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The Market for Minimally Invasive Medical Devices

  • January 2015
  • -
  • BCC Research
  • -
  • 140 pages

This BCC Research report looks at the current and future markets, and 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.

Use this report to:
- Review the minimally invasive surgical devices industry and the U.S. market for these devices.
- Gain insight into major types and applications of minimally invasive surgical devices and instruments.
- Learn about the future of minimally invasive surgical devices and instruments.
- Receive information about profiles of key companies in the field.

Highlights
- The global market for minimally invasive medical devices and equipment totaled $14.5 billion in 2013. The market reached roughly $15.4 billion in 2014 and is expected to reach $21.5 billion in 2019, registering a compound annual growth rate (CAGR) of 6.8% for the period 2014-2019.
- The U. S. as a segment will grow from about $10.2 billion in 2014 to about $ 14.0 billion by 2019 at a 6.4% CAGR for the period 2014-2019.
- Europe as a segment will grow from nearly $3.3 billion in 2014 to $4.8 billion in 2019, increasing at a CAGR of 7.9% from 2014-2019.

Introduction & Scope

INTRODUCTION

MINIMALLY INVASIVE SURGERY
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.

This report details the actuals for 2009 and 2013, and compound annual growth rate (CAGR) projections for 2014 through 2019 for the North American, European, Far Eastern and Rest-of-World markets. Power source sales and values are provided under consensus, optimistic and pessimistic scenarios. A patent analysis and discussion for power sources and vehicle components describes where research is performed and emphasizes intellectual property issues.

As defined by BCC Research for this report, electric vehicles and fuel cell vehicles include the following:
- Hybrid electric vehicles (HEVs).
- Plug-in hybrid electric vehicles (PHEVs).
- Electric vehicles (pure EVs).

Specific types of vehicles using these batteries include:
- Passenger vehicles (sedans, microcars, SUVs, crossover SUVs, pickup trucks, sports cars).
- Low-velocity (golf carts, neighborhood electric vehicles, personal mobility devices).
- Scooters (two-wheelers, motorcycles, some three-wheelers).
- Buses.
- Commercial/industrial (material handling equipment, burden carriers, forklifts, trucks).
- Niche (military, locomotives).

These market sectors are defined, leading companies are identified and the markets analyzed (including a five-year market forecast). Finally, status and recent events for
power source maker companies are provided in the “Company Profiles” section.

Regions covered include:
- North America: Canada and the U.S.
- Far East: Japan, China, India, Indonesia, etc.
- Europe: Western Europe.
- Rest of World (ROW): South America, Mexico, Central America, Africa, Middle East, Australia, New Zealand, other Pacific nations, Russia, Eastern Europe and Turkey.

