Minimally invasive surgery is performed without making a major incision or opening, resulting in fewer traumas for the patient and yielding significant cost savings.  These are results of shorter hospitalization times and reduced therapy requirements.  Other benefits of minimally invasive surgery are less pain, less need for postsurgical pain medication, less scarring, and less likelihood of complications related to the incision.

Thus, minimally invasive surgery is defined either as based on the operative procedure (e.g., small incisions) or the outcome (reduced surgical complications or costs).  However, minimally invasive is not the same as minor surgery.  Some “minimally invasive” procedures, (e.g., coronary artery bypass surgery), are still major operations requiring a hospital stay.

In minimally invasive surgery, a miniature camera is introduced into the body through a small incision.  It transmits images to a video monitor, enabling the physician to diagnose and, if necessary, treat a variety of conditions.  To do this, the physician inserts surgical instruments and auxiliary devices, such as irrigation and drainage devices, through one or more small incisions.

Minimally invasive procedures share some important characteristics with minimally invasive surgery, but should not be confused with either ambulatory (“walk-in”) or noninvasive surgery.

MINIMALLY INVASIVE SURGERY VS. AMBULATORY SURGERY

Some types of minimally invasive surgery can be performed in an ambulatory (nonhospital) setting, but minimally invasive surgery is not necessarily identical with ambulatory surgery.  Attempts to delineate minimally invasive surgery from ambulatory surgery, on the basis of incision size or use of an endoscope or other device to look inside the patient’s body, run into too many exceptions to be very useful.

Perhaps the best way to distinguish minimally invasive surgery from other types of ambulatory surgery is to define it as surgery that if performed using conventional open-incision techniques, requires hospital admission.  This definition excludes such minor surgical procedures as vasectomies.  These almost never are performed separately in a hospital setting.

MINIMALLY INVASIVE SURGERY VS. NONINVASIVE SURGERY

In a sense, the ultimate minimally invasive surgery does not require any incision or physical entry into the patient’s body.  Examples include the use of ultrasound to break up gallstones and radiation to shrink or kill tumors.  For purposes of this report, only those surgical procedures that involve physical access to the body through an incision or a natural orifice are considered minimally invasive surgery.

STUDY BACKGROUND

A growing number of surgical procedures are carried out using minimally invasive techniques.  This has created a multibillion-dollar market for specialized devices and instruments used for these procedures.  They include monitors and imaging equipment, electrosurgical devices, handheld instruments, auxiliary devices, and accessories.

Because the use of these products is increasing so rapidly, there is a pressing need to develop an up-to-date base of market information to better understand the dynamics of the market for minimally invasive surgical devices and instruments.  More than two years have passed since analysts published the previous edition of this study.  It analyzed key growth areas and developed quantitative market projections.

Since then, the market has continued to evolve.  The population served by established markets is aging, bringing new surgical needs, while new markets are opening up.  Technological advances have expanded the range of surgical procedures that can be performed using minimally invasive techniques, while giving physicians new tools for the diagnosis and treatment of injuries and pathologies.

Meanwhile, the structure of the healthcare industry is changing, as traditional hospitals consolidate and other healthcare options become available to consumers.  This study attempts to give management readers the information and analysis they need to deal with these challenges.

STUDY GOALS AND OBJECTIVES

This study meets these needs by analyzing global markets for minimally invasive surgical devices and instruments in light of the most recent available information.  In addition to looking at current and future markets, the study will analyze technological, demographic, and economic developments that may have a long-term impact on the size and structure of the market for minimally invasive devices and instruments.

This report also provides an analysis of the market for minimally invasive devices and instruments by type of surgical procedure, device, end user, and region.  The future of minimally invasive surgical equipment also will be discussed, with forecasts for consumption of specific products.

