Rubina™ lets you toggle seamlessly between 4K and NIR/ICG fluorescence imaging in overlay, monochromatic, and intensity mapping modes. Even better it plugs in to your existing IMAGE1 S™ system. Learn more in this recorded webinar. Yeah. Mhm. Welcome to the Carl Starts Endoscopy. America Image one s Rabin a webinar with President and C 00 Charlie Wilhelm, Executive director of Surgical Devices and Imaging Solutions. Mark and Lane, medical Director Dr Aarti. Tell Carrie Sing marketing manager Libby Math Lor an executive director of surgical marketing Monica Ambrose to introduce us to the latest evolution in imaging technology. Image one s with Rubina. Please welcome our host group video marketing manager PJ quickly. All right. Hello, ladies and gentlemen. How you doing? And welcome. I'm t j quickly the group marketing manager for video here at Carl's Stores. Endoscopy America. You know, there's a lot going out there right now, and it's a strange and interesting time to be alive. I was having dinner with my kids last night and I said, they're literally living in history. This is going to be a pivotal time where people are going to look back at this and go Wow, we got through that together. And don't worry, because Carl Stores is doing everything we can to help you out. So today we're gonna talk about one thing Onley, and it's the brand new modular video system called Image one s with Rubina. The great news is that you can add this amazing technology to your existing image one s video system and it's available right now. It combines the four K technology you've come to know in love with the near infrared I C G fluorescence imaging capabilities which helps our surgeons perform better outcomes. We've got a very, very distinguished panel of guests that are gonna come out here today to speak with you. Starting off with the Karl Stores Endoscopy America President and CEO Oh, Mr Charlie Wilhem. Charlie's gonna talk about the vision of Carl starts. He's gonna talk about our history over the last 75 years and then he's got some amazing patient stories that I don't want you to miss. Next. We're gonna bring out our executive director of surgical image ing and surgical devices, Mr Mark ambling Mark and I are going to sit down and talk about the technology behind Rubina. You're gonna get a chance to find out why we chose the technology that we did. Why it is so effective. And why is it so different? This is going to be a talk you don't wanna miss. We're gonna take a little break, and then we're gonna bring in. Dr. Arthuis shall carry Sing and Libby matter. They're going to give us a deeper dive into the clinical aspect of Rubina and how that works. She's gonna walk us through the various imaging modalities and how they make a difference in the various procedures that are being performed in your hospital. This is gonna be a conversation you're not gonna want to miss. Finally, we're gonna bring out our executive director of surgical marketing, Mrs Monica Ambrose. She's really going to tie a bow on the whole presentation, focusing in on what makes image one s with her being a different. And she's also going to be aligning it with the messaging associated with the value of one taking a look at the clinical, the financial and the operational impacts of this groundbreaking new technology. So we've got a big, exciting show ready for you today, and I can't tell you how excited I am to spend this time with you. So from everyone here a Carl stores. I wanna thank you for being here. We hope you're just as excited as we are about the Rubina imaging system powered by image one s. Now, don't forget you've got a chat box down on the lower right hand side here where you can add in any questions. We'll try to get to as many as we can, or you can scroll down to the bottom of your on the mobile device on the video player. So let's get this party started. Why don't you come on over here with me and we're gonna have a great rest of the day? Okay, We're going to get this party started now. I have the pleasure of talking to our Karl stores and gossipy America President and CEO, Mr Charlie. Well, him. He's out in our Karl stores studio right now. How you doing, Charlie? T. J Doing great today. Appreciate you having me involved in such an exciting product launch. Yeah, we're very, very happy to have you here. Thank you so much for making the time. What? You know, we were talking about the Rubina system a couple of weeks ago, and one of things that stood out in that conversation was the evolution of imaging, how it's changed not only in your career, but also here at Carl stores and how all of this kind of gets put together and putting our patients first. So without further ado, I'd like to give the stage to you so you could tell us a little about your stories and how things have gone t j to date myself. Some of the some of the first image ing products that were brought into a no are as big in size is the cameras they're using here today for for this launch, uh, followed by tube cameras which were still very, very large and heavy and and hard to adapt. Thio two telescopes and and so on. But they were opening up the inside of the body and pulling images out for clinical procedures. And, you know, the the evolution of resolution, the evolution of digital and so on. It's just been a ah story, a continuum of advancements that allow physicians to do some clinicians to do some amazing work on patient, from from advanced technology to advanced procedures, thio driving safety and and improved outcomes. So what we're about to talk about is is again enhancements and kind of the next step in the ongoing evolution of imaging before I get too deep into today's program. Two Acknowledgments, First of all, 2020 has been an incredibly challenging year, and Carl Starts is in the health care arena, and I just want to really acknowledge the frontline caregivers. It's been, uh, unprecedented year, Hopefully, uh, once in a lifetime year, so to speak, on the frontline caregivers, the emergency medical technicians and really everybody behind the caregivers, you all our heroes. You've been doing an amazing job. Obviously, it's not over yet, but ah, thank you from everybody. For all of your efforts, a zit relates to coral starts were an essential business. To this end, our airway product has been used in treating Cove in 19 patients. We've maintained our essential business status. We've kept manufacturing facilities open, a swell a czar logistics centers. To that end, we've been able Thio adhere to our service level agreements with the clinicians. So I wanna thank the coral starts employees throughout the world for safely keeping our business up and running and in support of the caregivers. 