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BackTable / ENT / Article
ExplORer Surgical: From OR Innovation to Industry Solution
Iman Iqbal • Updated Jun 29, 2025 • 51 hits
ExplORer Surgical was born out of a vision to improve the operating room, a place where precision, timing, and communication are critical. But as with many startups, the journey of ExplORer did not follow a straight path. What began as a solution for hospitals eventually evolved into something much broader, with implications far beyond its initial scope. This article explores how ExplORer transformed from a clinical operations tool into a powerful platform for medical device companies. Along the way, it highlights how mentorship, adaptability, and a willingness to embrace feedback shaped its success.
This article features excerpts from the BackTable ENT Podcast with Dr. Alex Langerman, founder of ExplORer Surgical. We’ve provided the highlight reel in this article, and you can listen to the full podcast below.
The BackTable ENT Brief
• ExplORer was created to reduce OR inefficiencies by standardizing surgical workflows and capturing procedural knowledge from surgeons and nurses.
• The product required high manual effort and data entry, which made adoption by hospitals difficult and limited its scalability.
• The company pivoted to serve medical device manufacturers, who needed standardized procedure guides and tracking tools for device use and training.
• ExplORer’s early integration with Zoom became critical during COVID-19, allowing remote surgical support when physical access to ORs was restricted.
• The founder’s career was shaped by mentors from all stages, senior, peer, and junior, and this openness helped guide key decisions.
• Repeated pitching and conversations helped refine the idea, improve the product, and reveal new opportunities, demonstrating the power of “idea harvesting.”
• Much of the success came from increasing "luck surface area" - seeking feedback, engaging in new environments, and staying open to chance collaborations.
Table of Contents
(1) The Evolution of ExplORer: Pivoting from Hospitals to Industry
(2) Lessons in Medical Innovation from ExplORer Surgical
The Evolution of ExplORer: Pivoting from Hospitals to Industry
ExplORer Surgical began as a solution to reduce inefficiencies in the operating room by ensuring that the right surgical tools were delivered, unnecessary ones were held back, and potential tools were kept on standby. It aimed to reduce waste and delays by capturing what experienced surgeons and nurses knew about each procedure and turning that into a step-by-step guide that anyone could follow. This was especially helpful in operating rooms with new or traveling nurses who weren’t familiar with specific surgeon preferences. However, the system required a lot of manual setup and input, which made it hard for hospitals to use and too costly to scale.
The company shifted direction when it found a better fit with medical device companies. These companies wanted a way to make sure their products, like pacemakers, were used exactly as intended, and ExplORer gave them a tool to train staff, guide procedures, and track how their devices were used. It also helped reduce the need for company reps to be physically present during surgeries, saving time and money. This version of ExplORer was easier to set up because the device companies already had the information needed for each procedure.
When the COVID-19 pandemic hit and outside access to operating rooms was restricted, ExplORer’s built-in Zoom features became especially valuable. Device reps could now support surgeries remotely, and hospitals had a way to keep things running smoothly without extra people in the OR. The success of ExplORer came from its ability to adapt to changing needs, shift to a better customer base, and build the right team to carry the idea forward.
[Dr. Brian Hartley]
Can you tell us a little bit about what is the value proposition exactly for Explorer?
…
[Dr. Alex Langerman]
I think that's the huge lesson, right? Is that this baby that you birth out into the world ends up growing on its own if you're paying attention to the market and becomes something not what you thought originally. The idea behind Explorer originally, and this is something that I still think there's a need, and honestly, it's something I'm currently working on at Vanderbilt, is a way to minimize the waste that occurs in the operating room. Simply put, making sure that the tools that you need are delivered so that there's not time wasted trying to find the tools that you need. That the tools that you don't need are not delivered or not opened at least. The tools that you might need are held in waiting if and when you need them. Basically getting the information that's stored in the surgeon's brain about how they know they're going to do something and the information that's stored in the brains of the nurses that are used to working on particular cases and in codifying it in a way that can be available to anybody.
This is particularly important now in a world of extreme use of traveling nurses, where you have nurses you've never worked with and have maybe new to the institution joining your team. You can't expect them to know-- They know how to pass you stuff. They know how to give you what you asked for, which is great, but they don't anticipate and they don't know what might not be needed or what special item might be needed. We got to find a way to provide that information that is scalable. The problem was with the original idea was it required a fair amount of interaction to use the app in the operating room. It required a lot of work to create the modules that had the surgeon's preferences in it. It was like a lot of handwork to do it.
