DAVIS & GECK LAPRO-CLIP APPLIER PRICED AT ABOUT $975

DAVIS & GECK LAPRO-CLIP APPLIER PRICED AT ABOUT $975, with accompanying packages of six bioabsorbable ligating clips selling for about $75, according to the company. D&G says that the Lapro- Clip Ligating Clip System, which includes clips and the reusable applier, will allow for savings "up to 25% per gallbladder procedure" compared to systems comprised of disposable appliers and metal clips. The Lapro-Clip system, cleared by FDA in July 1993, was unveiled the week of Oct. 11 at the American College of Surgeons annual meeting in San Francisco. D&G's direct sales force will begin marketing the system before the end of the year. The American Cyanamid division maintains that the Lapro-Clip is the first "effective" non-metal ligating clip. Molded from two synthetic polymers, the clip is intended for use in laparoscopic cholecystectomy and other minimally invasive procedures. The clips are designed to seal "vessels and ducts with mesentery tissue, or membrane still attached" that are "up to 8 mm in diameter." The company initially will make the clips available in one-clip cartridges; an eight-clip cartridge is expected to be released in 1994. Most metal clips are sold in 20-clip cartridges. In addition to claiming cost savings over metal clip systems, D&G claims that "extensive" testing has indicated that Lapro-Clips "have more than twice the holding power of any metal ligating clip." In addition, the clips are radiotransparent and will "not produce imaging artifacts or distortion on X-ray, CAT or MRI scans"; they also are "nonconductive" to electrosurgical current, "nonantigenic" and "nonpyrogenic," the firm says. At the American College of Surgeons meeting, D&G also introduced 25-30 additions to its Professional line of reusable endoscopic surgery instruments and expanded its Prestige line of "premium-quality" reusable endoscopic instruments with three types of products. The new Professional line instruments are geared towards the fields of pediatric and thoracoscopic surgery; most of the previously available Professional line products were for general surgery. Among the line additions are scissors and forceps for pediatric surgery with jaw patterns in lengths of 26 mm, which are shorter than the standard 33 mm length. The company also introduced rigid and flexible trocars with curved shafts "in a variety of sizes for thoracic applications." The additions to the D&G Prestige line are a 10 mm forceps, a 5 mm "dual-action atraumatic grasper" and four types of 5 mm monopolar electrosurgical dissectors. The forceps, available in eight jaw patterns, have dual flush ports, which make it "easy to clear internal lumens and channels, not only in the shaft but also the handle," the company says. Both the grasper and the dissectors feature a rotating shaft with low-torque and a 12-position detent knob which provides for "precise rotation and one-handed operation," the company says. One of the principal factors currently affecting the laparoscopic instrument market is the controversy over the cost- effectiveness of reusable versus disposable laparoscopic instruments. D&G maintains that annual laparoscopic cholecystectomy instrumentation costs for a medium-sized hospital (performing six procedures per week) would be roughly 86% less if the hospital used reusable instruments rather than disposable products. With reusables, the annual cost of the instrumentation would be $30,980, D&G estimates, while if disposables are used, the annual cost would be $225,888. D&G estimates that the annual reusable costs would include $11,025 for the purchase of instruments other than trocars, $3,010 for the purchase of trocars, $10,090 for repair costs, and $6,855 for instrument processing. Annual reusable costs would include $137,280 for the purchase of instruments other than trocars, $87,360 for trocar purchases, and $1,248 for instrument processing. D&G's cost calculations contrast with those recently made in a study sponsored by U.S. Surgical ("The Gray Sheet" Oct. 4, p. 21). The USSC-sponsored study, which calculated costs on a per-procedure rather than an annual basis, found that single-use and reusable instruments have "essentially equal" costs.