2020 As I said, Crazy year. But it's a milestone year for coral starts, So in 1945 coral starts and humble instrument maker actually incorporated and created the company Coral stores, starting with a small workshop and again making instrumentation Fast forward. 75 years, three generations of coral starts, family entrepreneurial leadership. And today you have a company. Ah, global leader. Uh, certainly recognized for instrumentation, but renowned for our customer. Centris it, er clinical care focus our our patient Focus a zwelling, as you know, an architectural full of technology and digital solutions from which the caregivers can choose from. So, uh, great story. Uh, congratulations to the Coral Stores family. And certainly congratulations to all Coral starts employees on 75 year anniversary. And I think there's a lot more to that story that's that's coming up in the future. So why am I here today? We're here to talk with T. J and other colleagues about the, uh, image one s rubina system. This is really an enhancement. The rubina is an enhancement to the image one architecture, er And when we talk about the enhancements, uh, from a clinical perspective, uh, it's taking white light image ing to a new level, uh, in the sense of this additive technology for enhanced visualization. So clinicians could see anatomy and other indications that they could not see previously. So a terrific enhancement. When you talk about technology, uh, it scares people. And if you are a financial buyer out there, it scares people. The reality is the image one s architectures is not obsolete. ID. This is an enhancement on if you're new to coral store, it's It's a modular approach, a configurable approach. So you Onley need to acquire what your use cases so very, very cost effective approach. So if I use the quadruple aim kind of as a as a backdrop, you're impacting patient, you're impacting patient care. You're impacting the clinical procedure itself. You're impacting the clinical caregiver, and you're doing it in a very cost effective way. So modularity the ability toe configure depending upon your use case, your ability to standardized on one company think one. And the scale ability of the architectural allows you to go to, for instance, baseline a basic physician office outpatient surgery center all the way through to the impatient or environment, but standardized on one company across that continuum of care so very, very powerful from a clinical perspective, from an asset management perspective, from a total cost of ownership perspective. Before we go any further, I'm gonna introduce a couple of videos to you just to talk about the kind of combination of clinical expertise, the coral stores, hardware and software, our technology and the impact that it has on patient care. A couple of patients stories M I s help to change my mission. My mission was now to challenge those medical regulations in order to keep flying and literally after seven months of hell, the Air Force surgeon general said if I underwent regular testing for one year post surgery, they would consider granting me full of flight status. So surgery was performed March 23rd, 2012 to what I'm told was textbook. The tumor was completely removed and I complied with the Air Force requests. When we shy of 12 months, the regulations were rewritten. I had my first flight and I'm back to plate status. E woke up from that surgery completely pain free completely. I don't mean a little bit. I don't mean slightly. I mean 1000% free, pain free. Going from where I waas to that moment was like a miracle for me. It Waas. It was the miracle of M I s Carl starts. Dr. Peter Witt changed my entire life. It was like I said, a miracle. I can't thank you guys enough for what you did for me. Dr Peter Witt. Carl starts everything. You guys do matters because there's real people out in the world like me that it changes their entire life. I could do everything I used to be able to do. I could play softball again. I can run again. I can do all sorts of things. My motto was Fight on. I know it may sound cliche. Yes, I'm a USC guy. But final through all obstacles through all the turmoil through all the hurdles in life through all the bad sale days through all the bad sale months, $5.4 million final fight on and know that are not on Lee. Is this product a product? It's a way of life. It's a way of life. How do I know? Because you saved my life. I was able Thio transfer my care to Vanderbilt University with the urology group there. Dr. Sam Chang was who I decided Thio to seek a second opinion with. And I was so glad I did. He was an amazing doctor. A person just immediately made me feel better about the situation and confident in him as a surgeon and a doctor. And he used Blue Light sista Skopje with Cece few. And and so really, I felt no downside to using the technology and all upside, which was that my doctor could see everything through the procedure that he needed Thio and showed us pictures that he, after the surgery, to really show how it illuminated the cancer cells, what he was able to take out and in since then, you know, seeing pictures where it's completely clear versus where it waas years ago. I think you'll agree those patients stories air pretty amazing, T g. I know you have a comprehensive program today. So with that, I'm going to kick it back to you and thank you again for allowing me to participate. Charlie, thank you so much for taking the time today, Thio, educate us on what makes Carl stars different and all the changes have gone on in the industry. You have a great rest of your day. Thank you so much for coming out. So now we're gonna transition on over into technology I've got are executive director of imaging and surgical devices, Mr Mark Ambling and Mark and I are gonna do a little deep dive into the technology And how Carl Stores is doing it differently. Please give a warm welcome to Mr Mark Ambling. Yeah, you know. Okay, you know I know. Elbow level Mark. How's it going? I'm doing good, TJ. How you doing today? I'm doing pretty darn