[Dr. Brian Hartley]
Was there any observation or are you using a camera to do any of this? Is this purely like everybody needs to be entering information? Once that information is there, the system runs itself, so to speak?
[Dr. Alex Langerman]
Exactly. It was more of that. We weren't automating any kind yet. We thought we'd get there, but we were more like hand-doing it. In the operating room, we basically have a step-by-step guide to the procedure based on the tools, tasks, safety tips for given questions of procedure. There was a lot of bells and whistles we built in that I think were great, but didn't necessarily convince people to buy it. What we found was that we had a lot of trouble convincing hospitals to see the problem. You and I, in preparation for this podcast, we're talking about an interview that Jen gave where she talked about a chief of surgery she was talking to who said, "You know, these problems don't happen in RORs." She said, "No, they happen in all the hours that aren't yours because you're the chief."
In fact, that turned out to be true. He became an investor in the company and we had surgeons who were sought immediately. They're like, "This needs to happen. We want to invest." That was initial funding, but we had so much trouble getting hospitals to want to buy it. That's where we were failing. It was just not going to be viable because no one wanted to pay for it. The work it would take to onboard a whole team, to use the new device to input all of their data in. We had not found ways to scale that efficiently. That's when Jen, with the team that she built, had the insight of looking at vendors, suppliers, people who were making devices. For them, it was a different value proposition because they were saying, "Okay, for us, we don't care about waste or all the other parts of our procedure, but for our device, we want the person we're teaching to use our pacemaker to implant it the same way that it was designed to be implanted."
We want to be able to track how well they're doing in the case. We want to train them on it and have them bring this protocol to their team. Their team's all on the same page and that will improve the device outcomes. It's a great use for a playbook. That became our customer were these manufacturers, because they also could say, "Well, we can support the cost of the tablet devices that you run your app on. We can build the modules because we're going to provide the information on what steps and tools and on our device that are needed. It simplified the module creation.
[Dr. Brian Hartley]
With this, for example, would this be like, you've got a pacemaker from a certain company A, and then you would be able to pull up this module and it would just say, "Here are the steps involved in the procedure and here are some of the equipment that might be needed. Here's some that you keep in waiting.", that type of stuff or--?
[Dr. Alex Langerman]
That's exactly right. That's exactly right. It also saved their reps time because what's the usual protocol is you just call the rep in to be like, "Okay, now remember, like remind me how do you, whatever. Then on top of it, they also didn't need their reps to necessarily be monitoring it because the app could be used to collect certain data points on confirming that you used a particular setting or implanted the lead in a particular place or whatever your device called for. Then they began to say, "Well, this repless function, it's nice. I wonder if we can create a remote capability so the rep can just Zoom into the operating, literally--
[Dr. Brian Hartley]
In case there's an issue, yes.
[Dr. Alex Langerman]
That's because, and I say literally Zoom because we wrapped our app around zoom and that was in 2019. Come 2020 when suddenly no one could go to the OR unless you were the surgeon or the patient or the anesthesiologist. This became a really valuable tool. I want to give all the credit that's due to Jen for creating the amazing team that could pivot and provide this. I'm proud of the work that I did to come up with this idea that ultimately morphed into this other idea.
[Dr. Brian Hartley]
Yes. A hundred percent. It's the fire. It's this basically like the little spark that gets the fire going and then you've got a little fire and then, it turns into a raging fire at some point.
[Dr. Alex Langerman]
The thing is that like, what do you point to is like, what was the big success of the company? It was the pandemic.
…
We couldn't have done it without Jen and her team creating the environment that could respond to that. Also, I should not talk about Explorer without talking about Eugene Fine, who was our CTO that we hired very early on. He was remarkable, remarkable human being and extremely good at what he did. He was able to make those pivots quickly. Rob Steinman, who is one of our senior folks under Jen really helped lead that team too. They were, they were all crucial. I was proud to be, I was proud to be on the team.
[Dr. Brian Hartley]
That's incredible.
[Dr. Alex Langerman]
I want to say, I think for the physicians out there that might be thinking about being entrepreneurs, I'm not saying you can't run a company because you can, but that is its own skillset. That's very different from our skillset. Sometimes having, recognizing that is as much the success of a company as a great idea or a great product. That you need to go into this with humility and recognize that you don't know and seek out mentors in business who can help you train you up so that you can speak the language and find partners that can help handle that aspect of, the necessary aspect of an entrepreneurial endeavor.