Table Of Contents

The Market for Minimally Invasive Medical Devices
TABLE OF CONTENTS
CHAPTER 1 INTRODUCTION 2
MINIMALLY INVASIVE SURGERY 2
MINIMALLY INVASIVE SURGERY VERSUS AMBULATORY SURGERY 2
MINIMALLY INVASIVE SURGERY VERSUS NONINVASIVE SURGERY 2
STUDY BACKGROUND 3
STUDY GOALS AND OBJECTIVES 3
INTENDED AUDIENCE 4
SCOPE AND FORMAT OF REPORT 4
METHODOLOGY AND INFORMATION SOURCES 5
ANALYST'S CREDENTIALS 5
RELATED BCC RESEARCH REPORTS 6
BCC RESEARCH WEBSITE 6
DISCLAIMER 6
CHAPTER 2 EXECUTIVE SUMMARY 8
SUMMARY TABLE GLOBAL MARKET FOR MIS DEVICES AND EQUIPMENT, THROUGH
2019 ($ MILLIONS) 8
SUMMARY FIGURE GLOBAL MARKET FOR MIS DEVICES AND EQUIPMENT,
2013-2019 ($ MILLIONS) 8
CHAPTER 3 OVERVIEW OF MINIMALLY INVASIVE SURGICAL DEVICES AND
INSTRUMENTS 11
GENERAL DESCRIPTION 11
HISTORY OF MINIMALLY INVASIVE SURGERY 11
ENDOSCOPY 11
INSUFFLATION 13
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 PERCENTAGE OF ALL SURGICAL PROCEDURES
PERFORMED IN THE U.S., 2013 (%) 17
FIGURE 2 MIS PROCEDURES AS A PERCENTAGE OF SELECTED TYPES OF SURGICAL
MEASURES IN THE U.S., 2013 17
PRINCIPAL APPLICATIONS OF MINIMALLY INVASIVE SURGERY 19
FIGURE 3 SURGICAL PROCEDURES PERFORMED IN THE U.S. USING ALL MIS
APPROACHES, 2013 (% OF ALL MIS PROCEDURES) 20
TABLE 1 SURGICAL PROCEDURES COMMONLY PERFORMED IN THE U.S. USING A
MINIMALLY INVASIVE APPROACH, 2013 21
GASTROINTESTINAL SURGERY 22
Gallbladder Removal (Cholecystectomy) 22
Nissen Fundoplication 23
Adhesiolysis (Removal of Abdominal Scar Tissue) 23
Gastric Bypass 24
Appendectomy 24
Colon Resection 25
Hernia Repair 25
GYNECOLOGY 26
Hysterectomy 26
Myomectomy 27
Endometrial Ablation 27
Pelvic Floor Reconstruction 28
Adnexectomy (Removal of Adnexal Structures) 28
UROLOGY 29
Nephrectomy 29
Cystocele/Rectocele Repair 29
Pediatric Urology 30
Adrenalectomy 31
Radical Prostatectomy 32
COSMETIC SURGERY 32
Breast Augmentation 32
Face and Forehead Lifts 33
THORACIC SURGERY 33
Lung Biopsy 33
Lung Resection 34
Endoscopic Thoracic Sympathectomy 34
CARDIOTHORACIC SURGERY 34
Angioplasty and Other Catheterization Types 35
Coronary Artery Bypass 36
Heart Valve Repair and Replacement 36
Congenital Heart Defect Surgery 37
NONCARDIAC VASCULAR INTERVENTIONAL SURGERY 37
Saphenous Vein Harvest 37
Peripheral Vascular Bypass 37
Aortoiliofemoral Bypass 38
Abdominal Aortic Aneurism Repair 38
Lower Extremity Angioplasty 38
ORTHOPEDIC SURGERY 39
Joint Surgery 39
Arthroscopic Surgery 39
Arthroplasty 40
Damaged or Diseased Spinal Disk Surgery 40
Microendoscopic Diskectomy 40
Intradiskal Electrothermal Annuloplasty 40
Vertebroplasty and Kyphoplasty 41
PRODUCT TYPES 41
MONITORING/VISUALIZATION EQUIPMENT 42
TABLE 2 PRINCIPAL TYPES OF MONITORING/VISUALIZATION EQUIPMENT 42
ROBOTICALLY ASSISTED SURGICAL SYSTEMS 44