good. How about you? To be honest, I'm I'm a little nervous. What do you nervous of? I'm used thio designing cameras, not sitting in front of them. Yeah, it's a little different. We got a lot of lights standing out on us. Thousands of people out there taking a look at it. But that's okay. We can get through this together. All right. Excellent. Sounds good. So how long have you been working at Carl? Stores up in Goleta, California for over 23 years now. Wow. So over 23 years, we heard it from Charlie talking about the evolution over 75. I'm assuming imaging there's been a couple changes over the last 23 years. Yeah, sure sure has. When I started, we started with standard definition video. We evolved to high definition. Most recently are four K product offerings. And in addition to resolution improvements, we also added three D capability and PDD and I c G imaging modalities over the years. Wow. So that sounds like they're not going on. Yeah, uh, one of the things for me that I'm most interested in I think people on TV are a swell is I was wondering about your design and how you approached it. What were some of the constraints you saw? How did you kind of work from an engineering standpoint? What were the various trade offs that you used to get the image one s with Rubina to the market? Yeah, so we started in a really good position. We have many years of experience in the emerging domain making endoscopic cameras, and we've been defining, refining and defining the image one s platform for a long time. In fact, as part of that several years ago, we introduced in N i R I C G product, and from there we started talking to physicians. We asked him, what do you like? What do you want to change about the product? And some of the feedback we got was that the surgeons told us that they really wanted simultaneous display of the N I. R I, C G and white light image, and that this would minimize our risk and prove their work flow and reduce their surgical times, all of which is a benefit to the patient and the surgeon. But they emphasized, I think this is really important that they're not willing to give up things like their four K ultra high resolution, the color accuracy and the low noise image, all of which they've grown accustomed to over the years. They also stressed one last thing here. They stressed the need to minimize additional capital equipment, so ensuring connectivity to the existing camera control units was a must. So what did? How did from a design perspective, how did it work from an engineering stand? Yeah, so the next thing we did was we went out, and as as we do, we serve. We surveyed technology. We way. Try to understand what's the latest technology out there in terms of image processing displays images themselves, And so based on these three The surgeon input the technology survey that we did and our experience in designing endoscopic cameras. We took a step back and we re thought how to develop the best system with the least compromises and t j. The image one s with Rubina is the result of that. I could definitely see that I can see how it you took in all of the things that you needed to consider the surgeons feedback what you know, from an engineering standpoint, how you could bring it to fruition. I'm assuming, as you're doing this to, the other thing you kind of looked into was modularity. Charlie brought up that it gives them the opportunity to buy what they want when they need it. But how does that impact you from an engineering standpoint or design? Modularity is at the heart of the image. One asked for being a system. Remember what I said about reducing overall capital cost and, um, surgeons asked if we could if they could reuse. Therefore, you see issues and monitors to reduce that cost, and they're Rabin a camera head does exactly that. It operates with our current for you. CCs are linked modules and are four K monitors. Trust me, it's not the easiest way to develop a product. I mean, you have to be absolutely obsessive about backward and forward compatibility. But we feel that with the rate of technology change, it's the right thing to do for our customers. I mean, just in the five years that I've been here, we've gone from HD to now four K iceberg, so I can completely see how that works is there's a lot going on from a technological standpoint. Um, I am so excited, and I can't wait any longer. I'd really like to get up and take a look at the image one s for being and get some hands on time with you to go through some of the key components. That sound good? Yeah. All right. Let's go. Mhm. Yeah. All right, Mark, here we are. The key components to the image. One s with Rabin. A system Exactly. Pretty cool looking, huh? Very nice. Very nice. You should know that you helped design it, so I've seen him. You've been using living and breathing this for a while. Uh, let's walk the audience through some of the key components of the image. One s with Rabin. A system first thing. I think we should start off his. Yeah, let's do the endoscopes. Yeah, let's talk about the big these air bag endoscopes. They are completely redesigned and optimized using the latest and optical design, including a sphere cleanses and new special types of glass. This ensures that the focal point of the white light image and the n i r I c g image are aligned, and the benefit to the surgeon is this eliminates the need to refocus when toggling between the white light and the n i. R I c g mode This and this is T. J. The first significant improvement, providing a clear, crisp image in both modes. Without surgeon intervention, I can completely see that I spend a lot of time in the operating room, and the last thing a surgeon wants to have to do is refocus right. They always complain about that. So designing this scope so that it could be in focus no matter if I'm in I c g mode or white like mode, that's amazing. That's awesome. The next part of the optical chain that I wanted to dive into is gonna be the camera head. Can you walk us through some of the cool things that you got inside that camera, right? Yeah, this is packed full of technology. If you remember, our surgeons told us that needed maintain their current for white light for you camera performance. So that set the first clear design requirement. We needed to start it with the newest, most recent four K images with improved performance. And we did that. And