E9: 2x YC founder Nick Damiano on his robotic surgery startup Andromeda Surgical | YC S23

Welcome to the Superconnector podcast. I am Matt Joseph, your host. My guest today is Nick Damiano, a two time YC founder and the CEO of Andromeda Surgical. Nick's first startup was valued at over a billion dollars, and he's raised tens of millions of dollars for subsequent ventures. Nick, welcome to the pod.

Thanks, Matt. Great to be here. Thanks for having

Absolutely. So, why don't we start with your current venture, Andromeda Surgical. Now I think this is fascinating. I think I read that your dad was a surgeon. My dad was also a surgeon. So robotic surgery is an area of great interest to me. How did you decide to start working on this?

Yeah, I guess, I was first exposed to it from my dad. My dad, who was a surgeon was doing some studies for, I think for computer motion. A company that was inquire

acquired by intuitive back in the nineties. He was doing trials for that and I was in high school. So always found it really interesting. I ended up deciding not to be a surgeon. In college I was pre med and then being at Stanford undergrad and just seeing all the startup activity happening around me in Silicon Valley, I pivoted from being a doctor to being an engineer and going into the startup world. Though I wanted to help patients.

And that's why I went into med tech as opposed to just into straight up tech. And then after having been in med tech with a few different companies, I really decided to get back into the robotics world. It really seemed like the future of where surgery was going. And then saw a really interesting opportunity to

merge that with another big emerging trend, which is AI and combine those two into a robotic system that could be a lot more powerful than what was currently out there.

I've read a lot about the Da Vinci system.

That's very popular.

It's a robotic surgery system that many surgeons use, but the industry is expanding quite a bit. And I'm actually very curious about that AI angle. So how is it that Andromeda is using AI to improve the landscape of robotic surgery?

Yeah. So our general hypothesis is that, robotics so far have been focused mostly on the physical elements of surgery, which are I think easier for, or less complicated for robots to address.

There are a lot of ergonomic challenges with surgery and that's how Da Vinci has built it's huge market now. I mean, they're worth, I don't haven't checked the latest price, but somewhere in the neighborhood of 140 billion and they're doing something like seven or 8 billion in annual revenue. It's been hugely valuable yet. There's even a bigger opportunity. As we see it to cognitively help with surgery. If you've ever been in an operating room, you'll see that lot of times things go wrong in ways that, if the surgeon, we're doing the perfect thing at every point in the surgery probably wouldn't happen.

So we're just trying to augment the surgeon and use AI and autonomy to make that cognitive aspect of surgery easier and help them make the right choice and do every action perfectly every time. That's kind of our long term vision. We're, building towards that step by step, of course, but we think there's a lot of clinical value that will come from being able to provide that cognitive assist.

context for the audience around what an operating room is like, it is not just a surgeon standing over a patient. There are anesthesiologists, nurses.

it's usually a lot of people who are in the room and it could be really chaotic, especially when things start to go wrong. So this is an environment that's highly dynamic and having a system like yours, which would be able to account for all the chaos of an operating room. I think that would be incredibly valuable.

How long is it taking to develop this system? Because everything I've seen around surgery and operating rooms, it's a very long time to build it. You're dealing with all the issues of the hospital administration, getting adoption.Yeah, I mean, if you're, depends on what you're building and yes, in general, there's lots of hurdles you have to get through

to get a product to market. We're trying to do as many of those as we can in parallel. So, when we think about the surgeon need and what the surgeon wants to be able to adopt a product and the hospital system, which you mentioned can be really complicated.

We're trying to de risk those as much as possible in parallel with developing the product. And one more thing we're doing that looks like will allow us to move much faster is building this step by step and focusing on what's the, minimal product that will meet the, clinical need and building that first.

And one more thing too with AI versus general robotics is that. The data is really key. So you want to also launch the product faster because you want to get that data to build the more sophisticated product. If we wanted to build the fully autonomous robot as the first generation, it might be impossible because the data has to come from somewhere.

And the best place to get the data is by having the robot out in the field.

So we're launching the robot first with some basic AI autonomy features, something that's exciting enough to really make the surgery easier and meet the clinical need, but then building that fully functional version with all the advanced features gradually as we collect more data.

