The dawn of surgery bots + buy a home for $250 (w/ Andromeda & Mogul) | E2313

The dawn of surgery bots + buy a home for $250 (w/ Andromeda & Mogul) | E2313 This Week In Startups is made possible by: Northwest Registered Agent https://northwestregisteredagent.com/twist CLA https://claconnect.com/withyou MongoDB https://MongoDB.com/ai Today's show: *Andromeda Surgical is building the autonomy layer that could one day allow robots to perform surgery. Rather than building their own intricate, complex hardware, Andromeda uses off-the-shelf arms from a German manufacturer, and focuses on the software that will allow doctors to operate it from an iPad. Plus Mogul co-founder and CEO Alex Blackwood shows Jason how his platform lets anyone buy fractional shares of rental homes for as little as $250, earning monthly dividends, appreciation, and tax benefits without the headache of being someone's landlord. It's a founder double feature on a brand new TWiST. Guests: Nick Damiano on X: https://x.com/nickdamian0 Andromeda Surgical: https://www.andromedasurgical.com/ Alex Blackwood on X: https://x.com/blackwoodtweets Mogul: https://www.mogul.club/ Relevant Links: KUKA: https://www.kuka.com/ Intuitive Surgical (and Da Vinci 5): https://www.intuitive.com/en-us Neuralink: https://neuralink.com/ Padsplit: https://www.padsplit.com/ AngelList: https://www.angellist.com/ The Syndicate: https://thesyndicate.com/ Timestamps: 0:00 The iPad controlled surgery bot 5:46 Building "Google Maps for the body" 10:10 Northwest Registered Agent - Get more when you start your business with Northwest. In 10 clicks and 10 minutes, you can form your company and walk away with a real business identity — Learn more at https://northwestregisteredagent.com/twist 14:28 What is a "sous surgeon" 20:46 CLA - Innovation takes balance. CLA's CPAs, consultants, and wealth advisors can help you get from startup to where you want to end up. Get started now at https://www.claconnect.com/withyou 24:30 The Neuralink connection 29:40 Understanding Mogul's business model 31:01 MongoDB - AI-assisted and agentic coding is helping you build faster than ever. Start building at https://MongoDB.com/ai 33:32 So who manages the homes? 36:50 Dividends vs. Appreciation 44:57 How Mogul picks markets Subscribe to the TWiST500 newsletter: https://ticker.thisweekinstartups.com Check out the TWIST500: https://www.twist500.com Subscribe to This Week in Startups on Apple: https://rb.gy/v19fcp Follow Lon: X: https://x.com/lons Follow Alex: X: https://x.com/alex LinkedIn: ⁠https://www.linkedin.com/in/alexwilhelm Follow Jason: X: https://twitter.com/Jason LinkedIn: https://www.linkedin.com/in/jasoncalacanis Check out all our partner offers: https://partners.launch.co/ Great TWIST interviews: Will Guidara, Eoghan McCabe, Steve Huffman, Brian Chesky, Bob Moesta, Aaron Levie, Sophia Amoruso, Reid Hoffman, Frank Slootman, Billy McFarland Check out Jason's suite of newsletters: https://substack.com/@calacanis Follow TWiST: Twitter: https://twitter.com/TWiStartups YouTube: https://www.youtube.com/thisweekin Instagram: https://www.instagram.com/thisweekinstartups TikTok: https://www.tiktok.com/@thisweekinstartups Substack: https://twistartups.substack.com

• 0:00Speaker 00

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• 0:42Speaker 02

  This week in startups is brought to you by MongoDB. AI-assisted and agentic coding is helping you build faster than ever. Start building at mongodb.com/ai. CLA, innovation takes balance. CLAs, CPAs, consultants, and wealth advisors can help you get from startup to where you want to end up. Get started now at claconnect.com/withyou. And Northwest Registered Agent. Get more when you start your business with Northwest. In 10 clicks in 10 minutes, you can form your company and walk away with a real business identity. Learn more at northwestregisteredagent.com/twist.

• 1:21Speaker 03

  Hello and welcome back to Twist. This is Alex. Now, have you read the books in the Expanse series or seen the show? One of my favorite parts of it is whenever they get hurt, they get shot, they get irradiated, whatever it is, they go back to their ship and they put their hand and arm into a little device and it fixes them. I've always thought that was a beautiful vision of the future. No matter what's wrong with you, there's this machine that can put you back together again. Now, we're a long way from that today. If you go into the doctor today, it's a person. If you get some surgery done, probably also a person, and on down the healthcare chain. But there are companies right now working on building us towards a more robotic and more autonomous healthcare future, including in the realm of surgery. Now, that will either delight you or terrify you, but I wanted to learn more about where the technology is today and how quickly

• 2:05Speaker 03

  it's advancing. So please join me in welcoming to the show. It's Nick Damiano, the CEO and co-founder of Andromeda Surgical. Nick, how are you?

• 2:12Speaker 04

  Doing well. Great to be here.

• 2:13Speaker 03

  I forgot to ask before we started, are you a science fiction fan?

• 2:16Speaker 04

  I am.

• 2:16Speaker 03

  That interview was perfect for you. Let's start by defining where the company is going. You said on LinkedIn that, quote, "Surgery is currently almost untouched by AI, but in 10 years, AI and autonomy will be ubiquitous." So paint that picture for me. Where are we going to be in a decade? And then I want to go back to where we are now.

