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Boston Scientific ESS-G02-160-Apollo OverStitch Endoscopic Suturing System in Advanced GI Procedures

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The Boston Scientific ESS-G02-160-Apollo OverStitch endoscopic suturing system is reshaping therapeutic endoscopy by allowing surgeons to perform full-thickness suturing through a flexible endoscope in the gastrointestinal tract. It transforms GI procedures by turning many traditional surgeries into minimally invasive, lumen-based interventions that improve outcomes, shorten recovery, and expand what can be done in the endoscopy suite.

How the Boston Scientific ESS-G02-160-Apollo OverStitch System Works

The Apollo OverStitch endoscopic suturing system mounts on a compatible dual-channel therapeutic endoscope and converts it into a full-thickness suturing platform inside the GI lumen. The system typically consists of a needle driver assembly, an anchor exchange mechanism, a suture and anchor assembly, a cinch mechanism for knotless fixation, and tissue approximation accessories such as a tissue helix.

During a GI procedure, the endoscopist advances the OverStitch device to the target site, uses the curved needle to take full-thickness bites of tissue, and passes the anchor-suture assembly between the needle driver and the anchor exchange channel to create running or interrupted suturing patterns. Once the desired tissue approximation is achieved, a dedicated cinch is advanced over the suture to secure and cut it, delivering a knotless closure without needing complex intracorporeal knot tying.

Because the tissue helix or grasper can be deployed through the second channel, the operator can pull tissue into the suturing aperture, optimizing bite depth and alignment. This approach allows controlled, reproducible suture placement in the esophagus, stomach, and proximal small bowel with minimal additional trauma to surrounding structures.

Core Technology Features that Transform GI Procedures

The ESS-G02-160-Apollo OverStitch system is built to overcome the limits of traditional endoscopic clips, loops, and tissue adhesives in complex GI defects. Its core technologies are specifically designed to support durable, surgical-grade repair and remodeling in a fully endoluminal environment.

Key technology elements include the following functional capabilities:

  • Full-thickness suturing: The curved needle, anchor, and tissue capture mechanism are engineered to obtain full-thickness bites through the GI wall, supporting robust closure and long-term suture retention even in dynamic regions such as the stomach and esophagus.

  • Running and interrupted suturing: The device supports multiple suture patterns, so endoscopists can replicate traditional surgical techniques such as purse-string, running, figure-of-eight, or interrupted stitches depending on the indication and tissue quality.

  • Knotless cinch fixation: A dedicated cinch component slides over the free suture end to tension and lock the stitch in place, providing secure closure and eliminating the need for hand-tied knots inside the lumen.

  • Interprocedural reloading under direct vision: The system allows reloading and redeployment of sutures without withdrawing the endoscope, reducing procedure time and the risk of losing orientation in complex GI anatomy.

  • Compatibility with dual-channel endoscopes: By leveraging two channels, one for the suturing head and one for tissue manipulation, the system enables precise tissue capture and bite placement even at challenging angles.

By combining these technologies, the Boston Scientific ESS-G02-160-Apollo OverStitch endoscopic suturing system provides the durability and flexibility needed for advanced endoluminal therapies that would previously have required laparoscopy or open surgery.

Clinical Applications Across the GI Tract

The OverStitch endoscopic suturing system supports a broad spectrum of GI applications that range from bariatric therapies to defect closure and revisional procedures. This versatility is central to how it transforms GI workflows.

Commonly described clinical use cases include the following therapeutic categories:

  • Endoscopic sleeve gastroplasty (ESG) for primary obesity treatment and metabolic control by reducing gastric volume.

  • Transoral outlet reduction and gastrojejunal anastomosis remodeling for weight regain after gastric bypass.

  • Closure of mucosal and submucosal defects after endoscopic mucosal resection or endoscopic submucosal dissection.

  • Management of perforations, fistulas, and leaks in the esophagus, stomach, and proximal bowel.

  • Reinforcement of stent fixation or anchoring of devices to prevent migration.

  • Anastomotic site revision and reinforcement in complex post-surgical anatomy.

  • Experimental and emerging applications such as third-space endoscopy, internal plication, and combined endoscopic–surgical strategies.

Because these procedures can be performed through the mouth without abdominal incisions, the system supports day-case or short-stay interventions, lowers perioperative pain, and can open access to therapy for patients who are poor candidates for major surgery.

Market Trends and Data in Endoscopic Suturing and GI Closure

Endoluminal suturing devices belong to a fast-growing segment of the interventional endoscopy and GI closure market. Demand is driven by rising global obesity prevalence, increased rates of gastroesophageal reflux disease, a higher volume of complex endoscopic resections, and the continuous push toward minimally invasive care pathways.

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Recent global market analyses of endoluminal suturing systems and endoscopic closure platforms project high double-digit growth rates over the next decade, supported by:

  • Expansion of endoscopic sleeve gastroplasty programs in bariatric centers.