[Dr. Brian Hartley]
Yes, I totally agree. I think often the physician or the clinical person, nurse, staff, whoever, that is the initial seed for an idea, often we're really good at finding clinical problems. That's our strength is finding areas where there might be inefficiencies or as you say, waste or complications. We're really good at finding that and describing what that problem is. Once you quarterback that and you've whittled it down, you've got some initial ideas on maybe a way to solve it, it's so important to bring in somebody who understands, not just the technical side, of course, for whatever your solution is, but understands the value side and how do you drive true value? Usually, it's a business person who knows how to do that. It's often not us, but knows how to find that value that can be hidden, that can be hidden and needs to be unlocked.
In your case, it sounds like, well, the value that's going to improve both, patient outcomes is codifying steps to a procedure, making sure everybody's on the same page. The value was hidden with the medical device companies, right? Also, you're improving patient care by making sure these steps are all done in a standardized way. Those business people can be huge. I don't think it can be underestimated or understated how important having business people at least as mentors early on can be to help you find that value when you're primarily a clinician.
[Dr. Alex Langerman]
Early on, when I was the one pitching Explorer, right, when we're doing these seed funds and innovation funds and competitions. It made a lot of sense for a surgeon to be standing up there being like, "This is a problem that I see every day in my own OR. This is why we're solving that. This, here's all the data behind it. This is why it's a good idea." People were like, "Yes. yes, this is, this is something worth giving, some pocket change to help build out." This was also how we wrote the STTR. We did an STTR through the National Science Foundation. That was a grant mechanism, non-diluted funding, which was great. Driving those, but then Jen had something like over a hundred investor calls before she found someone to really invest in the company. That is, and she's speaking, she's speaking the language of-
[Dr. Brian Hartley]
She knows exactly what to say.
[Dr. Alex Langerman]
It can make you more than your money back. I can turn this into a viable entity that produces a profit, a return on investment, not just something that would be great for the world, not that that's not important. That's not that that doesn't motivate people like Jen who want to change the world in with their skillset. You also have to speak the language of the investors to be like, "This is a safe investment. This is an investment where you will get your money back. We will make you money." It just turns out she was right.
…
[Dr. Alex Langerman]
It's technically, it's true. If you had a really great idea and you happen to talk to somebody who could actually execute it on immediately, like you have a, you suddenly come up with this idea of a different way to wrist a surgical instrument. You happen to be meeting with someone from Intuitive, not under an NDA. You're like, "Hey, what if you did it this way?" They could maybe execute on your idea. That that's possible, right?
[Dr. Brian Hartley]
Even then it's not likely because they're so busy with what they're doing.
[Dr. Alex Langerman]
That's right. That's right.
[Dr. Brian Hartley]
You got to think entropy with everybody. Everybody's got their own problems and issues they have to deal with, but go ahead.
[Dr. Alex Langerman]
There's, well, yes, exactly. There's unicorn events aside, right? The more you talk about the idea, the better it will get. It lives in the world. It does not live in your head. I've got, I've changed the way I think about my "IP", in air quotes, of the ideas I have is I want to talk about them. I want, I'm careful about not publishing things that might be patentable without investigating the patent. That is something that's important for people to remember. In the absence of creating a public disclosure of an invention, talking to colleagues about the problems that you're facing or trying to solve, what their pain points are, ideas that you might have and see, how they respond to those. Those are really important conversations for refining an idea that you have that might someday turn into something.
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Lessons in Medical Innovation from ExplORer Surgical
The evolution of ExplORer and its founder’s journey offers a broader lesson on how innovation develops through mentorship, curiosity, and adaptability. Early career support from mentors helped shape a mindset that values both guidance and diverse perspectives, including those from junior colleagues. This openness extended into the approach to innovation: identifying real clinical problems through firsthand observation, needs-finding, and listening carefully to others. The original idea behind ExplORer shifted over time through feedback and experience, highlighting how important it is to begin with a clear vision but remain flexible as the product takes shape.
