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What's New in Minimally Invasive Surgery?
It's all about improved visualization and less trauma at this year's SAGES Annual Meeting.
Aurora Pryor
Publish Date: June 4, 2015   |  Tags:   General Surgery
Dr. Aurora Pryor and Dr. Mike Holzman NEW IN MIS Dr. Aurora Pryor and Dr. Mike Holzman, co-chairs of this year's SAGES conference, took time to check out the latest offerings in the exhibit hall.

Surgeons from all over gathered at the beautiful Gaylord Opryland Resort and Convention Center in Nashville for this year's SAGES Annual Meeting. In between listening to country music on Broadway and chowing down on some of the best barbeque, attendees learned about the latest innovations for minimally invasive surgery. As co-chairs of this year's conference, we got an inside-look at some of the coolest products being shown off in the exhibit hall.

4K Monitor BETTER VIEWS This 4K monitor features 4 times the resolution of traditional high-definition screens.

Sony | 4K Monitor

Many say the next big thing in surgical visualization is 4K, which boasts 4 times the resolution of traditional high definition. Taking a cue from its consumer market, Sony is breaking into 4K visualization with its latest monitors, which come in either a 55-inch or 31-inch model.

If you split your surgical monitor into separate images — for example, to view the surgery and X-rays simultaneously — you tend to lose resolution. With 4K, you can split the screen into 4 separate images, each displayed in clear, crisp high definition. Besides the clear view, 4K's lifelike quality may help some surgeons with depth perception activities, like suturing or separating tissue.

While 4K is in demand on the consumer side, it's still finding its place in surgery, since few companies make compatible cameras. Sony says it will release these new 4K monitors in the fall, with a 4K camera and medical recorder to follow.

iniLap Percutaneous Surgical System MALL SCALE This percutaneous surgery platform has been modified to fit surgeons' preferences.

Teleflex | MiniLap
Percutaneous Surgical System

In an effort to make minimally invasive surgery even less invasive, Teleflex debuted its recently acquired MiniLap system, which looks to take percutaneous surgery into more ORs.

The MiniLap instruments have 2.3 mm shafts that you can percutaneously insert using an integrated needle tip. The company says that in many cases, using the MiniLap system helps eliminate 2 or more trocars per procedure, making for better cosmetic outcomes and less trauma.

While the premise of the MiniLap system has been around for a while, it has had a slow surgeon adoption rate. To combat this, a company rep says that Teleflex worked with surgeons to make ergonomic changes and additions to the line that improve comfort and feel. While percutaneous surgery isn't perfect for every case, this system's selection of graspers and probes makes it look more promising.

Percuvance Percutaneous Surgical System\ PERC'S PERKS The Percuvance system combines the familiarity of 5-mm instruments with a 2.9-mm shaft.

Teleflex | Percuvance
Percutaneous Surgical System

Looking to be a leader in percutaneous surgery, Teleflex also debuted its Percuvance system at the conference. The FDA approved the system in January. The Cleveland Clinic is an early user. Percuvance seeks to combine the benefits of percutaneous surgery with the traditional feel of laparoscopic instruments. A needle introducer tip inserts the 2.9-mm shaft of the instrument into the abdomen. The instrument is then aligned and advanced through an existing trocar, where the needle tip is replaced with a 5-mm interchangeable tool outside of the body. These tips are designed to combine the familiar durability of 5-mm instruments surgeons use to cut, grasp and manipulate tissue with a percutaneous-sized shaft. This allows for a comfortable feel for surgeons with the added benefit of fewer trocars and smaller incisions. Because of this, we could see it working very well for single-port surgery.

Hands-Free Intracorporeal Retracto\r REVISED RETRACTOR This hands-free retractor is fully adjustable during surgery.

Freehold | Hands-Free
Intracorporeal Retractor

The Freehold retractor is designed to provide hands-free tissue retraction during laparoscopic and robotic procedures, using hooks, sutures and a pulley system to move and suspend tissue away from the surgical field.

The retractor arrives in a delivery and removal sterile tube. After you place the tube through a 5-mm or larger trocar, the surgeon uses a grasper to push the device into the abdomen. It can then be hooked to anchor points inside the abdomen to allow for retraction. The surgeon can adjust the amount of retraction during the procedure by using the pulley system. When you're done, you just insert the sterile tube into the trocar, unhook the hooks and pull it out into the tube for disposal.

The device comes in 2 models. The Trio features 3 hooks and works well for sling-based retraction, such as liver retraction, while the Duo's 2 hooks are great for direct organ or tissue retraction. The device is surprisingly simple to use, and because it's hands-free, it makes retraction more efficient.

MUSE Syst\em GERD RELIEF Instead of surgery, the MUSE system treats GERD endoscopically.

