Reusable and disposable surgical tools combine best of both worlds

Add the word “reposable” to your vocabulary. This method may be cheaper and safer than reusing single-use items.

No study of the sterility of re usable versus disposable equipment has provided a universally accepted answer as to if one is safer than the other. As a result, surgeons make personal decisions about what equipment can or cannot be reused.

Reprocessors claim to sterilize millions of surgical tools without incident, but the practice clearly is questioned by surgeons who refuse to reuse. Developing countries reuse out of necessity those items that surgeons in industrial countries never would consider, such as gloves and drapes.

Kenneth R. Kenyon, MD, of Cornea Consultants in Boston, said he selects instruments for quality as well as sterility. He will not use disposable microkeratomes for his refractive surgeries, because using a conventional instrument gives him the confidence that the disposable ones will not, he explained.

However, disposable vacuum trephines can be sterilized and reused because they are designed more simply than a microkeratome, he said.

“Disposable microkeratomes have been less than impressive,” Dr. Kenyon said, “whereas disposable corneal transplantation trephines seem to be underutilized. For tubing and cannulas, I err on the side of one use and then dispose for fear of the consequences of infection.”

Examination of reused cannulas has revealed debris residing in the bore, which may trigger keratitis. As a rule, if there is a risk of infection, he chooses disposable instruments.

However, many surgeons still reuse equipment to reduce overhead costs in an ambulatory surgical center (ASC) setting.

According to R. Bruce Wallace III, MD, in practice in Alexandria, U.S.A., reusing equipment means more profit to the surgery center and not necessarily less cost to the patient.

“If surgeons are not invested in the surgical center, then they favor one-use disposables,” he said. “If they are dealing in a surgical center, they may be using diamond knives for incisions. If they are using stainless steel, they tend to sterilize and reuse. But that can raise some patient safety issues and even medical-legal ramifications.”

Cost, sterility

Richard J. Ruckman, MD, routinely examines these issues and teaches coursework on running efficient practices at large ophthalmic conferences. His practice at the Center for Sight in Lufkin, U.S.A., provides a testing ground for his efforts to make phaco practices as efficient as possible.

Because he has not found any sterility differences in reusable versus disposable knives, he allows economics to guide his thinking.

Instead of buying disposable metal knives, Dr. Ruckman buys a diamond paracentesis and keratome, with the belief that he can use it for 5 years without needing anything more than standard maintenance.

The paracentesis blade costs him US$2,400, the keratome costs US$2,800 and repairs cost US$866 annually, without considering any accidents befalling the blade.

Compared with a single-use metal paracentesis blade and keratome, which would cost US$24.50 per case, in the first year that he converted to diamond blades he saved US$19,000 based on his procedure volume, he said. Over the course of 5 years, the cost per case of diamond blades is US$3 per case. Using metal at US$24.50 per blade, reusable blades saved him US$118,000 in 5 years, based on the volume of eyes he performs in his clinics.

Diamond blades are as sterile as disposable ones, Dr. Ruckman said, so the cost weighs in more heavily.

“The key here is repair and maintenance,” he said. “I’ve been fortunate in that I have not damaged a blade until one last year. The key is a single designated person to maintain the diamond and take great care. We have one technician who is key to that success.”

Wear and tear

Also, Dr. Ruckman runs a single-surgeon ASC. Multi-surgeon facilities and hospitals can create greater wear and tear on diamond blades, so at these facilities it may be more effective to use disposable equipment, he explained.

“There shouldn’t be any question with a single-use disposable or a diamond blade. The question comes up in the reuse of single-use items,” Dr. Ruckman said. What must be questioned is a metal blade with a plastic handle, which is more likely to collect debris and become a potential source of infection.

Physicians and ASCs seek to work as inexpensively and efficiently as possible, and a metal blade may be sharp enough for three to five cases, even though it is only marked for one use.

Dr. Ruckman said, “This has become a topic of great concern not only to the ophthalmologist, but also to virtually all the hospitals, where they use bigger instruments or items that they send out to third party reprocessors. There’s a big question about whether it is safe or effective to use that.”

Costs compared

One solution has been “reposable” instruments, or the reusable, disposable equipment. These items are labeled for more than one use, but are not designed for years of wear.

Blades are not the only area where this development can save surgeons money. Phaco tubing is now labeled as reposable. Dr. Ruckman compared the costs on two brands of phaco equipment he uses in his ASC.

For one of those units, disposable tubing cost US$37 per eye. The cost per eye of reusable tubing was US$3.16. The other phaco unit cost US$53.75 per eye for disposable and US$5.36 for reposable.

“Reposable is the best of both worlds,” Dr. Ruckman said. “Your liability is minimized. You’re not exceeding the manufacturer’s recommendations or overstepping that you cannot verify product safety and function.”

For Your Information:

Kenneth R. Kenyon, MD, practices at Cornea Consultants, 100 Charles River Plaza, Boston, MA 02114 U.S.A.; +(1) 617-523-2010; fax: +(1) 617-523-4242. Dr. Kenyon has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

R. Bruce Wallace III, MD, practices at 4110 Parliament Drive, Alexandria, LA 71303 U.S.A.; +(1) 318-448-4488; fax: +(1) 318-448-9731. Dr. Wallace has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

Richard J. Ruckman, MD, practices at the Center for Sight, Two Medical Center Blvd., Lufkin, TX 75904 U.S.A.; +(1) 409-634-8434; fax: +(1) 409-639-2581. Dr. Ruckman has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.