You'll find all of the innovative tools for minimally invasive surgery on display at the exhibit hall floor at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons. At this year's meeting in April in National Harbor, Md., the recurring themes among the technical exhibits were reusable devices, more product choice for single-incision laparoscopy, and products to help the surgeon work from a clear and steady image during laparoscopy. Here are 10 new products that caught my eye.

Challenger Ti-P Clip Applicator from Aesculap
Reducing per-procedure costs is becoming more of a priority these days, whether you work in a surgery center or a large teaching institution, like I do. This reusable clip applicator, the Challenger Ti-P ($2,388), helps takes a bite out of your supply costs, compared to disposable clip applicators that can cost $100 or more per case. With this applicator, the only disposables are the clip cartridges ($1,499 for 12 cartridges with 12 small-medium clips, or $1,234 for 12 cartridges with 8 medium-large clips). The clip applicator can be reprocessed and used an unlimited number of times. And you can reprocess the device assembled or in pieces. The newest evolution of the Challenger fires pneumatically with single triggering. The CO2 cylinders load into the pistol grip and are included in each box of cartridges. www.aesculapusa.com

Lektrafuse Caiman Tissue Cutting and Sealing Instrument from Aragon Surgical
The Lektrafuse Caiman has large articulating jaws for cutting and sealing in less time during procedures because fewer passes are needed. You can cut and seal 50mm of tissue in a single bite. The system's radiofrequency generator uses an algorithm to modulate power and time in response to properties of the tissue in each bite. This helps prevent over- and under-sealing and limits thermal spread to protect nearby tissue. The Caiman is available in 2 sizes: 44cm shaft length for laparoscopy and 24cm for open cases.

The Caiman is indicated to cut and seal tissue and vessels up to 7mm during bariatric, gynecologic and colorectal procedures. A Dutch research group is testing the Caiman for intestinal anastomoses on pigs. If Aragon Surgical gets FDA approval for this on humans, it would be very interesting for surgeons like me because it could eliminate the need for stapling the bowel. Initial tests have been positive, but there's still plenty of research to do, says the company. www.aragonsurgical.com

CareFusion's EnView Laparoscopic Control Device
Holding a laparoscope for long periods of time at sometimes difficult angles can result in shaky images during a procedure. Working this way is tiring for the assistant holding the scope and frustrating for the surgeon, who needs a stable image to effectively manipulate the instruments. Using EnView is like having an assistant that can keep as still as a statue. The control device holds 5mm and 10mm endoscopes at nearly any angle and frees the assistant to do other tasks during the procedure. An arm and clamp hold the scope, and the surgeon uses a joystick to position and articulate the arm. Since the surgeon does the positioning, there's also less risk of miscommunication during the procedure. EnView is completely human-powered, so there are no batteries, software or electrical cords to deal with during surgery. www.carefusion.com

Covidien's EndoGIA Reload with Tri-Staple Technology
Covidien has redesigned its laparoscopic stapling system for improved tissue grasping and sealing and to be more comfortable in the surgeon's hand. The new stapler is lighter and the grip has an ergonomic design that requires a shorter reach. This is a plus for surgeons with smaller hands. Each stapler can be loaded with reloads with Tri-Staple Technology. These staggered staples create more compression toward the center of the tissue and less extrusion at the edge of the tissue to be sealed. The Tri-Staple line comes in 3 sizes, compared to as many as 5 for other manufacturers. Two sizes can handle extra-thin to thick tissue through a 12mm port, and a third size is designed for extra thick tissue through a 15mm port. www.covidien.com

Endopath XCEL Trocar with Optiview from Ethicon Endo-Surgery
Smudging on the scope after an instrument exchange is a disruption that causes frustration and delays when you have to remove the camera and clean the lens several times during a minimally invasive procedure. A few manufacturers are addressing this problem from different angles. Ethicon Endo-Surgery has added a new feature to its EndoPath XCEL trocars called Optiview technology. During the insertion and removal of the laparoscope, the Optiview feature wipes fluid and debris from the endoscope shaft. The material that has been wicked away is channeled into an absorbent ring. As a result, there's no smudging the scope's clean lens when it's re-inserted into the trocar. www.endopathxcel.com

FloShield from CareFusion
Here's another take on addressing the smudged lens problem. FloShield, manufactured by Minimally Invasive Devices and distributed by CareFusion, is a disposable sheath designed to eliminate fog and debris from laparoscopes during surgery. FloShield directs a curtain of air over the end of the laparoscope to eliminate condensation and to prevent debris from settling on the lens. The sleeve ($125) takes just a minute to set up and lets the OR team concentrate without the interruption and frustration of having to remove the scope to clean it. Fits 10mm laparoscopes and 12mm trocars. (Soon available for 5mm scopes.) www.floshield.com

Bio-A Fistula Plug from Gore
One of the major concerns of colorectal and anal surgeons is an anal fistula plug dislodging after insertion. Often this is the result of the plug extruding away from the distal, or inside, end of the fistula. Each Gore Bio-A fistula plug has a disk at the end to help keep the plug in place at the internal end of the fistula. Once inserted, the plug's hollow tubes expand to help create a snug fit. The plug is made of a bioabsorbable polymer scaffold for sphincter-preserving repairs. The Bio-A can be easily configured by trimming with scissors or removing tubes in order to fit the geometry of each fistula. www.goremedical.com

X-Cone from Karl Storz
The German device maker is setting its sights on single-incision laparoscopy and environmentally friendly multi-use products with the X-Cone, part of the S-Portal single-access line. It's a reusable access port for transumbilical laparoscopy. The X-Cone offers a full lateral range of motion for up to 4 instruments from 5mm to 12mm in size. It's compatible with HD cameras and special curved instruments that help with triangulation and precise manipulation of tissue and structures.

The device is a cone cut in 2 halves that can be inserted through a 2cm incision with a bit of finger guidance. Once each half is in place, the cone keeps a strong hold on the tissue. Then you snap the top seal with the ports for the instruments on top of the cone. The seal keeps the halves tightly together. The slender design makes the X-Cone well suited for reconstructive procedures, according to the manufacturer. www.karlstorz.com

QuadPort, TriPort and HiQ LS from Olympus
As more surgeons are moving towards single-incision surgery, more device manufacturers are getting in on the act. Olympus has expanded its LESS offerings to include 4- and 3-port access devices. The QuadPort allows the surgeon to introduce up to 4 instruments, including a laparoscope, through a single incision. The ports are 15mm, 10mm (2 ports) and 5mm. The large port also allows for the extraction of larger specimens. The TriPort system is placed into an umbilical incision (12mm to 25mm) allowing single-port access for up to 3 straight, bent or flexible instruments. The HiQ LS is a 5mm diameter instrument curved at both ends to prevent interference with other LESS devices. HiQ LS features well-designed ergonomics and easy force transmission that let the surgeon grasp and dissect tissue with minimal effort. www.olympusamerica.com/less

Radius T Surgical System from Tuebingen Scientific
Sometimes the limited mobility (in degrees of movement) of laparoscopic instruments can pose challenges during surgery. Tuebingen Scientific addresses this with the Radius T Surgical System, which adds the improved mobility of robotic surgery to hand-held laparoscopy. You get more degrees of mobility and tactile feedback, since you're holding the manipulators. The Radius system is a pair of reusable hand-held manipulators ($18,000) with disposable endo effectors (graspers, needle holders, scissors) at the ends. The 5mm shaft rotates 360 ? and lets the surgeon keep his arms in the same position while working on different planes. Like the surgical robot, there's a learning curve to operating with a pair of mechanical joysticks rather than your hands. www.tuebingen-scientific.com