Disposables usage as reuse instruments discussed

1. Reuse of Disposable
Instruments in Laparoscopy
Drs Pravin John & Dr John Thanakumar
Anurag Hospital
Coimbatore
India 641028
www.anuraghospital.com

3. Laparoscopic
Instruments
• Disposable
• Reusable

4. Advantages of
Disposables
• Sharpness
• Theoretical reduced risk of disease
transmission

5. Disposable instruments
• 10mm, 5 mm Ports or trochars
• Lap Hand instruments like scissors,
dissectors, graspers
• Stapler Handles
• Heat source Handles- US, Bipolars
• Single incision/ access/ port devices

6. Why do we use disposable
instruments only once?
• Manufacturer says,‘Use only once’
• Fear of litigation in case of malfunction
• Easy to throw away after single use
• Human labour and work avoided

7. Cost in Disposables
• 1990-94, Canadian Study
• Each lap instrument cost $ 2.64 -4.66
• Purchase of 10 reusable instruments $ 1,83,279
• By reusing these, $ 527,575 saved
• Reusables priced thrice by hospital overheads
DesCoteaux et al, Can J Surg,1996

8. Precautions while
reusing disposables
• Instruments discarded in Hep B, Hep C &HIV
• Check instrument integrity before cleaning
• Note the number of previous uses
• Thorough cleaning
• Complete sterilization

9. Mechanical Cleaning
• Mechanical wipe of the instruments
• Immerse in saline for 10 min
• Wash off the blood
• Take it apart and inspect parts
• Discard if unfit
• Use brushes for ports and graspers

10. Chemical Cleaning
• After mechanical cleaning with running
water and drying with pressured air
• Chemical cleaning with enzymatic products
(protease, lipase, amylase,etc)- enhances
breakdown of blood and other products

11. Ultrasonic Cleaner
• Ultrasonic cleaners are more efficient, 10-
15 minutes, in neutral pH solution
• Then dry with compressed air

12. Sterilization
• STERRAD using hydrogen peroxide vapor
and gas plasma is rapid and preferred.
• Ethylene oxide (ETO) can also be used.It is
slow
• Disposables are NOT to be autoclaved.

13. Colak et al, 2004
• 125 laparoscopic cholecystectomies
• Single use disposables reused by 2%
gluteraldehyde
• No difference in operating time, pain, hospital
stay or complications including infection
Results

14. Advantages of Reusing
Disposables
• Economic- Definitely
• Ecologic - Less wastage of plastics
• Educative- Learning of parts by nurses & students
• Employment- affords work force
• Exploring new avenues - SILS port after multiple
uses substituted in anal end as operating
proctoscope for transanal endoscopic resection

15. Dr Pravin John & Dr John Thanakumar
Bariatric & Advanced Laparoscopic Surgery
Anurag Hospital,
8, Krishna Nagar,
Sowripalayam Main Road,
Sowripalaym,
Coimbatore 641028.
Landline 0422 6587871
Email: drjact@gmail.com
https://twitter.com/Lapsurgeon_JACT