  • Broader adoption of revisional endobariatric procedures for weight regain.

  • Increased utilization of endoscopic defect closure after EMR and ESD in high-volume centers.

  • Reimbursement improvements for endoscopic bariatric and GERD procedures in major markets.

  • Technological advances toward robotic, AI-guided, and automated suturing within the lumen.

As endoscopic sleeve gastroplasty and related bariatric interventions become standardized and codified in clinical guidelines, the ESS-G02-160-Apollo OverStitch system is positioned as a foundational technology that enables scalable, reproducible endoluminal suturing in both hospital and ambulatory settings.

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How the OverStitch System Changes ESG and Bariatric Endoscopy

One of the most impactful applications of the Boston Scientific ESS-G02-160-Apollo OverStitch system is in endoscopic sleeve gastroplasty. ESG uses full-thickness gastric suturing to reduce stomach volume and alter gastric motility through a transoral, incision-free approach.

With OverStitch, the endoscopist can:

  • Create a tubular gastric sleeve by applying longitudinal or U-shaped plication sutures along the greater curvature of the stomach.

  • Reduce gastric volume by an estimated 70 to 80 percent, mimicking the restrictive component of surgical sleeve gastrectomy without resection.

  • Customize suture patterns based on individual anatomy, comorbidities, and operator preference.

  • Achieve durable gastric remodeling that supports significant and sustained weight loss as part of a supervised lifestyle and nutrition program.

Clinical series and controlled trials have reported meaningful excess weight loss and improvement in obesity-related comorbidities such as type 2 diabetes, dyslipidemia, and hypertension after ESG using OverStitch. Many programs report short hospital stays, rapid return to daily activities, and a favorable safety profile compared to traditional bariatric surgery in appropriately selected patients.

The ability to use the same device for revisional procedures, such as outlet reduction after bypass, gives endoscopists a single suturing platform for the full continuum of bariatric care, from primary intervention to revision.

Transforming Defect Closure and Complication Management

Beyond metabolic and bariatric indications, the ESS-G02-160-Apollo OverStitch endoscopic suturing system has transformed how GI teams handle defects, perforations, and leaks that arise in diagnostic and therapeutic endoscopy.

Traditional closure tools such as through-the-scope clips or over-the-scope clips can be limited in closing large, irregular, or high-tension defects. By contrast, full-thickness suturing allows:

  • Closure of larger iatrogenic perforations created during EMR, ESD, or dilation.

  • Management of chronic fistulas and anastomotic leaks with robust tissue apposition.

  • Layered closure of complex defects in difficult locations.

  • Reinforcement of staple lines or anastomoses after surgery.

Endoscopic suturing can reduce the need for emergency surgery, shorten hospital stay, and limit the risk of long-term complications associated with stomas or permanent diversions. It also gives interventional endoscopists increased confidence to tackle advanced resection and dissection procedures knowing they have a powerful closure tool available.

Workflow, Efficiency, and Training Considerations

From a practical standpoint, the OverStitch system is designed to fit into existing GI lab workflows while offering advanced capabilities. However, effective use requires dedicated training and standardized protocols.

Key workflow and training aspects include:

  • Familiarity with mounting and calibrating the ESS-G02-160-Apollo OverStitch device on the endoscope before each case.

  • Training on optimal tissue capture using the tissue helix or graspers to avoid superficial bites and ensure full-thickness engagement.

  • Practice in selecting the appropriate suture pattern for each clinical scenario, including ESG, defect closure, and stent anchoring.

  • Use of simulation, animal models, and proctorship programs to overcome the learning curve safely.

  • Clear team communication regarding device handling, reloading steps, and cinch deployment.

High-volume centers commonly implement a structured pathway where early cases are supervised by experienced endoscopists, and standardized checklists are used to avoid avoidable errors such as excessive tension or misaligned bites. Over time, procedure duration tends to decrease significantly as operators become more familiar with the device.

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Real-World User Cases and Quantified ROI

In routine practice, GI teams using the Boston Scientific ESS-G02-160-Apollo OverStitch system report measurable clinical and economic benefits across several use cases.

Examples of real-world impact include:

  • Bariatric endoscopy programs demonstrating substantial excess weight loss at one and two years after ESG, with improved quality of life and reduced medication use for obesity-related conditions.

  • Hospitals reducing emergency surgical rescue rates for iatrogenic perforations by incorporating endoscopic suturing as a first-line rescue tool.

  • Shorter inpatient stays and fewer ICU admissions when leaks and fistulas can be managed endoscopically rather than with major reoperations.

  • New revenue streams for GI units through advanced therapeutic endoscopy services with high demand and referral value.

  • Reduced utilization of operating room resources when procedures can be performed in the endoscopy suite with moderate or deep sedation instead of general anesthesia.

