Laparoscopic techniques are finding uses in more and more surgical procedures, but wider acceptance doesn't mean the field is standing still. As a colorectal surgeon at Geisinger Medical Center in Pennsylvania, it's in my and my patients' interests to keep on top of the latest advancements, both in technique and technology. Between seminars at the Society of American Gastrointestinal and Endoscopic Surgeons' annual meeting in Dallas in April, I spent some time in the exhibit hall scoping out the latest products on the market.

Instruments and accessories
Richard Wolf's EndoMotion Support Arm seems like an easy-to-use extra hand for laparoscopic procedures. The device, a series of tubes connected by articulating joints, clamps to your OR table to hold lap telescopes, retractors and other instruments steady. It's moved single-handedly, without the need for electricity, compressed air or adjustments to multiple knobs and switches. A squeeze of the pistol-grip handle lets the joints move freely; releasing the handle locks them in place. The EndoMotion arm lists for about $15,000, say company representatives.

When you're performing any laparoscopic procedure, your access to the surgical site depends on the placement of operating ports. While the blades on standard trocars can lead to patient injuries, Taut's Adapt Balloon Open Access Port has a bladeless tip for increased safety. Its clear cannula accommodates instruments from 5mm to 12mm and a 35mm latex-free, saline-filled balloon anchor provides a tight seal without requiring the placement of stay sutures. Pricing of this device was not available.

On a traditional ratcheting-handle grasper, the release lever is located close to the user's index finger. As a result, there's always the threat of accidental release if an engaged grasper is handed to an assistant. Snowden-Pencer Products' Slide-lock Grasper improves on the design by changing the shape of the ratcheting mechanism from half-moon to a low-profile, one-finger slide. Available in rotating and stationary configurations, the grasper lists for $1,000.

Novare Surgical Systems presented EndoLink, a family of single-use laparoscopic instruments that articulate not just at the distal tip, but at the proximal end, too. This "dynamic articulation" lets a surgeon change the angle of attack of a grasper, dissector, needle driver or scissors quickly, with a bend of the wrist, as opposed to the manual repositioning required with traditional rigid laparoscopic tools. The company did not disclose pricing.

Cutting and sealing
The first thing I noticed about SurgRx's EnSeal Laparoscopic Vessel Sealing System was how comfortable the grasper-cutter handpiece was, even in a smaller-sized hand like mine. The electrosurgical system seals the vessel first, in a matter of seconds, then cuts through it. It does so without heating the tip, so adjacent tissue doesn't get burned. It's operated by a foot pedal, so there's no button to hold while you're grasping, and an audible signal alerts you when the job's done. The system's RF generator lists for $15,000; the disposable handpieces, $425 for the 35cm laparoscopic version and $350 for the 25cm open version.

Gyrus ACMI's Plasma Trissector, Plasma J-Hook and Plasmaseal Open Forceps are recent additions to its PK Technology line of electrosurgical instruments for laparoscopic or open procedures. With bipolar energy and without the use of a mechanical blade, the devices seal and cut simultaneously and can even make "hemostatic running cuts" while their jaws are open. The company suggests a cost of $400 for the handpiece, shaft, jaws and cord.

Power Medical Interventions' 60mm Power Linear Cutter plugs into the company's previously introduced SurgAssist power console to bring computer mediation for consistent and accurate endoscopic transection and stapling. The autoclavable, single-handedly operated device can also be equipped with circular stapler heads at 21mm for oral introduction and at 29mm for laparoscopic colon resection. Pricing was not available.

Wound closure
SuturTek's 360? Fascia Closure Device appears to have idiot-proofed closure. The reusable handheld device incorporates a sterile, disposable, semicircular needle-and-suture cartridge at the distal end. One squeeze of the handle pushes the curved suture needle out of the cartridge and through the tissue. A second squeeze grasps the needle by the point and pulls it back around. Utilitywise, it provides a consistent depth of suture. It's easy to learn, and because the point is never exposed, it prevents needlestick injuries. Company reps list the sterilizable handpiece at $1,500 and a box of 12 cartridges at $300.

Until now, you could only apply a medium/ large, 8.8mm clip with a 10mm clip applier. Ethicon Endo-Surgery's introduction of the Ligamax 5mm Endoscopic Multiple Clip Applier means that bigger clips can be delivered through smaller incisions. The angled jaws collapse for insertion through a trocar, then spring open once inside the patient. It must be noted, though, that Ligamax's 8.8mm titanium clips are only 0.8mm longer than the 8mm clips dispensed by U.S. Surgical's 5mm clip applier. The handpiece was ergonomically comfortable and a built-in indicator lets you know when you're low on clips. The Ligamax lists for about $1,100 for three appliers.

