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

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 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."

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."

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."

TransEnterix
Senhance Surgical Robotic System
FDA approval appears imminent for the first surgical robot that could challenge the dominance of da Vinci, says TransEnterix, which drew a large crowd at its booth. (TransEnterix filed for FDA 510(k) clearance shortly after the conference ended.) The price remains to be seen, but a less expensive alternative would be welcome, since "the da Vinci is too expensive for 99.99% of surgery centers," says Dr. Towfigh.

The Senhance, which has been cleared for use in urology, gynecology, general surgery and thoracic surgery in several European countries, uses fully reusable instrumentation — instruments that can be autoclaved, "so it can be used again and again, and the per-case cost is very much like laparoscopy," says a company rep.

From the user's standpoint, it offers some interesting advanced features, including haptic feedback, which is designed to help surgeons "feel" how much pressure they're applying. (But "the haptic feedback feels more like a generic jolt than a sense of touching hard versus soft tissue," says Dr. Towfigh.) Additionally, the camera is controlled by the surgeon's eyes, so it senses where the surgeon is looking and adjusts its focus in concert with that movement. There's also an open-source platform for visualization, so it can use different types of cameras.

BD
Snowden-Pencer Take-Apart Instruments
BD has filled a gap in its portfolio with the addition of needle holders that can be taken fully apart. The company's line of take-apart instruments also includes surgical clamps, graspers and dissectors.

In total, BD offers 3-piece take-apart instruments in 6 different jaw patterns, with 4 different handle styles, helping to ensure that cleanability and sterility can be achieved at a peace-of-mind level — particularly when it comes to the inner lumen of the shaft.

Another advantage: If you have to replace a piece of an instrument, you don't have to replace the whole instrument, which is a lot more expensive.

"Snowden-Pencer are very well known to be high-quality, top-of-the-line instruments," says Dr. Towfigh. "And as a surgery center, you don't want a million instruments and trays. You want to be able to buy a handful of instruments and have 2 trays, so you can run more than one room at the same time. The fact that the handle is take-apart is also helpful for containing costs, because you don't need a handle for every single instrument."

Ethicon
Energy platform
Ethicon has substantially broadened its energy portfolio by acquiring Megadyne, and the company had its full range of electrosurgical instruments on display.

Its X1 bipolar device requires less hand movement, thanks to its 360-degree shaft rotation, and is designed to improve access to targeted tissue. It also has separate seal and cut functionality.

The company says it provides better hemostasis (88% less bleeding) and 41% less thermal spread than its primary competitor, and has a better ergonomic feel. There's also an algorithm that senses changes in tissue and conditions and responds with the optimal amount of energy, says Ethicon.

A new harmonic model — the HD1000i — has a unique shape that mimics a mechanical dissector, which reduces the need to use a separate dissecting instrument. It also has an integrated handpiece, so there's no need to manage and clean a separate item.

"Faster is always better," says Dr. Towfigh, noting that the technology seals in 2 seconds instead of 5 seconds, and "it's pretty light. But I don't like the sharp tips. I guess surgeons told them to make it sharp, but when you're dissecting, you want it to be a little bit blunt, because you're using it to seal the vessels. You don't want to go in too sharply when there's a vessel there."

ConMed
MicroLap Specialty Instruments
ConMed is trying to change the way minimally invasive surgery is done, touting the benefits of low-impact or "microlaparoscopic" surgery. The company's new 3 mm instruments address a previous concern by using a proprietary alloy to achieve strength and stability that equal that of traditional 5 mm instruments, says a company rep.

Combined with ConMed's AirSeal technology, the smaller instruments are designed to minimize pain and scarring and eliminate the need for suturing. More and more surgeons, says the rep, are now using a single steri-strip to protect the small puncture made by the micro instruments.

"They have a very low profile, and the fact that they can get by with just a steri-strip is really nice for any population that's concerned about scarring," says Dr. Towfigh, who practices on appearance-conscious patients in Beverly Hills, Calif.

Karl Storz
Endoflator 50 and S-Pilot
Karl Storz is combining insufflation and smoke evacuation with its Endoflator 50 and S-Pilot.

In its high-flow mode, the insufflator has a 50-liter output with heated gas designed to increase patient comfort, but it can also be dialed down to a maximum "sensitive" flow of 15 l/min for pediatric cases and other more delicate patients.

The insufflator's touchscreen is easy to read and easy to use, and it features a heating element designed to ensure that CO2 flows at a constant temperature of 37 ?C and minimizes telescope fogging.

"It certainly would be useful if it cuts down on the amount of wiping off of the scope lens you have to do during a procedure," says Dr. Olasky. "Fogging can delay cases significantly, and it's unpredictable. Sometimes you can go a whole case without having to wipe off the lens, and sometimes you're wiping it off every minute."

Dr. Olasky expressed concern about the metal filament in the insufflation tube. "I would want to make sure the metal is sufficiently insulated, because it's hard to imagine it is, if it's heating up the air around it."