniversary of the issuance date, unless terminated earlier as provided in the Series A Warrant. Receipt of 510(k) clearance for the Senhance System on October 13, 2017, triggered the acceleration of the expiration date of the Series A Warrants to October 31, 2017. As such, all of the Series A Warrants were exercised prior to the expiration date. Each Series B Warrant may be exercised at any time beginning on the date of issuance and from time to time thereafter through and including the fifth anniversary of the issuance date.

The exercisability of the Series B Warrants may be limited if, upon exercise, the holder or any of its affiliates would beneficially own more than 4.99% of the Common Stock. If, at any time Series B Warrants are outstanding, any fundamental transaction occurs, as described in the Series B Warrants and generally including any consolidation or merger into another corporation, the consummation of a transaction whereby another entity acquires more than 50% of the Company’s outstanding voting stock, or the sale of all or substantially all of its assets, the successor entity must assume in writing all of the obligations to the Series B Warrant holders. Additionally, in the event of a fundamental transaction, each Series B Warrant holder will have the right to require the Company, or its successor, to repurchase the Series B Warrants for an amount of cash equal to the Black-Scholes value of the remaining unexercised portion of such Series B Warrants. During the years ended December 31, 2018 and 2017, 542,478 and 684,131, respectively, Series B Warrants were exercised. There were no Series B Warrants exercised during the year ended December 31, 2019.

On May 10, 2017, in connection with the entry into the Innovatus Loan Agreement, the Company issued warrants to Innovatus to purchase shares of the Company’s common stock. The warrants are issued on the funding date of each tranche and will expire five (5) years from such issue date. The warrants issued in connection with funding of the first tranche will entitle Innovatus to purchase up to 95,750 shares of the Company’s common stock at an exercise price of $13.00 per share. None of these warrants were exercised as of December 31, 2019.

On September 12, 2017, the Company entered into a service agreement with a third party vendor. In connection with the service agreement, the Company issued 73,076 common stock warrants (“Service Warrants”) to purchase shares of the Company’s common stock, with an exercise price of $13.00 per share. The Service Warrants vest as follow: (a) twenty-five percent (25%) on the date of execution of the services agreement; (b) fifty percent (50%) upon completion of hiring the sales team; and (c) the remaining twenty-five percent (25%) upon achieving cumulative product revenue of $15.0 million. The Service Warrants expire ten years from their issue date. The Company concluded that the Service Warrants are considered equity instruments. The fair value of the Service Warrants on the issuance date was determined using a Black-Scholes Merton model. The fair value of the remaining Service Warrants was updated each reporting period and the expense was recorded over the service period. The initial expense of $0.6 million and additional expense of $0.3 million was recognized during the year ended December 31, 2017. In February 2018, the Company terminated its relationship with the vendor and accelerated the full vesting of the Service Warrants in accordance with the service agreement. The remaining expense of $0.3 million was recognized during the year ended December 31, 2018. During the year ended December 31, 2019 and 2018, 15,385 and 50,000 of these warrants were exercised, respectively.



	Number of Warrant Shares		Weighted Average Exercise Price		Weighted Average Remaining Contractual Life (in years)	Weighted Average Fair Value
Outstanding at Outstanding at December 31, 2017	1,012,513		$	14.04	4.5	$	5.07
Exercised	(672,125	)	14.17		0	—
Expired	(7,354	)	21.45		0	—
Outstanding at Outstanding at December 31, 2018	333,034		$	13.39	3.7	$	3.38
Exercised	(15,385	)	13.00		0	—
Reserved for future issuance	1,753,523		1.39		2.2	1.22
Outstanding at Outstanding at December 31, 2019	2,071,172		$	2.05	2.4	$	1.34

The aggregate intrinsic value of the common stock warrants in the above table was $0.2 million and $5.3 million at December 31, 2019 and 2018, respectively. The aggregate intrinsic value is before applicable income taxes and is calculated based on the difference between the exercise price of the warrants and the estimated fair market value of the applicable stock as of the respective dates.

At-The-Market Offering and Firm Commitment Offering

12 Months Ended

Dec. 31, 2019

Equity [Abstract]

At-The-Market Offering and Firm Commitment Offering

Purchase Agreement and Offerings

On August 12, 2019, the Company entered into a Controlled Equity Offering Sales Agreement (the “2019 Sales Agreement”) with Cantor Fitzgerald & Co. (“Cantor”) pursuant to which the Company may sell from time to time, at its option, up to an aggregate of $25.0 million, shares of the Company’s common stock, through Cantor, as sales agent (the “2019 ATM Offering”). Pursuant to the Sales Agreement, sales of the Common Stock were made under the Company’s previously filed and currently effective Registration Statement on Form S-3. The aggregate compensation payable to Cantor was 3.0% of the aggregate gross proceeds from each sale of the Company’s common stock.

On September 4, 2019, the Company entered into an Underwriting Agreement (the “Underwriting Agreement”) with Cantor (the “Underwriter”). Subject to the terms and conditions of the Underwriting Agreement, the Company agreed to sell to the Underwriter, in a firm commitment underwritten offering, 2,153,846 shares of the Company’s common stock (the “Firm Commitment Offering”). In addition, the Company granted the Underwriter a 30-day option to purchase 323,077 of additional shares of common stock. The 30-day option was not exercised.

The following table summarizes the total sales under the ATM Offering and Firm Commitment Offering for the period indicated (in thousands except for share and per share amounts):



			Firm Commitment
	ATM Offering		Offering
	For the year ended		For the year ended		Total
	December 31, 2019		December 31, 2019		December 31, 2019
Total shares of common stock sold	1,374,686		2,153,846		3,528,532
Average price per share	$	5.23	$	8.73	$	7.37
Gross proceeds	$	7,193	$	18,796	$	25,989
Commissions earned by Cantor	212		—		212
Net Proceeds	$	6,981	$	18,796	$	25,777

On December 28, 2018, the Company entered into an At-the-Market Equity Offering Sales Agreement (the “2018 Sales Agreement”) with Stifel, Nicolaus & Company, Incorporated ("Stifel") as sales agent, pursuant to which the Company could sell through Stifel, from time to time, up to $75.0 million in shares of common stock in an at-the-market offering. The Company was to pay Stifel a commission of approximately 3% of the aggregate gross proceeds received from all sales of common stock under the 2018 Sales Agreement. Effective August 12, 2019, the Company terminated the 2018 Sales Agreement. The Company sold no shares of its common stock under the Stifel Sales Agreement.

On April 28, 2017, the Company sold 24.9 million units, each consisting of approximately 0.077 shares of the Company’s common stock, a Series A warrant to purchase approximately 0.077 shares of Common Stock with an exercise price of $13.00 per share,

and a Series B warrant to purchase approximately 0.058 shares of common stock with an exercise price of $13.00 per Unit for aggregate gross proceeds of $24.9 million in an underwritten firm commitment public offering. Net proceeds after issuance costs were $23.2 million, assuming no exercise of the warrants. The closing of the public offering occurred on May 3, 2017.

Purchase Agreement and Offerings

12 Months Ended

Dec. 31, 2019

Purchase Agreement Controlled Equity Offering And Public Offering Of Common Stock [Abstract]

Purchase Agreement and Offerings

The following table summarizes the total sales under the ATM Offering and Firm Commitment Offering for the period indicated (in thousands except for share and per share amounts):



			Firm Commitment
	ATM Offering		Offering
	For the year ended		For the year ended		Total
	December 31, 2019		December 31, 2019		December 31, 2019
Total shares of common stock sold	1,374,686		2,153,846		3,528,532
Average price per share	$	5.23	$	8.73	$	7.37
Gross proceeds	$	7,193	$	18,796	$	25,989
Commissions earned by Cantor	212		—		212
Net Proceeds	$	6,981	$	18,796	$	25,777

Restructuring

12 Months Ended

Dec. 31, 2019

Restructuring and Related Activities [Abstract]

Restructuring

During the fourth quarter of 2019, the Company announced the implementation of a restructuring plan to reduce operating expenses as the Company continues the global market development of the Senhance platform. Under the restructuring plan, the Company reduced headcount primarily in the sales and marketing functions and determined that the carrying value of its inventory exceeded the net realizable value due to a decrease in expected sales. The restructuring charges amounted to $8.8 million, of which $7.4 million was an inventory write down and was included in cost of product revenue and $1.4 million related to employee severance costs and was included as restructuring and other charges in the consolidated statements of operations and comprehensive loss, for the year ended December 31, 2019. Future payments under the restructuring plan are expected to conclude in 2020 and total $0.9 million. During the year ended December 31, 2019, the activity related to the Company's restructuring liability, which is included in accrued expenses in the consolidated balance sheet, was as follows:



	Restructuring Liability
	(In thousands)
Balance at December 31, 2018	$	—
Amount charged to operating expenses	1,374
Cash payments	(492		)
Balance at December 31, 2019	$	882

Basic and Diluted Net Loss per Share

12 Months Ended

Dec. 31, 2019

Earnings Per Share [Abstract]

Basic and Diluted Net Loss per Share

Basic net loss per common share is computed by dividing net loss attributable to common stockholders by the weighted average number of common shares outstanding during the period. Diluted net loss per common share is computed giving effect to all dilutive potential common shares that were outstanding during the period. Diluted potential common shares consist of incremental shares issuable upon exercise of stock options, warrants and restricted stock units. No adjustments have been made to the weighted average outstanding common shares figures for the years ended December 31, 2019 or 2018 as the assumed exercise of outstanding options, warrants and restricted stock units would be anti-dilutive.

Potential common shares not included in calculating diluted net loss per share are as follows:



	December 31
	2019	2018
Stock options	1,830,958	1,529,964
Stock warrants	2,071,172	333,034
Nonvested restricted stock units	443,927	382,098
Total	4,346,057	2,245,096

Related Person Transactions	12 Months Ended
Related Person Transactions	Dec. 31, 2019
Related Party Transactions [Abstract]
Related Person Transactions	Related Person Transactions A member of the Company’s Board of Directors is an executive officer of Synecor, LLC. Various research and development services were purchased by the Company from Synecor, LLC and its wholly owned subsidiary Synchrony Labs LLC. These purchases were approved by the Audit Committee and totaled approximately $0 and $24,000 for the years ended December 31, 2019 and 2018, respectively. A member of the Company's Board of Directors is an executive officer of Sofar S.p.A. Various equipment was purchased by the Company from Sofar S.p.A. and totaled approximately $26,000 and $0 for the years ended December 31, 2019 and 2018, respectively. In March 2018, TransEnterix Europe entered into a Service Supply Agreement with 1 Med S.A. for certain regulatory consulting services. Andrea Biffi, a current member of the Company’s Board of Directors, owns a non-controlling interest in 1 Med S.A. Expenses under the Service Supply Agreement were approximately $12,000 and $71,000 for the years ended December 31, 2019 and 2018, respectively.

Commitments and Contingencies	12 Months Ended
Commitments and Contingencies	Dec. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Contingent Consideration As discussed in Note 3, in September 2015, the Company completed the Senhance Acquisition using a combination of cash, stock and potential post-acquisition milestone payments. These milestone payments may be payable in the future, depending on the achievement of certain commercial milestones. On December 30, 2016, the Company entered into an Amendment to restructure the terms of the Second Tranche of the Cash Consideration. Under the Amendment, the Second Tranche was restructured to reduce the contingent cash consideration by €5.0 million in exchange for the issuance of 286,360 shares of the Company’s common stock with an aggregate fair market value of €5.0 million. As of December 31, 2019, the fair value of the contingent consideration was $1.1 million. Legal Proceedings When determining the estimated probable loss or range of losses, significant judgment is required to be exercised in order to estimate the amount and timing of the loss to be recorded. Estimating an amount or range of possible losses resulting from litigation proceedings is inherently difficult and requires an extensive degree of judgment, particularly where the matters involve indeterminate claims for monetary damages, are in the early stages of the proceedings, and are subject to appeal. In addition, because most legal proceedings are resolved over extended periods of time, potential losses are subject to change due to, among other things, new developments, changes in legal strategy, the outcome of intermediate procedural and substantive rulings and other parties’ settlement posture and their evaluation of the strength or weakness of their case against the Company. For these reasons, the Company is currently unable to predict the ultimate timing or outcome of, or reasonably estimate the possible losses or a range of possible losses resulting from, the matters described above. Based on information currently available, the Company does not believe that any reasonably possible losses arising from currently pending legal matters will be material to the Company’s results of operations or financial condition. However, in light of the inherent uncertainties involved in such matters, an adverse outcome in one or more of these matters could materially and adversely affect the Company’s financial condition, results of operations or cash flows in any particular reporting period. No liability or related charge was recorded to earnings in the Company’s consolidated financial statements for legal contingencies for the years ended December 31, 2019 and 2018. Operating Leases On November 2, 2009, TransEnterix Surgical entered into an operating lease for its corporate offices for a period of five years commencing in April 2010. On June 12, 2014, the Company entered into a lease amendment extending the term of the lease for a period of 3 years and 2 months commencing on May 1, 2015 and expiring on June 30, 2018, with an option to renew for an additional three years. On January 8, 2018, the Company entered into a lease amendment extending the term of the lease for a period of eighteen months commencing on July 1, 2018 and expiring on December 31, 2019, with an option to renew for an additional five years. On June 10, 2019, the Company entered into a lease amendment extending the term of the lease for an additional twelve months commencing on January 1, 2020 and expiring on December 31, 2020, with no option to renew. On October 25, 2013, the Company entered into an operating lease for its warehouse for a period of four years and four months commencing in January 2014, with an option to renew for an additional six years. On December 27, 2017, the Company entered into an agreement to terminate this lease effective January 31, 2018. On May 12, 2016, TransEnterix Italia entered into an operating lease for research and development and demonstration facilities for a period of six years commencing in July 2016. On April 15, 2019, TransEnterix Israel entered into an operating lease for research and development facilities for a period of five years commencing in April 2019. On April 25, 2018, TransEnterix Japan entered into an operating lease for office space for a period of five years commencing in April 2018. On July 1, 2018, TransEnterix Europe S.à.R.L entered into an operating lease for office space for a period of five years commencing in July 2018. Rent expense was approximately $1.4 million and $1.2 million for the years ended December 31, 2019 and 2018, respectively. License and Supply Agreements As discussed in Note 3, in September 2015, the Company completed the Senhance Acquisition. As part of this transaction, the Company assumed certain license and supply agreements. Commitments under these agreements amount to approximately $5.5 million in 2020, $0.6 million in 2021, $0.6 million in 2022, $0.6 million in 2023, $0.6 million in 2024, and $1.1 million thereafter until termination in 2027. The Company has placed orders with various suppliers for the purchase of certain tooling, supplies and contract engineering and research services. Each of these orders has a duration or expected completion within the next twelve months.

