Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Five experts had used this technology. All have significant experience of it and continue to use it. All said that the technology is widely used in the NHS for minimally invasive surgery.

Level of innovation

All experts said that the technology is a novel concept and the only product available to perform this function. Two said the technology is a complete replacement for hand-tied knots. None of the experts was aware of any competing products.

Potential patient impact

All experts agreed that the technology would be beneficial for minimally invasive surgery. Four believed using the technology reduces cross-clamp and bypass time or would shorten procedure time in general. One said the technology could improve the speed of knotting. Four experts said that the technology results in a securer, more accurate knot.

Potential system impact

All experts acknowledged the benefit of this technology in helping minimally invasive surgery. All said that the technology costs more than standard care. Two experts believed the increased cost of the technology could be offset by reduced patient length of stay. One also believed the technology would reduce the amount of blood product needed for surgery. Two experts said that the technology would help in complex surgery. One felt shorter procedure time would be a benefit for people who are older. All experts believed training is needed but that training was simple. Three felt the technology could change the care pathway for minimally invasive surgery. One expert felt the effect of the technology should first be investigated in more clinical trials. Four experts referenced the case reports of aortic valve leaflet perforation as a safety concern, but 2 said that they happen because of inaccurate orientation of the device. One expert has completed a recent audit of more than 150 cases in their trust and reported no adverse events.

General comments

Three experts said the technology works well, or they have found it helpful, particularly in difficult cases. Three said the cost is likely to be a barrier to adoption. Three experts felt NICE guidance would help. One queried whether NICE guidance would help because the technology is already widely used. One expert believed guidance would be useful for surgeons planning a non-sternotomy approach to cardiac valve surgery.