There's no arguing that devices that simultaneously cut and seal tissue help surgeons perform faster, more efficient surgery in a growing variety of procedures. Improved cutting and sealing technologies let them operate on larger tissues containing larger vessels, making these instruments suitable for abdominal, GYN, thoracic and ENT cases. Answer these 7 questions before deciding which device will make it into your ORs.

1. Is it safe and reliable? Patient safety should drive every purchasing decision related to surgical instrumentation. Make sure that the company making the device you're evaluating has a proven track record and a strong reputation for making reliable products that perform safely and efficiently. The devices can offer inherent safety themselves, in that they cut and seal tissue using low-heat energy sources, which limit thermal spread and collateral tissue damage. Some also come with built-in safety features — an audible alarm that lets surgeons know when a vessel is sealed or settings that limit the amount of energy delivered to the surgical site, for example. They may also minimize smoke at the surgical site, giving the surgeon a clear view of the operative field and limiting staff's exposure to hazardous plumes.

2. How much does it cost? Of course, cost benefits follow closely behind safety concerns when outfitting your ORs. Generators ranging from about $5,000 to approximately $20,000 power cutting and sealing modalities. That's a significant capital expense, but if your surgeons use a device 3 times a day (or 750 times a year), the per-case expense is easier to stomach than the up-front cost. You'll also need to factor in the costs of the disposable handpieces when crunching the case-cost numbers. They range from $10 for a simple cautery stick to roughly $500 for the more advanced cutting and sealing devices.

Weigh the one-time capital purchase and cost of disposables against the opportunity costs of not using these devices, which include the purchase of dissectors, clips and scissors used during basic laparoscopy, for example, as well as the valuable OR time your surgeons waste while clipping, cutting and tying their way to slower cases.

3. Is it easy to use? The latest generators are easy to maneuver (one on the market is the size of an IV bag) and a snap to set up (just plug and play),which make them valuable tools in busy surgical facilities. That ease of use can help reduce your up-front expenses when bringing these devices into your facility. My hospital's surgical team easily shifts our numerous generators between multiple ORs, setting them up quickly and easily whenever they're needed for a case.

4. How does it feel? Some handpieces deliver energy to the surgical site through button activation, others are switch-operated, and some are both (a button delivers heat to tissue, a switch employs a blade to dissect it). Still others are foot-activated, while a few models offer surgeons a choice between foot or hand activation. Surgeons often opt for the controls that they're familiar with and confident in using .

In recent years, several manufacturers have focused on improving the ergonomics of their handpieces (using pistol-grip designs, for example). The devices need to fit comfortably in hands of various shapes and sizes to eliminate user fatigue during long procedures. And while maneuverability within the surgical site is key, don't ignore how quickly hand muscles can cramp when holding a static position for minutes at a time. You'll also want to consider how many female surgeons operate at your facility. If they're like my wife — a GYN surgeon and colleague of mine here at Drexel — they'll prefer smaller, more compact handpieces.

5. Is it versatile? Surgeons want to work with instruments and devices that accommodate developing skill sets and surgery's constantly evolving clinical possibilities. Purchase handpieces compatible with numerous instrument attachments that are designed for many types of procedures. Surgeons might establish their tissue cutting and sealing skills during basic abdominal procedures, but will likely want to graduate to challenging cases such as thyroid surgery. Your surgical instruments shouldn't restrict their growth and, ultimately, the complexity and number of cases you host.

6. Do you really need it? Your case mix can mean the difference between providing surgeons with an unneeded surgical toy and a valuable surgical instrument. Tissue cutting and sealing devices are especially helpful during procedures in highly vascular areas of the body, such as splenectomies and GYN cases, where surgeons who clip, cut and tie their way through the anatomy watch as surgical efficiencies grind to a halt. However, performing a basic lap chole without one of these devices would be cheaper and no less efficient.

7. Can it be reprocessed? Cost-conscious healthcare leaders and the momentum of the going-green movement have spurred a push toward reprocessing single-use devices. Reprocessing basic instruments such as clip applicators or trocars makes sense; reusing these high-volume devices results in significant cost savings. But I'm not yet sold on the idea of reprocessing instruments that cut and coagulate tissue. For example, reprocessing single-use surgical scissors tends to make them dull and less effective in surgery. Can reprocessed cutting and sealing devices continue to deliver focused energy to targeted tissues safely and predictably? I'll reserve my final judgment until more data is released about how the sterilization process impacts the performance of the devices.