More specific objectives are to:

• Identify and segment the main types of minimally invasive devices and instruments that have been commercialized to date.
• Analyze the historical and current volume and value of shipments of each of these product segments in specified end user and geographic markets.
• Identify and evaluate the impact of demographic, economic, and other factors that will drive future demand for minimally invasive devices.
• Forecast the volume and value of shipments of the product segments by the probabilities that future demand will be higher or lower than the baseline forecast.
• Identify promising new surgical procedures and products still in the development and testing stage, and assess the probability that they will be commercialized successfully in the next five years.
• Forecast the potential market for these developmental procedures and products, taking into account the estimated probability that they will be commercialized.
• Identify leading device manufacturers and analyze the structure of the minimally invasive surgical devices industry (e.g., market shares, concentration, and recent M&A activity).
• Assess the long-term outlook for minimally invasive surgical devices, taking into account market opportunities, as well as technological, financial, and economic factors.

INTENDED AUDIENCE

The report has been written for the minimally invasive surgical interest community, but it is especially tailored for readers with an interest in the marketing and management dimensions of minimally invasive surgical (MIS) devices and instruments.  This especially includes readers in:

• The medical and surgical devices industry
• Medical research institutions
• The investment community
• The financial and analyst community

SCOPE AND FORMAT OF REPORT

This report is an analytical business tool whose primary purpose is to describe the minimally invasive surgical devices industry and the U.S. market for these devices.  The scope of the study does not include:

• Devices and instruments used exclusively for traditional open surgical procedures (e.g., heart-lung machines)
• Devices and equipment used exclusively in an ambulatory surgery setting
• Equipment for nonsurgical types of therapy such as radiation therapy

The format of the study is organized around the following topics:

• Major types and applications of minimally invasive surgical devices and instruments
• Industry structure
• Market size and segmentation, including historical data on sales by application, product type, end-user group, and geographical market
• Market drivers
• Detailed market projections through 2016
• Competition and market shares
• bservations and conclusions regarding the future of minimally invasive surgical devices and instruments

METHODOLOGY AND INFORMATION SOURCES

Both primary and secondary research methodologies were used in preparing this study. Findings and conclusions are based on information gathered from manufacturers and users of minimally invasive surgical devices, as well as other informed sources.  Interview data were combined with information gathered from an extensive review of secondary sources, such as trade publications, trade associations, company literature, and online databases to produce the market estimates contained in this report.

The base year for analysis and projection is 2010.  With 2010 as a baseline, market projections were developed for 2011 to 2016.  These projections are based on a consensus of primary contacts combined with analysts' understanding of the key market drivers and their impact from a historical and analytical perspective.  The analytical methodologies used to generate the market estimates are described in detail in the section on Detailed Market Projections.

All dollar projections presented in this report are in 2010 constant dollars.

Highlights of the Report

• The global market for MIS devices and instruments was worth an estimated $13.4 billion in 2010.  The market is expected to reach $14.4 billion in 2011 and $21.1 billion by 2016, a compound annual growth rate (CAGR) of 7.9% between 2011 and 2016.
• Cardiothoracic surgery was the largest application segment for MIS devices and equipment in 2010, representing 68% of the total market.
• Orthopedic surgery is the fastest growing application segment, with a CAGR of 11.2% between 2011 and 2016, followed by cardiothoracic surgery (8%) and vascular surgery (7.8%).

TABLE OF CONTENTS

CHAPTER ONE: INTRODUCTION  
MINIMALLY INVASIVE SURGERY  1
MINIMALLY INVASIVE SURGERY VS. AMBULATORY
SURGERY . 1
MINIMALLY INVASIVE SURGERY VS. NONINVASIVE
SURGERY . 2
STUDY BACKGROUND  2
STUDY GOALS AND OBJECTIVES . 3
INTENDED AUDIENCE  4
SCOPE AND FORMAT OF REPORT  4
METHODOLOGY AND INFORMATION SOURCES . 4
ANALYST CREDENTIALS  5
RELATED BCC RESEARCH STUDIES . 5
BCC ONLINE SERVICES  6
DISCLAIMER . 7

