Among the cowboy hats in San Antonio's Henry B. Gonzalez Convention Center where the Society of American Gastrointestinal and Endoscopic Surgeons met this spring for their annual meeting, I came across several devices and technologies that will help laparoscopic surgeons like myself do their work. Here's a Texas-size roundup of new products for minimally invasive surgery.

Ideal Eyes 5mm Articulating Laparoscope from Stryker
With an articulating laparoscope, you can look around the corner behind organs and tissue structures and set your view during single-incision or conventional laparoscopy. Stryker has added a 5mm version to its Ideal Eyes line of HD laparoscopes. Until now, your choices in articulating scopes were either a 5mm standard definition or HD in a 10mm. With simple hand controls, the surgeon can move the tip 100 ? in any direction and use just 2 buttons to record video, capture still images, white-balance and adjust the light. One advantage of this scope is the friction brake that prevents drift of the camera when set in a position. You just take your thumb off the button and the camera will stay put. With Stryker's medical imaging information management system you can switch input channels allowing for easy toggling between an articulating and rigid laparoscope. After surgery, send your captured images to the systems server and edit them remotely from any computer via the Internet. www.stryker.com/endoscopy

MD2GO Remote HD Camera from Sony
Until now, one of the limitations of telemonitoring patients was that fixed cameras and monitors required both the patient and healthcare provider to be in a location hard-wired for monitoring. Sony has created a system that can go where the patient is and allow the provider to be anywhere he has access to a computer. The MD2GO ($10,000) is an HD camera with a 10X zoom and 2-way audio system on a mobile stand with a built-in wireless card. Through the system, you can send real-time videos with audio and photos to any computer with Internet Explorer and a Windows Media player. The MD2GO seems suited for situations when you need to bring a camera into the OR to consult with a colleague who's off-site or when the supervising anesthesiologist wants to keep an extra eye on a patient in PACU while working in the anesthesia workroom. After you've created the video images, you can use Sony's new Opsigate Content Management System to store and share the images with others on your facility's network from which they can be viewed on a computer, tablet or smart phone. www.sony.com

Halo90 Ultra Ablation Catheter from Barrx
Barrx has introduced a larger version of its Halo90 radiofrequency ablation device designed to treat intermediate-sized, non-circumferential Barrett's esophagus ranging from 1cm to 3cm. The Halo90 Ultra has a 40mm-by-13mm bipolar electrode on a 4mm catheter that can be mounted on an endoscope for direct visualization of the area to be ablated. Because it ablates more area than the smaller version (520mm2 vs. 260mm2), you can shave a few minutes off the procedure time. The single-use catheter is powered by a new HaloFlex generator, which has a shorter delay between energy bursts (2 seconds vs. 5 seconds), compared to the company's previous generators. www.barrx.com

Stretta Radiofrequency Generator from Mederi Therapeutics
At last year's SAGES meeting, Mederi Therapeutics re-introduced the Stretta radiofrequency treatment for the 20% of GERD patients who don't respond to medication such as omeprazole or esomeprazole and those who have had no success with surgery. In the Stretta procedure, the surgeon uses a catheter with radiofrequency electrodes to create thermal lesions at the lower esophageal sphincter that cause the tissue to contract. Early this year, Mederi Therapeutics launched the MDRF1 Generator, which is smaller and more portable than the previous generator. It also powers the company's Secca device for bowel control disorders. www.mederitherapeutics.com

AirSeal for Single-Port Surgery from SurgiQuest
I'm already a big fan of the AirSeal System because it has no valve — which means no smudging — and it continuously recycles and filters the CO2 in the pneumoperitoneum. Any smoke generated during the procedure vanishes immediately. Now SurgiQuest has added an access port designed for single-incision surgery to the AirSeal line. The 12mm access port has an opening large enough so that you can pass multiple instruments through it. As with the other versions, the AirSeal quickly whisks smoke away and through a closed system out of the room. The product, still pending FDA approval, should be on the market by the end of year. www.surgiquest.com

