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At least 37 records · Page 2Linked to original sources
PubMed1995

Single-use versus reusable laparoscopic surgical instruments: a comparative cost analysis.

OBJECTIVE: Our purpose was to determine and compare the total annual costs for reusable and single-use laparoscopic instruments. STUDY DESIGN: Records were kept over a 12-month period of all laparoscopic operations (performed only with reusable instrumentation), the surgical instruments used, depreciation costs, and all associated expenses (repairs, maintenance, replacements, cleaning, sterilization, wages). The total cost was then calculated and compared with the total cost (purchase price plus disposal fees) that single-use instruments would have caused for the same operations. RESULTS: The total cost for single-use instruments would have been more than seven times that for reusable instruments. CONCLUSION: We have decided to continue using reusable instruments for most of our laparoscopic operations. However, single-use instruments are used in situations in which they present a definite advantage. A proper balance is thus sought between the importance of cost factors, on the one hand, and the recognition of the need for the best instrument available for certain procedures, on the other.

Costs and Cost Analysis↗
PubMed2006

Simulating staffing needs for surgical instrument distribution in hospitals.

Timely and accurate delivery of surgical instruments to operating rooms is critical for success in surgical operations in hospitals. The National Hospital of Singapore was facing several problems in the process of surgical instrument distribution on ad hoc orders from operating rooms. To solve the problems, the Hospital management considered adopting a new process of surgical instrument distribution on ad hoc orders that involves staffing new healthcare assistants for delivery of surgical instruments to operating rooms. Using computer simulation, this study assessed the efficiency of the new process and recommended the optimal number of healthcare assistants needed for delivery of surgical instruments on ad hoc orders, at which healthcare assistants as well as surgical instruments could be most efficiently utilized. The results show that computer simulation is an effective tool supporting decisions on staffing needs for surgical instrument distribution in hospitals.

Computer Simulation↗
PubMed1995

Evolution of powered surgical instruments.

The history of powered surgical instruments has paralleled their need in surgery, particularly surgery involving hard tissue like bone or teeth. This development was of great importance, as the sophistication of procedures became more demanding, requiring the use of implants. The fields of neurosurgery, orthopaedics, otology, and dentistry have all played key roles in the development of the high-powered surgical instruments that are now used in every surgical and dental subspecialty. Power modalities that include pneumatic and electric sources along with the development of interchangeable accessories have revolutionized the surgical field, making procedures both safer and faster. Many physicians, dentists, and companies continue to contribute to this exciting and rapidly evolving industry.

Electricity↗
PubMed1999

Universal calibration of surgical instruments for spinal stereotaxy.

PURPOSE: To describe new software applications and interchangeable instrumentation enabling the use of standard surgical instruments with image-guided systems for stereotactic spinal procedures. CONCEPT: The ability to adapt essentially any surgical instrument for stereotactic procedures will improve the safety and accuracy of image-guided spinal surgery. RATIONALE: Using universal dynamic registration hardware and software, standard surgical instruments are adapted for real-time image-guided surgery. The Radionics Optical Tracking System (Radionics, Inc., Burlington, MA) has custom software applications and universal hardware adaptation devices for spinal stereotaxy that allows the use of standard instruments for intraoperative guidance. An array of light-emitting diodes can be attached to essentially any rigid instrument with a definable tip and can then be calibrated to the system for intraoperative use. Stereotactic guidance of a drill, tap, and screwdriver may improve screw placement accuracy in spinal surgery because every step of the procedure can be monitored in real time. DISCUSSION: Most stereotactic systems have only a standard probe or limited instruments for localization, targeting, and tracking a procedure. The surgeon then resumes the operation using standard surgical instruments without the benefit of image guidance for the key steps of the procedure. Because each surgical step for screw placement in the spine has a potential for error, use of multiple instruments that can be interchanged for real-time image-guided spinal surgery may increase the accuracy and safety of spinal instrumentation procedures. These techniques can also be applied to intracranial image-guided surgery.

Bone Screws↗
PubMed1991

[Burns caused by electric surgical instruments].

Employment of electric surgical instruments involves a potential risk of burning at the neutral electrode. These are frequently third degree burns. Skin grafting may shorten the course of the illness. The importance of good contact over the entire neutral electrode plate is emphasized.

Adult↗
PubMed1999

Levels of naturally occurring microorganisms on surgical instruments after clinical use and after washing.

Surgical instruments exposed to sterile body sites should be contaminated with relatively low levels of microbial contamination or bioburden; however, few studies in the literature have determined the quantitative level and types of contamination. A study was conducted at 2 clinical sites to determine the level of microbial contamination of surgical instruments after clinical use and after washing. Quantitative assays showed that bioburden levels were in the range of 0 to 4415 colony forming units per instrument after clinical use, and 88% of the instruments had bioburden levels lower than 1000. As expected, a reduction in counts occurred after washing; however, in some cases, higher counts were found on the instruments after the washing process. Although the washing procedure is effective in reducing the microbial levels deposited on the surgical instruments during use, a recontamination process occurs that results in increased counts after washing. The low bioburden level after washing consists of predominantly vegetative microorganisms that present a relatively low challenge to sterilization and disinfection systems.