TABLE 3 PRINCIPAL TYPES OF SURGICAL ROBOTIC SYSTEMS 44
ELECTROSURGICAL EQUIPMENT 45
TABLE 4 ELECTROSURGICAL EQUIPMENT 46
MECHANICAL INSTRUMENTS 47
TABLE 5 PRINCIPAL TYPES OF MECHANICAL INSTRUMENTS 47
AUXILIARY EQUIPMENT 48
TABLE 6 PRINCIPAL TYPES OF AUXILIARY EQUIPMENT USED FOR MINIMALLY
INVASIVE SURGERY 48
SURGICAL DEVICES 48
TABLE 7 MINIMALLY INVASIVE SURGICAL DEVICES 49
REGULATORY STATUS OF MIS EQUIPMENT 49
UNITED STATES 49
EUROPEAN UNION (EU) 52
JAPAN 54
OTHER COUNTRIES 54
Canada 54
China 55
India 56
Latin American Nations 56
Saudi Arabia 56
END-USER SEGMENTS 57
HOSPITAL SURGICAL DEPARTMENTS 57
FIGURE 4 U.S. HOSPITALS WITH SURGERY DEPARTMENTS, 2013 (NUMBER OF
HOSPITALS) 57
OUTPATIENT SURGERY CENTERS 58
GROUP PRACTICES 58
INDIVIDUAL SURGEONS 58
FIGURE 5 U.S. SURGICAL SPECIALTIES, 2013 (% OF ALL U.S. SURGEONS) 58
MEDICAL SCHOOLS 59
CHAPTER 4 MARKET FOR MIS DEVICES AND EQUIPMENT BY TYPE, APPLICATION
SEGMENTS AND USER SEGMENTS 61
OVERALL MARKET SIZE AND SEGMENTATION 61
TABLE 8 GLOBAL SALES OF MIS DEVICES AND EQUIPMENT, THROUGH 2019 ($
MILLIONS) 61
FIGURE 6 TRENDS IN GLOBAL SALES OF MIS DEVICES AND EQUIPMENT, 2013-2019
($ MILLIONS) 61
GEOGRAPHIC SEGMENTS 62
TABLE 9 MARKET FOR MIS DEVICES AND EQUIPMENT SALES BY REGION, THROUGH
2019 ($ MILLIONS) 62
FIGURE 7 MAJOR MIS GEOGRAPHIC SEGMENTS, 2013 VS. 2019 (% OF TOTAL SALES) 62
APPLICATION SEGMENTS 64
TABLE 10 U.S. MARKETS FOR MIS DEVICES AND EQUIPMENT SALES BY
APPLICATION, THROUGH 2019 ($ MILLIONS) 64
FIGURE 8 MAJOR U.S. MIS APPLICATION SEGMENTS, 2013 VS. 2019 (% OF TOTAL
SALES) 65
DEVICE AND EQUIPMENT SEGMENTS 66
TABLE 11 U.S. MARKETS FOR MIS SALES BY EQUIPMENT TYPE, THROUGH 2019 ($
MILLIONS) 67
FIGURE 9 MAJOR U.S. MIS EQUIPMENT SEGMENTS, 2013 VS. 2019 (% OF TOTAL
SALES) 67
END-USER SEGMENTS 68
TABLE 12 U.S. MARKETS FOR MIS DEVICES AND EQUIPMENT SALES BY END-USER
TYPE, THROUGH 2019 ($ MILLIONS) 68
FIGURE 10 MAJOR U.S. MIS END-USER SEGMENTS, 2013 VS. 2019 (% OF TOTAL
SALES) 69
DETAILED MARKET ANALYSIS 70
MINIMALLY INVASIVE GASTROINTESTINAL SURGERY 70
Current Status 70
FIGURE 11 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED IN
GASTROINTESTINAL SURGERY, 2013 (% OF TOTAL SALES) 71
Market Drivers 72
Demographic Trends 72
TABLE 13 PROJECTED NUMBER OF PERSONS 18 YEARS AND OLDER IN THE U.S.,
THROUGH 2019 (MILLIONS OF PEOPLE) 72
Trends in Obesity Surgery 72
Projected Market Trends 73
TABLE 14 PROJECTED TRENDS IN MINIMALLY INVASIVE GASTROINTESTINAL
PROCEDURES, THROUGH 2019 (NUMBER OF PROCEDURES) 73
TABLE 15 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED FOR
GASTROINTESTINAL SURGERY, THROUGH 2019 ($ MILLIONS) 74
MINIMALLY INVASIVE GYNECOLOGICAL SURGERY 74
Current Status 74
FIGURE 12 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED FOR
