Investor Presentation TSX: TMD / OTCQX: TITXF
May 2016
Forward Looking Statements This presentation contains "forward-looking statements" which reflect the current expectations of management of the Company's future growth, results of operations, technological development and implementation, performance and business prospects, opportunities, and illustrations and prototypes of the SPORT™ Surgical Systems. Wherever possible, words such as "may", "would", "could", "will", "anticipate", "believe", "plan", "expect", "intend", "estimate" and similar expressions have been used to identify these forward-looking statements. These statements reflect management's current beliefs with respect to future events and are based on information currently available to management. Forward-looking statements involve significant risks, uncertainties and assumptions. Many factors could cause the Company's actual results, performance, achievements or technological development and implementation to be materially different from any future results, performance, achievements or technological development and implementation that may be expressed or implied by such forward-looking statements, including, without limitation, those listed in the "Risk Factors" section of the Company's Annual Information Form in respect of the fiscal year ended December 31, 2015 and other information contained in the Company’s public filings (which may be viewed at www.sedar.com). Information contained in this presentation is qualified in its entirety by such public filings. Should one or more of these risks or uncertainties materialize, or should assumptions underlying the forward looking statements prove incorrect, actual results, performance or achievements may vary materially from those expressed or implied by the forward-looking statements contained in this presentation. These factors should be considered carefully and prospective investors should not place undue reliance on the forward-looking statements. Although the forward-looking statements contained in the presentation are based upon what management currently believes to be reasonable assumptions, the Company cannot assure prospective investors that actual results, performance or achievements will be consistent with these forward-looking statements. This presentation does not constitute an offer to sell any class of securities of the Company in any jurisdiction.
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PG 2
Co mp an y Ov erv iew
Titan Medical is… the designer and developer of SPORT™, a highly versatile single incision advanced surgical system that significantly expands the addressable market for single and multiquadrant abdominal surgeries performed on a robotic platform. The System is designed to provide superior clinical capabilities and unparalleled OR efficiency at operating costs similar to traditional laparoscopic surgery.
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PG 3
Co mp an y Ov erv iew
Investment Considerations •
Addressing market opportunity for robotic surgery valued at $20 billion* by 2021
•
Highly versatile single incision advanced surgical technology including 13 patents and 30 patent applications pending
•
Substantial benefits to patient, surgeon and hospital versus competitive offerings
•
More features, more OR flexibility, lower cost, improved economics versus da Vinci®
•
Highly experienced management team with significant track record of success
•
Attractive business model; expect 510(k) submission in the second half of 2017**
* Source: WinterGreen Research Report 2014 ** Last reported in Titan MD&A filed May 16, 2016
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PG 4
Co mp an y Ov erv iew
Robotic Surgery Market Opportunity Total market opportunity for robotic surgery valued at $20 billion
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PG 5
Bu sin ess Ov erv iew
$10B Capital Revenue Opportunity US HOSPITALS FOR ROBOTIC SYSTEMS da Vinci Penetration
Available Market
~ 10,500 Placement Opportunities with $10B Capital Revenue Potential
(1)
6000
1000
3500
1000 P RI M A RY A N D S E CON D A RY
(1) $950K per system and on average, 1 system per hospital
0
T E RT I A RY
0
A M BU LA T OR Y S U RG E RY CE N T E RS /
PG 6
Bu sin ess Ov erv iew
$3.75B in Annual Recurring Revenue $3,000,000,000
~ 2.5M Available Procedures with $2.7B Procedure Revenue Potential (2)
$2,500,000,000
$2,000,000,000
$1,500,000,000