Colony Count, Microbial↗
PubMed1979

Clean air bench. Use for sterile maintenance of unwrapped surgical instruments.

Microbiologic sterility of unwrapped surgical instruments has been maintained for long periods by the use of an operating room instrument cabinet that continuously circulates high-flow, "particle-free" air. Use of this clean air bench has had excellent acceptance by operating room nurses and by surgeons because fewer instrument storage procedures are needed and setup time, takedown time, and case turnover time in the operating room are diminished. It has been found to be effective in operating rooms having busy schedules for both elective and emergency procedures.

Air Microbiology↗
PubMed1987

Proximity storage of surgical instruments in the operative field.

A new microsurgical instrument, the surgical pocket, is described, and its value for storing instruments in the surgical field during operation is discussed. Specific procedures for using the pocket in the field with the bipolar coagulator, suction irrigator, dissector, and scissors are presented. Proximity storage of microsurgical instruments reduces the surgeon's reliance upon other surgical personnel by allowing instrument transfers to be made without assistance. In addition, it reduces stress and fatigue for the surgeon by shortening the length of the operation and reducing eye strain by reducing the need to shift vision from the eyepieces of the microscope to the operating room and back each time an instrument is exchanged.

Ergonomics↗
PubMed1988

[Experimental validation of the use of an ultrasonic surgical instrument in neurophysiology].

The effect of ultrasonic and surgical instruments on nervous tissue in chronic experiments on the cats were investigated with electrophysiological and morphological methods. The authors compared the results of removal of the neocortex zones using ultrasonic and surgical instruments or routine methods. Electrophysiological and morphological studies have shown small injury effects made by ultrasonic and surgical instruments on the surrounding brain tissue.

Animals↗
PubMed1990

Surgical instruments: the unmanaged asset.

Hundreds of thousands of dollars are invested in surgical instruments in hospitals. Materiel management and central service professionals should focus attention on managing this asset, just as we have done for supply and linen inventories. However, there are no performance standards against which to measure performance in this area; in fact, there are not even any commonly accepted indicators of surgical instrument inventories. The purpose of this article is to stimulate interest in the issue of surgical instrument inventory, so that materiel management and central service professionals will begin collecting data that will eventually allow definition of performance standards. Indicators of performance are suggested, specifically: 1. The number of "pars" of instruments in inventory, where one par equals the average amount of instruments used in one day. 2. The average of the value of instruments used per surgical procedure. Management of surgical instrument inventories could become a new source of both one-time savings (by reducing purchasing as inventories decrease) and ongoing annual savings (by decreasing the size of instrument trays in use).

Central Supply, Hospital↗
PubMed1998

Levels of microbial contamination on surgical instruments.

OBJECTIVE: To ascertain the microbial load and type of organisms on used surgical instruments following standard cleaning, which consisted of the use of a washer sterilizer followed by sonic cleaning. DESIGN: In this prospective experimental study, used surgical instruments were immersed in Peptamin Tween broth, the broth agitated, and then filtered through a 0.45 microm filter. Quantitative cultures were performed, and all microbes were identified by using standard techniques. SETTING: This study was conducted at a 660-bed university hospital. RESULTS: The microbial load remaining on used surgical instruments after cleaning was as follows: 36 (72%) instruments 0 to 10 colony-forming units (CFU), 7 (14%) instruments 11 to 100 CFU, and 7 (14%) instruments > 100 CFU. Organisms contaminating the instruments included coagulase-negative staphylococcus (56%) followed by Bacillus (22%) and diphtheroids (14%). No other microbes were isolated from more than 4% of the instruments. CONCLUSION: Most used nonlumen surgical instruments contain less than 100 CFU of relatively nonpathogenic microorganisms after cleaning. This suggests that new low-temperature sterilization technologies are likely to be highly effective in preventing cross-transmission of infection via nonlumen medical instruments.

Bacteria↗
PubMed2005

Disposable laparoscopic surgical instruments and the economic effects of repackaging.

The purpose of this study was to evaluate the economic effects of repackaging disposable laparoscopic surgical instruments. We repacked a total of 28 disposable instruments for gynecologic laparoscopic surgery into one package. The time of preparation of surgical instruments, the amount of medical waste, and other economic effects were compared before and after the repackaging of disposable instruments. The time required for the preparation of surgical instruments was shortened by 22 minutes per operation, and medical waste decreased by 400 g, by repackaging the instruments, resulting in an estimated direct economic saving of $10,000 per year. Indirect economic effects might include savings due to a reduced inventory of surgical instruments and simplified cost-accounting for each operation. It is likely that preparation for surgery can be significantly improved and the cost reduced by repackaging the laparoscopic surgical instruments.

