"Incorporation of this deflectable tip on the telescope provides surgeons with a larger operative view, helps them avoid situations where the tips of the instruments collide and delivers the maneuverability and access that are required for the emerging field of Laparo-Endoscopic Single-Site surgery," he explained. "In addition, the Olympus LTF-VH EndoEYE offers a new technology known as Narrow Band Imaging (NBI) that manipulates the interaction of light and tissue by enhancing visual contrast of capillary patterns on mucosal surfaces that often times are difficult to distinguish."

According to Coolidge, "Olympus’ EndoEYE deflectable laparoscopes are advancing the boundaries of minimally invasive surgery and LESS surgery for physicians and patients alike in procedures such as: Cholecystectomy (gallbladder removal), Hysterectomy (removal of Uterus), Nephrectomy (Kidney resection), Heller Myotomy (procedure for Achalasia) and more."

CareFusion’s V. Mueller Switch-Blade reposable scissors with reusable handles and disposable scissor tips

"Along with Minimally Invasive Devices Inc. (MID), CareFusion recently introduced the FloShield System which is a disposable sheath that fits over the shaft of the laparoscope during laparoscopic surgery and diverts a small portion of gas from insufflation over the lens," offered Waldroup. "This system helps provide an uninterrupted view during surgery by helping to defog the lens, deflect debris and help prevent trocar smudge on the lens of the laparoscope without having to remove the scope from the abdominal cavity for cleaning."

Waldroup also touted the benefits of CareFusion’s newest Snowden-Pencer reusable ring-handled laparoscopic instruments. "Snowden-Pencer next generation instruments provide three distinct benefits – ergonomics, versatility, and durability. Not only are the instrument handles ergonomically contoured and designed with surgeon-based feedback, but also allow for multiple gripping positions and stand up to today’s more aggressive cleaning and sterilization environment with their non-corrosive materials."

In addition, "The ergonomic ring-handled laparoscopic instruments offered by Snowden-Pencer present more surface contact than ‘traditional’ style handles, resulting in a reduction of peak pressure in the user’s hand which may reduce the potential for intraoperative hand fatigue," she said.

"The balance between surgeon need (technology) and hospital need (cost reduction) can be accomplished through an investment in high quality reusable product that offers a return on investment over a period of time. Reusable product is also greener for the environment, saving hospital trash fees, and creating more jobs for people to handle and reprocess instruments," emphasized Waldroup.

Spectrum 3-part, take-a-part laparoscopic grasping forceps

Spectrum Surgical Instruments Corp. recently introduced their new, fully cleanable, three-part, take-a-part, atraumatic laparoscopic grasping forceps. Consisting of three components for quick and easy disassembly, the unique design of the fully autoclavable lap grasper allows for optimal cleaning and sterilization. Spectrum’s lightweight grasping forcep offers easy, 360-degree rotation and ergonomic and precise single-hand use. The German-crafted instrument features a rotatable and detachable shaft, individual replacement components, and is available in 5mm diameter with 33cm and 45cm working lengths.

The new LapFinger finger-activated laparoscopic instrument from Microline Surgical is designed to mimic the movements of the human index finger, explained Sharad Joshi, president and COO. "Typically with open procedures, surgeons would often use their finger to dissect, to palpate, or even to retract and move objects out of their way. But in laparoscopic surgery, those things that are done very simply with your finger are very difficult to do with an instrument – particularly with feel. LapFinger is designed in such a way that it allows you to palpate with feel, retract with strength and also dissect with confidence."

"LapFinger has a unique ability to maneuver around and get behind structures that you don’t see in traditional laparoscopic instruments," continued Joshi. "For example, there’s a maneuver that most surgeons can’t do in laparoscopic surgery, called anterior dissection." He compared this maneuver to that of using the forefinger to "beckon" someone from across the room.

"It’s a very difficult maneuver because with other laparoscopic instruments you have to grasp tissue in order to do that," he explained. "Here, you can actually feel a plane of tissue, dissect into that plane and once you’re through that tissue you can actually retract, which is really an unusual capability. And then the whole idea of being able to do it with feel is really desired by surgeons."

