TOOL TIME Surgeons want the right mix of speed and torque.

Orthopods love their power tools, don't they? The whir of high-powered drills and the snarl of saws is music to their ears as they cut bone and sink screws. When looking for the latest in handheld devices designed for speed and safety, consider these 5 key features your surgeons are sure to appreciate.

1. Settings and ergonomics
The way you use a tool can affect surgical outcomes. Exercise caution to minimize the trauma that drills or saws might do to tissue around the operative site. For example, drilling a hole through bone — as with drilling a hole through wood — may result in smoke, which indicates the risk of thermal damage to surrounding tissue.

Adjusting a tool's speed and torque to the task at hand can have an impact on efficiency and precision as well as safety. In terms of power tools' bits and blades, speed is how many revolutions or complete cycles they make in a certain amount of time, while torque is the amount of force they exert. While low speeds with high torque will deliver the best results on large, dense bones, the smaller bones are more aptly handled with low torque and high speed. The programmable settings available on some tools can make these balances easy to set up.

Many surgeons like drills that incorporate oscillation modes because they provide a measure of protection to patients. Drill bits that don't make full revolutions, but instead repeatedly and quickly make part of a turn, then turn back, are less likely to catch, twist and damage tendons, blood vessels, nerves or soft tissue.

Don't neglect weight and ergonomics. A power tool that's lightweight and fits nicely into surgeons' hands is less likely to fatigue their shoulders and arms over the course of a procedure, which means they'll maintain better control and achieve better outcomes.

2. Battery benefits
When I got started in surgery about 15 years ago, we used pneumatic tools that were connected with tubing to wall sources of compressed air for power. Electrically powered tools also required lengths of cord, which tethered surgeons to power consoles or outlets. Today, battery-powered drills and saws are widely available and widely used.

Battery-life lengths and recharge demands are much discussed among surgical tool users. Sometimes surgeons don't get the same amount of life out of them each time, and when sterilizing the battery is necessary, it can affect the amount of charge batteries hold and deliver. But overall, the benefits of tools powered by lithium-ion batteries, currently the industry standard, are many.

First and foremost, battery-operated tools add no additional cord clutter to the OR, freeing surgeons and staff to greater mobility with fewer tangles and potential trips and falls. Battery power also prevents the risk of non-sterile cords contaminating the surgical field as surgeons maneuver tools in and around joints. A study published in the November-December 2002 issue of the Journal of Orthopedic Trauma (tinyurl.com/kmy8vo6) noted the exhaust produced by pneumatic power tools very likely disperses bacteria across the surgical field, unless they are fitted with contained exhaust systems. That's another potential infection prevention advantage of battery-operated tools: no exhaust.

TOOL SAFETY
Beware the Noise and Splash

SAY WHAT? Researchers suggest surgeons and staff should wear ear protection during orthopedic procedures

Surgical power tools can make quite a racket. Noting that orthopedic cases can frequently exceed 100 decibels, a level that carries hearing loss potential, researchers from Howard University in Washington, D.C., examined whether surgical "space suits" offered any noise reduction, as had been implied in previous clinical studies.

Writing in the November 2009 issue of the journal Orthopedics (tinyurl.com/lsjqpwp), they reported that the space suits offered no protection against the noise. In fact, when the suit's internal fan was on, the noise level inside averaged 61 decibels, approximately the volume of casual conversation.

"If surgical noise is to be decreased, earplugs or muffs must be worn not only by the surgeon, but also by all personnel in the operating theater," write the researchers. "At greatest risk may be the anesthesiologist, who may experience several orthopedic surgeries in a single day and is positioned close to the patient."

Space suits — or, at the least, full-face visors — are essential barrier protection against spattering bodily fluids and the possibility of infectious exposure. Researchers from the Leicester Royal Infirmary in Leicestershire, England, have determined that the risk of splash injuries to the face increases when power tools are used during orthopedic surgeries. Their account appears in the October 2008 issue of Acta Orthopaedica Belgica, the journal of the Belgian Society of Orthopaedics and Traumatology (tinyurl.com/mgu2ceg).

— David Bernard

3. Reprocessing requirements
A power tool's moving parts are also key considerations in between-use reprocessing. Sterilization is always a concern with regard to surgical instruments, and for many reprocessing professionals, the devil's in the details — or the lumens, hinges, nooks and crannies. While a pair of Metzenbaum scissors presents certain reprocessing challenges, orthopedic power tools offer their own tests to central sterile staff.

When selecting and purchasing the tools, inquire about which method (or methods) of sterilization they can be reprocessed through. In order to ensure that all parts of the tools can be thoroughly and effectively cleaned, decontaminated and sterilized, consider products that are relatively simple to disassemble and reassemble. Easier handling will save time during reprocessing, while proper handling will conserve the tool's usability over the long term. Single-use power tools are now available for emergent situations or when reusable devices break down, which is a nice safety net to have, although many facilities' budgets will better accommodate the reusable tools for routine procedures.

4. Safe handling
Simply put, the devices that cut, bore and shave bone for the implantation of plates, screws or joint components have a lot of moving parts themselves. Some of those parts are sharp and can be activated inadvertently. When trialing new tools, look for models with the smallest number of exposed moving parts.

Staff must handle surgical power tools carefully between uses. When a tool is passed, the person receiving it might not grab the handle. If staffers should grasp one of the moving parts — such as the nose or chuck — when the trigger is accidentally pressed, they could easily be injured by the sharp at the business end as it makes contact with their hand or gets tangled in their sleeve. Even if an inadvertent activation doesn't cause injury, it can surely compromise the sterility of a case. A power tool's sharp that perforates a glove or tears a gown can create a contamination situation. It's therefore important that staff learn safe passing practices not just for scalpels, suture needles and syringes, but also for the sharps that are moving parts on power tools.

5. Maintenance and service
The safest power tool is one that's always functioning properly. Make sure your tools undergo routine maintenance in the hands of a trained biomedical engineer, either one you've hired in-house or one you contract out to. Taking regular steps to keep the moving parts moving will keep tools at work in the OR and not sitting on a shelf waiting for service.

When purchasing surgical tools, the manufacturer's brand is usually a major deciding factor. As with home improvement tools, the name the surgeon is comfortable and confident with, that has performed consistently for him, is something he'll return to. Just be sure that the name and durability are backed up by reliable and responsive service. When unexpected breakdowns occur, loaner tools should be readily available while repairs are being made.