• 2:34Speaker 04

  Yeah, I mean, like a lot of labor in the world, surgeons are going to be totally transformed by AI in the next decade. Right now, surgery is way behind where it really should be in terms of where we are in terms of tech. So we're somewhere between the, to use a driving analogy, the horse and buggy era and the car era now. There's not really much autonomy happening at all, whereas for driving, of course, we have Tesla, Waymo, and others deploying autonomous cars on roads now. So we're taking surgery to that point where it's going to be mostly autonomous. Surgeons will still have a job and a role to play, but a lot of it's going to be done by AI.

• 3:13Speaker 03

  So now, you guys currently have a system that involves an iPad app, endoscopy. So we have a camera. We can look and see where we are. You work with surgeons. So it's kind of surgeon mediated. And there's also a robotic arm doing some of the work. It might be better if you do explain kind of what the current Andromeda system is and then what procedures it can kind of currently tackle.

• 3:33Speaker 04

  Yeah, so it is a robot that's controlled by an iPad. The robot is fairly simple. It's an off-the-shelf arm. We don't want to be a company that builds lots of complex hardware. The exciting part is really in the software. And so what's happening on the iPad is the important part.

• 3:50Speaker 03

  Okay.

• 3:50Speaker 04

  We are starting with urology with this procedure called HOLEP. It's for BPH or enlarged prostate, something that almost every man gets at some point in life. And then we're expanding from there into other urology and then other, a lot of other surgical procedures to where this can be a general platform doing most types of surgery eventually.

• 4:10Speaker 03

  If I was thinking about the realm of surgery, and you know, as a non-surgeon, I'm clearly an expert, I don't know if I would have gone with urology and endoscopy because it involves putting things in sensitive places, which to me seems a little bit terrifying. So just because I'm such a layperson here, why was this the right procedure to pick as kind of the company's wedge point into our future, more autonomous surgical future?

• 4:32Speaker 04

  Yeah, one of the things you wouldn't expect in surgery is that urologists were the first adopters of robots and really one of the most tech-forward types of surgeons. So like intuitive with the DaVinci robot started in urology initially. There are a lot of procedures, though, like this HOLEP procedure, that are not done with robots now. So DaVinci covers some of it, but then we're covering basically everything else in urology. We have these surgeons that love robots, that really want new tech to do these other procedures. And this HOLEP procedure specifically is one that's really hard to do. And you've got this huge gap between somebody who's just learning, who takes like five hours and struggles through a procedure, and then the

• 5:13Speaker 04

  best in the world who's doing it in 30 minutes easily. And so we want to elevate everybody from the novice on up, up to that level of the best surgeon who's just cranking through eight or 10 cases in a day with no problem.

• 5:26Speaker 03

  This begs the question of what in the current system is autonomous, what is educational, and what is assistive? I'm trying to figure out kind of today, what can Andromeda bring to a surgeon who hasn't done a HOLEP procedure before to help get them from, oh, God, this sounds scary, to I can do three or four or eight of these in a day?

• 5:46Speaker 04

  So right now, you can do it robotically with the iPad. And so that's like, just kind of table stakes for a robot. You can do the procedure using our controls. And then we've built some early autonomy features. One is like Google Maps for the body, where it tracks the landmarks and what you've done in the surgery so far in real time throughout the procedure. So you always have that spatial sense and just know where you are and what you need to do next. And then there's also, we built this auto pivoting where instead of having to worry about all the degrees of freedom of the scope, it controls the pivot point and kind of auto adapts to force to minimize. As you can imagine, in the area that urologists operate, you don't want to have these huge forces applied where it's going

• 6:30Speaker 04

  to cause all kinds of damage. And so we automatically minimize that, which we think will reduce the incidence of things that are damaging in that space. And then we're releasing software every week. So we, we're in the cadaver lab, we're in the clinic doing live cases all the time, and then we're building stuff. And every week we release new features and are improving the autonomy level to where it's becoming more and more autonomous and then easier and easier, of course, for the surgeon.

• 6:57Speaker 03

  Yeah, to be clear, I was not trying to be rude by saying what autonomy exists yet. I think you're laying the correct foundation, the right technology to get there. I'm just trying to figure out kind of like, as we draw this arc forward, where are we starting from? Because currently, as far as I can tell, there's no autonomous surgery being done. So we're, you have to build this. Now, data is an interesting question that I talk to you about with everyone in the broader AI space. And you know, scraping websites does not apply to you, nor does bring you in enterprise B2B workflow data. How do you get the information to train systems about human tissue and surgeries and such? Because I would presume there's a lot less to get to scrape. So how do you get the right stuff to teach these robots to be more autonomous?

• 7:40Speaker 04

  The data is hard to get. That's one of the things in this space that's really challenging, and it becomes a moat for any company that operates in this space. Once you get that data, you can get surgical videos from YouTube. And we've actually talked to a lot of surgeons that are YouTube creators that have shared some of their videos. So we have a huge data set of that type. But then there are other things like the robot kinematics, the forces, anything else you can pick up in the procedure that is not available from just videos. So we have to get that data ourselves because no one's ever collected that. So then being out in the clinic, doing these cases is how we, we get it. Right now, we've done, I think, the only, we've done 45 cases, and it's the only data set of 45 cases that exists. Like,

• 8:21Speaker 04

  that's 100% of the world's data. And it's really hard for anyone else to, to get that.

• 8:26Speaker 03

  Yeah. So then, as you want to add procedures, you know, moving away from just HOLEP and urology and endo urology, I think is the phrase that I had to learn while prepping for our chat today. How, are you going to have to go out and do that as well? Or are there data sets that exist that you could bring to bear on bringing more autonomy to robotics? Or is this going to be, you guys have to create it every time you want to add collarbone surgery or whatever it is?

