0001437749-23-013965 | 10-Q | XBRL Viewer

Organization, Consolidation, Basis of Presentation, Business Description and Accounting Policies [Text Block]

1.	Description of the Business

Asensus Surgical, Inc. (formerly known as TransEnterix, Inc.) (the "Company") is a medical device company that is digitizing the interface between the surgeon and the patient to pioneer a new era of what we are calling “Performance-Guided Surgery™” by unlocking clinical intelligence for surgeons to enable consistently superior outcomes and a new standard of surgery. Based upon the foundations of digital laparoscopy and the Senhance® Surgical System, the Company is developing the LUNA™ Surgical System, a next generation robotic and instrument system as a foundation of its digital surgery solution. These systems will be powered by the Intelligent Surgical Unit™(ISU™) to increase surgeon control and reduce surgical variability. With the addition of machine vision, augmented intelligence, and deep learning capabilities throughout the surgical experience, we intend to holistically address the current clinical, cognitive and economic shortcomings that drive surgical outcomes and value-based healthcare. The Company continues market development for and commercialization of the Senhance System, which digitizes laparoscopic minimally invasive surgery, or MIS. The Senhance System is the first and only digital, multi-port laparoscopic platform designed to maintain laparoscopic MIS standards while providing digital benefits such as haptic feedback, robotic precision, comfortable ergonomics, advanced instrumentation including 3mm microlaparoscopic instruments, 5mm articulating instruments, eye-sensing camera control and fully-reusable standard instruments to help maintain per-procedure costs similar to traditional laparoscopy.

Note 2 - Summary of Significant Accounting Policies

3 Months Ended

Mar. 31, 2023

Significant Accounting Policies [Text Block]

2.	Summary of Significant Accounting Policies

Basis of Presentation

The accompanying unaudited interim condensed 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. All inter-company accounts and transactions have been eliminated in consolidation. The results reported in these unaudited interim condensed consolidated financial statements should not be regarded as necessarily indicative of results that may be expected for any subsequent period or for the entire year. These unaudited condensed consolidated financial statements and notes thereto should be read in conjunction with the Company’s audited consolidated financial statements and the notes thereto included in the Fiscal 2022 Form 10-K. Certain information and footnote disclosures normally included in the annual consolidated financial statements prepared in accordance with U.S. GAAP have been condensed or omitted in the accompanying interim condensed consolidated financial statements. In the opinion of the Company’s management, the accompanying unaudited condensed consolidated financial statements contain all adjustments, consisting only of normal recurring adjustments, except as otherwise indicated, necessary for a fair statement of its financial position, results of operations, and cash flows of the Company for all periods presented.

Going Concern

The Company's condensed 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 $883.2 million and working capital of $60.7 million as of March 31, 2023. 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.

The Company will need to obtain additional financing to proceed with its business plan. Management's plan to obtain additional resources for the Company may include additional sales of equity, traditional financing, such as loans, entry into strategic collaborations, entry into an out-licensing arrangement or provision of additional distribution rights in some or all of our markets. 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.

Principles of Consolidation

The accompanying condensed consolidated financial statements include the accounts of the Company and its direct and indirect wholly owned subsidiaries, Asensus Surgical US, Inc., Asensus International, Inc., Asensus Surgical Italia S.r.l., Asensus Surgical Europe S.àr.l., Asensus Surgical Taiwan Ltd., Asensus Surgical Japan K.K., Asensus Surgical Israel Ltd., Asensus Surgical Netherlands B.V., and Asensus Surgical Canada, Inc. All inter-company accounts and transactions have been eliminated in consolidation.

Risk and Uncertainties

The Company is subject to risks similar to other similarly sized companies in the medical device industry. These risks include, without limitation: the historical lack of profitability; the Company’s ability to raise additional capital; its ability to successfully develop, clinically test and commercialize its products and products in development; negative impacts on the Company's operations caused by the COVID-19 pandemic and other geopolitical factors; the success of its market development efforts; the timing and outcome of the regulatory review process for its products; changes in the healthcare 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 company; competition in the market for robotic surgical devices; and its ability to identify and pursue development of additional products.

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 impairment considerations for long-lived assets, fair value estimates related to contingent consideration, stock compensation expense, revenue recognition, short-term and long-term investments, excess and obsolete inventory reserves, inventory classification between current and non-current, measurement of lease liabilities and corresponding right-of-use (“ROU”) assets, and deferred tax asset valuation allowances.

Significant Accounting Policies

There have been no new or material changes to the significant accounting policies discussed in the Company’s audited financial statements and the notes thereto included in the Fiscal 2022 Form 10-K.

Impact of Recently Issued Accounting Standards

The Company has evaluated issued ASUs not yet adopted and believes the adoption of these standards will not have a material impact on its consolidated financial statements.

Note 3 - Revenue Recognition

3 Months Ended

Mar. 31, 2023

Revenue from Contract with Customer [Text Block]

3.	Revenue Recognition

The following table presents revenue disaggregated by type and geography:

	Three Months Ended March 31,
	2023		2022
	(in thousands)
U.S.
Systems	$	-	$	-
Instruments and accessories		60		64
Services		75		74
Leases		71		113
Total U.S. revenue		206		251

Outside of U.S. ("OUS")
Systems		-		-
Instruments and accessories		233		283
Services		120		234
Leases		417		298
Total OUS revenue		770		815

Total
Systems		-		-
Instruments and accessories		293		347
Services		195		308
Leases		488		411
Total revenue	$	976	$	1,066

Remaining Performance Obligations

The 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. The transaction price allocated to remaining performance obligations as of March 31, 2023 was $0.9 million, which is expected to be recognized over one to four years.

Contract Assets and Liabilities

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 for the three months ended March 31, 2023 and 2022 that was included in the deferred revenue balance at the beginning of each reporting period was $0.2 million and $0.2 million, respectively.