~ 10,500 Placement Opportunities with $1.05B Service Revenue Potential (1)
$2,700,000,000
$1,000,000,000
$500,000,000
$0
(1) (2)
$1,050,000,000
Service Revneue
$100K of Annual Service Revenue $1075 per procedure revenue
Procedure Revenue /
PG 7
SPORT Robotic Surgery Open Surgery - Broad application - Requires significant hospital stay and recovery time - Significant risk of adverse events
MIS - Minimally Invasive Surgery (“MIS”) has been a growing trend over the past 25 years - Reduced hospitalization time - Reduced risk of adverse events - Requires highly skilled surgeons
- Further expands upon the benefits of MIS - Robotic procedures have grown
- A premier solution that will transform the challenges facing robotics today - Will be significantly
from 1,000 procedures in 2000 to
more affordable, agile
650,000* in 2015
and versatile as compared to existing
- However, most robots are
robotic solutions
expensive and have procedural and operational limitations /
* Source: Intuitive Surgical Earnings Call Transcript for Q4 2015
PG 8
SPORT™ Mark et Ov erv iew
Evolution of Surgical Care
To mitigate the downside of MIS and improve surgical care of patient outcomes, robotic technology was introduced to the operating room:
Challenges
Benefits - Better Dexterity
- High Cost of Entry
- Improved 3D Visualization
- Huge Footprint
- Improved Ergonomics
- High Level of Training - Increased Cost For Each Case
- Reduced Operational EfficiencyLong Setup Time - Low ROI for Hospitals - Limited Procedural Capability
Last year only 650,000 surgeries out of a possible 4,000,000 were done using a robot… “Proven technology is easily replaced by same or better if it provides a greater ROI--clinically, financially and operationally” - Rand A. Ballard, Chief Commercial Officer, Vizient Inc. (New VHA, MedAssets, Novation and UHS Combined Entity)
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PG 9
SPORT™ Pro d u ct Ov erv iew
Today’s Robotic Surgery Environment
Benefits to Patient
Benefits to Surgeon
Benefits to Hospital
- Less Pain
- Improved Visualization with 3D Vision
- Decreased Length of Hospital Stay
- Quicker Recovery
- Improved Dexterity With Multi-
- Increased Patient Satisfaction
- Fewer and Smaller Scars - Shorter Hospital Stay - Reduced Blood Loss - Reduced Risk of Infection
Articulating Instruments - Easier and Shorter Learning Curve
- Potentially Longer Operating Careers of Surgeons
- Improved Precision
- Increased Surgical Case Volume
- Improved Ergonomics
- Employee Participation and Retention
- Automation of Tasks and Subtasks
- Improved ROI- Clinically, Financially, and Operationally
“A surgeon could use SPORT for every abdominal operation!” - David Larson, Chief of Colorectal Surgery, Mayo Clinic, Rochester, MN /
PG 10
SPORT™ Mark et Ov erv iew
SPORT: Benefits
SPORT: Robotic Surgery Optimized Single-Arm Mobile Patient Cart Open 3D High Definition Visualization
Ergonomic Mobile Workstation
Camera Insertion Tube with Self-Cleaning Lens
Natural Multi-articulated Handle Control Interface Multi-articulated Instruments with Replaceable Tips
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PG 11
SPORT™ Pro d u ct Ov erv iew
SPORT Workstation - Highly Ergonomic Design - Natural Multi-articulated Handle Interface with Proximity Finger Sensors - Open Un-obtrusive 3D High Definition Platform with 32-inch Flat-screen Monitor - Multi-configurable Elbow Resting and Pedal Positioning Feature - Adjunct Touchscreen LCD monitor that can interface to hospital information systems, including PACS for images - Swiveling Easy Gliding Coasters /
PG 12
SPORT™ Ov erv iew
SPORT Patient Cart - Single-arm configuration - Mobile, compact, transportation capability - Easy to maneuver and position Central Unit - Easy to load and unload Camera Insertion Tube (CIT) and Instrument Interface - Single cable for easy cable management
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PG 13
SPORT™ Pro d u ct Ov erv iew
SPORT CIT and Instruments - Camera Insertion Tube (CIT) accommodates 2 multi-articulated instruments with self-cleaning dual channel camera - 10 Multi-Articulated Multi-Use instruments with Single-Use Replaceable Tips - Monopolar, Bipolar, Vessel Sealing and Clip Applier capabilities - Multi-quadrant access
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PG 14
SPORT in Actio n
SPORT in Action
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PG 15
SPORT™ Mark et Ov erv iew
