7Baggers

Establishment Labs Holdings Inc
(NASDAQ:ESTA) 

ESTA stock logo

Establishment Labs Holdings Inc., a medical technology company, manufactures and markets medical devices for aesthetic and reconstructive plastic surgery. The company primarily offers silicone gel-filled breast implants under Motiva Implants brand. It also provides Divina 3D surgical simulation syst...

Founded: 2004
Full Time Employees: 602
Sector: Healthcare
Industry: Medical Devices
Healthcare
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At a glance:
Bull Thesis:
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Moat:
Income Statements:
Quarterly
Annual
    Unit: USD2026-03-31 2025-12-31 2025-09-30 2025-06-30 2025-03-31 2024-12-31 2024-09-30 2024-06-30 2024-03-31 2023-09-30 2023-06-30 2023-03-31 2022-12-31 2022-09-30 2022-06-30 2022-03-31 2021-12-31 2021-09-30 2021-06-30 2021-03-31 2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 2018-06-30 
                                   
      revenue
    		59,877,000 64,617,000 53,782,000 51,300,000 41,377,000 44,514,000 40,227,000 44,117,000 37,167,000 38,506,000 48,561,000 46,524,000 43,813,000 38,245,000 41,190,000 38,452,000 35,313,000 29,039,000 31,994,000 30,336,000 26,963,000 22,758,000 10,474,000 24,481,000 24,249,000 22,854,000 21,684,000 20,778,000 16,397,000 16,286,000 13,709,000 
      yoy
    		44.71% 45.16% 33.70% 16.28% 11.33% 15.60% -17.16% -5.17% -15.17% 0.68% 17.90% 20.99% 24.07% 31.70% 28.74% 26.75% 30.97% 27.60% 205.46% 23.92% 11.19% -0.42% -51.70% 17.82% 47.89% 40.33% 58.17%     
      qoq
    		-7.34% 20.15% 4.84% 23.98% -7.05% 10.66% -8.82% 18.70% -3.48% -20.71% 4.38% 6.19% 14.56% -7.15% 7.12% 8.89% 21.61% -9.24% 5.47% 12.51% 18.48% 117.28% -57.22% 0.96% 6.10% 5.40% 4.36% 26.72% 0.68% 18.80%  
      cost of revenue
    		17,542,000 19,085,000 16,086,000 16,028,000 13,569,000 14,022,000 14,510,000 15,181,000 12,787,000 12,454,000 18,300,000 16,445,000 15,648,000 12,205,000 13,736,000 13,516,000 11,087,000 9,419,000 10,526,000 10,246,000 12,319,000 7,612,000 3,240,000 9,003,000 7,890,000 8,616,000 8,672,000 9,526,000 6,524,000 6,173,000 5,492,000 
      gross profit
    		42,335,000 45,532,000 37,696,000 35,272,000 27,808,000 30,492,000 25,717,000 28,936,000 24,380,000 26,052,000 30,261,000 30,079,000 28,165,000 26,040,000 27,454,000 24,936,000 24,226,000 19,620,000 21,468,000 20,090,000 14,644,000 15,146,000 7,234,000 15,478,000 16,359,000 14,238,000 13,012,000 11,252,000 9,873,000 10,113,000 8,217,000 
      yoy
    		52.24% 49.32% 46.58% 21.90% 14.06% 17.04% -15.02% -3.80% -13.44% 0.05% 10.22% 20.62% 16.26% 32.72% 27.88% 24.12% 65.43% 29.54% 196.77% 29.80% -10.48% 6.38% -44.41% 37.56% 65.69% 40.79% 58.35%     
      qoq
    		-7.02% 20.79% 6.87% 26.84% -8.80% 18.57% -11.12% 18.69% -6.42% -13.91% 0.61% 6.80% 8.16% -5.15% 10.10% 2.93% 23.48% -8.61% 6.86% 37.19% -3.31% 109.37% -53.26% -5.39% 14.90% 9.42% 15.64% 13.97% -2.37% 23.07%  
      gross margin %
    		70.70% 70.46% 70.09% 68.76% 67.21% 68.50% 63.93% 65.59% 65.60% 67.66% 62.32% 64.65% 64.28% 68.09% 66.65% 64.85% 68.60% 67.56% 67.10% 66.22% 54.31% 66.55% 69.07% 63.22% 67.46% 62.30% 60.01% 54.15% 60.21% 62.10% 59.94% 
      operating expenses:
    		                               
