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Reuse disposables
This document discusses the reuse of disposable laparoscopic instruments. It notes that while manufacturers recommend single use, instruments can be safely reused through a rigorous cleaning and sterilization process. This includes mechanical cleaning, chemical cleaning with enzymes, ultrasonic cleaning, and sterilization with hydrogen peroxide vapor or ethylene oxide. A 2004 study of 125 laparoscopic procedures found no differences in outcomes when single-use disposables were reused after sterilization with glutaraldehyde. Reusing instruments can provide significant cost savings for hospitals while reducing plastic waste. Proper cleaning, sterilization, and inspection of instruments is required to ensure safety when reusing disposables.
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Reuse disposables
- 1. Reuse of Disposable Instrumentsin Laparoscopy Drs Pravin John & Dr John Thanakumar Anurag Hospital Coimbatore India 641028 www.anuraghospital.com
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- 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 weuse 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 • Mechanicalwipe 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 • Aftermechanical 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 • Ultrasoniccleaners are more efficient, 10- 15 minutes, in neutral pH solution • Then dry with compressed air
- 12. Sterilization • STERRAD usinghydrogen 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