0001437749-23-032025 | 10-Q | XBRL Viewer

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

	September 30, 2023
(In thousands)	Gross Carrying Amount		Accumulated Amortization			Foreign Currency Translation Impact			Net Carrying Amount
Developed technology	$	68,838	$	(66,872	)	$	(830	)	$	1,136
Technology and patents purchased		400		(269	)		11			142
Total intellectual property	$	69,238	$	(67,141	)	$	(819	)	$	1,278

	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 5 - Investments, Available-for-sale

9 Months Ended

Sep. 30, 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 accumulated other comprehensive loss in the condensed consolidated balance sheets are as follows:

	September 30, 2023
										Balance Sheet Classification
(In thousands)	Amortized Cost		Unrealized Gain		Unrealized Loss			Fair Value		Short-term investments		Long-term investments
Commercial Paper	$	-	$	-	$	-		$	-	$	-	$	-
Corporate Bonds		4,960		-		(28	)		4,932		4,932		-
US Treasuries		5,491		-		-			5,491		5,491		-
U.S. Government Agencies		1,000		-		(3	)		997		997		-
Total Investments	$	11,451	$	-	$	(31	)	$	11,420	$	11,420	$	-

	December 31, 2022
										Balance Sheet Classification
(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

As of September 30, 2023, contractual maturities of available-for-sale investments were one year or less. 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 or nine months ended September 30, 2023 or 2022.

Note 12 - Equity Offerings (Details Textual) - USD ($) $ / shares in Units, $ in Thousands		3 Months Ended	9 Months Ended
	Jul. 23, 2023	Sep. 30, 2023	Sep. 30, 2023	Mar. 18, 2022
Warrants Issued in Registered Direct Offering [Member]
Other Nonoperating Expense		$ 700	$ 700
Warrants Issued in Registered Direct Offering [Member]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)	23,809,524
Class of Warrant or Right, Exercise Price of Warrants or Rights (in dollars per share)	$ 0.42
Warrants and Rights Outstanding, Term (Year)	5 years
Proceeds from Issuance of Common Stock	$ 2,900
The 2022 ATM Offering [Member]
Stock Offering Agreement, Maximum Share Value				$ 100,000
Stock Offering Agreement, Commission, Percent				3.00%
Stock Issued During Period, Shares, New Issues (in shares)		78,600	433,672
Proceeds from Issuance of Common Stock		$ 25	$ 227
Common Stock Issued in Registered Direct Offering [Member]
Stock Issued During Period, Shares, New Issues (in shares)	23,809,524
Proceeds from Issuance or Sale of Equity	$ 10,000
Proceeds from Issuance of Warrants	7,100
Adjustments to Additional Paid in Capital, Stock Issued, Issuance Costs	$ 1,000

Document And Entity Information - shares	9 Months Ended
Document And Entity Information - shares	Sep. 30, 2023	Nov. 10, 2023
Document Information [Line Items]
Entity Central Index Key	0000876378
Entity Registrant Name	ASENSUS SURGICAL, INC.
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Period Focus	Q3
Document Fiscal Year Focus	2023
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
Document Transition Report	false
Entity File Number	0-19437
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	11-2962080
Entity Address, Address Line One	1 TW Alexander Drive, Suite 160
Entity Address, City or Town	Durham
Entity Address, State or Province	NC
Entity Address, Postal Zip Code	27703
City Area Code	919
Local Phone Number	765-8400
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Title of 12(b) Security	Common Stock $0.001 par value per share
Trading Symbol	ASXC
Security Exchange Name	NYSEAMER
Entity Common Stock, Shares Outstanding		264,316,749

Note 4 - Fair Value Measurements - Summary of Change in Fair Value for Contingent Consideration (Details) - The 2015 Senhance Acquisition [Member] - USD ($) $ in Thousands	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2023
Balance	$ 1,564	$ 1,361	$ 1,256	$ 1,256
Change in fair value	366	203	105
Balance	$ 1,930	$ 1,564	$ 1,361	$ 1,930

Note 11 - Stock-based Compensation - Non-cash Share-based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Share-based compensation	$ 2,019	$ 2,033	$ 5,913	$ 6,361
Share-Based Payment Arrangement, Option [Member]
Share-based compensation	552	913	1,808	2,812
Restricted Stock Units (RSUs) [Member]
Share-based compensation	1,037	772	2,873	2,480
Performance Restricted Stock Unit [Member]
Share-based compensation	$ 430	$ 348	$ 1,232	$ 1,069

Note 15 - Segments and Geographic Areas - Sales by Geographic Area (Details) - Revenue Benchmark [Member] - Geographic Concentration Risk [Member]	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
UNITED STATES
Concentration risk, percent	17.00%	7.00%	17.00%	13.00%
EMEA [Member]
Concentration risk, percent	64.00%	86.00%	62.00%	72.00%
Asia [Member]
Concentration risk, percent	19.00%	7.00%	21.00%	15.00%
All Countries [Member]
Concentration risk, percent	100.00%	100.00%	100.00%	100.00%

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

Sep. 30, 2023

Dec. 31, 2022

^[1]

$ 21,669

$ 6,329

1,615

1,141

11,420

64,195

34,704

75,530

1,930

1,256

4,842

6,772

1,256

Fair Value, Inputs, Level 1 [Member]

3,865

^[1]

21,669

6,329

1,615

1,141

23,284

7,470

Fair Value, Inputs, Level 2 [Member]

^[1]

11,420

64,195

11,420

68,060

Fair Value, Inputs, Level 3 [Member]

3,865

^[1]

1,930

1,256

4,842

$ 6,772

1,256

$ 0

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

Note 7 - Intellectual Property

9 Months Ended

Sep. 30, 2023

Intangible Assets Disclosure [Text Block]

7.	Intellectual Property

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

	September 30, 2023
(In thousands)	Gross Carrying Amount		Accumulated Amortization			Foreign Currency Translation Impact			Net Carrying Amount
Developed technology	$	68,838	$	(66,872	)	$	(830	)	$	1,136
Technology and patents purchased		400		(269	)		11			142
Total intellectual property	$	69,238	$	(67,141	)	$	(819	)	$	1,278

	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 3.4 years and 3.6 years, respectively, as of September 30, 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 10 - Income Taxes

9 Months Ended

Sep. 30, 2023

Income Tax Disclosure [Text Block]

10.

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 (0.3)% 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 September 30, 2023 and 2022 was (0.3)% and (0.3)%, respectively. The Company’s effective tax rate for the nine months ended September 30, 2023 and 2022 was (0.2)% and (0.4)%, respectively.

The Company incurred losses for the three and nine months ended September 30, 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 September 30, 2023 and 2022 was approximately $57,000 and $55,000, respectively. The total tax expense during the nine months ended September 30, 2023 and 2022 was approximately $136,000 and $224,000, respectively.

At September 30, 2023 the Company had no unrecognized tax benefits that would affect the Company’s effective tax rate.

The Financial Accounting Standards Board (“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 nine months ended September 30, 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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Note 4 - Fair Value Measurements

9 Months Ended

Sep. 30, 2023

Fair Value Disclosures [Text Block]

4.	Fair Value Measurements

The Company records certain assets and liabilities at fair value. Accounting Standards Codification (“ASC”) 820 – Fair Value Measurement states that fair value is the price that would be received to sell an asset, or paid to transfer a liability, in an orderly transaction between market participants at the measurement date. As such, the fair value is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or a liability. The three-tiered fair value hierarchy that prioritizes the inputs used in measuring fair value, is comprised of:

Level 1 - Quoted prices in active markets for identical assets or liabilities;

Level 2 - Inputs other than Level 1, that are observable, either directly or indirectly, such as quoted prices in active markets for similar assets or liabilities;

Level 3 - Unobservable inputs that are supported by little or no market data, and that are significant to the fair value of the assets and liabilities.

