The exhibit hall at the Society of Gastrointestinal and Endoscopic Surgeons' annual conference in San Diego was filled with innovative solutions to common laparoscopic challenges: improving visualization and maneuverability during techniques that make both extremely difficult. Here are a few of the devices on display that are worth checking out.

1. Thunderbeat from Olympus
The world's first handpiece with integrated advanced bipolar and ultrasonic energies generated a great deal of buzz on the show floor. Available in pistol and in-line handle styles and 4 working lengths, the instrument lets surgeons switch between both modalities with easy-to-access push-button controls for cutting and consistent sealing of vessels up to 7mm, which is aided by the deflection of the instrument's jaw design that delivers evenly distributed pressure at the cutting or sealing location. I've long believed that bipolar and ultrasonic energies are complimentary, not competing, technologies. The combination of both in a single handpiece is an interesting design that finally brings these 2 modalities together. This device would be especially useful during GYN procedures, which often require use of each modality.

2. Echelon Flex from Ethicon Endo Surgery
"Controlled stability" was the catchphrase at Ethicon's booth. The company says its new powered stapler compresses tissue before staples are fired, which presses excess fluid out of the tissue to create a uniform thickness for placement of securely closed staples along the entire length of the staple line. With powered firing, the force needed to activate the stapler is minimized, leading to less movement of the tip near tissue or vital organs that surround stapling locations. The device's manual jaw provides tactile feedback upon closing, and an ergonomically designed handle allows for single-handed articulation. Surgical staplers are already amazingly effective instruments. The addition of powered activation with the virtual elimination of any loss of control at the stapling site could represent the next step in surgical stapler design.

3. Full High-Def Camera from Olive Medical
This is easily the lightest clinically available camera head I've ever held. Company reps say a native CMOS imaging sensor acquires 1920x1080p high-def images at the camera head, making it the only true alternative to 3-chip HD cameras. CMOS sensors generate less heat because of system-on-chip technology, keeping the camera head cool to the touch and maintaining image quality longer, according to Olive Medical, which says its goal is to offer true high-def technology at a price facilities can easily afford. One more positive, says Olive Medical: The camera head can be used on any company's endoscope with a C-mount or standard eyepiece, and its light cabling is compatible with most manufacturers' light sources.

4. Eragon Modular Forceps from Richard Wolf
These lightweight and versatile instruments boast 3 ergonomic handle designs and 3 sheath lengths — pediatric (260mm), standard (330mm) and bariatric (450mm). The instruments' various handles, sheaths and jaws click together for easy assembly and configuration, and a quick-release button allows for easy disassembly. That versatility means you can switch out damaged portions of the instrument instead of buying a whole new device or buy 1 set of handles and sheaths that can be configured to meet the needs of numerous surgeons, which limits the number of instruments you'll need on hand. Being able to take the forceps completely apart also helps ensure proper cleaning and sterilizing.

5. Robotic Passport Trocar from Stryker
Stryker entered the abdominal access market earlier this year with the purchase of Patton Surgical's line of Passport trocars. At SAGES, the company unveiled its 8.5mm and 12mm Passport SmarTip trocars, the first disposable ports specifically designed for use with Intuitive Medical's da Vinci robotic system. The trocar has a nice safety mechanism: It can be used in both bladed and blunt settings, which lets surgeons penetrate the abdominal wall with the bladed tip during initial entry into the surgical cavity or use the unarmed mode to protect vital organs during subsequent entries.

6. AirSeal IFS from SurgiQuest
This self-contained insufflation unit, unlike conventional insufflators, features a circulatory flow design that allows for simultaneous high-flow insufflation, intra-abdominal pressure sensing and continuous smoke evacuation. The system detects changes in intra-abdominal pressure in real time and automatically sends more CO2 into the surgical cavity or allows gas to escape through an access port to maintain stable pneumoperitoneum, according to the company, even during the constant use of high-flow suction, the placement of open trocars for the passing of large specimens or instruments, and in the event of trocar dislodgement or valve leakage.

7. Caiman Instruments from Aesculap
A radiofrequency tissue- and vessel-sealing device that features an 80 ?, 50mm articulating jaw, the longest on the market, according to Aesculap. The jaw's extended length means surgeons can cover more ground with fewer seals. In addition, the jaw's unique tip-first closure and hinged design grasps tissue evenly to deliver uniform compression from tip to distal end for more reliable seals. The instrument line is said to create less than 1mm of thermal spread, which limits damage to surrounding tissue and creates seals with minimal charring. I like that the tip-first closing means tissue won't squeeze past the jaws, so surgeons can be confident the instrument will remain where they intend it to be for more controlled bites.

8. Inzii Universal Retrieval System from Applied Medical
Even though about 4 out of 5 gallbladders can be removed through 5mm ports, some surgeons still prefer to secure specimens in 10mm bags. Those docs will like Applied Medical's offering of a 10mm bag in a 5mm shaft, which minimizes the need to add larger ports just for specimen extraction and provides a nice transition for surgeons who want to start operating through smaller incisions. The bag's reinforced tip, where specimen bags typically tear, minimizes contamination risks. That's a nice feature. The system's extra-large, angled opening lets surgeons easily open and close the specimen bag, according to the company.

9. MicroGrip from Pare Surgical
This 2mm plastic percutaneous access device features a flexible shaft and grasping jaws that retain their shape even when stressed, letting surgeons manipulate tissue during conventional or single-incision laparoscopy. The retractor is available in 3 jaw designs for grasping and retracting various types of tissue. Surgeons might find it difficult to manipulate organs while maneuvering instruments through a single trocar, but by popping the MicroGrip through a 2mm incision instead of adding another 5mm trocar, they'd be able to retract organs or tissue and hold it in place. With the growing movement toward reduced- or single-port approaches, the development of top-notch needlescopic technology has become incredibly important.

10. View1 Image Station from Global Care Quest
Global Care Quest, a division of Karl Storz, showcased its universal PACS reader that gives surgeons instant access to a lot of clinical information — including CT, MRI or X-ray images, and patient lists and physiological data — displayed right where they need it most: on a high-resolution screen in the OR. Although your surgeons might not demand all of the info available on the Image Station during every case, knowing it's easily available is a huge plus when they do need it. Instead of asking nurses or anesthesia providers concentrating on their own tasks for patient data, or trying to remember what a chest X-ray showed, surgeons can immediately review the information or image up on the screen. With electronic health records becoming commonplace — and soon required — the potential benefits of having this display in your ORs will only increase.