GYNECOLOGICAL SURGERY, 2013 (% OF TOTAL SALES) 74
Market Drivers 75
Demographic Trends 76
TABLE 16 PROJECTED NUMBER OF U.S. WOMEN AGES 40 TO 54, THROUGH 2019
(MILLIONS OF WOMEN) 76
Increasing Use of Robotic Gynecological Surgery 76
Projected Market Trends 76
TABLE 17 PROJECTED TRENDS IN MINIMALLY INVASIVE GYNECOLOGICAL
PROCEDURES, THROUGH 2019 (NUMBER OF PROCEDURES) 77
TABLE 18 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED FOR
GYNECOLOGICAL SURGERY, THROUGH 2019 ($ MILLIONS) 77
MINIMALLY INVASIVE UROLOGICAL SURGERY 78
Current Status 78
FIGURE 13 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED FOR
UROLOGICAL SURGERY, 2013 (% OF TOTAL SALES) 78
Market Drivers 79
Trends in the Incidence of Certain Cancers 79
TABLE 19 NUMBER OF NEW CASES OF SELECTED CANCERS, THROUGH 2014
(THOUSAND CASES) 79
Demographic Trends 80
TABLE 20 TREND IN NUMBER OF U.S. WOMEN OVER 45, THROUGH 2019 (MILLIONS) 80
TABLE 21 TREND IN NUMBER OF U.S. BOYS UNDER FIVE, THROUGH 2019
(MILLIONS) 80
Technological Trends 81
Projected Market Trends 81
TABLE 22 PROJECTED TRENDS IN MINIMALLY INVASIVE UROLOGICAL PROCEDURES,
THROUGH 2019 (NUMBER OF PROCEDURES) 81
TABLE 23 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED FOR
UROLOGICAL SURGERY, THROUGH 2019 ($ MILLIONS) 82
MINIMALLY INVASIVE COSMETIC SURGERY 82
Current Status 82
FIGURE 14 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED IN COSMETIC
SURGERY, 2013 (% OF TOTAL SALES) 82
Market Drivers 83
FIGURE 15 TRENDS IN SELECTED U.S. COSMETIC SURGERY PROCEDURES,
2000-2013 (THOUSANDS OF PROCEDURES) 84
FIGURE 24 ENDOSURGICAL INSTRUMENT MARKET LEADERS, 2013 (% OF TOTAL
SALES) 84
Projected Market Trends 85
TABLE 25 PROJECTED TRENDS IN MINIMALLY INVASIVE COSMETIC SURGICAL
PROCEDURES, THROUGH 2019 (NUMBER OF PROCEDURES) 85
TABLE 26 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED FOR
COSMETIC SURGERY, THROUGH 2019 ($ MILLIONS) 85
MINIMALLY INVASIVE THORACIC SURGICAL PROCEDURES 86
Current Status 86
FIGURE 16 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED IN THORACIC
SURGERY, 2013 (% OF TOTAL SALES) 86
Market Drivers 87
Incidence of Lung Cancer 87
TABLE 27 U.S. LUNG CANCER TRENDS, THROUGH 2013 (THOUSANDS OF NEW
CASES) 87
Sympathectomy Trends 87
Projected Market Trends 88
TABLE 28 PROJECTED TRENDS IN MINIMALLY INVASIVE THORACIC PROCEDURES,
THROUGH 2019 (NUMBER OF PROCEDURES) 88
TABLE 29 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED FOR
THORACIC SURGERY, THROUGH 2019 ($ MILLIONS) 88
MINIMALLY INVASIVE CARDIOTHORACIC SURGERY 89
Current Status 89
FIGURE 17 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED FOR CARDIAC
SURGERY, 2013 (% OF TOTAL SALES) 89
Market Drivers 90
Demographic Trends 91
Trends in the Occurrence of Cardiovascular Disease 91