      sales, general and administrative
    		43,605,000 44,028,000 37,166,000 44,176,000 39,699,000 44,018,000 34,055,000 32,792,000 28,941,000 39,962,000 37,027,000 31,706,000 34,846,000 31,268,000 32,957,000 26,913,000 27,558,000 24,780,000 21,753,000 18,138,000 18,195,000 15,008,000 14,438,000 18,984,000 17,134,000 19,227,000 18,394,000 16,056,000 14,833,000 12,985,000 10,829,000 
      research and development
    		5,241,000 5,434,000 4,555,000 5,203,000 5,055,000 5,144,000 4,801,000 5,488,000 4,273,000 7,128,000 6,947,000 6,533,000 6,479,000 5,289,000 4,903,000 3,598,000 6,034,000 3,884,000 4,349,000 4,048,000 4,466,000 2,729,000 2,399,000 4,199,000 3,630,000 3,776,000 4,001,000 3,584,000 3,661,000 3,174,000 3,705,000 
      total operating expenses
    		48,846,000 49,462,000 41,721,000 49,379,000 44,754,000 49,162,000 38,856,000 38,280,000 33,214,000 47,090,000 43,974,000 38,239,000 41,325,000 36,557,000 37,860,000 30,511,000 33,592,000 28,664,000 26,102,000 22,186,000 22,661,000 17,737,000 16,837,000 23,183,000 20,764,000 23,003,000 22,395,000 19,640,000 18,494,000 16,159,000 14,534,000 
      income from operations
    		-6,511,000 -3,930,000 -4,025,000 -14,107,000 -16,946,000 -18,670,000 -13,139,000 -9,344,000 -8,834,000 -21,038,000 -13,713,000 -8,160,000 -13,160,000 -10,517,000 -10,406,000 -5,575,000 -9,366,000 -9,044,000 -4,634,000 -2,096,000 -8,017,000 -2,591,000 -9,603,000 -7,705,000 -4,405,000 -8,765,000 -9,383,000 -8,388,000 -8,621,000 -6,046,000 -6,317,000 
      yoy
    		-61.58% -78.95% -69.37% 50.97% 91.83% -11.26% -4.19% 14.51% -32.87% 100.04% 31.78% 46.37% 40.51% 16.29% 124.56% 165.98% 16.83% 249.05% -51.74% -72.80% 82.00% -70.44% 2.34% -8.14% -48.90% 44.97% 48.54%     
      qoq
    		65.67% -2.36% -71.47% -16.75% -9.23% 42.10% 40.61% 5.77% -58.01% 53.42% 68.05% -37.99% 25.13% 1.07% 86.65% -40.48% 3.56% 95.17% 121.09% -73.86% 209.42% -73.02% 24.63% 74.91% -49.74% -6.59% 11.86% -2.70% 42.59% -4.29%  
      operating margin %
    		-10.87% -6.08% -7.48% -27.50% -40.96% -41.94% -32.66% -21.18% -23.77% -54.64% -28.24% -17.54% -30.04% -27.50% -25.26% -14.50% -26.52% -31.14% -14.48% -6.91% -29.73% -11.39% -91.68% -31.47% -18.17% -38.35% -43.27% -40.37% -52.58% -37.12% -46.08% 
      interest income
    		26,000 34,000 48,000 91,000 250,000 199,000 234,000 556,000 488,000 271,000 170,000 75,000 25,000 10,000 32,000 20,000 8,000 7,000 4,000 4,000 3,000 2,000 2,000 8,000 -9,000 3,000 4,000 6,000 7,000 5,000  
      interest expense
    		-7,088,000 -7,244,000 -6,203,000 -5,956,000 -5,853,000 -5,949,000 -5,313,000 -5,186,000 -4,381,000 -3,679,000 -3,620,000 -3,756,000 -2,200,000 -3,880,000 -3,388,000 -2,292,000 -2,326,000 -2,293,000 -2,248,000 -2,195,000 -2,211,000 -2,886,000 -2,130,000 -2,146,000 -2,128,000 -1,805,000 -2,521,000 -2,242,000 -2,266,000 -2,204,000 -2,173,000 
      other income
    		479,000 -775,000 -542,000 4,383,000 2,753,000 -11,519,000 2,046,000 -2,779,000 -3,037,000  1,343,000 729,000   -4,860,000 2,709,000 -1,910,000 -3,339,000 1,705,000  2,889,000 525,000   1,321,000 -2,340,000 118,000 -304,000 850,000 -1,274,000 -2,159,000 
      income before income taxes
    		-13,094,000 -11,915,000 -10,722,000 -15,589,000 -19,796,000 -35,939,000 -16,172,000 -16,753,000 -15,764,000 -28,604,000 -15,820,000 -11,112,000 -12,743,000 -18,005,000 -36,542,000 -5,534,000 -13,403,000 -14,612,000 -4,914,000 -6,783,000 -6,146,000 -4,066,000 -10,277,000 -17,528,000 -5,303,000 -12,467,000 -9,005,000 -10,735,000 -10,362,000 1,207,000 -5,208,000 
      provision for income taxes
    		-288,000 -585,500 -424,000 -1,004,000 -914,000 -344,000 -510,000 -428,000 -438,000 -669,000 -925,000 -830,000 -819,000 -603,000 -564,000 -399,000 -788,000 -66,000 -408,000 -165,000 502,000 -181,000 -194,000 -231,000   -35,000 -44,000   -152,000 
      net income
    		-13,382,000 -2,615,000 -11,146,000 -16,593,000 -20,710,000 -34,531,000 -16,682,000 -17,181,000 -16,202,000 -29,273,000 -16,745,000 -11,942,000 -13,562,000 -18,608,000 -37,106,000 -5,933,000 -14,191,000 -14,678,000 -5,322,000 -6,948,000 -5,644,000 -4,247,000 -10,471,000 -17,759,000 -5,556,000 -12,775,000 -9,040,000 -10,779,000 -10,514,000 1,306,000 -5,360,000 
      yoy
    		-35.38% -92.43% -33.19% -3.42% 27.82% 17.96% -0.38% 43.87% 19.47% 57.31% -54.87% 101.28% -4.43% 26.77% 597.22% -14.61% 151.44% 245.61% -49.17% -60.88% 1.58% -66.76% 15.83% 64.76% -47.16% -1078.18% 68.66%     
      qoq
    		411.74% -76.54% -32.83% -19.88% -40.02% 107.00% -2.90% 6.04% -44.65% 74.82% 40.22% -11.95% -27.12% -49.85% 525.42% -58.19% -3.32% 175.80% -23.40% 23.10% 32.89% -59.44% -41.04% 219.64% -56.51% 41.32% -16.13% 2.52% -905.05% -124.37%  
      net income margin %
    		-22.35% -4.05% -20.72% -32.35% -50.05% -77.57% -41.47% -38.94% -43.59% -76.02% -34.48% -25.67% -30.95% -48.65% -90.08% -15.43% -40.19% -50.55% -16.63% -22.90% -20.93% -18.66% -99.97% -72.54% -22.91% -55.90% -41.69% -51.88% -64.12% 8.02% -39.10% 
      basic and diluted net loss per share
    		-0.45 -0.08 -0.38 -0.57 -0.7 -1.2 -0.59 -0.62 -0.58 -1.12 -0.65 -0.48 -0.55 -0.76 -1.52 -0.24 -0.59 -0.61 -0.22 -0.29 -0.35 -0.18 -0.45 -0.79   -0.44 -0.53   -0.35 
      weighted-average outstanding shares used for basic and diluted net loss per share
    		29,947,157 29,620,022 29,622,101 28,913,811 29,475,649 28,161,761 28,248,256 27,905,614 27,788,120 26,034,185 25,615,444 24,678,113 24,457,793 24,511,495 24,396,847 24,310,856 23,972,722 24,091,546 23,949,006 23,827,137 23,316,102 23,611,925 23,482,031 22,456,365 20,541,528  20,448,643 20,495,671 17,350,705   
      change in fair value of derivative instruments
    		              1,099,000 -396,000 191,000 57,000 259,000 230,000 1,190,000 879,000 1,492,000 -1,929,000 209,000 235,000 2,640,000 -32,000 -51,000 11,420,000 5,830,000 
      other expense
    		         -4,158,000   2,592,000 -3,618,000      -2,726,000   103,000 -6,196,000        
      loss on extinguishment of debt
    		              -19,019,000                 
      change in fair value of contingent consideration
    		                     5,000 -141,000 440,000 -291,000 205,000 137,000 225,000 -281,000 -694,000 -389,000 
      benefit for income taxes
    		                        -96,750 -308,000   -152,000 99,000  
      basic net income per share
    		                        -0.398 -0.62   -0.165 0.07  
      diluted net income per share
    		                        -0.398 -0.62   -0.165 0.06  
      weighted-average outstanding shares used for basic net income per share
    		                         20,620,828    19,152,995  
      weighted-average outstanding shares used for diluted net income per share
    		                         20,620,828    20,123,297  
      initial public offering expenses
    		                               
      weighted-average outstanding ordinary shares used for net loss per share
    		                              15,351,899 
    Balance Sheets:
    Quarterly
    Annual
      Unit: USD2026-03-31 2025-12-31 2025-09-30 2025-06-30 2025-03-31 2024-12-31 2024-09-30 2024-06-30 2024-03-31 2023-09-30 2023-06-30 2023-03-31 2022-12-31 2022-09-30 2022-06-30 2022-03-31 2021-12-31 2021-09-30 2021-06-30 2021-03-31 2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 2018-06-30 
                                     
        assets
      		                               
        current assets:
      		                               
