Power Tools Keep Getting Better

New features in ever-evolving drills and saws improve performance and increase safety for patients and surgeons alike.

Innovation in instrumentation is something I’m passionate about because advances in the tools we use can help me, as an academic orthopedic surgeon, further my goal to perform more reliable, predictable surgery. An experienced, expert surgeon will still do outstanding work regardless of the type of instruments you give them. But how do the companies that make these tools help the less-experienced surgeon perform stellar work as well? That’s where ongoing innovations come into play.

Key collaborations

Surgeons should collaborate with device manufacturers whenever possible, not just to help them make safe tools, but ones that allow us to perform surgeries more efficiently. Patient safety and safety of the surgeon is so critical, of course, and the ergonomics of the devices are key in this regard. A power tool that feels good in a surgeon’s hand isn’t primarily about comfort. That comfort is a means to an end; it allows them to safely hold and control these devices. A good power saw blade, for example, is crucial to make a clean and efficient osteotomy. Blades or drill bits with too much chatter or wobble obviously make the jobs of making cuts or drilling holes into patients’ bones more difficult.

Facilities should also make sure they don’t purchase a power tool fleet that includes saws and blades that generate excessive amounts of heat. A dull saw blade generates much more heat than a very sharp one, a factor that is sometimes overlooked. Likewise, a power tool that can generate more revolutions per second can do its intended job more efficiently, not burning the bone, which could lead to necrosis or bone death.

Innovations in power tools help to keep every patient safe and make every surgery more predictable and precise.

We also want drill bits that give us the feedback we need while drilling holes to place screws into bones to ensure we don’t plunge the drill bit into the soft tissue. Power tools that assist us with this are vital to help us do our job safely. Like a dull saw blade, a dull drill might cause you to push harder to advance it, which could cause you to plunge it in too far, or skive it off the bone, potentially hindering your sense of whether the placement is where you want it. A sharp drill bit helps ensure you’re able to go through the bone in a predictable way with the proper number of revolutions, speed and torque.

It’s often difficult for newer vendors to be disruptive in this market because companies with long relationships with health systems maintain these relationships because they make quality products they stand behind. When health systems buy lower-quality tools to save money, it can be detrimental to efficiency and patient safety. You could wind up with drills and saws that no longer hold their charge after going through sterilization a few times. You wind up spending more because these instruments may have to be replaced more often than the more expensive ones, and there are intraoperative implications as well, such as having to prolong surgical times by having to ask for new batteries.

Involving representatives from all phases of the intraoperative cycle is important when trialing new items, even if you’ll likely be purchasing the newest version from your current vendor. Surgeons have to approve of how the instruments feel in their hands, learn about battery life, and check out things such as the quick-connect collet systems for surgical drill bits. If that isn’t working well and doesn’t mate with the drill and bit properly, you’ll likely have wobble issues that will lead to inefficient procedures. Nurses and Sterile Processing should approve any changes, too. They need to understand and feel comfortable with how the tool gets set up, broken down, cleaned and put back together. The indication during each procedure largely determines whether you’ll use a tool with a traditional handle or a smaller, newer pencil-like device. Larger tools are more appropriate for larger screws in the ankle joints while smaller ones are better for placement in the big toe joint, for example.

Fleets continue to improve

From a staff safety perspective, many new tools have smoke-evacuation abilities, which can reduce exposure to carcinogens. There’s also an obvious long history of ergonomic-related injuries to surgeons. When it comes to sharps injuries, there are great new saw blade designs — essentially the power tool equivalent of blunt-tipped needles — in which the edges aren’t as sharp as the rest of the blade, thereby reducing the likelihood of doctors, nurses or scrub techs getting cut by the part of the blade they’re most likely to come into contact with.

Superior work is being done on instrumentation that will make surgery safer and more reproducible. For example, I’m very interested in how we can make a safer drill bit. When you’re drilling into the bone, there are arteries, veins and nerves on the other side. Hitting any of them can lead to surgical complications, so the development of a new drill bit may help us better gauge how far it should go into the bone before it goes out the other side. Can we design a safety mechanism or some kind of process that would allow these injuries to happen less often? Ultimately, engagement of the surgeon and nursing team will allow for innovations that improve surgical efficiency and patient safety. OSM

Note: This three-part article series is supported by CONMED.