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with John H. Marks, M.D., FACS, FASCRS

John H. Marks, M.D., FACS, FASCRS, Chief of Colorectal Surgery and Director of the Fellowship in Minimally Invasive Colorectal Surgery and Rectal Cancer Management at Lankenau Hospital, is an expert in and an advocate of minimally invasive colorectal surgical techniques. He has performed over 950 laparoscopic colorectal surgeries during the course of his career.

Dr. Marks had been using a disposable Babcock grasper to handle tissue during these procedures but was concerned about the device’s clinical efficacy since the grasper tip was unsuitable for handling delicate bowel tissue. According to Marks, if the grasper tip is too small or too sharp, it can tear the tissue and lead to serious post-operative complications. In the case of bowel surgery, tissue perforations can allow fecal matter to leak into the abdomen, putting the patient at risk for sepsis.

"Tissue handling is crucial for colorectal surgery since you have to manipulate and move various organs during the procedures. There’s a lot of opportunity to inflict tissue damage if you’re using poor quality instrumentation," said Dr. Marks.

In addition, the plastic handles on disposable devices were uncomfortable to manipulate. As a result, Dr. Marks experienced numbness in his fingers during long, complicated cases. Since he frequently performs two or three cases each day, it became a significant issue.

"It was so severe that I was concerned that I would no longer be able to perform these procedures," said Dr. Marks.

The high cost of the disposable device was a concern as well. A typical hospital performs an average of 2,000 laparoscopic procedures each year and during each procedure, the surgeon uses approximately three different instruments, including graspers, dissectors and scissors. Since disposable devices can cost $90 or more, a typical hospital spends approximately $540,000 annually on such instruments and $180,000 on this single device alone.

"The fact that we had to throw out the device after a single use increased the cost of each case," said Dr. Marks. "I wanted to find something more economical for the hospital."

John H. Marks, M.D., FACS, FASCRS

For 10 years, Dr. Marks searched for a solution but no single instrument met all of his needs. That changed in 2005 when he led a laparoscopic colorectal surgery training course at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Annual Meeting. During the course, he had the opportunity to use a variety of surgical instrumentation, including Microline Surgical’s reposable laparoscopic surgical system.

"It was immediately apparent to me that this was the solution that I had been searching for all of those years," said Dr. Marks. "The device felt great in my hands, it handled tissue well and it was cost effective to the hospital, a real trifecta."

The Microline Surgical system that Dr. Marks used is comprised of the ReNew universal reusable hand piece and a wide variety of disposable tips for tissue cutting, grasping and dissecting. This reposable system offers the clinical and economic benefits of a disposable instrument combined with the quality and precision of a fully reusable instrument. The scissor tips are changed after every case to ensure that the surgeon always has a sharp cutting edge while the grasper and dissector tips can be used many times before they must be discarded, providing a significant cost savings over single-use devices.

Shortly thereafter, Dr. Marks began using Microline Surgical’s reposable system in his practice. Because of its intuitive, integrated design, there is minimal training involved. The system features coaxial threading for easy assembly, which is unique to the industry. Since there are two sets of interlocking threads, the tip cannot detach from the handle during surgery. This patented design provides added safety.

"I’ve performed many laparoscopic surgeries during my career so I have a rule that if you place an instrument into my hand and I can’t figure out how to use it in a couple of minutes, then there must be a design flaw," said Dr. Marks. "Because Microline Surgical’s instruments are so intuitively simple, I needed no training at all."

The quality and versatility of Microline Surgical’s system addresses Dr. Marks’ efficacy concerns as well. The company offers a wide variety of precision graspers in different sizes and widths, enabling Dr. Marks to choose a tip that best meets his needs. For example, Microline Surgical’s Super Atrau Graspers are single use tips with a soft padded grasper designed to protect sensitive tissue like the bowel.

"In the past, I had a very difficult time finding a grasper paddle for handling delicate bowel tissue," said Dr. Marks. "The paddle on Microline Surgical’s 5 mm grasper is excellent for holding the bowel since it is wide enough to spread the force over a greater area and prevent tearing."

In addition, the system is ergonomically designed to provide a more substantial and responsive tactile experience compared to disposable plastic handles. It features removable, reusable ring inserts for a custom fit, which addresses the comfort issues that Dr. Marks had been experiencing with the disposable device.

"The numbness is completely gone," said Dr. Marks. "When I now use instruments that don’t have the handle rings, it feels so foreign to me – like the difference between sitting on a non-cushioned versus a cushioned seat."

To date, Dr. Marks has performed over 400 laparoscopic colorectal procedures with Microline Surgical’s reposable system, including rectal cancer surgery, right/left colectomies and total proctocolectomies. It has provided a significant cost savings to the hospital over single-use devices.

Since Microline Surgical’s hand piece is reusable and its grasper tips can be reused for multiple cases, the cost to the hospital is just a few dollars per procedure, compared with $90 per procedure for a single use device. If a hospital, such as Lankenau, replaced just one single disposable instrument with one of Microline Surgical’s devices, it could save well over $180,000 annually and that hard cost savings could be well over half a million dollars if it replaced all three disposable instruments – graspers, scissors and dissectors – with reposable devices.

Lastly, in the midst of the current economic crisis as the U.S. focuses its sights on healthcare reform, "going green" can be an effective way for hospitals to both reduce waste and cut hard and soft costs. The eco-friendly design of Microline Surgical’s reposable instruments enable hospitals to achieve this goal since they require less shelf space, feature less packaging materials and generate less waste compared to fully disposable devices.