It may not be trending on Twitter, but minimally invasive surgery (MIS) is one of the hottest areas in healthcare today. Since its inception in the mid-1960s, clinicians and medical technology leaders around the world have explored ways to employ MIS in a wide array of diagnostic and therapeutic procedures. Never has the need for advances in minimally invasive techniques been more important to industry and the clinical community. Healthcare reform is drivingâessentially mandating—efforts to reduce hospitalization time and re-interventions while improving patient care and clinical outcomes. Cost-reduction efforts have a trickle-down effect on medical device companies—and subsequently to their entire supply chain. The challenge is to forge a different path for accessing anatomy that was previously accomplished via open surgery procedures. This is driving the need for advances in polymer extrusion technology and other processes and components for minimally invasive devices.
Shrinking medical devices
From an end-user perspective, MIS offers huge benefits in terms of cost (procedure time), recovery (hospitalization), patient comfort (reduced trauma) and improved clinical outcomes (efficacy). Better yet, the idea isn’t limited to the vascular procedures, such as stenting and balloon angioplasty, that are most often associated with minimally invasive, catheter-based procedures.
Percutaneous coronary intervention (PCI) has come a long way since Dr. Andreas Gruentzig performed the first procedure in 1977. New PCI devices and procedural approaches surface on a regular basis and in other fields of medicine; otolaryngologists, for example, may have taken a page out of Gruentzig’s book to treat chronic sinusitis sufferers. It wasn’t long ago when patients unresponsive to drug therapy were left with no other choice than an invasive and painful procedure to treat chronic sinus infections. Modeling coronary balloon angioplasty, most ENT offices now offer balloon sinuplasty procedures, a much less invasive, painful, and costly alternative.
Similar examples abound across disciplines. What were once complex and often dangerous procedures in GI/endoscopy, laparoscopy, structural heart repair, neurology, oncology, urology and women’s health, among others, are now routinely performed using percutaneous, catheter-based, minimally invasive devices. Patients benefit from reduced trauma, less scarring and postoperative pain, and speedier recoveries. Doctors and hospitals win as well—MIS affords them the ability to better control escalating costs via more efficient procedures, reduced hospitalization times, and lower risks for secondary infections or re-interventions.
This paradigm shift in approach from open surgery to minimally invasive access would not be possible without the co-evolution of polymer extrusion technology. Advances in device design that afford improved access require delivery catheters with lower profiles, i.e. smaller outer diameters, without sacrificing real estate inside the catheter. These innovative product offerings in extruded polymer tubing let doctors and hospitals treat more patients, disease states, and challenging cases with unprecedented levels of improved safety and efficacy.
A leap forward for traditional interventions
Minimally invasive techniques are being used in almost every anatomical area from head to toe. New successes are being announced on a regular basis. A recent study out of Ireland, reported in the March 25 online edition of JAMA Surgery, found that patients who underwent laparoscopic colon resections greatly benefitted from MIS when compared to patients who underwent traditional open surgery. The MIS procedure reduced patients’ hospital stays by almost three days (4.5 versus 7.4) and recorded a 23% cost-of-care reduction ($24,196 versus $31,601). Perhaps most significant in the findings—although the most difficult to quantify—are the implications for improved patient care. According to lead author Dr. Conor Delaney of University Hospitals Case Medical Center in Cleveland, MIS enables “faster recovery, less pain, and fewer complications.”
Although not cited in the study, other clinical benefits for MIS procedures will almost always include reduced incidence of hospital-associated infection (HAI)— also known as nosocomial infection—because of minimized hospitalization time.
The next generation of MIS—Bioabsorbables
Attend almost any endovascular conference and it will become immediately apparent that the bioabsorbable revolution is upon us. Bioabsorbable polymers, namely polylactic acid or PLA and polyglycolic acid or PGA, have been used for decades in areas including orthopedics and closure devices. More recently, these materials have been used in increasingly sophisticated applications such as coronary scaffolds and tissue engineering. With customized absorption profiles, these extruded polymers perform their prescribed function for a pre-determined period, after which they are safely absorbed and excreted by the body. Fully absorbable coronary scaffolds â which start out as highly customized, finely tuned extruded tubing âare already on the market with refinements and new advances forthcoming.
The benefits of these next-generation extruded polymer offerings are of paramount importance. When combined with minimally invasive procedures, bioabsorbable technology represents perhaps the greatest stride in medical device innovation witnessed in years.
Bioabsorbable polymers such as Zeus’ Absorv are capable of safely existing in the body for controlled lengths of time before absorbing without harm or adverse interactions.
Advances in polymer science and extrusion technology directly correlate to the evolution from surgical-based intervention to minimally invasive approaches and associated medical device design. The goal of reducing procedure and hospitalization times, and patient trauma, while improving outcomes has created a dependency on polymer and extrusion science to keep pace with clinical demands. Whether it’s the laparoscopic repair of a ventral hernia or the placement of a bioabsorbable scaffold to treat coronary artery disease, polymer tubing suppliers are harnessing their ingenuity to constantly remain at the forefront of emerging technology. In doing so, they are helping change the landscape around minimally invasive surgery.