Subsequent Events

12 Months Ended

Dec. 31, 2019

Subsequent Events [Abstract]

Subsequent Events

Series B Warrant Exchange

On February 24, 2020, the Company entered into a Series B Warrants Exchange Agreement (the “Exchange Agreement”) with holders of its Series B Warrants. Under the terms of the Exchange Agreement, each Series B Warrant was canceled in exchange for 0.61 shares of common stock. The Warrant holders participating in the exchange held 3,373,900 of the 3,638,780 Series B Warrants then outstanding, and received an aggregate of 2,040,757 shares of common stock, leaving 264,880 Series B Warrants outstanding to acquire 160,226 shares of common stock. The number of shares of common stock subject to the outstanding Series B Warrants increased to 292,178 shares as a result of the adjustment made following the 2020 Public Offering.

Lincoln Park Capital Purchase Agreement

On February 10, 2020, the Company entered into a Purchase Agreement with Lincoln Park Capital Fund, LLC, an Illinois limited liability company, pursuant to which the Company has the right to sell to Lincoln Park up to an aggregate of $25,000,000 in shares of common stock over the 36-month term of the Purchase Agreement, subject to certain limitations and conditions set forth in the Purchase Agreement. In consideration for entering into the Purchase Agreement, the Company issued to Lincoln Park 343,171 shares of common stock as commitment shares on February 10, 2020. No shares have been sold to Lincoln Park under the Purchase Agreement to date.

Public Offering of Securities

On March 10, 2020, the Company closed an underwritten public offering (the "2020 Public Offering") with Ladenburg Thalmann & Co. Inc. as underwriter and sold an aggregate of 14,121,766 Class A Units at a public offering price of $0.68 per Class A Unit and 7,937,057 Class B Units at a public offering price of $0.68 per Class B Unit. Each Class A Unit consists of one share of the Company’s common stock, one warrant to purchase one share of common stock that expires on the first anniversary of the date of issuance (collectively, the “Series C Warrants”), and one warrant to purchase one share of common stock that expires on the fifth anniversary of the date of issuance (collectively, the “Series D Warrants”). Each Class B Unit consists of one share of Series A Convertible Preferred Stock, par value $0.01 per share (the “Series A Preferred Stock”), convertible into one share of common stock, a Series C Warrant to purchase one share of Common Stock and a Series D Warrant to purchase one share of Common Stock. The Class A Units and Class B Units have no stand-alone rights and were not certificated or issued as stand-alone securities. The shares of common stock, Series A Preferred Stock, Series C Warrants and Series D Warrants are immediately separable. In addition, the underwriter for the public offering exercised an overallotment option allowing them to purchase 3,308,823 Series C Warrants and 3,308,823 Series D Warrants.

The net proceeds to the Company from the 2020 Public Offering were approximately $13.4 million, after deducting underwriting discounts and commissions and estimated offering expenses payable by the Company.

At-The-Market Offering

The following table summarizes the total sales under the 2019 Sales Agreement for the period commencing January 1, 2020 through the date of this filing (in thousands except for per share amounts):



Total shares of common stock sold	6,688
Average price per share	$	1.73
Gross proceeds	$	11,558
Commissions earned by Cantor	$	347
Net Proceeds	$	11,211

Restructuring

During March 2020, the Company continued the restructuring efforts with additional headcount reductions which resulted in $0.8 million related to severance costs. These 2020 severance costs are primarily expected to be paid in 2020 and 2021.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Basis of Presentation

Use of Estimates

Cash and Cash Equivalents and Restricted Cash

The Company considers all highly liquid investments with original maturities of 90 days or less at the time of purchase to be cash equivalents.

Short-term Investments

The Company reviews its short-term investments for other-than-temporary impairment if the cost exceeds the fair value.

Concentrations and Credit Risk

Accounts Receivable

Inventories

Identifiable Intangible Assets and Goodwill

In-Process Research and Development

The IPR&D from MST was acquired on October 31, 2018.

The Company performed an impairment test of its IPR&D at the end of the third quarter 2019 as recent events and changes in market conditions indicated that the asset might be impaired.

Property and Equipment

Property and equipment consists primarily of machinery, manufacturing equipment, demonstration equipment, computer equipment, furniture, and leasehold improvements, which are recorded at cost.

Depreciation is recorded using the straight-line method over the estimated useful lives of the assets as follows:



Machinery, manufacturing and demonstration equipment	3-5 years
Computer equipment	3 years
Furniture	5 years
Leasehold improvements	Lesser of lease term or 3 to 10 years

Impairment of Long-Lived Assets

Contingent Consideration

Warrant Liabilities

Translation of Foreign Currencies

Business Acquisitions

Risk and Uncertainties

Revenue Recognition

•


•	Service. Service revenue is recognized ratably over the term of the service period as the customers benefit from the service throughout the service period. Revenue related to services performed on a time-and-materials basis is recognized when performed.

The following table presents revenue disaggregated by type and geography:



	Year Ended December 31,
	2019		2018
	(in thousands)
U.S.
Systems	$	90	$	2,556
Instruments and accessories	108		967
Services	338		255
Total U.S. revenue	536		3,778

Outside of U.S. ("OUS")
Systems	5,459		16,193
Instruments and accessories	1,447		3,552
Services	1,089		579
Total OUS revenue	7,995		20,324

Total
Systems	5,549		18,749
Instruments and accessories	1,555		4,519
Services	1,427		834
Total revenue	$	8,531	$	24,102

The Company recognizes sales by geographic area based on the country in which the customer is based.

Cost of Revenue

Research and Development Costs

Reversal of Transfer Fee Accrual

Stock-Based Compensation

The Company records as expense the fair value of stock-based compensation awards, including stock options and restricted stock units.

Income Taxes

Comprehensive Loss

Comprehensive loss is defined as the change in equity of a business enterprise during a period from transactions and other events and circumstances from non-owner sources.

Segments

Impact of Recently Issued Accounting Standards

The following table presents the minimum lease payments as of December 31, 2019 (in thousands):



January 1, 2020 to December 31, 2020	$	1,372
January 1, 2021 to December 31, 2021	716
January 1, 2022 to December 31, 2022	454
January 1, 2023 to December 31, 2023	207
January 1, 2024 to December 31, 2024	28
Thereafter	—
Total minimum lease payments	$	2,778
Less: Amount of lease payments representing interest	(266		)
Present value of future minimum lease payments	$	2,512

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Summary of Estimated Lives of Assets

Depreciation is recorded using the straight-line method over the estimated useful lives of the assets as follows:



Machinery, manufacturing and demonstration equipment	3-5 years
Computer equipment	3 years
Furniture	5 years
Leasehold improvements	Lesser of lease term or 3 to 10 years

Summary of Revenue Disaggregated by Type and Geography

The following table presents revenue disaggregated by type and geography:



	Year Ended December 31,
	2019		2018
	(in thousands)
U.S.
Systems	$	90	$	2,556
Instruments and accessories	108		967
Services	338		255
Total U.S. revenue	536		3,778

Outside of U.S. ("OUS")
Systems	5,459		16,193
Instruments and accessories	1,447		3,552
Services	1,089		579
Total OUS revenue	7,995		20,324

Total
Systems	5,549		18,749
Instruments and accessories	1,555		4,519
Services	1,427		834
Total revenue	$	8,531	$	24,102

Lessee, Operating Lease, Liability, Maturity

The following table presents the minimum lease payments as of December 31, 2018 (in thousands):



January 1, 2019 to December 31, 2019	$	929
January 1, 2020 to December 31, 2020	399
January 1, 2021 to December 31, 2021	385
January 1, 2022 to December 31, 2022	175
January 1, 2023 to December 31, 2023	38
Thereafter	—
Total minimum lease payments	$	1,926

The following table presents the minimum lease payments as of December 31, 2019 (in thousands):



January 1, 2020 to December 31, 2020	$	1,372
January 1, 2021 to December 31, 2021	716
January 1, 2022 to December 31, 2022	454
January 1, 2023 to December 31, 2023	207
January 1, 2024 to December 31, 2024	28
Thereafter	—
Total minimum lease payments	$	2,778
Less: Amount of lease payments representing interest	(266		)
Present value of future minimum lease payments	$	2,512

Acquisitions (Tables)

12 Months Ended

Dec. 31, 2019

Business Combinations [Abstract]

Summary of Fair Value Consideration

The following table summarizes the acquisition date fair value of the consideration (in thousands).



Stock consideration	$	8,300
Cash consideration	5,800
Present value of deferred consideration	5,900
Other consideration	314
Total consideration	$	20,314

Schedule of Estimated Fair Values of Assets Acquired and Liabilities Assumed

The following table summarizes the estimated fair values of the assets acquired and liabilities assumed on October 31, 2018, the date of acquisition (in thousands):



Property and equipment	$	43
In-process research and development	10,633
Goodwill	9,638
Net assets acquired	$	20,314

Summary of Business Acquisition, Pro Forma Information

The pro forma consolidated financial information has been calculated after applying the Company’s accounting policies and includes adjustments for transaction-related costs.



	Year Ended December 31,
	2018
	(In thousands except per share amounts) (unaudited)
Revenue	$	24,170
Net loss	(64,365		)
Net loss per share	$	(0.31	)

Cash, Cash Equivalents, and Restricted Cash (Tables)

12 Months Ended

Dec. 31, 2019

Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents [Abstract]

Summary of Cash, Cash Equivalents and Restricted Cash

Cash, cash equivalents and restricted cash consist of the following:



	December 31, 2019		December 31, 2018
	(In thousands)
Cash	$	9,596	$	1,485
Money market	2		19,576
Total cash and cash equivalents	$	9,598	$	21,061
Restricted cash	969		590
Total	$	10,567	$	21,651

Fair Value (Tables)

12 Months Ended

Dec. 31, 2019

Fair Value Disclosures [Abstract]

Summary of Assets Measured at Fair Value on Recurring Basis



	December 31, 2019
	(In thousands) (unaudited)
Description	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Total
Assets measured at fair value
Cash and cash equivalents	$	9,598	$	—	$	—	$	9,598
Restricted cash	969		—		—		969
Total Assets measured at fair value	$	10,567	$	—	$	—	$	10,567
Liabilities measured at fair value
Contingent consideration	$	—	$	—	$	1,084	$	1,084
Warrant liabilities	—		—		2,388		2,388
Total liabilities measured at fair value	$	—	$	—	$	3,472	$	3,472



	December 31, 2018
	(In thousands)
Description	Quoted Prices in Active Markets for Identical Assets (Level 1)		Significant Other Observable Inputs (Level 2)		Significant Unobservable Inputs (Level 3)		Total
Assets measured at fair value
Cash and cash equivalents	$	21,061	$	—	$	—	$	21,061
Restricted cash	590		—		—		590
Total Assets measured at fair value	$	21,651	$	—	$	—	$	21,651
Liabilities measured at fair value
Contingent consideration	$	—	$	—	$	10,637	$	10,637
Warrant liabilities	—		—		4,636		4,636
Total liabilities measured at fair value	$	—	$	—	$	15,273	$	15,273

Quantitative Information about Inputs and Valuation Methodologies Used for Fair Value Measurements Classification