Trends in Numbers of Cardiovascular Surgeons 92
Development of New MIS Techniques 92
Transcatheter Cardiac Surgery 93
Transcatheter DMR 93
Transcatheter Hole Closure 93
Other Transcatheter Procedures 94
Robot-Assisted Cardiac Surgery 94
Projected Market Trends 95
TABLE 30 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED IN
CARDIAC SURGERY, THROUGH 2019 ($ MILLIONS) 95
MINIMALLY INVASIVE NONCARDIAC VASCULAR INTERVENTIONAL SURGERY 95
Current Status 96
FIGURE 18 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED IN NONCARDIAC
VASCULAR SURGERY, 2013 (% OF TOTAL SALES) 96
Market Drivers 97
Projected Market Trends 97
TABLE 31 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED IN
VASCULAR SURGERY, THROUGH 2019 ($ MILLIONS) 97
MINIMALLY INVASIVE ORTHOPEDIC SURGERY 98
Current Status 98
FIGURE 19 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED IN ORTHOPEDIC
SURGERY, 2013 (% OF TOTAL SALES) 98
Market Drivers 99
Arthroscopy Procedures 99
Joint Replacements 100
Spinal Disk Surgery 100
Vertebroplasty/Kyphoplasty 100
Projected Market Trends 100
TABLE 32 PROJECTED TRENDS IN MINIMALLY INVASIVE ORTHOPEDIC PROCEDURES,
THROUGH 2019 (NUMBER OF PROCEDURES) 101
TABLE 33 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED IN
ORTHOPEDIC SURGERY, THROUGH 2019 ($ MILLIONS) 101
MARKET BY TYPE OF DEVICE AND EQUIPMENT 102
TABLE 34 PROJECTED U.S. MIS MARKET DEVICE/EQUIPMENT SEGMENTS BY
APPLICATION, THROUGH 2019 ($ MILLIONS) 102
CHAPTER 5 INDUSTRY STRUCTURE, COMPETITION AND MARKET SHARES 105
INDUSTRY STRUCTURE 105
FIGURE 20 EMPLOYEE NUMBERS AND SALES DISTRIBUTION OF U.S. MEDICAL AND
SURGICAL EQUIPMENT MANUFACTURERS, 2007* (% OF ALL ESTABLISHMENTS) 105
TABLE 35 U.S. MEDICAL AND SURGICAL EQUIPMENT MANUFACTURERS BY
EMPLOYMENT SIZE AND SALES CATEGORY, 2007* 106
COMPETITION AND MARKET SHARES 106
MONITORING/VISUALIZATION EQUIPMENT 106
FIGURE 21 MONITORING/VISUALIZATION EQUIPMENT MARKET LEADERS, 2013 (%
OF TOTAL SEGMENT SALES) 106
ROBOTICS/COMPUTER-ASSISTED SURGERY 107
FIGURE 22 ROBOTICS/COMPUTER-ASSISTED SURGERY MARKET LEADERS, 2013 (%
OF TOTAL SALES) 107
ELECTROSURGICAL EQUIPMENT 108
FIGURE 23 GLOBAL ELECTROSURGICAL AND AUXILIARY EQUIPMENT MARKET
LEADERS, 2013 (% OF TOTAL SALES) 108
SURGICAL INSTRUMENTS 109
FIGURE 24 ENDOSURGICAL INSTRUMENT MARKET LEADERS, 2013 (% OF TOTAL
SALES) 109
SURGICAL DEVICES 110
FIGURE 25 CORONARY STENT MARKET LEADERS, 2013 (% OF TOTAL SALES) 110
CHAPTER 6 CONCLUSIONS: THE OUTLOOK FOR MINIMALLY INVASIVE SURGICAL
DEVICES AND INSTRUMENTS 113
MAJOR DEVELOPMENTS THAT WILL INFLUENCE THE MINIMALLY INVASIVE
SURGICAL DEVICES AND INSTRUMENTS INDUSTRY 113
TECHNOLOGICAL DEVELOPMENTS 113
Adaptation of Minimally Invasive Techniques to New Types of
Surgical Procedures 113
