Executive Summary / Key Takeaways

• SS Innovations International ($SSII) is a commercial-stage surgical robotics company focused on democratizing advanced surgical care globally through its affordable and technologically advanced SSi Mantra system.
• The company is experiencing rapid revenue growth, with Q3 2025 total revenue surging 192% year-over-year to $12.83 million, driven by increased system and instrument sales, and a significant improvement in gross profit margins due to manufacturing efficiencies.
• SSII's technological edge is demonstrated by its modular SSi Mantra system, capable of complex procedures including cardiac and pediatric telesurgeries across vast distances with "zero perceptible lag," and a robust pipeline of complementary innovations.
• Despite strong operational momentum and strategic global expansion efforts, including anticipated U.S. FDA submission in Q4 2025, the company faces "going concern" risks due to accumulated deficits and reliance on external financing, necessitating careful monitoring of future capital raises and potential dilution.
• The company's valuation, reflected in a high Price-to-Sales (P/S) ratio of 39.27, indicates significant market expectations for sustained, rapid growth, placing pressure on SSII to execute its expansion and profitability roadmap flawlessly.

The Dawn of Accessible Robotic Surgery: SS Innovations' Global Vision

The landscape of modern medicine is being reshaped by robotic-assisted surgery, a field characterized by increasing awareness of its benefits, reduced learning curves for surgeons, and growing insurance coverage. This burgeoning market sets the stage for SS Innovations International, Inc. ($SSII), an American company headquartered in India, which is rapidly emerging as a key player dedicated to making advanced surgical robotics both affordable and accessible to a global population. SSII's core mission revolves around its proprietary SSi Mantra surgical robotic system and the comprehensive SSi Mudra suite of instruments, designed to support a wide array of soft-tissue procedures, including complex cardiac surgeries.

The company's journey began in 2015 as AVRA Surgical Microsystems, Inc., evolving through a pivotal recapitalization in April 2023 with CardioVentures, Inc., which ultimately led to its current identity and a strategic pivot towards innovative surgical robotics. This foundational shift culminated in a significant milestone in April 2025, when SSII successfully uplisted its common stock to the Nasdaq Stock Market LLC, signaling its intent for broader market engagement and global expansion.

Technological Prowess: The SSi Mantra Ecosystem

At the heart of SS Innovations' investment thesis lies its differentiated technology, primarily the SSi Mantra surgical robotic system. This user-friendly, modular, multi-arm system boasts advanced features crucial for precision surgery. It incorporates 3 to 5 modular robotic arms, an open-faced ergonomic surgeon command center, a large 3D 4K monitor, and a touch panel for patient information. The system also provides a virtual real-time image of the robotic patient-side arm carts and the ability for superimposition of 3D models of diagnostic imaging, enhancing surgical planning and execution. A dedicated vision cart offers the table-side team the same magnified 3D 4K view as the surgeon, contributing to improved safety and efficiency in the operating room.

The tangible benefits of the SSi Mantra are underscored by its operational achievements. The system has been clinically validated in India across more than 100 different types of surgical procedures. By July 15, 2025, over 5,000 surgical procedures had been successfully performed using the SSi Mantra, including 240 cardiac surgeries and 32 telesurgeries. Notably, the company has pioneered groundbreaking telesurgeries, including the world's first intercontinental robotic cardiac telesurgery, performed remotely from France to India over 4,000 miles, and the world's first robotic telesurgery for weight loss, executed over 560 miles with "zero perceptible lag, flawless precision, and seamless robotic control." These achievements highlight the system's robustness and the potential for remote surgical capabilities to bridge healthcare gaps.

SSII's innovation extends beyond the SSi Mantra. Its SSi Mudra instruments comprise over 40 types of robotic endo-surgical tools supporting various specialties. The company is also actively developing a pipeline of new technologies, including NADI – an Automated Coronary Anastomotic Connector, SSi Multi-Fire Clip Applier, SSi Robotic Stapler, SSi Maya – XR Pre-Operative Simulator, SSi Holographic Anatomy, SSi Chitrasa – Advanced DICOM Viewer, and SSi Mixed Reality Headset. These R&D initiatives aim to enhance existing capabilities and expand product offerings, with a specific focus on developing smaller instrumentation to address the unmet needs of the growing pediatrics market. For investors, this technological leadership and continuous innovation are critical, forming a competitive moat that can drive higher average selling prices, lower manufacturing costs (due to Indian-based operations), and ultimately, better margins and sustained market positioning in a rapidly evolving industry.

Competitive Dynamics and Strategic Positioning

SS Innovations operates in a highly competitive surgical robotics market, where it contends with established giants like Intuitive Surgical (ISRG), Johnson & Johnson (JNJ), Medtronic (MDT), and Stryker Corporation (SYK). These larger players benefit from extensive market penetration, mature ecosystems, and substantial R&D budgets. Intuitive Surgical, with its dominant da Vinci platform, boasts widespread global adoption and a robust training and support infrastructure, often translating to strong recurring revenue and superior profitability. Johnson & Johnson and Medtronic leverage their diversified healthcare portfolios and integrated solutions, offering broad market reach and stable financial performance. Stryker, strong in surgical instruments and orthopedics, emphasizes procedural efficiency and product reliability.