Conceptualized by surgeon Michael A. Goldfarb, M.D., and then developed and fast-tracked to market by Microline, LapFinger can be used both right and left-handed and features a rotator knob that allows the surgeon to orient the finger trigger in various positions to reach anatomical features in different ways, as well as articulate the tip in different configurations, and then lock it into place, explained Joshi.

The flexibility of LapFinger also means it’s not limited to a particular type of procedure. Kristina Cabel, director of marketing, Microline, described some of the ways in which LapFinger is being used, including gastric procedures and colorectal procedures.

"I’ve seen it used to palpate tumors in the colon and also in the stomach. When they’re trying to determine what to resect, the surgeon can figure out where the cancerous tumor ends and they can make sure that they have sufficient margins."

The LapFinger has also been used in placing French bougies during gastric procedures. "They can palpate the stomach and actually feel where the bougie ends just like you would feel it with your finger," said Cabel.

Like most of the instruments offered by Microline, the LapFinger is a reposable device. It features a high-quality handpiece that can be used hundreds of times along with a variety of disposable single-use tips with various levels of firmness for different dissection needs – for example an atraumatic soft cotton swab versus a firmer rubber or plastic tip.

"The beauty of it is, the surgeon doesn’t have to go out and buy four or five different instruments," said Joshi. "Because it’s reposable they can just have four or five different tips on the table. They don’t even have to open them until they’re needed."

Microline’s MiSeal reposable tissue sealing system

As a result, reposable instruments allow for a low cost per procedure without compromising quality. "You’re not selling the entire instrument to a hospital every single time they do a procedure," said Joshi. "You’re simply re-sterilizing the bulk of the device and therefore you can have a much higher quality handpiece that’s well balanced and gives the tactile feel needed for laparoscopic surgery. And then you marry that with that combination of a tip that is relatively low cost and also takes up very little space. There are multiple benefits for this. It produces a lot less waste because you’re not shipping and storing hundreds of instruments; you’re shipping these tiny little pouches that include the tips." Consequently, hospital storage cost is minimized, and expensive red bag waste is reduced as well, he noted.

Microline is also developing new tips for the LapFinger, including a longer length for bariatric surgery and a shorter version for head and neck procedures, Cabel noted.

"The cost of healthcare is obviously on everybody’s mind and reposability is a great way to lower costs while keeping quality high," Joshi reinforced. "In general I think cost is becoming a major component of purchasing decisions. Surgeons obviously have a main role in deciding on the technology, but really the hospitals and the purchasing agents and the people responsible for the bottom line have a larger say in what technologies are brought into the hospital. The technologies that will do well in the future not only provide a high clinical efficacy but also do it in a low cost manner. I think that’s a major trend in healthcare, smart companies are finding out ways to get the cost per procedure down to a reasonable number."

Another new product being introduced by Microline is the MiSeal reposable tissue sealing system based on a direct conduction heating method.

Explained Joshi, "Direct heating does not send electrical currents like many other modalities. Cautery, bipolar and monopolar [modalities] send electrical currents through the tissue in order to seal it. This technology applies direct heat within a very narrow area of the jaw [of the MiSeal instrument], so therefore your thermal spread is minimized. You also don’t have a lot of collateral damage that extends beyond the jaw. It’s less likely to damage nearby tissue when you’re sealing."

In addition to exceptional tissue sealing, the reposable MiSeal also offers a significant cost advantage, said Joshi. "There are many devices in this space that cost a hospital over $600 for the entire device, but for MiSeal it would be a fraction of that cost."　

Waldroup described the benefits of using a reposable scissor, "A reposable laparoscopic instrument refers to an instrument where there is a component that is disposable and a component that is reusable. This functionality is critical to the laparoscopic scissor due to the maintenance required of re-sharpening a reusable scissor or the waste aspect of a fully disposable laparoscopic scissor. CareFusion offers Switch-Blade scissors, a reposable scissor solution pairing a reusable handle and shaft with a disposable tip. This solution provides a fresh cutting experience at every case and could potentially be a financially viable alternative to a disposable or reusable scissor option."