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Research & Development

Pioneering Next-Generation Surgical Solutions

Rigorous, evidence-driven innovation across an expanding portfolio of independent women's health device programs — spanning surgical instrumentation, pelvic diagnostics, interventional analgesia, and intrapartum monitoring.

Transformative Devices for Critical Unmet Needs

NEG+ is committed to developing medical devices that address the persistent, clinically documented gaps in women's pelvic diagnostics and surgical instrumentation. Our R&D process integrates voice-of-customer research, engineering precision, and evidence-based clinical validation from day one.

Each program is designed around a closed-loop evidence system — where user acceptance research informs engineering requirements, which drive a predefined publication strategy — creating the self-reinforcing evidence cycle that NIH reviewers and institutional investors recognize as fundable, adoption-ready innovation.

Our development principles: clinical-driven design, evidence-based innovation, iterative refinement, patient safety primacy, and data-driven optimization.

Multi
Independent Device Programs
$400M+
Combined US TAM
4+
Provisional Patents on File
6
Stage-Gate Development Phases
37.7%
POP Surgical Recurrence Rate Targeted
30%
Reduction in POP-Q Variability Targeted
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Device 1 · Surgical Access · FDA Class II · 510(k) Pathway

Belotte Colpotomizer™

Automated reusable handle + single-use disposable crown system for laparoscopic and robotic-assisted total hysterectomy. Integrates motor-assisted 360° circumferential electrosurgical colpotomy, pneumatic vaginal stenting (balloon insufflation), and microprocessor-regulated energy delivery — targeting a 60-second colpotomy time vs. the 8–14 minute current standard of care, with <2mm thermal spread.

Clinical Problem & Innovation

  • 450,000 hysterectomies annually in the US (55–60% laparoscopic/robotic)
  • 1–4% vaginal cuff dehiscence rate — leading reoperation cause after TLH
  • Standard colpotomy: 8–14 minutes, surgeon-dependent quality, 3–6mm thermal spread
  • Asymmetric blade geometry — patent-pending curved electrode array conforming to vaginal fornix anatomy
  • Integrated balloon insufflation — pneumatic vaginal stent maintains pneumoperitoneum, eliminates gas loss
  • Motor-assisted 360° rotation — eliminates surgeon free-hand variability
  • 60-second target colpotomy time — 6–12 minutes OR time savings per procedure
  • Estimated OR cost savings: $300–$2,400 per procedure at $50–$200/min

Market & Commercial

ParameterData
TAM (US Disposable)$290M+
Primary Target Surgeons~3,500 high-volume MIGS surgeons (>100 TLH/year)
WTP — Disposable Crown ASP$400–$600
ReimbursementCPT 58571/58573 — absorbed in existing DRG (LOW risk)
Regulatory PathwayFDA 510(k) — mechanical + electrosurgical + balloon
Predicate StrategyRUMI II/VCare + Thunderbeat/LigaSure combo
Regulatory Timeline3–4 years to clearance
Estimated Reg. Cost$800K–$1.2M
Individual Exit Range$250–$400M
Exit ProfileStrategic fit with established medtech platforms in gynecologic surgery

Development Milestones

1
2026 Q1–Q2

Concept Lock & Provisional Patent

Clinical needs assessment complete; asymmetric blade geometry and rotation mechanism patent application filed; voice-of-customer research with MIGS KOLs

2
2026 Q2–Q3

Engineering Prototype

CAD finalization; prototype fabrication; bench testing of rotation mechanism, balloon insufflation, and energy delivery; design controls initiation per 21 CFR Part 820

3
2026 Q3–Q4

Preclinical Validation

200-cycle mechanical endurance testing; ex vivo/cadaveric colpotomy validation; thermal spread thermocouple mapping; biocompatibility assessment

4
2027 Q1–Q3

FDA Pre-Sub & Clinical Study

Q-Sub meeting with FDA; IRB approval; multicenter human factors validation; primary endpoints: colpotomy time, thermal spread, cuff integrity rate

5
Q4 2027

FDA 510(k) Submission & Clearance (Target)

510(k) submission; Design History File complete; Quality Management System in place per ISO 13485

6
2028

Commercial Launch

GPO contracting; KOL-led clinical champion program; publications in JMIG and AJOG; robotic surgery program director targeted outreach

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Device 2 · Pelvic Diagnostics · FDA 510(k) + De Novo (SaMD) · NIH STTR Targeted

POP-Q AutoSense™ — Digital POP-Q Platform

Sensorized conformable anatomical vaginal sleeve system with indexed ring electronics, providing real-time simultaneous measurement of all nine POP-Q reference points. Outputs a digital twin 3D visualization and HL7 FHIR-compliant EMR export — eliminating the 30% inter-observer variability (ICC 0.45–0.75) inherent to manual POP-Q assessment that drives surgical misclassification and 37.7% recurrence rates.

