The technology revolution continues in minimally invasive surgery. As MIS techniques evolve, systems and instruments are designed smaller and more compact. They take up less space in the OR and combine technology to further their cost-effectiveness. Endoscopes and instruments are becoming less rigid and more in sync with the surgeon's natural hand movements. Video imaging displays are crisper and instruments continue to advance into multi-purpose tools that cut, coagulate and limit the risk of thermal energy burns to patients.

But smaller and newer isn't always better. Sometimes big and bulky still gets the job done. Before allocating valuable dollars to the purchase of minimally invasive capital equipment, talk to your surgeons and document a need. Focus on practical concerns and purchases that will improve case efficiency and outcomes instead of the surgeon's toy collection.

- David Renton, MD

Aesculap, a division of B. Braun
PL700 Bipolar Metzenbaum Scissor
(800) 282-9000
www.aesculapusa.com
List price: Not disclosed

Aesculap's PL700 combines ceramic-bladed scissor technology and safe bipolar energy for cutting and sealing tissue bundles and vessels. The Metzenbaum-style ceramic blade provides a self-sharpening action to provide a superior, lasting, high-performance cut in both the cold and energy mode, says Aesculap. The bipolar technology of the PL700 delivers controlled and precise energy directly to the desired tissue or vessels.

Allied Surgical
Versatile Laparoscopic Dissection System
(877) 387-8505
www.alliedsurgical.net
List price: Not disclosed

This is a neat product, a sort of three-for-one deal. It has the capacity to cut, irrigate fluids and evacuate smoke to provide a clearer view of the surgical field. You have both a blunt dissector in the form of a peanut and a Bovie dissector that extends beyond the gauze end. The availability of all these functions in an integrated system results in less operative time, says Allied Surgical, eliminating the need for repeated instrument exchanges.

Arthrocare
PROcise XP Coblation Wand
(800) 797-6520
www.arthrocareent.com
List price: Not disclosed

This wand is designed specifically for pediatric adenotonsillectomy. The wand irrigation system ensures that saline is always at the tip, creating a more consistent flow and temperature regardless of wand orientation. Increased shaft flexibility and decreased diameter provide surgeons with greater visualization for the smaller anatomy of pediatric patients, says Arthrocare.

Civco Medical Solutions
Laparostat
(800) 445-6741
www.civco.com
List price: $14,995

A device that holds the laparoscopic camera, possibly eliminating the need for a surgical tech, is very helpful. The Laparostat serves as the surgeon's assistant by holding the laparoscopic camera steady until the surgeon changes its position by hand. It can be closely contoured to the patient and takes up minimal space in the operative field, says Civco. The company also offers a rail adapter that secures the Laparostat to any surgical table.

CompView Medical
NuBoom-HD
(800) 448-8439
www.compviewmedical.com
List price: Not disclosed

NuBoom-HD is an all-in-one equipment management and video system featuring four fully adjustable high-definition monitors around the OR table. The system provides surgeons and members of the OR staff with ergonomically sound viewing angles of high quality images from anywhere within the operating field, says the company. Available with 19" monitors or 23" widescreen format, the system accommodates composite, S-video, VGA, DVI or HD sources. All the equipment hangs from a floor-mounted boom, which is ideal for lower-clearance ORs.

E-Z-EM
CO2Efficient
(800) 544-4624
www.ezem.com
List price: $7,795

The CO2Efficient blows CO2 into the upper and lower GI tracts, distending them for visualization. Using CO2 is said to be better than using room air for insufflation because CO2 is more readily absorbed and expelled, which minimizes cramping. This device's insufflator attaches to the scope's water bottle, so you don't need specialized CO2 air and water valves, regulators and flow meters, says E-Z-EM. The company's trademarked software regulates gas flow to minimize CO2 waste.

Gyrus
Invisio DUR-D Digital
Flexible Ureteroscope
(800) 852-9361
www.gyrusacmi.com
List price: $21,000

A miniature CMOS sensor placed at the distal tip provides imaging that produces a larger image and improved resolution over traditional fiberoptic flexible endoscopes, says the company. The fully integrated digital CMOS imaging sensor and built-in LED illumination eliminate accessories for one simple plug-and-play connection.

Karl Storz Endoscopy-America
Autocon II 400 Electrosurgical Unit
(800) 421-0837
www.karlstorz.com
List price: Not disclosed

This single unit is capable of powering both bipolar and monopolar instruments, as well as offering automatic output regulation and optimal hemostasis. It is said to limit thermal damage, reduce complications and speed patient healing. Space is money in the OR and the more utilities that can be bundled into one device, the better. The capacity for this unit to power both bipolar and monopolar instruments makes it a cost-effective option.

Megadyne
Reduced Stick Bipolar Forceps
(800) 747-6110
www.megadyne.com
List price: From $4.25 to $259 each, depending on style.