Micromedics showed its FibriJet Rigid Endoscopic Biomaterials Applicators, a range of single-use instruments designed to place surgical adhesives and other dual-component biomaterials into laparoscopic sites. Double-barrelled syringes deliver the components into a mixing tip for dispensing through applicators, available in three sizes: 7, 12 and 16 inches. A gas-assisted option lets the applicators evenly spray the material. The product lists at $75 for a box of five applicators.

Video equipment
Olympus America highlighted its new Evis Exera II 180 Series high definition system, a video platform for use in any surgical specialty. Using "narrow band imaging" technology, which the company says converts a white light source into selected wavelength bands to take advantage of tissue's light properties, the system delivers clearer views of and more detail in anatomical structure. Olympus has priced the video processor at $22,000 and the light source at $12,500.

Karl Storz's flexible distal chip video endoscope for translumenal surgery offers a compact alternative to video towers in your OR. Instead of rolling in a cart-based system, this handheld option plugs into Storz's OR 1 network system. This new accessory is lightweight, straightforward in design and easy to use; however, since engineers' hands are often quite differently shaped than surgeons', its ergonomics still leave a little to be desired. Storz reps say they expect the scope to reach the market later this year.

Barco presented its MDSC-1119 advanced surgical color LCD display, a 19-inch flat-panel monitor for ORs and endo suites. Its high brightness provides sharp images even under surgical lights, the company says, and its fanless design prevents the spread of contaminants or anesthetic agents. The company did not provide pricing.

Surgical mesh
For laparoscopic hernia repairs, you want a surgical mesh that's not only strong, but also flexible enough to push and pull through a trocar and manipulate inside the site. Tyco Healthcare's Autosuture division is distributing Parietex Polyester Mesh, a demonstration of which showed its durability and pliability as well as its porosity. The company says it's an improvement over polypropylene mesh due to the multifilament makeup of each thread, which allows tissue ingrowth between the fibers, as opposed to tissue encapsulation of monofilament mesh. Pricing was not available.

Another way to add strength to surgical mesh is to add titanium. TiMesh, manufactured by GFE Nanomedical International and distributed by PFM Medical, includes titanium atoms covalently bonded to molecules of synthetic polymer. The combination of these two implant materials results in a strong, biocompatible, flexible and lightweight product, says the company, which did not disclose pricing.

Atrium Medical's C-Qur Mesh combines a lightweight polypropylene material with a proprietary, Omega 3 fatty acid bioabsorbable coating to minimize tissue attachment, foreign body reaction and inflammation during reinforcement and healing, says the company. Atrium reps expect the mesh to reach the market this summer.

Evacuation and aspiration
Buffalo Filter's LapEvac in-body smoke evacuation system connects to two trocars to form a closed loop that removes smoke and aerosols during laparoscopic procedures while recirculating the CO2 inside. It's a small unit - 4 inches by 4 inches by 6 inches and only 13.4 ounces - and quiet at 39 decibels. The disposable unit runs for 2.5 to 3 hours on 4 AA batteries and lists for $40.

ConMed Linvatec's 10k Fluid System may appeal to facilities or, more likely, departments looking for equipment that does double duty. The compact, electrically powered console is able to serve either laparoscopic or arthroscopic pumping purposes simply by changing its tubing cassette. Gastrointestinal surgeons wouldn't have much use for the arthroscopic option, but a small facility or unit that sees both GI and orthopedic surgeons might.

Miscellaneous
According to Inamed Health, makers of the Lap-Band System for weight-loss surgery, some patients with larger anatomies found the 9.75cm and 10cm silicone bands too tight, resulting in post-surgical complications. Inamed's new Lap-Band VG System addresses that concern by offering a wider adjustment range and pre-shaped inflatable pockets inside the band to maintain its shape. The company did not disclose pricing for the line extension.

One big hazard of bowel prep is that your patients might suffer from dehydration. Fleet Laboratories' HydraLife Oral Rehydration Drink serves up electrolytes and carbohydrates to replace the depleted nutrients with less dextrose and fewer calories than a popular sports drink. Each serving of the ready-to-mix powder makes one 12-ounce glass of the clear, orange-flavored drink. A box of four servings is expected to retail for $9, and scheduled to be available through wholesale suppliers this summer.

Applied Surgical's Gemini Surgical Control and Display System is a cart-mounted network hub and software interface that coordinates up to four electrosurgical systems simultaneously, regardless of manufacturer. The value, the company says, is integrated control and OR safety (namely, fewer cords on the floor) while preserving your surgeons' preferences. A foot pedal provides convenient control and the interface provides audio and video feedback during electrosurgery use. An automatic smoke evacuator is included. The Gemini system lists at $20,000 to $30,000.