The path from idea to implementation wasn’t linear. There were pivots in the business model, learning curves in startup management, and personal trade-offs in time and family life. These challenges brought new insights about alternate paths to impact, such as licensing, academic intrapreneurship, or advisory roles. As the company grew, the importance of testing ideas with others, through conversation, iteration, and even failed pitches, became clear. These interactions helped sharpen the value proposition and ultimately made the product more viable. Underlying all of this was the principle of increasing “luck surface area”- actively placing oneself in situations where chance encounters and shared ideas can open doors. Talking about ideas, asking for input, and embracing serendipity helped drive ExplORer forward. The lesson isn’t just about launching a successful product, but about creating the conditions through mentorship, openness, and persistence that allow innovation to flourish.
[Dr. Brian Hartley]
Right now I'm going to run through a quick summary of just some ideas I jotted down while we were chatting. Number one, this was a theme throughout. Mentors are so important. Your initial mentor at Howard Hughes really honed your integrity, it sounded like, which was really important with your OR device. Your surgeon mentors who helped you out after your clinical trial didn't turn out the way you thought. All the other surgeons who proposed that you should make a lab to study the OR. All of this is foundational in shaping your career and the successes you've had. It can do the same for everybody.
[Dr. Alex Langerman]
I'd like to just add to that just one thing, which is mentors can also be people who are younger and less experienced than you. That was these fresh eyes that I consider. I consider Emily Stockard a mentor through and through because she taught me to think differently and even to this day, I have one of our wonderful Vanderbilt residences on my mentorship committee because she's a really interesting thinker and she knows things I don't. She also has a perspective as me as an educator and as an attending from the residence point of view that allows her to have different insights in how I could improve my career. Again, I think having mentors from different fields and from above and below you and next door are important.
[Dr. Brian Hartley]
That's a really good point. That's awesome. Thank you for saying that. Next, clinical needs-based innovation. I think this is a theme also throughout. You went to look for problems, right? You were saying, where's the inefficiency? You even toured the country to see how other surgeons handled the OR. This is basically a needs finding from Stanford Biodesign and how important it is to make sure that you have a need there, right? That there's actually a problem that needs to be solved. You did the work. I think it worked out very well. You don't know where you're, this is another point. You don't know where this product or idea solution is going to go. You have no idea. All is you've got a problem and a problem area and you're learning as much as you can about it. You've got to trust that down that road, you're going to start getting feedback that's going to point your vision in the right direction. Because your vision that you started out with was not the vision that you ended with, right? That's hugely, hugely important to understand is that this road is winding. The more you follow it and be open to things, the better off you're going to be.
…
[Dr. Alex Langerman]
Would you do it again? It's funny. I used to joke that I wasn't going to start another company until the first one sold…
Yes, right, right. I don't know if I would necessarily pick that path. I'd say what's happened, what's changed is that I now can see how that path works, how that path could work, and where there might be other alternative paths that also follow a commercialization pathway, whether it's licensing a product, intrapreneurship where you're starting programs internally and maybe building it out and then letting the institution take it from there. I'm experimenting with those models right now. I certainly, if I had a thing, I wouldn't be opposed to starting another company, but I think I'd go into it with eyes much more wide open about the commitment it requires, which is massive, and honestly overwhelming to be a surgeon and try to even have a second job, and be a physician. I know you, Ryan, appreciate that as much as anyone, that it's hard to have a day job and a night job.
[Dr. Brian Hartley]
And a family.
[Dr. Alex Langerman]
Yes, and a family, right? Give it your all. That was a lot of stress in our, in my marriage, and my amazing wife, Charlotte, stood with me and let me pursue this crazy dream. I think I would also approach the ask that I'd be making of my family a lot differently now that I know what it would entail. I think that also gives you some pause, when you think about, "Should I do this or maybe there's, maybe someone else is better cut out for the day-to-day of a startup and I can just be here on the side helping out.", and that might be attractive.
[Dr. Brian Hartley]
You can be an idea generator, right? You can be a guide, you can be an advisor, you can be any number of things that don't involve the day-to-day that is actually mountains of pressure built upon you. I love that. It's really important to bring that in, that this is tough to be a physician and an entrepreneur, and especially if you have a family too, the stress is out of this world. That's great. Really important to mention. Then you mentioned also, I really liked the questioning mind versus the hierarchical mind with Emily using the fresh eyes. That's huge. Always be open to these things and always ask questions. Try to bring in your fresh eyes if you can at every point because you'll see things that you didn't think about when you're in your training. Next is, I love the idea of chance encounters and co-localization and serendipity, increasing your luck surface area. I think that's throughout this, your career. I didn't coin increasing your luck surface area. I saw that on Twitter, one of these guys said it, but it's a beautiful thing.