	Valuation Methodology	Significant Unobservable Input	Weighted Average (range, if applicable)
			December 31, 2019	December 31, 2018
Contingent consideration	Probability weighted income approach	Milestone dates	2020 to 2024	2019 to 2022
		Discount rate	10% to 11%	11.5% to 12%

he following table presents the inputs and valuation methodologies used for the Company’s fair value of the Series B warrants:



Series B	December 31, 2019	December 31, 2018
Fair value	$2.4 million	$4.6 million
Valuation methodology	Monte Carlo	Monte Carlo
Term	2.32 years	3.32 years
Risk free rate	1.59%	2.47%
Dividends	—	—
Volatility	109.80%	87.60%
Share price	$1.47	$29.38
Probability of additional financing	100% in 2020	100% in 2019

Change in Fair Value for All Assets and Liabilities Using Unobservable Level 3 Inputs As Determined By Level 3 Inputs

The following table summarizes the change in fair value, as determined by Level 3 inputs for the warrants and the contingent consideration for the years ended December 31, 2019 and 2018:



	Fair Value Measurement at Reporting Date (Level 3)
	(In thousands)
	Common stock warrants			Contingent consideration
Balance at December 31, 2017	$	14,090		$	12,418
Payment for contingent consideration	—			(770		)
Exercise of warrants	(23,774		)	—
Change in fair value	14,320			(1,011		)
Balance at December 31, 2018	4,636			10,637
Change in fair value	(2,248		)	(9,553		)
Balance at December 31, 2019	2,388			1,084
Current portion	—			73
Long-term portion	2,388			1,011
Balance at December 31, 2019	$	2,388		$	1,084

Accounts Receivable, Net (Tables)

12 Months Ended

Dec. 31, 2019

Receivables [Abstract]

Summary of Accounts Receivable

The following table presents the components of accounts receivable:



	December 31, 2019			December 31, 2018
	(In thousands)
Gross accounts receivable	$	2,274		$	8,640
Allowance for uncollectible accounts	(1,654		)	(80		)
Total accounts receivable, net	$	620		$	8,560

Inventories (Tables)

12 Months Ended

Dec. 31, 2019

Inventory Disclosure [Abstract]

Schedule of Inventory, Current

The components of inventories are as follows:



	December 31, 2019		December 31, 2018
	(In thousands)
Finished goods	$	9,737	$	5,439
Raw materials	8,510		5,502
Total inventories	$	18,247	$	10,941

Current Portion	$	10,653	$	10,941
Long-term portion	7,594		—
Total inventories	$	18,247	$	10,941

Schedule of Inventory, Noncurrent

The components of inventories are as follows:



	December 31, 2019		December 31, 2018
	(In thousands)
Finished goods	$	9,737	$	5,439
Raw materials	8,510		5,502
Total inventories	$	18,247	$	10,941

Current Portion	$	10,653	$	10,941
Long-term portion	7,594		—
Total inventories	$	18,247	$	10,941

Other Current Assets (Tables)

12 Months Ended

Dec. 31, 2019

Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]

Schedule of Other Current Assets

The following table presents the components of other current assets:



	December 31, 2019		December 31, 2018
	(In thousands)
Advances to vendors	$	2,534	$	5,427
Prepaid expenses	1,834		1,443
VAT receivable	2,716		2,335
Total	$	7,084	$	9,205

Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2019

Property, Plant and Equipment [Abstract]

Summary of Property and Equipment

Property and equipment consisted of the following:



	December 31, 2019			December 31, 2018
	(In thousands)
Machinery, manufacturing and demonstration equipment	$	10,421		$	12,320
Computer equipment	2,321			2,260
Furniture	637			639
Leasehold improvements	2,295			2,280
Total property and equipment	15,674			17,499
Accumulated depreciation and amortization	(10,968		)	(11,162		)
Property and equipment, net	$	4,706		$	6,337

Goodwill, In-Process Research and Development and Intellectual Property (Tables)

12 Months Ended

Dec. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Carrying Value of Goodwill and Change in Balance

The carrying value of goodwill and the change in the balance for the years ended December 31, 2019 and 2018 is as follows:



	Goodwill
	(In thousands)
Balance at December 31, 2017	71,368
Additions	9,638
Foreign currency translation impact	(875		)
Balance at December 31, 2018	$	80,131
Foreign currency translation impact	(1,162		)
Impairment	(78,969		)
Balance at December 31, 2019	$	—

Carrying Value of Company's Intangible Assets and Change in Balance

The carrying value of the Company’s IPR&D assets and the change in the balance for the years ended December 31, 2018 and 2019 is as follows:



	In-Process Research and Development
	(In thousands)
Balance at December 31, 2017	$	—
Additions	10,633
Foreign currency translation impact	114
Balance at December 31, 2018	10,747
Impairment	(7,912		)
Foreign currency translation impact	(365		)
Balance at December 31, 2019	$	2,470

The components of gross intellectual property, accumulated amortization, and net intellectual property as of December 31, 2019 and 2018 are as follows:



	December 31, 2019										December 31, 2018
	(In thousands)										(In thousands)
	Gross Carrying Amount		Accumulated Amortization			Foreign currency translation impact			Net Carrying Amount		Gross Carrying Amount		Accumulated Amortization			Foreign currency translation impact		Net Carrying Amount
Developed technology	$	66,413	$	(36,918	)	$	(1,208	)	$	28,287	$	66,413	$	(27,174	)	$	119	$	39,358
Technology and patents purchased	400		(112		)	21			309		400		(72		)	30		358
Total intellectual property	$	66,813	$	(37,030	)	$	(1,187	)	$	28,596	$	66,813	$	(27,246	)	$	149	$	39,716

Summary of Estimated Future Amortization Expense of Intangible Assets

The estimated future amortization expense of intangible assets as of December 31, 2019 is as follows:



	Year ending December 31, 2019
	(In thousands)
2020	$	10,328
2021	10,328
2022	7,757
2023	42
2024	42
Thereafter	99
Total	$	28,596

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Summary of Components of Income Tax Benefit

The components for the income tax expense (benefit) are as follows for the years ended December 31 (in thousands):



	2019			2018
Current income taxes
Federal	$	—		$	—
State	—			—
Foreign	100			—
Deferred income taxes
Federal	—			—
State	—			—
Foreign	(3,224		)	(3,377		)
Total income tax benefit	$	(3,124	)	$	(3,377	)

Schedule of Income (Loss) From Operations Before Taxes

The United States and foreign components of loss from operations before taxes are as follows for the years ended December 31 (in thousands):



	2019			2018
United States	$	(91,935	)	$	(44,744	)
Foreign	(65,390		)	(20,410		)
Total loss from operations before taxes	$	(157,325	)	$	(65,154	)

Summary of Deferred Tax Assets and Liabilities

Significant components of the Company’s deferred tax assets consist of the following at December 31 (in thousands):



	2019			2018
Noncurrent deferred tax assets:
Stock-based compensation	$	3,665		$	2,281
Accrued expenses and other	1,007			795
Research credit carryforward	6,776			6,182
Fixed assets	345			392
Capitalized start-up costs and other intangibles	3,618			1,859
Net operating loss carryforwards	113,410			74,566
	128,821			86,075
Valuation allowance	(123,108)			(81,337		)
Net noncurrent deferred tax asset	5,713			4,738
Noncurrent deferred tax liabilities
Fixed assets and other	(1,445		)	(686		)
Purchase accounting intangibles	(5,660		)	(8,772		)
Net noncurrent deferred tax liability	(7,105		)	(9,458		)
Net deferred tax liability	$	(1,392	)	$	(4,720	)

Summary of Change in Gross Unrecognized Tax Positions

The following is a tabular reconciliation of the Company’s change in gross unrecognized tax positions at December 31 (in thousands):



	2019		2018
Beginning balance	$	1,363	$	1,202
Gross increases for tax positions related to current periods	149		161
Gross increases for tax positions related to prior periods	—		—
Ending balance	$	1,512	$	1,363

Summary of Provision for Income Taxes

Taxes computed at the then-current statutory federal income tax rate of 21% are reconciled to the provision for income taxes as follows for the years ended December 31:



	2019					2018
	Amount			% of Pretax Earnings		Amount			% of Pretax Earnings
United States federal tax at statutory rate	$	(33,038	)	21.0	%	$	(13,682	)	21.0	%
State taxes (net of deferred benefit)	(4,778		)	3.0	%	(1,080		)	1.7	%
Nondeductible expenses	709			(0.5	)%	(1,320		)	2.0	%
Change in fair market value of contingent consideration	(2,342		)	1.5	%	(256		)	0.4	%
Warrant remeasurement and financing costs	(551		)	0.4	%	3,630			(5.6	)%
Research & Development credits	(743		)	0.5	%	(803		)	1.2	%
Change in unrecognized tax benefits	149			(0.1	)%	161			(0.2	)%
Foreign tax rate differential	2,590			(1.6	)%	(96		)	0.1	%
Goodwill impairment	(6,638		)	4.2	%	—			—
Change in enacted tax rates and other, net	(253		)	0.2	%	252			(0.3	)%
Change in valuation allowance	41,771			(26.6	)%	9,817			(15.1	)%
Income tax benefit	$	(3,124	)	2.0	%	$	(3,377	)	5.2	%

Accrued Expenses (Tables)

12 Months Ended

Dec. 31, 2019

Accrued Liabilities, Current [Abstract]

Schedule of Accrued Expenses

The following table presents the components of accrued expenses:



	December 31, 2019		December 31, 2018
	(In thousands)
Compensation and benefits	$	5,061	$	6,243
Restructuring costs	882		—
Consulting and other vendors	308		895
Other	242		539
Lease Liability	1,112		—
Royalties	148		498
Legal and professional fees	474		432
Deferred rent	—		391
Taxes and other assessments	326		365
Interest	—		256
Total	$	8,553	$	9,619

Stock-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2019

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Summary of Share Based Fair Value Assumptions

The fair value of options granted were estimated using the Black-Scholes-Merton option pricing model based on the assumptions in the table below:



	Year ended December 31,
	2019	2018
Expected dividend yield	0%	0%
Expected volatility	81% - 92%	73% - 75%
Risk-free interest rate	1.39% - 2.66%	2.35% - 3.02%
Expected life (in years)	5.5 - 6.1	5.5 - 6.1

Schedule of Stock Option Activity

The following table summarizes the Company’s stock option activity, including grants to non-employees, for the year ended December 31, 2019:



	Number of Shares		Weighted- Average Exercise Price		Weighted- Average Remaining Contractual Term (Years)
Options outstanding at December 31, 2018	1,529,964		$	31.45	7.82
Granted	623,272		29.79
Forfeited	(248,834	)	33.13
Cancelled	(43,525	)	38.67
Exercised	(29,919	)	18.00
Options Outstanding December 31, 2019	1,830,958		$	30.71	7.36

Schedule of Stock Options Outstanding

The following table summarizes information about stock options outstanding at December 31, 2019:



	Number of Shares	Weighted Average Exercise Price		Weighted Average Remaining Contractual Term (Years)
Exercisable at December 31, 2019	926,498	$	32.48	6.14
Vested or expected to vest at December 31, 2019	1,763,300	$	30.75	7.28

Restricted Stock Units (Tables)

12 Months Ended

Dec. 31, 2019

Equity [Abstract]

Summary of Restricted Stock Unit Activity

The following is a summary of the RSU activity for the years ended December 31, 2019 and 2018:



	Number of Restricted Stock Units Outstanding		Weighted Average Grant Date Fair Value
Unvested December 31, 2017	338,055		$	14.95
Granted	170,403		28.66
Vested	(123,539	)	17.44
Forfeited	(2,821	)	17.71
Unvested December 31, 2018	382,098		$	20.24
Granted	192,987		31.42
Vested	(85,153	)	25.98
Forfeited	(46,005	)	21.38
Unvested December 31, 2019	443,927		$	23.88

Warrants (Tables)

12 Months Ended

Dec. 31, 2019

Warrants and Rights Note Disclosure [Abstract]

Summary of Warrant Activity



	Number of Warrant Shares		Weighted Average Exercise Price		Weighted Average Remaining Contractual Life (in years)	Weighted Average Fair Value
Outstanding at Outstanding at December 31, 2017	1,012,513		$	14.04	4.5	$	5.07
Exercised	(672,125	)	14.17		0	—
Expired	(7,354	)	21.45		0	—
Outstanding at Outstanding at December 31, 2018	333,034		$	13.39	3.7	$	3.38
Exercised	(15,385	)	13.00		0	—
Reserved for future issuance	1,753,523		1.39		2.2	1.22
Outstanding at Outstanding at December 31, 2019	2,071,172		$	2.05	2.4	$	1.34

At-The-Market Offering and Firm Commitment Offering (Tables)

12 Months Ended

Dec. 31, 2019

Equity [Abstract]

Schedule Of Sales Under Sales Agency Agreement Table

The following table summarizes the total sales under the ATM Offering and Firm Commitment Offering for the period indicated (in thousands except for share and per share amounts):