Natural Orifice Transluminal Endoscopic Surgery 114
New Technologies 114
Nonvisual Imaging Techniques 114
Optical Imaging Technologies 115
Nonoptical Imaging Technologies 116
"Hybrid" Optical/Nonoptical Systems 116
Robotics 116
Computer-Assisted Surgery 118
Transcatheter Surgery 118
Percutaneous Ablation 118
Transcatheter Methods 119
Radio Frequency (RF) Ablation 119
Microwave Ablation 119
Surgical Lasers 120
DEMOGRAPHIC AND ECONOMIC TRENDS 120
Aging Populations Worldwide 120
TABLE 36 TRENDS IN AGE COMPOSITION OF THE WORLD'S POPULATION, 2010
AND 2019 (MILLIONS) 120
Income Growth in Emerging Markets 121
TABLE 37 PROJECTED TRENDS IN PER-CAPITA REAL GROSS DOMESTIC PRODUCT
(GDP) GROWTH BY REGION, 2011-2015 (ANNUAL AVERAGE PERCENTAGE CHANGE) 121
CHANGING STRUCTURE OF THE HEALTHCARE INDUSTRY 121
Hospital Consolidation 121
Health Insurance Developments 122
LONG-TERM OUTLOOK FOR MINIMALLY INVASIVE SURGICAL DEVICES AND
INSTRUMENTS 122
CHAPTER 7 MINIMALLY INVASIVE SURGICAL PROCEDURES 125
ABDOMINAL SURGERY 125
CARDIAC SURGERY 126
ENDOCRINE SURGERY 126
GYNECOLOGY 126
NEUROSURGERY 126
ORTHOPEDIC SURGERY 126
PEDIATRICS 127
PLASTIC SURGERY 127
THORACIC 128
UROLOGY 128
VASCULAR INTERVENTIONAL 129
CHAPTER 8 VENDOR PROFILES 131
ACUEITY INC./ATOSSA INC. 131
ARTHROCARE CORP. 131
B. BRAUN AESCULAP 132
BOSTON SCIENTIFIC 132
CLARUS MEDICAL LLC 133
COHERENT INC. 133
CONMED CORP. 133
CONVERGENT LASER TECHNOLOGIES 134
COOPER SURGICAL INC. 134
COVIDIEN PLC. 134
C.R. BARD INC. 134
CUREXO TECHNOLOGY CORP. 135
ENCISION INC. 135
ETHICON ENDO-SURGERY INC. 136
FREEHAND 2010 LTD. 136
FUJINON PHOTO OPTICAL CO. LTD. 136
GIVEN IMAGING LTD. 137
GYRUS ACMI CORP. 137
HANSEN MEDICAL 137
HITACHI MEDICAL CORP. 138
INTEGRATED ENDOSCOPY 138
INTUITIVE SURGICAL INC. 138
LUMENIS LTD. 139
MAKO SURGICAL CORP. 139
MEDTRONIC INC. 140
MEDTRONIC ENT INC. 140
MENTICE MEDICAL SIMULATION AB 140
MGB ENDOSCOPY LTD. 141
MICRODEXTERITY SYSTEMS INC. 141
OLYMPUS OPTICAL CO. LTD. 141
PENTAX MEDICAL 142
PHOTOMEDEX 142
PILLING SURGICAL 142
REMA MEDIZINTECHNIK GMBH 143
SMITH and NEPHEW PLC 143
SPECTRANETICS CORP. 143
KARL STORZ ENDOSKOPE BERLIN GMBH and CO. 144
STRYKER CORP. 144
SURGICAL INNOVATIONS GROUP LTD. 145
VALLEYLAB 145
VISION SCIENCES INC. 145
RICHARD WOLF GMBH 146
CHAPTER 9 INDUSTRY AND PROFESSIONAL ORGANIZATIONS 148
AMERICAN ASSOCIATION OF GYNECOLOGICAL LAPAROSCOPISTS 148
AMERICAN COLLEGE OF SURGEONS 148
AMERICAN MEDICAL ASSOCIATION 148
AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 148
ASSOCIATION FOR THE ADVANCEMENT OF MEDICAL INSTRUMENTATION 148
EUROPEAN ASSOCIATION FOR ENDOSCOPIC SURGERY 149
THE INTERNATIONAL SOCIETY FOR MINIMALLY INVASIVE CARDIAC SURGERY 149
SOCIETY OF AMERICAN GASTROINTESTINAL ENDOSCOPIC SURGEONS 149
SOCIETY OF LAPAROENDOSCOPIC SURGEONS 149

