Minimally invasive does not mean minimal instrumentation. There are a lot of components from set-up to closure, and manufacturers are improving upon old designs and devising new ones to deal with the myriad tasks your physicians must perform during a procedure. Here's a step-by-step, alphabetical look at your newest options for making MIS easier, more efficient and safer.

On the outside
Here are some tools that can help take the surgeon's mind off what's going on outside the patient's body.

• Low Profile Scope Holder from Kronner Medical. This device attaches to the side rail of the OR table to hold the laparoscope, freeing the surgeon's hands for other tasks without losing the view on the monitor. This model is easily adjusted if the holder interferes with the movement of other devices, says Richard F. Kronner, MD, the president of Kronner Medical. When the surgeon releases the control button attached to the camera, nitrogen gas provides pressure that holds the joints in place, eliminating the need to manually loosen and tighten joints, says Dr. Kronner.
• AHTO Irrigation System from Stryker. Stryker has added a rechargeable battery to its cordless irrigation/suction device, which holds power for eight hours, says Mark Colella, marketing manager for Stryker.

Into the patient
Instruments are becoming easier to handle and even less invasive while building on safety innovations that have been developed in recent years.

• EnTouch AEM Laparoscopic Probes from Encision. You can now get both haptic feedback and active electrode monitoring on your laparoscopic intruments with Encision's EnTouch AEM Laparoscopic line of instruments, the first to combine the two, the company says. The handles provide improved ergonomics for Encision's articulating instruments, are more lightweight for smooth operation and less hand fatigue, and provide more predictable control, the company says.

• Encision EnTouch AEM Laparoscopic Instruments (800) 998-0986 writeOutLink("www.encision.com",1)

  Multiple Instrument Guide from LapSurgical Systems. With three lumens - one for a 2.8mm choledochoscope and two others for instruments such as an irrigation catheter, lithotripter or stone basket - the MIG can treat gall bladder and bile duct stones in a single procedure. It's the only device on the market that can be used for either the choledochotomy or transcystic technique to aid laparoscopic common bile duct exploration and bile duct stone extraction, says Donald Wenner, MD, FACS, principal of LapSurgical. One hospital, he says, has reduced incidence of scope damage from 50 percent to 5 percent with the MIG.
• 10mm Balloon Open Access Port from Taut Medical Products. The streamlined access port gives surgeons a little extra space to work by letting them use smaller scopes. Previous balloons accommodated 12mm scopes.

'Two or three millimeters - that's a lot in the world of surgery,' says Raul Brizuela, the company's vice president of marketing. The latex-free balloon inflates to 35mm and is said to be 20 percent stronger than previous models.

Making the cut
Manufacturers are working to combine the best of blunted and sharp trocars to minimize damage but retain smooth entry.

• PassPort Shielded Trocar from Patton Surgical. Two spring-loaded shields effectively make this new trocar blunt while maintaining ease of entry into the body, says the company (www.pattonsurgical.com). The blunt tip shield covers the trocar's cutting tip upon entering the abdominal cavity. A secondary blade shield covers the remaining blade edges to help control the temporary loss of control due to dramatic decrease in resistance, says Michael Patton, the company's president. The dual shield prevents the trocar's being held back by tissue, as can happen with traditional single-shield trocars, but it is still blunt, so you can safely retract loose bowel.

• Taut Medical Products 10mm Balloon Open Access Port (800) 231-8288 ext. 127 writeOutLink("www.taut.com",1)

  Adapt 3mm to 5mm Pediatric Access Ports and 15mm Bariatric Access Ports from Taut Medical Products. The company has recently introduced bariatric and pediatric versions of its access ports. The bariatric includes a modified top that can be emptied without losing suction that would start leakage, says Mr. Brizuela. The pediatric has a ring that can be sutured to the abdomen to prevent the access port's slipping out of the child's thinner skin, says Mr. Brizuela.

A broad view
Monitors and cameras continue to make great strides for visualization.

• Karl Storz Hopkins II 5mm Telescope (800) 421-0837 writeOutLink("www.karlstorz.com",1)

  Hopkins II 5mm Telescope from Karl Storz. The company says it is using a larger number of light fibers in this line of scopes, resulting in improved optics: increased brightness, maximized image size, and enhanced clarity and depth of the surgical field. The company also says that a double-lumen shaft makes the scopes 'substantially more durable, which can help reduce repair costs.'

• Olympus Surgical LTF-VP 5mm Video Laparoscope (800) 548-5515 writeOutLink("www.olympussurgical.com",1)

  LTF-VP 5mm Video Laparoscope from Olympus Surgical. This new scope features a camera chip on the tip on the scope that provides flexible angles. 'It goes 100 degrees in any direction - left, right, up, down,' says Tony Krizan, product manager for Olympus Industrial and Surgical America. 'You can go left and up at the same time.' The chip wears better than those in other scopes, Mr. Krizan says, and the lens fogs up a third less.

Sew it up
Here's what companies are doing to help you close patients' wounds as efficiently as possible.

• Ethicon Endo Echelon 60 Endopath (800) 873-3636 writeOutLink("www.ethiconendo.com",1)

  Echelon 60 Endopath from Ethicon Endo. This stapler can accommodate a wide cartridge selection to be fit through a 12mm trocar, the company says. The design allows for one-handed clamp, fire and release, the company says.

• Karl Storz Endoscopy America Axial KOH Macro Needle Holders (800) 421-0837 writeOutLink("www.karlstorz.com",1)

  Axial KOH Macro Needle Holders from Karl Storz Endoscopy America. These needle holders come in either a right handle with a left-curved tip or a left with a right-curved tip. (There's also a right handle with a straight tip). A surgeon can use two of the instruments while suturing, the company says. One driver is controlled by the surgeon's dominant hand with the ratchet engaged for needle driving. The second driver, with ratchet disengaged, assists.

• United States Surgical Endo GIA Universal Stapling System (203) 845-1000 writeOutLink("www.ussurg.com",1)

  Endo GIA Universal Stapling System from United States Surgical. This device gives you the ability to deliver a large staple - up to 4.8mm - that can be closed down to 2mm, according to the company. All 20 of the company's endoscopic staplers are interchangeable on one universal handle.