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Segment Reporting and Foreign Operations - Operating Income (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended
--- | --- | ---
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Net Sales | $ 233,249 | $ 221,659 | $ 224,810 | $ 203,035 | $ 190,897 | $ 179,337 | $ 186,549 | $ 171,069 | $ 882,753 | $ 727,852 | $ 603,838
Operating expenses |  |  |  |  |  |  |  |  | 336,153 | 293,184 | 230,149
Operating income (loss) | 13,661 | 21,061 | 15,114 | 8,781 | 13,219 | 879 | 13,362 | 5,609 | 58,617 | 33,069 | 34,876
Total other income (expense) - net |  |  |  |  |  |  |  |  | (9,098) | 2,812 | (9,490)
Income tax expense | 3,022 | 2,766 | 624 | 1,090 | 4,474 | 1,364 | 1,830 | 690 | 7,502 | 8,358 | 5,265
NET INCOME | $ 9,188 | $ 16,619 | $ 10,941 | $ 5,269 | $ 6,806 | $ (3,569) | $ 9,483 | $ 14,803 | 42,017 | 27,523 | 20,121
Cardiovascular |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Net Sales |  |  |  |  |  |  |  |  | 849,477 | 700,613 | 580,151
Operating expenses |  |  |  |  |  |  |  |  | 321,461 | 281,095 | 218,659
Operating income (loss) |  |  |  |  |  |  |  |  | 49,289 | 24,819 | 30,053
Endoscopy |  |  |  |  |  |  |  |  |  |  |
Segment Reporting Information [Line Items] |  |  |  |  |  |  |  |  |  |  |
Net Sales |  |  |  |  |  |  |  |  | 33,276 | 27,239 | 23,687
Operating expenses |  |  |  |  |  |  |  |  | 14,692 | 12,089 | 11,490
Operating income (loss) |  |  |  |  |  |  |  |  | $ 9,328 | $ 8,250 | $ 4,823

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