        cash and cash equivalents
      		68,101,000 75,572,000 70,624,000 54,639,000 69,178,000 90,347,000                          
        accounts receivable
      		77,076,000 77,497,000 71,442,000 70,092,000 63,236,000 65,002,000 67,251,000 59,982,000 50,838,000 54,693,000 51,395,000 41,049,000 35,423,000 31,246,000 32,003,000 29,689,000 24,437,000 24,704,000 23,093,000 23,777,000 19,127,000 18,756,000 17,142,000 21,615,000 22,767,000 22,022,000 21,312,000 20,115,000 17,648,000 18,248,000 16,204,000 
        inventory
      		86,659,000 85,611,000 88,158,000 94,683,000 90,425,000 78,766,000 67,122,000 64,213,000 72,489,000 67,935,000 56,370,000 46,141,000 36,583,000 31,557,000 26,532,000 28,538,000 28,407,000 26,652,000 23,946,000 22,377,000 23,210,000 28,400,000 29,057,000 25,512,000 28,660,000 26,387,000 26,540,000 23,752,000 24,845,000 15,365,000 13,223,000 
        prepaid expenses and other current assets
      		13,991,000 11,260,000 9,373,000 9,754,000 8,857,000 8,922,000 8,883,000 7,337,000 7,388,000 11,903,000 11,070,000 12,004,000 11,543,000 10,013,000 6,634,000 7,133,000 7,012,000 8,726,000 4,336,000 4,194,000 5,439,000 5,431,000 3,841,000 7,173,000 6,757,000 6,968,000 4,455,000 4,714,000 4,303,000 5,597,000 4,273,000 
        total current assets
      		245,827,000 249,940,000 239,597,000 229,168,000 231,696,000 243,037,000 182,953,000 186,132,000 203,695,000 186,721,000 209,017,000 142,041,000 149,904,000 138,165,000 156,428,000 110,016,000 113,271,000 124,705,000 128,181,000 128,298,000 132,299,000 134,018,000 136,422,000 147,896,000 95,839,000 97,936,000 84,177,000 91,716,000 99,435,000 104,787,000 45,342,000 
        long-term assets:
      		                               
        property and equipment
      		74,654,000 75,615,000 76,241,000 76,362,000 76,390,000 78,028,000 79,423,000 79,546,000 79,244,000 72,642,000 66,208,000 57,051,000 51,092,000 39,214,000 35,359,000 23,301,000 18,658,000 16,781,000 16,590,000 16,321,000 16,202,000 16,263,000 16,085,000 16,235,000 16,418,000 16,650,000 16,708,000 13,202,000 12,913,000 12,892,000 13,241,000 
        goodwill
      		1,209,000 1,209,000 1,209,000 1,209,000 1,209,000 1,209,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 465,000 
        intangible assets
      		9,303,000                               
        right-of-use operating lease assets
      		3,930,000 4,339,000 4,507,000 4,802,000 5,192,000 5,561,000 4,849,000 3,717,000 3,908,000 3,561,000 3,811,000 3,998,000 3,702,000 3,730,000 2,023,000 2,113,000 2,206,000 2,307,000 2,408,000 2,511,000 2,610,000           
        other non-current assets
      		16,114,000 16,122,000 6,942,000 6,941,000 7,311,000 7,313,000 5,212,000 5,187,000 5,011,000 1,439,000 1,569,000 1,437,000 1,290,000 1,447,000 1,194,000 1,191,000 558,000 447,000 617,000 628,000 664,000 401,000 360,000 362,000 368,000 312,000 370,000 325,000 315,000 283,000 1,071,000 
        total assets
      		351,037,000 357,167,000 338,895,000 329,668,000 333,364,000 346,831,000 282,685,000 285,088,000 301,838,000 270,533,000 285,299,000 209,359,000 211,061,000 187,653,000 199,883,000 141,556,000 139,529,000 148,359,000 152,120,000 152,349,000 156,388,000 154,684,000 156,812,000 168,423,000 116,531,000 118,256,000 104,801,000 108,956,000 116,573,000 121,472,000 63,323,000 
        liabilities and shareholders’ equity
      		                               
        current liabilities:
      		                               
        accounts payable
      		41,813,000 43,109,000 39,719,000 55,806,000 45,188,000 44,760,000 34,397,000 28,420,000 31,070,000 28,928,000 24,359,000 20,254,000 20,034,000 14,878,000 15,986,000 16,651,000 14,475,000 10,257,000 10,020,000 8,994,000 9,722,000 6,954,000 8,293,000 9,881,000 10,366,000 9,383,000 8,531,000 5,583,000 6,239,000 5,492,000 7,471,000 
        accrued liabilities
      		22,211,000 18,856,000 18,107,000 17,367,000 20,604,000 16,536,000 13,821,000 11,812,000 15,207,000 19,388,000 17,434,000 19,638,000 17,237,000 16,705,000 17,600,000 18,057,000 16,236,000 19,178,000 16,180,000 14,408,000 14,532,000 12,092,000 10,517,000 10,555,000 10,677,000 9,866,000 8,718,000 6,846,000 6,125,000 5,861,000 4,900,000 
        other liabilities, short-term
      		19,129,000 20,177,000 14,155,000 7,569,000 3,246,000 6,982,000 2,280,000 1,660,000 1,739,000 1,986,000 1,480,000 1,579,000 1,688,000 793,000 1,166,000 1,802,000 1,178,000 1,015,000 1,070,000 1,431,000 1,646,000           
        total current liabilities
      		83,153,000 82,142,000 71,981,000 80,742,000 69,038,000 68,278,000 50,498,000 41,892,000 48,016,000 50,302,000 43,273,000 41,471,000 38,959,000 32,376,000 34,752,000 36,510,000 31,889,000 30,450,000 27,270,000 24,833,000 25,900,000 20,141,000 20,552,000 22,460,000 23,242,000 20,346,000 21,386,000 16,558,000 16,447,000 14,851,000 18,772,000 
        long-term liabilities:
      		                               
        note payable
      		248,592,000                               
        operating lease liabilities, long-term
      		2,407,000                               
        other liabilities, long-term
      		2,102,000 1,136,000 1,111,000 1,666,000 1,633,000 1,678,000 1,292,000 1,456,000 1,545,000 1,505,000 1,992,000 1,821,000 1,626,000 2,243,000 2,056,000 1,821,000 2,392,000 2,145,000 2,219,000 1,820,000 2,332,000           
        total liabilities
      		336,254,000 333,620,000 322,532,000 306,905,000 294,814,000 293,736,000 249,975,000 240,069,000 244,927,000 240,046,000 230,426,000 225,355,000 219,246,000 186,134,000 184,016,000 93,721,000 88,790,000 86,799,000 83,291,000 79,798,000 81,427,000 74,727,000 75,026,000 78,116,000 76,917,000 74,452,000 51,014,000 47,926,000 47,088,000 44,485,000 60,952,000 
        commitments and contingencies
      		                               
        shareholders’ equity:
      		                               