Clinical Problem & Innovation

  • 50% of parous women have anatomical prolapse; 2.9–8% symptomatic (200M+ women in US)
  • 200,000–300,000 POP surgeries annually; 37.7% recurrence rate at 2 years
  • Manual POP-Q ICC: 0.45–0.75 — 30% of surgical decisions based on examinations that would be re-staged by a second clinician
  • Current exam: 8–12 minutes, no digital record, no EMR integration, no audit trail
  • FDA mesh ban (2019) heightened need for precise pre-surgical staging for non-mesh repair planning
  • Sensorized sleeve — indexed ring electronics, simultaneous 9-point POP-Q measurement
  • Digital twin — Bayesian FEM solver + ML compartment classification, 3D visualization
  • SaaS platform — HL7 FHIR EMR export, longitudinal monitoring, RTM codes 98975–98978

Revenue Architecture

StreamPrice Point
Device Kit (Capital)$8,500–$12,500 initial
Single-Use Sleeve (Consumable)$95–$145 per exam
SaaS Platform License$350–$750/month per site
Target Reimbursement$125–$185/exam (professional component)
CPT StrategyCPT 59899 → Category III → Category I (3–5 yr)
Market Size (2025)$1.06B → $1.7B by 2030 (6.6% CAGR)
FDA Clearance TargetQ1 2028
Series A Target$4–5M at Q3 2027

Evidence Roadmap — Closed-Loop System

0
Phase 0 · 2026 Q1

Baseline Perception Survey (REDCap)

Multi-specialty survey (urogynecologists, high-volume OB/GYNs): TAM framework — workflow pain points, technology adoption readiness, institutional & reimbursement context. Target n=80–120. Establishes non-promotional baseline for NIH reviewers.

1
Phase 0 → I · 2026 Q2

Design Requirements Lock + STTR Submission

Survey-driven FDA-compliant design inputs; sensor accuracy requirements, software architecture specifications; NIH STTR Phase I submission to NICHD/NIBIB. NSF STTR parallel track for algorithm and sensor engineering.

2
Phase I · 2026 Q3–Q4

Prototype Validation

Sensor accuracy vs. gold-standard manual POP-Q; intra/inter-user reproducibility (ICC >0.90 target); signal stability; software output validation. Cadaveric and simulated clinical cases.

3
Phase I · 2027

Early Feasibility Study + Publication

IRB-approved EFS; physician experience study (prospective); primary manuscript: "Automated Sensorized POP-Q vs. Manual Gold Standard" → AJOG (IF 9.8). Secondary: IUGA Journal, JMIG.

4
2027–2028

Multi-Site Clinical Trial + FDA Submission

Multicenter prospective accuracy study; STTR subaward partner sites provide CRC, IRB, OR access. 510(k) + De Novo SaMD submission — FDA clearance target Q1 2028.

5
2028+

Commercial Launch + CPT Category III

AMA CPT Editorial Panel application for Category III tracking code (AUGS coding committee endorsement). Platform positions NEG+ for strategic partnership or acquisition by established medtech companies serving the urogynecology and pelvic floor market.

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Device 3 · Interventional · FDA 510(k) · Multi-Specialty Application

NEG+ Pudendal Nerve Block Device™

A novel finger-mounted modular system integrating: (a) a reusable sensing module (RSM) with PMUT ultrasound ring array and near-infrared optical ring for real-time nerve localization and vascular avoidance; (b) a sterile disposable delivery module (DSUM) with spring-loaded retractable needles and fluid distribution; and (c) the Pudendal Nerve Localization Instrument (PNLI) with bilateral ischial spine registration arms and a spherical focused acoustic transducer — all within a single-operator workflow.