Intellectual Property The SPORT system is a single incision robotic surgical system that has been developed from the ground up with a unique technical footprint Patents & Patent Applications
Licensed Technology
- 11 U.S. Patents
- 2 U.S. Patent
- 27 Patent Applications
- 3 Patent Applications (US, EP)
(PCT, US, EP, CA, CN, JP, IN)
The Company anticipates expanding its patent portfolio by filing patent applications as it progresses in the development of robotic surgical technologies and by licensing suitable technologies /
PG 16
SPORT™ Mark et Ov erv iew
Competition Critical Features for Robotic Surgery
SPORT™
daVinci®
SurgiBOT™
Alf-X™
Multi-Articulated Instruments 3D High Definition Visualization Natural Handle Control (left is left, right is right, up is up and down is down) Ergonomic Surgeon Workstation or Console Needle Driver/ Graspers/ Monopolar / Bipolar / Advanced Instruments Dual Channel Endoscope for High-caliber 3-D Mobile, Low Profile Footprint with Minimal Cables (Ease of Transportation) Ease of Setup (single arm is easy, having multiple arms is complex) Quick and Easy Intraoperative Multi Quadrant Access New Tips for each procedure (No compromise on instrument performance) Open, Non-isolated Display (Surgeon always has direct view of OR table) Scope Lens-washing Capability (Minimal scope cleaning adds to efficiency) Tool or Eye tracking Camera Movement (Least disruptive to procedural flow)
PG 17 Source: Product Information from Intuitive Surgical and TransEnterix websites
SPORT™
daVinci®
~$950,000
~$1,800,000 (1)
No. of Cases Amortized Over (7 years at 150 per year)
1,050
1,050
Amortized Robot Cost Per Case
$905
$1,714
Instrument and Accessory Cost Per Case
$1,075
$1,835
Annual Service Agreement (10% of System Cost)
$95,000
$180,000
Amortization Period (150 cases)
150
150
Cost of Service Agreement Per Case
$634
$1,200
$2,614
$4,749
System Cost
Estimated Cost Per Procedure (1)
Initial cost of daVinci will vary based on features purchased
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PG 18
SPORT™ Mark et Ov erv iew
SPORT vs da Vinci® - Hospital Savings Per Procedure
Bu sin ess Ov erv iew
Rated Top 5 at GPO Technology Expo! Example - Med Assets – New Technology Meeting -
One of the largest GPOs – 4,500 acute care members
-
200+ applicants – Only 88 selected
-
420 committee members (representing 200 healthcare systems) reviewed new technologies and rated them on a scale of 1-5 in 5 key areas: -
Innovative technology
-
Improves quality of care at my facility
-
Improves efficiencies at my facility
-
Meets a need in healthcare
-
Ready to purchase /
PG 19
“I see this as a potential in most of my bariatric patients….” “Out of all the robotic platforms I’ve seen, this is the best design and has the most potential….”
“You have to create a sense of organization around robotic surgery to understand that the robotic system is a total program, not a piece of technology.” “Proven technology is easily replaced by same or better if it provides a greater ROI--clinically, financially and operationally” /
PG 20
SAGES March 2016
Voice of Customer – SAGES and AORN
•
Initiate usability study – 1H 2016
•
Complete usability study – 2H 2016
•
Optimization trials – 1H 2017
•
System design freeze – 1H 2017
•
Build design verification units / Initial audit for CE mark – 2H 2017
•
Complete design verification and validation – 2H 2017
•
Final CE mark audit – 2H 2017
•
Submit 510 (k) application to FDA – 2H 2017
Milestones
Remaining Development Milestones
Bu sin ess Ov erv iew
Titan Medical: Clinical Adoption Strategy -
Develop clinical support – Regional Centers of Excellence by Specialty
-
Develop executive support – Executive Champions Network for Execution Guidance
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Deliver “ROI” to support the program investment for Healthcare Institutions
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Train, support and service our customers
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PG 22
Summary
Financial Snapshot
TMD (TSX), TITXF (OTCQX)
Share price (TMD)
$0.78 (As of May 24, 2016)
Shares outstanding
145.4 million FD*
Management ownership (3/31/16)
4.48%
Cash, cash equivalents (3/31/16)
$12 million
*Fully diluted includes, under the Treasury Stock method, an additional 3,453,055 options with a weighted-average exercise price of CDN $1.32, as well as common shares issued as result of the public offering, November 16, 2015 and the private placement of November 23, 2015.