			Firm Commitment
	ATM Offering		Offering
	For the year ended		For the year ended		Total
	December 31, 2019		December 31, 2019		December 31, 2019
Total shares of common stock sold	1,374,686		2,153,846		3,528,532
Average price per share	$	5.23	$	8.73	$	7.37
Gross proceeds	$	7,193	$	18,796	$	25,989
Commissions earned by Cantor	212		—		212
Net Proceeds	$	6,981	$	18,796	$	25,777

The following table summarizes the total sales under the 2019 Sales Agreement for the period commencing January 1, 2020 through the date of this filing (in thousands except for per share amounts):



Total shares of common stock sold	6,688
Average price per share	$	1.73
Gross proceeds	$	11,558
Commissions earned by Cantor	$	347
Net Proceeds	$	11,211

Purchase Agreement and Offerings (Tables)

12 Months Ended

Dec. 31, 2019

Purchase Agreement Controlled Equity Offering And Public Offering Of Common Stock [Abstract]

Schedule Of Sales Under Sales Agency Agreement Table

The following table summarizes the total sales under the ATM Offering and Firm Commitment Offering for the period indicated (in thousands except for share and per share amounts):



			Firm Commitment
	ATM Offering		Offering
	For the year ended		For the year ended		Total
	December 31, 2019		December 31, 2019		December 31, 2019
Total shares of common stock sold	1,374,686		2,153,846		3,528,532
Average price per share	$	5.23	$	8.73	$	7.37
Gross proceeds	$	7,193	$	18,796	$	25,989
Commissions earned by Cantor	212		—		212
Net Proceeds	$	6,981	$	18,796	$	25,777

The following table summarizes the total sales under the 2019 Sales Agreement for the period commencing January 1, 2020 through the date of this filing (in thousands except for per share amounts):



Total shares of common stock sold	6,688
Average price per share	$	1.73
Gross proceeds	$	11,558
Commissions earned by Cantor	$	347
Net Proceeds	$	11,211

Restructuring (Tables)

12 Months Ended

Dec. 31, 2019

Restructuring and Related Activities [Abstract]

Restructuring and Related Costs

During the year ended December 31, 2019, the activity related to the Company's restructuring liability, which is included in accrued expenses in the consolidated balance sheet, was as follows:



	Restructuring Liability
	(In thousands)
Balance at December 31, 2018	$	—
Amount charged to operating expenses	1,374
Cash payments	(492		)
Balance at December 31, 2019	$	882

Basic and Diluted Net Loss per Share (Tables)

12 Months Ended

Dec. 31, 2019

Earnings Per Share [Abstract]

Summary of Potential Common Shares

Potential common shares not included in calculating diluted net loss per share are as follows:



	December 31
	2019	2018
Stock options	1,830,958	1,529,964
Stock warrants	2,071,172	333,034
Nonvested restricted stock units	443,927	382,098
Total	4,346,057	2,245,096

Subsequent Events (Tables)

12 Months Ended

Dec. 31, 2019

Subsequent Events [Abstract]

Schedule Of Sales Under Sales Agency Agreement Table

The following table summarizes the total sales under the ATM Offering and Firm Commitment Offering for the period indicated (in thousands except for share and per share amounts):



			Firm Commitment
	ATM Offering		Offering
	For the year ended		For the year ended		Total
	December 31, 2019		December 31, 2019		December 31, 2019
Total shares of common stock sold	1,374,686		2,153,846		3,528,532
Average price per share	$	5.23	$	8.73	$	7.37
Gross proceeds	$	7,193	$	18,796	$	25,989
Commissions earned by Cantor	212		—		212
Net Proceeds	$	6,981	$	18,796	$	25,777

The following table summarizes the total sales under the 2019 Sales Agreement for the period commencing January 1, 2020 through the date of this filing (in thousands except for per share amounts):



Total shares of common stock sold	6,688
Average price per share	$	1.73
Gross proceeds	$	11,558
Commissions earned by Cantor	$	347
Net Proceeds	$	11,211

Organization and Capitalization - Additional Information (Detail)		1 Months Ended
	Dec. 11, 2019	Dec. 31, 2018 USD ($) shares	Dec. 31, 2019 shares	Dec. 06, 2013 $ / shares shares
Organization And Capitalization [Line Items]
Reverse stock split, conversion ratio	0.07692307692000
Common stock, shares authorized (in shares)		750,000,000	750,000,000
Preferred stock, shares authorized (in shares)				25,000,000
Preferred stock, par value (in dollars per share) \| $ / shares				$ 0.01
Minimum
Organization And Capitalization [Line Items]
Common stock, shares authorized (in shares)				225,000,000
Maximum
Organization And Capitalization [Line Items]
Common stock, shares authorized (in shares)				750,000,000
China National Scientific and Instruments and Materials Company
Organization And Capitalization [Line Items]
Proceeds from distribution agreement \| $		$ 15,000,000.0
Distribution minimum royalties payment \| $		14,000,000.0
China National Scientific and Instruments and Materials Company \| Minimum
Organization And Capitalization [Line Items]
Expected proceeds from distribution agreement \| $		$ 29,000,000.0

Summary of Significant Accounting Policies - Additional Information (Detail)	3 Months Ended		6 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2019 USD ($)	Sep. 30, 2015 USD ($)	Jun. 30, 2019 USD ($)	Sep. 30, 2019 USD ($)	Dec. 31, 2019 USD ($) Segment shares	Dec. 31, 2018 USD ($) shares	Dec. 11, 2019 shares	Dec. 10, 2019 shares	Jan. 01, 2019
Accounting Policies [Line Items]
Common stock, shares outstanding (in shares) \| shares					20,691,301	16,641,999	20,200,000	261,900,000
Cumulative effect on retained earnings, net of tax					$ 0	$ 11,000
Accumulated deficit					(663,600,000)	(509,406,000)
Right-of-use asset					2,300,000
Stock-based compensation					11,508,000	9,039,000
Inventory write-down related to restructuring					7,400,000
Restricted cash						590,000
Short-term investments					0	51,790,000
Bad debt expense					$ 1,634,000	0
Number of business segments \| Segment					1
Intangible assets impairment	$ 7,900,000				$ 7,912,000	$ 0
Period of service sale arrangement						5 years
Product warranty						1 year
Period of service sale arrangement at stated service price						4 years
Revenue, remaining performance obligation					3,700,000
Contract assets included in accounts receivable					200,000	$ 200,000
Revenue recognized, included in deferred revenue			$ 1,300,000		1,000,000.0	400,000
Reversal of transfer fee accrual					0	2,994,000
Decrease in valuation allowance due to newly enacted tax rate						36,100,000
Assets					74,779,000	239,307,000
Cash and cash equivalents used in operating activities					73,484,000	48,493,000
Cash and cash equivalents provided by investing activities					67,645,000	(53,481,000)
Goodwill and in-process research and development impairment					86,881,000	0
Goodwill impairment	$ 79,000,000.0			$ 79,000,000.0	78,969,000	0
Present value of future minimum lease payments					2,512,000
Lease Liability					1,112,000	0
Operating lease, liability, noncurrent					$ 1,400,000
Operating leases, rent expense						1,200,000
Operating lease, weighted average remaining lease term					2 years 7 months 6 days
Operating lease, payments					$ 1,700,000
Operating lease, weighted average discount rate, percent					7.80%
Working capital					$ 14,900,000
Inventory write-down					$ 1,523,000	$ 0
U.S
Accounting Policies [Line Items]
Percentage of total consolidated assets					19.00%	54.00%
International
Accounting Policies [Line Items]
Percentage of total consolidated assets, excluding goodwill					81.00%	34.00%
Stock Options
Accounting Policies [Line Items]
Share based compensation, expense recognized					$ 9,039,000
Senhance Surgical Robotic System Acquisition
Accounting Policies [Line Items]
Reversal of transfer fee accrual		$ 3,000,000.0
Transfer fee accrual term		3 years
Senhance Surgical Robotic System Acquisition \| Europe
Accounting Policies [Line Items]
Assets					$ 60,500,000	$ 111,000,000.0
Patents
Accounting Policies [Line Items]
Amortization period					10 years
Intangible assets impairment				$ 0	$ 0
Minimum
Accounting Policies [Line Items]
Incremental borrowing rate									6.10%
Amortization period					5 years
Minimum \| Developed Technology
Accounting Policies [Line Items]
Amortization period					5 years
Maximum
Accounting Policies [Line Items]
Incremental borrowing rate									8.50%
Amortization period					10 years
Maximum \| Developed Technology
Accounting Policies [Line Items]
Amortization period					7 years
Customer Concentration Risk \| Accounts Receivable \| Eight Customer
Accounting Policies [Line Items]
Concentration risk					85.00%
Customer Concentration Risk \| Accounts Receivable \| Five Customer
Accounting Policies [Line Items]
Concentration risk						89.00%
Customer Concentration Risk \| Sales \| Six Customer
Accounting Policies [Line Items]
Concentration risk					82.00%
Customer Concentration Risk \| Sales \| Twelve Customer
Accounting Policies [Line Items]
Concentration risk						89.00%
Geographic Concentration Risk \| Sales \| U.S
Accounting Policies [Line Items]
Concentration risk					6.00%	16.00%
Geographic Concentration Risk \| Sales \| Europe
Accounting Policies [Line Items]
Concentration risk					39.00%	78.00%
Geographic Concentration Risk \| Sales \| Asia
Accounting Policies [Line Items]
Concentration risk					55.00%	6.00%
U.S. Government Securities
Accounting Policies [Line Items]
Short-term investments						$ 51,800,000
Short-term investments, other-than-temporary impairment					$ 0	0
Held In Cash Collateral Accounts
Accounting Policies [Line Items]
Restricted cash					969,000	600,000
Operating Expense
Accounting Policies [Line Items]
Operating lease, cost					1,400,000
SurgiBot System
Accounting Policies [Line Items]
Inventory write-down					$ 1,500,000	$ 0

Summary of Significant Accounting Policies - Summary of Estimated Lives of Assets (Detail)	12 Months Ended
	Dec. 31, 2019
Computer equipment
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful lives	3 years
Furniture
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful lives	5 years
Minimum \| Machine Manufacturing Equipment and Demonstration Equipment
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful lives	3 years
Minimum \| Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful lives	3 years
Maximum \| Machine Manufacturing Equipment and Demonstration Equipment
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful lives	5 years
Maximum \| Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, estimated useful lives	10 years

Summary of Significant Accounting Policies - Summary of Revenue Disaggregated by Type and Geography (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Disaggregation of Revenue [Line Items]
Total revenues	$ 8,531	$ 24,102
Systems
Disaggregation of Revenue [Line Items]
Total revenues	5,549	18,749
Instruments and Accessories
Disaggregation of Revenue [Line Items]
Total revenues	1,555	4,519
Services
Disaggregation of Revenue [Line Items]
Total revenues	1,427	834
U.S
Disaggregation of Revenue [Line Items]
Total revenues	536	3,778
U.S \| Systems
Disaggregation of Revenue [Line Items]
Total revenues	90	2,556
U.S \| Instruments and Accessories
Disaggregation of Revenue [Line Items]
Total revenues	108	967
U.S \| Services
Disaggregation of Revenue [Line Items]
Total revenues	338	255
Outside of U.S
Disaggregation of Revenue [Line Items]
Total revenues	7,995	20,324
Outside of U.S \| Systems
Disaggregation of Revenue [Line Items]
Total revenues	5,459	16,193
Outside of U.S \| Instruments and Accessories
Disaggregation of Revenue [Line Items]
Total revenues	1,447	3,552
Outside of U.S \| Services
Disaggregation of Revenue [Line Items]
Total revenues	$ 1,089	$ 579

Summary of Significant Accounting Policies - Summary of Adjustment (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Jan. 01, 2019	Dec. 31, 2018
Assets
Other long term assets	$ 2,489		$ 203
Liabilities and Stockholders’ Equity
Other long term liabilities	$ 1,403		$ 0
Accounting Standards Update 2016-02
Assets
Other long term assets		$ 1,800
Liabilities and Stockholders’ Equity
Accrued expenses		500
Other long term liabilities		$ 1,200

Summary of Significant Accounting Policies Summary of Significant Accounting Policies - Summary of Minimum Lease Payments (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Accounting Policies [Abstract]
January 1, 2020 to December 31, 2020	$ 1,372	$ 929
January 1, 2021 to December 31, 2021	716	399
January 1, 2022 to December 31, 2022	454	385
January 1, 2023 to December 31, 2023	207	175
January 1, 2024 to December 31, 2024	28	38
Thereafter	0	0
Total minimum lease payments	2,778	$ 1,926
Less: Amount of lease payments representing interest	(266)
Present value of future minimum lease payments	$ 2,512