The following information summarizes the Company’s contract assets and liabilities:

	As of
	March 31, 2023		December 31, 2022
	(in thousands)
Contract Assets	$	81	$	116
Deferred Revenue	$	456	$	465

Senhance System Leasing

The Company enters into lease arrangements with certain qualified customers. Revenue related to arrangements including lease elements are allocated to lease and non-lease elements based on their relative standalone selling prices. Lease elements generally include a Senhance System, while non-lease elements generally include instruments, accessories, and services. For some lease arrangements, the customers are provided with the right to purchase the leased Senhance System at some point during and/or at the end of the lease term. In some arrangements lease payments are based on the usage of the Senhance System. For the three months ended March 31, 2023, and 2022, variable lease revenue related to usage-based arrangements was not material.

Accounts Receivable

Accounts receivable are recorded at net realizable value, which includes an allowance for expected credit losses. The allowance for expected credit losses is based on the Company’s assessment of the collectability of customer accounts. The Company regularly reviews the allowance by considering factors such as historical experience, credit quality, the age of the accounts receivable balances, and current economic conditions that may affect a customer’s ability to pay. The allowance for expected credit losses was $1.6 million and $1.6 million as of March 31, 2023 and December 31, 2022, respectively. The Company recorded immaterial amounts for expected credit losses during the three months ended March 31, 2023 and 2022, respectively.

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

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Note 4 - Fair Value

3 Months Ended

Mar. 31, 2023

Fair Value Disclosures [Text Block]

4.	Fair Value

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

	March 31, 2023
	(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⁽¹⁾	$	18,737	$	-	$	-	$	18,737
Restricted cash		1,142		-		-		1,142
Short-term investments		-		37,697		-		37,697
Long-term investments		-		958		-		958
Total assets measured at fair value	$	19,879	$	38,655	$	-	$	58,534
Liabilities measured at fair value
Contingent consideration	$	-	$	-	$	1,361	$	1,361
Total liabilities measured at fair value	$	-	$	-	$	1,361	$	1,361

⁽¹⁾Includes investments that are readily convertible to cash with original maturities of 90 days or less.

	December 31, 2022
	(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⁽¹⁾	$	6,329	$	-	$	-	$	6,329
Restricted cash		1,141		-		-		1,141
Short-term investments		-		64,195		-		64,195
Long-term investments		-		3,865		-		3,865
Total assets measured at fair value	$	7,470	$	68,060	$	-	$	75,530
Liabilities measured at fair value
Contingent consideration	$	-	$	-	$	1,256	$	1,256
Total liabilities measured at fair value	$	-	$	-	$	1,256	$	1,256

⁽¹⁾Includes investments that are readily convertible to cash with original maturities of 90 days or less.

The carrying values of accounts receivable, prepaid expenses, employee retention tax credit receivables, other current assets, accounts payable, accrued employee compensation and benefits, accrued expenses and other current liabilities, and deferred revenue as of March 31, 2023, and December 31, 2022, approximate their fair values due to the short-term nature of these items.

The Company’s financial liabilities consisted of contingent consideration payable to Three Heads Investment S.r.l., related to the Company’s 2015 acquisition of the Senhance System from an assignor to Three Heads Investment S.r.l. (the “Senhance Acquisition”). Adjustments associated with the change in fair value of contingent consideration are included in the Company’s condensed consolidated statements of operations and comprehensive loss.

The following table presents quantitative information about the inputs and valuation methodologies used for the Company’s fair value measurements for contingent consideration utilizing a Monte-Carlo simulation as of March 31, 2023 and December 31, 2022:

	Valuation Methodology	Significant Unobservable Input	March 31, 2023		December 31, 2022

Contingent consideration	Probability weighted income approach	Milestone dates	2032		2032
		Discount rate		16.0%		16.5%
		Revenue volatility		40.0%		45.0%
		EUR-to-USD exchange rate		1.09		1.07

The following table presents the current and long-term portion of the contingent consideration for the three months ended March 31, 2023 and summarizes the change in fair value, as determined by Level 3 inputs for the contingent consideration for the three months ended March 31, 2023 and 2022:

	Fair Value Measurement at Reporting Date (Level 3)
	(in thousands)
	Contingent consideration
Balance at December 31, 2021	$	2,371
Change in fair value		(154	)
Balance at March 31, 2022	$	2,217

Balance at December 31, 2022	$	1,256
Change in fair value		105
Balance at March 31, 2023	$	1,361

Current portion	$	-
Long-term portion		1,361
Balance at March 31, 2023	$	1,361

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

Note 5 - Investments, Available-for-sale

3 Months Ended

Mar. 31, 2023

Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block]

5.	Investments, available-for-sale

The aggregate fair values of investment securities along with cumulative unrealized gains and losses determined on an individual investment security basis and included in other comprehensive loss are as follows:

	March 31, 2023
	(in thousands)

	Amortized Cost		Unrealized Gain		Unrealized Loss			Fair Value		Short-term investments		Long-term investments
Commercial Paper	$	5,442	$	-	$	(16	)	$	5,426	$	5,426	$	-
Corporate Bonds		29,459		2		(178	)		29,283		28,325		958
U.S. Treasuries		2,953		-		(1	)		2,952		2,952		-
U.S. Government Agencies		999		-		(5	)		994		994		-
Total Investments	$	38,853	$	2	$	(200	)	$	38,655	$	37,697	$	958

	December 31, 2022
	(in thousands)

	Amortized Cost		Unrealized Gain		Unrealized Loss			Fair Value		Short-term investments		Long-term investments
Commercial Paper	$	12,364	$	-	$	(49	)	$	12,315	$	12,315	$	-
Corporate Bonds		55,201		-		(447	)		54,754		50,889		3,865
U.S. Government Agencies		999		-		(8	)		991		991		-
Total Investments	$	68,564	$	-	$	(504	)	$	68,060	$	64,195	$	3,865

The following table summarizes the contractual maturities of the Company’s available-for-sale investments:

	March 31, 2023
	(in thousands)
	Amortized Cost		Fair Value
Mature in less than one year	$	37,897	$	37,697
Mature in one to two years		956		958
Total	$	38,853	$	38,655

Actual maturities may differ from contractual maturities because certain borrowers have the right to call or prepay certain obligations. There were no sales of investments or gross realized gains or losses for the three months ended March 31, 2023 or 2022.

