Modern thoracic surgery has really evolved since its beginnings in the early 20th century. You can imagine with the technology that has been introduced over that period of time, that has helped spur on the evolution of thoracic surgery from limited open procedures to minimally invasive surgery…and now to today’s more advanced and complex procedures.
That evolution has largely been driven by improvements and miniaturization of surgical instruments and cameras, which make it possible for progressively more complex surgeries to be performed minimally invasively.
Without a doubt, one of the most significant developments in thoracic surgery was the advent of video-assisted thoracoscopic surgery or VATS in the 1990s.
VATS generally requires two to four small incisions or ports which allow the surgeon to insert specially designed endoscopic devices to remove diseased tissue, fluid drainage, and repair damaged areas.
A small video camera, called a thoracoscope, is also inserted into a port, allowing the surgeon to view the procedure on a video monitor and magnify the image of the surgical target.
With VATS procedures, the ribs are not spread, which means less trauma to the nerves under the ribs and less pain for patients.
Patients with early stage lung cancers and small tumors are the best candidates for VATS. The use of VATS continues to grow, but currently most lobectomies are still performed by way of a thoracotomy, which is an open (not minimally invasive) procedure.
It’s important to note that today, surgery is considered the only curative treatment for early-stage lung cancer patients.
How many thoracic surgical procedures are now minimally invasive and what impact is this having on the thoracic community?
It’s about a 40/60 split between minimally invasive versus open procedures.
According to a 2013 study, based on the Society of Thoracic Surgeons Database between 2000 and 2010, of the 12,290 patients who had a lobectomy, 8,439 were thoracotomies, and 4,531 were VATS – or approximately 37 percent.
VATS is having a tremendous impact on the thoracic community. It may offer patients shorter hospitalization, less pain and earlier mobilization-- as I mentioned before due to not having to spread the ribs-- lower overall morbidity, and a quicker recovery than thoracotomy, while effectively treating the problem. VATS has quickly become standard practice for many surgeons and we expect continued growth in this area.
These procedural evolutions, and our surgeons’ preferred techniques, continue to shape and influence the innovation we bring to market. And, we always have one eye on the horizon to anticipate where thoracic procedures may continue to evolve, potentially through new approaches such as tissue sparing and single port procedures among others.
We’re excited to introduce future innovations that will help our customers around the world advance treatment through evidence-based solutions. It’s an important responsibility, and one that we don’t take lightly.
Could you please outline the new powered vascular stapler that has been developed by Ethicon?
Ethicon recently developed the new ECHELON FLEX™ Powered Vascular Stapler that is really focused on two things: precision and stability.
It’s the smallest, narrowest anvil on the market today and it’s designed to provide greater precision and stability than any other stapler in the market1, for those critical vessel transections that thoracic surgeons have told us are the most stressful point in the procedure.
We designed the Powered Vascular Stapler to have the narrowest anvil (versus competitors) with an articulating shaft and advanced placement tip to help provide better visibility, navigation and precise placement during thoracic procedures, including VATS for lung cancer.
This powered stapler represents a significant advance that may help surgeons avoid potential complications and improve patient outcomes.
What input did you have from thoracic surgeons when developing this product?
As with all our new product introductions, we always begin from a place of deep surgeon understanding and insight. Some of the ways in which we do this is through hands-on lab training, early prototype sharing, and ethnographic research. We know that a stapler designed for gastric applications is considerably different than for vascular transections.
The Powered Vascular Stapler was defined by an iterative, interactive process of discovery that utilized the input of hundreds of thoracic surgeons around the globe. This innovation centers around miniaturization, materials, and optimization for specific use in thoracic procedures.
We started with illustrations and descriptions of possible options that were evaluated by surgeons and used as the building blocks for prototypes that were further modified and perfected.
The original options were often the output of extensive research into the specific procedures, combined with efforts to understand unmet user needs by attending and documenting numerous thoracic procedures.