Acquisitions - Additional Information (Detail) € in Millions									12 Months Ended
	Sep. 30, 2019 shares	Oct. 31, 2018 USD ($) shares	Oct. 31, 2018 USD ($)	Dec. 30, 2016 shares	Dec. 30, 2016 EUR (€)	Sep. 21, 2015 EUR (€)	Sep. 21, 2015 USD ($) shares	Sep. 21, 2015 EUR (€) shares	Dec. 31, 2019 USD ($)	Dec. 31, 2019 EUR (€)	Dec. 31, 2018 USD ($)	Dec. 31, 2019 EUR (€)	Oct. 15, 2019 USD ($)
Business Acquisition [Line Items]
Additional consideration									$ 1,084,000		$ 10,637,000
Revenue									8,531,000		24,102,000
Net loss									$ (154,201,000)		(61,777,000)
Escrow and security interest period						24 months
Medical Surgery Technologies Ltd.
Business Acquisition [Line Items]
Cash consideration			$ 5,800,000
Stock consideration			$ 8,300,000
Unrestricted securities consideration									75.00%	75.00%
Revenue									$ 0
Net loss									400,000
Medical Surgery Technologies Ltd. \| Ending on Twelve Month Anniversary \| Maximum
Business Acquisition [Line Items]
Percentage of securities consideration			25.00%
Medical Surgery Technologies Ltd. \| First Tranche
Business Acquisition [Line Items]
Cash consideration			$ 5,800,000
Common shares issued \| shares		242,310
Medical Surgery Technologies Ltd. \| Second Tranche
Business Acquisition [Line Items]
Common shares issued \| shares	370,423
Additional consideration			$ 6,600,000
Stock consideration		$ 6,600,000
Senhance Surgical Robotic System Acquisition
Business Acquisition [Line Items]
Common shares issued \| shares							1,195,647	1,195,647
Additional consideration									10,600,000
Senhance Surgical Robotic System Acquisition \| U.S. Dollars
Business Acquisition [Line Items]
Cash consideration							$ 25,000,000.0
Senhance Surgical Robotic System Acquisition \| Euro
Business Acquisition [Line Items]
Cash consideration \| €								€ 27.5
Senhance Surgical Robotic System Acquisition \| Second Tranche
Business Acquisition [Line Items]
Cash consideration \| €										€ 15.1
Common shares issued \| shares				286,360
Additional consideration \| €					€ 5.0
Aggregate fair market value \| €								5.0
Senhance Surgical Robotic System Acquisition \| Second Tranche \| U.S. Dollars
Business Acquisition [Line Items]
Cash consideration payable									25,000,000.0
Senhance Surgical Robotic System Acquisition \| Second Tranche \| Euro
Business Acquisition [Line Items]
Cash consideration payable \| €												€ 22.5
Senhance Surgical Robotic System Acquisition \| Third Tranche
Business Acquisition [Line Items]
Cash consideration payable \| €						€ 15.0		15.0
Senhance Surgical Robotic System Acquisition \| Third Tranche \| Minimum
Business Acquisition [Line Items]
Target revenue to be achieved \| €						25.0		25.0
Senhance Surgical Robotic System Acquisition \| Fourth Tranche
Business Acquisition [Line Items]
Cash consideration \| €										€ 2.4
Cash consideration payable \| €						€ 2.5		€ 2.5
AutoLap
Business Acquisition [Line Items]
Disposal group, including discontinued operation, consideration													$ 17,000,000.0
Proceeds from sale of productive assets									16,000,000
Consideration receivable													$ 1,000,000.0
AutoLap
Business Acquisition [Line Items]
Gain from sale of assets, net									$ (15,965,000)		$ 0

Acquisitions - Summary of Fair Value Consideration (Detail)2 - Medical Surgery Technologies Limited $ in Thousands	Oct. 31, 2018 USD ($)
Business Acquisition [Line Items]
Stock consideration	$ 8,300
Cash consideration	5,800
Present value of deferred consideration	5,900
Other consideration	314
Total consideration	$ 20,314

Acquisitions - Schedule of Estimated Fair Values of Assets Acquired and Liabilities Assumed (Detail)2 - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018	Oct. 31, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
Goodwill	$ 0	$ 80,131		$ 71,368
Medical Surgery Technologies Limited
Business Acquisition [Line Items]
Property and equipment			$ 43
In-process research and development			10,633
Goodwill	$ 9,600		9,638
Net assets acquired			$ 20,314

Acquisitions - Summary of Business Acquisition, Pro Forma Information (Detail) - Medical Surgery Technologies Ltd. $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($) $ / shares
Business Acquisition [Line Items]
Revenue	$ 24,170
Net loss	$ (64,365)
Net loss per share ( in dollar per share) \| $ / shares	$ (0.31)

Cash, Cash Equivalents, and Restricted Cash - Summary of Cash, Cash Equivalents and Restricted Cash (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents [Abstract]
Cash	$ 9,596	$ 1,485
Money market	2	19,576
Total cash and cash equivalents	9,598	21,061
Restricted cash		590
Total	$ 10,567	$ 21,651	$ 97,606

Cash, Cash Equivalents, and Restricted Cash - Additional Information (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Restricted Cash and Cash Equivalents Items [Line Items]
Restricted cash		$ 590
Held In Cash Collateral Accounts
Restricted Cash and Cash Equivalents Items [Line Items]
Restricted cash	$ 969	$ 600

Fair Value - Additional Information (Detail)		12 Months Ended
Fair Value - Additional Information (Detail)	Apr. 28, 2017 USD ($) $ / shares shares	Dec. 31, 2019 USD ($) $ / shares shares	Dec. 31, 2018 USD ($) $ / shares	Dec. 11, 2019 $ / shares	Dec. 31, 2017 shares
Fair Value Measurements Disclosure [Line Items]
Transfers of assets		$ 0	$ 0
Transfers of liabilities		0	0
Change in fair value of contingent consideration		9,553,000	1,011,000
Offering price (in dollars per share) \| $ / shares	$ 1.00
Change in fair value of warrant liabilities		(2,248,000)	14,320,000
Series A Warrant
Fair Value Measurements Disclosure [Line Items]
Warrants, exercise price (in dollars per share) \| $ / shares	$ 13.00
Series A Warrant \| Black-Scholes Merton Model
Fair Value Measurements Disclosure [Line Items]
Estimated fair value of warrants	$ 2,500,000
Share price (in dollars per share) \| $ / shares	$ 8.45
Series A Warrant \| Black-Scholes Merton Model \| Measurement Input, Expected Term
Fair Value Measurements Disclosure [Line Items]
Fair value input, term	1 year
Series A Warrant \| Black-Scholes Merton Model \| Measurement Input, Risk Free Interest Rate
Fair Value Measurements Disclosure [Line Items]
Fair value input, risk free rate	0.0107
Series A Warrant \| Black-Scholes Merton Model \| Measurement Input, Expected Dividend Payment
Fair Value Measurements Disclosure [Line Items]
Fair value input, risk free rate	0
Series A Warrant \| Black-Scholes Merton Model \| Measurement Input, Price Volatility
Fair Value Measurements Disclosure [Line Items]
Fair value input, risk free rate	0.7314
Series B Warrant
Fair Value Measurements Disclosure [Line Items]
Warrants, exercise price (in dollars per share) \| $ / shares	$ 13.00			$ 1.39
Estimated fair value of warrants		$ 2,400,000	$ 4,600,000
Share price (in dollars per share) \| $ / shares		$ 1.47	$ 29.38
Series B Warrant \| Measurement Input, Expected Term
Fair Value Measurements Disclosure [Line Items]
Fair value input, term		2 years 3 months 25 days	3 years 3 months 25 days
Series B Warrant \| Measurement Input, Risk Free Interest Rate
Fair Value Measurements Disclosure [Line Items]
Fair value input, risk free rate		0.0159	0.0247
Series B Warrant \| Measurement Input, Expected Dividend Payment
Fair Value Measurements Disclosure [Line Items]
Fair value input, risk free rate		0	0
Series B Warrant \| Measurement Input, Price Volatility
Fair Value Measurements Disclosure [Line Items]
Fair value input, risk free rate		1.0980	0.8760
Common Stock \| Series A
Fair Value Measurements Disclosure [Line Items]
Gross proceeds from public offering	$ 24,900,000
Common Stock \| Series A Warrant
Fair Value Measurements Disclosure [Line Items]
Number of common stock or warrants in each unit \| shares	0.077
Common Stock \| Series B Warrant
Fair Value Measurements Disclosure [Line Items]
Gross proceeds from public offering	$ 24,900,000
Number of common stock or warrants in each unit \| shares	0.058
Warrants Not Settleable in Cash
Fair Value Measurements Disclosure [Line Items]
Number of warrants outstanding (in shares) \| shares					1,012,513
Warrants Not Settleable in Cash \| Series B Warrant
Fair Value Measurements Disclosure [Line Items]
Number of warrants outstanding (in shares) \| shares		1,963,451

Fair Value - Summary of Assets Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Assets measured at fair value
Cash and cash equivalents	$ 9,598	$ 21,061
Restricted cash	969	590
Total Assets measured at fair value	10,567	21,651
Liabilities measured at fair value
Contingent consideration	1,084	10,637
Warrant liabilities	2,388	4,636
Total liabilities measured at fair value	3,472	15,273
Quoted Prices in Active Markets for Identical Assets (Level 1)
Assets measured at fair value
Cash and cash equivalents	9,598	21,061
Restricted cash	969	590
Total Assets measured at fair value	10,567	21,651
Liabilities measured at fair value
Contingent consideration	0	0
Warrant liabilities	0	0
Total liabilities measured at fair value	0	0
Significant Other Observable Inputs (Level 2)
Assets measured at fair value
Cash and cash equivalents	0	0
Restricted cash	0	0
Total Assets measured at fair value	0	0
Liabilities measured at fair value
Contingent consideration	0	0
Warrant liabilities	0	0
Total liabilities measured at fair value	0	0
Level 3
Assets measured at fair value
Cash and cash equivalents	0	0
Restricted cash	0	0
Total Assets measured at fair value	0	0
Liabilities measured at fair value
Contingent consideration	1,084	10,637
Warrant liabilities	2,388	4,636
Total liabilities measured at fair value	$ 3,472	$ 15,273

Fair Value - Quantitative Information about Inputs and Valuation Methodologies Used for Fair Value Measurements Classification (Detail) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2019 USD ($) $ / shares	Dec. 31, 2018 USD ($) $ / shares
Measurement Input, Discount Rate \| Senhance Surgical Robotic System Acquisition \| Level 3 \| Contingent Consideration \| Minimum
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Discount rate	0.10	0.115
Measurement Input, Discount Rate \| Senhance Surgical Robotic System Acquisition \| Level 3 \| Contingent Consideration \| Maximum
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Discount rate	0.11	0.12
Series B Warrant
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value \| $	$ 2.4	$ 4.6
Share price (in dollars per share) \| $ / shares	$ 1.47	$ 29.38
Probability of additional financing in 2020	100.00%
Probability of additional financing in 2019		100.00%
Series B Warrant \| Measurement Input, Expected Term
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Term	2 years 3 months 25 days	3 years 3 months 25 days
Series B Warrant \| Measurement Input, Risk Free Interest Rate
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value measurement input	0.0159	0.0247
Series B Warrant \| Measurement Input, Expected Dividend Payment
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value measurement input	0	0
Series B Warrant \| Measurement Input, Price Volatility
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value measurement input	1.0980	0.8760

Fair Value Fair Value - Change in Fair Value for All Assets and Liabilities Using Unobservable Level 3 Inputs As Determined By Level 3 Inputs (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2019
Common Stock Warrants
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	$ 4,636	$ 14,090
Payment for contingent consideration		0
Exercise of warrants		(23,774)
Change in fair value	(2,248)	14,320
Current portion			$ 0
Long-term portion			2,388
Ending balance	4,636	14,090	2,388
Contingent Consideration
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance	10,637	12,418
Payment for contingent consideration		(770)
Exercise of warrants		0
Change in fair value	(9,553)	(1,011)
Current portion			73
Long-term portion			1,011
Ending balance	$ 10,637	$ 12,418	$ 1,084

Accounts Receivable, Net - Summary of Accounts Receivable (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Receivables [Abstract]
Gross accounts receivable	$ 2,274	$ 8,640
Allowance for uncollectible accounts	(1,654)	(80)
Total accounts receivable, net	620	8,560
Bad debt expense	$ 1,634	$ 0

Inventories - Schedule of Inventory (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Inventory Disclosure [Abstract]
Finished goods	$ 9,737	$ 5,439
Raw materials	8,510	5,502
Total inventories	18,247	10,941
Current Portion	10,653	10,941
Long-term portion	$ 7,594	$ 0

Inventories - Additional Information (Detail) - USD ($)	12 Months Ended
Inventories - Additional Information (Detail) - USD ($)	Dec. 31, 2019	Dec. 31, 2018
Inventory [Line Items]
Inventory write-down related to restructuring	$ 7,400,000
Write down of inventory	1,523,000	$ 0
SurgiBot System
Inventory [Line Items]
Write down of inventory	$ 1,500,000	$ 0