Note 6 - Inventories

3 Months Ended

Mar. 31, 2023

Inventory Disclosure [Text Block]

6.	Inventories

The components of inventories are as follows:

	March 31, 2023
	(in thousands)

	Gross Carrying Amount		Reserve Balance			Net Carrying Amount
Finished goods	$	16,101	$	(4,175	)	$	11,926
Raw materials		4,617		(2,501	)		2,116
Total inventories	$	20,718	$	(6,676	)	$	14,042

Current Portion	$	10,013	$	(1,169	)	$	8,844
Long-term portion		10,705		(5,507	)		5,198
Total inventories	$	20,718	$	(6,676	)	$	14,042

	December 31, 2022
	(in thousands)

	Gross Carrying Amount		Reserve Balance			Net Carrying Amount
Finished goods	$	15,337	$	(4,129	)	$	11,208
Raw materials		4,718		(2,173	)		2,545
Total inventories	$	20,055	$	(6,302	)	$	13,753

Current Portion	$	9,399	$	(1,115	)	$	8,284
Long-term portion		10,656		(5,187	)		5,469
Total inventories	$	20,055	$	(6,302	)	$	13,753

Note 7 - Intellectual Property

3 Months Ended

Mar. 31, 2023

Intangible Assets Disclosure [Text Block]

7.	Intellectual Property

The components of gross intellectual property, accumulated amortization, and net intellectual property are as follows:

	March 31, 2023
	(in thousands)
	Gross Carrying Amount		Accumulated Amortization			Foreign Currency Translation Impact			Net Carrying Amount
Developed technology	$	68,838	$	(66,646	)	$	(853	)	$	1,339
Technology and patents purchased		400		(248	)		15			167
Total intellectual property	$	69,238	$	(66,894	)	$	(838	)	$	1,506

	December 31, 2022
	(in thousands)
	Gross Carrying Amount		Accumulated Amortization			Foreign Currency Translation Impact			Net Carrying Amount
Developed technology	$	68,838	$	(66,562	)	$	(874	)	$	1,402
Technology and patents purchased		400		(239	)		13			174
Total intellectual property	$	69,238	$	(66,801	)	$	(861	)	$	1,576

The weighted average remaining useful life of the developed technology and technology and patents purchased was 3.9 years and 4.1 years, respectively, as of March 31, 2023. The weighted average remaining useful life of the developed technology and technology and patents purchased was 4.2 years and 4.3 years, respectively as of December 31, 2022.

Note 8 - Leases

3 Months Ended

Mar. 31, 2023

Lessee, Operating Leases [Text Block]

8.	Leases

Lessee Information

Components of operating lease expense are primarily recorded in general and administrative on the condensed consolidated statements of operations and comprehensive loss were as follows:

	Three Months Ended March 31,
	2023		2022
	(in thousands)
Long-term Operating	$	451	$	398
Short-term Operating		-		-
Total Operating lease expense	$	451	$	398

Supplemental balance sheet information related to operating leases was as follows:

	March 31, 2023			December 31, 2022
Weighted-average remaining lease term (in years)		6.7			6.8
Weighted-average discount rate		8.4%			8.4%
Incremental borrowing rate	7.07%	-	14.5%	6.1%	-	14.5%

Maturities of operating lease obligations as of March 31, 2023 were as follows (in thousands):

Fiscal Year
2023	$	897
2024		1,142
2025		1,061
2026		847
2027		780
Thereafter		2,199
Total minimum lease payments	$	6,926
Less: Amount of lease payments representing interest		(1,583	)
Present value of future minimum lease payments	$	5,343

Note 9 - Income Taxes

3 Months Ended

Mar. 31, 2023

Income Tax Disclosure [Text Block]

9.	Income Taxes

Income taxes have been accounted for using the asset and liability method in accordance with ASC 740 “Income Taxes”. The Company computes its interim provision for income taxes by applying the estimated annual effective tax rate method. The Company estimates an annual effective tax rate of (0.4)% for the year ending December 31, 2023. This rate does not include the impact of any discrete items. The Company’s effective tax rate for the three months ended March 31, 2023 and 2022 was (0.4)% and (0.4)%, respectively.

The Company incurred losses for the three months ended March 31, 2023, and is forecasting additional losses through the year, resulting in an estimated net loss for both financial statement and tax purposes for the year ending December 31, 2023. Due to the Company’s history of losses, there is not sufficient evidence to record a net deferred tax asset associated with the U.S., Luxembourg, Swiss, Italian, Taiwanese, and Canadian operations. Accordingly, a full valuation allowance has been recorded related to the net deferred tax assets in those jurisdictions.

The total tax expense during the three months ended March 31, 2023 and 2022, was approximately $0.09 million and $0.08 million, respectively.

At March 31, 2023 the Company had no unrecognized tax benefits that would affect the Company’s effective tax rate.

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. The Company does not expect a GILTI inclusion for 2023; no GILTI tax has been recorded for the three months ended March 31, 2023 or 2022, respectively.

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482603/740-30-50-2

Note 10 - Stock-based Compensation

3 Months Ended

Mar. 31, 2023

Share-Based Payment Arrangement [Text Block]

10.

Stock-Based Compensation

Stock Options

The following table summarizes the Company’s stock option activity, including grants to non-employees, for the three months ended March 31, 2023:

	Number of Shares			Weighted- Average Exercise Price		Weighted-Average Remaining Contractual Term (Years)
Balance at December 31, 2022		7,584,967		$	4.22		5.31
Granted		2,748,415			0.73
Forfeited		-			-
Cancelled		(913	)		4.21
Exercised		(13,300	)		0.38
Balance at March 31, 2023		10,319,169		$	3.30		5.54

The following table summarizes information about stock options outstanding at March 31, 2023:

Number of

Shares

Weighted-

Average Exercise

Price

Weighted-Average

Remaining

Contractual Term

(Years)

Aggregate

Intrinsic Value

(Millions)

Exercisable at March 31, 2023

4,843,264

5.96

4.80

0.4

Vested or expected to vest at March 31, 2023

9,645,630

3.47

5.47

0.6

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

	Three Months Ended March 31,
	2023			2022
Expected dividend yield		0%			0%
Expected volatility	124%	-	126%	131%	-	133%
Risk-free interest rate	3.73%	-	4.14%	1.25%	-	1.94%
Expected life (in years)	4.3	-	4.5	4.3	-	4.5