CHAPTER TWO: EXECUTIVE SUMMARY
SUMMARY TABLE GLOBAL MARKET FOR MIS DEVICES AND
EQUIPMENT, THROUGH 2016 ($ BILLIONS)  8
SUMMARY FIGURE GLOBAL MARKET FOR MIS DEVICES AND
EQUIPMENT, 2010-2016 ($ BILLIONS) . 8
EXECUTIVE SUMMARY (CONTINUED)  9

CHAPTER THREE: OVERVIEW OF MINIMALLY INVASIVE SURGICAL DEVICES AND INSTRUMENTS
GENERAL DESCRIPTION  10
HISTORY OF MINIMALLY INVASIVE SURGERY  10
ENDOSCOPY . 11
INSUFFLATION  12
SPECIALIZED SURGICAL INSTRUMENTS  13
MINIMALLY INVASIVE SURGICAL PROCEDURES . 14
SURGICAL ROBOTICS . 15
MEDICAL LASERS . 15
SURGICAL TRENDS AND THE GROWING IMPORTANCE OF
MINIMALLY INVASIVE SURGERY . 16
FIGURE 1 MIS PROCEDURES AS A PERCENT OF ALL SURGICAL
PROCEDURES PERFORMED IN THE U.S., 2010 (%)  17
FIGURE 2 MIS PROCEDURES AS A PERCENTAGE OF SELECTED
TYPES OF SURGICAL MEASURES IN THE U.S., 2010. 18
PRINCIPAL APPLICATIONS OF MINIMALLY INVASIVE
SURGERY  19
FIGURE 3 SURGICAL PROCEDURES PERFORMED IN THE U.S.
USING ALL MIS APPROACHES, 2010 (% OF ALL MIS
PROCEDURES) . 20
FIGURE 3 (CONTINUED) . 21
TABLE 1 SURGICAL PROCEDURES COMMONLY PERFORMED IN
THE U.S. USING A MINIMALLY INVASIVE APPROACH, 2010 . 21
TABLE 1 (CONTINUED)  22
GASTROINTESTINAL SURGERY . 23
Gallbladder Removal (Cholecystectomy)  23
Nissen Fundoplication . 24
Adhesiolysis (Removal of Abdominal Scar Tissue)  24
Appendectomy  25
Gastric Bypass . 25
Colon Resection  26
Hernia Repair  26
GYNECOLOGY  27
Hysterectomies  27
Myomectomy  28
Endometrial Ablation  29
Pelvic Floor Reconstruction . 29
Adnexectomy (Removal of Adnexal Structures) . 30
UROLOGY  30
Nephrectomy  31
Cystocele/Rectocele Repair  32
Pediatric Urology . 32
Adrenalectomy . 33
Radical Prostatectomy . 34
COSMETIC SURGERY 35
Breast Augmentation  35
Face and Forehead Lifts  35
THORACIC SURGERY  36
Lung Biopsies . 36
Lung Resection  37
Endoscopic Thoracic Sympathectomy . 37
CARDIOTHORACIC SURGERY . 38