Disposable Equipment↗
PubMedDate not supplied

Corrosion protection of reusable surgical instruments.

To understand the corrosion properties of surgical scissors, 416 stainless steel disks and custom electrodes were used as simulated surfaces under various conditions. These simulated surfaces were exposed to tap water and 400-ppm synthetic hard water as Ca2CO3 under different conditions. The samples were evaluated by various techniques for corrosion potential and the impact of environmental conditions on the integrity of the passive film. The electrodes were used to monitor the corrosion behavior by potentiodynamic polarization technique in water both in the presence and absence of a cleaning product. The surface topography of the 416 stainless steel disks was characterized by visual observations and scanning electron microscopy (SEM), and the surface chemistry of the passive film on the surface of the scissors was characterized by x-ray photoelectron spectroscopy (XPS). The results suggest that surgical instruments made from 416 stainless steel are not susceptible to uniform corrosion; however, they do undergo localized corrosion. The use of suitable cleaning products can offer protection against localized corrosion during the cleaning step. More importantly, the use of potentiodynamic polarization techniques allowed for a quick and convenient approach to evaluate the corrosion properties of surgical instruments under a variety of simulated-use environmental conditions.

Calcium Carbonate↗
PubMed1994

Processing of surgical instruments for minimally invasive surgery.

Processing of surgical instruments for Minimally Invasive Surgery (MIS). General information on the development of Minimally Invasive Surgery and MIS instruments is given. The "MIS" scientific study group was formed to discuss and find solutions for design and hygienic problems in MIS. The article describes various groups of MIS instruments, i.e. disposable instruments, instruments with a cleaning channel, and instruments which can be dismantled. Aspects of how the instruments can be processed effectively will be discussed in detail, including an example of a survey carried out in a German hospital with a special monitoring method. Requirements are described for MIS instrumentation with regard to design, material, and surface conditions. Requirements for hygienic processing methods are listed. The article also describes the necessary control and confirmation of cleanliness, which proves to be a very particular problem. Conclusions on the present status of technology and the possibilities for future development with regard to the processing of MIS-instrumentation are given.

Disposable Equipment↗
PubMed1995

Residual organic debris on processed surgical instruments.

This preliminary study describes the degree of cleanliness of three categories of surgical instruments after processing (ie, decontamination, inspection, sterilization). The three categories were reusable laparoscopic, reused disposable laparoscopic, and conventional surgical instruments. The objective of the study was to identify from visual inspection and microscopic examination residual particles, stains, or liquid on processed instruments. The investigators studied 32 instruments selected at random from a hospital's supply of processed surgical instruments. On visual inspection, 90.6% (29/32) of the instruments appeared clean. Microscopic examination with a photomicrographic system, however, revealed residual debris on 84.3% (27/32) of the instruments. The quantity of residual debris on both types of laparoscopic instruments (ie, reusable, reused disposable) was equivalent. The conventional instruments contained less residual debris than the laparoscopic instruments. Sites that contained residual debris included junctions between insulating sheaths and activating mechanisms of laparoscopic instruments and articulations and grooves of forceps. More research is needed to determine the prevalence and clinical significance of these findings.

Alberta↗
PubMed2001

Surgical instrument restraint in weightlessness.

BACKGROUND: Performing a surgical procedure during spaceflight will become more likely in the future as the duration of missions becomes longer. Only minimal surgical capability was available on previous missions since the definitive medical care time was short and the likelihood of a surgical event too low to justify carrying surgical hardware onboard. Early demonstrations of surgical procedures in the microgravity environment of parabolic flight indicated the need for careful logistical planning and restraint of surgical hardware. Human ergonomics also has more effect in microgravity than in the conventional 1-G environment. METHODS: Three methods of surgical instrument restraint--a Minor Surgical Kit (MSK), a Surgical Restraint Scrub Suit (SRSS), and a Surgical Tray (ST)--were evaluated in parabolic flight surgical procedures. RESULTS: The MSK was easily stored, easily deployed, and demonstrated the best ability to facilitate a surgical procedure in microgravity. CONCLUSION: Important factors in a surgical restraint system for microgravity include excellent organization of supplies, ability to maintain sterility, accessibility while providing secure restraint, ability to dispose of sharp items and biological trash, and ergonomic efficiency.

Aerospace Medicine↗
PubMed2002

[Reliability of the sterilization of surgical instruments is a key point in prevention of surgical infection].

Occurrence of postoperative purulent-inflammative complications (PPIC), their structure and dynamics after improvement of sterilization are studied. For epidemiological analysis 65,246 medical histories of operated patients were studied, in 404 of them PPIC were revealed. The PPIC rate reduced from 3.05% in 1981 to 0.49 in 2000 though surgical activity increased 12 times after this period. Thus developed measures for improvement of sterilization promoted reduction of the PPIC rate.

Humans↗