Other Current Assets - Schedule of Other Current Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Advances to vendors	$ 2,534	$ 5,427
Prepaid expenses	1,834	1,443
VAT receivable	2,716	2,335
Total	$ 7,084	$ 9,205

Property and Equipment - Summary of Property and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 15,674	$ 17,499
Accumulated depreciation and amortization	(10,968)	(11,162)
Property and equipment, net	4,706	6,337
Machinery, Manufacturing and Demonstration Equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	10,421	12,320
Computer equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	2,321	2,260
Furniture
Property, Plant and Equipment [Line Items]
Property and equipment, gross	637	639
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 2,295	$ 2,280

Property and Equipment - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Abstract]
Depreciation	$ 2,166	$ 2,400

Goodwill, In-Process Research and Development and Intellectual Property - Additional Information (Detail) - USD ($)			3 Months Ended	9 Months Ended	12 Months Ended
	Oct. 31, 2018	Sep. 21, 2015	Sep. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Goodwill And Intangible Assets [Line Items]
Goodwill					$ 0	$ 80,131,000	$ 71,368,000
Accumulated impairment of goodwill					140,800,000	61,800,000
Goodwill impairment			$ 79,000,000.0	$ 79,000,000.0	78,969,000	0
In-process research and development impairment			$ 7,900,000		7,912,000	$ 0
In-Process Research and Development
Goodwill And Intangible Assets [Line Items]
Discount rate	15.00%	45.00%
In-process research and development impairment					$ 7,912,000
Technology and Patents Purchased
Goodwill And Intangible Assets [Line Items]
Weighted average remaining useful life					7 years 3 months 18 days
Developed Technology
Goodwill And Intangible Assets [Line Items]
Weighted average remaining useful life					2 years 9 months 18 days
Safe Stitch Medical Inc
Goodwill And Intangible Assets [Line Items]
Goodwill					$ 93,800,000
Senhance Surgical Robotic System Acquisition
Goodwill And Intangible Assets [Line Items]
Goodwill					38,300,000
Senhance Surgical Robotic System Acquisition \| In-Process Research and Development
Goodwill And Intangible Assets [Line Items]
In-process research and development		$ 17,100,000
Medical Surgery Technologies Ltd.
Goodwill And Intangible Assets [Line Items]
Goodwill	$ 9,638,000				$ 9,600,000
Medical Surgery Technologies Ltd. \| In-Process Research and Development
Goodwill And Intangible Assets [Line Items]
In-process research and development	$ 10,600,000

Goodwill, In-Process Research and Development and Intellectual Property - Carrying Value of Goodwill and Change in Balance (Detail) - USD ($)	3 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2019	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018
Goodwill [Roll Forward]
Beginning balance		$ 80,131,000	$ 80,131,000	$ 71,368,000
Additions				9,638,000
Foreign currency translation impact			(1,162,000)	(875,000)
Impairment	$ (79,000,000.0)	$ (79,000,000.0)	(78,969,000)	0
Ending balance			$ 0	$ 80,131,000

Goodwill, In-Process Research and Development and Intellectual Property - Carrying Value of Company's IPR&D Assets and Change in Balance (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Sep. 30, 2019	Dec. 31, 2019	Dec. 31, 2018
Finite-lived Intangible Assets [Roll Forward]
Additions			$ 10,633
Impairment	$ (7,900)	$ (7,912)	0
In-Process Research and Development
Finite-lived Intangible Assets [Roll Forward]
Beginning balance		10,747	0
Foreign currency translation impact		(365)	114
Impairment		(7,912)
Ending balance		$ 2,470	$ 10,747

Goodwill, In-Process Research and Development and Intellectual Property - Summary of Gross Intellectual Property, Accumulated Amortization, and Net Intellectual Property (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Developed Technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 66,413	$ 66,413
Accumulated Amortization	(36,918)	(27,174)
Foreign currency translation impact	(1,208)	119
Net Carrying Amount	28,287	39,358
Technology and Patents Purchased
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	400	400
Accumulated Amortization	(112)	(72)
Foreign currency translation impact	21	30
Net Carrying Amount	309	358
Intellectual Property
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	66,813	66,813
Accumulated Amortization	(37,030)	(27,246)
Foreign currency translation impact	(1,187)	149
Net Carrying Amount	$ 28,596	$ 39,716

Goodwill, In-Process Research and Development and Intellectual Property - Summary of Estimated Future Amortization Expense of Intangible Assets (Detail) - Intellectual Property - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Finite-Lived Intangible Assets [Line Items]
2020	$ 10,328
2021	10,328
2022	7,757
2023	42
2024	42
Thereafter	99
Total	$ 28,596	$ 39,716

Income Taxes - Summary of Components of Income Tax Benefit (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Current income taxes
Federal	$ 0	$ 0
State	0	0
Foreign	100	0
Deferred income taxes
Federal	0	0
State	0	0
Foreign	(3,224)	(3,377)
Total income tax benefit	$ (3,124)	$ (3,377)

Income Taxes - Schedule of Income (Loss) From Operations Before Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
United States	$ (91,935)	$ (44,744)
Foreign	(65,390)	(20,410)
Loss before income taxes	$ (157,325)	$ (65,154)

Income Taxes - Summary of Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Noncurrent deferred tax assets:
Stock-based compensation	$ 3,665	$ 2,281
Accrued expenses and other	1,007	795
Research credit carryforward	6,776	6,182
Fixed assets	345	392
Capitalized start-up costs and other intangibles	3,618	1,859
Net operating loss carryforwards	113,410	74,566
Deferred tax assets, gross	128,821	86,075
Valuation allowance	(123,108)	(81,337)
Net noncurrent deferred tax asset	5,713	4,738
Noncurrent deferred tax liabilities
Fixed assets and other	(1,445)	(686)
Purchase accounting intangibles	(5,660)	(8,772)
Net noncurrent deferred tax liability	(7,105)	(9,458)
Net deferred tax liability	$ (1,392)	$ (4,720)

Income Taxes - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Contingency [Line Items]
Valuation allowance	$ 41,800,000
Operating loss carry forwards	113,410,000	$ 74,566,000
Remaining operating loss carryforwards	4,700,000
Unrecognized tax benefits	1,512,000	1,363,000	$ 1,202,000
Unrecognized tax benefits and interest accrued	0	$ 0
GILTI income tax	0
Domestic Tax Authority
Income Tax Contingency [Line Items]
Operating loss carry forwards	337,600,000
Operating loss carryforwards subject to expiration	254,500,000
Remaining operating loss carryforwards	83,100,000
State and Local Jurisdiction
Income Tax Contingency [Line Items]
Operating loss carry forwards	287,500,000
Operating loss carryforwards subject to expiration	282,800,000
Foreign Tax Authority \| Italy
Income Tax Contingency [Line Items]
Operating loss carry forwards	23,100,000
Foreign Tax Authority \| Luxembourg
Income Tax Contingency [Line Items]
Operating loss carryforwards subject to expiration	95,100,000
Foreign Tax Authority \| Switzerland
Income Tax Contingency [Line Items]
Operating loss carryforwards subject to expiration	42,300,000
Foreign Tax Authority \| Japan
Income Tax Contingency [Line Items]
Operating loss carryforwards subject to expiration	2,000,000.0
Research Tax Credit Carryforward
Income Tax Contingency [Line Items]
Tax credit carry forward, amount	$ 6,800,000

Income Taxes - Summary of Change in Gross Unrecognized Tax Positions (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Beginning balance	$ 1,363	$ 1,202
Gross increases for tax positions related to current periods	149	161
Gross increases for tax positions related to prior periods	0	0
Ending balance	$ 1,512	$ 1,363

Income Taxes - Summary of Provision for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
United States federal tax statutory rate, Amount	$ (33,038)	$ (13,682)
State taxes (net of deferred benefit), Amount	(4,778)	(1,080)
Non-deductible expenses, Amount	709	(1,320)
Change in fair market value	(2,342)	(256)
Warrant remeasurement	(551)	3,630
Research & development credits	(743)	(803)
Change in unrecognized tax benefits, Amount	149	161
Foreign tax rate differential, Amount	2,590	(96)
Goodwill impairment	(6,638)	0
Change in enacted tax rates	(253)	252
Change in valuation allowance, Amount	41,771	9,817
Total income tax benefit	$ (3,124)	$ (3,377)
United States federal tax	21.00%	21.00%
State taxes (net of deferred benefit)	3.00%	1.70%
Non-deductible expenses	(0.50%)	2.00%
Change in fair market value	1.50%	0.40%
Warrant remeasurement and financing costs	0.40%	(5.60%)
Research & development credits	0.50%	1.20%
Change in unrecognized tax benefits	(0.10%)	(0.20%)
Foreign tax rate differential	(1.60%)	0.10%
Goodwill impairment	4.20%	0.00%
Change in enacted tax rates and other	0.20%	(0.30%)
Change in valuation allowance	(26.60%)	(15.10%)
Provision for income taxes	2.00%	5.20%

Accrued Expenses - Schedule of Accrued Expenses (Detail) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2019	Dec. 31, 2018
Accrued Liabilities, Current [Abstract]
Compensation and benefits	$ 5,061	$ 5,061	$ 6,243
Restructuring costs	882	882	0
Restructuring and other charges	8,800	1,374	0
Consulting and other vendors	308	308	895
Other	242	242	539
Lease Liability	1,112	1,112	0
Royalties	148	148	498
Legal and professional fees	474	474	432
Deferred rent	0	0	391
Taxes and other assessments	326	326	365
Interest	0	0	256
Total	$ 8,553	$ 8,553	$ 9,619

Notes Payable - Additional Information (Detail) - USD ($)						12 Months Ended
	Nov. 04, 2019	Jul. 10, 2019	May 23, 2018	May 10, 2017	May 10, 2017	Dec. 31, 2019	Dec. 31, 2018	Apr. 30, 2019	Oct. 23, 2018	May 31, 2018
Debt Instrument [Line Items]
Minimum advances available								$ 5,000,000.0
Unrestricted cash balance requirement						$ 7,000,000.0
Termination fees	$ 16,400,000
Prepayment fees	$ 1,400,000
Loss on extinguishment of debt						1,006,000	$ 1,400,000
Notes Payable \| Interest Expense
Debt Instrument [Line Items]
Loss on extinguishment of debt						1,000,000.0
Hercules Loan Agreement
Debt Instrument [Line Items]
Repayments of debt		$ 15,000,000.0
Notes payable		$ 30,000,000.0
Debt discount liability										$ 300,000
Debt Instrument, redemption price amount			$ 700,000
Hercules Loan Agreement \| Notes Payable \| Interest Expense
Debt Instrument [Line Items]
Loss on extinguishment of debt						1,400,000
Hercules Loan Agreement \| Term Loan
Debt Instrument [Line Items]
Term loans aggregate principal amount			$ 40,000,000.0
Repayment of term loans period			18 months
Debt instrument amortization schedule			18 months
Debt discount liability			$ 400,000
Debt issuance costs recorded as debt discount			$ 1,100,000
Prepayment fee percentage			6.95%
Percentage outstanding			120.00%
Percentage of maintained cash			80.00%
Amount of investment to any future equity offering			$ 2,000,000.0
Hercules Loan Agreement \| Term Loan \| Fixed Rate and Prime Rate
Debt Instrument [Line Items]
Term loans interest rate			5.00%
Hercules Loan Agreement \| Term Loan \| Maximum
Debt Instrument [Line Items]
Term loans fixed interest rate			9.55%
Hercules Loan Agreement \| Term Loan \| First Year After Initial Funding Date
Debt Instrument [Line Items]
Prepayment fee percentage			3.00%
Hercules Loan Agreement \| Term Loan \| Second Year After Initial Funding Date
Debt Instrument [Line Items]
Prepayment fee percentage			2.00%
Hercules Loan Agreement \| Term Loan \| Second Year After Initial Funding Date And Thereafter
Debt Instrument [Line Items]
Prepayment fee percentage			1.00%
Hercules Loan Agreement \| Term Loan \| First Tranche
Debt Instrument [Line Items]
Term loans aggregate principal amount			$ 20,000,000.0
Hercules Loan Agreement \| Term Loan \| Second Tranche
Debt Instrument [Line Items]
Term loans aggregate principal amount									$ 10,000,000.0
Hercules Loan Agreement \| Term Loan \| Tranche Four
Debt Instrument [Line Items]
Term loans aggregate principal amount								$ 20,000,000.0
Loan and Security Agreement \| Term Loan
Debt Instrument [Line Items]
Debt issuance costs recorded as debt discount				$ 1,200,000	$ 1,200,000
Loan and Security Agreement \| Term Loan \| Innovatus Life Sciences Lending Fund I, LP
Debt Instrument [Line Items]
Term loans aggregate principal amount				$ 17,000,000.0	$ 17,000,000.0
Repayment of term loans period					2 years
Debt instrument amortization schedule				24 months
Term loans fixed interest rate				11.00%	11.00%
Term loans fixed interest rate				2.50%	2.50%
Interest only payment period					24 months
Loan and Security Agreement \| Term Loan \| First Tranche
Debt Instrument [Line Items]
Debt discount liability				$ 200,000	$ 200,000
Warrants, exercise price (in dollars per share)				$ 13.00	$ 13.00
Estimated fair value of warrants				$ 300,000	$ 300,000
Unamortized debt discount						$ 0
Loan and Security Agreement \| Term Loan \| First Tranche \| Innovatus Life Sciences Lending Fund I, LP
Debt Instrument [Line Items]
Term loans aggregate principal amount				$ 14,000,000.0	$ 14,000,000.0
Loan and Security Agreement \| Term Loan \| First Tranche \| Maximum
Debt Instrument [Line Items]
Issue of warrants to purchase shares				95,750	95,750

