He’s turning an iPad into a surgical cockpit—and launching semi-autonomous surgery from New Zealand to the world.

Nick Damiano is a Bay Area deep-tech founder with strong New Zealand ties: after building medtech across pacemakers, tele-presence OR support, and implantables (YC alum twice), he co-founded Andromeda to bring autonomous surgical robotics to market—faster and cheaper than the traditional medtech playbook. The bet: software-first robots that learn like self-driving cars, starting with urology and HOLEP (pioneered in Tauranga), guided on an iPad with “Google Maps for the prostate.”

This episode gets real about why most medtech financing is broken, how to avoid co-founder minefields, what the FDA actually cares about, and why New Zealand is a killer launchpad for clinical studies and first-in-market deployments. It’s a masterclass in building deep tech with startup speed—plus bold takes on Intuitive (Da Vinci), disposables-free business models, and taking world-class surgery global.

🧠 From surgeon family → Stanford → engineering → startups.

🫀 Leadless pacing & ultrasound targeting algorithms at EBR.

🛰️ Avail/NewRep: remote OR support and the COVID tailwind.

🧩 Co-founder fit, intensity alignment, and conflict habits.

🧪 Zenflow (BPH): YC medtech, trials, and NZ clinical beachhead.

🤖 Andromeda: software-first surgical robots with iPad control.

🗺️ HOLEP + “Google Maps for the prostate” to de-risk learning.

🏥 FDA pragmatism, NZ fast-track launches, and global access.

💼 Business model: no disposables, subscription + partnerships.

🥊 Startups vs incumbents: where Da Vinci stops and autonomy starts.

Connect with the Guest

LinkedIn (Nick): www.linkedin.com/in/nickdamiano

Company (Andromeda): https://www.andromedasurgical.com

Learn more about NZVC & Hosts

NZVC: https://www.nzvc.co.nz

Mark Pavlyukovskyy: https://www.linkedin.com/in/pavlyukovskyy/

Hendrik Remigereau: https://www.linkedin.com/in/hendrik-remigereau-09a03067/

Timestamps

00:00 – Intro

01:07 – Nick’s medical family roots

02:53 – Stanford & switch from medicine to startups

07:38 – Early jobs & pacemaker innovation

11:47 – Founding Avail (NewRep)

17:39 – Medical device reps explained

20:33 – Lessons on co-founders & teams

27:29 – Company #2: ZenFlow29:19 – Getting into Y Combinator

34:34 – Why MedTech is so hard

40:25 – ZenFlow outcome & NZ connection

45:15 – Founding Andromeda: autonomous surgery

48:19 – What the Da Vinci robot does

52:34 – Andromeda’s unique approach

57:32 – Starting with prostate surgery (HoLEP)

1:00:26 – Navigating FDA approval

1:05:45 – Future of autonomous surgery

If this sharpened your startup/business brain, hit 👍, drop your questions for Nick below, and subscribe for more New Zealand-powered deep-tech stories.

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