from here, there's a few ways that you can combine a white light and and I r I C J image. You can cycle between the two images. White light and I are rigged with either a single chip or a three chip camera head. But this reduces that image refresh rate, and it feels like the images air, not a line, and they're lagging one another, always one after the other. Another approach is to use a four chip camera head. In this case, you have one dedicated toe ir. This reduces that lag feeling but also normally reduces the resolution. In other words, it's not true. Four K. Well, you already said that they wanted true four K and you already said that the surgeons don't want lag, right? So I'm assuming we did something a little different here. So our our design approach was we took the best of both worlds. We started with the custom designed to chip Prism Assembly one ship solely dedicated Thio white light and one for N i R i C g Both four K resolution operating at 60 frames a second. Wow, Both images are acquired at the same time. So the overlay of the white light and the n i r i C g is perfectly aligned Super cool. So all of that's in that camera head right here. That's pretty cool. Well, one of the things that before we jump into here I wanted to bring up is you know, Carl Stores has pioneered the cold light source, right? And what they have done since then is keep on improving the technology in the light source. I'm assuming that's the same case here with this led light source. Yes. So this is the Rabin a light source, and I gotta tell you, our engineers out did themselves with this one. Normally light source design is really based on two type of technologies, either laser or led lasers. Nice because it has high power output. But the drawback is that it's a laser. Yeah, I've heard of the nurses Say they got enough training, right? They don't wanna have to do more training to use a product of the operating room. So exactly. But what if you could use the power of a laser, but without the hassle of a laser? And that's what we did? We built an led light source optimized for the i. R I C G application. It has a custom optical assembly in it that's capable of mixing to L. E. D s one for broadband white light and one for the N i. R I C G. And as an added bonus, TJ, using dual led s extends the life of the light source to 30,000 hours There, 39,000 hours. And that's more than most surgeons will spend in the or in their entire life. That's pretty nuts. So what? Whoa, there's one. Wait, there's more. There's more. There's one more cool thing about this. This is the first product to use our brand new Ethernet based communication network. We call the chaos hive. As you're probably familiar with the Karl Starts communication bus. This replaces that this is gonna allow us new features, new capabilities, stuff that we're really excited about introducing the market in the future. You mean to tell May not only is this light source all led, but it's also we're changing the way that it's communicating in the operating room. Exactly how this is groundbreaking stuff. Exactly. So we're almost to the end of the optical chain. I think one of the things that Carl Stores has been known for up to this point has been It's exquisite image processing things like Clara, things like chroma that our customers have come to love. Do you mind? Spend a little time kind of walking through how image processing impacted Rubina. Our image processing processing engineers went to work here, too, you know, they had to maintain that four K white light image, including both through Clara and Chroma and adding on top of that. Now the new I C N i r I C g image. So they went from processing 14 k images 60 frames a second to processing to simultaneously four K images at 60 frames a second. This increase the bandwidth of our module from five gigabits per second to 10 gigabits per second bits and yeah, and what's interesting about that is we knew this was coming back in 2018 when we designed that module and we were thinking ahead and how to prepare for that back then. And I could tell you were thinking about how to prepare for the next product products in the future. I totally agree, Mark. It gives them the opportunity to buy what they want when they need it. Not when Carl Store says they need it. Right. Exactly. So you're not paying for technology you're not going to use, right? You're not having excess technology that you're not able to take advantage of. So when we talk about technology, we did a really good deep dive on that, but I want to know we talked about the surgeons a little bit at the beginning, You know what does the surge I want to see? You're gonna have to wait for the next segment with Dr Libby for that. Give me a little bit. Mark, please. No, no. All right. All right. We'll give you a little bit. All right. We're offering four visualization boats in the new system. The first is a white light only image. The second is an I R I C G image, basically a black and white image. The third is a white light image perfectly over laid with that n i r I C g image which the surgeon can select green or blue so green or blue, it's up to you. It's up to you like it. And the final mode is a white light image over laid with an I R I C G image and a colored intensity map showing the intensity by the color e can't wait to see this little more in depth. So you say next segment next segment through it. There's a lot of technology packed in all this. I'm assuming I gotta buy a whole new tower and I got to get all these. Can you just walk me through? What do I need to get this into my operating? Yeah, it's pretty straightforward, TJ. If you're in existing image, one for you Customer. There's only three pieces of equipment that you need. You need the I C G scope, the new camera and the new light source. That's it. A software update for your your current system. That's pretty straightforward to Dio. But there's nothing else that you need. Wow. I mean, this is amazing, right? Every other time we come out, I hear other companies come out with new technology. Gotta buy all new tower, right? Don't just add on three simple components to make this war. This really is amazing. There's nothing else out there on the market today on the market with Rubina we re envisioned, we redesign and we optimized every aspect of the system considering our search and feedback that we got