While the exact return on investment depends on case volume, payer mix, and local costs, many centers identify endoscopic suturing as a strategic capability that supports growth of interventional endoscopy, bariatric programs, and complex GI care lines.

Top GI Suturing and Closure Solutions Overview

To understand how the ESS-G02-160-Apollo OverStitch system fits into the broader landscape, it is helpful to examine key GI endoluminal suturing and closure options that might appear in the market.

Representative Endoluminal Suturing and Closure Systems

Name / System Type Key Advantages Typical Ratings and Feedback Primary GI Use Cases
Boston Scientific ESS-G02-160-Apollo OverStitch System Full-thickness suturing, running and interrupted stitches, knotless cinch, flexible patterns High satisfaction among advanced endoscopists for versatility and durability ESG, outlet reduction, defect closure, perforations, fistulas, stent fixation
Over-the-scope clipping platforms Strong mechanical closure for focal defects, relatively straightforward use Positive for selected indications Acute perforations, small to moderate leaks, focal mucosal defects
Through-the-scope clip systems Widely available, easy to deploy, low incremental cost per case Good for simple closures Small mucosal defects, hemostasis, minor perforation risk
Endoscopic plication and suturing alternatives Various designs, sometimes single-use, may have narrower indication range Mixed feedback depending on indication Limited bariatric applications, selected GERD, tissue remodeling at discrete sites
Tissue sealants and adhesives Rapid application, can complement mechanical closure Variable durability Adjunctive use in leaks, fistulas, and post-resection bed management

While clips and sealants remain essential, the OverStitch suturing system stands out for its ability to handle larger, more complex, and higher-tension lesions using surgical-style suture constructs.

Competitor Comparison Matrix for GI Suturing Technologies

A direct comparison of the Boston Scientific ESS-G02-160-Apollo OverStitch system with other closure and suturing options highlights the unique role of full-thickness endoluminal suturing.

Comparative View of Endoscopic Closure Platforms

Feature / Capability Boston Scientific ESS-G02-160-Apollo OverStitch Over-the-Scope Clips Through-the-Scope Clips Sealants / Adhesives
Full-thickness suturing Yes Indirect compression only Typically partial thickness No
Running and interrupted patterns Yes No No Not applicable
Knotless cinch fixation Yes Not required Not required Not applicable
Customizable defect coverage High Moderate for focal lesions Low Low to moderate
Use in ESG and bariatric remodeling Yes Rare Rare No
Large, irregular defect closure Strong Moderate Limited Limited as standalone
Need for dual-channel endoscope Yes (for standard configuration) No No No
Learning curve Moderate to high Low to moderate Low Low
Reusability and per-case economics Capital plus procedure-specific disposables Device cost per case Clip cost per case Adhesive cost per application

This matrix illustrates that while clips and sealants remain important tools, the Boston Scientific ESS-G02-160-Apollo OverStitch system offers a uniquely comprehensive solution for advanced endoscopic suturing where durability and flexibility are critical.

Future Technology and Innovation Directions in Endoscopic Suturing

The evolution of endoluminal suturing is likely to accelerate as new technologies converge on the GI lumen. For systems like the ESS-G02-160-Apollo OverStitch, several innovation trends are particularly relevant.

Expected developments include:

  • Integration with robotic platforms: Robotic endoscopes and robotic-assist systems could improve instrument articulation and stability, enabling more precise suturing in complex anatomy.

  • AI-supported navigation and suture planning: Real-time AI guidance could suggest optimal suture placement paths, bite spacing, and tension parameters to standardize outcomes across operators.

  • Enhanced imaging and tissue characterization: Advanced endoscopic imaging modalities may help identify ideal tissue planes and avoid critical structures during full-thickness suturing.

  • New materials and bioactive sutures: Sutures that elute drugs or biologics could turn the suturing act into a targeted drug-delivery event, supporting localized healing and anti-fibrotic or anti-inflammatory effects.

  • Streamlined device design for ambulatory centers: Simplified mounting, automated loading, and shorter setup times will support broader adoption in high-throughput outpatient settings.

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As these future innovations emerge, the Boston Scientific ESS-G02-160-Apollo OverStitch endoscopic suturing system is poised to serve as a central platform, building on its established design principles of full-thickness suturing, knotless fixation, and flexible suturing patterns.

Practical FAQs on the ESS-G02-160-Apollo OverStitch System

What types of endoscopes are typically compatible?

The OverStitch system is designed to work with selected dual-channel therapeutic endoscopes that can accommodate the suturing head on the primary channel and a tissue manipulation accessory on the secondary channel. Compatibility details are provided in the technical documentation and should always be verified before case scheduling.

Which GI procedures benefit most from the system?