        common shares — zero par value, unlimited amount authorized; 29,793,081 and 29,713,024 shares issued at march 31, 2026 and december 31, 2025, respectively; 29,385,011 and 29,304,954 shares outstanding at march 31, 2026 and december 31, 2025, respectively
      		434,529,000                               
        additional paid-in-capital
      		89,879,000 87,624,000 84,864,000 82,130,000 79,117,000 76,992,000 73,569,000 70,004,000 66,841,000 60,335,000 56,473,000 53,171,000 49,911,000 46,659,000 43,761,000 40,018,000 36,584,000 33,856,000 30,947,000 28,427,000 26,717,000 25,658,000 24,338,000 22,799,000 21,214,000 19,998,000 18,640,000 16,837,000 15,156,000 12,891,000 30,354,000 
        treasury shares, at cost, 408,070 shares held at march 31, 2026 and december 31, 2025
      		-2,854,000                               
        accumulated deficit
      		-509,138,000 -495,756,000 -493,141,000 -481,995,000 -465,402,000 -444,692,000 -410,161,000 -393,479,000 -376,298,000 -339,554,000 -310,281,000 -293,536,000 -281,594,000 -268,032,000 -249,424,000 -212,318,000 -206,385,000 -192,194,000 -177,516,000 -172,194,000 -165,246,000 -159,602,000 -155,355,000 -144,884,000 -127,125,000 -121,569,000 -108,794,000 -99,754,000 -88,975,000 -78,461,000 -79,767,000 
        accumulated other comprehensive income
      		2,367,000 1,155,000 1,427,000 -373,000 3,157,000 3,285,000 3,226,000 3,116,000 2,084,000 1,954,000 1,810,000 2,313,000 2,715,000 2,603,000 2,534,000 1,550,000 3,657,000 3,536,000 2,256,000 3,814,000 2,873,000 4,003,000 3,725,000 3,512,000 691,000 1,021,000 362,000 516,000 449,000 799,000 599,000 
        total shareholders’ equity
      		14,783,000 23,547,000 16,363,000 22,763,000 38,550,000 53,095,000 32,710,000 45,019,000 56,911,000 30,487,000 54,873,000 -15,996,000  1,519,000 15,867,000 47,835,000 50,739,000 61,560,000 68,829,000 72,551,000 74,961,000 79,957,000 81,786,000 90,307,000 39,614,000 43,804,000 53,787,000 61,030,000 69,485,000 76,987,000 2,371,000 
        total liabilities and shareholders’ equity
      		351,037,000 357,167,000 338,895,000 329,668,000 333,364,000 346,831,000 282,685,000 285,088,000 301,838,000 270,533,000 285,299,000 209,359,000 211,061,000 187,653,000 199,883,000 141,556,000 139,529,000 148,359,000 152,120,000 152,349,000 156,388,000 154,684,000 156,812,000 168,423,000 116,531,000 118,256,000 104,801,000 108,956,000 116,573,000 121,472,000 63,323,000 
        intangible assets, net of accumulated amortization
      		 9,942,000 10,399,000 11,186,000 11,566,000 11,683,000 9,783,000 10,041,000 9,515,000 5,705,000 4,229,000 4,367,000 4,608,000 4,632,000 4,414,000 4,470,000 4,371,000 3,654,000 3,859,000 4,126,000 4,148,000 3,537,000 3,480,000 3,465,000 3,441,000 2,893,000 3,081,000     
        note payable, oaktree, net of debt discount and issuance costs
      		 247,522,000    219,577,000       175,461,000 148,192,000 145,482,000                 
        operating lease liabilities, non-current
      		 2,820,000 2,982,000 3,364,000 3,803,000 4,203,000 3,825,000 2,989,000 3,180,000 2,918,000 3,191,000 3,415,000 3,200,000 3,323,000 1,726,000 1,805,000 1,900,000 1,967,000 2,041,000 1,630,000 1,923,000           
        common shares – zero par value, unlimited amount of shares authorized at december 31, 2025 and 2024; 29,713,024 and 29,195,439 shares issued at december 31, 2025 and 2024, respectively; 29,304,954 and 28,787,369 shares outstanding at december 31, 2025 and 2024, respectively
      		 433,378,000                              
        treasury shares, at cost, 408,070 shares held at december 31, 2025 and 2024
      		 -2,854,000                              
        note payable, net of debt discount and issuance costs
      		  246,458,000 221,133,000 220,340,000  194,360,000 193,732,000 192,186,000 185,321,000 181,970,000 178,648,000                    
        common shares — zero par value, unlimited amount authorized; 29,463,851 and 29,195,439 shares issued at september 30, 2025 and december 31, 2024, respectively; 29,055,781 and 28,787,369 shares outstanding at september 30, 2025 and december 31, 2024, respectively
      		  426,067,000                             
        treasury shares, at cost, 408,070 shares held at september 30, 2025 and december 31, 2024
      		  -2,854,000                             
        common shares — zero par value, unlimited amount authorized; 29,377,603 and 29,195,439 shares issued at june 30, 2025 and december 31, 2024, respectively; 28,969,533 and 28,787,369 shares outstanding at june 30, 2025 and december 31, 2024, respectively
      		   425,855,000                            
        treasury shares, at cost, 408,070 shares held at june 30, 2025 and december 31, 2024
      		   -2,854,000                            
        common shares — zero par value, unlimited amount authorized; 29,316,407 and 29,195,439 shares issued at march 31, 2025 and december 31, 2024, respectively; 28,908,337 and 28,787,369 shares outstanding at march 31, 2025 and december 31, 2024, respectively
      		    424,532,000                           
        treasury shares, at cost, 408,070 shares held at march 31, 2025 and december 31, 2024
      		    -2,854,000                           
        common shares – zero par value, unlimited amount of shares authorized at december 31, 2024 and 2023; 29,195,439 and 26,495,250 shares issued at december 31, 2024 and 2023, respectively; 28,787,369 and 26,087,180 shares outstanding at december 31, 2024 and 2023, respectively
      		     420,364,000                          
        treasury shares, at cost, 408,070 shares held at december 31, 2024 and 2023
      		     -2,854,000                          
        cash
      		      39,697,000 54,600,000 72,980,000 52,190,000 90,182,000 42,847,000 66,355,000 65,349,000 91,259,000 44,656,000 53,415,000 64,623,000 76,806,000 77,950,000 84,523,000 81,431,000 86,382,000 93,596,000 37,655,000 42,559,000 31,870,000 43,135,000 52,639,000 65,577,000 11,642,000 
        common shares — zero par value, unlimited amount authorized; 28,372,099 and 26,495,250 shares issued at september 30, 2024 and december 31, 2023, respectively; 27,964,029 and 26,087,180 shares outstanding at september 30, 2024 and december 31, 2023, respectively
      		      368,930,000                         
        treasury shares, at cost, 408,070 shares held at september 30, 2024 and december 31, 2023
      		      -2,854,000                         
        common shares — zero par value, unlimited amount authorized; 28,349,936 and 26,495,250 shares issued at june 30, 2024 and december 31, 2023, respectively; 27,941,866 and 26,087,180 shares outstanding at june 30, 2024 and december 31, 2023, respectively
      		       368,232,000                        
        treasury shares, at cost, 408,070 shares held at june 30, 2024 and december 31, 2023
      		       -2,854,000                        
        common shares — zero par value, unlimited amount authorized; 27,884,749 and 26,495,250 shares issued at march 31, 2024 and december 31, 2023, respectively; 27,476,679 and 26,087,180 shares outstanding at march 31, 2024 and december 31, 2023, respectively
      		        367,138,000                       
        treasury shares, at cost, 408,070 shares held at march 31, 2024 and december 31, 2023
      		        -2,854,000                       
        shareholders’ equity
      		                               
        common shares - zero par value, unlimited amount authorized; 26,213,504 and 24,815,908 shares issued at september 30, 2023 and december 31, 2022, respectively; 25,805,434 and 24,407,838 shares outstanding at september 30, 2023 and december 31, 2022, respectively
      		         310,606,000                      
        treasury shares, at cost, 408,070 shares held at september 30, 2023 and december 31, 2022
      		         -2,854,000                      
        common shares - zero par value, unlimited amount authorized; 26,181,033 and 24,815,908 shares issued at june 30, 2023 and december 31, 2022, respectively; 25,772,963 and 24,407,838 shares outstanding at june 30, 2023 and december 31, 2022, respectively
      		          309,725,000                     
        treasury shares, at cost, 408,070 shares held at june 30, 2023 and december 31, 2022
      		          -2,854,000                     
        common shares - zero par value, unlimited amount authorized; 24,869,763 and 24,815,908 shares issued at march 31, 2023 and december 31, 2022, respectively; 24,461,693 and 24,407,838 shares outstanding at march 31, 2023 and december 31, 2022, respectively
      		           224,910,000                    
        treasury shares, at cost, 408,070 shares held at march 31, 2023 and december 31, 2022
      		           -2,854,000                    
        note payable, madryn, net of debt discount and issuance costs
      		               52,486,000 51,906,000 51,343,000 50,810,000 50,305,000 49,832,000 49,374,000 48,939,000 48,529,000 48,142,000 47,770,000 24,053,000 23,190,000    
        madryn put option
      		               1,099,000 703,000 894,000 951,000 1,210,000 1,440,000 2,630,000 3,509,000 5,001,000 3,072,000 3,281,000 2,160,000 4,800,000    
        shareholders’ (deficit) equity:
      		                               
