The purpose of this report is to analyze the market for Laparoscopic Devices Worldwide. Topics discussed include laparoscopic procedures, product definitions, types of equipment, applications, market trends, business strategies, competition, and key players, epidemiology, disease and treatment trends and technology trends. The report provides detailed market estimates and forecasts for Laparoscopic devices in U.S. dollars.
Product/Market Segment Analysis and Forecasts by Region (2007-2015)
Market estimates and forecasts for Laparocopy Devices by country/region (US $, 2007– 2015) for:USA; Europe; Japan; and Rest of the World (ROW).
Detailed market forecasts (US $) for:
Access Devices
Direct Energy Devices
Probes
Generators
Female Sterilization Devices
Gastric Banding
Hand Instruments
Insufflators
Internal Closure devices
Clip Appliers
Endolinear Staplers
Endostaplers
Endosuturing Devices
Laparoscopes
Rod Lens
Video
Reprocessed Laparoscopic Devices
Suction Irrigation Devices
This report can help in
Assessing the market for Laparoscopic Devices, growth segments, and growth regions.
Understanding market drivers and restraints.
Business planning, strategic decision making and competitive strategy.
Identifying opportunities for partnerships and alliances.
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MARKET SUMMARY
The world market for Laparoscopy devices is expected to reach $2.8 billion by the end of 2009, growing at a rate of 8.9 percent per year during the 2007-2015 period.
Laparoscopy is endoscopy performed on organs of the abdominal cavity. It is a minimally invasive surgical technique where the surgeon inserts a lighted viewing instrument called a laparoscope through a small incision, about 1cm wide. Laparoscopy facilitates direct visualization of abdominal organs including ovaries, fallopian tubes and uterus as well as the bowel and kidneys. A built-in micro camera projects a magnified real time image on a TV monitor, allowing the surgeon to see surrounding tissues. Both diagnostic and surgical procedures can be done laparoscopically. Laparoscopic surgery may be as simple as occluding fallopian tubes or as complex as organ removal.
The Laparoscopic devices universe includes the following products: Access Devices; Direct Energy Devices (Probes, Generators); Female Sterilization Devices; Gastric Banding; Hand Instruments; Insufflators; Internal Closure devices (Clip Appliers, Endolinear Staplers, Endostaplers, Endosuturing Devices); Laparoscopes (Rod Lens, Video; Reprocessed Laparoscopic Devices; and Suction Irrigation Devices.
Leading providers of laparoscopic devices are Aesculap, Covidien (Autosuture, Valleylab), Cardinal Health, Ethicon and Gyrus ACMI/ Olympus.
Female sterilization is the smallest segment of the laparoscopy devices market (1 percent) since this is a very specific procedure. Internal closure devices account for the largest share of the market (34 percent) due to ubiquitous use of these devices in all laparoscopic procedures. Other significantly large markets are direct energy devices and access devices.
Instruments used in all or many laparoscopic procedures include internal closure devices, access devices, direct energy devices and hand instruments. Market share of these segments is influenced by Average Sale Price (ASP) and volume of procedures, which is directly correlated to instrument usability (single use or multiple uses). Apart from closure devices, all others above may be disposable, reusable or reposable. Although closure devices do not necessarily have the highest ASPs, volume of usage and the fact that they can only be used once, makes them the largest segment.
The total U.S. market for Direct Energy Devices is expected to cross $500 million in 2009. Advances in technology, targeted at increasing safety of these devices, are expected to increase their use over the forecast period. Many energy devices can be used to cut as well as coagulate/seal tissue and provide hemostasis, thereby reducing time as well as eliminating need for other more complex procedures. The US will remain the biggest market; it is estimated to have accounted for about 48 percent of the world market in 2008.
Female sterilization is the smallest segment of the laparoscopy devices market (1 percent) since this is a very specific procedure. Internal closure devices account for the largest share of the market (34 percent) due to ubiquitous use of these devices in all laparoscopic procedures. Other significantly large markets are the direct energy devices and access devices. Instruments used in all or almost all laparoscopic procedures include internal closure devices, access devices, direct energy devices and hand instruments.
Market share of these segments is influenced by Average Sale Price (ASP), volume of procedures which is directly correlated to instrument usability (single or multiple use). Apart from closure devices, all others above may be disposable, reusable or reposable. Although closure devices do not necessarily have the highest ASPs, volume of usage and the fact that they can only be used once, makes them the largest segment. Market rankings remain largely the same over the forecast period.
