- May 14, 2019
By David Wexler
Laparoscopic surgery, also known as Band-aid or minimally invasive surgery, has revolutionized abdominal procedures.
With the promise of smaller, thumbnail-like incisions leading to less pain and quicker recovery, minimally invasive procedures are now being applied to an increasing variety of surgeries. They are gaining in popularity with patients and doctors.
Dr. Stephen Moenning, a third-generation physician based in Punta Gorda, is on the forefront of this technology. He has developed a device designed to improve the delivery of medications during laparoscopic surgery.
The device also is intended to protect medical professionals from being accidentally stuck by a needle during surgery; the issue of accidental needle stick injuries is often talked about in medical circles, although a clear solution has never been developed.
Moenning's work toward fixing this problem was recognized by the judges for the Technology Innovation Awards, sponsored by the Gulf Coast Business Review/82 Degrees Tech. Moenning's company, RxTrocar was a runner-up in the contest.
Trocars are required for use in laparoscopic surgeries and almost all other types of minimally invasive surgery. Trocars are basically body access devices used for going in and out of a body cavity such as the abdomen.
Moenning says 66% of surgeons who use traditional trocars will frequently inject the area around a trocar to reduce a patient's pain.
The problem with this standard "needle" approach, Moenning says, is the transfer of a needle and syringe from a surgeon to a health care worker. The transfer of a contaminated sharp needle can potentially infect either the worker or the surgeon. If a needle stick injury occurs, there is the risk of hepatitis, HIV or other blood borne pathogens.
"The challenge of the RxTrocar was to add onto existing trocars design while creating a new drug delivery system and eliminate the risk of a needle stick injury," Moenning says.
During a laparoscopic surgical procedure, small incisions are made and plastic tubes called ports are placed through these incisions. A camera is introduced through the ports, which allow access to the inside of the patient.
"The RxTrocar enables the surgeon to use one device to perform two separate functions," Moenning says. "One, is injecting the patient's port site to lower pain at that area, and secondly, the surgeon has access into the patient's body cavity to do the minimally invasive surgery."
Moenning, 46, knows first-hand the dangers of a needle stick injury, having been stuck once while completing a fellowship at Parkland Hospital in Dallas.
"We saw a huge number of HIV-positive patients and people with hepatitis, and it really rocks your boat for a little bit," Moenning says. "When a surgeon or a health care worker becomes stuck, it really is a life-changing event."
The cost to a hospital if a health care worker is stuck with a needle is about $2,500, Moenning says.
There are other benefits of RxTrocar. Medication is infused at the port in a 360-degree fashion; the device can accurately deliver the exact volume to the port site for predictable and reproducible dosing; the surgeon can infuse at any time during the case.
RxTrocar evolved from CA Guard, a company that Moenning incorporated in 1998 that developed a medical product called a Port Site Protector. Moenning changed the name from CA Guard to RxTrocar in June 2004 to better reflect the company's emerging biotechnology growth.
Moenning was born in Greenfield, Ind. and graduated from Indiana University before joining his father, Dr. John Moenning, and two other surgeons at Harborside Surgery Center in Punta Gorda.
He spent much of his life around medicine. His father, a general surgeon, is now the current president of the Florida Chapter of the American College of Surgeons. His grandfather was also a surgeon and one of the founders of St. Francis Hospital in Indianapolis.
Moenning says his interest in medicine grew after taking three missionary trips with his family: two to Africa and one to South America.
"I got to see a part of medicine that I think really endeared me to it," Moenning says. "I got to see the old-fashioned Marcus Welby-type thing with patients and doctors, where you're truly delivering a service to people."
Straws, duct tape and string
Moenning first thought of the idea for the drug delivery device in 1994, after reading an article about how trocars were being used to treat cancer.
"At that time, they started to find that when they took these trocars out, if they were doing cancer surgery, they would occasionally get tumor cells," Moenning says. "Everybody, including the surgeons, were worried that these tumor cells were spreading to the skin, so I thought, 'Wouldn't it be nice if we had a trocar that would protect the skin?' I said, 'Well maybe I can make a sleeve that could go around the trocar.'"
So one afternoon, he gathered some plastic straws, electrical tape and some string from around the house and devised the first prototype at his kitchen table.
The product has yet to hit the commercial market. Moenning's strategy is to license the technology to a larger trocar manufacturer for a royalty payment or through an outright purchase of the company. Moenning says he hopes a manufacturer will incorporate the design improvements into a new type of trocar.
But Moenning has learned over the past eight years that convincing manufacturers to license his innovation has not been easy. In fact, there were times when he thought about giving up on his dream.
"As a surgeon, I can see the benefit, so I know it appeals to me," Moenning says. "But you have to say, 'Do you believe in it enough to invest money and be willing to lose money?' I've been willing to take that risk."
In April, Moenning teamed with Madison Keats, a life sciences investment firm, to assist in finding a partner. Moenning says he hopes the product will hit the market by next year.
He attributes his success to two things: having the funds to support his innovation - he has funded his innovations entirely by himself with $500,000 - and perseverance.
Moenning has developed six different prototypes of the trocar. He has 15 patents and three patents pending for the RxTrocar and some additional innovations. His product also has received approval from the Food and Drug Administration.
Moenning faces fierce competition in the trocar market, which is dominated by Johnson & Johnson's Ethicon Endo-Surgery and Tyco's United States Surgical Corp. Combined, the two companies control more than 90% of the $500 million trocar market.
"I can't tell you the number of times doors from the experts have been shut in my face," Moenning says. "The medical device companies would take a look at my first-generation prototype and say 'No, I don't like it. It doesn't work because of the following reasons.' At that point, you go back to the drawing board. I kind of went through the learning curve on my own."
Dr. Stephen Moenning, whose advances in tools for surgery landed him as a runner up for the Technology Innovation Awards, says the best part of emerging technologies is that it is like Christmas morning – the kind where you don't know what's in the box.
"With technology, there's a certain excitement and appeal in regards to the unknown. In our day and age of technology, there's always the opportunity to go back to the store again," he says. "If you wait long enough, there is always new technology coming down the pike. What I like is the unexpected and the satisfaction that one gets when you hit upon the correct technology that does truly make your life a little bit easier and a bit safer."
The tough part, Moenning concedes, is getting past the trial and error part of what works and what doesn't work. But he tells budding technological entrepreneurs to stick with it.
"If you believe in the product, no matter what other people tell you, you need to follow your dream. Because at the end of your dream, there will be a rainbow," he says. "It may not be the rainbow you want or the rainbow that last night when you put your head on that cool pillow you thought you would get, but it will be a rainbow. You'll be a better person the next morning."