As of September 30, 2023 and December 31, 2022, the Company’s assets and liabilities measured at fair value on a recurring basis were as follows:

	September 30, 2023
(In thousands)	Level 1		Level 2		Level 3		Total
Assets:
Cash and cash equivalents ⁽¹⁾	$	21,669	$	-	$	-	$	21,669
Restricted cash		1,615		-		-		1,615
Short-term investments		-		11,420		-		11,420
Total assets	$	23,284	$	11,420	$	-	$	34,704
Liabilities:
Contingent consideration	$	-	$	-	$	1,930	$	1,930
Warrant liabilities		-		-		4,842		4,842
Total liabilities	$	-	$	-	$	6,772	$	6,772

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

	December 31, 2022
(In thousands)	Level 1		Level 2		Level 3		Total
Assets:
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	$	7,470	$	68,060	$	-	$	75,530
Liabilities:
Contingent consideration	$	-	$	-	$	1,256	$	1,256
Total liabilities	$	-	$	-	$	1,256	$	1,256

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

As of September 30, 2023 and December 31, 2022, carrying amounts reported on the Company’s balance sheet for cash and cash equivalents, restricted cash, accounts receivable, prepaid expenses, employee retention tax credit receivable, other current assets, accounts payable, accrued employee compensation and benefits, accrued expenses and other current liabilities, and deferred revenue approximate their respective fair value due to liquidity and short-term nature of these items.

At September 30, 2023, the Company’s financial liabilities consisted of contingent consideration and warrant liability:

Contingent Consideration

Contingent consideration represents a liability related to the Company’s 2015 acquisition of the Senhance System (the “Senhance Acquisition”). Adjustments associated with changes in fair value of contingent consideration are included in the Company’s condensed consolidated statements of operations and comprehensive loss. The following table summarizes changes in estimated fair value of the contingent consideration for the nine months ended September 30, 2023:

(In thousands)	Fair Value
Balance at December 31, 2022	$	1,256
Change in fair value		105
Balance at March 31, 2023		1,361
Change in fair value		203
Balance at June 30, 2023		1,564
Change in fair value		366
Balance at September 30, 2023	$	1,930

The following table presents quantitative information about the inputs and valuation methodologies used for fair value measurement of contingent consideration liability utilizing a Monte-Carlo simulation method as of September 30, 2023 and December 31, 2022:

	Valuation Methodology	Significant Unobservable Inputs	September 30, 2023		December 31, 2022

Contingent consideration	Probability weighted income approach	Milestone date	2032		2032
		Revenue discount rate		11.0%		16.5%
		Revenue volatility		37.5%		45.0%
		EUR-to-USD exchange rate		1.06		1.07

Warrant Liabilities

During the three months ended September 30, 2023, the Company recorded warrant liabilities related to common stock warrants issued in the registered direct offering in July 2023 (for additional information about the offering, please refer to Note 12 -Equity Offerings).

Warrant liabilities were recorded at their initial estimated fair value. Adjustments associated with changes in fair value of the warrant liabilities are included in the Company’s condensed consolidated statements of operations and comprehensive loss. The following table summarizes changes in estimated fair value of the warrant liabilities for the warrants issued in July 2023 as of September 30, 2023:

(In thousands)	Fair Value
Balance at June 30, 2023	$	-
Issuance of warrants		7,120
Change in fair value		(2,278	)
Balance at September 30, 2023	$	4,842

The fair value of the warrant liabilities were estimated using the Black-Scholes option pricing model, which is based on unobservable inputs and is designated as Level 3 in the fair value hierarchy. The following table summarizes the assumptions used in determining fair value of warrant liabilities:

	As of July 31, 2023			As of September 30, 2023
Expected volatility		115	%		115	%
Risk-free interest rate		4.2	%		4.6	%
Expected life (in years)		5.0			4.8
Expected dividend yield		0	%		0	%

During the nine months ended September 30, 2023, there were no transfers of assets or liabilities between Level 1, Level 2, or Level 3 fair value categories.

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

Significant Accounting Policies (Policies)	9 Months Ended
Significant Accounting Policies (Policies)	Sep. 30, 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 Year 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 basis of accounting, which contemplates the realization of assets and liquidation of liabilities in the normal course of business. The Company had an accumulated deficit of $922.1 million and working capital of $33.8 million as of September 30, 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 execute its business plan. Management's plans 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 its 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 raises substantial doubt about the Company’s ability to meet its existing obligations, and to continue as a going concern for one year from the date that these financial statements are issued. The condensed 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.à r.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, obtain regulatory clearance for and commercialize its products and products in development; negative impacts on the Company's operations caused by the hostilities in the Middle East, 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 in development; 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-based 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, measurement of warrant liabilities and deferred tax asset valuation allowances.
Warrant Liabilities [Policy Text Block]	Warrant Liabilities The Company’s warrants (see Note 12) 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 4). 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.
New Accounting Pronouncements, Policy [Policy Text Block]	Impact of Recently Issued Accounting Standards The Company has evaluated issued Accounting Standards Updates (“ASUs”) not yet adopted and believes the adoption of these standards will not have a material impact on its consolidated financial statements.

Note 11 - Stock-based Compensation (Details Textual) - USD ($) $ in Millions		9 Months Ended
	Jun. 06, 2023	Sep. 30, 2023
Share-Based Payment Arrangement, Option [Member]
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount		$ 2.2
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)		1 year 8 months 12 days
Restricted Stock Units (RSUs) [Member]
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount		$ 6.0
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)		1 year 4 months 24 days
Incentive Compensation Plan [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award, Number of Additional Shares Authorized (in shares)	22,000,000
Share-Based Compensation Arrangement by Share-Based Payment Award, Number of Shares Authorized (in shares)	54,072,307

Note 3 - Revenue Recognition - Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenue	$ 1,089	$ 2,563	$ 3,146	$ 4,623
UNITED STATES
Revenue	188	181	527	578
Non-US [Member]
Revenue	901	2,382	2,619	4,045
Systems [Member]
Revenue	0	1,227	0	1,228
Systems [Member] \| UNITED STATES
Revenue	0	0	0	0
Systems [Member] \| Non-US [Member]
Revenue	0	1,227	0	1,228
Instruments and Accessories [Member]
Revenue	301	737	892	1,337
Instruments and Accessories [Member] \| UNITED STATES
Revenue	71	60	169	142
Instruments and Accessories [Member] \| Non-US [Member]
Revenue	230	677	723	1,195
Service [Member]
Revenue	295	335	779	1,067
Service [Member] \| UNITED STATES
Revenue	77	75	228	225
Service [Member] \| Non-US [Member]
Revenue	218	260	551	842
Lease [Member]
Revenue	493	264	1,475	991
Lease [Member] \| UNITED STATES
Revenue	40	46	130	211
Lease [Member] \| Non-US [Member]
Revenue	$ 453	$ 218	$ 1,345	$ 780

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
-Topic 924
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479941/924-10-S99-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 5
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-5

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 30
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-30

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 42
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-42

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 40
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-40

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 41
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-41

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-4

Note 15 - Segments and Geographic Areas (Details Textual)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Number of Operating Segments			1
Revenue Benchmark [Member] \| Customer Concentration Risk [Member]
Number of Major Customers	1	1	0	1
Revenue Benchmark [Member] \| Customer Concentration Risk [Member] \| One Customer [Member]
Concentration Risk, Percentage	10.00%	10.00%		10.00%