        common shares - zero par value, unlimited amount of shares authorized at december 31, 2022 and 2021; 24,815,908 and 24,488,335 shares issued at december 31, 2022 and 2021, respectively; 24,407,838 and 24,080,265 shares outstanding at december 31, 2022 and 2021, respectively
      		            223,637,000                   
        treasury shares, at cost, 408,070 shares held at december 31, 2022 and 2021
      		            -2,854,000                   
        total shareholders’ (deficit) equity
      		            -8,185,000                   
        common shares - zero par value, unlimited amount authorized; 24,750,397 and 24,488,335 shares issued at september 30, 2022 and december 31, 2021, respectively; 24,342,327 and 24,080,265 shares outstanding at september 30, 2022 and december 31, 2021, respectively
      		             223,143,000                  
        treasury shares, at cost, 408,070 shares held at september 30, 2022 and december 31, 2021
      		             -2,854,000                  
        common shares - zero par value, unlimited amount authorized; 24,638,037 and 24,488,335 shares issued at june 30, 2022 and december 31, 2021, respectively; 24,229,967 and 24,080,265 shares outstanding at june 30, 2022 and december 31, 2021, respectively
      		              221,850,000                 
        treasury shares, at cost, 408,070 shares held at june 30, 2022 and december 31, 2021
      		              -2,854,000                 
        common shares - zero par value, unlimited amount authorized; 24,602,156 and 24,488,335 shares issued at march 31, 2022 and december 31, 2021, respectively; 24,194,086 and 24,080,265 shares outstanding at march 31, 2022 and december 31, 2021, respectively
      		               221,439,000                
        treasury shares, at cost, 408,070 shares held at march 31, 2022 and december 31, 2021
      		               -2,854,000                
        common shares - zero par value, unlimited amount of shares authorized at december 31, 2021 and 2020; 24,488,335 and 23,925,789 shares issued at december 31, 2021 and 2020, respectively; 24,080,265 and 23,517,719 shares outstanding at december 31, 2021 and 2020, respectively
      		                219,737,000               
        treasury shares, at cost, 408,070 shares held at december 31, 2021 and 2020
      		                -2,854,000               
        common shares - zero par value, unlimited amount authorized; 24,394,766 and 23,925,789 shares issued at september 30, 2021 and december 31, 2020, respectively; 23,986,696 and 23,517,719 shares outstanding at september 30, 2021 and december 31, 2020, respectively
      		                 219,216,000              
        treasury shares, at cost, 408,070 shares held at september 30, 2021 and december 31, 2020
      		                 -2,854,000              
        common shares - zero par value, unlimited amount authorized; 24,133,453 and 23,925,789 shares issued at june 30, 2021 and december 31, 2020, respectively; 23,725,383 and 23,517,719 shares outstanding at june 30, 2021 and december 31, 2020, respectively
      		                  215,996,000             
        treasury shares, at cost, 408,070 shares held at june 30, 2021 and december 31, 2020
      		                  -2,854,000             
        common shares - zero par value, unlimited amount authorized; 24,094,051 and 23,925,789 shares issued at march 31, 2021 and december 31, 2020, respectively; 23,685,981 and 23,517,719 shares outstanding at march 31, 2021 and december 31, 2020, respectively
      		                   215,358,000            
        treasury shares, at cost, 408,070 shares held at march 31, 2021 and december 31, 2020
      		                   -2,854,000            
        common shares - zero par value, unlimited amount of shares authorized at december 31, 2020 and 2019; 23,925,789 and 21,057,040 shares issued at december 31, 2020 and 2019, respectively; 23,517,719 and 20,648,970 shares outstanding at december 31, 2020 and 2019, respectively
      		                    213,471,000           
        treasury shares, at cost, 408,070 shares held at december 31, 2020 and 2019
      		                    -2,854,000           
        other liabilities, short term
      		                     1,095,000 1,742,000 2,024,000 2,199,000 1,097,000 4,137,000 4,129,000 4,083,000 3,498,000 1,333,000 
        other liabilities, long term
      		                     2,582,000 2,026,000 2,126,000 2,461,000 3,055,000 3,415,000 3,378,000 3,551,000 3,431,000 5,361,000 
        common shares - zero par value, unlimited amount authorized; 23,827,680 and 21,057,040 shares issued at september 30, 2020 and december 31, 2019, respectively; 23,419,610 and 20,648,970 shares outstanding at september 30, 2020 and december 31, 2019, respectively
      		                     212,752,000          
        treasury shares, at cost, 408,070 shares held at september 30, 2020 and december 31, 2019
      		                     -2,854,000          
        common shares - zero par value, unlimited amount authorized; 23,762,787 and 21,057,040 shares issued at june 30, 2020 and december 31, 2019, respectively; 23,354,717 and 20,648,970 shares outstanding at june 30, 2020 and december 31, 2019, respectively
      		                      211,932,000         
        treasury shares, at cost, 408,070 shares held at june 30, 2020 and december 31, 2019
      		                      -2,854,000         
        common shares - zero par value, unlimited amount authorized; 23,735,013 and 21,057,040 shares issued at march 31, 2020 and december 31, 2019, respectively; 23,326,943 and 20,648,970 shares outstanding at march 31, 2020 and december 31, 2019, respectively
      		                       211,734,000        
        treasury shares, at cost, 408,070 shares held at march 31, 2020 and december 31, 2019
      		                       -2,854,000        
        common shares - zero par value, unlimited amount of shares authorized at december 31, 2019 and 2018; 21,057,040 and 20,672,025 shares issued at december 31, 2019 and 2018, respectively; 20,648,970 and 20,263,955 shares outstanding at december 31, 2019 and 2018, respectively
      		                        147,688,000       
        treasury shares, at cost, 408,070 shares held at december 31, 2019 and 2018
      		                        -2,854,000       
        common shares - zero par value, unlimited amount authorized; 20,983,139 and 20,672,025 shares issued at september 30, 2019 and december 31, 2018, respectively; 20,575,069 and 20,263,955 shares outstanding at september 30, 2019 and december 31, 2018, respectively
      		                         147,208,000      
        treasury shares, at cost, 408,070 shares held at september 30, 2019 and december 31, 2018
      		                         -2,854,000      
        common shares - zero par value, unlimited amount authorized; 20,882,419 and 20,672,025 shares issued at june 30, 2019 and december 31, 2018, respectively; 20,474,349 and 20,263,955 shares outstanding at june 30, 2019 and december 31, 2018, respectively
      		                          146,433,000     
        treasury shares, at cost, 408,070 shares held at june 30, 2019 and december 31, 2018
      		                          -2,854,000     
        intangible assets, net of accumulated amortization of 1,410 and 1,213
      		                           3,248,000    
        common shares - zero par value, unlimited amount authorized; 20,803,803 and 20,672,025 shares issued at march 31, 2019 and december 31, 2018, respectively; 20,395,733 and 20,263,955 shares outstanding at march 31, 2019 and december 31, 2018, respectively
      		                           146,285,000    
        treasury shares, at cost, 408,070 shares held at march 31, 2019 and december 31, 2018
      		                           -2,854,000    
        intangible assets, net of accumulated amortization of 1,213 and 573
      		                            3,445,000   
        restricted cash
      		                             75,000 75,000 
        notes payable related party, including accrued interest
      		                              5,068,000 
        madryn call option
      		                               
