Category Archives: ablation

treatment via various energy-based (e.g., laser, microwave, ultrasound, radiofrequency, thermal, etc.) technologies to destroy diseased tissue, cauterize blood vessels for hemostasis, create lesions in myocardium to preempt errant electrical signals in arrhythmia and other purposes.

Ablation technology regional growth to 2019

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In our analysis of the global market for the spectrum of ablation technologies – Electrical, Radiation, Light, Radiofrequency, Ultrasound, Cryotherapy, Thermal (other than cryo), Microwave, and Hydromechanical — we assessed the size and growth of sales of these technologies with specificity to a large number of regions and countries:

  • U.S.A.
  • Canada
  • Brazil
  • Mexico
  • Germany
  • United Kingdom
  • France
  • Italy
  • Spain
  • BeNeLux
  • Japan
  • China
  • India
  • Australia
  • Rest of World

Below, we illustrate, ranked from low to high, the compound annual growth rates of each geography/technology combination.  This data reflects the strong trends that exist for clinical adoption and sales growth of specific technologies, driven by the unique combination of country-specific and technology-specific forces.

Source: Report #A145, MedMarket Diligence, LLC.

Global Energy-based Ablation Devices Markets, Forecast to 2019

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The global market for energy-based ablation devices in 2011 stood at $11.5 billion.

“Ablation” is considered in the context of medical technology to be a therapeutic destruction and sealing of tissue. As general as this effect on tissue can be, its clinical applications — from cancer to cardiology, urology to ophthalmology and all manner of general surgical procedures — is as broad a therapeutic range as any medical technology on the market.

The technologies represented in clinical practice are, by type of energy:

  • Electrical
  • Radiation
  • Light
  • Radiofrequency
  • Ultrasound
  • Cryotherapy
  • Thermal (other than cryotherapy)
  • Microwave
  • Hydromechanical

The MedMarket Diligence report #A145, “Ablation Technologies Worldwide Market, 2009-2019″, is considered the most comprehensive global report on the products, technologies, and the current and forecast global, regional and country-specific markets.  In this report, the market for the spectrum of ablation technologies has been analyzed, considering current and emerging products and companies, by modality (energy type) and country to 2019.

The dominant market is the U.S., representing a full 43% of the global market (and for this reason needs to be shown on a different y-axis scale than all other country markets for ablation) :

US_Ablation

Source: Report #A145.

 

Clinical Applications of $11.5 Billion Ablation Technologies Market Mapped

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The performance of surgery has undergone a steady evolution over the past 40 years, moving from procedures employing scalpels and sutures to procedures employing a dizzying number of product types — reusables/disposables, devices/biologics/hybrids, percutaneous/endo-laparoscopic, real-time MRI and other image-guidance and the whole spectrum of devices and equipment in the $11.5 billion ablation technology market.  This last field harnesses the capabilities of instruments differentiated largely by energy type to therapeutically treat tissue by destruction, excision, sealing and other means.

For reference, a dictionary definition of tissue ablation is “the removal of a body part or the destruction of its function, as by surgery, disease, or a noxious substance.” From a device/instrumentation standpoint (as opposed to, for example, chemically-based ablation), ablation is the therapeutic destruction and sealing of tissue or creation of other therapeutic effect in tissue. The predominant forms of device-based ablation technologies include:

  • Electrical
  • Radiation
  • Light
  • Radiofrequency
  • Ultrasound
  • Cryotherapy
  • Thermal (other than cryotherapy)
  • Microwave
  • Hydromechanical

While the tissue effects produced by these different modalities have potential for use in virtually all clinical applications, their emerging use is concentrated in a fairly well defined but detailed list.  The largest share of the market for energy-based ablation devices, driven to a significant extent by its long history in clinical practice, is in cancer therapy, primarily via radiation therapy. General surgical applications represent the next most common use of ablation technologies, especially those using electrocautery and electrosurgical devices, radiofrequency ablation and cryotherapy, etc. Cardiovascular applications then represent the next most active area of ablation technologies, especially given the often acute nature of cardiovascular disease.