Against these formidable competitors, SSII positions itself as a challenger, emphasizing affordability and accessibility, particularly in underserved regions. Its manufacturing base in India provides significant operating cost advantages, enabling lower production costs and a more affordable surgical robotic system. While SSII may currently lag in overall market share and the sheer scale of R&D investment compared to its larger rivals, its specialized focus on areas like cardiac and pediatric telesurgery, coupled with advanced visualization features, offers a compelling value proposition. For instance, the SSi Mantra's demonstrated ability to perform complex telesurgeries with "zero perceptible lag" could differentiate it in markets prioritizing remote surgical capabilities.

However, SSII's smaller scale presents vulnerabilities, potentially leading to higher customer acquisition costs and challenges in matching the broader integration capabilities of its larger competitors. The company's valuation, with a Price-to-Sales (P/S) ratio of 39.27, significantly exceeds industry averages, indicating that the market is assigning a substantial growth premium. This aggressive valuation implies high expectations for rapid revenue scaling and flawless execution, leaving little margin for error if growth targets are not met. Barriers to entry in this sector, such as high R&D costs and stringent regulatory approvals, are substantial, which both protects existing players and poses hurdles for SSII's expansion into new, highly regulated markets like the U.S. and Europe.

Financial Performance and Operational Momentum

SS Innovations has demonstrated impressive revenue growth, reflecting increasing adoption of its SSi Mantra system. For the three months ended September 30, 2025, total revenue surged to $12.83 million, a substantial increase from $4.39 million in the prior-year period. This 192% year-over-year growth was primarily driven by system sales, which reached $11.71 million (up from $3.97 million), and instrument sales of $854,440 (up from $337,580). Over the nine months ended September 30, 2025, total revenue more than doubled to $27.95 million, compared to $12.53 million in the same period of 2024. The company sold 28 surgical robotic systems in Q3 2025 and 55 systems over the nine-month period.

Gross profit also saw significant improvement, reaching $6.16 million in Q3 2025 (up from $2.32 million) and $13.17 million for the nine months (up from $4.48 million). This expansion in gross profit margin is attributed to decreases in raw material prices and enhancements in manufacturing processes, leading to reduced raw material consumption. While the company continues to incur net losses ($3.72 million in Q3 2025 and $9.66 million for 9M 2025), these were partially offset by non-cash items like stock compensation expense and depreciation. Notably, stock compensation expense decreased substantially due to reversals related to resigned employees. Selling, general, and administrative (SGA) expenses increased, primarily due to higher legal and underwriting fees and costs associated with business events. The company also recognized income tax expense in its Indian operations for the first time, as these operations generated sufficient taxable profits.

Liquidity, Capital Resources, and Outlook

As of September 30, 2025, SS Innovations reported a working capital surplus of $27.24 million, a positive indicator for short-term operational flexibility. However, the company also carries an accumulated deficit of $53.32 million and has consistently reported net losses. These conditions, coupled with a historical dependence on related parties for funding, raise "substantial doubt" about the company's ability to continue as a going concern within the next year. Net cash used in operating activities for the nine months ended September 30, 2025, was $17.02 million, primarily driven by the net loss and increases in inventory, prepaid assets, and accounts receivables.

Management is actively working to address these liquidity challenges, planning to raise additional capital through further private or public offerings during the remainder of 2025 to scale operations and meet longer-term capital needs. The company has a history of securing financing through promissory and convertible notes, largely from its principal stockholder's affiliate, Sushruta Pvt Ltd. While management expresses confidence in its capital formation efforts and operational expansion, there is no assurance that additional equity capital will be raised or that profitability will be achieved. Any future financing could also lead to substantial dilution for existing stockholders.

Looking ahead, SS Innovations is aggressively pursuing global expansion. The SSi Mantra systems are currently cleared in seven countries, and the company aims to expand its presence further, with a strategic focus on the European Union and the United States. The company anticipates submitting a 510(k) premarket notification to the U.S. FDA in the fourth quarter of 2025, with a decision expected in the first half of 2026. This regulatory roadmap is central to its vision of decentralizing and democratizing robotic surgery globally.

Conclusion

SS Innovations International stands at a pivotal juncture, demonstrating impressive technological innovation and rapid revenue growth in the burgeoning surgical robotics market. Its SSi Mantra system, with its proven capabilities in complex and remote surgeries, positions the company as a compelling challenger to established players, particularly through its focus on affordability and accessibility. The recent Nasdaq uplisting and aggressive global expansion plans underscore a clear strategic direction.

However, the company's "going concern" warning, accumulated deficits, and reliance on external financing present significant risks that investors must carefully weigh against its growth potential. The high market valuation reflects substantial expectations for future performance, demanding flawless execution of its operational and strategic initiatives, including successful regulatory approvals in key markets and efficient capital deployment. SSII's ability to secure additional funding without excessive dilution, coupled with its continued technological advancements and disciplined cost management, will be critical in determining its long-term success in democratizing advanced surgical care worldwide.