        ordinary shares - 1.00 par value (class a and b), zero and 21,206,630 shares authorized at december 31, 2018 and 2017, respectively; zero and 13,427,536 shares issued at december 31, 2018 and 2017, respectively; zero and 12,206,326 shares outstanding at december 31, 2018 and 2017, respectively
      		                               
        ordinary shares - no par value (class c, d, e, f, g and g-1), zero and 2,316,169 shares authorized at december 31, 2018 and 2017, respectively; zero and 2,316,169 shares issued and outstanding at december 31, 2018 and 2017, respectively
      		                               
        common shares - zero and 1.00 par value as of december 31, 2018 and 2017, respectively, unlimited amount and 84,050,000 shares authorized at december 31, 2018 and 2017, respectively; 20,672,025 and zero shares issued at december 31, 2018 and 2017, respectively; 20,263,955 and zero shares outstanding at december 31, 2018 and 2017, respectively
      		                            145,709,000   
        treasury shares, at cost, 408,070 and 1,221,210 shares held at december 31, 2018 and 2017, respectively
      		                            -2,854,000   
        intangible assets, net of accumulated amortization of 1,038 and 573
      		                             2,970,000  
        ordinary shares - 1.00 par value (class a and b), zero and 21,206,630 shares authorized at september 30, 2018 and december 31, 2017, respectively; zero and 13,427,536 shares issued at september 30, 2018 and december 31, 2017, respectively; zero and 12,206,326 shares outstanding at september 30, 2018 and december 31, 2017, respectively
      		                               
        ordinary shares - no par value (class c, d, e, f, g and g-1), zero and 2,316,169 shares authorized at september 30, 2018 and december 31, 2017, respectively; zero and 2,316,169 shares issued and outstanding at september 30, 2018 and december 31, 2017, respectively
      		                               
        common shares - zero par value, unlimited amount and 84,050,000 shares authorized at september 30, 2018 and december 31, 2017, respectively; 20,539,095 and zero shares issued at september 30, 2018 and december 31, 2017, respectively; 20,131,025 and zero shares outstanding at september 30, 2018 and december 31, 2017, respectively
      		                             144,612,000  
        treasury shares, at cost, 408,070 and 1,221,210 shares held at september 30, 2018 and december 31, 2017, respectively
      		                             -2,854,000  
        intangible assets, net of accumulated amortization of 880 and 573
      		                              3,129,000 
        ordinary shares - 1.00 par value (class a and b), 21,206,630 shares authorized at june 30, 2018 and december 31, 2017; 13,631,041 and 13,427,536 shares issued at june 30, 2018 and december 31, 2017, respectively; 12,409,831 and 12,206,326 shares outstanding at june 30, 2018 and december 31, 2017, respectively
      		                              13,631,000 
        ordinary shares - no par value (class c, d, e, f, g and g-1), 4,191,169 and 2,316,169 shares authorized at june 30, 2018 and december 31, 2017, respectively; 3,327,343 and 2,316,169 shares issued and outstanding at june 30, 2018 and december 31, 2017, respectively
      		                              44,019,000 
        common shares - 1.00 par value, 84,050,000 shares authorized at june 30, 2018 and december 31, 2017; zero shares issued and outstanding at june 30, 2018 and december 31, 2017
      		                               
        treasury shares, at cost, 1,221,210 shares held at june 30, 2018 and december 31, 2017
      		                              -6,465,000 
      Cashflow Statements:
      Quarterly
      Annual
        Unit: USD2026-03-31 2025-12-31 2025-09-30 2025-06-30 2025-03-31 2024-12-31 2024-09-30 2024-06-30 2024-03-31 2023-09-30 2023-06-30 2023-03-31 2022-12-31 2022-09-30 2022-06-30 2022-03-31 2021-12-31 2021-09-30 2021-06-30 2021-03-31 2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 
                                      
          cash flows from operating activities:
        		                              
          net loss
        		-13,382,000 -2,615,000 -11,146,000 -16,593,000 -20,710,000 -34,531,000 -16,682,000 -17,181,000 -16,202,000 -29,273,000 -16,745,000 -11,942,000 -13,562,000 -18,608,000 -37,106,000 -5,933,000 -14,191,000 -14,678,000 -5,322,000 -6,948,000 -5,644,000   -17,759,000 -5,556,000 -12,775,000 -9,040,000 -10,779,000 -10,514,000 1,306,000 
          adjustments to reconcile net loss to net cash from operating activities:
        		                              
          depreciation and amortization
        		2,478,000 2,485,000 2,388,000 2,355,000 2,335,000 2,154,000 1,990,000 1,422,000 1,268,000 1,061,000 947,000 936,000 989,000 978,000 950,000 953,000 926,000 948,000 936,000 908,000 846,000 873,000 796,000 833,000 1,078,000 794,000 783,000 633,000 769,000 696,000 
          provision for credit losses
        		217,000 578,000 810,000 238,000 1,726,000  613,000 78,000 275,000                      
          provision for inventory obsolescence
        		1,300,000 428,000 764,000 804,000 650,000 1,012,000 275,000 -44,000 562,000 402,000 1,041,000 -387,000 90,000 217,000 -145,000 1,415,000 245,000 116,000 -116,000 93,000 -332,000   137,000 236,000 -71,000 61,000 -83,000   
          share-based compensation
        		3,003,000 2,902,000 2,894,000 3,185,000 2,434,000 3,546,000 3,656,000 3,758,000 3,444,000 3,971,000 3,616,000 3,324,000 3,260,000 2,921,000 3,743,000 3,434,000 3,030,000 3,064,000 2,557,000 1,756,000 1,187,000 1,348,000 1,557,000 1,629,000 1,352,000 1,444,000 1,894,000 1,836,000 2,354,000  
          loss from disposal of property and equipment
        		47,000 97,000 64,000 -444,000 436,000 212,000 -90,000 35,000 6,000 -105,000 59,000 288,000 108,000 41,000 21,000 59,000 37,000 70,000 43,000 20,000 18,000   5,000 -8,000 51,000 16,000 8,000 3,000  
          unrealized foreign currency gain
        		-428,000                              
          amortization of right-to-use asset
        		214,000 285,000 154,000 241,000 231,000 239,000 198,000 161,000 145,000 183,000 182,000 177,000 158,000 124,000 92,000 95,000 101,000 101,000 103,000 101,000           
          stock compensation in lieu of cash fees
        		97,000 97,000 98,000 98,000 110,000 110,000 634,000 110,000 110,000                      
          non-cash interest expense and amortization of debt discount
        		1,070,000 887,000 1,002,000 793,000 763,000 749,000 629,000 1,546,000 3,447,000 3,351,000    2,711,000                819,000 
          changes in operating assets and liabilities:
        		                              