ANGIOPLASTY AND OTHER CATHETERIZATION TYPES  38
Coronary Artery Bypass  39
Heart Valve Repair and Replacement  40
Congenital Heart Defect Surgery . 40
NONCARDIAC VASCULAR SURGERY  40
Saphenous Vein Harvest . 41
Peripheral Vascular Bypass  41
Aortoiliofemoral Bypass  42
Abdominal Aortic Aneurism Repair  42
Lower Extremity Angioplasty . 42
ORTHOPEDIC SURGERY  43
Joint Surgery . 43
Arthroscopic Surgery  43
Arthroplasty  44
Damaged or Diseased Spinal Disk Surgery . 44
Microendoscopic Diskectomy  44
Intradiscal Electrothermal Annuloplasty  45
Vertebroplasty and Kyphoplasty  45
PRODUCT TYPES  46
MONITORING/VISUALIZATION EQUIPMENT  46
TABLE 2 PRINCIPAL TYPES OF MONITORING/VISUALIZATION
EQUIPMENT . 47
Monitoring/Visualization Equipment (Continued)  48
ROBOTICALLY ASSISTED SURGICAL SYSTEMS . 49
TABLE 3 PRINCIPAL TYPES OF SURGICAL ROBOTIC SYSTEMS  49
ELECTROSURGICAL EQUIPMENT . 50
TABLE 4 ELECTROSURGICAL EQUIPMENT  51
MECHANICAL INSTRUMENTS  52
TABLE 5 PRINCIPAL TYPES OF MECHANICAL INSTRUMENTS  52
AUXILIARY EQUIPMENT . 53
TABLE 6 PRINCIPAL TYPES OF AUXILIARY EQUIPMENT USED FOR
MINIMALLY INVASIVE SURGERY . 53
SURGICAL DEVICES . 54
TABLE 7 MINIMALLY INVASIVE SURGICAL DEVICES  54
REGULATORY STATUS OF MIS EQUIPMENT . 55
UNITED STATES  55
United States (Continued)  56
United States (Continued)  57
EUROPEAN UNION (EU) . 58
European Union (EU) (Continued) . 59
JAPAN  60
OTHER COUNTRIES  61
Canada . 61
China  61
India . 62
Latin American Nations  63
Saudi Arabia  63
END-USER SEGMENTS 63
HOSPITAL SURGICAL DEPARTMENTS . 64
FIGURE 4 U.S. HOSPITALS WITH SURGERY DEPARTMENTS, 2010
(NUMBER OF HOSPITALS)  64
OUTPATIENT SURGERY CENTERS  65
GROUP PRACTICES . 65
INDIVIDUAL SURGEONS . 65
TABLE 8 U.S. SURGICAL SPECIALTIES, 2009 (NUMBER AND % OF
ALL U.S. SURGEONS) . 65
FIGURE 5 U.S. SURGICAL SPECIALTIES, 2009 (% OF ALL U.S.
SURGEONS)  66
MEDICAL SCHOOLS  66