So it's kind of a positive feedback loop that allows us to build next generation that's more exciting and then, you know, use that generation to in turn collect the data that builds the generation beyond that.

Oh man, it's fascinating how data comes into everything now, that it ends up being such an important piece of development. That's so interesting. So which specialties then are you targeting to start? Like which surgeries do you want to have this work on in the beginning?

Well, we're starting with urology. I worked in urology with my last company's Zenflow. So I've kind of been immersed in this space for about 10 years now, and we didn't limit ourselves to that. Initially, we wanted to go and find the most compelling clinical need to start.

We had a lot of conversations with surgeons to do this, and it was surgeons in various specialties, but because I knew so many urologists and also had a really good feel already for the needs in the urology space, we overwhelmingly talked to urologists.

And when we found a compelling need, which is this procedure called whole lap, homeom laser nucleation of the prostate. I already happen to know the guy who invented whole up. I'd work with him on clinical trials in the past and already had a sense for this being a need. So it was easier for us to get comfortable with the need and understand there was really a market demand there than it would have been going into somewhere else like pulmonology or neurology or something like that would have been a lot more learning we'd have to do ahead of time.

Yeah. I mean, it makes sense to go with what you know and what you've done. And that's always, I think, a smart approach, especially when you're in an area that's so complex and so highly regulated. How is it that you work with surgeons then in the development of this? I mean, you mentioned that you're dealing with a lot of urologists. What role do they play in the development of the system?

It's a very heavy role. So we have a lot of surgeons involved into the development, some in pretty hands on roles where they're directly advising and giving feedback all the time. We have a few surgeons that we, we talked to on an almost weekly basis that are doing that.

We've also spent a lot of time with a lot more surgeons, just getting into the operating room and immersing ourselves in this procedure and seeing what this is actually like when they're doing it in manual sense.

One good thing with what we're building is that we're not creating a new procedure, we're taking a procedure that already works really well and then making that even better and more accessible to more surgeons. So I think, I've myself been in least a hundred, maybe 120 hole up cases in the last year.

So I've been out there a lot and a lot of our team has been in, I think combined, maybe we've been in several hundred cases. So we've really immersed ourselves in that and, wanted to learn from surgeons. Then every time we build a feature, we want to make sure that it's meeting the need, not, letting the surgeons drive the features directly saying, Oh, you should build this thing. So we go build it, but it's more understanding their needs. Then the ones who translate that into what features will meet the needs.

It's almost like the role that any user might give you for feedback if you were building a piece of software. Yeah Obviously a little bit different in this case because they are your ideal target customer in a very sophisticated way. How is it that you set up the relationship with these surgeons?

It depends on the surgeon. And I mean, there's certain kinds of relationships, like advisory board relationships. You only have so many of those, so you're not going to have a hundred surgeons on your advisory board, but we've had them involved in different ways. Some are advisors or consultants that help out more regularly.

And then there's a lot more that are just, I guess, kind of informal advisors, or we have also data collection partnerships where they're recording cases that they're doing manually now that we then feed into our AI algorithm. So we have. I think we have at least 10 centers, 10 urologists that are actively providing data right now.

We're looking for more and that's one way we've been able to build the first version of the product is just sourcing this data from lots of different operators. We also want to cover uh, variety of different kinds of operators. So, I mean, it's great to get data from the world expert but then we also want to get the resident who's just learning the procedure so we can see more mistakes and challenges people are having.

Well, it sounds like such a complicated process to build a startup like this. And given that you've built several of these now, I want to zoom out a little bit and ask a more general question, which is. Why is it so difficult to build medical technology startups?

There's a lot of challenges in med tech. the obvious ones are just the hurls you have to go through when you think about first the technical hurdles, then clinical trials, where there's always surprises when anything meets the human body for the first time, there's always something surprising.

It never goes the way you expect. And then of course, FDA, the challenges of getting through FDA and other regulatory bodies around the world are well known and then there's things like reimbursement. Then you finally have to face the challenge that every startup faces, which is getting market adoption, getting users to use the product.

So you have most of the challenges of any industry. And then all these other challenges layered on that usually are going to take lots of time and cost lots of money. And because of that, then the investment ends up being tough because the ROI is tough to justify for a lot of companies where you've got, you know, five years, 10 years, 50 or a hundred billion dollars, sometimes getting things to market before you make any revenue, whereas you could invest in a tech company that could be on the market in a couple of weeks.