The system is particularly impactful in endoscopic sleeve gastroplasty, transoral outlet reduction after gastric bypass, closure of post-resection defects, management of perforations and leaks, and reinforcement or revision of surgical anastomoses. It can also be used for stent fixation and investigational applications in third-space and transluminal endoscopy.

How steep is the learning curve?

The learning curve is meaningful but manageable with structured training. Endoscopists familiar with advanced therapeutic procedures generally achieve proficiency after a focused sequence of supervised cases, supplemented by simulation models or animal-lab training.

What are the key safety considerations?

Operators must ensure full visualization of the suture path, control tissue depth with the tissue helix or grasper, avoid excessive tension that could cause tissue tearing, and maintain awareness of nearby structures outside the lumen. Adherence to device instructions for use and institutional protocols is essential for safe performance.

How does suturing compare with clips in terms of durability?

Endoscopic suturing with full-thickness bites typically offers stronger, more durable tissue apposition than superficial clips, especially for large, high-tension, or chronic defects. Clips remain useful for small, low-tension lesions and hemostasis, but suturing is preferred when long-term mechanical strength is required.

Three-Level Conversion Funnel CTA for Endoscopy Stakeholders

For GI physicians and bariatric endoscopists, the Boston Scientific ESS-G02-160-Apollo OverStitch endoscopic suturing system represents an opportunity to expand the therapeutic toolkit, offer incision-free alternatives to surgery, and lead comprehensive metabolic and GI complication management programs. The next logical step is to evaluate current case volumes and referral patterns to determine which indications—such as ESG, outlet reduction, or complex defect closure—would benefit most from introducing or scaling suturing capabilities.

For hospital and ambulatory center decision-makers, assessing resource allocation and strategic growth plans can clarify how advanced endoluminal suturing aligns with institutional goals in bariatric services, interventional endoscopy, and minimally invasive surgery. Building a multidisciplinary team that includes surgeons, endoscopists, anesthesiologists, and nursing leaders will help integrate the system into standardized care pathways.

For industry partners, distributors, and technology leaders, collaborating around training, outcomes tracking, and workflow optimization is essential to drive sustainable adoption. Aligning device capabilities with data-driven performance metrics, patient-reported outcomes, and economic analyses will support informed decisions and long-term program success.

Outlook: The Future of GI Procedures with Endoscopic Suturing

The Boston Scientific ESS-G02-160-Apollo OverStitch endoscopic suturing system has moved endoscopy beyond diagnostics and superficial interventions into a new era of therapeutic, reconstructive, and metabolic treatments delivered entirely through the GI lumen. By combining full-thickness suturing, flexible suture patterns, and knotless fixation in a single platform, it enables endoscopists to replicate many surgical maneuvers without incisions.

As endoluminal suturing technologies continue to evolve, their role in obesity management, GERD and reflux therapy, complex defect closure, and revisional GI procedures is expected to grow further. The convergence of advanced imaging, robotics, and intelligent guidance promises even more precise and reproducible outcomes, reinforcing the central role of systems like ESS-G02-160-Apollo OverStitch in the future of gastrointestinal care.

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(d) Exclusions. MRP reserves the right, without liability, to void all warranties and remedies, including any obligation to service, repair, replace or otherwise remedy defects, errors or failures of the Equipment due to the occurrence of any of these events, and MRP shall be in no way responsible for: (i) handling, maintenance or use in a manner that is inconsistent with and/or contrary to the original manufacturer’s or MRP’s recommended procedures and/or instructions, including, without limitation, use of or with an unauthorized third-party good or part; (ii) any failure or damage resulting from negligence, alteration, modification or relocation of the Equipment by Buyer, its employees, agents or representatives; (iii) attempted or actual unauthorized dismantling, disassembling, service, repair, addition or change of the Equipment, including, without limitation, changing the serial number or shot count; (iv) abnormal wear and tear, including, without limitation, use under abnormal conditions (e.g., unclean, dusty, or exposure to extreme electromagnetic radiation, temperature or humidity); or (v) damage or failure of the Equipment due to a Force Majeure Event or a problem in the premises of the Equipment. In any of the above situations, or for any Equipment that has no warranty, MRP has sole discretion to service the Equipment, at Buyer’s expense, at MRP’s then-in-effect rates for service, labor, travel, shipping and materials.

(e) Notice and Inspection. The limited warranties contained in this Section 8 are made on condition that immediate written notice of any noncompliance with the Equipment’s and/or the Service’s warranty be given to MRP, and provided that MRP’s inspection reveals that Buyer’s claim is valid under the terms of such warranty.