All these data points with customers helped influence the design of this newly introduced ECHELON FLEX Powered Vascular Stapler.
We’re really excited about the positive reaction we’ve already heard-- so early in our launch-- from customers in the US. The product will be commercial available globally beginning in April.
Why is visibility and stability particularly important in thoracic surgery?
Thoracic surgical procedures are incredibly technically challenging operations that require control and transection of very fragile blood vessels in restricted, narrow spaces.
State-of-the-art surgical devices that provide increased visibility, precision and stability are absolutely required to allow for safe dissection and transection of these critical structures.
How does the ECHELON FLEX compare to other products on the market?
The ECHELON FLEX Powered Vascular Stapler is thin, nimble and precise. It’s the narrowest anvil in the marketplace. It offers superior manoeuvrability, increased freedom of movement and more flexibility during placement.
Compared to the Endo GIATM Curved Tip Reload with Tri-StapleTM Technology from the manufacturer Covidien, the ECHELON FLEX Powered Vascular Stapler has a curved blunt anvil that is 26 percent narrower and a shaft that is 26 percent thinner, offering the greatest angle of reach in the tight intercostal space.
The new powered stapler also provides 11 percent greater manual articulation in each direction, allowing more flexibility during final placement than the competitor device. The Powered Vascular Stapler also allows for 83 percent reduction in tip movement during firing for less movement during transaction.
Our competitive advantage extends beyond the device itself to our procedural approach to thoracic surgery. We support research to further the understanding of lung cancer treatment and advance procedural approaches.
Ethicon has supported investigator studies on VATS that appeared in the journals Chest, Annals of Thoracic Surgery, Minimally Invasive Surgery and Journal of Thoracic and Cardiovascular Surgery.
In addition, we sponsor numerous training events each year around the world and we offer resources and support for patients, surgical teams and hospital administration.
In addition, last fall Johnson & Johnson announced a new Lung Cancer Innovation Center in China to develop new ways to treat lung cancer and address the unmet health needs of patients in China, where the rate of lung cancer is disproportionately high compared to the rest of the world.
What feedback have you had on the product so far and how do you plan to improve the device going forward?
The ECHELON FLEX™ Powered Vascular Stapler has had terrific reception from thoracic surgeons and is exceeding our expectations. The device is enabling surgeons to more easily place the stapler and transect difficult-to-reach, fragile pulmonary vessels, which our customers are calling a “game-changer”.
Ethicon remains committed to the thoracic specialty and the new launch of Powered Vascular Stapler is one example of our deep focus on Tissue-Specific Designed devices that help solve unmet needs in the specialty.
Across the Ethicon portfolio we’ll continue to bring new innovation to market to help fight the health burden and devastating incidence of lung cancer around the globe.
What do you think the future holds for thoracic surgery and how does Ethicon plan to add to it?
Today, we are offering a procedural solution for thoracic surgery to help surgeons improve clinical outcomes, control costs and save lives. A surgeon can use Ethicon products throughout every phase of a thoracic procedure.
In addition, to our new Powered Vascular Stapler we also recently introduced our ECHELON FLEX GST SYSTEM, which is uniquely designed to provide a better grip on tissue for less tissue slippage during firing.
These staplers are also offered along with the Harmonic ACE®+7 Shears for precision and multi-functionality in dissection, mobilization and adhesiolysis, as well as our repair and wound closure products, Surgicel SNoW®, Vicryl® Plus, and DERMABOND® ADVANCED Topical Skin Adhesive.
With our Johnson & Johnson Lung Cancer Innovation Center, our addition of a dedicated thoracic Medical Director in-house, and our very recent (March 27) announcement of our partnership between Ethicon and Google to deliver robotic solutions, we have a robust future strategy to support thoracic advancement.
