Nearly 600 companies set up shop in the 172,100-square-foot exhibit hall at the Association of periOperative Registered Nurses' (AORN) 51st annual Congress in San Diego in March. I saw a host of improvements in mature technologies and some innovative approaches to timeless OR management challenges. Here's a report from the show floor.
Sterile processing options
New for flexible endoscope reprocessing is Steris's Reliance Endoscope Reprocessing system, which as of press time is awaiting final FDA clearance. Based on the already-proven Reliance 333 washer disinfector chassis, Steris designed this high-level scope disinfection device for the gastroenterology market. The system can reprocess two scopes per cycle, using a binary peracetic acid agent. A Steris rep told me the device will be competitive in cycle cost and process times to other peracetic acid devices (such as Steris's System 1).
I believe instrument- and sterile processing-tracking software will become a future inventory management and quality improvement standard of care. Toward that end, Steris displayed its ConnectAssure system, which interfaces instruments via a bar code reader to any instrument-tracking system. The system works with any Steris sterilizer with Eagle System 3 controls, along with other Steris processing equipment like the Steris System 1 and the Synergy washer-decontaminator. Steris also showed its Sterile Processing Microsystem, a complete sterile processing department information management system.
For small-load instrument washing, there's SciCan's new Hydrim-L washer decontaminator, which uses a proprietary hydrogen peroxide cleaning solution that the manufacturer says eliminates the need for hand scrubbing and pre-washing soiled instruments. The Hydrim-L requires 220-volt power and household washing machine-type plumbing. It comes with a stainless steel top, which can be removed for under-counter installation, and costs about $6,300.
Skytron introduced a sterilization method to the U.S. market this year with the Skytron 125L ozone sterilizer, which makes its own sterilant from medical oxygen, distilled water and 120-volt household current for about 15 cents per load. The upside to this device is that it requires no drain or vent; the only plumbed requirement is medical oxygen. The oxygen could also be provided by gas cylinder in locations where the house oxygen system is not accessible. The downside to this sterilizer is its small chamber size (roughly equivalent capacity to a 16-inch by 16-inch by 26-inch sterilizer, the most common "flash" sterilizer size), and long cycle time (four-and-a-half hours). The 125L lists for $130,000.
Over at Johnson & Johnson, Advanced Sterilization Products displayed its Sterrad 200 system, which launched last fall. Like the other Sterrad devices, the Sterrad 200 is a hydrogen peroxide gas plasma reprocessor. A company rep says that one of the key features of the system is its large capacity chamber, which can process 150 liters in about 75 minutes. The device is probably best suited for hospitals and large ASCs.
Versatile surgical tables
Skytron showed off a new full-function table aimed at the ambulatory care market. The Skytron Model 1700 is rated at 500-pound capacity in lift and for all articulations. It has Skytron's trademark radiolucent top and 180-degree tabletop rotation that lets the surgical staff "flip" the orientation of the table when setting up a case. The table features a pendant for operation and automatically locks the base with any touch of the pendant. The table is line-powered and doesn't have a battery option. It sells for about $20,000.
Another new table targeted for the outpatient market is Steris's new ASC2000 surgical table. This table is rated with a 400-pound lift capacity and 350 pounds in all articulations. The radiolucent top is fully C-arm compatible with the exception of an area approximately 8 inches by 10 inches, near the patient's right hip, where the table top attaches to the structure of the table base. This table is offered only in a battery/AC model and sells for less than $20,000.
Steris boldly proclaims its model 3085 the "gold standard" for surgical tables and drew conference attendees with an eye-catching display featuring a gilded version of the 3085 table with gold metal-flake vinyl upholstery for the table pads. Steris used the display to help introduce a new accessory for the 3085 table that takes advantage of its inherent 1,000-pound lift capacity - side extensions to widen the tabletop for bariatric patients.