Stock-Based Compensation - Additional Information (Detail) $ / shares in Units, $ in Thousands			1 Months Ended	12 Months Ended
	Dec. 11, 2019	Sep. 03, 2013	Sep. 30, 2006 shares	Dec. 31, 2019 USD ($) $ / shares shares	Dec. 31, 2018 USD ($) $ / shares shares	Dec. 31, 2014 shares	Dec. 31, 2013 shares	Apr. 24, 2019 shares	May 24, 2018 shares	May 25, 2017 shares	Jun. 08, 2016 shares	May 07, 2015 shares	Oct. 29, 2013 shares	Dec. 31, 2011 shares	Dec. 31, 2009 shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Reverse stock split, conversion ratio	0.07692307692000
Common stock, capital shares								4,072,308	3,149,231	1,995,385
Stock-based compensation expense \| $				$ 11,508	$ 9,039
Intrinsic value of options exercised \| $				200	9,300
Proceeds from options exercised \| $				$ 500	$ 7,100
Granted (in shares)				623,272	669,662
Grant date fair value (in dollars per share) \| $ / shares				$ 21.23	$ 20.67
Unrecognized employee \| $				$ 19,600
Weighted average period				1 year 4 months 24 days
Expected dividend yield				0.00%	0.00%
Incentive Compensation Plan 2006
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award limitations for options (in shares)			6,154
Stock option, number of shares														259,861	85,389
Options vesting period				4 years
Options expiration period				10 years
Stock Appreciation Rights (SARs) \| Incentive Compensation Plan 2007
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award limitations for options (in shares)						76,923	15,385
Other Stock Based Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted average period				2 years 6 months
Other Stock Based Awards \| Incentive Compensation Plan 2007
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award limitations for options (in shares)						38,462	7,692
June 19, 2012 Amendment
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, capital shares													76,923
October 29, 2013 Amendment
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, capital shares													380,000
May 7, 2015 Amendment
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, capital shares												918,462
June 8, 2016 Amendment
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock, capital shares											1,456,923
Merger Agreement
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Option exchange ratio		0.0887

Stock-Based Compensation - Summary of Share Based Fair Value Assumptions (Detail)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected dividend yield	0.00%	0.00%
Expected volatility, Maximum	92.00%	75.00%
Expected volatility, Minimum	81.00%	73.00%
Risk-free interest rate, Minimum	1.39%	2.35%
Risk-free interest rate, Maximum	2.66%	3.02%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected life (in years)	5 years 6 months	5 years 6 months
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected life (in years)	6 years 1 month 6 days	6 years 1 month 6 days

Stock-Based Compensation - Schedule of Stock Option Activity (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Number of Shares
Granted (in shares)	623,272	669,662
Forfeited (in shares)	(248,834)
Cancelled (in shares)	(43,525)
Exercised (in shares)	(29,919)
Weighted Average Exercise Price
Weighted Average Exercise Price, Outstanding (in dollar per share)	$ 31.45
Granted (in dollar per share)	29.79
Forfeited (in dollar per share)	33.13
Cancelled (in dollar per share)	38.67
Exercised (in dollar per share)	18.00
Weighted Average Exercise Price, Outstanding (in dollar per share)	$ 30.71	$ 31.45
Weighted- Average Remaining Contractual Term (Years)
Weighted- Average Remaining Contractual Term (in years)	7 years 4 months 9 days	7 years 9 months 25 days

Stock-Based Compensation - Schedule of Stock Options Outstanding (Detail)	12 Months Ended
	Dec. 31, 2019 $ / shares shares
Number of Shares
Number of Shares, Exercisable (in shares) \| shares	926,498
Vested or expected to vest (in shares) \| shares	1,763,300
Weighted Average Exercise Price
Exercisable, Weighted-Average (in dollar per share) \| $ / shares	$ 32.48
Vested or expected to vest (in dollar per share) \| $ / shares	$ 30.75
Weighted Average Remaining Contractual Term (Years)
Weighted-Average Remaining Contractual Term, Exercisable (in years)	6 years 1 month 20 days
Weighted-Average Remaining Contractual Term, Vested or expected to vest (in years)	7 years 3 months 10 days

Restricted Stock Units - Summary of Restricted Stock Unit Activity (Detail) - Nonvested Restricted Stock Units - $ / shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Weighted average number of shares used in computing net loss per common share:
Number of Warrant Shares, Outstanding Beginning balance (in shares)	382,098	338,055
Granted (in shares)	192,987	170,403
Vested (in shares)	(85,153)	(123,539)
Forfeited (in shares)	(46,005)	(2,821)
Number of Warrant Shares, Outstanding Ending balance (in shares)		382,098
Weighted Average Grant Date Fair Value
Unvested beginning balance (in dollars per share)	$ 20.24	$ 14.95
Granted (in dollars per share)	31.42	28.66
Vested (in dollars per share)	25.98	17.44
Forfeited (in dollars per share)	21.38	17.71
Unvested ending balance (in dollars per share)	$ 23.88	$ 20.24

Restricted Stock Units - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted average period	1 year 4 months 24 days
Nonvested Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Deferred liability	$ 3.2	$ 2.9
Unrecognized stock	$ 5.5
Weighted average period	3 years	3 years

Warrants - Additional Information (Detail) $ / shares in Units, $ in Millions										4 Months Ended	12 Months Ended
	Dec. 11, 2019 $ / shares	Sep. 12, 2017 USD ($) $ / shares shares	Sep. 12, 2017 $ / shares shares	May 10, 2017 $ / shares shares	Apr. 28, 2017 USD ($) $ / shares shares	Apr. 28, 2017 $ / shares shares	Sep. 26, 2014 $ / shares shares	Sep. 03, 2013	Mar. 22, 2013 USD ($) Investor $ / shares shares	Dec. 14, 2015 shares	Dec. 31, 2019 USD ($) shares	Dec. 31, 2018 USD ($) shares	Dec. 31, 2017 USD ($) shares	Dec. 31, 2016 shares	Dec. 31, 2013 shares	Aug. 14, 2015 $ / shares	Jan. 17, 2012 $ / shares shares
Class of Warrant or Right [Line Items]
Offering price (in dollars per share) \| $ / shares					$ 1.00	$ 1.00
Warrants outstanding									92,277
Warrants exercised (in shares)						0
Reverse stock split, conversion ratio	0.07692307692000
Warrants Not Settleable in Cash
Class of Warrant or Right [Line Items]
Number of warrants outstanding (in shares)													1,012,513
Share-based compensation arrangement \| $											$ 0.2	$ 5.3
Minimum
Class of Warrant or Right [Line Items]
Percentage of warrants exercisability											4.99%
Outstanding voting stock acquisition											50.00%
Series A Warrant
Class of Warrant or Right [Line Items]
Warrants, exercise price (in dollars per share) \| $ / shares					13.00	$ 13.00
Series B Warrant
Class of Warrant or Right [Line Items]
Warrants, exercise price (in dollars per share) \| $ / shares	$ 1.39				$ 13.00	$ 13.00
Warrants exercised (in shares)											0	542,478	684,131
Series B Warrant \| Warrants Not Settleable in Cash
Class of Warrant or Right [Line Items]
Number of warrants outstanding (in shares)											1,963,451
Service Warrants \| Service Agreements
Class of Warrant or Right [Line Items]
Warrants, exercise price (in dollars per share) \| $ / shares		$ 13.00	$ 13.00
Warrant, expiration period (in shares)			10 years
Warrants exercised (in shares)											15,385	50,000
Number of common stock or warrants in each unit		73,076	73,076
Percentage of vesting date of execution agreement		25.00%
Percentage of vesting completion			50.00%
Percentage of vesting achieving		25.00%
Achieving cumulative product revenue \| $		$ 15.0
Recognized initial expense \| $													$ 0.6
Share-based compensation \| $													$ 0.3
Warrants, remaining expense recognized \| $												$ 0.3
Common Stock \| Series A Warrant
Class of Warrant or Right [Line Items]
Number of common stock or warrants in each unit					0.077	0.077
Common Stock \| Series B Warrant
Class of Warrant or Right [Line Items]
Gross proceeds from public offering \| $					$ 24.9
Number of common stock or warrants in each unit					0.058	0.058
Common Stock \| Series A
Class of Warrant or Right [Line Items]
Gross proceeds from public offering \| $					$ 24.9
First Amended SVB Loan Agreement
Class of Warrant or Right [Line Items]
Warrants, exercise price (in dollars per share) \| $ / shares							$ 52.20
Warrant, expiration period (in shares)							7 years
Warrants exercised (in shares)											0	2,145		0
Stock issued due to exercise of options												660
Common stock warrants issued							2,948
Second Amended SVB Loan Agreement
Class of Warrant or Right [Line Items]
Warrants, exercise price (in dollars per share) \| $ / shares																$ 40.30
Warrant, expiration period (in shares)										7 years
Warrants exercised (in shares)											0	5,211		0
Stock issued due to exercise of options												2,426
Common stock warrants issued										8,684
Stock Purchase Agreement 2013 \| 2013 PIPE investors
Class of Warrant or Right [Line Items]
Number of investors \| Investor									17
Stock issued, shares									186,092
Offering price (in dollars per share) \| $ / shares									$ 16.25
Proceeds from PIPE \| $									$ 3.0
Warrants to purchase common shares									93,046
Warrants, exercise price (in dollars per share) \| $ / shares									$ 21.45
Warrant, expiration period (in shares)									5 years
Loan and Security Agreement \| Term Loan
Class of Warrant or Right [Line Items]
Warrant, expiration period (in shares)				5 years
Warrants exercised (in shares)											0
Loan and Security Agreement \| Term Loan \| First Tranche
Class of Warrant or Right [Line Items]
Warrants, exercise price (in dollars per share) \| $ / shares				$ 13.00
Loan and Security Agreement \| Maximum \| Term Loan \| First Tranche
Class of Warrant or Right [Line Items]
Warrants to purchase common shares				95,750
Related Parties \| Stock Purchase Agreement 2013 \| 2013 PIPE investors
Class of Warrant or Right [Line Items]
Stock issued, shares									98,462
Warrants to purchase common shares									49,231
Warrants exercised (in shares)												61,538	18,462
Warrants, expirations in period												7,354
Prior Lenders
Class of Warrant or Right [Line Items]
Warrants to purchase common shares																	21,506
Warrants, exercise price (in dollars per share) \| $ / shares																	$ 18.85
Warrant, expiration period (in shares)		10 years
Warrants exercised (in shares)												10,753		0	10,753
Stock issued due to exercise of options												8,065			8,674
Merger Agreement
Class of Warrant or Right [Line Items]
Option exchange ratio								0.0887

Warrants - Summary of Warrant Activity (Detail) - $ / shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017	Apr. 24, 2019	May 24, 2018	May 25, 2017
Class of Warrant or Right [Line Items]
Number of Warrant Shares, Reserved (in shares)				4,072,308	3,149,231	1,995,385
Weighted Average Exercise Price, Expired (in dollars per share)	$ 38.67
Warrants Not Settleable in Cash
Class of Warrant or Right [Line Items]
Number of Warrant Shares, Outstanding Beginning balance (in shares)		1,012,513
Number of Warrant Shares, Exercised (in shares)	(15,385)	(672,125)
Number of Warrant Shares, Expired (in shares)		(7,354)
Number of Warrant Shares, Reserved (in shares)	1,753,523
Number of Warrant Shares, Outstanding Ending balance (in shares)			1,012,513
Weighted Average Exercise Price, Outstanding, Beginning balance (in dollars per share)	$ 13.39	$ 14.04
Weighted Average Exercise Price, Exercised (in dollars per share)	13.00	14.17
Weighted Average Exercise Price, Expired (in dollars per share)		21.45
Weighted Average Exercise Price, Reserved (in dollars per share)	1.39
Weighted Average Exercise Price, Outstanding, Ending balance (in dollars per share)	$ 2.05	$ 13.39	$ 14.04
Weighted Average Remaining Contractual Life, Outstanding	2 years 4 months 24 days	3 years 8 months 12 days	4 years 6 months
Weighted Average Remaining Contractual Life, Reserved for future issuance	2 years 2 months 12 days
Weighted Average Fair Value, Outstanding, Beginning balance (in dollars per share)	$ 3.38	$ 5.07
Weighted Average Fair Value, Reserved (in dollars per share)	1.22
Weighted Average Fair Value, Outstanding, Ending balance (in dollars per share)	$ 1.34	$ 3.38	$ 5.07