the technology readiness and building on our history of developing high quality endoscopic cameras. How well, Mark, I cannot thank you enough for doing this deep dive peeling back the onion a little bit toe. Let us see and how you go in through developing all of these amazing products. This was truly an eye opening experience. Thank you so much for your time. Mark. I really appreciate it. E. All right, we're going to take a short break now. Why don't you go out and grab some coffee, maybe do some stretches get up. Check your messages Whatever you need to dio. But be sure to come right back. We do not want to miss the next segment. As Mark was alluding to earlier. We have Dr Chill, Kerry and Libby Matt Lor coming down in a nice fireside chat toe Walk through all of the differences that can happen from a clinical perspective with the different image ing modalities that we touched on with Mark. So we'll see in about five. Thanks again. Mhm. Okay. Yeah. Okay. Yeah, yeah, yeah, yeah, yeah. Hi, everybody. Welcome back. I hope you had a nice little break. Had a chance to stretch your legs and get going a little bit. Well, we have a great opportunity right now to head on over to our Karl store studio. We're gonna be ableto work and learn a little bit more about the clinical benefits of using image one s with Rubina. We have our marketing manager, Libby, Matt Lor and our medical director, Dr Arthuis. Trickery sing toe, walk us through What separates Rubina from everything else out there. We'll get to see some amazing videos and also get some key insights on where it makes a difference in these particular procedures. Let's see. Arthuis, Libya. Are you over there? We're here. T. J. Thanks for having us. Yeah. We're thrilled to be part of this big day. It's so great to see you guys. I'll let you guys take it away. Thanks. T J. Yes. The two of us have spent the last several months really looking at all of the clinical advantages across multiple specialties, some of which has been very interesting. Some eye opening. But before we get started, Doctor, tell Kerry, would you mind briefly describing what indusind nine green is and how it works? There is a fantastic video done by Diagnostic Green and the International Society of Fluorescence guided surgery that we can use as a great visual guide. Yes, of course. Libby Indusind nine Green or I C. G. As you stated as a medical fluorescent dye that is used as an indicator for diagnosis in the visible light spectrum, our eyes can see certain colors are rainbow colors. We cannot, however, see in the range of near infrared. When I see G is stimulated by near infrared light, it becomes fluorescent and any tissue containing I c g becomes immediately visible using specially designed cameras. The technology of these cameras allows us to see the contrast and tissue definitions that we cannot see in white light image ing that we traditionally used during surgery, for example, I C G is excreted in the bile. Therefore, after a period of circulation in the bloodstream, the structures that contain bile such as the bile ducts will become visible with the near infrared light as well. To use iceberg, the solution is reconstituted with sterile water in preparation for injection. After the injection is being administered intravenously, I C g binds to plasma proteins, mainly albumin, and then is delivered in tow all parts of the body through the bloodstream. So, as you can see from this animation, the blood vessels and organs become well defined with BCG injection. The value of I C. G with near infrared light is that it safely allows for visualization of these specific structures and can provide an assessment of blood flow in many parts of the body. Thank you so much for the overview. So now that we understand what I c g is, how about we talk about where it matters and how it makes a difference in patient care. Absolutely. Let's start our conversation with one of the most common procedures, the laproscopic colossus ectomy. We know with this procedure that it's very important to properly visualize the biliary anatomy due to the consequences. Often unexpected injury. Can you take us through that? The first video and talk about how I, C G and systems like Rubina can not only improve visualization but can also potentially change patient outcomes? Surely be I reviewed. Many published studies for Laproscopic will assist ectomy and realize that while bio duct injuries are relatively low, they still do occur, and they do impact patient outcomes. Unfortunately, in one of the most recent studies, Dr Dip and his colleagues conducted a prospective multi center randomized international trial, and they demonstrated that key critical structures could be identified more clearly by a factor of nearly three. When using ice e g for us, it's I want to show you a video that I think will help us to better understand their conclusion. Here we can see the gall bladder is held up on traction. One of the features of Reuben I especially appreciate with this video is the demonstration of the ductile structures with the I. C. G. In overlay mode, it is extremely helpful. Thio operate in white light as that is the standard image in light surgeons air used to operating in. So with the combination of I C G overlay and white light, all the surrounding an atomic structures can be appreciated while highlighting the key anatomy of concern to aid in the surgical procedure. What we're seeing in this video is that the surgeon is trying to identify between the cystic duct, common hepatic duct and the common bile duct. The cystic duct is short, and therefore any misidentification can lead to injury of the other ducks. The fluorescents allows for contrast and definition to enable the surgeon to operate around and isolate these structures. Here we can see the cystic duct and artery well isolated. Remember Libya? I told you that I C g goes through the blood vessels first. Well, the reason why we don't see the die in the cystic artery at this point of the procedure is because I see G was injected 45 minutes ago that I already went through the bloodstream and is now concentrated in the bile ducts, but we can see the cystic artery pulsating very clearly in the video. After being able to identify and isolate all of the structures in the area of interest, the surgeon can now proceed with the coolest ectomy and likely reduce the risk of