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PG 23
Summary
Summary •
Addressing market opportunity for robotic surgery valued at $20 billion by 2021
•
Highly versatile single incision advanced surgical technology including 13 patents and 30 patent applications pending
•
Substantial benefits to patient, surgeon and hospital versus competitive offerings
•
More features, more OR flexibility, lower cost, improved economics versus da Vinci®
•
Highly experienced management team with significant track record of success
•
Attractive business model; expect 510(k) submission in the second half of 2017
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PG 24
Thank You TSX: TMD / OTCQX: TITXF
Co mp an y Ov erv iew
Management Team John Hargrove, Chairman & CEO -
40 years of executive-level health care experience
-
Vice President of Corporate Accounts, Johnson & Johnson; President, Corporate Account Management, Ohmeda Inc.
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B.A. from the University of Georgia
Dr. Reiza Rayman MD, PhD, President -
Collaborated in the world’s first robotic beating heart cardiac bypass surgery in September 1999
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Entrenched researcher on all available robotic platforms, Active practitioner with over 400 robotic surgeries under belt
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M.D. from Univ of Toronto and Ph.D. in Telesurgery from Univ of Western Ontario; M.Sc. In Fluid Dynamics from Univ of Western Ontario,
Stephen Randall, CFO -
+19 years of Executive level experience
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Extensive experience in accounting, finance, capital markets, tax planning, compliance, IT management, mergers/acquisitions and operations
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CPA, CGA, B. Comm
Dr. Dennis Fowler MD, MPH, Executive Vice President, Clinical and Regulatory Affairs -
Co-inventor of the single-incision Insertable Robotic Effector Platform (IREP) technology licensed from Columbia University to Titan Medical
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Certified by the American Board of Surgery; Formerly the Gerald and Janet Carrus Professor of Surgical Science, Director of the Center for Innovation and Outcomes Research in the Department of Surgery, Columbia University College of Physicians and Surgeons
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MD from University of Kansas School of Medicine, Master in Public Health from Columbia University
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PG 26
Co mp an y Ov erv iew
Commercial Leadership Team Sachin Sankholkar, Vice President, Marketing -
+15 Years of Robotic Device Development, Launch and Marketing Experience at Intuitive Surgical, +19 Years of Med Device Experience
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Exceptional Surgeon Network and KOL Development Expertise in GYN, Urology, General, Colorectal and Bariatric Surgery.
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M.B.A. in Marketing and General Management at USC Marshall School of Business, M.S. in Biomedical Engineering at Drexel University
Paige Hargrove, Vice President, WW Sales -
+8 Years of Robotic Sales and Management Experience at Intuitive Surgical and Stereotaxis, +11 Years of Tenure at J&J
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Years of track record with team building, strategic planning, training, customer retention and business development
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BA, Bloomsburg University of Pennsylvania
Chris Seibert, Vice President, Corporate Accounts -
+10 Years of Robotic Sales and Management Experience at Intuitive Surgical and Stereotaxis, +12 Years of total Med Device Experience
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Entrenched IDN/GPO sales channel expertise and C-level access/network within top GPOs/IDNs
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MBA at University of South Alabama; MA at University of Oklahoma; BA at University of Alabama.
Frederic Nahon, Vice President, Sales EMEA and Asia -
+ 12 Years of Capital/Clinical Sales Management Experience at Intuitive Surgical, Stereotaxis and Imacor
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Sergeant Major in the French Army;
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OR Chief, Hospital Jean Prince, Tahiti, French Polynesia. /
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