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Is It Time to Replace Your Operating Microscope?
Simple ways to get years of dependable service from your scope - and what to do when it's time to shop for a new or refurbished one.
Judith Lee
Publish Date: October 10, 2007

Your operating microscope is a workhorse of an instrument, used for every cataract removal, most other ophthalmic procedures, as well as GYN and ENT microsurgery, orthopedic and neuro procedures. This big-ticket item can pay for itself during its expected 10- to 15-year lifespan. The key to making your scope last this long, experts say, is to perform routine maintenance and to update your scope along the way. Read on to find out how to extend the life of your scope - and what to do once your current scope is no longer serviceable.

Replace or upgrade?
A reasonable life expectancy for an operating microscope is 15 years, says Edmund Thall, MD, of Riverton, Wyo., an ophthalmologist with a PhD in optics. "As reimbursements continue to dwindle," he says, "we'll be trying to stretch out the use of a scope to amortize the expense over more years."

Components of your scope are susceptible to wear and tear, as are other parts or features that might need upgrading due to changing technology. You can replace most components at a cost significantly less than purchasing a new scope.

"Replacing or upgrading binoculars, eyepieces, light sources and foot pedals are quite easy, readily available on the used/refurbished market and will save a surgery center many thousands of dollars compared to purchasing a new system," says Edie Hewlett of Endure Medical, a microscope refurbisher. Here's a review.

  • Foot pedal. This component is vulnerable to fluids and other abuses related to being on the floor. Many surgery centers cover the foot pedal to protect it. The foot pedal can also simply wear out. "Many times you can just replace the cable connecting the foot pedal to the scope. You can have the foot pedal repaired, or get 'repair exchange' with a reconditioned foot pedal (an extra cost of $1,000 or $2,000)," says Betsy Schwartz of Leica Microscopes.

Given the foot pedal's importance and vulnerability, you might consider buying an extra foot pedal for your scope. A new one will cost about $3,600, while a refurbished one is $2,000 to $3,000.

  • Eyepieces or binoculars. These are the surgeon's direct contact with the scope, and their importance cannot be overemphasized. The rubber padding may simply be worn out and uncomfortable, or perhaps the binoculars do not incline enough to accommodate the varying heights of surgeons.

Seven Microscope Misconceptions

Here are seven common misconceptions about OR microscopes, and answers to set the record straight.

1. Optics are easy to evaluate. Manufacturers like to boast about optics, but few medical professionals understand them, and it's difficult to evaluate this feature in a simple demonstration. Your best strategy: Use a scope in the OR on as many different cases as possible before you purchase it.

2. The footswitch must be broken. When there's something wrong with the foot pedal, many users immediately assume it's the switch on the pedal. However, the footswitch is just the first in a long line of components that need to work together to run the focus motor.

3. Scopes can take a licking. Because OR microscopes are large and encased in metal, nurses and technicians assume they can withstand quick movement and occasional bumps. In fact, the optics are quite delicate. If jolted or even slightly hit, the optics can become out of alignment. This requires expensive repair services with a calibration machine.

4. Light bulbs set lower last longer. There's a belief that if you set the bulbs lower, they will last longer. Not true. They wear out at the same pace, whether they are set high or low.

5. You don't need a dust cover. Surgery center staff members seem to think that once it's inside, the operating microscope doesn't need a dust cover. Not true. You should keep the scope covered when not in use.

6. A yearly cleaning will suffice. Surgical staff members believe an annual cleaning is adequate for an OR scope. Not true for scopes in frequent use. Calculate how many times a week the scope is used for eight hours, and that's the number of preventive maintenance checks you should have in a year.

7. They're all the same. Facility managers seem to think OR scopes are interchangeable. However, operating microscopes are all different, and many of those differences matter to the surgeon.

- Judith Lee

"New binoculars can often be placed on an older microscope and create a better view for the surgeon. By doing this, a surgery center can save thousands of dollars by not buying a new system and just updating a few features," says Ms. Hewlett.

The cost can vary quite a bit, depending on the type of scope. Ms. Hewlett says widefield binoculars for an ENT scope might cost $1,800, while the same item for an ortho/spine/ neuro scope can cost $5,500.

Lutz Heinrich, technical expert for Carl Zeiss, Inc., says that eyepieces themselves rarely wear out, although it's likely the rubber eyecups will. These can be replaced at a modest cost.

