Reusable versus Disposable Laparoscopic Instruments

Reusable Versus Disposable Laparoscopic Instruments

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Want more information on What Is a Trocar Used for in Surgery? Feel free to contact us.

Cost-effectiveness in health care management is critical. The financial crisis and continuous cuts in National Health System expenses in Greece have compounded the situation. In an effort to reduce the costs of laparoscopic procedures, our department introduced reusable laparoscopic instruments (RLIs) in December 2011. This study aimed to assess the potential cost savings of laparoscopic operations within general surgery. Hospital records, invoice lists, and operative notes from January 2012 to December 2013 were reviewed, collecting data on laparoscopic procedures, instrument failures, and replacement needs. The initial acquisition cost of five basic RLI sets was €21,422. Over the next 24 months, they were used in 623 operations, with a total maintenance cost of €11,487. Based on an average retail price of €490 per set, the projected cost with disposable laparoscopic instruments (DLIs) would amount to €305,270, resulting in savings of €272,361 over the two-year study period. Despite the high initial purchase price, each set paid off its acquisition cost after just nine procedures, reducing instrument cost to less than €55 per case. Disposable instruments cost nine times more than reusable ones, with high costs nearly matching the total hospital reimbursement by social security funds for many common laparoscopic procedures.

Under budget limitations, our department introduced RLIs to minimize laparoscopic surgery costs without compromising health service quality. The primary aim was to assess the potential cost reduction for laparoscopic procedures between January 2012 and December 2013 in general surgery. The secondary aim was to calculate annual maintenance expenses of RLIs and explore further cost-reducing strategies.

The adoption of minimally invasive laparoscopic surgery and advancements in technology have reduced the cost of sophisticated instruments. However, laparoscopic surgery generally remains more expensive than open surgery. While higher operating theater costs are partly offset by shorter hospital stays, less medication, shorter recovery periods, and faster returns to work, multiple studies have shown that RLIs significantly reduce costs for surgical departments.

The study excluded the costs of insufflation and suction-irrigation tubes, clip appliers, retrieval bags, mesh patches, staplers, etc., as there are no reusable alternatives. Hospital records and opera­tive notes from January 2012 to December 2013 were examined, and data were collected on the types and numbers of laparoscopic operations, instrument failures, and replacement needs. Maintenance cost was calculated based on resterilization, repackaging, repair, and replacement expenses. Retail prices for DLIs were obtained from the National Price Observatory for Health Supplies. DLI disposal costs, based on waste weight, were negligible.

Based on an average retail price of €490 per set, the cost of 623 procedures with DLIs would be €305,270. The actual total instrument cost was €32,909, yielding savings of €272,361 over two years.

Two-year maintenance costs amounted to €11,487. Resterilization and repackaging costs were calculated at €5 per procedure, totaling €3,115 for the study period. Replacement and repair expenses amounted to €8,372, primarily due to torn trocar valves and a broken grasper forceps. Trocar valves were replaced every 10 procedures on average, while scissors were sharpened after 60-80 operations.

In December 2011, five basic RLI sets were purchased (AESCULAP, B-BRAUN, Tuttlingen, Germany) for €21,422 each. Each set included a curved monopolar dissector, atraumatic grasp monopolar forceps, Metzenbaum monopolar scissors, a suction-irrigation device, a Veress needle, a Hasson cannula, and bladeless trocars. These sets were used in 623 laparoscopic operations over the following two years.

Discussion

Effective health care management has always been a critical issue, further exacerbated by Greece's financial crisis and National Health System budget cuts. Hospital administrators face the challenge of drastically reducing expenditures and using resources wisely.

Our preliminary study of reusable versus disposable laparoscopic instruments anticipated net yearly savings of around €80,000, based on 200 laparoscopic operations annually. Two years later, our analysis supports these expectations. Despite the seemingly high purchase price, each RLI set recouped its cost after only nine additional laparoscopic operations. The initial cost was 65% of total two-year expenditure, depreciating to less than €55 per patient. This figure is expected to fall even more with each future use of the instruments.

Approximately 30% of annual maintenance costs covered fixed expenses like resterilization and repackaging, while 70% accounted for replacements and repairs. Worn-out valves required frequent replacement, resulting in higher CO2 volumes to maintain pneumoperitoneum pressure. We observed that most leaking valves were torn at the rubber seal, likely due to forceful instrument insertion/withdrawal.

Our reusable instruments study, based on specific retail prices for DLIs from the National Price Observatory, offers a clear financial advantage for RLIs over single-use instruments. Each institute may have different cost factors, and deals with suppliers can vary. However, this study indicates that RLIs provide significant cost savings. The choice between RLIs and DLIs ultimately lies with the surgeon, guided by cost-effectiveness rather than personal preference.

Increasing RLI use in urology and gynecology could add 50 to 100 procedures annually, further reducing costs. Annual maintenance expenses, at €5,750, are already quite acceptable.

The company is the world’s best What Is Trocar Used for supplier. We are your one-stop shop for all needs. Our staff are highly-specialized and will help you find the product you need.

Further discussions about reusable versus disposable laparoscopic instruments have considered initial skepticism regarding RLIs, weighing high acquisition and maintenance costs against the risk of infecting patients or medical personnel, instrument inefficiency, and durability. However, these issues, once prevalent in the 1990s, are now largely resolved through technological advancements, newer designs, and proper training.

Next to trocar valves requiring replacement every 10 procedures, scissors need sharpening after 60-80 operations, while bladeless trocars do not require sharpening. Reusable trocars may require more force during insertion, potentially leading to more intra-abdominal injuries. However, our team has not observed any visceral or vascular injuries with either the Veress or the Hasson approach. It is imperative to insert trocars under direct vision to minimize the risk of damaging abdominal organs.

To learn more about Keyes Punch Biopsy Forceps, contact us today to secure an expert consultation!

Instrument cost is a small fraction of total hospital costs per patient. For sustainable healthcare management, a comprehensive cost-effectiveness approach should involve ambulatory protocols, targeted preoperative patient assessments, and standardized enhanced recovery pathways.