If you know me, then you know surgical robotics is my sweet spot, so there was no way I was missing SRS2026! There's a moment at every conference where the story tells on itself. For me, that was at the pre-conference investor sessions on Wednesday. Dr. Vip Patel showed a telesurgery case performed more than 1,500 kilometers away with just 51 milliseconds of latency. This is great from a conceptual or humanitarian perspective, but what about real life? What about: Licensure?

The Factor That Makes or Breaks Renewals, Expansions, and Long-Term U.S. Adoption The first sale gets all the attention. It's the LinkedIn post. The celebratory email. The board slide with another hospital logo added to the pipeline because apparently one contract means world domination now. Unfortunately, it's also the sale that's most likely losing you money. Step 8 was about getting a hospital live. Step 9 is about making sure they never want to leave. Launch is an event.

The Part Where Enthusiasm Meets Reality and Reality Wins A pitch deck. A sales rep you hired three weeks ago. A pricing slide that got thrown together the night before a board meeting. A VP of Commercial who starts next month. A shiny new logo the leadership team spent four months arguing about. And, naturally, a LinkedIn post announcing your FDA clearance with enough fire emojis to trigger a smoke alarm. Congratulations. According to a shocking number of MedTech startups, yo

FDA clearance is not a commercial strategy. It's permission to start building one. That distinction matters more than most international MedTech founders realize until they've already arrived in the U.S. market, pitch deck in hand, expecting momentum. What they find instead: Clinical skepticism Procurement committees Reimbursement walls Hospital IT And Decision-makers with zero emotional investment in their technology. Clearance doesn't protect you from any of that. Over the