• 8:52Speaker 04

  So it is scalable in a few ways, where we're not just starting from zero. One, one thing is that you can break surgery down into a series of surgical tasks. And so once we can make tasks autonomous, those might be repeated in different procedures. And so that's one way we're going to be able to scale faster and faster as we build. And then we can also go back to the tactic of taking videos for different procedures. There's people even building databases of surgical videos. So to at least get started, we can access those or talk to the surgeons we work with, get videos, and build some basic features based on that, and then expand from, from there.

• 9:26Speaker 03

  Is there a flywheel effect? Like, as you get a bunch of data from other parts of the body, like if you get really good at working on livers, does that apply anywhere else? Or is the body sufficiently specialized that what works for kidneys in terms of pressure or sensitivity or vision or whatever, does not apply to, I'm going to name another thing, a gallbladder?

• 9:43Speaker 04

  Yeah, because the set of surgical tasks people do now is finite and pretty small, then yes, you can, you can generalize across procedures. If you do a, say, a prostate annuiation versus an eye annuiation, there are similarities to that. And so in different parts of the body, you can repeat some of the stuff you've built. And that's how we're planning to scale from maybe one or two new procedures a year now, then up to four, five, hopefully 10 someday.

• 10:10Speaker 00

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• 11:04Speaker 03

  You just mentioned that there's kind of a finite number of surgeries that we do. That's a very interesting comment to me because when I think about it, surgery does seem to be... Relatively broad, but it sounds like it's actually more narrow and more systematized than I might have thought.

• 11:18Speaker 04

  It is. So there's, there's a finite number of surgeries and it's, it's the world in general is more bounded than, for example, driving. There are just fewer edge cases. Not that there aren't edge cases. Surgery is, the body is more variable than you would, would think, but it's a lot less complex than the entire outside world that cars are operating in. The data is more scarce, so you don't have as much training data to go on, but then the world is less complex. And most importantly, you don't have these other adversarial actors like other cars or pedestrians. You have to model their behavior when you're in surgery. There's nobody else working against you, fortunately, when you're in the human body.

• 11:53Speaker 03

  No, that, that makes, that makes a lot of sense. I mean, because the body can't fight back because I presume everyone who's getting a surgery done in this way is unconscious, so they're not even moving. They're just, you know, pretty much static. No, I appreciate that. So when you decided to build the company,

• 12:08Speaker 03

  was it kind of made possible by the fact that there are now off the shelf robotic arms that are sufficiently finely controlled and, and workable that you can build this? Is that, is that a new thing in the market?

• 12:19Speaker 04

  That is, that is new. There's, there's this arm from Kuka that we use right now. They're a German company that makes robot arms for different use cases. And there weren't that many until very recently you could use off the shelf. We could have possibly built one, though it would have been a lot more complexity for us to take on. I think also for the world being ready for this, there are two factors that had to exist before this for people to really embrace this concept. And one was surgical robots in general, mostly DaVinci from intuitive. And then autonomous driving, because now people are accepting that cars can drive themselves with Waymo and Tesla and so on. So those two things coexisting make the world a lot more receptive to what we're building now.

• 12:58Speaker 03

  Why use off the shelf tools versus something that you designed for your own, your own use? Now, I love the idea of getting to use whatever people have around loosely, but to me, it sounds like if you're building something for a robot, it might have a different shape, a different sharpness than something that a human might use. I'm curious about that.

• 13:19Speaker 04

  I mean, there are great tools for surgery already, and we, we want to focus on what we are, what we're good at as a company, which is building this autonomy layer. And so we, while it does help to have a robot, to have some physical incarnation where you can actually control the whole autonomy loop. It doesn't really help to build custom tools. So it's a lot faster for us to be able to focus on the software and not have to build a tool for every surgery that's done. The companies that choose that game, which is basically every other robotics company so, that exists so far, will find themselves moving a lot slower and a lot more inertia than what we have.

• 13:55Speaker 03

  Yeah, you've really kind of excised all the things that you don't need to do in-house, focused on data collection, software improvements through an iPad mediator. And that does seem to be a really fast way to build a better system. But that does kind of bring us into the what happens when it works and how doctors fit into this. Now, on one hand, every surgeon that I know is completely overloaded, exhausted, burned down, about to fall over. On the other hand, they're quite highly paid. And so there's kind of a bit of a trade off there. But to me, the idea of letting surgeons do more work more quickly, you know, with the help of autonomous tools, makes a lot of sense. On your website, you guys talk about this being a, a Sue surgeon, which I really appreciate that. That's a good framing. But down the road in time, maybe not 10 years, maybe it's 15.

• 14:37Speaker 03

  I can also see this technology improving to the point to which it can handle routine stuff like taking out my appendix if it's going to explode, for example. And so how do, how do doctors and surgeons feel about being accelerated? And then possibly down the road made slightly archaic or anachronistic in certain procedures?

• 14:56Speaker 04

  People like a lot of areas that AI is expanding into that the job of a surgeon will change fundamentally, but it's not necessarily going to go away. I mean, there may be a point in the future that all of our jobs go away and it's all just AI and we'll have to learn to reckon with that when the time comes. But for this one, I think it's going to be just a surgeon seeing their job in a different way than way before it becomes something that totally replaces surgeons. So what we envision in the long term is a surgeon sitting at kind of an air traffic control center where there's a lot of different procedures happening. They can orchestrate that at a high level, but not have to do all the tedious mundane tasks all the time. So maybe you're overseeing 10 surgeries instead of one right now, and your job in each surgery is

• 15:42Speaker 04

  different. It's more high level and, and less just routine, low level stuff than it is now. And most surgeons we found are really into that, that people, they want things to be autonomous. They want to have these unpleasant mundane tasks taken away up to the point that they're totally cut out and don't get paid anymore. And that's, that's a line we don't really worry about crossing.