Condensed Consolidated Statements of Changes in Stockholders' Equity (Unaudited) - USD ($) $ in Thousands	Common Stock [Member]	Treasury Stock, Common [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	AOCI Attributable to Parent [Member]	Total
Balance (in shares) at Dec. 31, 2021	235,219,000	0
Balance at Dec. 31, 2021	$ 235	$ 0	$ 954,649	$ (785,374)	$ (264)	$ 169,246
Stock-based compensation	$ 0	$ 0	2,245	0	0	2,245
Exercise of stock options (in shares)	30,000	0
Exercise of stock options	$ 0	$ 0	12	0	0	12
Issuance of common stock related to vesting of restricted stock units (in shares)	1,166,000	0
Issuance of common stock related to vesting of restricted stock units	$ 1	$ 0	0	0	0	1
Shares withheld related to net share settlement of equity awards (in shares)	0	436,000
Shares withheld related to net share settlement of equity awards	$ 0	$ 0	(349)	0	0	(349)
Cancellation of treasury stock (in shares)	0	(436,000)
Cancellation of treasury stock	$ 0	$ 0	0	0	0	0
Other comprehensive income (loss)	0	0	0	0	(1,202)	(1,202)
Net loss	0	0	0	(19,128)	0	(19,128)
cancellation of treasury stock	$ (0)	$ (0)	(0)	(0)	(0)	(0)
Balance (in shares) at Mar. 31, 2022	236,415,000	0
Balance at Mar. 31, 2022	$ 236	$ 0	956,557	(804,502)	(1,466)	150,825
Balance (in shares) at Dec. 31, 2021	235,219,000	0
Balance at Dec. 31, 2021	$ 235	$ 0	954,649	(785,374)	(264)	169,246
Net loss						(57,671)
Balance (in shares) at Sep. 30, 2022	236,783,000	0
Balance at Sep. 30, 2022	$ 237	$ 0	960,676	(843,045)	(4,892)	112,976
Balance (in shares) at Mar. 31, 2022	236,415,000	0
Balance at Mar. 31, 2022	$ 236	$ 0	956,557	(804,502)	(1,466)	150,825
Stock-based compensation	$ 0	$ 0	2,083	0	0	2,083
Exercise of stock options (in shares)	13,000	0
Exercise of stock options	$ 0	$ 0	6	0	0	6
Issuance of common stock related to vesting of restricted stock units (in shares)	192,000	0
Issuance of common stock related to vesting of restricted stock units	$ 1	$ 0	0	0	0	1
Other comprehensive income (loss)	0	0		0	(1,857)	(1,857)
Net loss	$ 0	$ 0	0	(19,619)	0	(19,619)
Balance (in shares) at Jun. 30, 2022	236,620,000	0
Balance at Jun. 30, 2022	$ 237	$ 0	958,646	(824,121)	(3,323)	131,439
Stock-based compensation	$ 0	$ 0	2,033	0	0	2,033
Issuance of common stock related to vesting of restricted stock units (in shares)	163,000	0
Issuance of common stock related to vesting of restricted stock units	$ 0	$ 0	0	0	0	0
Shares withheld related to net share settlement of equity awards (in shares)	0	7,000
Shares withheld related to net share settlement of equity awards	$ 0	$ 0	(3)	0	0	(3)
Cancellation of treasury stock (in shares)	0	(7,000)
Cancellation of treasury stock	$ 0	$ 0	0	0	0	0
Other comprehensive income (loss)	0	0	0	0	(1,569)	(1,569)
Net loss	0	0	0	(18,924)	0	(18,924)
cancellation of treasury stock	$ (0)	$ (0)	(0)	(0)	(0)	(0)
Balance (in shares) at Sep. 30, 2022	236,783,000	0
Balance at Sep. 30, 2022	$ 237	$ 0	960,676	(843,045)	(4,892)	112,976
Balance (in shares) at Dec. 31, 2022	236,895,000	0
Balance at Dec. 31, 2022	$ 237	$ 0	962,731	(860,935)	(2,388)	99,645
Stock-based compensation	$ 0	$ 0	1,916	0	0	1,916
Exercise of stock options (in shares)	13,000	0
Exercise of stock options	$ 0	$ 0	5	0	0	5
Issuance of common stock related to vesting of restricted stock units (in shares)	2,434,000	0
Issuance of common stock related to vesting of restricted stock units	$ 2	$ 0	0	0	0	2
Shares withheld related to net share settlement of equity awards (in shares)	0	649,000
Shares withheld related to net share settlement of equity awards	$ 0	$ 1	(490)	0	0	(489)
Cancellation of treasury stock (in shares)	0	(649,000)
Cancellation of treasury stock	$ 0	$ (1)	0	0	0	(1)
Other comprehensive income (loss)	0	0	0	0	857	857
Net loss	0	0		(22,218)	0	(22,218)
cancellation of treasury stock	$ (0)	$ 1	(0)	(0)	(0)	1
Balance (in shares) at Mar. 31, 2023	239,342,000	0
Balance at Mar. 31, 2023	$ 239	$ 0	964,162	(883,153)	(1,531)	79,717
Balance (in shares) at Dec. 31, 2022	236,895,000	0
Balance at Dec. 31, 2022	$ 237	$ 0	962,731	(860,935)	(2,388)	$ 99,645
Exercise of stock options (in shares)						13,300
Net loss						$ (61,198)
Balance (in shares) at Sep. 30, 2023	264,111,000	0
Balance at Sep. 30, 2023	$ 264	$ 0	970,952	(922,133)	(1,830)	47,253
Balance (in shares) at Mar. 31, 2023	239,342,000	0
Balance at Mar. 31, 2023	$ 239	$ 0	964,162	(883,153)	(1,531)	79,717
Stock-based compensation	$ 0	$ 0	1,978	0	0	1,978
Issuance of common stock related to vesting of restricted stock units (in shares)	273,000	0
Issuance of common stock related to vesting of restricted stock units	$ 0	$ 0	0	0	0	0
Other comprehensive income (loss)	0	0	0	0	274	274
Net loss	$ 0	$ 0	0	(20,662)	0	(20,662)
Issuance of common stock, net of issuance costs (in shares)	355,000	0
Issuance of common stock, net of issuance costs	$ 1	$ 0	195	0	0	196
Balance (in shares) at Jun. 30, 2023	239,970,000	0
Balance at Jun. 30, 2023	$ 240	$ 0	966,335	(903,815)	(1,257)	61,503
Stock-based compensation	$ 0	$ 0	2,019	0	0	2,019
Issuance of common stock related to vesting of restricted stock units (in shares)	253,000	0
Issuance of common stock related to vesting of restricted stock units	$ 0	$ 0	0	0	0	0
Shares withheld related to net share settlement of equity awards (in shares)	0	8,000
Shares withheld related to net share settlement of equity awards	$ 0	$ 0	(7)	0	0	0
Cancellation of treasury stock (in shares)	0	(8,000)
Cancellation of treasury stock	$ 0	$ 0	0	0	0	0
Other comprehensive income (loss)	0	0	0	0	(573)	(573)
Net loss	$ 0	$ 0	0	(18,318)	0	(18,318)
Issuance of common stock, net of issuance costs (in shares)	23,888,000	0
Issuance of common stock, net of issuance costs	$ 24	$ 0	2,598	0	0	2,622
cancellation of treasury stock	$ 0	$ 0	0	0	0	0
Balance (in shares) at Sep. 30, 2023	264,111,000	0
Balance at Sep. 30, 2023	$ 264	$ 0	$ 970,952	$ (922,133)	$ (1,830)	$ 47,253

Note 12 - Equity Offerings (Tables)

9 Months Ended

Sep. 30, 2023

Schedule of Common Stock Outstanding Roll Forward [Table Text Block]

	Three Months Ended September 30, 2023			Nine Months Ended September 30, 2023
Shares of common stock issued		78,600			433,672
Average price per share	$	0.31		$	0.52
Gross proceeds	$	25		$	227
Commission paid to Agents	$	(1	)	$	(7	)
Net proceeds	$	24		$	220

Note 3 - Revenue Recognition - Contract Assets and Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022	Dec. 31, 2021
Contract Assets	$ 54	$ 116	$ 91
Deferred Revenue	$ 456	$ 465	$ 543

Note 7 - Intellectual Property (Details Textual) - Weighted Average [Member]	Sep. 30, 2023	Dec. 31, 2022
Developed Technology Rights [Member]
Finite-Lived Intangible Assets, Remaining Amortization Period (Year)	3 years 4 months 24 days	4 years 2 months 12 days
Technology-Based Intangible Assets [Member]
Finite-Lived Intangible Assets, Remaining Amortization Period (Year)	3 years 7 months 6 days	4 years 3 months 18 days

Note 2 - Summary of Significant Accounting Policies

9 Months Ended

Sep. 30, 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 Year 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 basis of accounting, which contemplates the realization of assets and liquidation of liabilities in the normal course of business. The Company had an accumulated deficit of $922.1 million and working capital of $33.8 million as of September 30, 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 execute its business plan. Management's plans 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 its 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 raises substantial doubt about the Company’s ability to meet its existing obligations, and to continue as a going concern for one year from the date that these financial statements are issued. The condensed 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.à r.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, obtain regulatory clearance for and commercialize its products and products in development; negative impacts on the Company's operations caused by the hostilities in the Middle East, 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 in development; 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-based 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, measurement of warrant liabilities and deferred tax asset valuation allowances.

Significant Accounting Policies

With the exception of the Company’s warrant policy (please see next section), 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 Year 2022 Form 10-K.

Warrant Liabilities

The Company’s warrants (see Note 12) 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 4). 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.

Impact of Recently Issued Accounting Standards

The Company has evaluated issued Accounting Standards Updates (“ASUs”) not yet adopted and believes the adoption of these standards will not have a material impact on its consolidated financial statements.