Megadyne's new line of bipolar forcep electrodes feature highly polished tips designed to help reduce tissue adherence and provide improved coagulation and desiccation. The forceps' electrodes are said to limit stray current, reducing the risk of injury to the patient. They are reusable and come in six styles: Scoville-Greenwood, Jeweler, Cushing, Adson, Semkin and Gerald.

New Wave Surgical
DHELP
(866) 346-8883
www.newwavesurgical.com
List price: $34.95

DHELP - short for Defogging Heated Endoscopic Lens Protector - is a disposable device designed to eliminate fogging of the endoscope. It also white-balances, cleans and protects the scope, says New Wave Surgical. By helping to secure the scope to the drapes during procedures, the device is said to eliminate the risk of fire caused by heat emanating from the scope's fiber-optic light.

Novare Surgical Systems
RealHand Instruments
(877) 668-2730
www.novaresurgical.com
List price: $425

RealHand instruments are designed to mirror surgeons' hand directions with the added benefit of tactile feedback. They offer seven degrees of movement without requiring additional hardware, says the company, allowing surgeons to perform more difficult maneuvers previously unable to be completed with rigid instruments. This instrument line - and others like it - is a significant development and may lead to new surgical approaches and techniques.

Pentax Medical
EPK-i System
(800) 431-5880
www.pentaxmedical.com
List price: Not disclosed

Pentax makes a great scope and if the new EPK-i system delivers 50 percent higher resolution than other endoscopes on the market today, as the company claims, this could be a nice addition to your equipment inventory. The system tracks your lab efficiency and brings benchmarking solutions that can improve your bottom line, and the company's i-star support allows remote technical service, says Pentax.

PHS West
Ergo Express Endoscopy Carts
(888) 639-5438
www.phswest.com
List price: $3,600 to retrofit an existing cart; $6,800 for new, custom modular workstations.

One person can transport needed equipment and supplies in one trip with this workstation, the company says. The exclusive, retractable, center-mounted drive offers 360' maneuverability in tight spaces. If your current endo cart suits your needs but is too heavy to push, it can easily and cheaply be retrofitted with motorization, says PHS West.

Spectrum
Surgical Instruments Continuity Tester
(800) 444-5644
www.spectrumsurgical.com
List price: $2,036.44

Undetected imperfections in your laparoscopic tools may cause patient burns. This device helps eliminate that risk by locating potentially dangerous tears and cracks along the tube and handle of instruments. It is designed for use in sterile processing, is reusable and runs on one 9-volt battery. All accessories are included.

Starion Instruments
Thermal Lighting Shears (TLS3)
(800) 782-7466
www.starioninstruments.com
List price: $419

These shears utilize focused thermal energy to simultaneously seal and divide tissue and minimize collateral damage. The TLS3 is the company's first device to employ heating elements on both jaws, a development Starion says creates a more uniform, higher integrity seal in less time. The ability to grasp and dissect soft tissue, as well as seal and divide, reduces the need for instrument exchange, claims the company.

Viking Systems
Viking 3DHD Vision System
(888) 847-8268
www.vikingsystems.com
List price: Configurations starting at $75,000

This vision system delivers high-definition, live 3-D images that allow the surgical team to naturally visualize the patient's underlying anatomy. When compared to 2-D imaging, says the company, this system provides greater detail while maintaining spatial relationships and improving the surgeon's hand-eye coordination. Other companies have tried to offer this technology but the weight of the headsets made them impractical. I've worn the Viking System. It's lightweight and comfortable and could revolutionize the way we do laparoscopic surgery.

More Minimally Invasive Products to Consider

Davol
Bard Composix L/P Mesh
(800) 556-6275
www.davol.com
List price: Ranges from $700 (for a 4.5" circle) to $2,102 (for a 10.2" x 14.2" rectangle).

This lightweight, low-profile prosthesis fits more easily through a trocar and offers permanent barrier protection against visceral attachment.

N.M. Beale Company
Baleen Polyp Trap
(800) 989-9558
www.nmbco.com
List price: $100 for a case of 100

Unlike an in-line filter, this screened device goes inside the colonoscope tubing, allowing fluid to go through the netting and leaving only the polyps behind.

Spectrum Surgical Instruments
Bariatric Instrument Sets
(800) 444-5644
www.spectrumsurgical.com
List price: Not disclosed

Longer-length instruments for improved reach in bariatric patients.

Starion Instruments
Universal Power Supply
(800) 782-7466
www.starioninstruments.com
List price: $14,999

Weighs three pounds and is designed to hang from an IV pole, requiring a smaller footprint in the operating room.

Vortek Surgical
Endodrape
(888) VORTEK-1
www.endodrape.com
List price: $20

Establishes a protective barrier to prevent the transfer of contamination from the scope to the linens and cart.

Xodus Medical
Electrosurgical Pencils and Electrodes
(800) 963-8776
www.xodusmedical.com
List price: Not disclosed

This new line features a lightweight ergonomic electrosurgery pencil design with push-button, rocker-switch o foot control configurations.