Safely Introducing New Surgical Devices in Minimally Invasive Gynecologic Surgery: an Argument for Use of the IDEAL Framework.

OBJECTIVE:To review the Food and Drug Administration (FDA) premarket regulatory and postmarket surveillance processes for 2 minimally invasive gynecologic surgery case studies-the laparoscopic power morcellator and the Essure permanent birth control device-and to introduce the IDEAL (Idea, Development, Exploration, Assessment, Long-term) framework for safely introducing and monitoring minimally invasive gynecologic surgery devices.DATA SOURCES:News media publications, agency websites, legal articles, and scientific papers.METHODS OF STUDY SELECTION:Articles and papers were selected that described events leading to FDA approval of these devices and subsequent complications.TABULATION, INTEGRATION, AND RESULTS:Based on current FDA premarket regulatory processes, 67% of devices do not currently require premarket review and only 1% are subject to clinical trial requirements. The IDEAL framework delineates 5 phases for safe introduction of medical devices: idea, development, exploration, assessment, and long-term study.CONCLUSION:The laparoscopic power morcellator and Essure cases illustrate possible shortcomings in our device approval system that could be improved upon using the IDEAL framework, which limits device use until safety and efficacy data have been established and recommends postmarket surveillance.