Note 10 - Income Taxes (Details Textual) - USD ($)	3 Months Ended			9 Months Ended
Note 10 - Income Taxes (Details Textual) - USD ($)	Dec. 31, 2023	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Effective Income Tax Rate Reconciliation, Percent		(0.30%)	(0.30%)	(0.20%)	(0.40%)
Income Tax Expense (Benefit)		$ 57,000	$ 55,000	$ 136,000	$ 224,000
Unrecognized Tax Benefits, Income Tax Penalties and Interest Accrued, Total		$ 0		0
Effective Income Tax Rate Reconciliation, GILTI, Amount				$ 0	$ 0
Forecast [Member]
Effective Income Tax Rate Reconciliation, Percent	(0.30%)

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Note 12 - Equity Offerings

9 Months Ended

Sep. 30, 2023

Equity Offerings [Text Block]

12.

Equity Offerings

2022 At-The-Market Offering

On March 18, 2022, the Company entered into a Controlled Equity Offering Sales Agreement (the “2022 Sales Agreement”) with Cantor Fitzgerald & Co. and Oppenheimer & Co. Inc., collectively, “the Agents”. The Company commenced an at-the-market offering (the “2022 ATM Offering”) pursuant to which the Company could offer and sell, from time to time, at its option, shares of its common stock for an aggregate offering price of up to $100.0 million. The aggregate compensation payable to the Agents was 3.0% of the aggregate gross proceeds from each sale of the Company’s common stock.

The following table presents details about common stock issued pursuant to the 2022 ATM Offering (in thousands, except share and per share amounts):

	Three Months Ended September 30, 2023			Nine Months Ended September 30, 2023
Shares of common stock issued		78,600			433,672
Average price per share	$	0.31		$	0.52
Gross proceeds	$	25		$	227
Commission paid to Agents	$	(1	)	$	(7	)
Net proceeds	$	24		$	220

2023 Registered Equity Offering

On July 27, 2023, the Company sold, in a registered direct offering, an aggregate of 23,809,524 shares of common stock, and warrants to purchase 23,809,524 of the Company’s common stock shares at an exercise price of $0.42 per common share (“the warrants”), for an aggregate purchase price of $10.0 million. The warrants are exercisable at any time on or after the date of issuance and will expire five years after the date of issuance. Based on the assessment of the warrant’s specific terms and applicable authoritative guidance in ASC 480 – Distinguishing Liabilities from Equity and ASC 815 – Derivatives and Hedging, the Company determined that warrants did not meet the requirements for equity classification. Accordingly, the warrants were recorded as a liability on the Company’s balance sheet at their initial estimated fair value on the date of issuance. For additional information regarding the fair value of warrant liabilities, please refer to Note 4 – Fair Value Measurements.

The Company allocated $7.1 million of the aggregate proceeds to warrants based on their estimated fair value, with the residual amount of $2.9 million allocated to common stock. Offering related issuance costs were approximately $1.0 million and consisted primarily of placement agent’s fees and legal expenses. Issuance costs were allocated to common stock and warrant liability proportionally to the allocation of the purchase price. For the three and nine months ended September 30, 2023, the Company recorded $0.7 million of Other expense, net, in the condensed consolidated statement of operations related to issuance costs allocated to warrant liabilities.

Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - $ / shares	Sep. 30, 2023	Dec. 31, 2022
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 (in shares)	264,111,257	236,895,440
Common stock, shares outstanding (in shares)	264,111,257	236,895,440
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	25,000,000	25,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0

Note 15 - Segments and Geographic Areas (Tables)

9 Months Ended

Sep. 30, 2023

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

	September 30, 2023			December 31, 2022
U.S.		37	%		39	%
EMEA		57	%		57	%
Asia		6	%		4	%
Total		100	%		100	%

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

	Three Months Ended September 30,						Nine Months Ended September 30,
	2023			2022			2023			2022


US		17	%		7	%		17	%		13	%
EMEA		64	%		86	%		62	%		72	%
Asia		19	%		7	%		21	%		15	%
Total		100	%		100	%		100	%		100	%

Note 8 - Leases

9 Months Ended

Sep. 30, 2023

Lessee, Operating Leases [Text Block]

8.	Leases

Lessee Information

Components of operating lease expense recorded in general and administrative expense in the condensed consolidated statements of operations and comprehensive loss were as follows (in thousands):

	Three Months Ended September 30,				Nine Months Ended September 30,
	2023		2022		2023		2022

Long-term Operating	$	494	$	408	$	1,424	$	1,192

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

	September 30, 2023			December 31, 2022
Weighted-average remaining lease term (in years)		6.1			6.8
Weighted-average discount rate		8.4	%		8.4	%

Maturities of operating lease obligations as of September 30, 2023 were as follows (in thousands):

Fiscal Year
Remainder of 2023	$	309
2024		1,329
2025		1,251
2026		936
2027		954
2028 and thereafter		2,227
Total minimum lease payments	$	7,006
Less: Amount of lease payments representing interest		(1,511	)
Present value of future minimum lease payments	$	5,495

Note 11 - Stock-based Compensation

9 Months Ended

Sep. 30, 2023

Share-Based Payment Arrangement [Text Block]

11.

Stock-Based Compensation

Incentive Compensation Plan Information

On June 6, 2023, at the 2023 Annual Meeting of Stockholders, the Company’s stockholders voted to approve an amendment and restatement of the Company’s Incentive Compensation Plan (“the Plan”) to increase the number of shares reserved for issuance under the Plan by 22,000,000 shares. As a result of this amendment, shares authorized for issuance under the Plan increased to 54,072,307 shares.

Stock Options

The following table summarizes options outstanding as of September 30, 2023, as well as activity, including grants to employees and non-employees, for the nine months ended September 30, 2023:

	Number of Shares			Weighted-Average Exercise Price		Weighted-Average Remaining Contractual Term (Years)		Aggregate Intrinsic Value (Millions)
Outstanding at December 31, 2022		7,584,967		$	4.22		5.31
Granted		3,047,615		$	0.71
Exercised		(13,300	)	$	0.38
Cancelled		(21,116	)	$	25.79
Forfeited		(106	)	$	15.86
Outstanding at September 30, 2023		10,598,060		$	3.17		5.10	$	-
Vested or expected to vest at September 30, 2023		10,132,754		$	3.29		5.05	$	-
Exercisable at September 30, 2023		5,591,291		$	5.15		4.37	$	-

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

	Nine Months Ended September 30,
	2023		2022
Expected volatility		124% - 130%		128% - 133%
Risk-free interest rate		3.53% - 4.14%		1.25% - 2.98%
Expected life (in years)		3.8 - 4.5		3.8 - 4.5
Expected dividend yield		0%		0%
Weighted average grant date fair value		$0.59		$0.60

Restricted Stock Units

The following table summarizes information about restricted stock units outstanding as of September 30, 2023, as well as activity, including performance restricted stock units, for the nine months ended September 30, 2023:

	Number of Shares			Weighted-Average Grant Date Fair Value
Outstanding at December 31, 2022		8,483,491		$	1.04
Granted		8,482,315		$	0.71
Vested		(3,623,411	)	$	1.14
Forfeited		(539,448	)	$	0.76
Outstanding at September 30, 2023		12,802,947		$	0.82

Performance-Based Restricted Stock Units

In 2023 and 2022, the Company granted performance-based restricted stock units. In particular, the number of shares earnable under the 2023 and 2022 awards is based on achieving certain operational targets by December 31, 2023 and October 1, 2023, respectively. 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 and nine months ended September 30, 2023 and 2022:

	Three Months Ended September 30,				Nine Months Ended September 30,
(In thousands)	2023		2022		2023		2022
Stock options	$	552	$	913	$	1,808	$	2,812
Restricted stock units		1,037		772		2,873		2,480
Performance restricted stock units		430		348		1,232		1,069
	$	2,019	$	2,033	$	5,913	$	6,361

As of September 30, 2023, the unrecognized stock-based compensation expense related to stock options was approximately $2.2 million, which is expected to be recognized over a weighted average period of 1.7 years. As of September 30, 2023, the unrecognized stock-based compensation expense related to unvested restricted stock units and performance restricted stock units was approximately $6.0 million, which is expected to be recognized over a weighted average period of 1.4 years.