Restricted Stock Units

The following is a summary of the restricted stock units activity, including performance restricted stock units, for the three months ended March 31, 2023:

	Number of Restricted Stock Units Outstanding			Weighted- Average Grant Date Fair Value
Unvested December 31, 2022		8,483,491		$	1.04
Granted		7,340,630			0.73
Vested		(3,082,354	)		1.18
Forfeited		(84,673	)		1.13
Unvested March 31, 2023		12,657,094		$	0.83

Performance Restricted Stock Units

In 2023 and 2022, the Company granted performance-based restricted stock units with vesting terms based on our attainment of certain operational targets by December 31, 2023 and October 1, 2023, respectively. The number of shares earnable under the 2023 and 2022 awards are based on achieving designated corporate goals. These operational targets have been achieved for the awards granted in 2022, therefore the 2022 performance-based restricted stock units are fully earned and remain subject to three-year time-based vesting requirements. The Company has not yet achieved the operational targets required for the awards granted in 2023.

Stock-based Compensation Expense

The following table summarizes non-cash stock-based compensation expense by award type for the three months ended March 31, 2023 and 2022:

	Three Months Ended March 31,
	2023		2022
	(in thousands)
Stock options	$	665	$	978
Restricted stock units		859		883
Performance restricted stock units		392		384
	$	1,916	$	2,245

As of March 31, 2023, the Company had future employee stock-based compensation expense of approximately $2.9 million related to unvested stock options, which is expected to be recognized over an estimated weighted-average period of approximately 2.0 years. As of March 31, 2023, the unrecognized stock-based compensation expense related to unvested restricted stock units and performance restricted stock units was approximately $7.4 million, which is expected to be recognized over a weighted average period of approximately 1.9 years.

Note 11 - Equity Offerings

3 Months Ended

Mar. 31, 2023

Equity [Text Block]

11.

Equity Offerings

2022 ATM Offering. On March 18, 2022, the Company entered a Controlled Equity Offering Sales Agreement (the “2022 Sales Agreement”), with Cantor Fitzgerald & Co., and Oppenheimer & Co. Inc. The Company commenced an at-the-market offering (the “2022 ATM Offering”) pursuant to which the Company could sell from time to time, at its option, up to an aggregate of $100.0 million shares of the Company’s common stock. No sales of common stock were made under the 2022 ATM Offering during the three months ended March 31, 2023 and 2022, respectively.

The entire disclosure for equity.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
-Paragraph 13
-Subparagraph (b)
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147481004/946-505-50-6

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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-SubTopic 40
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480237/815-40-50-6

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.3-04)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480008/505-10-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
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-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(e)(1))
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-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
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-URI https://asc.fasb.org//505/tableOfContent

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147481112/505-10-50-13

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147481112/505-10-50-14

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
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-Section 50
-Paragraph 14
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-14

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 16
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-16

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-18

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-18

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Topic 505
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 18
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481112/505-10-50-18

Note 12 - Basic and Diluted Net Loss Per Share

3 Months Ended

Mar. 31, 2023

Earnings Per Share [Text Block]

12.

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 potential dilutive common shares that were outstanding during the period when the effect is dilutive. Potential dilutive common shares consist of incremental shares issuable upon exercise of stock options, restricted stock units, and warrants. No adjustments have been made to the weighted average outstanding common shares figures for the three months ended March 31, 2023 or 2022 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:

	March 31,
	2023		2022
Stock options		10,319,169		6,766,520
Stock warrants		1,021,076		1,120,300
Nonvested restricted stock units		12,657,094		7,299,111
Total		23,997,339		15,185,931

Note 13 - Commitments and Contingencies

3 Months Ended

Mar. 31, 2023

Commitments and Contingencies Disclosure [Text Block]

13.

Commitments and Contingencies

License and Supply Agreements

The Company has purchase orders with various suppliers for certain tooling, supplies, contract engineering and research services. Commitments related to these agreements and purchase orders are as follows (in thousands):

Fiscal Year
2023	$	8,058
2024		439
2025		315
2026		303
Total commitments	$	9,115

Note 14 - Segments and Geographic Areas

3 Months Ended

Mar. 31, 2023

Segment Reporting Disclosure [Text Block]

14.

Segments and Geographic Areas

The Company operates in one business segment—the research, development and sale of medical devices 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.

The following table presents consolidated assets and long-lived assets by geographic area, which includes property and equipment, intellectual property, and operating lease assets:

	March 31, 2023
	Long-Lived Assets			Total Assets
U.S.		36	%		71	%

EMEA
Switzerland		45	%		24	%
Italy		8	%		2	%
Other		8	%		2	%
Total EMEA		61	%		28	%

Asia		3	%		1	%
Total		100	%		100	%

	December 31, 2022
	Long-Lived Assets			Total Assets
U.S.		35	%		72	%

EMEA
Switzerland		46	%		24	%
Italy		8	%		2	%
Other		8	%		1	%
Total EMEA		62	%		27	%

Asia		3	%		1	%
Total		100	%		100	%

The following table presents sales by geographic area based on the country in which the customer is based.

	Three Months Ended March 31,
	2023			2022

US		21	%		24	%
EMEA		58	%		48	%
Asia		21	%		28	%
Total		100	%		100	%

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
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-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147482810/280-10-50-15

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147482810/280-10-50-31

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147482810/280-10-50-42

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-40

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//280/tableOfContent

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 26
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-26

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-34

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-URI https://asc.fasb.org//1943274/2147482810/280-10-50-41

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
-Paragraph 21
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-21

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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-Paragraph 21
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-21

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Note 15 - Related Party Transactions

3 Months Ended

Mar. 31, 2023

15.

Related Party Transactions

In March 2018, Asensus Surgical Europe S.àr.l 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 $19,000 and $73,000 for the three months ended March 31, 2023 and 2022, respectively.