[Dr. Alex Langerman]
I'm taking it. I'm keeping it. [laughs]
[Dr. Brian Hartley]
Take it. Do it, do it, do it. There's a guy named Sahil Bloom who said that.
[Dr. Alex Langerman]
I follow him. Yes, he's great, he's great.
[Dr. Brian Hartley]
He's awesome. Yes, he's basically, you went around to each surgeon's department, you just listened to what they said and that leads to chance encounters. The IT gentleman, your Chris Radel, connected you with the innovation fund. That's increasing your luck surface area. You said, "I want to build a website.", but you're also open to other things. That's huge. I think I see that throughout. Your initial vision will change. I know mentioned that before, but it's so important. I think just having a vision is the key here. It is so important to start with a vision, whether it's right, wrong, doesn't matter. You have to have a vision that will attract people to your team. You had a vision for improving waste and inefficiency in the OR, that attracted Jen and others.
They brought in their own version to it and dove into value, and how do you drive value? Then, you're off to the races with that. Having an initial vision is critical. a lot of people take that for granted, but the second you started talking about waste and inefficiency, you were building a vision. That attracted people because they thought they could drive value for investors and patients and founders as well. Once an entrepreneur, your relationship with your institution can change. You mentioned this. Consider taking longer maybe to make the jump out of the research because you're protected there. You can iterate your product longer, work out the kinks, and before you're ready to go out and really be beholden to your investors and milestones and everything else.
[Dr. Alex Langerman]
Just to respond to that, I think that, particularly remembering that for a physician, clinician, entrepreneurs, this is your comfort zone, right? We've been trained in research. We've been trained to do clinical, hopefully, right?
[Dr. Brian Hartley]
Yes.
[Dr. Alex Langerman]
This is a safe space for us in a way that if you don't have the experience in entrepreneurship, in the business world, not that you can't build that experience, but before leaping into that with no experience and then trying to manage things, which is ultimately what we ended up doing because of the, that competition we entered that required a business.
[Dr. Brian Hartley]
Then once you started a business, that starts the wheels rolling in the university's eyes.
[Dr. Alex Langerman]
Yes, it does.
[Dr. Brian Hartley]
Totally agree. That's, it's important to know. You know, it's a balance. You don't want to take too long, okay? You don't want to take too long because then you can entropy or inertia can set in and you just keep going in the same direction. The next thing I love is the fact that Jim had to go do a hundred calls to raise funding. It takes time, folks. It doesn't matter how good your idea is, but don't look at that time spent as wasted time. You are stress-testing your ideas. You are refining them. My pitches for Palmyra got so much better over time because people would ask hard questions that I'd be like, "Oh, I don't-- Crap, I don't know that." You need to go and figure it out so that the next time somebody's going to ask you that question or they're going to ask you, "How are you going to make money? How are you going to make money? Who's going to pay you for this?" You got to answer those questions.
I loved your idea, the social physics book, Idea Harvesting. You're basically, I see it almost as the way AI works today, right? AI is not some magical thing. It's basically like, it just, you get, it gets feedback. It tries something, it gets feedback. It tries something, it gets feedback based on rules. That's what this is. It's basically like the more you put an idea out there, you stress test it, you get feedback, you change it, it gets better, you change it, it gets better. By the end, the idea you have may be unrecognizable to what you started with and be infinitely more valuable because you got that feedback, which is a lot like AI. Then finally share your idea. I think, don't be afraid that somebody's going to steal it. Make sure you file your IP, right?
Protect yourself. Even if the back of the napkin, file your provisional patent, it's $140. Don't give public disclosures, but always be asking people. Don't say, "Oh, I can't, that's confidential. I can't talk about that." If you're a physician and you're saying things like that, the chance, you've just raised your chances of failure probably 10X. You've got to be out there sharing and be like, "Is this a good idea? Is, what do you think about this? This?" That's how you're going to find out if really there's something there. You're greatly increasing your chance also for that luck surface area that somebody's going to say, "You know what? I know somebody who works on, have you talked to so-and-so?"
Podcast Contributors
Cite This Podcast
BackTable, LLC (Producer). (2023, April 25). Ep. 106 – Operating Room Innovation: the ExplORer Surgical Story [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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