You've got to have something really compelling to justify all that upfront time and money invested.

That makes a lot of sense. I mean, on that point, how is it that you go about finding and building relationships with your investors? then I mean, I'm sure it's different for you now having succeeded significantly before. But if you were starting today, what would you do to build those types of relationships with investors?

Yeah, it does. It does help with this company, with my third startup now it was a lot easier to get off the ground and get people investing in the beginning, because if they've seen you operate before and if you've made them money, especially then they can get on board much more easily.

I think if you're a first time founder, then the best thing you can really do is execute well. And it's hard to do that sometimes without money, especially in med tech that I hear a lot of founders say, I can execute well once I get the money, but you can always find ways to kind of scrap things together in the beginning. I remember with my last company Zenflow and the prior one was called Nurep, and then eventually Avail, we were out there doing pitch contests, even like going to these things, trying to get a $5,000 prize.

We were submitting grants and, just being as scrappy and resourceful as possible to find anybody to put in money. There's of course, always accelerators too. I've been part of lots of accelerators some that have put in funding and some that haven't in the past. So you just really need to hit the pavement and look for people to back you as much as you can, then use that to just make as much progress as you can.

And then, you know, do as much as you can in ways that don't involve money. I remember we convinced contract manufacturers to make stuff for us upfront without putting money down. It's hard to find those people, but you have to go and have the conversations and try. Even like for animal studies, we were able to go and get a free animal study at one point an animal lab to get some early proof of concept.

So going out and trying those things is all you can do. It's really the number of shots you take determines whether you make it or not, because the success rate in the beginning as a first time founder, especially will be very low.

Yeah. Yeah. Rings true to my experience with it as well. Well, who are the best investors you feel like you've worked with? And you don't have to name names if you don't want to, but what would have been the best experience you've had with investors so far?

Yeah, I think I've had lots of good investors. There's lots of names I could name. I've been involved with pioneer fund for a while. They're also an investor in Andromeda. love pioneer fund. And there's a few other YC alumni funds like rebel fund and orange collective as well, that are great investors.

I think investors that have these really good founder networks can be particularly good because, whenever you send an update, whenever you have an ask, they can ping a lot of people that might be able to help with that. And I found people like pioneer fund had been incredibly helpful in doing that. Pioneer fund, by the way, it is YC focused.

There is a new fund that's a bio and health fund that doesn't just fund YC companies so if you're in the healthcare world, you can still get funded by them without being in YC. So yeah, people like that have been good. Zelda ventures as well who's a pre seed investor in Andromeda and Suzanne, who's the lead partner there also invested in both Zenflow and Avail and is just incredibly helpful.

And she's really the one who got me to go ahead with this company when I was kind of working on a few different things before we started Andromeda and think I had five projects going at once that might've become companies. I had a call with her just catching up. And she said, that this, this one idea, this autonomous robots for surgery ideas sounded particularly interesting.

I sounded more excited in that than the other things, which I was, but I maybe didn't realize it myself before that. And said, if you start this company, I'll fund you on day one. I'll write a check, you know, no, pitch or anything needed and that kind of made me think maybe we should go ahead with this.

And then the next week we just, we went and did it and sure enough, she signed the docs on the first day.

That's a great story. Well, tell me more about that idea matrix that you were considering going into Andromeda. what were you thinking about doing as opposed to doing this?

There were a lot of medtech type projects, and I didn't realize at the time, but I definitely realize now that the pathway I went through with, with ZenFlow, which was an implantable class three, Basically hard mode med tech device. I don't really want to do again. It's really painful.

It's also incredibly tough in a high interest rate environment, like we're in now. So there were a lot of those kinds of things. They were really moonshot ideas. Like, you know, treating heart failure was one of them. There was a really interesting heart failure device I was working on with, really promising potential co founders. But in the end, that was just going to be really, really tough path to go down.

I think you have to spend time vetting the idea and also the co founders that you're going to be working with, because that relationship is just so important that you don't want to get it wrong and get in with the wrong people. especially in something like a heart failure device. It's probably going to be 10 years least.

