CORDLESS OPTIONS For drills and saws, orthopods want tools that are battery-operated and lightweight.

There have been multiple significant design improvements to power tools over the last several years. New features are offering surgeons more control and precision, while changes in ergonomics help lessen fatigue in the OR. If you're in the market for new drills, saws or burrs, give your surgeons what they want by focusing on these 5 features.

1 Enhanced ergonomics
During surgery, especially long cases, the instruments' weights can really take a toll on your body and cause fatigue. To combat this problem, manufacturers have developed tools that are small and lightweight, but still strong enough to get the job done. Look for lightweight, balanced options that feature handpieces designed to fit nicely into your surgeons' hands. This is even more crucial for your orthopods performing arthroscopy. In these cases, we're often holding a camera while introducing the power tools, which means we are relying on a single arm to maneuver the tool. That's where light, strong instruments really shine. They let the surgeon drill a hole for an anchor without compromising visualization or accuracy.

2 More control
The latest tools also offer surgeons more control than ever before. While the standard handpiece in the past simply featured an on-off switch, the latest models offer oscillation or slow-motion modes that enhance accuracy and precision during the procedure. For example, many devices make it easier for surgeons to switch from a forward direction to a reverse mode by putting 2 buttons on the handpiece. The top button moves the drill forward; the bottom reverses the spin. Some models put the reverse on the side, but that can require an awkward motion during the case, especially if you're rapidly switching back and forth.

Another great thing about these controls is that by pressing both the top and bottom button at the same time you get an oscillating movement. That means that instead of a continuous spin, the drill would make a rapid half turn before reversing and going back the other way. This feature is really helpful when drilling near sensitive soft tissue or when you need to change the direction of a hole mid-drill.

The same idea applies to the latest generation of saws as well. Historically, you could only power up the saw and use it with the blade moving at full speed. Now the controls let the tip move at different speeds, depending on how the handpiece is used. Press the button down fully, and the saw moves at full speed. A halfway push will move it at half-speed. Having those slower options can help improve accuracy and is especially helpful when you're making delicate cuts, like during knee resurfacing. This also reduces the risk of quickly slicing through a bone and hurting a vital structure that's on the other side.

SHOPPING STRATEGIES
3 Tips for Finding the Right Tools

MORE POWER When trialing new power tools, make sure you know each surgeon's must-have features for the device.

As a spine surgeon, the features I'm looking for in my power tools are similar to the demands of other orthopods: good ergonomics, long lasting and efficient at cutting through bone. But when trialing a new instrument, there are a few other factors to consider:

• Know what your specialties need. The most common tools we spine surgeons use are the burr to remove bone and the drill to place screws. I need a high-speed burr with several attachment options. In order to have the power necessary to safely and efficiently remove bone with the burr, I need to use a pneumatic drill, which has a cord. Yet I'd still like a cordless, lightweight drill that can quickly bore the holes necessary for anterior cervical spinal hardware. Start your shopping by asking surgeons about the tools they most commonly use and the features those tools need to have versus the ones they want them to have.
• Look for multi-taskers. Once you know the needs of your surgeons, you may be able to find options that fill those requirements across specialties. For example, the drill I use for my spinal procedures is the same one our sports medicine physicians use. The handpiece stays the same, but the vendor gives me the different attachments and guides I need for each spine case. By standardizing your equipment, you can save money while also making case set-up more efficient. And don't forget about reprocessing: It's always beneficial when you can reduce the number of items staff must learn how to assemble and disassemble.
• Trial it with as many surgeons as possible. Orthopedic power tools can be personal for surgeons. The "feel" of the instrument and the way it handles are paramount to efficency and accuracy. That's why trialing a new tool with as many future users as possible is so important. Let them test the tool for a few days and ask for their input. The key question: Is this going to benefit the patient, the facility and the surgeon? While cost is obviously going to play a big role in making a final decision, getting consensus on the tool first from your docs is the best way to ensure good patient outcomes and happy surgeons.

— David T. Anderson, MD

Dr. Anderson ([email protected]) is an orthopedic spine surgeon at OrthoCarolina in Monroe, N.C.

3 Improved working ends
Drill tips, saw blades and other "working -end" pieces now come in various sizes, widths and curves to give your orthopods a greater range of options during cases.

Saw blades have seen some of the biggest growth in this area. Blades are becoming thinner and shorter, which makes them easier to maneuver in delicate procedures. They also let surgeons be more precise when relying on templates for their cuts, like using jigs during knee replacement surgery.

Oscillating-tip-only blades are another new feature some manufacturers offer in their saws. In these saws, only the very tip of the blade moves while the rest of it stays still. This can limit collateral damage when sawing, and works very well for bunionectomies or total hip replacements, where you're trying to cut deep holes in the bone as opposed to slices.

EASY ATTACHMENTS Reduce case time by shopping for power tools that have a "quick release" function for attachments.

4 Easy to assemble
There are 2 basic ways to connect the handpiece to the chosen tip. The traditional chuck key option requires the surgeon to manually turn the end of the handpiece and attach the new tip. This can be time-consuming and complex, especially if you're changing tips frequently during a case. Newer options include a quick-release function that lets the surgeon press a button and enlarge the opening where the attachment is inserted. The surgeon can press the button, remove the tip and replace it extremely quickly.

Another consideration is the assembly of the instrument itself. If your facility is going to be doing the reprocessing, make sure that your reprocessing techs can thoroughly clean and sterilize all parts of the tool. Products that are easy to assemble and disassemble make this task easier. You may also consider single-use tools for emergency situations or when one of your devices breaks down, though they tend to be expensive and increase your medical waste.

5 Better battery options
Power tools can be tethered or battery operated. Tethered options are connected to a power source, or are powered by tubing connected to tanks of compressed air, known as pneumatic power tools. While tethered options are still used today in some heavy-duty surgeries — they work well when you need to cut through a metal implant — most surgeons prefer cordless options.

A few years ago, battery options didn't produce high speeds and torques, and therefore were reserved for shorter, smaller cases. Now, lithium-ion batteries have much longer lives and can deliver the same results as their tethered counterparts. Cordless options also come with a few added benefits. They remove the tripping hazard of the cord, as well as reduce the risk of compromising sterility as the cord moves in and out of the surgical field.

Batteries still lose their charge over time, though, especially with repeated reprocessing. Question your vendor about the durability of the battery when exposed to repeated sterilization. You might also want to consider stocking several of the batteries. At our facility, we always have backups available so if one dies during a case while another is being reprocessed, we can switch it out and continue the case with little delay. OSM