Note 9 - Accrued Expenses and Other Current Liabilities (Tables)

9 Months Ended

Sep. 30, 2023

Schedule of Accrued Liabilities [Table Text Block]

(In thousands)	September 30, 2023		December 31, 2022
Income and other taxes payable	$	694	$	839
Legal and professional fees		374		275
Royalties		23		24
Consulting services		167		155
Total accrued expenses and other current liabilities	$	1,258	$	1,293

Note 4 - Fair Value Measurements (Tables)

9 Months Ended

Sep. 30, 2023

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

	September 30, 2023
(In thousands)	Level 1		Level 2		Level 3		Total
Assets:
Cash and cash equivalents ⁽¹⁾	$	21,669	$	-	$	-	$	21,669
Restricted cash		1,615		-		-		1,615
Short-term investments		-		11,420		-		11,420
Total assets	$	23,284	$	11,420	$	-	$	34,704
Liabilities:
Contingent consideration	$	-	$	-	$	1,930	$	1,930
Warrant liabilities		-		-		4,842		4,842
Total liabilities	$	-	$	-	$	6,772	$	6,772

	December 31, 2022
(In thousands)	Level 1		Level 2		Level 3		Total
Assets:
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	$	7,470	$	68,060	$	-	$	75,530
Liabilities:
Contingent consideration	$	-	$	-	$	1,256	$	1,256
Total liabilities	$	-	$	-	$	1,256	$	1,256

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

(In thousands)	Fair Value
Balance at December 31, 2022	$	1,256
Change in fair value		105
Balance at March 31, 2023		1,361
Change in fair value		203
Balance at June 30, 2023		1,564
Change in fair value		366
Balance at September 30, 2023	$	1,930

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

	Valuation Methodology	Significant Unobservable Inputs	September 30, 2023		December 31, 2022

Contingent consideration	Probability weighted income approach	Milestone date	2032		2032
		Revenue discount rate		11.0%		16.5%
		Revenue volatility		37.5%		45.0%
		EUR-to-USD exchange rate		1.06		1.07

	As of July 31, 2023			As of September 30, 2023
Expected volatility		115	%		115	%
Risk-free interest rate		4.2	%		4.6	%
Expected life (in years)		5.0			4.8
Expected dividend yield		0	%		0	%

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

(In thousands)	Fair Value
Balance at June 30, 2023	$	-
Issuance of warrants		7,120
Change in fair value		(2,278	)
Balance at September 30, 2023	$	4,842

Note 8 - Leases - Minimum Lease Payments (Details) $ in Thousands	Sep. 30, 2023 USD ($)
Remainder of 2023	$ 309
2024	1,329
2025	1,251
2026	936
2027	954
2028 and thereafter	2,227
Total minimum lease payments	7,006
Less: Amount of lease payments representing interest	(1,511)
Present value of future minimum lease payments	$ 5,495

Note 4 - Fair Value Measurements - Quantitative Information about Inputs and Valuation Methodologies Used for Fair Value Measurements Classification (Details)	Sep. 30, 2023	Jul. 31, 2023	Dec. 31, 2022
Measurement Input, Price Volatility [Member] \| Warrant [Member]
Measurement Input	1.15	1.15
Measurement Input, Risk Free Interest Rate [Member] \| Warrant [Member]
Measurement Input	0.046	0.042
Measurement Input, Expected Term [Member] \| Warrant [Member]
Measurement Input	4.8	5
Measurement Input, Expected Dividend Rate [Member] \| Warrant [Member]
Measurement Input	0	0
The 2015 Senhance Acquisition [Member] \| Fair Value, Inputs, Level 3 [Member] \| Milestone Date, Year [Member]
Contingent consideration milestone dates	Dec. 31, 2032		Dec. 31, 2032
The 2015 Senhance Acquisition [Member] \| Fair Value, Inputs, Level 3 [Member] \| Measurement Input, Price Volatility [Member]
Contingent consideration, measurement input	0.375		0.45
The 2015 Senhance Acquisition [Member] \| Fair Value, Inputs, Level 3 [Member] \| Measurement Input, Discount Rate [Member]
Contingent consideration, measurement input	0.11		0.165
The 2015 Senhance Acquisition [Member] \| Fair Value, Inputs, Level 3 [Member] \| Measurement Input, Currency Exchange Rate [Member]
Contingent consideration, measurement input	1.06		1.07

Note 3 - Revenue Recognition 1 (Details Textual) $ in Millions	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Dec. 31, 2022 USD ($)
Contract with Customer, Liability, Revenue Recognized	$ 0.2	$ 0.2	$ 0.5	$ 0.7
Accounts Receivable, Allowance for Credit Loss	$ 1.6		$ 1.6		$ 1.6
Customer Concentration Risk [Member] \| Accounts Receivable [Member]
Number of Major Customers			4		1
Customer Concentration Risk [Member] \| Accounts Receivable [Member] \| Customer One [Member]
Concentration Risk, Percentage			18.00%
Customer Concentration Risk [Member] \| Accounts Receivable [Member] \| Customer Two [Member]
Concentration Risk, Percentage			16.00%
Customer Concentration Risk [Member] \| Accounts Receivable [Member] \| Customer Three [Member]
Concentration Risk, Percentage			15.00%
Customer Concentration Risk [Member] \| Accounts Receivable [Member] \| Customer Four [Member]
Concentration Risk, Percentage			14.00%
Customer Concentration Risk [Member] \| Accounts Receivable [Member] \| One Customer [Member]
Concentration Risk, Percentage					69.00%

Note 8 - Leases -Supplemental Balance Sheet Information (Details)	Sep. 30, 2023	Dec. 31, 2022
Weighted-average remaining lease term (in years) (Year)	6 years 1 month 6 days	6 years 9 months 18 days
Weighted-average discount rate	8.40%	8.40%

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

9 Months Ended

Sep. 30, 2023

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

	September 30, 2023
										Balance Sheet Classification
(In thousands)	Amortized Cost		Unrealized Gain		Unrealized Loss			Fair Value		Short-term investments		Long-term investments
Commercial Paper	$	-	$	-	$	-		$	-	$	-	$	-
Corporate Bonds		4,960		-		(28	)		4,932		4,932		-
US Treasuries		5,491		-		-			5,491		5,491		-
U.S. Government Agencies		1,000		-		(3	)		997		997		-
Total Investments	$	11,451	$	-	$	(31	)	$	11,420	$	11,420	$	-

	December 31, 2022
										Balance Sheet Classification
(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

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
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-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

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Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481800/320-10-50-3

Note 7 - Intellectual Property - Intellectual Property (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Finite-Lived Intangible Assets, Gross	$ 69,238	$ 69,238
Finite-Lived Intangible Assets, Accumulated Amortization	(67,141)	(66,801)
Finite-Lived Intangible Assets, Foreign Currency Translation Impact	(819)	(861)
Intellectual property, net	1,278	1,576
Developed Technology Rights [Member]
Finite-Lived Intangible Assets, Gross	68,838	68,838
Finite-Lived Intangible Assets, Accumulated Amortization	(66,872)	(66,562)
Finite-Lived Intangible Assets, Foreign Currency Translation Impact	(830)	(874)
Intellectual property, net	1,136	1,402
Technology-Based Intangible Assets [Member]
Finite-Lived Intangible Assets, Gross	400	400
Finite-Lived Intangible Assets, Accumulated Amortization	(269)	(239)
Finite-Lived Intangible Assets, Foreign Currency Translation Impact	11	13
Intellectual property, net	$ 142	$ 174

Note 8 - Leases (Tables)

9 Months Ended

Sep. 30, 2023

Lease, Cost [Table Text Block]

	Three Months Ended September 30,				Nine Months Ended September 30,
	2023		2022		2023		2022

Long-term Operating	$	494	$	408	$	1,424	$	1,192

Lessee, Operating Lease, Disclosure [Table Text Block]

	September 30, 2023			December 31, 2022
Weighted-average remaining lease term (in years)		6.1			6.8
Weighted-average discount rate		8.4	%		8.4	%

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

Fiscal Year
Remainder of 2023	$	309
2024		1,329
2025		1,251
2026		936
2027		954
2028 and thereafter		2,227
Total minimum lease payments	$	7,006
Less: Amount of lease payments representing interest		(1,511	)
Present value of future minimum lease payments	$	5,495

Note 14 - Commitments and Contingencies - Purchase Orders Commitments (Details) - License and Supply Agreement [Member] $ in Thousands	Sep. 30, 2023 USD ($)
2023 (remaining three months)	$ 4,223
2024	1,543
2025	314
2026	303
Total commitments	$ 6,383

Note 13 - Basic and Diluted Net Loss Per Share (Tables)

9 Months Ended

Sep. 30, 2023

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

	September 30,
	2023		2022
Stock options		10,598,060		7,404,858
Nonvested restricted stock units		12,802,947		8,038,575
Stock warrants		24,830,500		1,021,076
Total		48,231,507		16,464,509

Note 6 - Inventory (Tables)

9 Months Ended

Sep. 30, 2023

Schedule of Inventory, Current [Table Text Block]

	September 30, 2023
(In thousands)	Gross Carrying Amount		Reserve Balance			Net Carrying Amount
Finished goods	$	11,750	$	(2,324	)	$	9,426
Raw materials		5,308		(2,411	)		2,897
Total inventories	$	17,058	$	(4,735	)	$	12,323

Current portion	$	7,380	$	(697	)	$	6,683
Long-term portion		9,678		(4,038	)		5,640
Total inventories	$	17,058	$	(4,735	)	$	12,323

	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 inventory	$	20,055	$	(6,302	)	$	13,753

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

Note 16 - Related Party Transactions

9 Months Ended

Sep. 30, 2023

16.