CHAPTER FOUR: MARKET FOR MIS DEVICES AND EQUIPMENT BY TYPE, APPLICATION SEGMENTS AND USER SEGMENTS  
OVERALL MARKET SIZE AND SEGMENTATION  67
TABLE 9 GLOBAL SALES OF MIS DEVICES AND EQUIPMENT,
THROUGH 2016 ($ BILLIONS) . 67
FIGURE 6 TRENDS IN GLOBAL SALES OF MIS DEVICES AND
EQUIPMENT, 2010–2016 ($ BILLIONS)  67
GEOGRAPHIC SEGMENTS . 68
TABLE 10 MARKET FOR MIS DEVICES AND EQUIPMENT SALES BY
REGION, THROUGH 2016 ($ MILLIONS) . 68
FIGURE 7 MAJOR MIS GEOGRAPHIC SEGMENTS, 2010 VS. 2016 (%
OF TOTAL SALES) . 69
APPLICATION SEGMENTS . 70
TABLE 11 U.S. MARKETS FOR MIS DEVICES AND EQUIPMENT
SALES BY APPLICATION, THROUGH 2016 ($ MILLIONS) . 71
FIGURE 8 MAJOR U.S. MIS APPLICATION SEGMENTS, 2010 VS.
2016 (% OF TOTAL SALES) . 71
FIGURE 8 (CONTINUED) . 72
DEVICE AND EQUIPMENT SEGMENTS  72
TABLE 12 U.S. MARKETS FOR MIS SALES BY EQUIPMENT TYPE,
THROUGH 2016 ($ MILLIONS) . 73
FIGURE 9 MAJOR U.S. MIS EQUIPMENT SEGMENTS, 2010 VS. 2016
(% OF TOTAL SALES)  74
END-USER SEGMENTS . 75
TABLE 13 U.S. MARKETS FOR MIS DEVICES AND EQUIPMENT
SALES BY END-USER TYPE, THROUGH 2016 ($ MILLIONS)  75
FIGURE 10 MAJOR U.S. MIS END-USER SEGMENTS, 2010 VS. 2016
(% OF TOTAL SALES)  76
DETAILED MARKET ANALYSIS . 77
MINIMALLY INVASIVE GASTROINTESTINAL SURGERY  77
Current Status . 78
FIGURE 11 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT
USED IN GASTROINTESTINAL SURGERY, 2010 (% OF TOTAL
SALES) . 78
FIGURE 11 (CONTINUED) . 79
Market Drivers  79
Demographic Trends . 79
TABLE 14 PROJECTED NUMBER OF PERSONS 18 YEARS AND
OLDER IN THE U.S., THROUGH 2016 (MILLIONS OF PEOPLE)  80
Trends in Obesity Surgery . 80
Projected Market Trends . 80
TABLE 15 PROJECTED TRENDS IN MINIMALLY INVASIVE
GASTROINTESTINAL PROCEDURES, THROUGH 2016 (NUMBER
OF PROCEDURES) . 81
TABLE 16 PROJECTED U.S. DEMAND FOR MIS DEVICES AND
EQUIPMENT USED FOR GASTROINTESTINAL SURGERY,
THROUGH 2016 ($ MILLIONS) . 81
MINIMALLY INVASIVE GYNECOLOGICAL SURGERY  82
Current Status . 82
FIGURE 12 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT
USED FOR GYNECOLOGICAL SURGERY, 2010 (% OF TOTAL
SALES) . 83
Market Drivers  83
Demographic Trends . 84
TABLE 17 PROJECTED NUMBER OF U.S. WOMEN AGES 40 TO 54,
THROUGH 2016 (MILLIONS OF WOMEN) . 84
Increasing Use of Robotic Gynecological Surgery . 84
Projected Market Trends . 85
TABLE 18 PROJECTED TRENDS IN MINIMALLY INVASIVE
GYNECOLOGICAL PROCEDURES, THROUGH 2016 (NUMBER OF
PROCEDURES) . 85
TABLE 19 PROJECTED U.S. DEMAND FOR MIS DEVICES AND
EQUIPMENT USED FOR GYNECOLOGICAL SURGERY, THROUGH
2016 ($ MILLIONS) . 86
MINIMALLY INVASIVE UROLOGICAL SURGERY . 86
Current Status . 86
FIGURE 13 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT
USED FOR UROLOGICAL SURGERY, 2010 (% OF TOTAL SALES)  87
Market Drivers  88
Trends in the Incidence of Certain Cancers  88
TABLE 20 NUMBER OF NEW CASES OF SELECTED CANCERS,
THROUGH 2010 (THOUSAND CASES) 88
Demographic Trends . 89
TABLE 21 TREND IN NUMBER OF U.S. WOMEN OVER 45,
THROUGH 2016 (MILLIONS) 89
TABLE 22 TREND IN NUMBER OF U.S. BOYS UNDER FIVE,
THROUGH 2016 (MILLIONS) 89
Technological Trends  90
Projected Market Trends . 90
TABLE 23 PROJECTED TRENDS IN MINIMALLY INVASIVE
UROLOGICAL PROCEDURES, THROUGH 2016 (NUMBER OF
PROCEDURES) . 90