So you're signing up for a lot and I'm glad I took the time and, spent several months kind of vetting these different projects the teams that would have been involved on each one. After doing that, I have no doubt that this was the right choice.

It's one of the things I find very interesting about MedTech that you go in knowing that you have longer timelines than maybe you think about if you're doing just more of traditional software. So it's like, if you build some, I don't know, some B2B SaaS app, you kind of know that you might sell it in like two years. Which is obviously possible with medtech, but you're gonna have a longer journey going in, right? Like, you kind of know, yeah, if I'm gonna build autonomous robots to do surgery, that might take me a decade plus. Versus, you know, if I think, well, I'm gonna build the next, you know, B2B SaaS app that incorporates AI in some way.

I'm like, yeah, there might be a two to three year timeline on this. Maybe longer. I'll probably tell the VCs it's going to be longer, but I don't actually know going in. It's a very different sense of timelines from the beginning is what it feels like to me.

I think you've got to have more conviction for that reason. And in, in both the need, the idea, the team. My co founder and I, I think we spent about five or six months from when we first met and started talking about this idea, which we had both been thinking about this general concept independently before we met, we met through the YC network.

We were both very excited by working on this, but because we were both three time founders I think we're almost too hesitant to go ahead. And there's so many ways you can think that it might fail when you've worked on multiple startups, you can kind of become a prisoner of your own experience in some ways.

But yeah, I mean, we spent, I think four or five months before we committed to work together and go ahead on this and it was a lot more than I would have done. I think my first startup, we met at a meetup and then decided pretty quickly this was a thing we wanted to work on together. Whereas now I definitely would, and have put a lot more effort into it.

Yeah. I feel like you hit the nail on the head there that the experience is a gift and a curse that you've gone through it a few times, you know, what pitfalls to avoid. You also know how things fail, you get almost a little bit gun shy, a little more risk averse than you were especially when you've had success, like you've had. Well, tell me more about your co founder.

I mean, what's that relationship? Like, how did you guys, I mean, you mentioned you met through the YC network, but what was that connection like?

Yeah. It's really a unique team composition for this kind of a product. And I think it's an advantage that we have to have someone who's got experience in MedTech and then someone who's got very relevant experience from outside of MedTech.

Medtech's a very insular bubble. And usually people that are in the space stay in the space and nobody comes in or out.

So Kartik is a two time founder before this in autonomous vehicles. And he accomplished a lot with his last company, which was called Starsky Robotics, where he was the CTO who designed and launched the first autonomous truck that ever drove on a highway without a person behind the wheel.

So he's got incredible experience in robotics and autonomy, which is of course, really relevant to what we're doing here. it's really been a great dynamic where I think of myself as being pretty unconventional for med tech, yet still there's certain assumptions that you have from being in the industry.

And since he's totally outside of that, he always questions those things. And it's nice to have somebody call those assumptions into questions. And sometimes you learn things that I don't think you would have figured out with just a med tech focused team. I

What kind of things does he call out? I mean, what's he zoning in on that feels different than what you're accustomed to?

Think there's, I think it really pervades all aspects of the development process and the preclinical process. I mean, definitely around product. One thing we've realized is that medtech people just have this instinctual bias towards solving things with hardware and

Kartik's very, I guess he was a mechanical engineer initially by training, but he's become much more software focused So we've, been really steering things in direction that's, software first, and we're going to end up questioning a lot of the usual robotics business models.

It's a very different approach to robotics and that's been driven largely by him. And then also just things like quality systems. We're both first principles type people. And he's kind of come in and seen the kinds of quality systems MedTech companies put into place and really questioned every element of that where we can figure out something where it's, still meets the need of having a product that's safe and not going to cause problems in the field, but then, and then also of course meets the regulatory requirements, but then fits the company as well as possible and isn't overly bloated.

A lot of companies just kind of copy these documents from other companies they worked at. And I think they tend to pick up fluff over time and then maybe aren't as streamlined as they could be. And we've been able to find a, an approach that's much more streamlined and automated than what most companies do.

That's great. I mean, having that efficiency early on in your DNA, I feel like that always just carries over that, you know, as you add more people, as you grow it, you scale it, that the efficiency, the culture of efficiency ends up extending to other teammates. And it seems like you guys have gotten to that pretty quickly.

Yeah.