LIST OF TABLES

SUMMARY TABLE GLOBAL MARKET FOR MIS DEVICES AND EQUIPMENT, THROUGH
2019 ($ MILLIONS) 8
TABLE 1 SURGICAL PROCEDURES COMMONLY PERFORMED IN THE U.S. USING A
MINIMALLY INVASIVE APPROACH, 2013 21
TABLE 2 PRINCIPAL TYPES OF MONITORING/VISUALIZATION EQUIPMENT 42
TABLE 3 PRINCIPAL TYPES OF SURGICAL ROBOTIC SYSTEMS 44
TABLE 4 ELECTROSURGICAL EQUIPMENT 46
TABLE 5 PRINCIPAL TYPES OF MECHANICAL INSTRUMENTS 47
TABLE 6 PRINCIPAL TYPES OF AUXILIARY EQUIPMENT USED FOR MINIMALLY
INVASIVE SURGERY 48
TABLE 7 MINIMALLY INVASIVE SURGICAL DEVICES 49
TABLE 8 GLOBAL SALES OF MIS DEVICES AND EQUIPMENT, THROUGH 2019 ($
MILLIONS) 61
TABLE 9 MARKET FOR MIS DEVICES AND EQUIPMENT SALES BY REGION, THROUGH
2019 ($ MILLIONS) 62
TABLE 10 U.S. MARKETS FOR MIS DEVICES AND EQUIPMENT SALES BY APPLICATION,
THROUGH 2019 ($ MILLIONS) 64
TABLE 11 U.S. MARKETS FOR MIS SALES BY EQUIPMENT TYPE, THROUGH 2019 ($
MILLIONS) 67
TABLE 12 U.S. MARKETS FOR MIS DEVICES AND EQUIPMENT SALES BY END-USER
TYPE, THROUGH 2019 ($ MILLIONS) 68
TABLE 13 PROJECTED NUMBER OF PERSONS 18 YEARS AND OLDER IN THE U.S.,
THROUGH 2019 (MILLIONS OF PEOPLE) 72
TABLE 14 PROJECTED TRENDS IN MINIMALLY INVASIVE GASTROINTESTINAL
PROCEDURES, THROUGH 2019 (NUMBER OF PROCEDURES) 73
TABLE 15 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED FOR
GASTROINTESTINAL SURGERY, THROUGH 2019 ($ MILLIONS) 74
TABLE 16 PROJECTED NUMBER OF U.S. WOMEN AGES 40 TO 54, THROUGH 2019
(MILLIONS OF WOMEN) 76
TABLE 17 PROJECTED TRENDS IN MINIMALLY INVASIVE GYNECOLOGICAL
PROCEDURES, THROUGH 2019 (NUMBER OF PROCEDURES) 77
TABLE 18 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED FOR
GYNECOLOGICAL SURGERY, THROUGH 2019 ($ MILLIONS) 77
TABLE 19 NUMBER OF NEW CASES OF SELECTED CANCERS, THROUGH 2014
(THOUSAND CASES) 79
TABLE 20 TREND IN NUMBER OF U.S. WOMEN OVER 45, THROUGH 2019 (MILLIONS) 80
TABLE 21 TREND IN NUMBER OF U.S. BOYS UNDER FIVE, THROUGH 2019 (MILLIONS) 80
TABLE 22 PROJECTED TRENDS IN MINIMALLY INVASIVE UROLOGICAL PROCEDURES,
THROUGH 2019 (NUMBER OF PROCEDURES) 81
TABLE 23 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED FOR
UROLOGICAL SURGERY, THROUGH 2019 ($ MILLIONS) 82
TABLE 25 PROJECTED TRENDS IN MINIMALLY INVASIVE COSMETIC SURGICAL
PROCEDURES, THROUGH 2019 (NUMBER OF PROCEDURES) 85
TABLE 26 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED FOR
COSMETIC SURGERY, THROUGH 2019 ($ MILLIONS) 85
TABLE 27 U.S. LUNG CANCER TRENDS, THROUGH 2013 (THOUSANDS OF NEW
CASES) 87
TABLE 28 PROJECTED TRENDS IN MINIMALLY INVASIVE THORACIC PROCEDURES,
THROUGH 2019 (NUMBER OF PROCEDURES) 88
TABLE 29 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED FOR
THORACIC SURGERY, THROUGH 2019 ($ MILLIONS) 88
TABLE 30 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED IN
CARDIAC SURGERY, THROUGH 2019 ($ MILLIONS) 95
TABLE 31 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED IN
VASCULAR SURGERY, THROUGH 2019 ($ MILLIONS) 97
TABLE 32 PROJECTED TRENDS IN MINIMALLY INVASIVE ORTHOPEDIC PROCEDURES,
THROUGH 2019 (NUMBER OF PROCEDURES) 101
TABLE 33 PROJECTED U.S. DEMAND FOR MIS DEVICES AND EQUIPMENT USED IN
ORTHOPEDIC SURGERY, THROUGH 2019 ($ MILLIONS) 101
TABLE 34 PROJECTED U.S. MIS MARKET DEVICE/EQUIPMENT SEGMENTS BY
APPLICATION, THROUGH 2019 ($ MILLIONS) 102
TABLE 35 U.S. MEDICAL AND SURGICAL EQUIPMENT MANUFACTURERS BY
EMPLOYMENT SIZE AND SALES CATEGORY, 2007* 106
TABLE 36 TRENDS IN AGE COMPOSITION OF THE WORLD'S POPULATION, 2010 AND
2019 (MILLIONS) 120
TABLE 37 PROJECTED TRENDS IN PER-CAPITA REAL GROSS DOMESTIC PRODUCT
(GDP) GROWTH BY REGION, 2011-2015 (ANNUAL AVERAGE PERCENTAGE CHANGE) 121