TABLE 24 PROJECTED U.S. DEMAND FOR MIS DEVICES AND
EQUIPMENT USED FOR UROLOGICAL SURGERY, THROUGH
2016 ($ MILLIONS) . 91
MINIMALLY INVASIVE COSMETIC SURGERY . 91
Current Status . 91
FIGURE 14 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT
USED IN COSMETIC SURGERY, 2010 (% OF TOTAL SALES)  92
Market Drivers  92
FIGURE 15 TRENDS IN SELECTED U.S. COSMETIC SURGERY
PROCEDURES, 2000–2010 (THOUSANDS OF PROCEDURES)  93
TABLE 25 NUMBER OF U.S. COSMETIC SURGERY PROCEDURES,
THROUGH 2010 (THOUSANDS OF PROCEDURES) . 94
Projected Market Trends . 94
TABLE 26 PROJECTED TRENDS IN MINIMALLY INVASIVE
COSMETIC SURGICAL PROCEDURES, 2010–2016 (NUMBER OF
PROCEDURES) . 94
TABLE 27 PROJECTED U.S. DEMAND FOR MIS DEVICES AND
EQUIPMENT USED FOR COSMETIC SURGERY, THROUGH 2016
($ MILLIONS)  95
MINIMALLY INVASIVE THORACIC SURGICAL
PROCEDURES . 95
Current Status . 95
FIGURE 16 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT
USED IN THORACIC SURGERY, 2010 (% OF TOTAL SALES) . 96
Market Drivers  96
Incidence of Lung Cancer . 97
TABLE 28 U.S. LUNG CANCER TRENDS, THROUGH 2010
(THOUSANDS OF NEW CASES) . 97
Sympathectomy Trends  97
Projected Market Trends . 98
TABLE 29 PROJECTED TRENDS IN MINIMALLY INVASIVE
THORACIC PROCEDURES, THROUGH 2016 (NUMBER OF
PROCEDURES) . 98
TABLE 30 PROJECTED U.S. DEMAND FOR MIS DEVICES AND
EQUIPMENT USED FOR THORACIC SURGERY, THROUGH 2016 ($
MILLIONS)  99
MINIMALLY INVASIVE CARDIAC SURGERY  99
Current Status . 99
FIGURE 17 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT
USED FOR CARDIAC SURGERY, 2010 (% OF TOTAL SALES)  100
Market Drivers  101
Demographic Trends . 101
Trends in the Occurrence of Cardiovascular
Disease . 102
Trends in Numbers of Cardiovascular Surgeons . 103
Development of New MIS Techniques . 103
 Transcatheter Cardiac Surgery  104
─ Transcatheter DMR  104
─ Transcatheter Hole Closure . 104
 Other Transcatheter Procedures  105
 Robot-Assisted Cardiac Surgery . 105
Projected Market Trends . 106
TABLE 31 PROJECTED U.S. DEMAND FOR MIS DEVICES AND
EQUIPMENT USED IN CARDIAC SURGERY, THROUGH 2016 ($
MILLIONS)  106
MINIMALLY INVASIVE NONCARDIAC VASCULAR
SURGERY . 107
Current Status . 107
FIGURE 18 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT
USED IN NONCARDIACVASCULAR SURGERY, 2010 (% OF TOTAL
SALES) . 108
Market Drivers  108
Projected Market Trends . 109
TABLE 32 PROJECTED U.S. DEMAND FOR MIS DEVICES AND
EQUIPMENT USED IN VASCULAR SURGERY, THROUGH 2016 ($
MILLIONS)  109
MINIMALLY INVASIVE ORTHOPEDIC SURGERY . 109
Current Status . 110
FIGURE 19 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT
USED IN ORTHOPEDIC SURGERY, 2010 (% OF TOTAL SALES) . 110
FIGURE 19 (CONTINUED) . 111
Market Drivers  111
Arthroscopy Procedures  111
Joint Replacements . 112
Spinal Disc Surgery  112
Vertebroplasty/Kyphoplasty . 113
Projected Market Trends . 113
TABLE 33 PROJECTED TRENDS IN MINIMALLY INVASIVE
ORTHOPEDIC PROCEDURES, THROUGH 2016 (NUMBER OF
PROCEDURES) . 113
TABLE 34 PROJECTED U.S. DEMAND FOR MIS DEVICES AND
EQUIPMENT USED IN ORTHOPEDIC SURGERY, THROUGH 2016
($ MILLIONS)  114
MARKET BY TYPE OF DEVICE AND EQUIPMENT . 114
TABLE 35 PROJECTED US MIS MARKET DEVICE/EQUIPMENT
SEGMENTS BY APPLICATION, THROUGH 2016 ($ MILLIONS)  115