        9.  DISCLAIMERS; NO OTHER WARRANTY. EXCEPT TO THE EXTENT AS PROVIDED IN SECTION 8(c)(i)(D), BUYER ACKNOWLEDGES THAT MRP IS NOT BOUND BY ANY WARRANTY THAT MAY BE SET FORTH IN A MANUFACTURER’S WRITTEN MATERIALS THAT WOULD HAVE APPLIED HAD BUYER PURCHASED THE EQUIPMENT DIRECTLY FROM THE MANUFACTURER IN ITS UNUSED STATE. BUYER ACKNOWLEDGES THAT BUYER HAS NOT RELIED UPON ANY WARRANTY OTHER THAN AS SET FORTH IN THIS AGREEMENT. IN ADDITION, BUYER ALSO HEREBY ACKNOWLEDGES AND AGREES THAT ANY ORAL OR WRITTEN STATEMENTS CONCERNING USE AND REGULATION OF MEDICAL DEVICES SOLD BY MRP ARE AND SHALL BE CONSTRUED AS FOR INFORMATIONAL PURPOSES ONLY AND WITHOUT WARRANTY OR ASSURANCE BY MRP AS TO THEIR ACCURACY OR VALIDITY. MRP ALSO HEREBY DISCLAIMS ANY AND ALL WARRANTIES REGARDING OTHER MEDICAL CARE OR HELP, INCLUDING THE SELECTION OF AESTHETIC AND MEDICAL PROCEDURES AND PRODUCTS FOR, OR CARE OF, PATIENTS. THE LIMITED WARRANTIES OF THIS AGREEMENT, IF APPLICABLE TO ANY EQUIPMENT OR SERVICE FURNISHED UNDER THIS AGREEMENT, CONSTITUTE THE ONLY WARRANTIES MADE WITH RESPECT TO THE EQUIPMENT AND/OR SERVICE AND ANY DEFECT, DEFICIENCY OR NONCONFORMITY. TO THE EXTENT PERMITTED BY LAW, SUCH WARRANTY IS IN LIEU OF ALL OTHER WARRANTIES, EXPRESS OR IMPLIED BY LAW, COURSE OF DEALING, COURSE OF PERFORMANCE, USAGE OF TRADE OR OTHERWISE, INCLUDING, BUT NOT LIMITED TO, ANY EXPRESS OR IMPLIED WARRANTY OF MERCHANTABILITY, TITLE, NONINFRINGEMENT OR FITNESS FOR A PARTICULAR PURPOSE.

        10.  LIMITATION OF LIABILITY. NOTWITHSTANDING ANYTHING TO THE CONTRARY IN THIS AGREEMENT, UNDER NO CIRCUMSTANCES SHALL MRP BE LIABLE FOR ANY INDIRECT, PUNITIVE, INCIDENTAL, CONSEQUENTIAL, EXEMPLARY OR SPECIAL DAMAGES, ARISING FROM, RELATED TO OR CAUSED, DIRECTLY OR INDIRECTLY, WHETHER FORESEEABLE OR NOT, BY THE EQUIPMENT AND/OR THE SERVICES, THE USE OR INABILITY TO USE THE EQUIPMENT, THE RESULTS GENERATED FROM THE EQUIPMENT AND/OR THE SERVICES, THIS AGREEMENT, ANY OTHER ACT OR OMISSION OF MRP, OR BASED UPON ANY OTHER LEGAL THEORY. IN NO EVENT SHALL MRP BE LIABLE FOR ANY LOSSES OF REVENUE, USE, BUSINESS OPPORTUNITY, PROFIT, SAVINGS OR ANY OTHER DAMAGES DUE TO ANY CAUSE WHATSOEVER, EVEN IF MRP OR ITS AGENTS HAS BEEN ADVISED OF THE POSSIBILITY THEREOF. THE FOREGOING IS A SEPARATE, ESSENTIAL TERM OF THIS AGREEMENT, AND SHALL BE EFFECTIVE UPON THE FAILURE OF ANY REMEDY, EXCLUSIVE OR NOT. IN NO EVENT WILL MRP’S TOTAL LIABILITY UNDER THIS AGREEMENT EXCEED THE PURCHASE PRICE ACTUALLY PAID TO MRP BY BUYER FOR THE EQUIPMENT AND/OR THE SERVICES GIVING RISE TO THE CLAIM FOR WHICH DAMAGES ARE BEING SOUGHT. NO SUIT OR ACTION MAY BE BROUGHT BY BUYER, ITS SHAREHOLDERS, DIRECTORS, MANAGERS, EMPLOYEES OR AGENTS FOR ANY BREACH OF THIS AGREEMENT MORE THAN ONE (1) YEAR AFTER THE ACCRUAL OF SUCH CAUSE OF ACTION. IT IS AGREED THAT MRP’S LIABILITY IS SO LIMITED. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, BUYER ASSUMES ALL RISK AND LIABILITY FOR THE RESULTS OBTAINED BY THE USE OF ANY EQUIPMENT IN THE PRACTICE OF ANY PROCESS, WHETHER IN TERMS OF OPERATING COSTS, GENERAL EFFECTIVENESS, SUCCESS OR FAILURE, AND REGARDLESS OF ANY ORAL OR WRITTEN STATEMENTS MADE BY MRP, BY WAY OF TECHNICAL ADVICE OR OTHERWISE, RELATED TO THE USE OF THE EQUIPMENT.