EsophyX Device for Transoral Incisionless Fundoplication from EndoGastric Solutions
Here's a scarless way to treat GERD. In Transoral incisionless fundoplication (TIF), the surgeon fits the EsophyX device over a video endoscope, then inserts it into the mouth and beyond the esophageal sphincter, where it grabs a fold of the stomach to create a tight valve below the diaphragm. When the surgeon fires the device, 6.5mm or 7.5mm fasteners — similar to 3.0 sutures — anchor the fold. EsophyX then creates a 3cm to 5cm valve that creates a strong anti-reflux barrier. www.endogastricsolutions.com

Jaimy Powered Articulating Instrument from EndoControl
Although it's yet to be FDA-approved, the Jaimy offers a glimpse of what's to come. This 5mm laparoscopic instrument is like a handheld robot that you control with your thumb. The tip articulates, rotates 360 ? and can grasp, retract and dissect while the thumb control offers tactile feedback. The device is autoclavable and can be reprocessed 30 times before disposal. The drawback with this instrument is that when you use it, there's another electric cord to add to the spaghetti around the OR table. I'd like to see a battery-powered version. www.endocontrol-medical.com

iDrive Right-Angle Linear Cutter and Stapler from Covidien
One of the challenges of mechanical staplers is the force you sometimes need to fire the stapler. The iDrive is a motorized stapler and right-angle linear cutter that lets you save your strength and reduces the risk of the stapler breaking under pressure. The motor provides 90 lbs. of firing force at a right angle to the flexible shaft. The right angle of the cutter-stapler gives you better visibility in the pelvis. The feedback mechanism built into the device means that if you have too much tissue between the jaws for the staples to close completely, the stapler won't fire. Once you fire it, the device delivers 32 titanium staples in 2 double-staggered rows, then cuts the tissue. The reusable handle is powered by rechargeable batteries, which reduces clutter in your OR because there is no power cord. www.covidien.com

Composix LP Mesh with Echo PS Positioning System
During laparoscopic procedures, placing hernia mesh, especially large pieces, is tricky because you need to unroll the mesh, orient it, hold it in place and then fix it to the abdominal wall. This Bard mesh is packaged with a tubular balloon scaffold that you inflate with a syringe. The scaffold holds the mesh in place until you're ready to fixate it. It's sort of like those quick-pitch tents that, when thrown in the air, open and erect themselves. Once the mesh is properly attached, you deflate the scaffold and pull it out of the cavity. www.crbard.com

MiSeal Reposable Thermal Ligator from Microline Surgical
Finally, device manufacturers are starting to introduce products that combine small single-use and larger multi-use components. For surgical facilities, this can help cut costs on instruments and medical waste disposal. The 5mm MiSeal ligator is a good example of this concept. Only the tip ($250) is disposable. The handpiece ($1,000) and shaft can be reprocessed 100 times. MiSeal uses direct thermal energy to seal and cut. It can also grasp and dissect. The energy is generated by a small 3-lb. reusable power source that hangs easily from an IV pole or sits on a nearby table. www.microlinesurgical.com

TriPort+ Access Device from Olympus
Olympus has added a port to its TriPort access device for single-incision surgery. The TriPort+ actually has 4 ports — a trio of 5mm ports and a 10mm port that can be reduced to 5mm. Two venting ports can be used for insufflating and smoke evacuation. This design should help surgeons perform a 4-port laparoscopic cholecystectomy through a single incision at the umbilicus. When it's time to extract the specimen, lift the valve tab to create a wide opening. Then pull the specimen through. www.olympusamerica.com

Cinch Intracorporeal Retractor from Aesculap
Whether you're doing single- or multi-incision laparoscopy, ports are always at a premium. Aesculap's new Cinch Intracorporeal Retractor allows for organ retraction while freeing up a port that can be used by other instruments. Once the retractor is in place, the surgeon removes the application forceps and the port is available again. Clips at one end of the device grasp tissue without causing trauma, while the other end remains attached to the peritoneum. A latex-free elastic band that connects the 2 ends gives the surgeon the freedom to place the clip end in different spots without having to change the anchored end. www.aesculap.com