• 16:03Speaker 03

  Well, I think we're, we're far enough away from that, that that's going to be a great problem to solve once we get there. But it does sound like as we've seen software development get automated to some degree by AI in a very condensed time period, this is going to be similar ish, but over a longer time period. For example, now a lot of developers orchestrate or observe and guide their agents versus writing the code themselves. This sounds analogous to that, although I, I do think it's going to take a longer time to get the data we need to tackle more surgeries than it is to get more coding data, which is indexable, available and, and online. How could you guys go faster?

• 16:37Speaker 04

  That's the question we ask ourselves every day. So we were really, besides, you know, the, I guess the goal of the company to just get to this, this like big autonomous surgery vision. We're really focused on being the fastest iterating company in the medical world. So we want to take the iteration cycle down from what it is now for most companies, it's years down to a month or weeks. And we've done that in the clinic so far. We've been, we've been basically doing cases, then building new stuff, testing on the bench, cadavers, then back into cases in less than a month. And it's, it's been shocking to the surgeons that have seen that there are way better features this month than there were last month.

• 17:18Speaker 03

  It's not, that's not the way the medical world has ever gone. That's not med tech. That's, that's the inverse of how medical technology is usually expanded. So of course they're blown away. They've never been treated like a, a first party customer before. They've always been treated as the thing that gets approved after the insurance company says yes. So yeah, I bet, I bet you're popular.

• 17:35Speaker 04

  It, yeah, it's, it's really just focus and automation that are the, the key principles behind that. When I talk about not making every device for surgery, like anything that goes into the patient and just looking at every step of the process and asking ourselves, how can we make this faster? How can we automate parts of this? That's the key. And I think most companies don't do that. In med tech especially, people just are not into automation. They're, they're following a, an old playbook that is usually quite slow and it's really hard to, to scale.

• 18:04Speaker 03

  Well, that means you can hit them like a hurricane then, because they're not even playing the same game. So that's quite, quite nice. Now going back to the car, the car analogy, self-driving as kind of a thing we figured out that's going to help people get to understand this. One thing that self-driving companies do, and we've talked to Wabi and Wave and just everybody. They're, they're very interested in world models and they have tinkered with synthetic data. And I'm just curious if those two things have any play in your realm? Or if those are things that don't work quite as well inside of dense biological systems?

• 18:32Speaker 04

  You could describe it as a world model in a way. So I think that concept and it's, it's, uh, there's a little, there's, I've seen a few different ways to define that concept, but I think that is basically what we're building. In terms of synthetic data, we're open minded to that. We haven't used it at all yet. There are definitely drawbacks to using that and there's ways it could, could go wrong. And if we were to go down that, that route. So for now, we've been using an approach that's more, I guess, more down the middle and not, not using, not taking too many liberties in, in that regard, though, we will try things out and see if that's something that produces good results as we move and, you know, make this more autonomous, go to more procedures and look for other ways to scale. Maybe synthetic data

• 19:17Speaker 04

  generation capabilities get better and better to where we, we do want to use those. And one thing we have to just like think about as we do this is that AI is advancing really fast and we want to be able to ride that wave and stay up with whatever the latest capabilities are.

• 19:31Speaker 03

  Literally stealing my next question. So Nick, I'm curious about how advances in general AI technology is improving or aiding the company? Because it seems like in the era of Fable, we've made a lot of progress since GPT 4.5. So tell me.

• 19:42Speaker 04

  I mean, we use AI for a lot of our operations. We have to make sure that like with things like, like with coding that doesn't introduce non deterministic bugs that, that end up causing big problems. We have to put a few guardrails on that and make sure that we're not overusing it. Yeah, definitely for all the documentation processes that bog down companies usually. And AI is a core part of everything that we do and in that regard. So in every, every process that we, we have, we look to use something, some kind of LLM or some AI to improve the process. So it's really been about optimization. And then, yeah, for all the paperwork, it's just massive in terms of how much effort is needed.

• 20:21Speaker 03

  I was more thinking about like, as, as we consider the idea of a, of a Sue surgeon, again, using that phrase from the website.

• 20:26Speaker 04

  Yeah.

• 20:26Speaker 03

  How much does a, a increase in generalized AI intelligence help you get to that point? Like, are the models smart enough today to accomplish your goals? Or are you, do you still hope for some step functions in generalized intelligence you can bring to bear on your specific problems that that will help you resolve, you know, other use cases more quickly?

• 20:46Speaker 00

  One of the themes we talk about over and over again on this week in startups is making sure you do your chores. I'm no expert on these things. I have some experience. Steven Estes from CLA is an expert. Let's talk about being cash efficient. Tell us about efficiency and what you see in the, in the top tier startups in your practice.

• 21:06Speaker 05

  We're seeing kind of an interesting trend out there where companies aren't needing to raise quite as much as they had in the past. You really have to be careful as a founder to only take on as much money as you really need. You've got to do the forecast and you've got to do the modeling and you've got to dial it in and get it right. Otherwise you're going to end up either not raising enough capital to get to where you're going and you're going to have to go get venture debt or go back, have an extender to the round, or you're going to give up too much of the company because you just didn't recognize how much money you actually needed.