Our resolve remains. Ethicon is committed to helping advance surgical care so that more patients live longer, more fulfilling lives. We are driven to develop meaningful thoracic solutions, enabling our customers to provide the treatment and positive outcomes that patients in every corner of the world deserve.
We’re working to redefine surgery to change the world for the better, and we continue to evolve to better serve our customers.
Where can readers find more information?
For more information on Ethicon and our thoracic surgery solutions visit, http://www.ethicon.com/healthcare-professionals/specialties/thoracic
About Dan Wildman
Dan Wildman is Vice President, Global Franchise Strategy & Innovation for Ethicon, a global provider of innovative surgical technologies and products (including sutures, staplers, energy devices, clip appliers, trocars, meshes and hemostasis solutions) used around the world to treat colorectal and thoracic conditions, women’s health conditions, hernias, cancer and obesity.
Ethicon is part of the Johnson & Johnson Family of Companies. Named to this position in June 2014, Dan oversees platform development across Ethicon to create meaningful innovation for customers and patients.
Dan’s new responsibilities also include Centers of Excellence for Global Health Economics & Market Access Pricing and Enterprise Brand Management to maximize focus, enable innovation and share best practices across Ethicon.
Dan is a member of the Ethicon Global Management Board and is based in Somerville, New Jersey.
Dan has held roles of increasing complexity and responsibility within the medical device industry over more than 30 years.
Most recently, Dan served as Worldwide President of Ethicon Biosurgery, a division of Ethicon, Inc. Since 2002, he led this global business dedicated to delivering innovative and life-saving solutions to surgeons with a commitment to advancing the future of biosurgery beyond hemostasis.
In this role, Dan was responsible for the Ethicon Biosurgery portfolio and for Guangzhou Bioseal Biotech Co., Ltd. based in China, a stand-alone company that manufactures products within the Ethicon Biosurgery portfolio. Dan led his team in achieving double-digit revenue and earnings growth.
Prior to leading Ethicon Biosurgery, Dan was Vice President, Marketing and Product Development for Codman, a DePuy operating company within Johnson & Johnson. There he produced record results on a consistent basis.
Dan began his career in 1981 with Johnson & Johnson as a sales representative in the Patient Care Division of the wound management business. He progressed to roles in sales, marketing and product development with both domestic and global responsibilities for companies such as Collagen Corporation, SCIMED Life Systems and Boston Scientific. He returned to his Johnson & Johnson roots in 2001 when he joined Codman.
Dan is an accomplished global leader. Throughout his career, he has earned a solid reputation for his strategic vision, ability to execute and his commitment to people development and the Johnson & Johnson Credo.
Dan received a Bachelor of Arts degree in Economics from St. Lawrence University in New York.
1 Benchtop testing on porcine stomach tissue. Surgeons (n=19) fired each instrument/ reload once: PSE60A/ ECR60G, 030449/ 030459, and EGIAUSTND/ EGIA60AMT. Distal tip motion measurement during the firing cycle showed a median of 88% and a range of reduction of 71% to 95% in tip movement of PSE60A/ ECR60G vs. the other two devices.
2 Benchtop testing in porcine stomach tissue. Mean tissue movement from after clamping on tissue to after firing ECHELON FLEX Powered Plus Stapler (PSEE60A) and ECHELON Reload with GST vs ENDO GIA™ ULTRA Handle (EGIAUSTND) and Endo GIA™ Reload with Tri-Staple™ Technology at 1.5, 2.5, 3.3 and 4.0mm tissue thicknesses (1.5mm; GST60B 1.067mm vs EGIA60AMT 2.452mm p<0.001; 2.5mm: GST60G 1.148mm vs EGIA60AMT 3.261mm p<0.001; 3.3mm: GST60T 0.642mm vs EGIA60AMT 4.806mm p<0.001; 4.0mm: GST60T 0.654mm vs EGIA60AXT 5.116mm p<0.001).
Comparing perioperative differences: Sleeve gastrectomy vs. Roux-en-Y gastric bypass