Archive June 2017 XVIII, No. 6

The Newest Entries in Minimally Invasive Surgery

The SAGES exhibit hall was a showcase for innovative GI and endoscopic products.

Jim Burger, Senior Editor

Jaisa Olasky, MD and Shirin Towfigh, MD, FACS EXPERT VIEWS General surgeon Jaisa Olasky, MD, left, and Shirin Towfigh, MD, FACS, a hernia and laparoscopic surgery specialist, tested some of the products on display at SAGES 2017 in Houston.

HOUSTON — For insights on some of the more interesting and innovative products on display in the exhibit hall at SAGES 2017, we called on the expertise of Shirin Towfigh, MD, FACS, a hernia and laparoscopic surgery specialist at the Beverly Hills (Calif.) Hernia Center, and Jaisa Olasky, MD, a general surgeon at the Beth Israel Deaconess Medical Center in Boston, Mass. Here are capsules of 9 products that caught their eyes.

— Jim Burger

 
MediCap MVR Lite 4K

MediCapture
MediCap MVR Lite 4K
MediCapture's compact new 4K recorder is surprisingly affordable at about $6,500, and offers about 90% of the functionality of recorders that cost 5 or 10 times as much.

Its plug-and-play functionality lets you record from endoscopes, arthroscopes, surgical cameras, ultrasound and other platforms in standard definition, high-definition and 4K. You can record directly to it, or plug in a flash drive and download your video. The company provides flash drives with your purchase, but any flash drive will work.

"It's really a great price," says Dr. Towfigh. "For smaller facilities where cost containment is an issue, it would be a good fit. In 2002, we paid $20,000 for a recorder. Now, I'm thinking if we wanted to add another unit, we could just use this. It makes no sense to buy a more expensive brand name when this will do just as well."

It doesn't have "push to PACS" capability, says a company rep, but that's not usually an issue in outpatient settings, says Dr. Towfigh.

 
FlexDex Robotic Arm

FlexDex Surgical
FlexDex Robotic Arm
The robot without a robot is surgeon-powered — there are no electronics, no batteries and no motors. An ingenious and relatively inexpensive ($500) alternative to the electronic robots that would break most budgets, the FlexDex facilitates the same kind of complex suturing currently being done with great success by its vastly more expensive counterparts.

There's a learning curve with the disposable device, but a company rep says it takes only a half hour or so to begin to feel comfortable with it. It fastens to the surgeon's wrist (it comes in various sizes) and works by translating hand, wrist and arm movements into corresponding movements of an end-effector inside the patient's body. As such, it lets surgeons drive needles at any angle.

As a disposable alternative to the robot, the company says it's analogous to a smartphone versus a desktop computer. "Robots are great for complex cancer cases, where you need a lot of technology," says another rep, "but we feel that facilities don't need to invest in robots for many easier procedures."

Dr. Towfigh sees potential. "The price isn't low, but it's reasonable," she says. "It would be great to be able to bring robotics to outpatient surgery centers. There are so many procedures that could be done that would increase income.

"Suturing is a good starting point," she adds. "The angle at which you can suture is better with a flexible tip than with the chopsticks that we currently use for laparoscopy." Her one concern: "It doesn't have the stability at the tip that I'd like to see."

 
Spy-phi

Novadaq 12
Spy-phi
Novadaq's new hand-held imaging device is not only lightweight and compact, it also features 3 distinct fluorescent video modes that combine with indocyanine green to display perfusion and blood flow more accurately and vividly.

That lets surgeons make better decisions than they'd be able to make just using the naked eye, says Dr. Olasky. "If you're doing a lap colectomy, having a better view of perfusion can help you salvage something that to the eye is a little dusky, and that you might otherwise resect. With this, you can see that there's good blood flow there."

Since it's light and portable, you can put it on a bed rail and hook it into an arm or you can simply hold it. That, says a company rep, lets you visualize areas that you can't get to with a larger device that isn't as easily moved.

It's a simple plug-and-play design and highly engineered to be both light and ergonomic. "I don't see any downside," says Dr. Olasky. "And the portability would also be a benefit if a facility is doing 2 colorectal cases at the same time."

 
Specimen Retrieval Bag

Medtronic
Specimen Retrieval Bag
It can be very bad news if a specimen bag breaks when you're trying to yank it out through a small incision.

"I actually know of a case where someone ended up with a wound infection from a routine non-perforated appendix," says Dr. Olasky. "The bag ripped and that person — a healthy 20-year-old — came back with a wound infection."

Fortunately, Medtronic has come up with a bag that's almost impossible to rip. It's made from ripstop nylon, the same material that's used to make parachutes and other items that need to be as strong as possible. It comes in 10 mm and 12 mm sizes and is significantly stronger than polyurethane, but the price is the same.

"I'd accept a slightly higher cost," says Dr. Olasky, who happily showed a relatively easily ripped polyurethane bag side by side with a piece of ripstop nylon. "It's definitely a good idea to have a stronger bag, and I'll probably bring this to my people. I have a tent and camping gear that are made out of the same material, because it's so strong."

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