• 21:35Speaker 00

  Yeah, very important to get this stuff right, folks. And that's really a bummer when startups don't do things in a button up way. Always have a great partner, a good partner to have on this adventure. While things change, my friend Steven over at CLA. So if you want a trusted advisor by your side who will navigate you through taxes, accounting and everything in between, it's time to take action. Visit claconnect.com slash with you. And don't forget to drop a mention that your boy Jake Al sent you. That's claconnect.com slash with you. Start today.

• 22:07Speaker 04

  I think it would, it would in the future that if you could have a better semantic understanding of what's happening in surgery. I don't think it's quite there yet to be as reliable as we'd want. We have to be careful in the beginning to not have things that are going to hallucinate in weird ways. So we're not using as much generative AI in the, the first version of this product, though that is a thing that I think there's huge potential as it, as it gets better and better. Especially with a surgeon in the loop where they can. Have control over what's happening and prevent things from getting out of hand. We can introduce that more and more. For now, though, it is more of the kinds of AI machine learning that's being used for autonomous vehicles, that's been used in Tesla and Waymo.

• 22:46Speaker 03

  Okay, now, two questions more. One about capital, one about commercialization. So when I think about robotics, I think about catastrophic levels of expense. Nothing but a lot of everyone building robots. It just takes a lot of money and time, it seems. You guys using off the shelf technology for the arms? So I presume that lowers your overall capital needs. But does the company have access to the funding that it needs? And how interested is the venture community in backing you?

• 23:09Speaker 04

  We, well, we were about to announce a round that we raised recently that will come very soon. So stay tuned for more on that.

• 23:15Speaker 03

  Do you want to give us a hint? Like, is it, is it tens of millions? Is it hundreds of millions?

• 23:20Speaker 04

  It's tens.

• 23:21Speaker 03

  There we go. It's between zero and 99 million, everybody. Breaking news.

• 23:24Speaker 04

  Yeah, so we've, I mean, we've been both very capital and time efficient so far. We were the fastest robot from zero to launch in three years. And we only spent about 15 million total in getting there, whereas the norm is hundreds of millions.

• 23:36Speaker 03

  Yeah.

• 23:36Speaker 04

  And that's because we don't go crazy on hardware. We've moved fast. Time is really expensive and just automating as much as possible that we don't have to do all these manual tasks that add up to a lot of expense normally.

• 23:49Speaker 03

  No, that's, that makes a lot of sense to me. And now in terms of making quick software iterations, I presume that means you have a relatively advanced fleet of developers. Are there any like medical specific people you have to bring into the company to make this function? And if so, what, who are you hiring from the health world and bringing them into technology?

• 24:09Speaker 04

  One thing unique about us versus other companies that are in the medical space is a lot of the team or more than half of the team is not from, has never worked in any healthcare at all. And a lot of them came from spaces like autonomous vehicles. My, my co-founder built the first autonomous truck that ever drove on a freeway before this. And we've hired a lot of his former employees to this company now. We do have, we have looked at companies like Neuralink to hire some of the people that have more medical experience. We found that's a company that really aligns well in terms of, of culture with us. So it's a much more deep tech and very unconventional team compared to what you'd see at like intuitive.

• 24:47Speaker 03

  What if, what if, what if, hear me out, we use the Andromeda surgical stack to do BCI insertion en masse? I think that would work.

• 24:57Speaker 04

  We're not going for that now, but it could, could be a thing.

• 24:59Speaker 03

  Well, after you get done fixing my prostate, can you just fix my brain? Like, I don't know, man. Like, I've, that's, that's what I would do next if I was you, because that's, that's super exciting. And people would also just rain capital down on you. Okay, I'm kidding. In terms of commercialization, you mentioned you've done several dozen procedures. How many do you think you'll have done by the end of the year? And when does this become something that you can do domestically with whatever the proper clearance is to are actually charged for it in a non-academic or research way?

• 25:29Speaker 04

  We have a lot of LOIs signed or people that are ready to pay for it once we're able to deploy it. Of course, we are subject to regulations and we're only cleared to be on the market in New Zealand right now, though we're close in a few other countries as well. And so, so yeah, we are, we are at the point that we're ready to, to launch the product.

• 25:49Speaker 03

  Is the regulatory environment in the United States conducive to this technology being allowed to function? Or are we behind the curve a bit in terms of how welcoming we are to robotics automation in the realm of surgery?

• 26:01Speaker 04

  There's nothing really that prevents this from being deployed. I mean, the same risk principles apply for this as they do for any product that's FDA regulated. So as long as we set up our risk analysis, our quality systems the right way, then nothing prevents this from happening. The fact that surgeons are in the loop really helps that I think if you're going to deploy something that's totally autonomous, that you press a button and then walk out of the room, that would be a lot more challenging. We need to take this in the right steps, though. One thing with FDA is that what really matters is the increment over either what they've seen before or what you last submitted. So we want to make those increments really like relatively small, but then also come back frequently with new updates so that every little bite they have to take is, is not that big.

• 26:46Speaker 04

  And then eventually that adds up to autonomous surgery across a huge range of procedures.

• 26:51Speaker 03

  Huge range of procedures. And also kind of to wrap up here, I'm curious about a huge swath of the world because, you know, one thing that I'm really hopeful when it comes to companies that are working in the medical technology space and are making things faster, cheaper, easier and so forth, is that they're going to be able to take these technologies around the world to places that don't have access to kind of already modern healthcare and empower doctors to do a lot more. So is there a future when like there's your setup in a clinic somewhere and maybe like a doctor can like remote in to it from a place where they're qualified and trained it and allow them to do a lot of surgeries, maybe via Starlink, where they couldn't normally get to and those people wouldn't have access to it?