        11.  BUYER’S REPRESENTATIONS AND WARRANTIES. Buyer represents and warrants to MRP that: (a) Buyer is duly organized, validly existing, and in good standing in the jurisdiction of Buyer’s formation; (b) Buyer is duly qualified to do business and is in good standing in every jurisdiction in which such qualification is required; (c) Buyer has the full right, power, and authority to enter into this Agreement and to perform Buyer’s obligations under this Agreement; (d) the execution of this Agreement by the person whose signature is set forth at the end hereof has been duly authorized by all necessary corporate action of Buyer; (e) when executed and delivered by each of MRP and Buyer, this Agreement will constitute the legal, valid and binding obligation of Buyer, enforceable against Buyer in accordance with its terms; (f) Buyer is in compliance with all applicable laws relating to this Agreement, the Equipment and the operation of Buyer’s business; (g) Buyer is not insolvent and is paying all of its debts as they become due; and (h) all financial information that Buyer has provided to MRP is true and accurate and fairly represents Buyer’s financial condition.

        12. PROPRIETARY RIGHTS.

(a) Ownership. No sale shall be construed as granting to Buyer any license or other right in, or to, any of MRP’s (i) patents; (ii) trademarks; (iii) internet domain names, whether or not trademarks, registered by any authorized private registrar or governmental authority, web addresses, web pages, websites and URLs; (iv) works of authorship, expressions, designs and design registrations, whether or not copyrightable, including copyrights and copyrightable works, software and firmware, technical data, data files, and databases and other specifications and documentation; (v) trade secrets; (vi) environmental or other testing applicable to the Equipment and/or the Services; and (vii) industrial and other intellectual property rights, and all rights, interests, and protections that are associated with, equivalent or similar to, or required for the exercise of, any of the foregoing, however arising, in each case whether registered or unregistered and including all registrations and applications for, and renewals or extensions of, such rights or forms of protection pursuant to the laws of any jurisdiction throughout in any part of the world (collectively, the “Intellectual Property Rights”).

(b) Prohibited Acts. Buyer shall not (i) take any action that might interfere with any of MRP’s rights in or to Intellectual Property Rights, including MRP’s ownership or exercise thereof; (ii) challenge any right, title, or interest of MRP in or to the Intellectual Property Rights; (iii) make any claim or take any action adverse to MRP’s ownership of the Intellectual Property Rights; (iv) register or apply for registrations, anywhere in the world, for MRP’s trademarks or any other trademark that is similar to MRP’s trademarks or that incorporates MRP’s trademarks in whole or in confusingly similar part; (v) use any mark, anywhere that is confusingly

similar to MRP’s trademarks in whole or in confusingly similar part; (vi) engage in any action that tends to disparage, dilute the value of or reflect negatively on the Equipment and/or the Services or any of MRP’s trademarks; (vii) misappropriate any of MRP’s trademarks for use as a domain name without prior written consent from MRP; or (viii) alter, obscure or remove any of MRP’s trademarks, or trademark or copyright notices or any other proprietary rights notices placed on the

Equipment, marketing materials or other materials that MRP may provide.

        13.  CONFIDENTIAL INFORMATION. Without the prior written consent of MRP,Buyer, directly or indirectly, shall not disclose (and will direct its directors, shareholders, employees and agents not to disclose) any Confidential Information. The term “Confidential Information” means any information of or relating to MRP or the Equipment and/or the Services not generally known to the public (other than as a result of disclosure in violation of this Agreement) in spoken, printed, electronic or any other form or medium, including, but not limited to, business processes, practices, methods, policies, plans, publications, documents, research, operations, services, strategies, techniques, agreements, contracts, transactions, potential transactions, know-how, trade secrets, databases, manuals, records, supplier information, financial information, accounting information, legal information, marketing information, pricing information, payroll information, personnel information, and supplier lists.

        14.  NON-SOLICITATION. Buyer agrees not to solicit or hire any personnel of MRP involved with the delivery of the Services during the provision of such Services and for twelve (12) months after the completion of such Services; provided, however, that Buyer may hire individuals employed by MRP who, without other solicitation, respond to advertisements or solicitations aimed at the general public.