a common bile duct injury. That's really a great image. I especially like how well ICBC perf uses along with the definition of the anatomy, and this is all while the surgeon continues to operate in white light. I agree, Libby. Now let's shift a bit and talk about another area where we've seen a lot of positive results. Real time assessment of blood flow or profusion in laparoscopy. This is most beneficial when you're reconnecting, tissue are performing in a nasty Moses, where generally leaks tend to be a major concern. Can you take us through the next segment and talk about the role of iceberg? First, let me define what an ass demonic leak is for some patient. A portion of bowel, stomach or esophagus may be removed, which leaves a gap in that tissue, and those tissue ends around that gap have to then be reconnected. That's an anastomosis. If the anastomosis line does not have good blood supply to it, then it won't heal properly, causing those edges to not seal together and then the contents on the inside to leak out. Therefore, the use of I C G in real time enables the surgeon toe Identify that there is adequate blood flow to the tissue before creating the anastomosis. While we look at the following sigmoid resection video, you can see profusion clearly demonstrated with I c G Without I c g. It could be difficult to differentiate tissue that has poor blood supply versus healthy tissue just based on the color difference alone. Pay attention to what you can see when we switch over the monochromatic mode. There is a clear demarcation between the areas with good blood flow versus the area with less highlighted blood vessels. The contract that the contrast this mode provides is incredible and cannot be seen with the naked eye. This additional information can not only change the surgical plan but ultimately help reduce the incidence of a nasty Matic leaks. In fact, literature and colorectal surgery has shown when using ice e g. The leak risk reduction rate is about 44% and the change in the plan transaction line was around 19% which are quite significant, although not as robust and publications and findings. We are seeing some similar positive outcomes for Asafa Jill, a nasty Moses and bariatric Gastrectomy procedures. I have to say Doctor shall carry through our whole review process. The risk reduction rates were the most surprising. You can really see now to how the contrast of the black and white in the monochromatic mode really can help surgeons assess blood flow and why nearly 20% of surgical plans were changed in real time based on what they saw with iceberg. Now let's shift to another area where I C G has been used for some time neurosurgery. However, traditionally, this has been with a microscope. This is where Carl Stores is really unique. We have a four millimeter I C G scope that allows surgeons to enter and operate through the nose to access the skull. And with iceberg, they can now locate blood vessels, identify anatomical structures, NSS, flat profusion. Can you take us through the next video so we can see some of this for ourselves? Yes, of course. Libby, it's so exciting to see the progression of endoscopic school based procedures in neurosurgery, you mentioned blood vessels. Libby. Although the reported incidence rate is low when the most catastrophic complications is injury to the internal carotid artery, I want to show you a video that clearly demonstrates how I C G could define the internal carotid artery anatomy for the surgeon to carefully navigate around in real time. This was a case where the tumor had invaded a Sinus space, the bone and the layer covering the brain called dura mater just for orientation. The bulbous structure at 12 o'clock is the pituitary gland, and what the surgeon is touching is the tumor in the middle of the screen, just underneath that gland. Here you can see the internal crowded arteries in green toe left and right of the tumor and pituitary gland. Due to the I C G fluorescents, you can also see blood vessels fluoresce ing behind the tumor as well. Fast forward, I want to show you, is the anatomy. Once the bulk of the tumor was respected without any vascular complications, the tumor was found to be right next to and behind the internal carotid artery here, I see G was used to not only identify the internal credit arteries, but too closely skeletonized the artery in order to optimize tumor resection. An alternative to utilizing ice E G has been the use of micro Doppler systems, which allows the surgeon to assess vessels but by hearing the blood flow in real time. However, in I c g, an overlay or monochromatic mode, this gives the clear visual confirmation of the vessel location for proceeding with more visual confidence. Another complication that I want to touch upon because it is more common is the cerebrospinal fluid leak, which most people referred to as the CSF leak. This fluid leaks from the brain through the surgery access point. If the closure or defect doesn't heal well post operatively similar to a nasty Matic leak reduction which we discussed earlier I C. G is helpful for the profusion assessment of the nasal septal flap, which is created from tissue of the nose to cover the defect made toe access the brain. It's always so fascinating to see the same principles of how I see G works in different areas of the body, which is a great segue to our next topic. Lymph node mapping and identification. This is certainly an area where there has been a lot of questions and a lot of curiosity over the last few years. We know that when you remove multiple lymph nodes, there's potential for a patient to have many postoperative side effects that could really disrupt their quality of life. This is another area where iceberg could be quite helpful. Can you not talk about how I si G helps with assessing lymph nodes? My pleasure. Libby Evaluation of lymph nodes is a crucial step in surgical staging for patients with certain cancers. However, sentinel lymph node mapping was developed to reduce these complications. That you describe. A sentinel lymph node is the note that's directly related to the primary tumor and is the most likely lymph node to have metastatic disease, therefore, therefore by Onley removing the suspicious nodes of cancer, the surgical trauma and operating times could be reduced, resulting in better patient outcomes. The use of I C G is applicable