• 27:28Speaker 04

  Definitely. That's one of the things I think is the most exciting about the long-term potential of this is that anywhere you want to be delivering healthcare, any facility around the world, even on other planets eventually, then you could have this in the operating room and it's not that expensive in terms of the value that it provides. And this could be the hub for all surgery in that center. So whether it's here in, at UCSF or in some remote village in a poorer country, then we could have, you could have this installed there and then do any procedure with any surgeon anywhere overseeing it. And so you give everybody access to the best possible healthcare.

• 28:09Speaker 04

  Like I mentioned earlier, there's this huge gap between one surgeon and the next in surgical skill. So we could totally condense that. So everybody gets the, the best surgeon in the world every time.

• 28:20Speaker 03

  Ah, all right. See, that gives me so much optimism for the future. I feel like when we think about AI and autonomy, everyone's so focused on losing their job that involves clicking buttons, when in reality, the best and most important story is we're going to make people's lives quite a lot better. Nick, thanks for coming on. Where can people find the company online? And is there a job that you're looking to hire that you'd love to shout out into our audience?

• 28:40Speaker 04

  Yeah, our website, AndromedaSurgical.com. We're on LinkedIn and X and other platforms and we are hiring. So we have a lot of technical roles open, both software, hardware, robotic controls, and then looking for people in like launching the product and clinical as well. So definitely hiring, looking for people that have this ambitious mindset to build something that could be really define the future of surgery. And so anybody who wants to take on a really hard project that could have big impact, then reach out.

• 29:12Speaker 03

  All right. Well, Nick, I'd love to, we need this is approved for use in the United States. I can't wait to see how quickly it expands. Thanks for coming on the show. We'll talk to you in six or nine months.

• 29:21Speaker 04

  Thanks, Alex. Thanks for having me.

• 29:23Speaker 00

  All right, everybody. Next up on today's twist, we're going to talk about a really big trend, which is tokenization and syndicates. We've been talking about tokenization for a decade. It's incredibly annoying to talk to crypto people and fractional ownership and blockchain, and it's immutable, and none of this has ever really worked. And it's a big question mark 10 plus years later. Then on the other side, you have syndicates, something that's worked incredibly well. Angel List pioneered them. We got involved with the Syndicate.com, creating an SPV, allowing a group of people to act as one unit to buy an asset. Well, today on the program, we have Alex Blackwood. He is the founder and CEO of Mogul, M-O-G-U-L.

• 30:09Speaker 00

  And what he's doing is he's saying, hey, people want to buy into single family rental properties, right? If you are an investor and you've got a portfolio, you want to maybe build some rental, there's plenty of reasons to do that and we'll hear about that today. But you, maybe you buy one or two of these units as an affluent person and then you've got a number of issues. You're only, you're not diversified, et cetera. So what if more people could invest and they could invest as little as $250? Similar to with our syndicate that invests in startups, our minimum on most deals is 5K or 10K. Most of the time when you invest in a startup, the minimum is 50K to 250K for a company to take you seriously.

• 30:52Speaker 00

  And if you get to series A or B, you know, they probably are looking for seven figures. Welcome to the program, Alex.

• 30:59Speaker 01

  Thanks so much for having me. Really appreciate being on.

• 31:01Speaker 00

  The founders I'm talking to are shipping code faster than ever, thanks to AI. But one big important question remains, if every feature you're writing ship has to slow down for an overwhelmed database, what's the point? But fear not, the solution is MongoDB. Instead of wrestling with rigid schemas and painfully reworking antiquated data structures and formats, MongoDB's native data model perfectly mirrors the language LLMs are already speaking. MongoDB gives you the flexibility to ship at the speed of AI. The asset compliance guarantees you actually get to sleep at night while it scales to handle massive Fortune 500 workloads. And the best part is developers swear by it, literally. I can't use the actual words they said in this ad, so let's just call it a really great

• 31:46Speaker 00

  database. Start building at MongoDB.com/ai. And so tell us a little bit about what you're building and like, how many homes have you put on the system? How many investors typically go into a home? Take us through the numbers.

• 32:00Speaker 01

  Yeah, of course. And so you hit the nail on the head, right? The idea is buying shares in a single family rental home. So myself and co-founder, we were both at Goldman Sachs in their real estate private equity group, where my co-founder grew Goldman's single family rental platform from zero to a billion in under 12 months with three to four individuals. So we took that approach of diligence, of vetting, structuring the deals, and actually gave access to everyone to invest. And so when you're buying into a single family rental home, it's fully vetted, fully diligent on our platform, fully structured. And as a result, you get all the direct benefits of it, including dividends from rental income on a monthly basis, appreciation, we track it in real time, and then tax benefits at year end.

• 32:45Speaker 01

  And so the idea behind it is.

• 32:48Speaker 01

  As for the numbers, we've done 130 properties and within those properties, we have about 600 plus units as we see on the site there. And these properties typically range anywhere from 500K all the way up to $2.5 million we've done. Typically, when you're investing, yes, it's a $250 minimum. However, people on average are investing 15, 20K plus into these deals. So you're typically looking at anywhere from 20 to 80 investors per deal on average.

• 33:20Speaker 00

  Got it. And so when we look at one of these homes, you know, they tend to be 250K, 500K. And so if I were to put in 5K, I'm 1%, a 1% owner. But managing these is incredibly hard. So walk us through that piece of the puzzle. How does that work? Who manages it? Who makes sure that it's generating revenue? And how do you not get upside down and have to go to your investors and say, hey, this thing's not renting? Hey, there was a flood. Hey, we've got an insurance payment. You know, we don't have to deal with those issues when we're doing a startup SPV. We do have to deal with legal K1s every year. So we have our own set of issues that we might have to manage.

