DISPOSABLE DRILLS? Orthopedic surgeon Brett Sanders, MD, at Memorial Mission Surgery Center in Chattanooga, Tenn.

We'll soon know if your orthopedic surgeons are ready for single-use power tools, cordless handpieces that you'd open at the time of surgery, use once and then dispose of as medical waste. Sounds radical, yes, but keep in mind that these soon-to-be released disposable saws, reamers and drills aren't intended to replace your traditional power tools, only to stand by at the ready in case of an overly busy schedule, a dead battery, reprocessing troubles, or tools that are out of commission or in need of repair.

The single-use tools will be provided clean and sterile, weigh less than 6-pound traditional handpieces, be powered by rechargeable lithium-ion batteries and cost a few hundred dollars apiece, says a source. A company called Insurgical received 510(k) clearance in November for its single-use orthopedic power tools. Insurgical plans a second-quarter launch.

The company plans to position its products as an on-demand solution when the primary power tool system is unavailable, or as an alternative to reusable power tools. So, would surgeons be receptive to using a single-use tool in a pinch?

"I can see how having a single-use power tool available for immediate use would appeal to surgeons and nurses," says orthopedic surgeon David Geier, Jr., MD, director of sports medicine at the Medical University of South Carolina in Charleston, S.C. "Most hospitals and surgery centers have many drills and saws, so nurses just open another one if the tool becomes unsterile, the batteries run out or for some other reason during a case. I wonder if the cost would keep most centers from purchasing these single-use products."

"I'm of the school that reusable products, when constructed well, are the way to go," says Greg DeConciliis, PA-C, administrator of Boston Out-Patient Surgical Suites in Waltham, Mass. "Breaking down is an issue, so proper research into quality tools and having a good service contract on it is key. I'm all for new concepts, and I certainly love emergency back-ups and would keep one on hand, but unless it were at a super price point — certainly not more than $100 — I would stay far away."

Pros and cons
Insurgical says single-use products could eliminate issues of readiness, contamination, sterilization, intra-operative failure, traceability and expensive equipment repairs.

Don't expect the TMC Orthopaedic Outpatient Surgery Center in Tucson, Ariz., to use them. "We have plenty of back-up instruments, and the added cost of using one of these disposable items is not reimbursable," says Stuart Katz, MBA, FACHE, the center's director. "If the surgeons don't know the economics, they'll be more apt to ask for these items. If they know the dollars involved and how it affects their pockets, they won't."

Perhaps this is the proposition: In a typical month, how many orthopedic surgeries are delayed or canceled because power tools were unavailable? While power tools are challenging to clean and reprocess (you can't submerge them), not to mention expensive ($50 to $100 in supplies and labor), the real utility of single-use tools could come into play when a power tool is to blame for a delayed or canceled case. When might this happen? When you open a power tool for surgery and the sterile wrapping is compromised or you spot residual bioburden. Or when the set that was to be used in surgery is still in reprocessing, delaying the start of the case by minutes or even hours.

What matters to surgeons
Whether you invest $30,000 in traditional power tool sets or $300 in single-use tools, what your surgeons want in their power tools remains the same:

• powerful and lightweight;
• quick and precise cutting action; and
• minimal fatigue.

"You have to have a reliable tool and a tool that's going to work," says Frederic Nicola, MD, the director of the Knee and Hip Institute at DISC Sports and Spine Center in Marina del Rey, Calif. "If it stops during the middle of a case and you don't have a backup or a replacement, then you can't finish the case."

Dr. Nicola appreciates simple 1-handed operation that lets you control functions with a finger. With a handheld shaver, he says, with his finger he can control the direction of the shaver (forward, backward and reciprocating) and the amount of suction.

All things being equal after a product trial, the tiebreakers are cost and the reliability of the service rep. "There's not much difference between most power tools," says Dr. Nicola. "If we know the service rep, we're more inclined to buy that piece of equipment. A lot of times these things will break. When that happens, you need a rep to bring you a replacement immediately while you're getting yours repaired."

Just as frustrating as a tool that breaks down is a drill battery that quickly loses its charge. "That's really frustrating," says Dr. Geier, who defines quickly as draining after 30 minutes of drilling through bone or using a saw attachment. "Just as there's a difference in drills and saws, there's a difference in batteries. Be willing to spend the extra money to get a drill that's reliable. You need a drill that has some power to it. We had some older drills that would get halfway in and would grind to a stop because they didn't have enough power."