Clinical Problem & Innovation

  • Pudendal nerve block: critical technique for second-stage labor, perineal repair, chronic pelvic pain, and pudendal neuralgia
  • Landmark-guided success rate: 50–70% (Iowa Trumpet / freehand finger-guided)
  • Primary failure modes: nerve miss, inadvertent intravascular injection (obturator/internal pudendal artery), inconsistent depth control
  • Ultrasound-guided success rate: 82–97% (Rofaeel et al. 2008; Karaman et al. 2019)
  • Current US guidance requires separate probe + separate operator — incompatible with single-operator obstetric and outpatient settings
  • PMUT ultrasound ring array — real-time nerve localization in finger-mounted form factor
  • NIR optical ring — vascular avoidance for LAST prevention
  • CLEAR/CAUTION/ABORT alerts — AI-assisted nerve segmentation with optional needle deployment interlock
  • Applicable across: OB/GYN, urogynecology, CNM/midwifery, pain medicine, regional anesthesia

Validation Study Design (Phase 0 → IDE)

PhaseObjective
Phase 0 SurveyTAM instrument (n=80–120); specialties: OB/GYN, Urogyn, MFM, CNM, Pain, Anesthesia
Bench TestingPMUT array accuracy; NIR vascular detection threshold; needle deployment force
Cadaveric EFSNerve localization accuracy vs. gold-standard; CLEAR/CAUTION threshold calibration
Human FactorsSingle-operator ergonomic assessment across 5 specialty groups; workflow integration
IDE Clinical TrialMulticenter prospective; primary endpoint: first-attempt success rate (target: ≥85%)
ReimbursementCPT 64430 existing code; new technology supplement code application
FDA Pathway510(k) — combination device (electronics + sensing + delivery)
FDA Clearance Target2028–2029

Development Milestones

1
2026 Q1–Q2

Multi-Specialty Focus Group Survey

REDCap survey instrument across 5 specialty groups. TAM domains: perceived usefulness, ease of use, behavioral intention to adopt. Target n=80–120. Cost acceptance thresholds and CPT code confidence assessment.

2
2026 Q2–Q4

PMUT Array & NIR Module Engineering

Reusable sensing module (RSM) engineering: PMUT ring array calibration, NIR optical ring sensitivity. Disposable delivery module (DSUM): needle deployment mechanism, fluid distribution system. Provisional patent prosecution.

3
2027 Q1

Cadaveric & Bench Validation

Pelvis model validation of PNLI ischial spine registration; PMUT nerve localization accuracy; CLEAR/CAUTION/ABORT threshold definition; mechanical reliability 200-cycle endurance.

4
2027 Q2–Q4

Early Feasibility Study (IRB)

IRB-approved EFS with STTR academic partner. Human factors validation — attending vs. fellow vs. resident; obstetric and outpatient pelvic pain settings. Primary: nerve localization accuracy vs. anatomical landmark.

5
2027–2028

IDE Clinical Trial — Multicenter

Prospective, multicenter IDE trial. Primary endpoint: first-attempt success rate ≥85%. Secondary: LAST event rate, operator confidence score, workflow integration rating. Publication: AJOG, Obstetrics & Gynecology.

6
2028–2029

FDA 510(k) Submission & Commercial Launch

510(k) submission — combination device strategy. Commercial targeting: academic OB/GYN programs, urogynecology practices, labor & delivery units, pain management centers.

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Device 4 · Intrapartum Monitoring · De Novo / PMA · Tier 3 — Milestone-Gated

MUMS™ — Multimodal Uterine Monitoring System

An autonomous, AI-enabled intrapartum platform targeting critical unmet needs in labor and delivery monitoring. MUMS addresses a $2.45B global market where the foundational clinical tool — continuous electronic fetal monitoring — has not experienced meaningful autonomous intelligence integration despite being the primary safety instrument in over 3.6 million US births annually. MUMS is developed under a milestone-gated capital strategy: SBIR Phase I funds sensor architecture validation before Series A capital is deployed.

Clinical Problem & Innovation

  • Adverse perinatal outcomes remain a persistent public health crisis: Hypoxic-ischemic encephalopathy (HIE) affects 1–3 per 1,000 live births in high-income countries; US maternal mortality rates are the highest among comparable nations.
  • Current electronic fetal monitoring (EFM) relies on L&D nurse continuous visual interpretation — a highly variable, fatigue-dependent process that has not been meaningfully augmented by autonomous decision support.
  • Existing EFM platforms (wired and wireless external monitoring) do not provide AI-assisted classification, autonomous alerting, or integrated multiparameter sensing within a single platform.
  • MUMS integrates multimodal sensing with AI-enabled classification — providing autonomous pattern recognition and decision-support alerts to augment L&D nursing and MFM clinical judgment.
  • Directly aligned with ERAS opioid-reduction objectives: MUMS supports safer neuraxial and opioid-sparing analgesic management in monitored high-risk labor.
  • Federal policy environment: White House Blueprint for Addressing the Maternal Health Crisis (2022), $558M HRSA maternal safety mandate, and CDC maternal mortality action plan create a uniquely favorable regulatory and payer backdrop.