Medigus | MUSE System

The MUSE System is designed to be a more attractive treatment option than surgery or lifelong medications for those suffering from GERD. The system uses a disposable endoscope equipped with a micro-camera, surgical endostapler and ultrasound sensor to change the shape of a patient's stomach to block acid from coming up through the esophagus.

This system is a good choice for patients who want a longer-lasting treatment option without going under the knife. It results in less trauma and better cosmetic outcomes because it is incisionless.

Only a single user is needed to operate it. After you place the patient under general anesthesia, you insert the endoscope down to the stomach. The endostapler can then "pinch" the stomach at the distal section to perform an anterior partial fundoplication, helping to prevent acid reflux.

While MUSE features some impressive innovations, there is other big news surrounding this and similar systems. A Category 1 CPT code (432XX1 describes esophagogastric fundoplasty trans-orifice procedures) has been created for this type of endoscopic treatment for GERD so you can bill payors.

Pinpoint Endoscopic Fluorescence Imaging Sys\tem IMPROVED VISUALIZATION This imaging system offers HD white light and HD fluorescence imaging through a single laparoscope.

Novadaq | Pinpoint Endoscopic Fluorescence Imaging System

The Pinpoint imaging system uses a combination of traditional HD images and HD fluorescence imaging to improve a surgeon's visualization and increase patient safety, says the company. Currently the only laparoscopic imaging system offering simultaneous real-time HD white light and on-demand HD fluorescence imaging through a single laparoscope, Pinpoint helps surgeons visualize anatomic structures and blood flow. The latest generation of the system features improved software as well as cart updates to allow for integrated insufflation.

Because of its on-demand fluorescence imaging, a company rep says that the system could potentially help reduce complications like anastomotic leaks and bile duct injury. While it doesn't excuse the need for good technique, the system is an innovative way to add an extra level of patient safety to your facility.

LATEST IN LAPAROSCOPY
More Great Tools for Your Endoscopic Surgeons

Here's a look at 6 more products on display at the SAGES 2015 Annual Meeting designed to advance safety and improve outcomes in GI surgery.

— Kendal Gapinski

NovaGrasp Laparoscopic Tethered Gra\sper

NovaTract | NovaGrasp Laparoscopic Tethered Grasper
This device is designed to be one of the least invasive methods of retraction for surgeons. It is a stainless steel grasper tip connected to a polyethylene tension line that's then used intra-abdominally to secure tissue and organs for retraction. Introduced via an existing port or percutaneously, the retractor is repositionable and allows for hands-free retraction. A company rep says the affordable device improves cosmesis and eliminates or reduces additional port closure time.

FMX Ferromagnetic Surgical S\ystem

Domain Surgical | FMX Ferromagnetic Surgical System
This new platform of cutting and coagulation devices uses ferromagnetic heating to produce a thermal energy that the company says is safer than existing modalities. The FMX generator passes electrical energy through the FMX tool's ferromagnetic-coated tip. No electrical energy is passed through the patient, eliminating the need for a grounding pad and reducing the risk of thermal tissue damage.

MiPort Reposable Access \System

Microline | MiPort Reposable Access System
This reposable trocar system is billed as a significant cost-savings solution. The system offers surgeons a wide variety of interchangeable cannula and obturator options. The valve of the trocar is disposed of after each case, guaranteeing a fresh seal each time, while the rest of the system is made of durable PEEK and stainless steel materials that can be reprocessed for a specified number of uses.

E\sophyX2

EndoGastric Solutions | EsophyX2
The EsophyX2 is part of a system that treats GERD endoscopically by changing the shape of a patient's stomach to prevent acid reflux. The result is a procedure that requires no incisions, leaving a better cosmetic outcome and fewer side effects. This latest generation of the EsophyX platform lets doctors use HD endoscopes for the procedure, enhancing visualization. The company also noted the creation of a new Category 1 CPT code (432XX1) for the treatment that will let insurers reimburse the procedure beginning in 2016.

Reliatack Fixatio\n Device

Covidien | Reliatack Fixation Device
This articulating fixation device for hernia repairs is the first of its kind. Its 65-degree articulation lets a surgeon deploy tacks at a perpendicular angle — a key for strong fixation in hernia repair — and minimizes mesh shift during tacking. Reliatack is also reloadable, which results in savings, says the company. If a surgeon decides mid-case that he needs more tacks, he can just reload the device instead of opening up a whole new instrument.

AEM E\ndoShield

Encision | AEM EndoShield
The EndoShield is part of Encision's AEM Burn Protection System, which is a range of laparoscopic instruments designed to prevent stray energy burns. The disposable EndoShield can be plugged into most electrosurgical generators and requires only 1 additional connection, simplifying set-up compared to traditional monopolar instruments. If the EndoShield detects an insulation failure or capacitive coupling of the connected electrosurgical instrument, it kills power to prevent stray burns.

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