for many different types of cancers. These include breast melanoma, colorectal, gastric, cervical and Demetria. Will prostate and head and neck cancers. On Lee, a few small studies were identified for Asafa, Jill and bladder cancers, but they did have high detection rates as well. Let's take a look at this video that shows the public lymphatic track fluoresce ing with I C G. Here you see the track in overlay mode and now in monochromatic mode. Another feature of the Rubina system that we haven't spoken about previously but could be useful in surgical evaluation is the intensity map. The surgeon has the ability thio use colors as a visual guide to provide information about the signal intensity of the I C G fluorescents. The color map that can be seen on the right side of the screen indicates the surgical areas that appear yellow, orange and color have a higher signal of ice e g intensity versus areas that are highlighting in blue or green. The surgeon in this video is dissecting in the space where the pelvic lymph nodes reside. Based on the signal intensity indicated by the color map, the surgeon is isolating and removing the notes that have that yellow orange color. Libby. I believe that we're going to continue to learn about intensity mapping as surgeons use this feature for a lymph node dissection. Yeah, this is a really exciting area, and I'm really looking forward to seeing the development around this topic doctors will carry. I have one final question for you before we wrap up. Can you talk a little bit about your own experience in the O. R. And how you embrace new technologies? Funny you asked Libby. Um, to me, technology in the operating room is constantly evolving, just like electric cars. I feel like the next greatest latest version is just always around the next corner. As a surgeon, I'm always interested in new products because if it's something that can help improve my surgical performance and patient outcomes, I'd obviously like an opportunity to evaluate it. However, if I could be really honest with you, my most biggest challenge and the most common answer I hear from my hospital administration is that we simply cannot budget for new capital equipment. Trust me, it's not the first time I've heard that, and this is really what makes Carl Store is different as an industry partner. So we heard from Mark Ambling earlier. He talked about the design philosophy of our video platform and how it really allows for our customers to have the flexibility to add new technologies like Rubina to an existing tower rather than having to purchase an entire new tower every few years. Actually, Libby, I learned over the course of time that that's one of the reasons why my hospital partnered with Carl Stores and as a surgeon that allowed me Thio upgrade my technology and provide better patient health care. Dr. To Carrie, thank you so much for this conversation. And for all of your insight across the various applications for I c g. It was also really helpful to see the value and how to incorporate some of the new image ing modes into surgery and show how it can better assist surgeons. It was my pleasure Libya to be with you here today. Thank you for having me. Well, this concludes our discussion now. I'll send it back to you, T J. Thank you, Doctor. Tell Carrie and Libby for a very insightful presentation. I'm hopeful that you can all see that there are a ton of clinical benefits with the image oneness with Rabin A system. My next and final guest needs no introduction. She is the executive director for surgical marketing. Her name is Monica Ambrose. She is going to walk through not only the value of one, but also the benefits of image one s Rubina from a clinical financial and an operational standpoint. With that, I'd like to introduce Miss Monica Ambrose. How's it going? Monica, thank you for having me teach. This is a great day with a lot to learn. So I'm not gonna take up any of your time. The floor is yours. Thank you. Thank you. I am thrilled to be with you here today for this very exciting moment. It is a true honor to share the launch of this meaningful image. One s for being a technology with you, but actually the same time. This is what we dio all day and every day at Carl Sports. You've heard that the customer our patient, is at the center of all that we dio. This is what drives our design philosophy and the technology that we engineer and deliver our patients needs. So our patients needs change in your world of delivering health care is changing, and it's changing and evolving at an extraordinarily rapid pace. What has served you and your patients for three years, three years ago, or even last year, or even maybe last month. We certainly know a lot has changed over the last year in the last few months. That is not the same as what you need today. And we understand this. Staying in touch with this is that the core of what we dio and those changing needs apply to the to i c g for fluorescence guided surgery as well. We've been delivering this technology for years, but now with a new unique twist. So as you think about your surgical image ing needs, I invite you now to think one think of one video system that can meet all of your needs. Think one partner, Carl, starts in which one us now with Rubina is a surgical video system with a design philosophy that is truly different than anything else. It can offer you what you need when you need it. So what is this design philosophy? It is truly unique and different than anything else available on the market. And that is because it is modular and scalable. So what is modularity and why is scalability important? How might this result and optimized clinical care, improved efficiencies and reduce cost for your hospital system. So let's talk about those three really important topics. Clinical care, operational efficiency and financial value. Image. One us Now with Rubina offers you a modular system that delivers you a pristine image across multiple specialties. Image one us is not just general surgery. It's also urology and gynecology and neurosurgery and orthopedic surgery and e n. T. Surgery and even the ability to manage the airway. In fact, it's every scope and camera that goes along with those clinical needs. So gone are the days of needing to roll in a whole separate tower for your flexible you re Doris copies or different equipment to check in a nasty