CHAPTER FIVE: INDUSTRY STRUCTURE, COMPETITION, AND MARKET SHARES  
INDUSTRY STRUCTURE . 116
FIGURE 20 EMPLOYEE NUMBERS AND SALES DISTRIBUTION OF
U.S. MEDICAL AND SURGICAL EQUIPMENT MANUFACTURERS
(% OF ALL ESTABLISHMENTS)  116
TABLE 36 U.S. MEDICAL AND SURGICAL EQUIPMENT
MANUFACTURERS BY EMPLOYMENT SIZE AND SALES
CATEGORY, 2007*  117
COMPETITION AND MARKET SHARES  117
MONITORING/VISUALIZATION EQUIPMENT  117
FIGURE 21 MONITORING/VISUALIZATION EQUIPMENT MARKET
LEADERS, 2010 (% OF TOTAL SEGMENT SALES) . 118
TABLE 37 GLOBAL MONITORING/VISUALIZATION MARKET
SHARES, 2010 . 119
ROBOTICS/COMPUTER-ASSISTED SURGERY . 119
TABLE 38 GLOBAL ROBOTICS/COMPUTER-ASSISTED SURGERY
MARKET SHARES, 2010 ($ MILLIONS/%) . 119
FIGURE 22 ROBOTICS/COMPUTER-ASSISTED SURGERY MARKET
LEADERS, 2010 (% OF TOTAL SALES) . 120
ELECTROSURGICAL EQUIPMENT  120
FIGURE 23 GLOBAL ELECTROSURGICAL AND AUXILIARY
EQUIPMENT MARKET LEADERS, 2010 (% OF TOTAL SALES)  121
TABLE 39 ELECTROSURGICAL AND AUXILIARY EQUIPMENT
MARKET SHARES, 2010  122
SURGICAL INSTRUMENTS . 122
TABLE 40 GLOBAL ENDOSURGICAL INSTRUMENT MARKET
SHARES, 2010 . 123
FIGURE 24 ENDOSURGICAL INSTRUMENT MARKET LEADERS,
2010 (% OF TOTAL SALES) . 123
SURGICAL DEVICES  123
TABLE 41 GLOBAL CORONARY STENT MARKET SHARES, 2010 . 124
FIGURE 25 CORNONARY STENT MARKET LEADERS, 2010 (% OF
TOTAL SALES) . 124