• 34:02Speaker 00

  But we certainly don't have to manage somebody like tearing the place down or a flood. So walk us through the management of each property.

• 34:09Speaker 01

  Yeah, I mean, so that's part of the value add for the end investors. It's completely headache free. And so real estate, as we know, is the world's largest wealth generator. There's that old quote from Carnegie, 90% of millionaires became such through real estate investing. However, the headaches attributed to real estate are tremendous, right? You've all heard the horror stories of the 3:00 AM tenant coming to you because the sink is burst. Now, with us, we work with direct boots on the ground property managers to actually operate this property. And so they do a few different things for us. If you walk from kind of top line down to bottom line, on the top line, from the revenue side, they're the ones making sure these things are rented out appropriately.

• 34:51Speaker 01

  We do algorithmic pricing to make sure that they're attractive across Airbnb, pad split, and on the long-term rental side to make sure that we're optimizing for revenue. Really dynamic pricing there. Then all the way walking it down to the bottom line, we deal with the utilities. We deal with the property manager who is working with any tenant that might have an issue or any sink that might burst. Now, for you as an end investor, anything below $1,000, the property manager takes care of it. You don't have to deal with it at all. Anything above $1,000, it actually triggers a governance vote. And so the idea being saying, listen, sink first, $100, you don't deal with it.

• 35:33Speaker 01

  HVAC burst, 6, 7K, we've got these two quotes for you. We recommend this quote, or we can get a third option. You come in, you vote, and also you can kind of assign the vote to the property manager to decide. Now, as for the actual kind of management on the go-forward and all of that, you are really hands-off as it relates to the property itself. So that's kind of the way that it works. Oh, and as for the capitalization, right? And so thinking about mitigating against that major capex burden. So that HVAC burst at 7K, we actually don't ask for any additional dollars from the end investor.

• 36:16Speaker 01

  As part of each individual raise, we capitalize a maintenance and the vacancy reserve. Maintenance reserve, we basically take into account the inventory of a home, say, okay, the HVAC is on year six of 10. We know that in the next five to seven years, we most likely will have to buy a new HVAC system. As a result, we capitalize that adequately enough in the maintenance reserve. And then vacancy reserve, we actually capitalize a 12-month reserve. So that asset could sit completely vacant for up to 12 months, and we would never call another dollar in the door.

• 36:49Speaker 00

  And so what is, what is the goal of your investors? They want to get 10, 15% back every year in a dividend? Or they want to get the appreciation and they're pushing you to sell this in five years and flip it? What's the goal of the investors? And how do you communicate that to them? Because they're two separate goals, yeah?

• 37:07Speaker 01

  Yeah, so on the platform itself, we like to say that we give as much, if not more, information than we would have needed during our time in Goldman's investment committee to make a decision on that asset in a much more digestible format. So the assets range from a mix of higher on the rental income and less on the appreciation. Maybe they're a little bit more stable on cash flow. Maybe they're more on the appreciation and less on the cash flow. All things told, the assets typically yield between 8% to 12% per year for dividend payout. That's dollars that you can withdraw tomorrow if you so choose. And so when you do that, that's the dividend payout. It's paid out monthly to you. You can withdraw it at any time. The appreciation too, obviously, it's around 3% to 4%.

• 37:51Speaker 01

  But because we lever up each purchase, we buy it with a mortgage in place. It actually results to another 4% to 8% on top of it. So all things told, it's between 15% to 20%. Typically, we underwrite to a 12% IRR on bear case scenarios to make sure it's completely conservative. We convey that to the end investor. So as you can see on the site, everything is completely for right, as transparent as possible. You know exactly what you're getting to. And the last piece that we always love to talk about, we like to joke that the IRS wrote the tax code to incentivize two things, procreation and homeownership. We can't help with the first, but we sure as hell can help with that second. And these assets typically, even though you're getting 8% to 12% in rental income,

• 38:36Speaker 01

  it actually is a passive loss for income reporting purposes. So no taxes on it.

• 38:40Speaker 00

  Wow. So explain that. You know, I'm not like Donald Trump or like these real estate moguls. I know the whole system is rigged for real estate people. What does it mean in terms of the tax break that it's losing money?

• 38:52Speaker 01

  Even though the asset is appreciating in value, the structural component of the asset is depreciating, right? Obviously, wear and tear throughout the property. So as a result, the IRS basically came up with this incentive program called depreciation. And so even it's considered a ghost expense, meaning it's not going to directly impact your cash flow. However, you can basically take that asset's value, divide it up over a set number of periods, and put that up against any rental income that you might receive from the property. And so it's almost a deduction after the fact. So even though you're generating that 8% to 12% yield, the depreciation should cover it up and then some, not to mention any other amortized major capital expenditure.

• 39:36Speaker 01

  So any other additional improvement that was done to the property.

• 39:39Speaker 00

  How do you make money?

• 39:41Speaker 01

  How do we at Mogul make money, you're saying? So we charge a platform fee upfront. It's 5%. Charge as percentage of purchase price. Amortized, you can think of it as a similar drag on return as a 2 and 20 structure of any alternative asset manager. It actually is less so because that 5% over a five-year period, 1% per year, obviously, it's upfront and time value of money on the return is something else. There are other two revenue streams that we have in addition to it. One is we're starting to really enact on our product roadmap and become all things up and down the supply pipeline of real estate. We're actually a lot of times not working with a broker on the buy side.