The entire disclosure for related party transactions. Examples of related party transactions include transactions between (a) a parent company and its subsidiary; (b) subsidiaries of a common parent; (c) and entity and its principal owners; and (d) affiliates.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-2

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
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-URI https://asc.fasb.org//1943274/2147480990/946-20-50-5

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-6

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481062/946-235-50-2

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483326/850-10-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.6-07(2)(g)(3))
-Publisher FASB
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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-URI https://asc.fasb.org//850/tableOfContent

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-URI https://asc.fasb.org//1943274/2147483326/850-10-50-1

Significant Accounting Policies (Policies)	3 Months Ended
Significant Accounting Policies (Policies)	Mar. 31, 2023
Accounting Policies [Abstract]
Basis of Accounting, Policy [Policy Text Block]	Basis of Presentation The accompanying unaudited interim condensed 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. All inter-company accounts and transactions have been eliminated in consolidation. The results reported in these unaudited interim condensed consolidated financial statements should not be regarded as necessarily indicative of results that may be expected for any subsequent period or for the entire year. These unaudited condensed consolidated financial statements and notes thereto should be read in conjunction with the Company’s audited consolidated financial statements and the notes thereto included in the Fiscal 2022 Form 10-K. Certain information and footnote disclosures normally included in the annual consolidated financial statements prepared in accordance with U.S. GAAP have been condensed or omitted in the accompanying interim condensed consolidated financial statements. In the opinion of the Company’s management, the accompanying unaudited condensed consolidated financial statements contain all adjustments, consisting only of normal recurring adjustments, except as otherwise indicated, necessary for a fair statement of its financial position, results of operations, and cash flows of the Company for all periods presented.
Substantial Doubt about Going Concern [Policy Text Block]	Going Concern The Company's condensed 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 $883.2 million and working capital of $60.7 million as of March 31, 2023. 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. The Company will need to obtain additional financing to proceed with its business plan. Management's plan to obtain additional resources for the Company may include additional sales of equity, traditional financing, such as loans, entry into strategic collaborations, entry into an out-licensing arrangement or provision of additional distribution rights in some or all of our markets. 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.
Consolidation, Policy [Policy Text Block]	Principles of Consolidation The accompanying condensed consolidated financial statements include the accounts of the Company and its direct and indirect wholly owned subsidiaries, Asensus Surgical US, Inc., Asensus International, Inc., Asensus Surgical Italia S.r.l., Asensus Surgical Europe S.àr.l., Asensus Surgical Taiwan Ltd., Asensus Surgical Japan K.K., Asensus Surgical Israel Ltd., Asensus Surgical Netherlands B.V., and Asensus Surgical Canada, Inc. All inter-company accounts and transactions have been eliminated in consolidation.
Risk And Uncertainties, Policy [Policy Text Block]	Risk and Uncertainties The Company is subject to risks similar to other similarly sized companies in the medical device industry. These risks include, without limitation: the historical lack of profitability; the Company’s ability to raise additional capital; its ability to successfully develop, clinically test and commercialize its products and products in development; negative impacts on the Company's operations caused by the COVID-19 pandemic and other geopolitical factors; the success of its market development efforts; the timing and outcome of the regulatory review process for its products; changes in the healthcare 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 company; competition in the market for robotic surgical devices; and its ability to identify and pursue development of additional products.
Use of Estimates, Policy [Policy Text Block]	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 impairment considerations for long-lived assets, fair value estimates related to contingent consideration, stock compensation expense, revenue recognition, short-term and long-term investments, excess and obsolete inventory reserves, inventory classification between current and non-current, measurement of lease liabilities and corresponding right-of-use (“ROU”) assets, and deferred tax asset valuation allowances.
Significant Accounting Policies [Policy Text Block]	Significant Accounting Policies There have been no new or material changes to the significant accounting policies discussed in the Company’s audited financial statements and the notes thereto included in the Fiscal 2022 Form 10-K.
New Accounting Pronouncements, Policy [Policy Text Block]	Impact of Recently Issued Accounting Standards The Company has evaluated issued ASUs not yet adopted and believes the adoption of these standards will not have a material impact on its consolidated financial statements.

Note 3 - Revenue Recognition (Tables)

3 Months Ended

Mar. 31, 2023

Disaggregation of Revenue [Table Text Block]

	Three Months Ended March 31,
	2023		2022
	(in thousands)
U.S.
Systems	$	-	$	-
Instruments and accessories		60		64
Services		75		74
Leases		71		113
Total U.S. revenue		206		251

Outside of U.S. ("OUS")
Systems		-		-
Instruments and accessories		233		283
Services		120		234
Leases		417		298
Total OUS revenue		770		815

Total
Systems		-		-
Instruments and accessories		293		347
Services		195		308
Leases		488		411
Total revenue	$	976	$	1,066

Contract with Customer, Contract Asset, Contract Liability, and Receivable [Table Text Block]

	As of
	March 31, 2023		December 31, 2022
	(in thousands)
Contract Assets	$	81	$	116
Deferred Revenue	$	456	$	465

Note 4 - Fair Value (Tables)

3 Months Ended

Mar. 31, 2023

Fair Value, Assets Measured on Recurring Basis [Table Text Block]

	March 31, 2023
	(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⁽¹⁾	$	18,737	$	-	$	-	$	18,737
Restricted cash		1,142		-		-		1,142
Short-term investments		-		37,697		-		37,697
Long-term investments		-		958		-		958
Total assets measured at fair value	$	19,879	$	38,655	$	-	$	58,534
Liabilities measured at fair value
Contingent consideration	$	-	$	-	$	1,361	$	1,361
Total liabilities measured at fair value	$	-	$	-	$	1,361	$	1,361

	December 31, 2022
	(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⁽¹⁾	$	6,329	$	-	$	-	$	6,329
Restricted cash		1,141		-		-		1,141
Short-term investments		-		64,195		-		64,195
Long-term investments		-		3,865		-		3,865
Total assets measured at fair value	$	7,470	$	68,060	$	-	$	75,530
Liabilities measured at fair value
Contingent consideration	$	-	$	-	$	1,256	$	1,256
Total liabilities measured at fair value	$	-	$	-	$	1,256	$	1,256

Fair Value Measurement Inputs and Valuation Techniques [Table Text Block]