And I think one more thing I'd add is the iterative approach to building this, that a lot of companies do spend many years and develop something complicated they're going to launch first. Whereas we've tried to really pare it down. What's the simple set of features that will bring value to our customers.

We can then launch and then learn from the field and iterate fast. And then how do we set ourselves up to iterate fast as well? And that's something we're really focused on.

Can you walk me through the steps it will take to actually get this into the operating room? Yeah. I mean, there's, there's a lot to do, even for a simple, simplified version of the product, it's still a robot. There's still an A. I. L. M. N. So that in itself makes it fairly hard to build. And there's certain features we're building that I don't think there's much precedent for. So there was always the question.

Is this even going to work in the way that we hope it will? And then I think it comes down to having a product that works.

So we're just now putting on the final touches of the product. Most of it seems to be working in the way that we think it will. And we've got a few last things to figure out.

So hopefully we'll get that done. So I think finishing the product is the 1st thing getting the quality system in place. That's a requirement to get into the clinic at any Part of the world, really, or at least you want to have that in place, even if it weren't required. And then there's a lot of testing.

So we're trying to figure out what the most efficient way is to get through all the testing.

There's things like electrical safety testing that take, usually the, the vendors have like a two or three month lead time. So you've got to build that in and kind of work back from where you want to be when.

So we want the clinic this year. We have to work back from Okay. We've got to enroll. What do we have to do to get to the, get to the clinic and treat a patient? We've got to enroll patients first of all. So we'll work back to how much time is that going to take? We've got to submit and get approved in whatever geography we're, going to.

So, whether that's the U S or somewhere like New Zealand, we're looking at Because the guy who invented the procedure is based there. So we've got to think back through what's the process to get there. And then what do we need to submit? So the testing, all the documentation, and then, upstream of that is the product.

So we're just kind of planning that out and thinking back, okay, what do we need to do, what are the long lead time items and just making sure we haven't overlooked anything that's going to end up setting us

back.

That makes a lot of sense. And what's the sales motion like for this? I'm very curious about this because you're sort of straddling a few different industries here.

It's not fully settled yet but we have some good hypotheses on what we think will work. We do want to frame ourselves as a lot more of a software product, yet there is a hardware element. So it's tough to sell pure software products into hospital systems. There's a lot of those products out there.

I think it's a little bit lower barrier than physical med tech to get into that. So we do have the hardware that I think is more of the model that people are used to in the surgical world that there, okay, there is a robot here. This is a robotic platform at heart, but then we are looking at things like doing more of a subscription based model where, it becomes a lot more like a software product as you go.

And a lot of robotics are moving in that direction, even despite us. I mean, I think moon surgical, which is a really exciting company that's building kind of a surgical assistant robot is talking about a subscription model. Even intuitive which is the DaVinci robot the behemoth in the space has moved more towards a annual or monthly recurring revenue model as opposed to just an upfront capital purchase.

So I think the industry is moving that direction and it makes even more sense for a company that is mostly software based.

Some of the stats that I saw, for the global surgical robotics industry that in 2022, it did eight and a half billion dollars. It's supposed to be 18. 4 billion by 2027. So this is an industry which is growing really quickly. Do you sense that growth, that momentum on the ground?

Do you feel like you're watching it happen in real time?

Yeah. It's really interesting. There's a lot of tailwinds that are very apparent in this space, I think in robotics, in AI, in AI plus robotics. And it's really exciting to be in a space that's like that. Yeah. In my prior companies, that wasn't really the feeling that we had it, really does make things feel like it's more of a downhill battle when that's the case, as opposed to you're trying to create some market that doesn't exist and there's really no trends in your favor.

And then you've got to convince people there will be a trend. it's really hard to get investors on board or users on board with something that's not currently happening, but you want to kind of make materialize versus the thing that the trends are already pointing in the right direction.

Even with the procedure we're doing this whole lab procedure, even though it's, it's really hard to learn and that's limiting how much it gets adopted, it's growing really fast and a lot of surgeons. This is kind of part of the reason why we get into this. A lot of surgeons believe that this will be the future, even outside of Andromeda existing, that this is already a procedure that's being enthusiastically adopted and growing really fast organically, which again, really helps as we're trying to make the case that this is going to be a big thing in the future.