KEY MARKET DRIVERS
Surgeons are increasingly finding new uses for laparoscopy and replacing traditional open surgical procedures and diagnostic procedures with laparoscopy. It is estimated that up to 70% of surgical procedures can be replaced by laparoscopy or other minimally invasive procedures.
Increasing demand for minimally invasive procedures from patients
Increase in number of trained surgeons, which is aided by training programs offered by device manufacturers
Availability of hand-assist (or hand-access, HALs) devices that improve accuracy and precision of laparoscopic procedures, minimize injury to peripheral organs and improve outcomes
A major trend across the world will be a rise in laparoscopic bariatric surgery as obesity rates rise the world over, including in developing countries. Increase in rates of obesity and laparoscopic weight loss procedures, in particular gastric banding which is less expensive and has lower mortality rates than laparoscopic gastric bypass. A recent study by Hinojosa, M W et al indicated that from 2004 to 2007 the number of laparoscopic adjustable gastric banding increased by 329%) and laparoscopic gastric bypass increased by 125%, with a simultaneous decrease by 73% in the number of open gastric bypass procedures.
Pediatric procedures are on the increase. It is expected that gastric banding will be used in adolescents in the future. Clinical trials indicate that the LapBand is safe and effective and has less morbidity than gastric bypass in adolescents.
Robotic systems are a major technology trend that is driving this industry. This is particularly evident in prostatectomy. Robots have improved surgical efficiency and procedural safety. Costs associated with robotic systems are expected to decrease over time and in some cases such as prostatectomy, they will be the gold standard for treatment in the future.
Increase in rates of weightloss surgery with corresponding increase in obesity rates. An estimated 150,000 laparoscopic surgeries are performed annually in the US. There is an increasing trend in these procedures for adolescents.
KEY MARKET RESTRAINTS
Laparoscopy is more expensive and time consuming. Costs of equipment and disposables, equipment maintenance, surgeon and nurse training, longer procedural time are all contributing factors.
In many specialty areas, physician training and experience is a major restraint. This is particularly the case with urology.
In some fields, such as gynecology and gastrointestinal laparoscopy, rates of peripheral organ damage are high
Urological procedures are more complex and there is no clear evidence for improved treatment outcomes with laparoscopy over open surgery
Female sterilization which is one of the most frequent laparoscopic procedures is likely to be replaced by less invasive procedures such as transcervical procedures.
Reimbursement often falls short of procedural costs. Medicare reimbursement caps in the face of longer procedural time and complexity lead to fewer laparoscopic procedures.
LAPAROSCOPY APPLICATIONS
Laparoscopic surgery is an established procedure in gynecology and gastroenterology. Other specialty areas such as urology and nephrology are increasingly gaining popularity. Applications may be diagnostic or surgical.
Diagnostic Laparoscopy is done to examine various abdominal organs. It is commonly used for the female reproductive system, the most common indications being abdominal or pelvic pain. Other uses include examination of the bowel, appendix, liver and gall bladder.
Disorders most frequently diagnosed laparoscopically are:
Endometriosis
Pelvic inflammatory disease
Ectopic pregnancy
Ovarian cysts
Appendicitis
Surgical laparoscopy is used for a wide range of procedures from biopsies to organ removal, female sterilization, weight-loss surgery, cancer treatment, etc. This is a well established procedure for:
Cholecystectomy
Appendectomy
Hysterectomy
Female sterilization
Prostatectomy
Mini-laparoscopy is a relatively recent procedure and uses smaller incisions, ranging between 2-3 mm diameters. It is not useful for many procedures although it inflicts fewer traumas. The procedure is only suitable for patients with certain characteristics such as a thin cavity wall, few adhesions, minimal inflammation, etc., since the instruments are smaller and more fragile with weak suction-irrigation and poorer video quality. However, instruments used for mini-laparoscopic procedures are generally more expensive and fragile. The instruments are also more expensive than other laparoscopic instruments.
TECHNOLOGY TRENDS
Technological advances that have been revolutionizing the laparoscopy field include:
Active Electrode Monitoring (AEM) from Encision Inc. that allows constant monitoring of power devices to prevent risk of stray burn injury.
Hand-assist devices, e.g. the Hand Port from Smith & Nephew and Gelport Hand Access Device from Applied Medical Inc., give the surgeon a sense of touch and a visual advantage thereby providing more control than traditional laparoscopic surgery.
Robotic systems are a major technology trend that is driving this industry. This is particularly evident in prostatectomy. Robots have improved surgical efficiency and procedural safety. Costs associated with robotic systems are expected to decrease over time and in some cases such as prostatectomy, they will be the gold standard for treatment in the future.