          accounts receivable
        		302,000 -6,473,000 -1,310,000 -4,461,000 775,000 -5,146,000 -6,909,000 -9,615,000 -4,608,000 -4,655,000 -9,623,000 -5,356,000 -2,450,000 -865,000 -3,951,000 -5,067,000 100,000 -2,421,000 844,000 -5,218,000 514,000 -859,000 4,321,000 -171,000 -232,000 -1,564,000 -832,000 -2,883,000 1,200,000 -2,207,000 
          inventory
        		-624,000 1,107,000 7,405,000 -5,390,000 -10,182,000 -11,337,000 -1,494,000 7,359,000 5,001,000 -13,880,000 -10,584,000 -8,494,000 -2,585,000 -7,351,000 -55,000 -909,000 -2,355,000 -4,212,000 -379,000 -698,000 6,508,000 1,513,000 -3,673,000 438,000 -1,365,000 -1,282,000 -2,469,000 1,744,000 -3,638,000 -2,339,000 
          prepaid expenses and other current assets
        		-186,000 1,539,000 1,078,000 -946,000 176,000 -261,000 -1,502,000 59,000 1,790,000 -898,000 41,000 -246,000 -1,298,000 -4,103,000 843,000 69,000 1,709,000 -4,443,000 -94,000 1,217,000 87,000 -1,624,000 3,327,000 -660,000 411,000 -2,715,000 592,000 -826,000 1,619,000 -2,394,000 
          other assets
        		5,000 -8,000 12,000 416,000 34,000 33,000 -2,000 -191,000 -323,000 110,000 -122,000 -137,000 187,000 -281,000 -20,000 -636,000 -114,000 163,000 15,000 26,000 -247,000 -34,000   -51,000 53,000 -45,000 -11,000 -32,000 786,000 
          accounts payable
        		-2,580,000 2,642,000 -16,323,000 10,031,000 1,354,000 11,047,000 6,625,000 -904,000 -10,097,000 4,999,000 5,157,000 -1,482,000 3,766,000 -769,000 -642,000 2,021,000 4,299,000 354,000 923,000 -617,000 2,357,000 -1,978,000 -1,655,000 366,000 -1,853,000 1,270,000 3,032,000 -619,000 -1,445,000 -1,973,000 
          accrued liabilities
        		3,341,000 -692,000 1,893,000 -3,392,000 4,038,000 1,898,000 2,501,000 -2,850,000 2,846,000 946,000 -2,395,000 2,236,000 123,000 1,078,000 -161,000 1,775,000 -2,102,000 4,615,000 2,371,000 -158,000 1,383,000 1,730,000 -45,000 40,000 680,000 1,255,000 1,567,000 1,142,000 127,000 980,000 
          operating lease liabilities
        		-247,000 -292,000 -128,000 -240,000 -227,000 -203,000 -149,000 -152,000 -142,000 -174,000 -162,000 -175,000 -127,000 -70,000 -90,000 -91,000 -99,000 -97,000 -117,000 -95,000           
          other liabilities
        		1,063,000 5,945,000 -374,000 -20,000 -1,158,000 1,696,000 -174,000 -119,000 -176,000 49,000 59,000 22,000 274,000 -171,000 195,000 -181,000 457,000 -94,000 1,000 -221,000 484,000 511,000 -24,000 19,000 144,000 -151,000 246,000 161,000 163,000 -464,000 
          net cash from operating activities
        		-4,310,000 -162,000 -11,250,000 -18,753,000 -20,725,000 -20,749,000 -12,461,000 -14,154,000 -11,152,000 -31,511,000 -28,240,000 -20,614,000 -14,016,000 -21,980,000 -11,330,000 -4,840,000 -7,709,000 -12,455,000 -814,000 -6,554,000 3,434,000 -3,047,000 -6,095,000 -6,802,000 -4,026,000 -10,896,000 -7,063,000 -7,998,000 -8,480,000 -10,495,000 
          capital expenditures
        		-1,853,000 -1,824,000 -1,848,000 -1,624,000 -753,000 -531,000 -1,473,000 -798,000 -3,312,000 -3,704,000 -3,117,000 -432,000 -966,000 -480,000 -607,000 -798,000 242,000 -963,000 -900,000 -804,000 -287,000 -846,000 -603,000 -687,000 -665,000 -741,000 -4,197,000 -685,000 -472,000 -561,000 
          free cash flows
        		-6,163,000 -1,986,000 -13,098,000 -20,377,000 -21,478,000 -21,280,000 -13,934,000 -14,952,000 -14,464,000 -35,215,000 -31,357,000 -21,046,000 -14,982,000 -22,460,000 -11,937,000 -5,638,000 -7,467,000 -13,418,000 -1,714,000 -7,358,000 3,147,000 -3,893,000 -6,698,000 -7,489,000 -4,691,000 -11,637,000 -11,260,000 -8,683,000 -8,952,000 -11,056,000 
          cash flows from investing activities:
        		                              
          purchases of property and equipment
        		-1,853,000 -1,824,000 -1,848,000 -1,624,000 -753,000 -531,000 -1,473,000 -798,000 -3,312,000 -3,704,000 -3,117,000 -432,000 -966,000 -480,000 -607,000 -798,000 242,000 -963,000 -900,000 -804,000 -287,000 -846,000 -603,000 -687,000 -665,000 -741,000 -4,197,000 -685,000 -472,000 -561,000 
          cash from business acquisitions, net of cash acquired
        		 0 0 0 -307,000                          
          cost incurred for intangible assets
        		-107,000 163,000 -112,000 -447,000 -276,000 -1,150,000 -1,132,000 -2,872,000 -1,879,000 -244,000 -77,000 -49,000 -282,000 -553,000 -266,000 -390,000 -1,000,000 -120,000 -33,000 -294,000 -837,000 -152,000 -233,000 -262,000 -694,000 0 -14,000 -3,000 0 -7,000 
          net cash from investing activities
        		-1,960,000 -1,661,000 -1,960,000 -2,071,000 -1,336,000 -1,819,000 -2,765,000 -4,401,000 -6,626,000 -6,600,000 -9,049,000 -4,278,000 -10,428,000 -4,810,000 -13,814,000 -5,739,000 -3,615,000 -1,083,000 -933,000 -1,532,000 -1,124,000 -2,153,000 -1,333,000 -949,000 -1,359,000 -741,000 -4,211,000 -1,455,000 -4,431,000 -568,000 
          cash flows from financing activities:
        		                              
          repayments on short term notes payable for insurance premium financing
        		-1,170,000                              
          proceeds from stock option exercises
        		1,008,000 7,206,000 31,000 273,000 79,000 392,000 59,000 577,000 1,426,000 593,000 210,000 1,271,000 485,000 1,275,000 411,000 1,702,000 487,000 1,681,000 533,000 1,882,000 680,000 192,000 193,000 181,000 434,000 102,000 92,000 84,000 27,000 180,000 
          tax payments related to shares withheld upon vesting of restricted stock
        		-702,000 -134,000 -77,000 -144,000 -282,000 -116,000 -87,000 -188,000 -119,000 -106,000 -282,000 -62,000 1,000    -268,000 -13,000 -34,000 -41,000 -89,000 -17,000 -14,000 -34,000 -89,000 -44,000 -35,000 -56,000   
          net cash from financing activities
        		-864,000 6,054,000 29,454,000 5,129,000 -203,000 74,491,000 -28,000 389,000 51,043,000 487,000 84,492,000 1,183,000 24,977,000 1,265,000 72,318,000 1,695,000 207,000 1,637,000 422,000 1,786,000 538,000 90,000 116,000 63,926,000 365,000 22,466,000 -26,000 -16,000 -60,000 65,283,000 
          effect of exchange rate changes on cash and cash equivalents
        		-337,000 717,000 -259,000 1,156,000 1,095,000 -1,273,000 351,000 -214,000 -320,000                      
          net decrease in cash and cash equivalents
        		-7,471,000                              
          cash and cash equivalents at beginning of period
        		75,572,000 0 0 0 90,347,000  0 0 40,035,000                      
          cash at end of period
        		68,101,000         -37,992,000 47,335,000 42,847,000 1,006,000 -25,910,000 46,603,000 44,656,000 -11,208,000 -12,183,000 -1,144,000 77,950,000 3,092,000 -4,951,000 -7,214,000 93,596,000 -4,904,000 10,689,000 -11,265,000 43,135,000 -12,938,000 53,935,000 
          change in reserve for pp&e impairment
        		         0 0 -341,000                   
          provision for deferred income taxes
        		                              