	Valuation Methodology	Significant Unobservable Input	March 31, 2023		December 31, 2022

Contingent consideration	Probability weighted income approach	Milestone dates	2032		2032
		Discount rate		16.0%		16.5%
		Revenue volatility		40.0%		45.0%
		EUR-to-USD exchange rate		1.09		1.07

Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Table Text Block]

	Fair Value Measurement at Reporting Date (Level 3)
	(in thousands)
	Contingent consideration
Balance at December 31, 2021	$	2,371
Change in fair value		(154	)
Balance at March 31, 2022	$	2,217

Balance at December 31, 2022	$	1,256
Change in fair value		105
Balance at March 31, 2023	$	1,361

Current portion	$	-
Long-term portion		1,361
Balance at March 31, 2023	$	1,361

Note 5 - Investments, Available-for-sale (Tables)

3 Months Ended

Mar. 31, 2023

Debt Securities, Available-for-Sale [Table Text Block]

	March 31, 2023
	(in thousands)

	Amortized Cost		Unrealized Gain		Unrealized Loss			Fair Value		Short-term investments		Long-term investments
Commercial Paper	$	5,442	$	-	$	(16	)	$	5,426	$	5,426	$	-
Corporate Bonds		29,459		2		(178	)		29,283		28,325		958
U.S. Treasuries		2,953		-		(1	)		2,952		2,952		-
U.S. Government Agencies		999		-		(5	)		994		994		-
Total Investments	$	38,853	$	2	$	(200	)	$	38,655	$	37,697	$	958

	December 31, 2022
	(in thousands)

	Amortized Cost		Unrealized Gain		Unrealized Loss			Fair Value		Short-term investments		Long-term investments
Commercial Paper	$	12,364	$	-	$	(49	)	$	12,315	$	12,315	$	-
Corporate Bonds		55,201		-		(447	)		54,754		50,889		3,865
U.S. Government Agencies		999		-		(8	)		991		991		-
Total Investments	$	68,564	$	-	$	(504	)	$	68,060	$	64,195	$	3,865

Investments Classified by Contractual Maturity Date [Table Text Block]

	March 31, 2023
	(in thousands)
	Amortized Cost		Fair Value
Mature in less than one year	$	37,897	$	37,697
Mature in one to two years		956		958
Total	$	38,853	$	38,655

Tabular disclosure of investment in debt security measured at fair value with change in fair value recognized in other comprehensive income (available-for-sale).

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-9

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (aa)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (aaa)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-2

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (d)
-Publisher FASB
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Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 320
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Note 6 - Inventories (Tables)

3 Months Ended

Mar. 31, 2023

Schedule of Inventory, Current [Table Text Block]

	March 31, 2023
	(in thousands)

	Gross Carrying Amount		Reserve Balance			Net Carrying Amount
Finished goods	$	16,101	$	(4,175	)	$	11,926
Raw materials		4,617		(2,501	)		2,116
Total inventories	$	20,718	$	(6,676	)	$	14,042

Current Portion	$	10,013	$	(1,169	)	$	8,844
Long-term portion		10,705		(5,507	)		5,198
Total inventories	$	20,718	$	(6,676	)	$	14,042

	December 31, 2022
	(in thousands)

	Gross Carrying Amount		Reserve Balance			Net Carrying Amount
Finished goods	$	15,337	$	(4,129	)	$	11,208
Raw materials		4,718		(2,173	)		2,545
Total inventories	$	20,055	$	(6,302	)	$	13,753

Current Portion	$	9,399	$	(1,115	)	$	8,284
Long-term portion		10,656		(5,187	)		5,469
Total inventories	$	20,055	$	(6,302	)	$	13,753

Note 7 - Intellectual Property (Tables)

3 Months Ended

Mar. 31, 2023

Schedule of Finite-Lived Intangible Assets [Table Text Block]

	March 31, 2023
	(in thousands)
	Gross Carrying Amount		Accumulated Amortization			Foreign Currency Translation Impact			Net Carrying Amount
Developed technology	$	68,838	$	(66,646	)	$	(853	)	$	1,339
Technology and patents purchased		400		(248	)		15			167
Total intellectual property	$	69,238	$	(66,894	)	$	(838	)	$	1,506

	December 31, 2022
	(in thousands)
	Gross Carrying Amount		Accumulated Amortization			Foreign Currency Translation Impact			Net Carrying Amount
Developed technology	$	68,838	$	(66,562	)	$	(874	)	$	1,402
Technology and patents purchased		400		(239	)		13			174
Total intellectual property	$	69,238	$	(66,801	)	$	(861	)	$	1,576

Note 8 - Leases (Tables)

3 Months Ended

Mar. 31, 2023

Lease, Cost [Table Text Block]

	Three Months Ended March 31,
	2023		2022
	(in thousands)
Long-term Operating	$	451	$	398
Short-term Operating		-		-
Total Operating lease expense	$	451	$	398

Lessee, Operating Lease, Disclosure [Table Text Block]

	March 31, 2023			December 31, 2022
Weighted-average remaining lease term (in years)		6.7			6.8
Weighted-average discount rate		8.4%			8.4%
Incremental borrowing rate	7.07%	-	14.5%	6.1%	-	14.5%

Lessee, Operating Lease, Liability, to be Paid, Maturity [Table Text Block]

Fiscal Year
2023	$	897
2024		1,142
2025		1,061
2026		847
2027		780
Thereafter		2,199
Total minimum lease payments	$	6,926
Less: Amount of lease payments representing interest		(1,583	)
Present value of future minimum lease payments	$	5,343

Note 10 - Stock-based Compensation (Tables)

3 Months Ended

Mar. 31, 2023

Share-Based Payment Arrangement, Option, Activity [Table Text Block]

	Number of Shares			Weighted- Average Exercise Price		Weighted-Average Remaining Contractual Term (Years)
Balance at December 31, 2022		7,584,967		$	4.22		5.31
Granted		2,748,415			0.73
Forfeited		-			-
Cancelled		(913	)		4.21
Exercised		(13,300	)		0.38
Balance at March 31, 2023		10,319,169		$	3.30		5.54

Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Vested and Expected to Vest, Exercisable [Table Text Block]

Number of

Shares

Weighted-

Average Exercise

Price

Weighted-Average

Remaining

Contractual Term

(Years)

Aggregate

Intrinsic Value

(Millions)

Exercisable at March 31, 2023

4,843,264

5.96

4.80

0.4

Vested or expected to vest at March 31, 2023

9,645,630

3.47

5.47

0.6

Schedule of Share-Based Payment Award, Stock Options, Valuation Assumptions [Table Text Block]

	Three Months Ended March 31,
	2023			2022
Expected dividend yield		0%			0%
Expected volatility	124%	-	126%	131%	-	133%
Risk-free interest rate	3.73%	-	4.14%	1.25%	-	1.94%
Expected life (in years)	4.3	-	4.5	4.3	-	4.5

Share-Based Payment Arrangement, Restricted Stock Unit, Activity [Table Text Block]

	Number of Restricted Stock Units Outstanding			Weighted- Average Grant Date Fair Value
Unvested December 31, 2022		8,483,491		$	1.04
Granted		7,340,630			0.73
Vested		(3,082,354	)		1.18
Forfeited		(84,673	)		1.13
Unvested March 31, 2023		12,657,094		$	0.83

Share-Based Payment Arrangement, Cost by Plan [Table Text Block]

	Three Months Ended March 31,
	2023		2022
	(in thousands)
Stock options	$	665	$	978
Restricted stock units		859		883
Performance restricted stock units		392		384
	$	1,916	$	2,245

Note 12 - Basic and Diluted Net Loss Per Share (Tables)

3 Months Ended

Mar. 31, 2023

Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share [Table Text Block]

	March 31,
	2023		2022
Stock options		10,319,169		6,766,520
Stock warrants		1,021,076		1,120,300
Nonvested restricted stock units		12,657,094		7,299,111
Total		23,997,339		15,185,931

Note 13 - Commitments and Contingencies (Tables)

3 Months Ended

Mar. 31, 2023

Contractual Obligation, Fiscal Year Maturity [Table Text Block]

Fiscal Year
2023	$	8,058
2024		439
2025		315
2026		303
Total commitments	$	9,115

Note 14 - Segments and Geographic Areas (Tables)

3 Months Ended

Mar. 31, 2023

Long-Lived Assets by Geographic Areas [Table Text Block]

	March 31, 2023
	Long-Lived Assets			Total Assets
U.S.		36	%		71	%

EMEA
Switzerland		45	%		24	%
Italy		8	%		2	%
Other		8	%		2	%
Total EMEA		61	%		28	%

Asia		3	%		1	%
Total		100	%		100	%

	December 31, 2022
	Long-Lived Assets			Total Assets
U.S.		35	%		72	%

EMEA
Switzerland		46	%		24	%
Italy		8	%		2	%
Other		8	%		1	%
Total EMEA		62	%		27	%

Asia		3	%		1	%
Total		100	%		100	%

Revenue from External Customers by Geographic Areas [Table Text Block]

	Three Months Ended March 31,
	2023			2022

US		21	%		24	%
EMEA		58	%		48	%
Asia		21	%		28	%
Total		100	%		100	%

Note 2 - Summary of Significant Accounting Policies (Details Textual) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Retained Earnings (Accumulated Deficit)	$ (883,153)	$ (860,935)
Working Capital	$ 60,700

Amount of accumulated undistributed earnings (deficit).

+ References + Details

Note 3 - Revenue Recognition 1 (Details Textual) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Contract with Customer, Liability, Revenue Recognized	$ 0.2	$ 0.2
Accounts Receivable, Allowance for Credit Loss	$ 1.6		$ 1.6

Note 3 - Revenue Recognition 2 (Details Textual) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-04-01 $ in Millions	Mar. 31, 2023 USD ($)
Revenue, Remaining Performance Obligation, Amount	$ 0.9
Minimum [Member]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Period (Year)	1 year
Maximum [Member]
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Period (Year)	4 years

Note 3 - Revenue Recognition - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Revenue	$ 976	$ 1,066
UNITED STATES
Revenue	206	251
Non-US [Member]
Revenue	770	815
Systems [Member]
Revenue	0	0
Systems [Member] \| UNITED STATES
Revenue	0	0
Systems [Member] \| Non-US [Member]
Revenue	0	0
Instruments and Accessories [Member]
Revenue	293	347
Instruments and Accessories [Member] \| UNITED STATES
Revenue	60	64
Instruments and Accessories [Member] \| Non-US [Member]
Revenue	233	283
Service [Member]
Revenue	195	308
Service [Member] \| UNITED STATES
Revenue	75	74
Service [Member] \| Non-US [Member]
Revenue	120	234
Lease [Member]
Revenue	488	411
Lease [Member] \| UNITED STATES
Revenue	71	113
Lease [Member] \| Non-US [Member]
Revenue	$ 417	$ 298

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
-Section S99
-Paragraph 1
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
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Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
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Note 3 - Revenue Recognition - Contract Assets and Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Contract Assets	$ 81	$ 116
Deferred Revenue	$ 456	$ 465

Note 4 - Fair Value - Summary of Assets and Liabilities Measured at Fair Value on Recurring Basis (Details) - USD ($)
$ in Thousands

Mar. 31, 2023

Dec. 31, 2022

^[1]

$ 18,737

$ 6,329

1,142

1,141

37,697

64,195

958

3,865

58,534

75,530

1,361

1,256

Fair Value, Inputs, Level 1 [Member]

1,361

1,256

^[1]

18,737

6,329

1,142

1,141

19,879

7,470

Fair Value, Inputs, Level 2 [Member]

^[1]

37,697

64,195

958

3,865

38,655

68,060

Fair Value, Inputs, Level 3 [Member]

^[1]

1,361

1,256

$ 1,361

$ 1,256

[1]	Includes investments that are readily convertible to cash with original maturities of 90 days or less.