You mentioned the difference between your last startup, ZenFlow and this startup, Andromeda Surgical. And I want to dive into that a little bit more. So ZenFlow was

in the BPH industry. And you raised, I think in the 70 million, it was in that range. So a lot of money raised for the

Yeah.

But it was, like you said, it was an uphill battle. How is it that you think about your last startup versus this startup?

Yeah, I mean, with ZenFlow, we did have a real clinical need. We were in the BPH space and the minimally invasive BPH space with that company, we developed this implant that we thought was going to be a better approach for treating BPH in a doctor's office procedure.

That was, you know, relatively quick and easy and not so invasive. So we had the need and the, I think market, interest and the demand for it right. We were a little bit ahead of our time as far as this market developing. So for the first few years of ZenFlow, we really had to convince people, this would be a thing.

There had been minimally invasive options before that, that had kind of fallen out of favor because they didn't work that well or had other problems. And we had to convince people that was going to come back, that we had learned lessons, other companies had learned lessons, and there was going to be a new resurgence of minimally invasive BPH therapies. That became apparent by about 2017, but we started it in 2014, so we had to bet on the market moving in that direction. Fortunately, it did.

I mean we really got into an uphill battle with, ZenFlow and we were not experienced founders really. We had an incredibly hard clinical regulatory and reimbursement process. Then the adoption was not even that guaranteed, given that this was not really a market, we'd have to create it.

One benefit with being a repeat founder is you pick your spots a lot better. So we did have a good need and product, but again, a lot of challenges were clearly ahead of us. And that became really hard. I mean, when you have a device like that, like an implantable device, that's going to require a long term clinical trials and a hard FDA process.

A lot of those timelines are incompressible. So if you need to get a year of data or two years of data on a patient, you can't do that in three months or six months. It's going to take a year to get a year of data. So that really rate limits how fast you can move. And we had this belief we were going to move incredibly fast and beat the usual timelines by Two or three X and get this to market in, you know, four or five years instead of like 12 years, which is the norm for that kind of product.

And that was not possible. So I think we ended up beating it by like 20%, two or three X was not possible. There's just fundamental limitations that prevent you from doing that.

With Andromeda, those limitations are not really there as much. So we intentionally went into this space knowing that we wouldn't have those limitations. We had a technical challenge that was going to take some time, but that was more in our hands. It wasn't in FDA's hands. It wasn't in, just time's hands where you need to wait a year to get results.

It's all about kind of how does the procedure go acutely. So it's, the results are apparent pretty immediately.

We don't have those same kinds of delays. I really admire people that build devices like ZenFlow and are willing to embrace that brutal timeline. That's going to be incredibly long and painful and expensive. But, now I understand why a lot of people do that once and then don't do it again.

Fascinating. I want to continue more down that line. So you've had two YC startups. You went through and. Winter 15 with ZenFlow, summer 23 with Andromeda Surgical. How do you feel like YC's changed from when you went through it before versus when you went through last summer?

Yeah. I mean, we were the first MedTech company to do YC ever. I mean, I think it was us and one more company in our batch called shift labs. And so there was no precedent for that. And they, because of that, they didn't understand MedTech at all. We had some really good partners that advise us like

Paul Buhheit was our, our lead partner there with ZenFlow back in winter 15. And he was amazing in lots of ways, around just generally building a company.

And those principles did apply to MedTech, which we believe they would. It was a lot smaller. We knew every company in our batch the first time it was generally really good, but didn't have that specific expertise around medtech. So there were certain things where we had to say, okay, we had to ask ourselves every piece of advice. Does this thing apply to us or is it different in medtech? And maybe half the time it applied to us and half the time we had to say, well, that's not going to work for us. We need to do something differently.

Now it's a lot more robust as far as being able to handle almost every vertical. So, I mean, Surbhi Sarna joined YC a few years ago and has been focused on medtech and healthcare. She's a medtech founder herself and h ad a successful exit with a, you know, pure medical device company. So definitely knows the space well.

And the same in other verticals, they've got a lot of people that have specific experience in deep tech or other areas that they can really help every startup that does YC in, not just in a general sense, but also in a specific industry focused sense, that's a lot better. It is a lot bigger now.