Most of the universe of ablation technology clinical applications is illustrated in the map, below.

Source: MedMarket Diligence, LLC (Report #A145)

Ablation technologies in cancer

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Cancer represents a major target of the clinical applications of ablation technologies, as illustrated by the share of each modality’s 2011 revenues that are used in cancer:

Source: Report #A145, “Ablation Technologies Worldwide Market 2009-2019″, MedMarket Diligence, LLC.

Considering the utility of the different ablation types for treatment of cancer, it’s not surprising that radiation is the dominant source of ablation technology revenues for cancer in 2011.

Share of All Ablation Revenues in Cancer, by Modality, 2011

Source: Report #A145, “Ablation Technologies Worldwide Market 2009-2019″, MedMarket Diligence, LLC.

Ablation technologies global growth (electrical, radiation, light, RF, ultrasound, cryo, thermal, microwave, hydro)

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The global market for ablation is in steady growth, but also is shifting in the balance of technologies employed.

The global market for energy-based ablation Devices in 2011 was estimated at almost $11.5 billion. For purposes of definition, ablation is considered to be a therapeutic destruction and sealing of tissue. The technologies that fall into this segment to nine different types based on the energy modality employed:

  • Electrical
  • Radiation
  • Light
  • Radiofrequency
  • Ultrasound
  • Cryotherapy
  • Thermal (other than cryotherapy)
  • Microwave
  • Hydromechanical

Below is illustrated, first, the 2009 and 2019 revenues ($millions) for ablation by energy type and, second, the 2009 and 2019 revenues by energy type as a percent of total.

 

Source: MedMarket Diligence, LLC, Report #A145, "Ablation Technologies Worldwide Market, 2009-2019".

 

Although the applications of ablation devices include a number of aesthetic treatments, the majority of applications remain chronic disorders in areas which include cancer, cardiovascular, urology, gynecology and orthopedics. Many of these disorders are age-related, and the related device segments are driven by the aging of the global populations.  Other market drivers include the Chinese government’s push to modernize its healthcare facilities by building 400 hospitals per year, and developed country populations which are demanding anti-aging treatments, to which physicians are responding by purchasing equipment

Clinical trends and market growth in ablation technologies

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The number and type of clinical applications for tissue ablation are proliferating almost as fast as the number and type of technologies and manufacturers.  These versatile technologies have clinically demonstrated ability to provide therapeutic destruction of tissue, excision of tissue, formation of therapeutic lesions and other therapeutic benefits across a wide range of clinical specialties.

Over the past decade, the application of ablation technologies has been propelled by clinical evidence, indeed.  The ability to precisely target malignant tissue (e.g., tumors, errant pathways in arrhythmia, fibroids, etc.) while producing minimal "collateral" tissue damage has validated many specific ablation modalities (e.g., laser, radiofrequency, microwave, cryo, etc.) for specific clinical applications. Those benefits notwithstanding, the growth of ablation technology in the medical device industry has been even further propelled by innovative manufacturers who have aligned their product development with the specific needs of clinicians and healthcare systems to produce instrumentation and equipment that facilitates the effective management of large patient caseload at reasonable cost and attractive clinical outcomes.

The future of ablation technology markets will be dictated by recent trends and the continued development of products that offer clinicians with effective tools in their armamentaria to manage growing patient populations in cost effective and clinically advantageous ways.

Below is illustrated the 2011 worldwide ablation technologies market and its forecast growth by modality type.

Source: MedMarket Diligence, LLC; Report #A145, "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities."

Growth and uptake of ablation technologies in clinical practice

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Technologies for the therapeutic ablation of tissues are diverse — from ultrasound to electrical, light to radiation — but their common function is to cause the controlled destruction of tissue, either for its excision or simply to remove its aberrant function (as in arrhythmia).