Moses at the end of a colorectal case, or even yet again a different tower for endoscopic three D neurosurgery. Now you can think one. This unique design philosophy of image one s really enables the addition of just simple modules with all the scopes and cameras available designed to meet all your clinical needs that gives you what you need when you need it. And the mix of your clinical service lines has varied and the use of fluorescence guided surgery is also evolving, in fact, trending towards standard of care in many of those specialties that we just mentioned Image, one asked. Rubina is truly unique, and you've heard about this from Libby and Dr Chill Kerry, and that we can offer fluorescence imaging capability across the broadest range of clinical applications. So clinical care of your patients is an absolute priority, but so are operational efficiencies. Your hospitals and your health care systems are complex logistical operations with many, many moving parts. And ensuring that these complex operations run smoothly requires you to have supply chain excellence, staff education, plenty of staff education and optimize utilization of your equipment. So we just talked about the clinical value of modularity. Now let's think about the operational value of scale ability with a scalable surgical video system like Image one s. You have one system to build upon as your needs for various service lines change and grow. Those needs may change hospital, the hospital or even operating room toe operating room, but they could be added as you need them. So no more buying multiple video towers for the needs of various service lines you could just add the capability when you need it. In fact, four K i c g with Rubina can be simply added to every Carl starts video tower you have with just a very simple upgrade. No need to purchase all new systems. This equates to extraordinary value available Onley in one system image one s So when you are thinking of investing in your surgical video towers, you really only need to think about investing in one image one ass. When you are investing in surgical video towers, you have the ability to invest in one video tower that can serve multiple specialties. And that video tower can be scaled up over time, where the alternative is a very, very costly investment in investing in multiple technologies. Having multiple technologies is confusing for staff takes up space in the hospital. It's more assets to manage, and it is most certainly more expensive. So this philosophy of modularity and scalability really is designed to deliver you the lowest cost of ownership. And this is what we've designed and engineered across the decades. So you really don't need to think about investing after expensive generation after expensive generation, perhaps every two years now with image one s Rubina, you can think one. So thank you so much for joining us. Thank you for allowing us to share the priorities we have and taking care of our patients through our unique value proposition and our design philosophy Image one s Rubina is now officially available. You will be amazed. And I cannot wait for you to experience this incredible advancement that can simply and cost effectively be added to your image. One asked our when you think about a surgical video system, think Carl stores when you think Carl starts, think one. Thanks, Monica. Thank you, T J. I was so enthralled with everything that we just saw through there. And I can't thank you enough again for taking the time out of data. Comes a pleasure to be here. Thank you. All right. And I also want to take an opportunity to thank everyone that made this product launch possible. Thank you, too, Charlie. To mark to Dr Tell Carrie, Toe Libby and Monica, who just joined us for making and sharing their amazing knowledge of this amazing product. I'd like to thank the crew here for the great job that they've done. And I'd like to thank you in the audience for joining us today. Now I want to take a couple minutes to answer a couple of your questions. Thank you very much. All right, let's start off with the first one. Our new endoscopes needed for use with Rubina. So, like Mark and I talked about here, the good news is you don't necessarily have to get new scopes. However, if you want to prevent having to focus back and forth when you trigger from white light to read, I So then you probably want to invest in some new scopes, and that's gonna improve the workflow that you currently have. But the older ones will work. You'll just focus a little more often to make it happen. Next step, we use your four K technology in the operating room. How would this transition? So the good news is, if you are an existing Carl Stores in s customer, all you need are three key components. The opponent is the camera head. The second component is the light source. Then the third component are gonna be the scopes we just talked about. Also need a software upgrade But that's something that our our sales representative can come in and do for you at no cost. All right, here. Third question is, let's see, Do you have insight into pricing of what the system is going to cost the hospital? Well, as you know, pricing can depend on a lot of various factors. There's a ton of different things that go into pricing. What idea? And you're affiliated with what GPO you're aligned with. So what we're gonna recommend is you contact your Carl stores representative directly. If you don't know here, Carl Stores is representive is Why don't you click on the bottom of the page here that as you're watching us and hit that email so that you can get that information, we'll get that information to you as quickly as possible. Okay, we got one more here. All right, So if I am trying to find out who my Carl Stores representative is, what's the best way to get in touch with them again at the bottom of the screen that you see right now, there's an email address. What I recommend you do is click on that email address. Send it on often. We'll get back to you ASAP with your respective Carl stores representative. Okay, so everyone, that was the last one. Thank you so much for your time today. You'll be hearing about the Rabin A system very soon. Feel free to reach out to me and to continue to continue the conversation. I'm t j quickly. Where? Carl Stores. And this is the image. One s with Rubina. Have a good night.