LIST OF FIGURES

SUMMARY FIGURE GLOBAL MARKET FOR MIS DEVICES AND EQUIPMENT, 2013-2019
($ MILLIONS) 8
FIGURE 1 MIS PROCEDURES AS A PERCENTAGE OF ALL SURGICAL PROCEDURES
PERFORMED IN THE U.S., 2013 (%) 17
FIGURE 2 MIS PROCEDURES AS A PERCENTAGE OF SELECTED TYPES OF SURGICAL
MEASURES IN THE U.S., 2013 17
FIGURE 3 SURGICAL PROCEDURES PERFORMED IN THE U.S. USING ALL MIS
APPROACHES, 2013 (% OF ALL MIS PROCEDURES) 20
FIGURE 4 U.S. HOSPITALS WITH SURGERY DEPARTMENTS, 2013 (NUMBER OF
HOSPITALS) 57
FIGURE 5 U.S. SURGICAL SPECIALTIES, 2013 (% OF ALL U.S. SURGEONS) 58
FIGURE 6 TRENDS IN GLOBAL SALES OF MIS DEVICES AND EQUIPMENT, 2013-2019
($ MILLIONS) 61
FIGURE 7 MAJOR MIS GEOGRAPHIC SEGMENTS, 2013 VS. 2019 (% OF TOTAL SALES) 62
FIGURE 8 MAJOR U.S. MIS APPLICATION SEGMENTS, 2013 VS. 2019 (% OF TOTAL
SALES) 65
FIGURE 9 MAJOR U.S. MIS EQUIPMENT SEGMENTS, 2013 VS. 2019 (% OF TOTAL
SALES) 67
FIGURE 10 MAJOR U.S. MIS END-USER SEGMENTS, 2013 VS. 2019 (% OF TOTAL
SALES) 69
FIGURE 11 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED IN
GASTROINTESTINAL SURGERY, 2013 (% OF TOTAL SALES) 71
FIGURE 12 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED FOR
GYNECOLOGICAL SURGERY, 2013 (% OF TOTAL SALES) 74
FIGURE 13 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED FOR UROLOGICAL
SURGERY, 2013 (% OF TOTAL SALES) 78
FIGURE 14 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED IN COSMETIC
SURGERY, 2013 (% OF TOTAL SALES) 82
FIGURE 15 TRENDS IN SELECTED U.S. COSMETIC SURGERY PROCEDURES,
2000-2013 (THOUSANDS OF PROCEDURES) 84
FIGURE 24 ENDOSURGICAL INSTRUMENT MARKET LEADERS, 2013 (% OF TOTAL
SALES) 84
FIGURE 16 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED IN THORACIC
SURGERY, 2013 (% OF TOTAL SALES) 86
FIGURE 17 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED FOR CARDIAC
SURGERY, 2013 (% OF TOTAL SALES) 89
FIGURE 18 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED IN NONCARDIAC
VASCULAR SURGERY, 2013 (% OF TOTAL SALES) 96
FIGURE 19 U.S. MARKET FOR MIS DEVICES AND EQUIPMENT USED IN ORTHOPEDIC
SURGERY, 2013 (% OF TOTAL SALES) 98
FIGURE 20 EMPLOYEE NUMBERS AND SALES DISTRIBUTION OF U.S. MEDICAL AND
SURGICAL EQUIPMENT MANUFACTURERS, 2007* (% OF ALL ESTABLISHMENTS) 105
FIGURE 21 MONITORING/VISUALIZATION EQUIPMENT MARKET LEADERS, 2013 (% OF
TOTAL SEGMENT SALES) 106
FIGURE 22 ROBOTICS/COMPUTER-ASSISTED SURGERY MARKET LEADERS, 2013 (%
OF TOTAL SALES) 107
FIGURE 23 GLOBAL ELECTROSURGICAL AND AUXILIARY EQUIPMENT MARKET
LEADERS, 2013 (% OF TOTAL SALES) 108
FIGURE 24 ENDOSURGICAL INSTRUMENT MARKET LEADERS, 2013 (% OF TOTAL
SALES) 109
FIGURE 25 CORONARY STENT MARKET LEADERS, 2013 (% OF TOTAL SALES) 110

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