In the world of women's services, uterine fibroids represent the most common indication for hysterectomy procedures, accounting for 30-50% of all surgeries. These non-malignant tumors can cause abnormal bleeding, pelvic pain, and pain during menstruation. Traditionally, women experiencing symptomatic uterine fibroids undergo a hysterectomy or a surgical resection of these fibroids, known as a myomectomy procedure.
Presently, there is significant training required for traditional myomectomy procedures, which are typically long and uncomfortable for the patient as a large cervical dilation is needed (up to 1 cm). Further, some radiofrequency techniques used to remove fibroids can damage surrounding tissue.
Technology options grow to provide alternatives to traditional myomectomy
Within bariatric surgery, a relatively new procedure that has been experiencing steady adoption is sleeve gastrectomy. Previously performed as the first part of a two-step roux-en-y gastric bypass (RYGBP) or biliopancreatic diversion/duodenal switch (BPD/DS), sleeve gastrectomy is a procedure during which the surgeon resects a large portion, perhaps up to 90 percent, of the patient's stomach. The idea is to reduce the size of the stomach so that the patient will eat less.
Although sleeve gastrectomy is performed primarily as a laparoscopic procedure, some surgeons have tried it using single incision minimally invasive surgery (SIMIS) techniques or with the robot. One of the sessions at ASMBS debated the merits of each approach for sleeve gastrectomy. At the outset, about 80 percent of the audience believed that laparoscopy is the best approach for sleeve gastretomy; the rest of the group was split evenly between robotics and SIMIS. Interestingly, after debate participants presented their cases for laparoscopy, SIMIS, and robotics, the audience's opinions shifted somewhat: percentage of audience members preferring laparoscopy dropped to 60 percent. In contrast, robotics and SIMIS saw their approval rates increase and each had 20 percent of the votes.
Based on our observations, it appears that one of the key points which won SIMIS favor was the fact that the physician champion for it was able to demonstrate excellent visualization of the operating field through a video of a live SG operation. In particular, the physician pointed out that, contrary to skeptics'claims, the GE junction can be easily seen and operated on with single incision surgery. On the other hand, one of the points that the robotic surgeon highlighted is the notion that robotic surgery can improve the skills of good surgeons and is not necessarily aimed to enable poor surgical skills. He went on to discuss results from trials suggesting better revisional outcomes with the robot than laparoscopy with bariatric surgery.
For us here at Technology Insights, we came away from the session understanding that SIMIS and robotic surgery support is growing. However, we believe that laparoscopy will still be the mainstay approach for sleeve gastrectomy for the next few years, especially given the degree of varying opinions we witnessed at ASMBS and the lack of long-term data and randomized trials supporting SIMIS and robotics.
Johnson & Johnson (Cordis) announced yesterday that it plans to exit the drug-eluting stent (DES) market by retiring its Cypher Sirolimus-eluting coronary stent by the end of 2011. In addition, the company will call off development efforts for its next-generation Nevo Sirolimus-eluting stent.
Though Johnson & Johnson led the market in development of DES 10 years ago, the company has seen continual declining sales and market share over the past several years (36 percent decreased Cypher sales from last year), with simultaneous increased competition from Boston Scientific, Abbott, and Medtronic for the $4 billion worldwide DES market. To compound these difficulties, the company lost access to the Abbott delivery catheters often accompanying the Cypher stent in early 2010. As a result of halted Cypher and Nevo production, two manufacturing plants will be closed in the near future and 1,000 jobs will be eliminated from the Cordis division of the company.
Market dynamics for the increasingly challenging DES terrain will likely be significantly affected by Johnson & Johnson's exit of the business as well; while Cordis brought in $400 million in sales last year--down from their peak worldwide sales of $2.6 billion in 2006--sales for competitor Boston Scientific, who has the highest portion of their sales tied to DES, grew by nearly five percent. Given the already highly developed market for DES, Boston Scientific, Abbott, and Medtronic will continue to research and produce next-generation products in the hopes of obtaining higher prices for these devices and creating additional market share for premium stents.
Despite this setback, Johnson & Johnson notes that it sees greater opportunities to aid patients and expand their business in other areas of the CV device market, and will thus pursue development of other technologies moving forward.