Related Party Transactions

In March 2018, Asensus Surgical Europe S.à r.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 $2,000 and $67,000 for the three months ended September 30, 2023 and 2022, respectively, and $73,000 and $208,000 for the nine months ended September 30, 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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Note 3 - Revenue Recognition (Tables)

9 Months Ended

Sep. 30, 2023

Disaggregation of Revenue [Table Text Block]

	Three Months Ended September 30,				Nine Months Ended September 30,
(In thousands)	2023		2022		2023		2022
U.S.
Systems	$	-	$	-	$	-	$	-
Instruments and accessories		71		60		169		142
Services		77		75		228		225
Leases		40		46		130		211
Total U.S. revenue		188		181		527		578

Outside of U.S. ("OUS")
Systems		-		1,227		-		1,228
Instruments and accessories		230		677		723		1,195
Services		218		260		551		842
Leases		453		218		1,345		780
Total OUS revenue		901		2,382		2,619		4,045

Total
Systems		-		1,227		-		1,228
Instruments and accessories		301		737		892		1,337
Services		295		335		779		1,067
Leases		493		264		1,475		991
Total revenue	$	1,089	$	2,563	$	3,146	$	4,623

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

	September 30, 2023		December 31, 2022		December 31, 2021
(In thousands)
Contract Assets	$	54	$	116	$	91
Deferred Revenue	$	456	$	465	$	543

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Cash Flows from Operating Activities:
Net loss	$ (61,198)	$ (57,671)
Adjustments to reconcile net loss to net cash and cash equivalents used in operating activities:
Depreciation	2,405	2,481
Amortization of intangible assets	340	7,601
Amortization of discounts and premiums on investments, net	(454)	556
Stock-based compensation	5,913	6,361
Deferred tax expense	136	224
Bad debt expense		9
Change in inventory reserves	297	386
Property and equipment impairment	0	432
Loss on disposal of property and equipment		97
Change in fair value of warrant liabilities	(2,278)	(0)
Change in fair value of contingent consideration	674	(1,168)
Changes in operating assets and liabilities:
Accounts receivable	1,587	(1,735)
Inventory	536	(535)
Operating lease right-of-use assets	(142)	237
Prepaid expenses	(590)	(693)
Employee retention tax credit receivable	554	164
Other current and long-term assets	310	(2,123)
Accounts payable	1,236	449
Accrued employee compensation and benefits	566	236
Accrued expenses and other current liabilities	(97)	0
Deferred revenue	(5)	(139)
Operating lease liabilities	(43)	(53)
Net cash and cash equivalents used in operating activities	(50,253)	(44,884)
Cash Flows from Investing Activities:
Purchase of available-for-sale investments	(12,268)	(25,588)
Proceeds from maturities of available-for-sale investments	69,835	67,702
Purchase of property and equipment	(488)	(904)
Net cash and cash equivalents provided by investing activities	57,079	41,210
Cash Flows from Financing Activities:
Proceeds from issuance of common stock and warrants, net of issuance costs	9,946	0
Taxes paid related to net share settlement of vesting of restricted stock units	(497)	(350)
Proceeds from exercise of stock options	5	18
Net cash and cash equivalents provided by (used in) financing activities	9,454	(332)
Effect of exchange rate changes on cash and cash equivalents	(466)	(300)
Net increase (decrease) in cash, cash equivalents and restricted cash	15,814	(4,306)
Cash, cash equivalents and restricted cash, beginning of period	7,470	19,283
Cash, cash equivalents and restricted cash, end of period	23,284	14,977
Supplemental Disclosure for Cash Flow Information
Cash paid for leases	1,067	729
Cash paid for taxes	230	79
Supplemental Schedule of Non-cash Investing and Financing Activities:
Transfer of inventory to property and equipment	2,227	1,293
Lease liabilities arising from obtaining right-of-use assets	$ 796	$ 316

Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Current Assets:
Cash and cash equivalents	$ 21,669	$ 6,329
Short-term investments, available-for-sale	11,420	64,195
Accounts receivable, net	662	2,256
Inventory, net	6,683	8,284
Prepaid expenses	4,174	3,584
Employee retention tax credit receivable	0	554
Other current assets	1,324	1,671
Total Current Assets	45,932	86,873
Restricted cash	1,615	1,141
Long-term investments, available-for-sale	0	3,865
Inventory, net of current portion	5,640	5,469
Property and equipment, net	9,237	9,542
Intellectual property, net	1,278	1,576
Deferred tax assets, net	150	174
Operating lease right-of-use assets, net	5,004	4,950
Other noncurrent assets	1,871	2,463
Total Assets	70,727	116,053
Current Liabilities:
Accounts payable	4,526	3,348
Accrued employee compensation and benefits	4,967	4,508
Accrued expenses and other current liabilities	1,258	1,293
Operating lease liabilities, current	916	800
Deferred revenue	456	465
Total Current Liabilities	12,123	10,414
Long-Term Liabilities:
Warrant liabilities	4,842	0
Contingent consideration	1,930	1,256
Operating lease liabilities, noncurrent	4,579	4,738
Total Liabilities	23,474	16,408
Stockholders' Equity:
Common stock $0.001 par value, 750,000,000 shares authorized at September 30, 2023 and December 31, 2022; 264,111,257 and 236,895,440 issued and outstanding at September 30, 2023 and December 31, 2022, respectively	264	237
Preferred stock, $0.01 par value, 25,000,000 shares authorized, no shares issued and outstanding at September 30, 2023 and December 31, 2022	0	0
Additional paid-in capital	970,952	962,731
Accumulated deficit	(922,133)	(860,935)
Accumulated other comprehensive loss	(1,830)	(2,388)
Total Stockholders' Equity	47,253	99,645
Total Liabilities and Stockholders' Equity	70,727	116,053
Intellectual Property [Member]
Current Assets:
Intellectual property, net	$ 1,278	$ 1,576

Note 13 - Basic and Diluted Net Loss Per Share

9 Months Ended

Sep. 30, 2023

Earnings Per Share [Text Block]

13.

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. 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 basic weighted average outstanding common shares figures for the three and nine months ended September 30, 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 the computation of diluted net loss per share are as follows:

	September 30,
	2023		2022
Stock options		10,598,060		7,404,858
Nonvested restricted stock units		12,802,947		8,038,575
Stock warrants		24,830,500		1,021,076
Total		48,231,507		16,464,509

Note 9 - Accrued Expenses and Other Current Liabilities

9 Months Ended

Sep. 30, 2023

Accrued Liabilities [Text Block]

9.	Accrued Expenses and Other Current Liabilities

Accrued expenses and other current liabilities consisted of the following:

(In thousands)	September 30, 2023		December 31, 2022
Income and other taxes payable	$	694	$	839
Legal and professional fees		374		275
Royalties		23		24
Consulting services		167		155
Total accrued expenses and other current liabilities	$	1,258	$	1,293