CHAPTER SIX: CONCLUSIONS: THE OUTLOOK FOR MINIMALLY INVASIVE SURGICAL DEVICES AND INSTRUMENTS  
MAJOR DEVELOPMENTS THAT WILL INFLUENCE THE
MINIMALLY INVASIVE SURGICAL DEVICES AND
INSTRUMENTS INDUSTRY . 125
TECHNOLOGICAL DEVELOPMENTS . 125
Adaptation of Minimally Invasive Techniques to New
Types of Surgical Procedures . 125
Natural Orifice Transluminal Endoscopic Surgery . 126
New Technologies  126
Nonvisual Imaging Techniques  127
 Optical Imaging Technologies . 127
 Nonoptical Imaging Technologies . 128
 “Hybrid” Optical/Nonoptical Systems . 129
Robotics . 129
Robotics (Continued)  130
Computer-Assisted Surgery . 131
Transcatheter Surgery  131
Percutaneous Ablation  131
Transcatheter Methods . 132
Radio Frequency Ablation  132
Microwave Ablation  133
Surgical Lasers  133
DEMOGRAPHIC AND ECONOMIC TRENDS  133
Aging Populations Worldwide . 133
TABLE 42 TRENDS IN AGE COMPOSITION OF THE WORLD’S
POPULATION, THROUGH 2015 (MILLIONS)  134
Income Growth in Emerging Markets  134
TABLE 43 PROJECTED TRENDS IN PER-CAPITA REAL GDP
GROWTH BY REGION, 2008-2012 (ANNUAL AVERAGE
PERCENTAGE CHANGE)  134
CHANGING STRUCTURE OF THE HEALTHCARE
INDUSTRY 135
Hospital Consolidation  135
Health Insurance Developments  135
LONG-TERM OUTLOOK FOR MINIMALLY INVASIVE SURGICAL
DEVICES AND INSTRUMENTS . 135
LONG-TERM OUTLOOK FOR MINIMALLY (CONTINUED) . 136
APPENDIX A: MINIMALLY INVASIVE SURGICAL PROCEDURES  137
ABDOMINAL SURGERY . 137
CARDIAC SURGERY . 138
ENDOCRINE SURGERY . 138
GYNECOLOGY . 138
NEUROSURGERY . 138
ORTHOPEDIC SURGERY . 139
PEDIATRICS  139
PLASTIC SURGERY  140
THORACIC . 140
UROLOGY . 141
VASCULAR . 141
APPENDIX B: VENDOR PROFILES  142
ACUEITY, INC.  142
GYRUS ACMI CORP. . 142
ARTHROCARE CORP. . 143
BOSTON SCIENTIFIC . 143
B. BRAUN AESCULAP  144
CLARUS MEDICAL LLC . 144
COHERENT, INC.  145
CONMED CORP.  145
CONVERGENT LASER TECHNOLOGIES  145
COOPER SURGICAL, INC. . 146
COVIDIEN PLC. . 146
C.R. BARD, INC. . 146
CUREXO TECHNOLOGY CORP. . 147
ENCISION, INC. . 147
ETHICON ENDO-SURGERY, INC.  148
FREEHAND 2010 LTD.  148
FUJINON PHOTO OPTICAL CO., LTD.  149
HANSEN MEDICAL  149
HITACHI MEDICAL CORP.  150
INTEGRATED ENDOSCOPY  150
INTUITIVE SURGICAL, INC. . 150
LUMENIS, LTD. . 151
MEDTRONIC, INC.  151
MEDTRONIC ENT, INC. . 152
MENTICE MEDICAL SIMULATION AB . 152
MGB ENDOSCOPY, LTD.  152
MICRODEXTERITY SYSTEMS, INC.  153
OLYMPUS OPTICAL CO., LTD. . 153
PENTAX CORP.  153
PHOTOMEDEX  154
PILLING SURGICAL . 154
REMA MEDIZINTECHNIK GMBH  154
SMITH & NEPHEW PLC . 155
SPECTRANETICS CORP.  155
KARL STORZ ENDOSKOPE BERLIN GMBH & CO.  156
STRYKER CORP. . 156
SURGICAL INNOVATIONS GROUP PLC . 157
VALLEYLAB . 157
VISION SCIENCES, INC.  157
RICHARD WOLF GMBH . 158
APPENDIX C: INDUSTRY AND PROFESSIONAL ORGANIZATIONS . 159
AMERICAN ASSOCIATION OF GYNECOLOGICAL
LAPAROSCOPISTS  159
AMERICAN COLLEGE OF SURGEONS 159
AMERICAN MEDICAL ASSOCIATION . 159
AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY  159
ASSOCIATION FOR THE ADVANCEMENT OF MEDICAL
INSTRUMENTATION  159
EUROPEAN ASSOCIATION FOR ENDOSCOPIC SURGERY . 160
THE INTERNATIONAL SOCIETY FOR MINIMALLY INVASIVE
CARDIAC SURGERY  160
SOCIETY OF AMERICAN GASTROINTESTINAL ENDOSCOPIC
SURGEONS . 160
SOCIETY OF LAPAROENDOSCOPIC SURGEONS . 160