Directed energy device-based medical therapies have greatly influenced the way physicians deliver care in a number of medical specialties. One of the most dramatic areas of change has been in the management of benign prostatic hyperplasia, commonly referred to as an enlarged prostate. DE treatments in this area have become so popular there has been a noticeable decline in once standard surgical therapies since the late 1990s as patients have migrated to these less-invasive alternatives. This expansion in BPH DE-based therapies is being driven not only by a shift toward less-invasive treatment options, but also by the rising number of patients susceptible to prostate ailments.

Small cap firms that reach a successful exit via M&A tend to share a set of chacteristics that enable significant value creation. Start-ups can use them as a template to gauge their own potential for success. Indeed, those characteristics, which include the development of a novel, best-in-breed technology with significant clinical impact, having a set of products that deliver a competitive edge, and careful execution of their respective business plans (including managing capital and timelines), can serve as a template for early-stage medical device companies, and help define the parameters necessary for them to engineer their way towards an outcome that maximizes value.

MiniMed's growth rate has been slipping down through the teens for some time: the introduction of long-acting basal insulin is slowing growth of its core insulin pump business, and development of a continuous glucose monitoring system has seemingly slowed to a snail's pace. And the dynamic growth opportunity envisioned two years ago, when Medtronic bought MiniMed, is now impinging on the parent corporation's balance sheet.

Dealmaking in the device industry is occasional and incremental when compared with the level of activity in pharmaceuticals, the result of that industry's maturing into a handful of dominant players, not all of which see acquisitions as strategically critical to their long-term success. The less-than-robust public market for small device companies is both symptom and cause of the device dealmaking lull. Because the markets they target are generally too small to sustain years of significant growth, few investors are willing to invest in them as stand-alone companies. And without long-term investor support, smaller firms have few options other than to sell out to large companies and little negotiating leverage when they do so.