        15.  EQUITABLE REMEDIES. Buyer acknowledges and agrees that (a) a breach or threatened breach by Buyer of any of its obligations under Sections 13 or 14 would give rise to irreparable harm to MRP for which monetary damages would not be an adequate remedy and (b) in the event of a breach or a threatened breach by Buyer of any such obligations, MRP shall, in addition to any and all other rights and remedies that may be available to MRP at law, at equity, or otherwise in respect of such breach, be entitled to equitable relief, including a temporary restraining order, an injunction, specific performance, and any other relief that may be available from a court of competent jurisdiction, without any requirement to post a bond or other security, and without any requirement to prove actual damages or that monetary damages will not afford an adequate remedy. Buyer agrees that Buyer will not oppose or otherwise challenge the appropriateness of equitable relief or the entry by a court of competent jurisdiction of an order granting equitable relief, in either case, consistent with the terms of this Section 15.

        16.  INDEMNIFICATION. Buyer agrees to indemnify, defend and hold harmless MRP and its directors, shareholders, employees and agents (collectively, “MRP Indemnitees”) against any liability, damage, loss or expense incurred by or imposed in connection with any claims, suits, actions, demands or judgments arising out of (a) any breach or non-fulfillment of any representation, warranty or covenant set forth in this Agreement by Buyer or its directors, managers, employees or agents (collectively, “Buyer’s Agents”); (b) any negligent act or omission or willful misconduct of Buyer or Buyer’s Agents in connection with this Agreement; (c) any bodily injury, death of any person or damage to real or tangible personal property caused by Buyer or Buyer’s Agents, including the use of unauthorized parts in or service of the Equipment; (d) any failure by Buyer or Buyer’s Agents to comply with any applicable laws; (e) any fraud or other intentional acts by Buyer or Buyer’s Agents; and (f) the use or operation of the Equipment, including, without limitation, any medical and/or surgical procedures performed by Buyer, and any of Buyer’s Agents, using the Equipment unless said damages are determined by a court of competence jurisdiction to be solely by the gross negligence of MRP or solely as result of a breach by MRP of the limited warranties contained herein.

        17.  DEFAULTS; REMEDIES. Notwithstanding anything herein to the contrary, should Buyer fail to pay for the order or any other amount, in whole or in part, when due or perform its other obligations under this Agreement or as otherwise mutually agreed in writing between Buyer and MRP (each, a “Default”), then MRP may take any and all actions available under law or equity to collect said amounts with a ten (10) day prior written notice, including, but not limited to, enforcing its security interest, accelerating the payment of and declaring immediately due and payable any unpaid balance of the order, referral to outside collection agencies and/or commencement of legal action. MRP’s rights shall be cumulative, and it shall not be required to have attempted to realize upon to the Equipment before taking any other collection actions. MRP may require that Buyer assemble and return any or all of the Equipment to MRP and, in the event Buyer fails to return such Equipment peaceably, enter upon the premises where such Equipment is located, with or without legal process, and repossess such Equipment. Upon a Default, Buyer agrees to pay upon MRP’s demand: (i) all costs and expenses incurred by MRP or its assignee in connection with the enforcement of any remedies, including all expenses incurred in connection with the return, sale, release or other disposition of the Equipment, including attorneys’ fees and other costs incurred by MRP or its assignee in enforcing or defending its rights and remedies under this Agreement and any other written agreement between Buyer and MRP.

        18.  COMPLIANCE WITH LAWS. Buyer shall (a) carry out the transactions contemplated by this sale and deal with the Equipment in conformity with all applicable laws, rules and regulations of all government authorities, including, without limitation, export laws, (b) obtain all permits and licenses required in connection with the purchase, shipment, installation or use of the Equipment, and (c) be solely responsible to fully understand and comply with laws, rules and regulations. Any information provided is as a convenience only.

        19.  FURTHER ASSURANCES. Upon MRP’s reasonable request, Buyer shall, at its sole cost and expense, execute and deliver all such further documents and instruments, and take all such further acts, necessary to give full effect to this Agreement.

        20.  ASSIGNMENT; SUCCESSORS AND ASSIGNS. Buyer cannot delegate any duties nor assign any rights or claims under this Agreement without MRP’s prior written consent, and any such attempt or assignment shall be void. In the event that Buyer finances its acquisition of any Equipment with a third party, Buyer may direct MRP to transfer title of such Equipment to such third-party financing company, with all remaining terms and conditions of this Agreement remaining in full force and effect. This Agreement is binding on and inures to the benefit of the parties to this Agreement and their respective permitted successors and permitted assigns.

        21.  NO THIRD-PARTY BENEFICIARIES. Subject to Section 16, this Agreement benefits solely the parties to this Agreement and their respective permitted successors and assigns, and nothing in this Agreement, express or implied, confers on any other person any legal or equitable right, benefit, or remedy of any nature whatsoever under or by reason of this Agreement.