At-The-Market Offering and Firm Commitment Offering - Additional Information (Details) - USD ($)				12 Months Ended
	Sep. 04, 2019	Aug. 12, 2019	Dec. 28, 2018	Dec. 31, 2019
Class of Stock [Line Items]
Total shares of common stock sold (in shares)				3,528,532
Stifel Nicolaus Company Incorporated
Class of Stock [Line Items]
Total shares of common stock sold (in shares)				0
Percentage of commission paid			3.00%
Stifel Nicolaus Company Incorporated \| Maximum
Class of Stock [Line Items]
Sale of common stock in an at- the-market offering			$ 75,000,000.0
Two Thousand Nineteen Sales Agreement
Class of Stock [Line Items]
Sale of common stock in an at- the-market offering		$ 25,000,000.0
Total shares of common stock sold (in shares)				1,374,686
Percentage of commission paid		3.00%
Underwriting Agreement \| Public Stock Offering
Class of Stock [Line Items]
Number of shares issued				2,153,846
Underwriting Agreement \| Over-Allotment Option
Class of Stock [Line Items]
Number of shares issued	323,077

At-The-Market Offering and Firm Commitment Offering - Summary ATM Offering and Firm Commitment Offering (Details) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($) $ / shares shares
Class of Stock [Line Items]
Total shares of common stock sold (in shares) \| shares	3,528,532
Average Price Per Share (in dollars per share) \| $ / shares	$ 7.37
Gross proceeds	$ 25,989
Commissions earned by Cantor	212
Net Proceeds	$ 25,777
2019 ATM Offering
Class of Stock [Line Items]
Total shares of common stock sold (in shares) \| shares	1,374,686
Average Price Per Share (in dollars per share) \| $ / shares	$ 5.23
Gross proceeds	$ 7,193
Commissions earned by Cantor	212
Net Proceeds	$ 6,981
Firm commitment offering
Class of Stock [Line Items]
Average Price Per Share (in dollars per share) \| $ / shares	$ 8.73
Gross proceeds	$ 18,796
Commissions earned by Cantor	0
Net Proceeds	$ 18,796

Purchase Agreement and Offerings - Additional Information (Detail) - USD ($)					12 Months Ended
	Sep. 04, 2019	Aug. 12, 2019	Dec. 28, 2018	Apr. 28, 2017	Dec. 31, 2019	Dec. 11, 2019
Stockholders Equity Common Stock [Line Items]
Total shares of common stock sold (in shares)					3,528,532
Offering price (in dollars per share)				$ 1.00
Net proceeds from public offering				$ 23,200,000
Gross proceeds					$ 25,989,000
Series A Warrant
Stockholders Equity Common Stock [Line Items]
Warrants, exercise price (in dollars per share)				$ 13.00
Series B Warrant
Stockholders Equity Common Stock [Line Items]
Warrants, exercise price (in dollars per share)				$ 13.00		$ 1.39
Stifel, Nicolaus & Company, Incorporated
Stockholders Equity Common Stock [Line Items]
Percentage of commission paid			3.00%
Total shares of common stock sold (in shares)					0
Stifel, Nicolaus & Company, Incorporated \| Maximum
Stockholders Equity Common Stock [Line Items]
Sale of common stock			$ 75,000,000.0
Common Stock \| Series A
Stockholders Equity Common Stock [Line Items]
Gross proceeds from public offering				$ 24,900,000
Common Stock \| Series A Warrant
Stockholders Equity Common Stock [Line Items]
Number of common stock or warrants in each unit				0.077
Common Stock \| Series B Warrant
Stockholders Equity Common Stock [Line Items]
Gross proceeds from public offering				$ 24,900,000
Number of common stock or warrants in each unit				0.058
Two Thousand Nineteen Sales Agreement
Stockholders Equity Common Stock [Line Items]
Sale of common stock		$ 25,000,000.0
Percentage of commission paid		3.00%
Total shares of common stock sold (in shares)					1,374,686
Gross proceeds					$ 7,193,000
Underwriting Agreement
Stockholders Equity Common Stock [Line Items]
Gross proceeds					$ 18,796,000
Public Stock Offering \| Underwriting Agreement
Stockholders Equity Common Stock [Line Items]
Number of shares issued					2,153,846
Over-Allotment Option \| Underwriting Agreement
Stockholders Equity Common Stock [Line Items]
Number of shares issued	323,077

Purchase Agreement and Offerings Purchase Agreement and Offerings - Summary ATM Offering and Firm Commitment Offering (Details) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($) $ / shares shares
Class of Stock [Line Items]
Total shares of common stock sold (in shares) \| shares	3,528,532
Average price per share (in dollars per share) \| $ / shares	$ 7.37
Gross proceeds	$ 25,989
Commissions earned by Cantor	212
Commissions earned by Cantor	$ 25,777
Two Thousand Nineteen Sales Agreement
Class of Stock [Line Items]
Total shares of common stock sold (in shares) \| shares	1,374,686
Average price per share (in dollars per share) \| $ / shares	$ 5.23
Gross proceeds	$ 7,193
Commissions earned by Cantor	212
Commissions earned by Cantor	$ 6,981
Underwriting Agreement
Class of Stock [Line Items]
Average price per share (in dollars per share) \| $ / shares	$ 8.73
Gross proceeds	$ 18,796
Commissions earned by Cantor	0
Commissions earned by Cantor	$ 18,796

Restructuring (Details) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended	12 Months Ended
Restructuring (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019	Dec. 31, 2019	Dec. 31, 2018
Restructuring Cost and Reserve [Line Items]
Restructuring and other charges		$ 8,800	$ 1,374	$ 0
Inventory write-down related to restructuring		7,400	7,408	0
Severance costs		1,400
Restructuring costs		882	0	0
Restructuring Reserve [Roll Forward]
Restructuring costs, beginning balance			0
Amount charged to operating expenses			1,374
Cash payments			(492)
Restructuring costs, ending balance		$ 882	$ 882	$ 0
Scenario, Forecast
Restructuring Cost and Reserve [Line Items]
Severance costs	$ 800

Basic and Diluted Net Loss per Share - Additional Information (Detail) - shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Earnings Per Share [Abstract]
Adjustment to weighted average	0	0

Basic and Diluted Net Loss per Share - Summary of Potential Common Shares (Detail) - shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities	4,346,057	2,245,096
Stock Options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Options outstanding (in shares)	1,830,958	1,529,964
Warrants Not Settleable in Cash
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Number of warrants outstanding (in shares)			1,012,513
Warrants Not Settleable in Cash \| Stock Warrants
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Number of warrants outstanding (in shares)	2,071,172	333,034
Nonvested Restricted Stock Units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Number of warrants outstanding (in shares)		382,098	338,055
Nonvested Restricted Stock Units \| Nonvested Restricted Stock Units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Number of warrants outstanding (in shares)	443,927

Related Person Transactions - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Sofar
Related Party Transaction [Line Items]
Expenses for administrative services	$ 26	$ 0
1Med S.A \| Service Supply Agreement
Related Party Transaction [Line Items]
Expenses incurred under related party transactions	12	71,000
Synecor, LLC
Related Party Transaction [Line Items]
Payments to acquire	$ 0	$ 24

Commitments and Contingencies - Additional Information (Detail) € in Millions							12 Months Ended
	Dec. 30, 2016 shares	Dec. 30, 2016 EUR (€)	May 12, 2016	Sep. 21, 2015 shares	Jun. 12, 2014	Nov. 02, 2009	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)	Jan. 08, 2018	Dec. 31, 2017 USD ($)	Oct. 25, 2013
Operating Leased Assets [Line Items]
Fair value of contingent consideration							$ 1,084,000	$ 10,637,000
Liability or related charge recorded for legal contingencies							0
Operating leases, rent expense								1,200,000
Corporate offices
Operating Leased Assets [Line Items]
Operating lease, lease not yet commenced						5 years
Operating lease, renew option period					3 years
Operating lease, lease not yet commenced, term of contract									18 months
Operating lease agreement period						5 years
Warehouse
Operating Leased Assets [Line Items]
Operating lease additional renewed period											6 years
Operating leases, rent expense							1,400,000	1,200,000
Senhance Surgical Robotic System Acquisition
Operating Leased Assets [Line Items]
Fair value of contingent consideration							10,600,000
Common shares issued \| shares				1,195,647
Senhance Surgical Robotic System Acquisition \| License and Supply Agreements
Operating Leased Assets [Line Items]
Commitments under agreements, in 2020							5,500,000
Commitments under agreements, in 2021							600,000
Commitments under agreements, in 2022							600,000
Commitments under agreements, in 2023							600,000
Commitments under agreements, in 2024							600,000
Commitments until termination in 2027							1,100,000
Senhance Surgical Robotic System Acquisition \| Second Tranche
Operating Leased Assets [Line Items]
Fair value of contingent consideration \| €		€ 5.0
Common shares issued \| shares	286,360
Contingent consideration related to acquisition \| €		€ 5.0
TransEnterix Italia \| Research and Development and Demonstration Facilities
Operating Leased Assets [Line Items]
Operating lease agreement period			6 years
Level 3
Operating Leased Assets [Line Items]
Fair value of contingent consideration							1,084,000	10,637,000
Contingent Consideration
Operating Leased Assets [Line Items]
Fair value, contingent consideration							$ 1,084,000	$ 10,637,000		$ 12,418,000

Subsequent Events (Details) - USD ($)					1 Months Ended	3 Months Ended	12 Months Ended
Subsequent Events (Details) - USD ($)	Mar. 10, 2020	Feb. 24, 2020	Feb. 10, 2020	Apr. 28, 2017	Mar. 31, 2020	Dec. 31, 2019	Dec. 31, 2019	Feb. 25, 2020	Dec. 11, 2019	Dec. 10, 2019	Dec. 31, 2018	Dec. 06, 2013	Mar. 22, 2013
Subsequent Event [Line Items]
Warrants outstanding													92,277
Common stock, shares outstanding (in shares)						20,691,301	20,691,301		20,200,000	261,900,000	16,641,999
Offering price (in dollars per share)				$ 1.00
Preferred stock, par value (in dollars per share)												$ 0.01
Net proceeds from public offering				$ 23,200,000
Severance costs						$ 1,400,000
Subsequent Event
Subsequent Event [Line Items]
Warrants outstanding		3,638,780
Preferred stock, par value (in dollars per share)	$ 0.01
Net proceeds from public offering	$ 13,400,000
Minimum
Subsequent Event [Line Items]
Percentage of warrants exercisability							4.99%
Outstanding voting stock acquisition							50.00%
Series C Warrants \| Subsequent Event
Subsequent Event [Line Items]
Stock issued, shares	3,308,823
Series D Warrants \| Subsequent Event
Subsequent Event [Line Items]
Stock issued, shares	3,308,823
Common Class A \| Subsequent Event
Subsequent Event [Line Items]
Stock issued, shares	14,121,766
Offering price (in dollars per share)	$ 0.68
Common Class B \| Subsequent Event
Subsequent Event [Line Items]
Stock issued, shares	7,937,057
Offering price (in dollars per share)	$ 0.68
Exchange Agreement \| Subsequent Event
Subsequent Event [Line Items]
Warrants outstanding		3,373,900
Common stock warrants issued		2,040,757
Warrants to purchase common shares		160,226
Exchange Agreement \| Series B Warrant \| Subsequent Event
Subsequent Event [Line Items]
Warrants outstanding								264,880
Purchase Agreement \| Subsequent Event
Subsequent Event [Line Items]
Sale of common stock in an at- the-market offering			$ 25,000,000
Stock issued, shares			343,171
Scenario, Forecast
Subsequent Event [Line Items]
Severance costs					$ 800,000
Common Stock \| Series B Warrant
Subsequent Event [Line Items]
Number of common stock or warrants in each unit				0.058
Common Stock \| Series B Warrant \| Subsequent Event
Subsequent Event [Line Items]
Common stock, shares outstanding (in shares)	292,178
Common Stock \| Exchange Agreement \| Series B Warrant \| Subsequent Event
Subsequent Event [Line Items]
Number of common stock or warrants in each unit		0.61

Subsequent Events - At-The-Market Offering Information (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 16, 2020	Dec. 31, 2019
Subsequent Event [Line Items]
Total shares of common stock sold (in shares)		3,528,532
Average Price Per Share (in dollars per share)		$ 7.37
Gross proceeds		$ 25,989
Commissions earned by Cantor		212
Net Proceeds		$ 25,777
Subsequent Event
Subsequent Event [Line Items]
Total shares of common stock sold (in shares)	6,688,000
Average Price Per Share (in dollars per share)	$ 1.73
Gross proceeds	$ 11,558
Commissions earned by Cantor	347
Net Proceeds	$ 11,211