Regulatory & Market Profile

ParameterProfile
Global Market$2.45B intrapartum monitoring (6.7% CAGR)
US Births / Year~3.6M — 42% covered by Medicaid
Primary IndicationHigh-risk labor and delivery monitoring
Regulatory PathwayDe Novo / PMA (AI/ML-enabled device)
Policy AlignmentWhite House Blueprint · HRSA Mandate · CDC Maternal Action Plan
Reimbursement StrategyNTAP → National Coverage Determination → Medicaid state coverage
Non-Dilutive FundingNIH SBIR Phase I — sensor architecture validation
Capital StrategyMilestone-gated: Series A contingent on Tier 1 device commercial milestones

Development Milestones (Milestone-Gated)

1
2026 — Immediate

SBIR Phase I Commitment

NIH SBIR Phase I application to fund sensor architecture validation and preliminary bench testing. Non-dilutive funding secures early development without consuming Series A capital allocated to Tier 1 devices.

2
2026–2027

FDA Pre-Submission (Q-Sub)

Pre-Submission meeting with FDA to confirm De Novo vs. PMA pathway and AI/ML device classification. Q-Sub outcome is the primary gate for Phase I FIH go/no-go decision.

3
2027–2028

Phase I — First-in-Human Study

Milestone-gated: initiated only after Q-Sub confirmation and Colpotomizer FDA submission milestone. FIH study establishes sensor performance baseline and safety data.

4
2028–2029

Phase II — Clinical Concordance Study

AI classification concordance vs. gold-standard expert interpretation. Multi-site enrollment at academic L&D centers. Supports SBIR Phase II application and Series A MUMS allocation.

5
2029–2030

Phase III — Pivotal RCT

Prospective randomized controlled trial. Co-primary endpoints target reduction in adverse perinatal outcomes vs. standard EFM. NTAP application filed at regulatory submission stage.

6
2030–2031

FDA De Novo / PMA & Commercial Launch

Regulatory submission and commercial launch. CMS NCD application, Medicaid state coverage pursuit, and WHO prequalification pathway for global maternal health markets.

Multidisciplinary Engineering & Clinical Expertise

Our team brings together engineering, clinical medicine, regulatory science, and commercial strategy — bridging the gap between clinical insight and FDA-cleared product.

Mechanical Engineering

Advanced mechanism design, precision manufacturing, materials science for medical-grade applications, CAD optimization for ergonomic clinical use.

Electrosurgical Systems

Energy delivery platform integration, microprocessor-regulated thermal management, electrical safety testing, <2mm thermal spread engineering.

Sensor Technology

PMUT ultrasound array design, NIR optical sensing, precision measurement calibration, signal processing algorithms for real-time clinical feedback.

Software & AI/ML (SaMD)

Embedded systems, Bayesian FEM solver, ML compartment classification, HL7 FHIR EMR integration, FDA SaMD framework compliance, cloud analytics.

Clinical Research

Study design (EFS, IDE, multicenter RCT), biostatistics, human factors validation, IRB navigation, evidence generation strategy aligned with NIH STTR.

Regulatory Affairs

FDA 510(k) / De Novo / IDE submission strategy, Q-Sub meeting preparation, predicate analysis, combination device classification, ISO compliance.

Quality Management

Design History File (DHF), Risk Management File (RMF) per ISO 14971, 21 CFR Part 820 design controls, ISO 13485 QMS architecture.

Manufacturing & Supply Chain

Contract manufacturing partnerships, process validation, disposable device supply chain management, reusable component lifecycle design.

Six Principles That Drive Every Decision

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Clinical-Driven Design

Direct surgeon and clinician input guide every design decision — voice-of-customer research precedes every engineering specification.

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Evidence-Based Innovation

Rigorous preclinical and clinical testing validates every safety and performance claim before regulatory submission.

Iterative Refinement

Continuous improvement through structured user feedback loops, post-market surveillance, and data-driven design updates.

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Patient Safety First

Comprehensive risk management per ISO 14971 and failure mode analysis applied throughout every development phase.

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Accessibility Focus

Designing devices deployable across diverse settings — academic medical centers, community hospitals, ASCs, and resource-limited environments globally.

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Closed-Loop Evidence

Publication strategy predefined before data collection — every clinical dataset collected with a specific peer-reviewed manuscript target in mind.

Collaborate on the Future of Women's Health

We welcome partnerships with research institutions, clinical investigators, regulatory experts, and industry partners who share our commitment to precision women's health innovation.

Contact NEG+ Innovations Our Clinical Operations