If you're in the market for surgical drills and saws, one of the first decisions you'll have to make is how they'll be powered: electrically, pneumatically or by battery. Electric power tools are tethered by cords to outlets, and pneumatic equipment requires hose connections to a source of compressed nitrogen. Battery-operated saws and drills have the advantage of cordless use.

Cordless is still a big deal. Less cord clutter means more mobility and freer movement. It offers increased safety by preventing trips and falls. It also eliminates the possibility of a non-sterile cord falling or being pulled into the sterile field.

But a battery only holds so much power before it's time to recharge it. Be sure to compare its expected life span against the length of time you'll need to power a tool. While it's unlikely that any procedure in ambulatory surgery will require hours upon hours of uninterrupted power, your surgeons will probably activate and deactivate the tool repeatedly during the course of an hour-long procedure.

Rechargeable batteries were once available only in nickel-cadmium-type versions. These had short shelf lives and developed battery "memories," which limited their life spans if routinely recharged when they weren't fully discharged. Newer lithium-ion-type batteries, however, not only hold a longer charge but also don't suffer from battery "memory" issues.

Measures of effectiveness
In addition to a tool's power source, its speed and torque strongly influence what it can accomplish, how easy it is to use and the precision it offers.

Speed is how many revolutions or complete cycles a bit or blade makes in a certain amount of time. Torque measures the turning force on an object. Different interactions with different anatomy are optimally accomplished with varying balances of speed and torque. On smaller, more delicate bones, high speed with low torque is preferable, while larger, denser bones can be handled at lower speeds with higher torque.

These details also play an ergonomic role, impacting how easy a tool is to use for specific tasks. A tool that doesn't offer the necessary speed or torque may require the surgeon to bear down on it, adding weight and elbow grease to make it work more effectively. While orthopedics may once have been a specialty of burly men, not all ortho surgeons conform to that type anymore, so ramped up speed and torque can provide a substantially easier, more efficient effort.

Speed and torque also add precision to the task. It's like the difference between cutting the grass with an old, heavy mower that you have to push over some patches more than once or with a newer, lighter one with a fresh blade. Increased speed and torque can make cleaner cuts on the bone. This even benefits the surgical administrator by speeding the procedure and cutting back on OR minutes and their associated costs.

Beyond the bones
You'll also benefit from an assessment of how easy the equipment is for nurses and scrub techs to prepare. Patient safety is a direct by-product of the efficient OR, and a staff that's confident in its ability to provide surgeons with tools in proper working order will lead to better outcomes.

Tools and power sources featuring programmable settings that automatically adjust speed and torque to different physicians' preferences are also a huge time-saver for staff, who then have one less device to set up before a case. Additionally, pedal-controls that can operate power tools remotely — and sometimes wirelessly — offer convenience to the surgeons.

Sterilization guidelines are another important factor for administrators and materials managers to discuss in advance with reprocessing techs. Power tools can be extremely durable equipment with the right care, and proper sterile processing of their handpieces and batteries are keys to extending longevity.

A tool may be easy to set up and use and also durable, but it's still critically important to assess the reliability of the customer service behind it. Where are the manufacturer's representatives located? Are they willing to spend time on site to train and in-service your staff? Since a malfunctioning tool can put a halt to surgeries, how available and responsive are they to calls seeking repairs or replacements? Do they offer a reasonable repair program, or would you do better with a third-party service?

Cost is a major deciding factor in purchasing power tools, which can be as much as $60,000 to $70,000 for a set, not including bits and blades (oftentimes disposable components), backup batteries and other accessories. Make sure the vendors you're considering know that you're trialing other products in order to obtain competitive pricing. Buying refurbished and leasing are alternatives to investing in new tools. But cost isn't the only factor. When weighing your choices and presenting the options to your surgeons, be sure to consider the details beyond the expense.

Brasseler USA Medical
Pneumicro Small Bone Power System
(800) 535-6638
www.brasselerusamedical.com
List price: $19,200 for complete system
FYI: Brasseler USA's Pneumicro Small Bone Power System includes high- and medium-speed drills; sagittal, oscillating and reciprocating saws; a wire driver; an air hose and attachments. The tools are ergonomically designed to reduce fatigue, lightweight and compact for site visibility and durable with high-performance motors.

BioAccess
Disposable Power Tools
(877) 593-9966
www.bioaccess.com
List price: Driver pricing starts at $195
FYI: Lightweight but balanced, BioAccess Disposable Power Tools can be set up in less than a minute and require no cleaning, no reprocessing, no recharging and no repairs, says the company. The small bone tool is available in 3 models with varying speeds and torques.

ConMed Linvatec
Mpower 2
(800) 237-0169
www.linvatec.com
List price: $22,118, including drill and saw, 5 attachments and instrument tray.
FYI: A 1-system solution for small and large bone procedures, ConMed Linvatec's MPower 2 is ergonomically designed to handle delicate anatomy while providing the torque to handle challenging cases, says the company. The battery-powered handpieces are sealed against moisture to enable washer-sanitizer reprocessing.

DeSoutter Medical
TDZ Small Bone Battery Driver
(866) 655-9040
www.gatewaymed.com
List price: $12,000 to $18,000
FYI: A lightweight, compact tool for small bone applications, the TDZ's modular handpiece enables drilling, reaming or sawing. Dual triggers provide precise, accurate, controllable speed. Power choices include a corded electrical module or small or large batteries.

IMT-USA
Woodpecker Pneumatic Broaching System
(651) 493-9634
www.imt-medicalusa.com
List price: $12,407
FYI: Offers a safe and efficient way to prepare the femur for a prosthesis. Accurately shapes the femoral canal for improved fit with press-fit stems.

Medtronic
Midas Rex ?Stylus Touch
(800) 433-7080 ?
www.medtronic.com
List price: $13,000
FYI: This compact electric drill, based on the design of Medtronic's Legend EHS Stylus drill, offers balance and maneuverability even in tight anatomic spaces. It is powered by the company's Integrated Power Console system, through which users can retrieve custom settings, remotely adjust irrigation and run multiple Medtronic handpieces.

MicroAire Surgical Instruments
Series 7000 Large-Bone Instruments
(800) 722-0822
www.microaire.com
List price: $8,000 for Model 7506 Cordless Oscillating Saw (pictured)
FYI: Series 7000 instruments, which include a drill/reamer, oscillating saw, reciprocating saw and a wide selection of modular attachments, can be powered by either a removable, autoclavable, nickel-metal hydride battery or an electrical adapter.

Stryker Instruments
Precision Oscillating Tip Saw
(800) 253-3210
www.stryker.com/surgical
List price: not disclosed
FYI: Stryker's saw features an oscillating tip, not a moving blade shaft, for reduced vibration. The result is greater control, precision, visibility, less risk of soft tissue damage and a saw steady enough that users can guide it with 1 finger, says the company.