Kurt Azarbarzin: That there is so many limitations associated with laparoscopy at early stages and even now. And one of those key limitations to me was access and visualization. So we focused on, holistically focused on how do we overcome these limitations. And when I say holistically, we just didn’t go after product, we went after the approach. So that’s really why we created a product platform that had all the components associated with access and visualization. So there’s an actual small video that I’m going to play next.

Video: ConMed’s AirSeal System is an access management platform that distinctively provides stable pneumoperitoneum, constant smoke evacuation, and valve free access to the surgical site. The AirSeal intelligent flow system offers three modes of operation, AirSeal mode, smoke evacuation mode, and standard insufflation mode. When used an AirSeal seal mode, the system maintains stable pneumoperitoneum by recirculating filtered CO2 through tiny pressure nozzles within the proximal AirSeal cannula to create an AirSeal pressure barrier that in general is equal in force to the patient’s intra-abdominal pressure.

AirSeal mode allows the surgeon to operate with sustainable low pressure while effectively maintaining the expected laparoscopic working space. From the simplest laparoscopy to the most complex robotic and other advanced procedures, the AirSeal access port offers significant advantages over conventional Trocars. Because conventional Trocars use a combination of seals and valves to maintain insufflation, scopes can infrequently smudge during insertion compromising visualization.

Unlike conventional Trocars, AirSeal access ports have no valves, thereby enabling unimpeded laparoscope insertion to offer clear visualization during laparoscopic surgery. Mechanical valves and conventional Trocars can fragment the specimen during removal. The AirSeal access port enables intact specimen removal, as well as unimpeded insertion of mesh sutures, needles, and clips. AirSeal mode also provides automatic and constant smoke evacuation throughout the procedure, dramatically improving visualization while maintaining stable pneumoperitoneum.

In the smoke evacuation only mode, the AirSeal IFS is attached to two conventional Trocars to offer continuous smoke evacuation while providing insufflation. In the standard insufflation mode, the AirSeal IFS efficiently provides conventional insufflation capabilities minimizing the need to have any duplicate insufflation device in the operating room. Schedule a demonstration.

Kurt Azarbarzin: So we started to launch the product and very successfully throughout the globe people were enjoying the positive aspects and they were asking questions such as, my patient’s actually feeling better, I have a more stable environment. And so the Aha moment happened when I received a call from Dr. Landman who was doing a study for us at UCI measuring the intraabdominal pressures live. And he said, “Kurt, you’ve got to look at this graph.” And basically what you’re looking at on the left is measuring the intraabdominal pressures live in standard insufflation with conventional Trocars and you see these significant spikes and drops in pressure versus the AirSeal mode where it’s very stable and it’s right at the pressured setting that you choose.

So right there is where we saw okay, the stability is key but the spike is really where patients are feeling the pressure. And we had to cut this slide up to 25 millimeters, but some of these pressure spikes went up to 40 millimeters of mercury, which is significant. Again, the positives are there is suction, you apply suction always through bleeding and when you apply a lot of suction, you lose your Pneumoperitoneum. You can see where on with AirSeal mode you don’t. And also when you have significant leaks it keeps up with any type of severe leaks. And then smoke evacuation, the same thing. I mean you could bust through and absolutely have a clear view.

So what does all this mean? For us was we saw the problem and now all these limitations that are gone should improve outcomes and that’s exactly what we started to see. Multiple studies came out and showed efficiency because you don’t have to wait for the smoke to clear. You don’t have to wait for insufflation gasses to catch up. You don’t have to deal with all these limitations. So we saw these very, very meaningful results, positive results on time with reduction and efficiency.

And then the other thing that happened was surgeons started approaching us saying, hey, this technology is so stable that I want to reduce my pressures. And so we started to look at the data on low pressures laparoscopy and there’s significant data available and surgeons in the past have tried to do this, but the issue was always longer procedure time and frequent need to increase pressure and which is not something you want to do.

So we said, look, we think we can improve that because we’re so stable. And that’s exactly what happened. Multiple studies in different specialties were published and being studied as we speak, where surgeons are doing procedures, complex and routine at significantly lower pressures, 7 millimeters of mercury is unheard of, 6 millimeters of mercury. So you’re seeing significant improvement in not only a procedural time but in shoulder pain, opiate use and things like that.

And, again, these are multiple studies that were done. This is a hernia study that was done that again showed significant improvement in all those three categories. And the latest one was a urology paper that just came out where again, a significant reduction in all these complications and this is significant numbers of patients and they were doing it at 6 millimeters of mercury.

So again, to me when you’d get rid of the limitations, the good news is that the outcomes are significantly better. So in summary, stable newer peritoneum, costs and smoke evacuation, and intact specimen removal, cleared through FDA by nine times so far, and we are the only one who’s got a thoracic indication just recently. And then obviously OR efficiency and reducing procedure time and obviously at the end patient outcome improvements where we see significant improved data.

Thank you. Our goal is to have opiate free surgery.