The desire to reduce costs, coupled with a growing population of patients who want to get in and out of the hospital as fast as possible is fueling the growth of minimally invasive surgery (MIS). A variety of factors are affecting the growth and adoption of MIS and its accompanying technologies. This includes cost containment and reimbursement, rising obesity rates, clinician training and education, and hospital-acquired infections, according to a MIS market report by Kalorama Information (New York City).

Many patients opt for MIS, because the procedure is lower risk and results in less trauma and blood loss, significantly smaller scars compared to traditional surgery (two- to four-in. incision length versus six to ten), and a short hospital stay. Oftentimes, MIS is an outpatient procedure.

The Kalorama report, "Minimally Invasive Surgical Devices, World Market," cites gastric bypass as the fastest growing laparoscopic procedure due to its lower risk. However, it’s a small portion of the MIS market, and there’s a lot of room for both new opportunities as well as the entrance of more competition. In addition to the development of new technologies, which will need to be smaller and smarter, it’s likely that conventional open procedures will also soon explore the MIS route.

Emerging Opportunities

Two of the hottest areas in MIS are robotics and natural orifice transluminal endoscopic surgery (NOTES). Robotic surgery is gaining ground as new applications for the procedure emerge and companies partner to expand uses of the technology. For example, during this year’s annual clinical meeting of the American College of Obstetricians and Gynecologists, physicians reported that robotics in MIS is tightening its grip as a viable gynecologic treatment option. The use of the market-dominating da Vinci system, which earned its fame in prostatectomy, is being explored in gynecology.

In December, FDA approved EndoControl’s (Grenoble, France) ViKY System, a motorized endoscopic holder for MIS involving the chest, abdominals, and pelvis. A surgeon can move the dedicated arm, which is attached to the table, via a foot or voice controller. The company announced the commercialization of the product last month.

Despite the promise of such surgical systems, it’s expected that high-priced devices like robotic surgical systems, some of which cost hospitals hundreds of thousands of dollars, will face a challenge during the recession, according to Ernst & Young’s 2009 update of its “Pulse of the Industry” report.

NOTES could be the next frontier in MIS, as it could further reduce the chance of infection and nearly eliminate scarring, as it presents the opportunity to remove an organ via an orifice. Thus far, its use has been explored in removing or accessing organs including the gallbladder, appendix, liver, and spleen. In order for NOTES to evolve into a commonly used procedure, manufacturers will need to continue their efforts to develop flexible surgical technologies.

Market Potential

According to a BCC Research report published in March, last year’s global market for minimally invasive surgical (MIS) devices and equipment was valued at $14.8 billion. In the report, titled “The Market for Minimally Invasive Medical Devices,” analyst Andrew McWilliams projects the market to hit $15.8 billion this year, and expects it could potentially reach $23 billion in 2014. This would put it at a 7.8% compound annual growth rate.

The United States currently holds the largest share of this market. It was worth $8.9 billion in 2008 and has been estimated to reach about $9.5 billion this year. McWilliams predicts it could grow to $13.6 billion in 2014.

Although financing has been slowing down in the device industry, that hasn’t stopped companies from continuing on their path to develop innovative MIS technologies. This can be most recently seen in the partnerships, acquisitions, and product development in academia:

• June 2009: Ev3 Inc. (Plymouth, MN) announces the acquisition of Chestnut Medical Technologies Inc. (Menlo Park, CA) for an upfront purchase price of $75 million. In addition to its foreign body retrieval device, Chestnut Medical is conducting U.S. clinical studies of the Pipeline embolization device, which is designed to divert blood flow away from a cerebral aneurysm.
   
• May 2009: Columbia University Science & Technology Ventures and EndoRobotics Inc. (both New York City) enter into a licensing agreement to develop and commercialize a robotic imaging and surgical device platform for MIS procedures.
   
• April 2009: Encision Inc. (Boulder, CO) and Intuitive Surgical Inc. (Sunnyvale, CA). Encision, a manufacturer of active electrode monitoring (AEM) surgical instruments for MIS, entered into an agreement with Intuitive to use its AEM technology with Intuitive’s da Vinci Surgical Systems. According to Encision’s president and CEO, Jack Serino, the deal expands the company’s technology into the rapidly growing laparoscopic robotic surgical market.
   
• April 2009: Covidien (Mansfield, MA) launches the first device indicated for multiple instrument access to the abdomen via one incision. The SILS Port has the capacity for up to three laparoscopic instruments and results in one scar versus the multiple scars that result from conventional laparoscopy.
   

Conclusion

As patient demand increases and more surgeons opt for the benefits of MIS, manufacturers will need to further develop the surgical tools necessary to facilitate the growth of this market. It has the opportunity for tremendous growth, from both a technological standpoint as well as from a financial perspective.