        22.  GOVERNING LAW; VENUE. The application of the UN Convention on Contracts for the International Sale of Goods is expressly excluded. The parties agree that any and all claims, demands, disagreements, controversies or disputes arising out of or relating to this Agreement and any agreement or document delivered in connection herewith (collectively, “Claims”) shall be governed by and construed in accordance with the laws of the State of Utah and adjudicated exclusively in the state and federal courts located in or nearest to Summit County, Utah, which courts shall have the sole and exclusive jurisdiction and venue for adjudication of all Claims. The parties hereby agree upon, consent and stipulate to the jurisdiction and venue of the aforementioned courts for the adjudication of all Claims, to the exclusion of all other courts, forums and venues whatsoever.

        23.  NON-DISPARAGEMENT. Buyer shall not disparage MRP or MRP’s trademarks, websites, products or services, or display any such items in a derogatory or negative manner on any website or in any public forum or press release.

        24.  NOTICES. Any notice, demand, or communication required, permitted or desired to be given hereunder shall be deemed effectively given when personally delivered, when sent by electronic means, when received by overnight courier, or when mailed by prepaid, certified or registered mail, return receipt requested, addressed to the other party at its address set forth on the Quote or to such other address that the receiving party may designate from time to time in accordance with this Section 25.

        25.  PUBLIC ANNOUNCEMENTS. Unless otherwise stated herein, neither party shall issue a press release or otherwise advertise, make a public statement or disclose to any third-party information pertaining to the relationship arising under this Agreement, the existence or terms of this Agreement, the underlying transactions between MRP and Buyer or agent for Buyer or refer to the other party in relation to this Agreement without the other party’s prior written approval.

        26.  ENTIRE AGREEMENT; ADDITIONAL OR INCONSISTENT TERMS. Subject to Section 32, this Agreement constitutes the sole and entire agreement between the parties hereto relating to the subject matter hereof, and any unincorporated representation, affirmation of fact, course of prior dealings, promise or condition in connection therewith, or usage of the trade, shall not be binding on either party. Terms and conditions set forth which differ from, conflict with or are not included in this Agreement shall not be part of any agreement between MRP and Buyer unless both parties specifically accept such terms and conditions in writing.

        27.  WAIVER. No waiver under this Agreement is effective unless it is in writing and signed by the party waiving its right. Any waiver authorized on one occasion is effective only in that instance and only for the purpose stated and does not operate as a waiver on any future occasion. None of the following constitutes a waiver or estoppel of any right, remedy, power, privilege or condition arising from this Agreement: any failure or delay in exercising any right, remedy, power or privilege or in enforcing any condition under this Agreement; or any act, omission or course of dealing between the parties.

        28.  SURVIVAL. Subject to the limitations and other provisions of this Agreement, the representations and warranties of Buyer contained herein shall survive the expiration or earlier termination of this Agreement for a period of twelve (12) months after such expiration o termination and (b) this Section 29 and Sections 10, 12, 13, 14, 15, 16, 17, 21, 22, 23, 24, 26, and 32 of this Agreement, as well as any other provision that, in order to give proper effect to its intent, should survive such expiration or termination, shall survive the expiration or earlier termination of this Agreement. All other provisions of this Agreement shall not survive the expiration or earlier termination of this Agreement.

        29.  RELATIONSHIP OF PARTIES. Nothing in this Agreement creates any agency, joint venture, partnership or other form of joint enterprise, employment or fiduciary relationship between the parties. Neither party has any express or implied right or authority to assume or create any obligations on behalf of or in the name of the other party or to bind the other party to any contract, agreement or undertaking with any third party.

        30.  HEADINGS. The headings in this Agreement are for reference only and do not affect the interpretation of this Agreement.

        31.  ORDER OF PRECEDENCE. In the event of conflict between the Quote, a written agreement by MRP, and these Terms, the order of priority shall be: (1) the written

agreement by MRP, if only if executed by an MRP Officer, (2) the Quote and (3) these Terms, and only to the extent of the direct conflict. Notwithstanding the foregoing, MRP shall not be bound by, and specifically objects to, any terms, conditions or other provisions, both written and oral, which are different from, in addition to or inconsistent with the provisions of this Agreement which are set forth in any purchase order, receipt, acceptance, confirmation, correspondence or otherwise of, or by, Buyer. Fulfillment of Buyer’s order shall not constitute acceptance of any of Buyer’s terms and conditions and does not serve to modify or amend the terms and conditions contained herein.

        32.  SEVERABILITY. If any part of this Agreement is held to be void, illegal or unenforceable, then it shall be deemed to be severed from this Agreement and the remaining provisions shall continue in full force and effect; provided, however, that if any fundamental term or provision of this Agreement is held to be void, illegal or unenforceable, the remainder of this Agreement shall be unenforceable. Upon a determination that any term or provision is void, illegal or unenforceable, the parties shall negotiate in good faith to modify this Agreement to effect the original intent of the parties as closely as possible in order that the transactions contemplated hereby be consummated as originally contemplated to the greatest extent possible.