Probing new openings in surgical equipment market - Silicon Valley / San Jose Business Journal:

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With a mere half dozen such procedures as yet performe inthe U.S., few others have had the Not for long, says chief of gastroenterology and hepatology at Stanford University, who predictsx that the technique -- knownn simply as NOTES, for natural orificer transluminal endoscopic surgery -- is about to revolutionize surgergy so dramatically "we will never be the same In doing so, it promisesa to be a huge bonanza for medical device companies, necessitatinbg an entirely new set of surgicao tools and instruments.
"We are stilk not quite sure where it will go and how it will get there but it has changed the way we thinkl aboutgastrointestinal diseases," says Pasricha, who has been at the forefron of the NOTES revolution ever sincse the idea was put fortu at a 1998 retreat, sponsored by the , of sevenj gastroenterologists. Now, nobody wantds to be left behind. Large from the in Michigan to in are scrambling to develop researchh and identifypossible acquisitions. Insiderz say the real activity is coming from small devic e companies like ofSan Clemente; of Tex.
(the company founded by the originalseven gastroenterologists); of Sunnyvalre (manufacturer of the da Vincik robotic surgical system); and of San It's still so new that several are reluctantg to discuss their activity in the But a couple of Silicon Valley companies are commercially launched, includinyg , which just opened a sales and marketing office in Redwood City. Neither of its two products is "pure in the academic sense of the acknowledges CEOThiery Thaure, who calls his company's technology "thde first rational step towards It includes two products -- one aimede at gastroesophageal reflux disease (GERD), the other at obesity.
In each one, toolsx are maneuvered down the through the esophagus and into the stomach in ordefr to reconstruct a natura valve orrestrictive pouch. The obesityu procedure permits a surgeon to perforjma "bariatric redo," a difficult four to six-hour operation, in a matter of 15 or 20 Bariatric redos take place on the failed heelzs of gastric bypass the now widely popular procedure to physically shrink the stomach of obesee patients.
Gastric bypass is most often accomplished witha $40,009 Roux-en-Y, which creates a smalkl pouch and allows food to bypass part of the small "There are approximately 1 million Roux-en-Y procedures and we estimatee that 30 percent of them will fail in the firsft five years," says Thaure. "It's a very fragild group of patients, mostly binge eaters who in timewill re-stretcg their pouches out. Our procedure givea them a second chance." And, if necessary, a thired or fourth. The redo costs aboutf $10,000. Over in Cupertino, meanwhile, takez its own hybrid approachto NOTES, developing tools intendedx for use through a single port.
The company began selling its productslast September. "We do it through the bellty button and then hide the scar inside thebell button," explains CEO Kerry Pope. "Transgastric (througuh the mouth) is the most challenging. You'ver got a relatively tortuous path down the through the esophagus and intothe stomach." Historically, surgeons have balkedr at transgressing the stomach, the thinking being that contamination of the abdomina l cavity is a recipe for disaster. Gynecologists, by contrast, have operatexd transvaginallyfor years.
In the last few it's been shown -- in pig trials and an estimated 100 humam casesworldwide - that it is, in fact, possiblde to puncture a hole in the operate, and close it without infection. "If the market converts to it," says "it's huge. There's 1 million gallbladders removed every Nephrectomy (kidney removal), appendix: thro them all together and that's a lot of If successful, medical innovators predict the techniquew could make laparoscopic surgery obsolete - just as 20 years ago or minimally invasive, surgery made open surgery a thing of the