The introduction of narrow-gauge Single Use Instruments in vitreoretinal surgery has resulted in more efficient surgery and is a general trend for retinal surgery in ambulatory surgery centers. Reusable vitreoretinal equipment was preferred during the 20-gauge vitrectomy era. Repair and maintenance of this larger equipment were less expensive than that of small-gauge surgical instruments. As the use of minimally invasive vitreoretinal surgery becomes more common, many surgeons favor disposable vitreoretinal equipment due to aspects such as reliability, fragility, sterility, competitive pricing, and a wide range of alternatives.
Disposable Single Use Instruments are Less Expensive:
RELIABILITY:
More than a decade ago, the first generation of disposable Single Use Instruments and 25-gauge vitreoretinal surgery was introduced. These first-generation instruments were extremely adaptable, but they lacked quality and consistency in their grabbing platform and cutting capacity. The first disposable 25-gauge instruments were less reliable than reusable 20-gauge instruments, and the limited instrumentation type selections limited the types of cases that could be done with them.
Vitrectomy surgery has since been transformed by the use of 23-gauge, 25-gauge, and, most recently, 27-gauge instruments. With improved microsurgical instruments, the concerns of instrument flexibility and reliability have been largely resolved. Manufacturers have made small-gauge instruments more rigid by modifying the shaft design and integrating titanium into its fabrication. As a result, the present generation of disposable small-gauge instruments is dependable.
Although the quality of microsurgical tools manufactured by different manufacturers varies, the general quality is outstanding, and the range of available instruments has greatly expanded, ensuring a plethora of possibilities to solve each surgical difficulty. When a fresh disposable tool is opened, a surgeon can be confident that it will perform consistently and as intended. Such dependability is critical for the surgeon. The progressive deterioration of reusable forceps or scissors, for example, can impair the precision of membrane removal or cutting, ultimately leading to surgical delays and possible problems that may harm outcomes.
FRAGILITY:
Reusable Single Use Instruments were the basis of vitreoretinal surgery during the era of 20-gauge vitrectomy, despite being considered small and fragile by most surgical personnel. Reusable devices deteriorated with time, necessitating periodic servicing and replacement. The total use of these devices, as well as how effectively they were maintained by ophthalmic surgical staff, determined their longevity.
Smaller-gauge surgical single use instruments are considerably more difficult to maintain. Even an experienced ophthalmic surgical worker can harm this sensitive equipment accidentally. The tiniest adjustment in the gripping platform or scissor blades will affect function, increased operative time, and influence results. Staff must receive extensive training to properly care for these little pieces of equipment. Because maintenance is onerous, the necessity for more frequent servicing and replacement has an even bigger impact.
These concerns are avoided by using disposable small-gauge equipment. An ophthalmic technician can readily be taught to always protect the instruments. This also allows for faster room turnover and preparation for the following surgery.
STERILITY:
With any reused instrument, sterility is an issue. The possibility of inadequate cleaning during the sterilisation process between instances raises concerns regarding sterility and hygiene. Tiny tissue fragments might be difficult to recognize and even more difficult to remove from the gripping platform or cutting blades. The handling of neural tissue may increase the possibility of prion infectious pathogens contaminating instruments. Washing reusable single use instruments is time-consuming, and complex, and causes surgery turnaround times to be delayed. Using disposable instruments, the surgeon may be confident that the instrument is always sterile.
COST:
There are numerous elements to consider when comparing disposable and reusable equipment for small-gauge vitreoretinal surgery. Disposable instruments have consistent costs. Furthermore, purchasing in bulk allows you to negotiate a cheaper unit cost. The true cost of reusable instruments is far more difficult to calculate and forecast.
In our experience, the average reusable device costs between $2000 and $3500. Of course, surgeons must have multiples of each tool, which dramatically increases the initial investment in new apparatus. Reusable instruments in our surgical center often require 3 or 4 repairs per year, depending on the number of cases done and wear and tear. Each repair costs between $800 and $1000 on average. We replace instruments once a year on average, with at least one working instrument of each type available at all times.
Reusable instrument intangible costs are more difficult to estimate. A tool that fails during a case might put the OR crew and surgeon under strain. The time it takes to clean and sterilize reusable microsurgical equipment is lengthy and can severely delay room turnover. While an instrument is being replaced, intraoperative time can be extended. Throughout a busy OR day, the cumulative effect of reusable tool delays can be equal. The time required to execute another surgical procedure. These time considerations are especially essential in an ambulatory surgery center situation.
A Large Selection of Options:
When we employed reusable tools in our surgical center. The expense of each instrument limited our capacity to keep a diverse array of instrument options on hand. When less commonly used single use instruments were needed, they were frequently in disrepair, corroded, or even rusted, depending on the time since their last usage.
Forceps, scissors, picks, laser probes, contact lenses, diamond-dusted sweepers, backflush instruments, and light fibers are among the disposable small-gauge instrument options available today. Several companies provide high-quality disposable items. Because each surgeon’s surgical techniques and tastes differ. We recommend that retina surgeons contact each firm individually to request samples for evaluating these items. Furthermore, because most disposable goods are marketed in packets of four or six, surgeons have the option of switching from one manufacturer to another. If numerous surgeons work in the same facility, each may have a different set of favorite instruments.
CONCLUSION:
When deciding between reusable and disposable vitreoretinal single use instruments, numerous considerations must be considered, including reliability, fragility, sterility, cost, and the number of instruments required on hand. Reusable equipment is difficult to maintain and prone to damage in the era of small-gauge vitrectomy surgery. The cost of reusable instruments can make having a wide range of possibilities unavailable. We believe that disposable devices provide outstanding dependability and sterility, are more cost-effective when calculating both tangible and intangible expenses, and allow for a considerably broader range of possibilities.