Other new devices include the following:
The Rebound HRD device from Minnesota Medical Development, Inc., designed to assist in the repair and/or reinforcement of hernia or other soft tissue defects with weaknesses. For these situations it is preferable to use the support of a non-absorbable material.
Endo Grab™ from Virtual Ports Ltd. is a device for withdrawing internal organs and securing them firmly to the internal abdominal wall during laparoscopic procedures.
The Ternamian ENDOTIP™ from Karl Storz is a second generation Visual Port System. It allows optically controllable access to the abdominal cavity and when used with the HOPKINS® II telescope, the surgeon can see and identify the different tissue layers.
The Single-Incision Laparoscopic Surgery (SILS(TM)) Kit from Covidien. The SILS(TM) Kit contains laparoscopic devices that can be inserted through the umbilicus. This was developed through research aimed at a new surgical procedure called Natural Orifice Transluminal Endoscopic Surgery (NOTES).
The drive for increasingly minimally invasive technologies is also leading to new technologies that threaten to replace established laparoscopic procedures. For example the Adiana Transcervical Sterilization System developed recently by Hologic, Inc., is a new minimally invasive device that presents an alternative to the highly popular laparoscopic occlusion techniques. The procedure is done either transvaginally or transcervically and therefore does not need any incisions.
COMPETITIVE ACTIVITY
Competitors in the laparoscopy worldwide include the following:
A Henniss, Ackermann Instrumente GmbH,, Advanced Endoscopy Devices Inc., Aesculap USA, Almedic, Allergan, Inc., Anton Hipp GmbH, Applied Medical, Aragon, BK Surgical Ultrasound, Bovie Medical Corporation, BuffaloFilter, Bauer und Haeselbarth-Chirurg GmbH, Biomed Importers Pvt Ltd., Boston Scientific Corp., Blueendo, Bryan Corp., C. R. Bard, Inc., Cambridge, Canada Endoscope Corp., Cardinal Health Medical Products & Services Group, Carl Zeiss Meditec, Civco, COMEG Endoskopie GmbH & Co KG, Contec Medical Ltd., Cooper Surgical Inc., CorTek Endoscopy Inc., Cory Brothers Ltd., Covidien/ Autosuture, Dufner Instrumente GmbH, EFER, Eisenhut Instrumente GmbH , Chirurgie-und Dentalinstrumente, Shenyang Shenda Endoscope Co Ltd., Elmed, Inc., Endoscopy Support Services Inc., Elektromedizin GmbH, Ethicon Endosurgery, Fiegert-Endotech Medizintechnik GmbH, Fujinon Endoscopic Systems, Geister Medizintechnik GmbH, GENICON, GIMMI GmbH, Gyrus ACMI Inc., Hans Hermann GmbH, Hayden Medical, Inc., Henke-Sass Wolf GmbH, Hi-TEC Medical GmbH, Immersion Medical, Innovamed, Intuitive Surgical, KARL STORZ GmbH & Co. KG, Karl-Heinz , Hinze Optoengineering GmbH & Co, Kencap Ltd., KS Instrumente Karl Schad, Labotect Labor-Technik-Goettingen GmbH, Lawton GmbH & Co KG, Medizintechnik, LEXION Medical, LLC., Lumenis Ltd., MAHE International Inc., Marina Medical Instruments, Inc., Medical Innovations, Medical Optics, Medicon eG, MediVision Inc., Microline PENTAX, Novare, Olympus Medical Systems Group, PAJUNK GmbH, Palex Medical SA, Patton Surgical, Pilling Weck Canada LP, Plasma Surgical Ltd., Precision Optics Corporation, Prosurgics, Inc., Proxy Biomedical Ltd., Qiao-Wei Medical Instruments Co Ltd., REMA Medizintechnik GmbH, Richard Wolf GmbH, Schoelly Fiberoptic GmbH, Shanghai Medical Instruments Co Ltd., Simulab Corp., Smith & Nephew Endoscopy, SOLOS Endoscopy, Inc., Starion Instruments, SterilMed, Southmedic Inc., Stryker Corp., Surgical Science, SurgRX, Inc., TAUT Inc., Tekno-Medical Optik Chirurgie GmbH & Co KG, Trendlines Group, Trokamed GmbH, Valleylab, Virtual Ports Ltd., WISAP GmbH, Viking Systems Inc., W. L. Gore & Associates, Inc., XION Medical GmbH