          unrealized foreign currency loss
        		 56,000 -531,000 -5,971,000 -3,510,000 3,451,000 -2,580,000 2,392,000 2,039,000 3,139,000 -2,051,000 -1,709,000 -4,100,000 3,797,000 4,924,000 -2,889,000 883,000 3,228,000 -2,941,000 3,030,000 -2,657,000 -604,000 -198,000 5,845,000 643,000 2,823,000 -825,000 892,000 115,000  
          non-cash loss on contract termination
        		 0 0                            
          interest capitalized for construction in progress
        		     0 0 -18,000 -537,000 -1,094,000 -1,125,000 -797,000                   
          capital expenditures on construction in progress
        		     -88,000 -160,000 -731,000 -1,435,000 -2,652,000 -5,855,000 -3,797,000 -9,180,000 -3,777,000 -12,416,000 -4,551,000               
          issuance of common stock, net of underwriters’ discount and issuance costs
        		       0 49,736,000 0                     
          borrowings under oaktree credit agreement, net of debt discount and issuance costs
        		 0                             
          borrowings on short term notes payable
        		                              
          repayments of short term notes payable for insurance premium financing
        		                              
          net increase in cash and cash equivalents
        		   -14,539,000 -21,169,000 50,650,000 -14,903,000 -18,380,000 32,945,000                      
          cash and cash equivalents at end of period
        		 4,948,000 15,985,000 -14,539,000 69,178,000 50,650,000 -14,903,000 -18,380,000 72,980,000                      
          supplemental disclosures:
        		                              
          cash paid for interest
        		 5,173,000        1,418,000             1,730,000 1,734,000   1,322,000 1,402,000  1,345,000 
          cash paid for income taxes
        		 131,000        812,000             1,000 1,000   59,000 87,000  0 
          supplemental disclosures of non-cash investing and financing activities:
        		                              
          unpaid balance for property and equipment
        		         -340,000                 -83,000 705,000   
          unpaid balance for intangible assets
        		                              
          equity consideration in an asset acquisition
        		                          0 337,000   
          equity consideration issued in a business acquisition
        		                              
          contingent consideration payable related to a business acquisition
        		                              
          consideration payable related to a business acquisition
        		                              
          cashless option exercises
        		                              
          cashless warrant exercises
        		                              
          cash payable to settle contract termination
        		                              
          liability to issue shares to settle contract termination
        		                              
          borrowings of short term notes payable for insurance premium financing
        		                              
          issuance of common shares, net of underwriters’ discount and issuance costs
        		                              
          borrowings on short-term notes payable
        		  5,000,000                            
          provision for doubtful accounts
        		         287,000 143,000 282,000 -282,000 237,000 87,000 69,000 -277,000 355,000 116,000 6,000 -383,000   599,000 41,000   112,000  90,000 
          loss on extinguishment of debt
        		            0 0                 
          gain from write-off of liability
        		            0                  
          change in fair value of derivative instruments
        		            0 0 -1,099,000 396,000 -191,000 -57,000 -259,000 -230,000 -1,190,000 -879,000 -1,492,000 1,929,000 -209,000 -235,000 -2,640,000 32,000 51,000 -11,420,000 
          cash from asset acquisitions
        		            0 0   0 0 0 -434,000 0          
          repayment of madryn debt agreement
        		            0 0                 
          repayments on finance leases
        		           -26,000 -9,000 -5,000 -5,000 -7,000 -12,000 -31,000 -77,000 -55,000           
          cash at beginning of period
        		         0 0 66,355,000 0 0 0 53,415,000 0 0 0 84,523,000 0 0 0 37,655,000 0 0 0 52,639,000 0 0 
          equity consideration in a business acquisition
        		                              
          stock compensation in lieu of cash fees to non-employee directors
        		                              
          effect of exchange rate changes on cash
        		         -368,000 132,000 201,000 473,000 -385,000 -571,000 125,000 -91,000 -282,000 181,000 -273,000 244,000 159,000 98,000 -234,000 116,000   -35,000 33,000 -285,000 
          net increase in cash
        		         -37,992,000   1,006,000 -25,910,000   -11,208,000 -12,183,000 -1,144,000 -6,573,000 3,092,000   55,941,000 -4,904,000 10,689,000   -12,938,000 53,935,000 
          amortization of debt discount
        		           3,187,000    580,000 562,000 533,000 505,000 474,000 458,000 435,000 409,000 388,000 372,000 325,000 863,000 868,000   
          net decrease in cash
        		           -23,508,000    -8,759,000            -9,504,000   
          provision for fixed asset obsolescence
        		                              
          change in fair value of contingent consideration
        		                    0 -5,000 141,000 -440,000 291,000 -205,000 -137,000 -225,000 281,000 694,000 
          borrowings under oaktree debt agreement, net of debt discount and issuance costs
        		            24,500,000 0                 
          proceeds from issuance of common shares, net of underwriters’ discount and issuance costs
        		                    0 0 0 63,855,000       
          consideration payable related to asset acquisition
        		                          20,000 1,257,000   
          inventory acquired in an asset acquisition
        		                          153,000 1,104,000   
          issuance of common shares in settlement of contingent consideration
        		                              
          intangible assets acquired in an asset acquisition
        		                              
          borrowings under madryn credit agreement, net of issuance costs
        		                        0      
          cash used to repurchase warrants
        		                        0      
          proceeds from warrant exercises
        		                        -2,000 0 0 58,000 0  
          assets acquired under finance leases
        		                              
          consideration payable related to asset acquisitions
        		                              
          repayments on capital leases
        		                     -85,000 -63,000 -76,000 22,000 -79,000 -83,000 -102,000 -85,000 -73,000 
          net income
        		                              
          adjustments to reconcile net income to net cash from operating activities:
        		                              
          benefit from doubtful accounts
        		                              
          benefit from inventory obsolescence
        		                              
          income from disposal of property and equipment
        		                              
          cash from asset acquisition
        		                         0 0 -767,000   
          net (decrease)/increase in cash
        		                              
          assets acquired under capital leases
        		                          0 69,000   
          repayments on related-party notes payable
        		                            0  
          proceeds from issuance of ordinary shares, net of issuance costs
        		                            -2,000 2,000 
          proceeds from issuance of common shares, net of underwriters’ discount
        		                            0  
          deferred equity issuance costs, ipo
        		                            0  
          bad debt recovery
        		                              
          payments of deferred offering costs
        		                              
          unpaid deferred offering costs
        		                              
          (bad debt recovery) provision for doubtful accounts
        		                              
          write off of deferred offering costs
        		                              
          conversion of accrued interest into principal and amortization of debt discount
        		                              
          increase in restricted cash
        		                              
          repayments on short term notes payable
        		                              
          repayments under perceptive credit agreement
        		                              
          shares repurchased
        		                              
          stock-based compensation
        		                              
          extinguishment of warrants with related party