Condensed Consolidated Statements of Operations and Comprehensive Loss (Unaudited) - USD ($) shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Revenue:
Revenue	$ 1,089,000	$ 2,563,000	$ 3,146,000	$ 4,623,000
Cost of revenue:
Cost of revenue	2,869,000	4,404,000	8,890,000	8,574,000
Gross loss	(1,780,000)	(1,841,000)	(5,744,000)	(3,951,000)
Operating expenses:
Research and development	9,290,000	6,741,000	28,409,000	20,422,000
Sales and marketing	4,138,000	3,615,000	13,140,000	10,936,000
General and administrative	4,571,000	4,853,000	15,163,000	15,378,000
Amortization of intangible assets	114,000	2,398,000	340,000	7,601,000
Change in fair value of contingent consideration	366,000	(416,000)	674,000	(1,168,000)
Impairment of property and equipment	0	0	0	432,000
Total operating expenses	18,479,000	17,191,000	57,726,000	53,601,000
Operating loss	(20,259,000)	(19,032,000)	(63,470,000)	(57,552,000)
Other income (expense), net
Change in fair value of warrant liabilities	2,278,000	0	2,278,000	0
Interest income	406,000	291,000	1,276,000	806,000
Interest expense	0	(99,000)	0	(440,000)
Other expense, net	(686,000)	(29,000)	(1,146,000)	(261,000)
Total other income, net	1,998,000	163,000	2,408,000	105,000
Loss before income taxes	(18,261,000)	(18,869,000)	(61,062,000)	(57,447,000)
Income tax expense	57,000	55,000	136,000	224,000
Net loss	$ (18,318,000)	$ (18,924,000)	$ (61,198,000)	$ (57,671,000)
Net loss per common share attributable to common stockholders - basic and diluted (in dollars per share)	$ (0.07)	$ (0.08)	$ (0.25)	$ (0.24)
Weighted average number of shares used in computing net loss per common share - basic and diluted (in shares)	256,184	236,713	244,744	236,373
Comprehensive loss:
Net loss	$ (18,318,000)	$ (18,924,000)	$ (61,198,000)	$ (57,671,000)
Foreign currency translation (loss) gain	(640,000)	(1,655,000)	84,000	(4,018,000)
Unrealized gain (loss) on available-for-sale investments	67,000	86,000	473,000	(610,000)
Comprehensive loss	(18,891,000)	(20,493,000)	(60,641,000)	(62,299,000)
Product [Member]
Revenue:
Revenue	301,000	1,964,000	892,000	2,565,000
Cost of revenue:
Cost of revenue	1,171,000	3,057,000	4,008,000	4,316,000
Service [Member]
Revenue:
Revenue	295,000	335,000	779,000	1,067,000
Cost of revenue:
Cost of revenue	581,000	365,000	1,849,000	1,506,000
Lease [Member]
Revenue:
Revenue	493,000	264,000	1,475,000	991,000
Cost of revenue:
Cost of revenue	$ 1,117,000	$ 982,000	$ 3,033,000	$ 2,752,000

Note 8 - Leases - Components of Operating Lease Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
General and Administrative Expense [Member]
Long-term Operating	$ 494	$ 408	$ 1,424	$ 1,192

Note 11 - Stock-based Compensation - Stock Option Activity (Details) - USD ($) $ / shares in Units, $ in Millions	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Options, Outstanding, Number of Shares (in shares)	7,584,967
Options, Outstanding, Weighted Average Exercise Price (in dollars per share)	$ 4.22
Options, Outstanding, Weighted Average Remaining Contractual Term (Year)	5 years 1 month 6 days	5 years 3 months 21 days
Options, Granted, Number of Shares (in shares)	3,047,615
Options, Grants in Period, Weighted Average Exercise Price (in dollars per share)	$ 0.71
Options, Exercised, Number of Shares (in shares)	(13,300)
Options, Exercises in Period, Weighted Average Exercise Price (in dollars per share)	$ 0.38
Options, Cancelled, Number of Shares (in shares)	(21,116)
Options, Expirations in Period, Weighted Average Exercise Price (in dollars per share)	$ 25.79
Options, Forfeited, Number of Shares (in shares)	(106)
Options, Forfeitures in Period, Weighted Average Exercise Price (in dollars per share)	$ 15.86
Options, Outstanding, Number of Shares (in shares)	10,598,060	7,584,967
Outstanding at September 30, 2023 (in dollars per share)	$ 3.17	$ 4.22
Options, Outstanding, Aggregate Intrinsic Value	$ 0
Options, Vested and Expected to Vest, Exercisable, Number of Shares (in shares)	10,132,754
Options, Vested and Expected to Vest, Exercisable, Weighted Average Exercise Price (in dollars per share)	$ 3.29
Options, Vested and Expected to Vest, Exercisable, Weighted Average Remaining Contractual Term (Year)	5 years 18 days
Options, Vested or Expected to Vest, Aggregate Intrinsic Value	$ 0
Options, Exercisable, Number of Shares (in shares)	5,591,291
Options, Exercisable, Weighted Average Exercise Price (in dollars per share)	$ 5.15
Options, Exercisable, Weighted Average Remaining Contractual Term (Year)	4 years 4 months 13 days
Options, Exercisable, Aggregate Intrinsic Value	$ 0

Note 5 - Investments, Available-for-sale - Summary of Investment Securities (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Amortized Cost	$ 11,451	$ 68,564
Unrealized Gain	0	0
Unrealized Loss	(31)	(504)
Fair Value	11,420	68,060
Short-term investments	11,420	64,195
Long-term investments	0	3,865
Commercial Paper [Member]
Amortized Cost	0	12,364
Unrealized Gain	0	0
Unrealized Loss	0	(49)
Fair Value	0	12,315
Short-term investments	0	12,315
Long-term investments	0	0
Corporate Debt Securities [Member]
Amortized Cost	4,960	55,201
Unrealized Gain	0	0
Unrealized Loss	(28)	(447)
Fair Value	4,932	54,754
Short-term investments	4,932	50,889
Long-term investments	0	3,865
US Treasury Securities [Member]
Amortized Cost	5,491
Unrealized Gain	0
Unrealized Loss	0
Fair Value	5,491
Short-term investments	5,491
Long-term investments	0
US Government Agencies Debt Securities [Member]
Amortized Cost	1,000	999
Unrealized Gain	0	0
Unrealized Loss	(3)	(8)
Fair Value	997	991
Short-term investments	997	991
Long-term investments	$ 0	$ 0

Note 6 - Inventory

9 Months Ended

Sep. 30, 2023

Inventory Disclosure [Text Block]

6.	Inventory

The components of inventory are as follows:

	September 30, 2023
(In thousands)	Gross Carrying Amount		Reserve Balance			Net Carrying Amount
Finished goods	$	11,750	$	(2,324	)	$	9,426
Raw materials		5,308		(2,411	)		2,897
Total inventories	$	17,058	$	(4,735	)	$	12,323

Current portion	$	7,380	$	(697	)	$	6,683
Long-term portion		9,678		(4,038	)		5,640
Total inventories	$	17,058	$	(4,735	)	$	12,323

	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 inventory	$	20,055	$	(6,302	)	$	13,753

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

Note 3 - Revenue Recognition

9 Months Ended

Sep. 30, 2023

Revenue from Contract with Customer [Text Block]

3.	Revenue Recognition

The following table presents revenue disaggregated by type and geography:

	Three Months Ended September 30,				Nine Months Ended September 30,
(In thousands)	2023		2022		2023		2022
U.S.
Systems	$	-	$	-	$	-	$	-
Instruments and accessories		71		60		169		142
Services		77		75		228		225
Leases		40		46		130		211
Total U.S. revenue		188		181		527		578

Outside of U.S. ("OUS")
Systems		-		1,227		-		1,228
Instruments and accessories		230		677		723		1,195
Services		218		260		551		842
Leases		453		218		1,345		780
Total OUS revenue		901		2,382		2,619		4,045

Total
Systems		-		1,227		-		1,228
Instruments and accessories		301		737		892		1,337
Services		295		335		779		1,067
Leases		493		264		1,475		991
Total revenue	$	1,089	$	2,563	$	3,146	$	4,623

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 September 30, 2023 was $0.7 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 (included in accounts receivable, net in the condensed consolidated balance sheets) for the periods presented.

Revenue recognized for the three months ended September 30, 2023 and 2022 that was included in the deferred revenue balance at the beginning of each reporting period was $0.2 million. Revenue recognized for the nine months ended September 30, 2023 and 2022 that was included in the deferred revenue balance at the beginning of each reporting period was $0.5 million and $0.7 million, respectively.

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

	September 30, 2023		December 31, 2022		December 31, 2021
(In thousands)
Contract Assets	$	54	$	116	$	91
Deferred Revenue	$	456	$	465	$	543

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 and nine months ended September 30, 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 as of September 30, 2023 and December 31, 2022. The Company recorded immaterial amounts for expected credit losses during the three and nine months ended September 30, 2023 and 2022.