The uptake of the different ablation technologies in clinical practice is driven by the relevance of specific energy types for specific tissue types, the ability to avoid collateral tissue damage, clinician acceptance of manufacturers' equipment and devices and a variety of other factors.

The resulting size of the different ablation market segments, and their growth, is a result of both the historical success each has had in clinical practice and the degree to which these are trending toward continued uptake in therapeutic ablation.

Source: MedMarket Diligence, LLC; Report #A145, "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities."

Use of ablation technologies in liver cancer

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Radio frequency ablation (RFA), with limitations, has shown to be effective and has increasingly become the standard of care for non-resectable liver disease. Radiofrequency ablation devices work by sending alternating current through the tissue. This creates increased intracellular temperatures and localized interstitial heat. When temperatures exceed 60°C, cell proteins rapidly denature and coagulate, killing the cells and producing a lesion. The lesion can be used to resect and remove the tissue or to simply destroy the tissue, leaving the ablated tissue in place.

Laser-induced interstitial thermotherapy (LITT) and microwave have also been utilized for the ablation of HCC tumors, although these two treatments do not seem to work as well on large tumors as other treatments. Interstitial laser photocoagulation uses a thin optical fiber (which is inserted into the center of the tumor) and a laser. When the laser light is emitted, the cancerous cells undergo thermal necrosis. Interstitial microwave kills the tumor cells by heating them to a high temperature (50 degrees C) for an extended period of time.

Minimally invasive irreversible electroporation is another treatment for HCC tumors. Electroporation increases the permeability of the cell membrane by exposing the cell to electric pulses. Irreversible electroporation opens the cell membrane in such a way that the cell cannot reverse the process and close the membrane. This open membrane causes the cell’s death. Irreversible electroporation is felt by some researchers to be comparable to cryosurgery, nonselective chemical ablation and high temperature thermal ablation.

From "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities", Report #A145; MedMarket Diligence, LLC

Ablation technologies are driven by cancer therapy, general surgery and cardiovascular disease treatments

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Technologies used for medical and surgical ablation are used in virtually all clinical practices.  Ablation is the therapeutic destruction or excision of tissue for purposes ranging from the destruction and excision of cancerous or otherwise diseased tissue, the cauterizing of wounds, the formation of therapeutic lesions as in ablation of abnormally conducting cardiac tissue in atrial fibrillation and others.

Ablation technology types are differentiated, for the most part, on the kind of energy employed.  These include light/laser, radiation, radiofrequency, microwave, ultrasound, cryo, electrical, thermal and hydromechanical.

While the number and type of ablation technologies makes them versatile tools for use in a wide range of general surgical procedures, the predominant use of ablation technologies is in cancer therapy for the excision and destruction of cancerous tissue, followed by general surgery applications, then cardiovascular disease applications. Below is the share of the global medical technology product revenues in ablation by major clinical area of application.

Share of Global Medical Product Revenues in Ablation, by Clinical Area

Source:  "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities", MedMarket Diligence, LLC, Report #A145.

The current aggregate market for ablation technologies worldwide stands at over $11 billion, with most technology types growing at double-digit rates as these technologies are made more and more routine in clinical practice and as physicians increase the patient caseload (and indications) targeted by these technologies.

Growth of modalities in tissue ablation

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An examination of the future markets for technologies used in therapeutic ablation has support for a general and sustained growth in ablation technology revenues:

Ablation-modality-growth-revenues

Source: Report #A145

However, when considering the relative growth of each of the modalities in tissue ablation, it is clear that some modalities are growing more aggressively than others:

Ablation-modality-growth-shares

Source: Report #A145

The “traditional” types of tissue ablation — electrosurgery and radiation therapy — are losing relative share as new modalities are able to penetrate caseload of other modalities, or even tap previously untreated patients and increase the aggregate caseload. In particular, radiofrequency and cryotherapy will demonstrate the highest growth over the 2011 to 2019 period.

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