I mean, there's, I think, at least twice as many companies. You're not going to know every company in your batch. It's divided up into four groups now where you probably know most companies in your group and very few of the ones outside of your group. But still, still really good.

I think YC has also been focused on building this in the same way that a good founder builds a startup and they've constantly been iterating and improving things, and so I've been really impressed as it progressed from, you know, Sam Altman leading it the first time I did YC to Michael Seibel and Gary Tan, they've all brought their own unique element to it.

And I think it's gotten better and better for that over the years.

such a great point. I mean, it feels like they treat it like a product. And they just are releasing features to their product every successive batch where they just have new things that they build. It's been pretty incredible to watch on that side as well. Another question here, you have been investing. Do you invest through the pioneer fund or are you angel investing? I mean, how do you approach your investment portfolio?

I wouldn't define myself as an investor in any significant sense, though I have done some investments, both on an angel basis and through pioneer fund. I did more individual deals before starting Andromeda now, I'm basically not doing that at all.

Any funds I have to invest I want to put into the company, any resources I have. And I also don't want to be distracted with too many side projects, like, you know, meeting lots of startups and deciding if I want to invest, I think it's, I want her to stay focused on this company. I still have been involved with pioneer fund.

I mean, they're an investor in us now, so it's also been helpful directly in the company. I think taking calls with Pioneer fund occasionally and evaluating startups also is pretty insightful on, how we think about strategy as a founder.

There's been times that I've given certain advice to a company or seen a flaw in a company, and then I've gone back and thought, well, actually I should be applying that my own company that sometimes it's easier from the outside to see something that it is from the inside. So in that way, it's really helpful though.

Yeah. I've tried to limit the time that it takes because now I'm just so immersed in building Andromeda.

Investing is a big distraction as a founder. I always found it fascinating when you have these founders who like raise VC funds on the side and they're like doing a bunch of deals. I feel like PG tweeted about that. He was like, that's essentially like a failure case for a founder. If they like have a fund on the side.

There's so many things you can get distracted by as a founder. And it's so tempting to do all those things. And I see lots of founders doing those things and it's really hard to Keep disciplined and not get involved in so many side

yeah, well, let's close out on this. What would you say is the most important lesson you've learned in your founding journey? You've had three startups now, so you've gone through it a lot.

I think it's longer than you think. I mean, there's going to be more time than you think. It's been a year for Andromeda and I think a year into, New Rep slash Avail and ZenFlow.

We felt like we had come so far in that first year. And that was like a significant percentage of the journey, but it really wasn't.

It was pretty insignificant in big scheme of things. And then kind of as a corollary to that, the things that you do for your company now are going to stick with you for many, many years in the future. So one thing I think that I really put a lot more emphasis on now is anybody that you get involved with or anything you do that's kind of irreversible.

You want to really make sure you get that right now so spend a lot more time vetting people, and especially for cultural reasons for the company, you want to really make sure that any employee that joins, you're really excited to have them join the company and contribute to the mission and be part of the thing that you're building.

Before I think if somebody kind of checked boxes and met a need, it's kind of the conventional med tech way of hiring somebody like, do they check these five boxes? If so, we'll hire them. If not, then we won't, you miss a lot of things that way. And same for investors. Definitely for board members, you know, those relationships are incredibly important and you just don't want to get into those things lightly. So I think I'm a lot more diligent about making sure that this is going to be a good fit for the long run before I jump into something.

I love that. There's a quote from Amazon, I worked at Amazon before, that Jeff Bezos had. He distinguished between one way doors and two way doors. That some decisions you make are a one way door that you can't reverse it. Whatever happens after that, it's going to be dependent on this event.

And some of them are two way doors. You can change your mind. And for a lot of the decisions that you just talked about from your employees to your investors investors in particular, it's a one way door. You can't take the equity back. Once you take the money, you signed the contract, you're pretty much stuck. So I love that long term thinking.

Yeah. And there's certain, I think there's definitely gray areas between one way doors and two way doors where there's things that you can undo, but it's really hard to undo. But I think you want to know where on that spectrum something falls. It's a really good way to

Yeah, absolutely. So, Nick, I really appreciate the time. Thank you so much for talking to me. And I hope you have a wonderful rest of your day.

Thanks. You too. Great to be here. Appreciate you having me on

All right, Nick. Take care.

Thanks, Matt.