  • Floorstand casters. These are simple wear items that can interfere with movement and positioning of the scope. If you move the scope a lot, you'll only get a year or so of use out of a set of casters; they can last up to five years if the scope isn't moved much. If you're noticing poor or stiff movement, just replace them for $30 to $35, says Justin Ball, service rep for Prescott's, a refurbishing company.
  • Illumination. Here's an important component that often you can address with a repair. If you have a fiber optic system (most scopes do), and the surgeon notices dim illumination, you might need to replace the fiber optic cable, which usually has to be replaced several times during an operating microscope's life, says Ms. Schwartz. "In most cases, the fiber optic cable can be replaced quickly without a lot of down time for the scope. We will send the new cable (cost of $450) to the facility, and a biomedical technician can install it. Sometimes we have to send a service rep," says Mr. Ball.

If your scope is relatively new, or you've recently replaced the fiber optic cable, you might address dim illumination with new bulbs, which cost from $15 to $400. Ms. Hewlett notes that you can replace the entire light source for $500 to $3,000.

  • Electrical components. These parts can take a beating as techs roll the scope over the cord, or plug and unplug the instrument. Dr. Thall suggests replacing the power supply every five to 10 years.
  • Camera equipment. While not a direct part of the scope, the camera equipment is important in most surgical settings. Experts say it's a component that's likely to become outdated. "Cameras have gone through several metamorphoses - we had still cameras, then video cameras and now we have computer-downloadable, digital-still cameras. You can replace the camera on most scopes," says Mike Haper of Jedmed, a microscope manufacturer.

What else you can do
Besides replacing worn or outdated parts, there are several steps you can take to extend the life of your operating microscope. These include:

  • Cover the scope when not in use. Surgery centers seldom take this simple step that doesn't cost a thing.
  • Preventive maintenance. Clean the lenses on the scope every two weeks (they get splashed with fluids, which can eat through the protective coatings, causing problems with glare and resolution). Every scope should have an annual scheduled maintenance, but many need it more often. Mike Hewitt, director of support services at Leica, suggests you estimate the number of eight-hour sessions your scope averages a week, and take that as the number of preventive-maintenance sessions the scope should have each year.
  • Train and re-train staff. "Most of the abuse happens to the scope when the users are not familiar with the equipment," says Mr. Hewitt. Be sure to schedule in-services with reps from the original manufacturer or refurbishers with in-depth knowledge of your scope.

When it make sense to replace
There comes a time when you'll need to replace your scope with a new one, a newer refurbished one or through one of the services that brings new equipment to your facility on a temporary basis for cases.

"Scopes don't get outdated per se," says Dr. Thall. "New features get added over time, and people like to upgrade. Also, add-on technology can't be added to older scopes." For example, says Dr. Thall, to add a laser capability, you'd need to add a safety filter to the scope, a filter that may not fit on older scopes. "The scope still works as it always did," he says, "but your needs have changed."

Zeiss's Mr. Heinrich agrees: "New surgical microscopes are all specialized - illumination, maneuvering, programming and operation - for ENT, ophthalmology, neuro, spine, GYN, reconstructive and dental. You must have the latest models to utilize advantages of the latest technology."

Listen for these complaints:

  • Limited field of view. Although you can add new binoculars to some scopes, you might not be able to obtain the wide field of view that a newer scope will offer.
  • Floorstand issues. Depend- ing on the types of surgeries being performed, the floorstand can be critical. "Sometimes, centers want to use an ENT system for ophthalmology or an ophthalmology system for orthopedics, and it just doesn't work well. All surgeons use microscopes in very different ways," says Ms. Hewlett. "Also, centers may need a smaller unit for space issues or they may decide to do more complex procedures and need a more sophisticated system."
  • Ergonomics. The scope's design elements that at one time made it comfortable may no longer make it so today. "The techniques being used at the time of the purchase dictate where the microscope needs to be placed, along with the placement of the assistants and observer binoculars. As different practices evolve, assistants and observers need to be further or closer, and at different angles," says Mr. Hewitt.

Don't overlook ergonomics. Be sure that the scope has enough adjustments for the user's comfort. "This is not a luxury," says Dr. Thall. "If the scope is not comfortable for the user, you can have real problems in surgery."

If your surgeons won't be satisfied by anything but the latest, you'll have to invest in new. If an update/upgrade on the scope you have fits the bill, or perhaps an extra scope that's compatible with one you have (surgeons don't like to switch brands/models very much), a good refurbished scope can save you money. Whatever you do, include your surgeons in the decision. Wherever possible, have scopes brought in for them to try before you buy. For Dr. Thall, a critical question is whether the scope is compatible with all the other components he may want to add: laser, assistant head, reversing system for widefield lens, video system and variable speed controls.

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