• 40:22Speaker 01

  And so as a result, we have an additional 1.5% that is paid to us by the seller at closing. Does not impact end investors, but just an incentive for us to, to keep these properties coming. So the first revenue stream, 5% upfront on the purchase price, that is incurred by the customer. The 2% or 1.5% to 2% is incurred by the seller. So it does not incur anything to our customer. And the last one is interest on reserve. So those maintenance and vacancy reserves, as a result, we do scrape interest on those. Typically, it's about a 2.75 effective rate there. Yeah.

• 40:56Speaker 00

  Let's say you had a $100 million portfolio. Now, I think you might. If you had a $100 million portfolio that you've got people to invest in, you get that 5% and you make $5 million. And then you have that 1.5% that you got as a kickback for being the buyer, and that's paid by the seller of the home. So you're sitting on $6.5 million. It's not anything to write home about, but it's not nothing. You are essentially getting paid that fee. It's a decent fee. And then you have all these other services where you can make a little money. So that nets up, from what I'm understanding, or feels like, that maybe you can make 10% over the five years on the life of the home? Am I ballpark correct?

• 41:38Speaker 01

  Yeah, so we're actually entering into additional revenue streams as we speak. So it'll actually be north of that. And the idea being, we have a title insurance joint venture that's starting by end of the quarter here. That'll add an additional, call it 9, 10, 12K per asset, which is going to be incredible. And then we also are going into other verticals like property insurance. And year one premiums from that property, we can underwrite the property better. We have better sources of data for the property. And as a result of it, we can lower the property insurance, increase cash flow to our end investors, all while generating roughly $4 to $5 million in recurring revenue year one.

• 42:16Speaker 00

  So if somebody gets divorced or somebody passes away and they have an inheritance, they've got to get out of this. They're in year one, they invested $50,000 with you. It's year two now. How can they get their money out? Is there a marketplace to sell it? Can you buy it back for them at a discount or something? How do you deal with redemption, early redemptions? Because we have this happen, you know, in startup land. We'll get a notification from somebody, hey, I'm getting divorced. I put a quarter million dollars into startups. And we have to figure out how to put two people on the cap table, or they'll ask us, hey, will you buy it back for me 20 cents on the dollar? And we're like, well, we really don't have the ability to do that. Sometimes I look at it as the GP and I'm like, maybe I'll buy it from you.

• 43:00Speaker 00

  But it's just, it's kind of a hard situation. So how do you deal with the early redemption issue, if at all?

• 43:05Speaker 01

  So there are two prompts to that. Number one, today, it's a five to seven-year typical period. And we're very transparent with the end investor. And they think of this as a very high-yielding savings account, almost, with a high appreciation on the back end. So five to seven years upfront now, the idea is we are launching a secondary market, targeted next year. And with that secondary market, we're looking to do what's never been done before, which is a fully liquid secondary market. So I worked with market makers during my time at GS in their investment banking division, got a chance to see how they do it firsthand, was amazed at just how efficient these markets are. Typically, when you think of the New York Stock Exchange and you're buying into and out of, let's say, Tesla,

• 43:48Speaker 01

  you might sell out a Tesla and the person on the other end of the transaction isn't actually a person at all. It's an institution. That institution is buying it, repackaging it, maybe selling it as part of an SP500 ETF, or maybe just selling it to another individual investor. They're bearing that what's called overnight risk. So as a result, Day one, we're actually going to come in and work as that market maker. And so the idea being maybe we get some sort of bid ask spread in there, like a little bit of a scrape on there. And the idea being that if you want to sell, you could sell out tomorrow. We come in and we provide you liquidity. We get a minor bid ask spread. And because we are generating rental income that yields between eight to 12% in a year.

• 44:33Speaker 01

  That would actually cover any debt service that we have to actually liquidate out that asset for the end investor. So as a result, day one, we will act as market maker. But day two is really where it gets interesting with a number of different products, different risk reward profiles to make it truly.

• 44:49Speaker 00

  How do you pick where to buy the homes? This is like a very dynamic market. You know, in Austin, we have people, they don't seem to stop building. They just build, build, build. You want to build something, they're just like, YOLO, go for it, Houston, same thing. It's your land, build what you want and rents and home prices have gone down for four years in a row, I think, which is awesome. For my team members and when you start a company here, I highly recommend everybody move to Austin. Your staff will love you, your team members will love you because their rent will go down two thirds if you're living in a major city. Or you'll be able to buy your first home because first homes here are 250K to a million dollars. Just 30 minutes outside the city, so it's a pretty great deal. How do you think about where to buy and what to buy?

• 45:33Speaker 01

  Yeah, so we come up with the initial market thesis, right? Saying net new supply on the horizon is not enough to meet demand. So for instance, in Austin, you did have a run up in supply that happened from 2020 to 2022 in that range. And then prices plummeted by about 25%. But the net new demand on the horizon for Austin is looking incredibly attractive, especially given the fact that a lot of developers are scared out of that area. So that's exactly kind of the thought process behind it is, is that supply on the horizon enough to meet demand? Is the rent as percentage of price a high enough dislocation to generate an attractive yield to our end investors? So is the market thesis there? Is the operating model there?

• 46:14Speaker 01

  And then is, do these assets operate within our typical target price range? From there, we come up with that initial market thesis. We go into it, we find infrastructure players, we incentivize them. And an outbound motion that starts at day one becomes an inbound motion where assets are coming to us, meeting our buy box criteria. And then we cycle through the full diligence process around it.

• 46:37Speaker 00

  All right, if you want to get more information, go to mogul.club. Really interesting startup. I'm fascinated by it. I'm fascinated by any group of syndicates buying assets together and scaling that. And we wish you great success.

• 46:51Speaker 01

  Thanks so much. Appreciate you, Jason.