The Company had four customers that accounted for 18%, 16%, 15% and 14%, respectively, of the Company’s net accounts receivable as of September 30, 2023. The Company had one customer that accounted for 69% of the Company’s net accounts receivable as of December 31, 2022.

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 15 - Segments and Geographic Areas

9 Months Ended

Sep. 30, 2023

Segment Reporting Disclosure [Text Block]

15.

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 long-lived assets (which include property and equipment and operating lease assets) by geographic area:

	September 30, 2023			December 31, 2022
U.S.		37	%		39	%
EMEA		57	%		57	%
Asia		6	%		4	%
Total		100	%		100	%

The following table presents revenue by geographic area based on the country in which the customer is based:

	Three Months Ended September 30,						Nine Months Ended September 30,
	2023			2022			2023			2022


US		17	%		7	%		17	%		13	%
EMEA		64	%		86	%		62	%		72	%
Asia		19	%		7	%		21	%		15	%
Total		100	%		100	%		100	%		100	%

For the three months ended September 30, 2023, one customer accounted for more than 10% of revenue. For the nine months ended September 30, 2023, no customers accounted for more than 10% of revenue. For the three and nine months ended September 30, 2022, the Company had one customer who accounted for more than 10% of revenue.

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.

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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Note 4 - Fair Value Measurements - Summary of Change in Fair Value for Warrants (Details) - Warrant [Member] $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Balance	$ 0
Issuance of warrants	7,120
Change in fair value	(2,278)
Balance	$ 4,842

Note 6 - Inventory - Components of Inventories (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Finished goods, gross	$ 11,750	$ 15,337
Finished goods, reserve	(2,324)	(4,129)
Finished goods, net	9,426	11,208
Raw materials, gross	5,308	4,718
Raw materials, reserve	(2,411)	(2,173)
Raw materials, net	2,897	2,545
Total inventories, gross	17,058	20,055
Total inventories, reserve	(4,735)	(6,302)
Total inventories, net	12,323	13,753
Current Portion, gross	7,380	9,399
Current Portion, reserve	(697)	(1,115)
Inventory, net	6,683	8,284
Long-term portion, gross	9,678	10,656
Long-term portion, reserve	(4,038)	(5,187)
Inventory, net of current portion	$ 5,640	$ 5,469

Note 1 - Description of Business

9 Months Ended

Sep. 30, 2023

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

1.	Description of Business

Asensus Surgical, 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 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’s control and reduce variability of surgical outcomes. With the addition of machine vision, augmented intelligence, and deep learning capabilities throughout the surgical experience, the Company intends 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 11 - Stock-based Compensation (Tables)

9 Months Ended

Sep. 30, 2023

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

	Number of Shares			Weighted-Average Exercise Price		Weighted-Average Remaining Contractual Term (Years)		Aggregate Intrinsic Value (Millions)
Outstanding at December 31, 2022		7,584,967		$	4.22		5.31
Granted		3,047,615		$	0.71
Exercised		(13,300	)	$	0.38
Cancelled		(21,116	)	$	25.79
Forfeited		(106	)	$	15.86
Outstanding at September 30, 2023		10,598,060		$	3.17		5.10	$	-
Vested or expected to vest at September 30, 2023		10,132,754		$	3.29		5.05	$	-
Exercisable at September 30, 2023		5,591,291		$	5.15		4.37	$	-

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

	Nine Months Ended September 30,
	2023		2022
Expected volatility		124% - 130%		128% - 133%
Risk-free interest rate		3.53% - 4.14%		1.25% - 2.98%
Expected life (in years)		3.8 - 4.5		3.8 - 4.5
Expected dividend yield		0%		0%
Weighted average grant date fair value		$0.59		$0.60

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

	Number of Shares			Weighted-Average Grant Date Fair Value
Outstanding at December 31, 2022		8,483,491		$	1.04
Granted		8,482,315		$	0.71
Vested		(3,623,411	)	$	1.14
Forfeited		(539,448	)	$	0.76
Outstanding at September 30, 2023		12,802,947		$	0.82

Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Table Text Block]

	Three Months Ended September 30,				Nine Months Ended September 30,
(In thousands)	2023		2022		2023		2022
Stock options	$	552	$	913	$	1,808	$	2,812
Restricted stock units		1,037		772		2,873		2,480
Performance restricted stock units		430		348		1,232		1,069
	$	2,019	$	2,033	$	5,913	$	6,361

Note 12 - Equity Offerings - Summary of Sales Under Offering (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2023	Sep. 30, 2022
Net proceeds		$ 9,946	$ 0
The 2022 ATM Offering [Member]
Shares of common stock issued (in shares)	78,600	433,672
Gross proceeds	$ 25	$ 227
Commission paid to Agents	1	7
Net proceeds	$ 24	$ 220
The 2022 ATM Offering [Member] \| Arithmetic Average [Member]
Average price per share (in dollars per share)	$ 0.31	$ 0.52

Note 11 - Stock-based Compensation - RSU Activity (Details) - Restricted Stock Units (RSUs) [Member]	9 Months Ended
	Sep. 30, 2023 $ / shares shares
Beginning of period, Restricted stock units, Unvested (in shares) \| shares	8,483,491
Beginning of period, Restricted stock units, Unvested, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 1.04
Restricted stock units, Granted (in shares) \| shares	8,482,315
Restricted stock units, Granted, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 0.71
Restricted stock units, Vested (in shares) \| shares	(3,623,411)
Restricted stock units, Vested, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 1.14
Restricted stock units, Forfeited (in shares) \| shares	(539,448)
Restricted stock units, Forfeited, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 0.76
Beginning of period, Restricted stock units, Unvested (in shares) \| shares	12,802,947
Beginning of period, Restricted stock units, Unvested, weighted average grant date fair value (in dollars per share) \| $ / shares	$ 0.82

Note 14 - Commitments and Contingencies

9 Months Ended

Sep. 30, 2023

Commitments and Contingencies Disclosure [Text Block]

14.

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 (remaining three months)	$	4,223
2024		1,543
2025		314
2026		303
Total commitments	$	6,383

Note 11 - Stock-based Compensation - Stock Option Valuation Assumptions (Details) - $ / shares	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Expected dividend yield	0.00%	0.00%
Weighted average grant date fair value (in dollars per share)	$ 0.59	$ 0.6
Minimum [Member]
Expected volatility	124.00%	128.00%
Risk-free interest rate	3.53%	1.25%
Expected life (in years) (Year)	3 years 9 months 18 days	3 years 9 months 18 days
Maximum [Member]
Expected volatility	130.00%	133.00%
Risk-free interest rate	4.14%	2.98%
Expected life (in years) (Year)	4 years 6 months	4 years 6 months

Note 3 - Revenue Recognition 2 (Details Textual) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-10-01 - USD ($) $ in Millions	Sep. 30, 2023	Jun. 30, 2023
Revenue, Remaining Performance Obligation, Amount	$ 0.7
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 13 - Basic and Diluted Net Loss Per Share - Antidilutive Securities Excluded from Computation of Earnings Per Share (Details) - shares	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	48,231,507	16,464,509
Share-Based Payment Arrangement, Option [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	10,598,060	7,404,858
Restricted Stock Units (RSUs) [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	12,802,947	8,038,575
Warrant [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share (in shares)	24,830,500	1,021,076

Note 16 - Related Party Transactions (Details Textual) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Asensus Surgical Europe S.à.R.L [Member] \| 1 Med S.A. [Member] \| Service Supply Agreement [Member]
Operating Costs and Expenses	$ 2,000	$ 67,000	$ 73,000	$ 208,000

Note 2 - Summary of Significant Accounting Policies (Details Textual) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Retained Earnings (Accumulated Deficit)	$ (922,133)	$ (860,935)
Working Capital	$ 33,800

Amount of accumulated undistributed earnings (deficit).

+ References + Details

Note 9 - Accrued Expenses and Other Current Liabilities - Components of Accrued Expenses (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Income and other taxes payable	$ 694	$ 839
Legal and professional fees	374	275
Royalties	23	24
Consulting services	167	155
Total accrued expenses and other current liabilities	$ 1,258	$ 1,293

Note 14 - Commitments and Contingencies (Tables)

9 Months Ended

Sep. 30, 2023