I'm always on the hunt for the tools and technologies that let surgeons perform procedures safely, effectively and efficiently. Here are 8 of the hottest developments in minimally invasive surgery I got a chance to review at this year's SAGES in Salt Lake City.

1. RIGID PART CareFusion's new mini-lap instruments have sturdy shafts.

CareFusion
MicroLap Instruments
The shafts of these 2.7mm mini-laparoscopy instruments are made of a proprietary ceramic-titanium design, giving them more mechanical strength than competing lines, says a company rep. An over-sleeve adds even more rigidity, especially for use in bariatric patients, and serves as a working trocar after insertion. Mini-lap technology is nothing new, but the instruments are notoriously fragile and can break when enough torque is applied. If the titanium-ceramic shafts and over-sleeve hold up in the OR, that'd be a nice improvement.

2. MESH ATTACHMENT A new stapler from Ethicon Endo-Surgery improves open hernia repairs.

Ethicon Endo-Surgery
SecureStrap Stapler
Applying mesh to an abdominal defect during an open hernia repair — a task described by a company rep as like trying to wallpaper your ceiling — is made easier with this ergonomically designed stapler, which lets surgeons reach deeper into the abdominal cavity to apply tacks uniquely designed to take a bite of mesh when fired at any angle.

3. PORT PERKS Lexion Medical's new trocar heats and humidifies insufflation gas.

Lexion Medical
Insuflow Synergy Port
This port warms and humidifies CO2 gas to 95 degrees and 95% relative humidity, which a rep says reduces laparoscope fogging and results in less post-op hypothermia, less shoulder pain, less use of narcotics and, ultimately, shorter recovery times. The secret is in the unique design of the trocar's tip, where gas enters the abdomen through a series of holes that limit pressure drops and deliver more gas per unit of time at a low velocity. The device costs $95 and retrofits to any manufacturer's insufflator, which is nice, but that's double the price of a conventional trocar. The reported benefits to patient recovery might be worth the added expense, however. There are other standalone insufflators that heat and humidify, but to have that incorporated in the trocar eliminates another loud machine in the OR.

4. COMPLETE PACKAGE Aesculap added to its 5mm line of vessel sealing instruments.

Aesculap
Caiman Vessel Sealing Instruments
Aesculap has added a bariatric length to its 5mm line of vessel sealing instruments known for 26mm jaws that close tip first, from distal to proximal ends, letting surgeons deliver consistent pressure in longer bites for more efficient and effective seals with less than 1mm of thermal spread.

5. BRIGHT OUTLOOK A new imaging system from Karl Storz improves the view of surgery.

Karl Storz
Image 1 SPIES
This new high-definition imaging system identifies, in real time, the dark areas in an image and automatically adjusts pixels to lighten hard-to-see anatomy. Surgeons face this problem a lot: When the foreground of an image gets too bright, a conventional camera's iris closes to keep the surgeon from being blinded by glare. However, that often darkens the entire image, forcing surgeons to reposition the camera in order to re-establish the view. This technology would cut down on those time-wasting and frustrating adjustments.

6. FAST PACE Covidien's new cutting and sealing technology is more efficient than ever.

Covidien
LigaSure Maryland Jaw
The one-button activation of the device enhances the design of an established platform indicated to cut and seal vessels up to 7mm in diameter. Surgeons pull the pistol grip, which depresses a button on the inner handle, until a loud click indicates the tissue is grasped. They then fully engage the grip until a second click and audible tone indicates the cutting and sealing energy has been activated. The design is ergonomically friendly for male and female surgeons who perform bariatric, general, esophageal and GYN procedures. The improved activation separates the device from its competitors by letting surgeons dissect, cut and seal multiple times quickly and easily.

7. SMALL WONDER Stryker showcased its new option for mini-laparoscopy.

Stryker Endoscopy
Mini-Grip Grasper
The latest addition to Stryker's mini-lap instrument line features an ergonomic pistol grip and a 13-gauge needle that's inserted into the abdominal cavity percutaneously, letting surgeons regain instrument triangulation without adding a working trocar. A new rotation knob and ratchet design grabs tissue and holds it in place, which is a nice innovation.

Stryker also showcased the incredible optics of its 1488 HD camera, which also features a light source that's 30% cooler than other cameras on the market. That lessens the possibility of flames igniting if the camera is accidentally rested on drapes after use. Surgeons can also use push-button controls on the camera's head, or voice commands delivered through a headset, to control OR equipment such as light sources and insufflators.

Surgeon profiles on the company's SDC3 information management system let the OR team set equipment to physician-specific settings with a tap on the system's touchscreen. Surgeons can connect wirelessly to a facility's intranet to send digital images and videos of surgery to a PACS system or EMR. They can also download the images and videos to a post-op report, add annotations and follow-up care recommendations, and email the information to patients or share it with them on a tablet in recovery soon after surgery. It's those types of educational efforts that can boost patient satisfaction scores, which impact facility reimbursements.

8. PULL THE STRING Novatract Surgical's tissue retractor (above) gives surgeons a helping hand, says Dr. Renton (below).

Novatract Surgical
Laparoscopic Dynamic Retractor
The retractor is designed for organ and tissue manipulation through a 5mm port, which is freed up for working instruments once the device is deployed. The surgeon clips the tissue that needs to be moved, releases the clip from the device's tip and fires an anchor into the abdominal wall to act as a fulcrum for retraction. A string attached to a pulley mechanism lets the surgeon adjust the tension as needed. A company rep told me the device reduces the need for ports dedicated to retraction for surgeons attempting single-incision procedures or 2-port lap choles. It's definitely a neat design, but sometimes the best devices have the fewest moving parts, so I'd like to see how the retraction works during a procedure to truly judge how it performs in practice.