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New survey reveals how surgeons define innovation in real life

A recent survey carried out by Sermo, a physician-only online community of more than 1.3 million healthcare providers globally, commissioned by Ethicon, has reported fascinating insights into the challenges that bariatric surgeons and other specialty surgeons are facing in this post-pandemic world. Bariatric News spoke with Tulio Oliveira, Global Head, Endocutters at Ethicon (a Johnson & Johnson MedTech company), who discussed surgeons’ concerns about risk of complications as patients present with more disease complexity and challenging tissue conditions. In addition, he revealed how innovation in surgical stapling technology, supported by evidence, is associated with improved clinical and economic outcomes.


Why did Ethicon decide to carry out the survey?

At Ethicon, our first responsibility is the patient. We are focused on the clinical impacts of our technologies and how we can continually enhance our technological development so we can help deliver improved outcomes. For us, this clinical conversation with surgeons – getting insights into what challenges they face and what technologies are needed to address their needs – is one of the most important conversations we can have.


It is crucial to understand, ‘what are the clinical impacts of what we do?’ That’s why we decided to partner with Sermo. The survey gave us the opportunity to hear from surgeons in a different way and get insights into the real-life challenges they are facing on a daily basis.


Why is it important to understand the challenges surgeons face post-COVID?

Tulio Oliveira

COVID impacted many different areas of society – economic, political, industrial, cultural and of course, healthcare. What we heard through the survey is that surgeons continue to cope with persistent issues exacerbated by the pandemic. In fact, 41% of surgeons stated they believe it is more challenging to practice surgery today than before COVID-19.


There was a significant impact on elective surgeries throughout the pandemic, and metabolic and bariatric surgeries are still affected today. Our goal is to understand what specific challenges surgeons are facing in this post-COVID world and how those challenges are impacting bariatric procedures, bariatric patients, patient conditions, tissue conditions and other considerations, as we keep innovating solutions to meet their real-life needs.


In the survey itself, you interviewed 156 surgeons, how many were bariatric surgeons?

In total, there were 156 surgeons interviewed; 53 bariatric, 51 thoracic and 52 colorectal. Each of these surgical specialties serve some of the most complex surgical procedures and patient tissue conditions.


Which countries did the surgeons come from?

We conducted the survey in seven countries including the US, Brazil, the UK, France, Germany, Italy and China as we believe it’s critical to identify priorities for innovation alongside surgeon partners around the world.

What were the key findings from bariatric surgeons?

First, nearly half of bariatric surgeons believe it is just as challenging, if not more so, to practice bariatric surgery today than before the COVID-19 pandemic. This manifested in several ways including cost constraints, patient backlog and staff shortages. These are challenges across any healthcare system today.


Secondly, 70% of bariatric surgeons said their top challenge is managing patients with more complexity. They are seeing patients present with more advanced disease, which can lead to more complex procedures. This may be due to patients having forgone routine screenings during the pandemic.


Third, 77% of bariatric surgeons reported that bleeding complications pose the most serious implications to patients and the healthcare system. This is likely connected to an aging, more complex patient population, leading to a greater risk of complications such as bleeding, haemostasis, anastomotic and pneumatosis-related leaks.


The survey revealed that nearly half of surgeons report managing patients with more complex tissue conditions, likely associated with aging and numerous comorbidities. Is this because the patients presenting now had to wait longer so their condition has deteriorated or is it because more patients are presenting with more challenging conditions, or is it a mixture of both?

What we are hearing is the delays – months and months, maybe even years – impacted the patient flow and have obvious consequences on the progression of disease. As a result, tissue becomes more complex to treat which may increase the risk of very serious complications like bleeding or leaks. Understanding the tissue variability that surgeons are facing informs how we develop our technology to support surgeons and patient outcomes. For example, our ECHELON surgical staplers have demonstrated an association with improved clinical outcomes across tissue types and a 73% reduction in hemostasis-related complications in bariatric laparoscopic sleeve gastrectomy (as compared to another device).


This type of technology reduces complications in exactly the areas that those patients are presenting with more risk. That is what all of us in the healthcare industry should fight for.


The survey highlighted ongoing cost-constraints in our health system. Can you elaborate?

Post-COVID, we have seen staff shortages around the globe. The combination of a rise in costs, fewer elective procedures, and continuing pressures on staffing levels has had a significant economic impact. Hospitals are working hard to provide care to patients in need and reduce patient backlog.


When you're talking about fewer complications it encompasses the clinical aspect as well as health economics, so we need to deliver technology that can help reduce complications in a tangible way.


Reducing complication rates ultimately reduces the overall costs to the health system. This means treating patients in the best way possible, and utilizing advanced technologies supported by evidence.


Johnson & Johnson is a company that has a proud history of innovation, not just in the surgical field but across healthcare. What innovations are you working on at the moment?

The solutions and technologies we develop are determined first and foremost by the needs of the patient. Our deep understanding of device-tissue interaction lies at the heart of our design process and guides our innovation in the pursuit of transforming surgery.


In the next several years there will be an interesting transformation with more advanced surgical stapling technologies coming to the forefront. For example, technologies that will be able to deliver tissue and device interaction. Our technologies will be tailored to deliver more tissue specific solutions, more precise and more personalised medicines, and treatments. In this way, technology will be able to respond to patient and tissue conditions, not just in a general way, but more specifically to the tissue variability of each individual.


60% of surgeons in the survey said that the primary driver of trust in the surgical device technology is clinical evidence. How do we deliver better clinical evidence?

Safety and superiority are driven by durable and effective evidence-based clinical data. Gathering robust evidence requires thoughtful planning and time – it is a multi-year, decades long effort. You cannot prove superior outcomes without evidence. When you develop evidence-based data, it means you can reliably show how design can translate to improved outcomes in this type of patient condition.

At Ethicon we have been developing and building our knowledge base for many years. Our ECHELON surgical stapling devices have been studied in more than 46,000 patients around the world. For us, it's not just about device features – it is about the clinical impacts and outcomes. We are already working hard preparing for the next generation of evidence that we need to develop the next gold standard in stapling.


Moving away from the survey, at the recent ASMBS meeting, Ethicon debuted a new approach to showcase the stapler and attendees took part in a friendly competition with other players. How did the interactive experience work?

ECHELON Interactive is a unique approach to engage surgeons and demonstrate the innovation

behind our technology. Through a game-like interface, we’ve created a sensory experience intended to highlight the differentiation of our newest stapling technology and it was very well received. Surgeons appreciated how the concepts of greater access and control came through in a fun and engaging way, and those who participated came back to check their status on the leader board throughout the meeting.

Overall, we had a great response which is really heartening when you hear such feedback from our surgical partners on a new innovation like ECHELON 3000 because it shows that we listened, and we delivered a better way to staple through enhanced control and improved access for challenging anatomy. This is the way we approach innovation. We listen, we capture real-life insights, and we deliver technologies to better serve patients living with obesity.

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