Xi Chen Analyst Decision Resources GroupThe windy city lived up to its nickname; the conference, in conjunction with the Chicago Marathon, saw the city well loaded with visitors. If I were to use one word to describe the event, it would be "green"—the city was overloaded with it. In addition to the beautiful park right across the street from my hotel, the very first poster that greeted me when I walked up to the McCormick Place concourse was green. Then I was greeted by a polite lady who handed me the daily newsletter, the back cover of which was, again, green. She was there every single day, and so was the green of the newsletter back cover. The green was, in fact, CR Bard green, as part of a massive advertising campaign by Bard for their hernia mesh and tacks. Unsurprisingly, the Bard booth at the exhibits was a big hit, perhaps second only to the ever so popular Da Vinci robots; however, Bard's attraction was simpler: free smoothies.

Hernia repair was definitely one the biggest topics this year at the ACSCC. There were heated discussions at multiple seminars over the use of different meshes and techniques, and ways to prevent post-surgical complications. Synthetic versus biologic and laparoscopy versus laparotomy were among the topics of debate; doctors seemed to have arrived at a consensus that large pore meshes are the way to go. Bariatrics, GERD, and breast cancer were among the other hot topics at this conference. I was particularly fascinated by the myriad of alternative therapies—Stretta, Esophyx, MUSE, and EndoStim—introduced to treat GERD endoscopically. Among which, Stretta and Esophyx are gaining traction in clinical use. The gold standard of laparoscopic fundopilication is definitely being challenged. Despite the overwhelming influx of therapy knowledge, I came home with a couple of rather unexpected insights.

Global surgery has arrived: a new market?

I have always been a fan of The Lancet. Their studies on the global distribution of operating rooms and access to surgical care have greatly helped the work I do here at DRG. At ACSCC this year, the Lancet commission on Global Surgery (LCoGS) panel session made a big hit, with packed seats and plenty of standing listeners. I am glad that global surgery is no longer a niche interest and making an impact on the grand stage. I am very eager to see where it will go from here. I am in full support of their cause to eliminate disparities in surgical care between developed and developing countries. I can also see how the medical device industry can participate in and benefit from this agenda. The industry can definitely play a role in empowering health care centers in these developing countries, not just by supplying the devices themselves, but also constructing the supply chain infrastructure, provide training, and developing local industries. I think that the industry should not shy away from the lack of immediate profit in the global surgery market. One cannot make a profit without first making an investment. The market has potential, but needs to be first developed to sustain a medical device industry. This actually also reminds me of TOMS shoes' "One for One" business model, which they will donate a pair of shoes to a child in need for every shoe they sell. Perhaps device companies can do something like that as well. If I were a medical device customer, it would definitely make me feel better about buying a product if I know I am also aiding a charitable cause while doing so. Wouldn't that be a good way for device companies to gain market share?

Physician injury is a real issue:  do not neglect ergonomics.

Ergonomics is now basic science! Increases in procedure volumes have driven surgeons to work harder, and in doing so they are paying a huge price in their own physical wellbeing. Injury and fatigue are real concerns among doctors; in fact, burnouts affect 40% of active surgeons. Bad ergonomics not only put doctors at risk, but also the patients being operated on. This was what I gathered from a talk called "Functional Ergonomics for Surgeons: Protect your Neck & your Career". Medical devices have traditionally focused on patient outcome and operational effectiveness, perhaps it is time to pay attention to ergonomics? Those were my first thoughts coming out of the seminar. Actually, device manufacturers needed no introduction to ergonomics. Thinking back, the phrase "with new and improved ergonomic handles" had appeared quite frequently in recent product launches. While perusing through the exhibits, I noticed just that. Companies have definitely been actively redesigning their device handles. For example, Olympus recently released a new handle for THUNDERBEAT because, according to a sales rep, that doctors "didn't quite like the previous one". Medtronic/Covidien showcased their cordless Sonicision and was marketing their ability to "reduce tangling of wires". I actually had the opportunity to try out THUNDERBEAT on a piece of steak. Frankly, even with this new handle, it was quite stressful to my fingers and wrist, perhaps due to the "fulcrum effect" (having to move my hand in the opposite direction of the instrument tip). The da Vinci robot wins the ergonomics competition hands down and I had a blast operating that machine. It had adjustable controllers, seats, pedals, headrests, and no fulcrum effect. If there's anything about robotics that is better than conventional laparoscopy, it is ergonomics. Perhaps FlexDex has a different answer to that? We shall wait and see.

Follow Xi Chen on Twitter at @XChenDRG

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