Note 4 - Fair Value - Quantitative Information about Inputs and Valuation Methodologies Used for Fair Value Measurements Classification (Details) - Senhance Surgical Robotic System Acquisition[Member] - Fair Value, Inputs, Level 3 [Member]	Mar. 31, 2023	Dec. 31, 2022
Measurement Input, Discount Rate [Member]
Contingent consideration, measurement input	0.160	0.165
Measurement Input, Price Volatility [Member]
Contingent consideration, measurement input	0.400	0.450
Measurement Input, Currency Exchange Rate [Member]
Contingent consideration, measurement input	1.09	1.07

Note 4 - Fair Value - Summary of Change in Fair Value for Warrants and Contingent Consideration (Details) - Warrant [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Balance	$ 1,256	$ 2,371
Change in fair value	105	(154)
Balance	1,361	$ 2,217
Current portion	0
Long-term portion	$ 1,361

Note 5 - Investments, Available-for-sale (Details Textual) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Proceeds from Sale of Debt Securities, Available-for-Sale	$ 0	$ 0

Note 5 - Investments, Available-for-sale - Summary of Investment Securities (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Amortized Cost	$ 38,853	$ 68,564
Unrealized Gain	2	0
Unrealized Loss	(200)	(504)
Fair Value	38,655	68,060
Short-term investments	37,697	64,195
Long-term investments	958	3,865
Commercial Paper [Member]
Amortized Cost	5,442	12,364
Unrealized Gain	0	0
Unrealized Loss	(16)	(49)
Fair Value	5,426	12,315
Short-term investments	5,426	12,315
Long-term investments	0	0
Corporate Debt Securities [Member]
Amortized Cost	29,459	55,201
Unrealized Gain	2	0
Unrealized Loss	(178)	(447)
Fair Value	29,283	54,754
Short-term investments	28,325	50,889
Long-term investments	958	3,865
US Treasury Securities [Member]
Amortized Cost	2,953
Unrealized Gain	0
Unrealized Loss	(1)
Fair Value	2,952
Short-term investments	2,952
Long-term investments	0
US Government Agencies Debt Securities [Member]
Amortized Cost	999	999
Unrealized Gain	0	0
Unrealized Loss	(5)	(8)
Fair Value	994	991
Short-term investments	994	991
Long-term investments	$ 0	$ 0

Note 5 - Investments, Available-for-sale - Contractual Maturities (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Mature in less than one year, amortized cost	$ 37,897
Mature in less than one year, fair value	37,697
Mature in one to two years, amortized cost	956
Mature in one to two years, fair value	958
Total, amortized cost	38,853	$ 68,564
Total, fair value	$ 38,655	$ 68,060

Note 6 - Inventories - Components of Inventories (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Finished goods, gross	$ 16,101	$ 15,337
Finished goods, reserve	(4,175)	(4,129)
Finished goods, net	11,926	11,208
Raw materials, gross	4,617	4,718
Raw materials, reserve	(2,501)	(2,173)
Raw materials, net	2,116	2,545
Total inventories, gross	20,718	20,055
Total inventories, reserve	(6,676)	(6,302)
Total inventories, net	14,042	13,753
Current Portion, gross	10,013	9,399
Current Portion, reserve	(1,169)	(1,115)
Inventories	8,844	8,284
Long-term portion, gross	10,705	10,656
Long-term portion, reserve	(5,507)	(5,187)
Inventories, net of current portion	$ 5,198	$ 5,469

Note 7 - Intellectual Property (Details Textual) - Weighted Average [Member]	Mar. 31, 2023	Dec. 31, 2022
Developed Technology Rights [Member]
Finite-Lived Intangible Assets, Remaining Amortization Period (Year)	3 years 10 months 24 days	4 years 2 months 12 days
Technology-Based Intangible Assets [Member]
Finite-Lived Intangible Assets, Remaining Amortization Period (Year)	4 years 1 month 6 days	4 years 3 months 18 days

Note 7 - Intellectual Property - Intellectual Property (Details) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets, Gross	$ 69,238	$ 69,238
Finite-Lived Intangible Assets, Accumulated Amortization	(66,894)	(66,801)
Finite-Lived Intangible Assets, Foreign Currency Translation Impact	(838)	(861)
Intellectual property, net	1,506	1,576
Developed Technology Rights [Member]
Finite-Lived Intangible Assets, Gross	68,838	68,838
Finite-Lived Intangible Assets, Accumulated Amortization	(66,646)	(66,562)
Finite-Lived Intangible Assets, Foreign Currency Translation Impact	(853)	(874)
Intellectual property, net	1,339	1,402
Technology-Based Intangible Assets [Member]
Finite-Lived Intangible Assets, Gross	400	400
Finite-Lived Intangible Assets, Accumulated Amortization	(248)	(239)
Finite-Lived Intangible Assets, Foreign Currency Translation Impact	15	13
Intellectual property, net	$ 167	$ 174

Note 8 - Leases - Components of Operating Lease Expense (Details) - General and Administrative Expense [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Long-term Operating	$ 451	$ 398
Short-term Operating	0	0
Total Operating lease expense	$ 451	$ 398

Note 8 - Leases -Supplemental Balance Sheet Information (Details)	Mar. 31, 2023	Dec. 31, 2022
Weighted-average remaining lease term (in years) (Year)	6 years 8 months 12 days	6 years 9 months 18 days
Weighted-average discount rate	8.40%	8.40%
Minimum [Member]
Incremental borrowing rate	7.07%	6.10%
Maximum [Member]
Incremental borrowing rate	14.50%	14.50%

Note 8 - Leases - Minimum Lease Payments (Details) $ in Thousands	Mar. 31, 2023 USD ($)
2023	$ 897
2024	1,142
2025	1,061
2026	847
2027	780
Thereafter	2,199
Total minimum lease payments	6,926
Less: Amount of lease payments representing interest	(1,583)
Present value of future minimum lease payments	$ 5,343

Note 9 - Income Taxes (Details Textual) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2023
Effective Income Tax Rate Reconciliation, Percent	(0.40%)	(0.40%)
Income Tax Expense (Benefit)	$ 91	$ 84
Unrecognized Tax Benefits, Income Tax Penalties and Interest Accrued, Total	$ 0
Forecast [Member]
Effective Income Tax Rate Reconciliation, Percent			(0.40%)