French surgical table manufacturer FH Surgical showed its C-Max line of tables. FH Surgical offers two tables in the U.S. market: the C-Max 110 and the C-Max EDS (Easy Drive System). These are the same major surgical tables previously sold under the ALM brand name; FH Surgical purchased this line from Getinge. Both tables feature 1,000-pound lift capacity and 600-pound capacity in all articulations. The tabletop has an 18-inch slide capability with an unobstructed 15-inch lateral window, and the manufacturer says there are no blind spots for a C-arm.
Moving on to Berchtold, I saw the Operon B710, a new general surgical table that has 770 pounds full-lift and articulate capability. While it doesn't have a kidney bridge, Berchtold says that the extreme flex position provides adequate surgical access and patient safety. This full-featured table has two unique features - its integrated beach chair shoulder surgery positioner and its integrated split-leg accessory. The basic table should sell for less than $30,000, says a company rep, and can be had with upgrades including power drive, infrared remote and voice control via an open software architecture.
Single-surface surgical tables are common in parts of Europe and starting to catch on this side of the Atlantic. The devices let patients start in pre-op on the same horizontal surface that later serves as the OR table and then the recovery room stretcher. This technology takes on two basic forms; one method is seen in inpatient facilities and features a permanent floor pedestal in the operating theater, transfer units (the bottom half of a stretcher) and the patient surface itself. This method offers several patient surfaces for various specialties and sizes of patients; it is also the most expensive. The other method is a hybrid stretcher-small surgical table such as the Stryker Trio, introduced several years ago.
Skytron showed a prototype of a promising combination stretcher-surgical table. The top is C-arm compatible and slides 12 inches to better accommodate the imaging device. Not yet named, this surgical surface is rated at 400 pounds of lift and in all articulations; the only powered articulations are Trendelenberg, tilt, height and the top slide feature; all other articulations are pneumatically assisted. The unit runs on battery or AC power and a company rep said it's targeted to sell for about $17,000.
Nuvo entered the general surgical table market with the T-20, a table manufactured by British company Eschmann and distributed here by Nuvo. The T-20 can be tilted and fully articulated to its 650-pound weight capacity. It's slightly wider than most tables to accommodate obese patients, C-arm friendly from head to toe with no blind spots and has removable head and leg extensions.
Geared for cardiovascular and other-image guided procedures, Biodex's 840 Surgical C-arm table has a radiolucent area of 51 inches by 24 inches unobstructed between the head and the accessory rail with a low-profile base to ensure C-arm clearance. The table has three-axis motorized positioning and a free-float XY-axis tabletop. The 840 lists for $33,900.
Lights and more lights
This year, like every year, there was no shortage of new surgical lights. You name it: lights with cameras, lights without cameras, lights without cameras but plug-and-play capability, voice-controlled lights, lights you can control from the nurses' documentation station, theater-style lights, procedure room lights and everything in between.
Stryker exhibited its long-anticipated OR light, the Visum light, as part of its total endosuite package. This 650mm-diameter lamp head produces 135,000 lux with a 4,200'K color temperature. This lamp is available in single-, dual- and triple-center-mount configurations. It's also offered in a tandem mount boom configuration with the new Stryker Hercules Equipment Delivery System. The new Hercules equipment manager is also available with the StrykeVac smoke evacuation system incorporated.
In addition to theater-style lighting, Getinge displayed two new compact lights geared toward the outpatient surgery market. The Axcel light is a compact surgical light particularly well-suited to ORs with lower ceilings, while the new X10 light is an innovation on the venerable Ingenue style light, notable because it provides ambient lighting below the light, directly to the surgical site.
Unlike the other lights in the Stellar series, Skytron's new Stellar ST19 is a fixed-focus light. The lamp was developed for an ambulatory care market demanding quality surgical light performance at a lower price than a major set of lights. These lights will sell for about $12,500 per pair or $7,500 for a single-lamp system. The lamp-intensity controls can be ordered as a wall mount or on the lamphead. The three-bulb lamphead is rated at 96,800 lux and 4,000'K color temperature from its 19-inch (482mm) fixture. The ST19 offers the same reflective design and the same heat dissipation method as its more-expensive focusable Stellar cousins.
Berchtold's new surgical light, the Chromophare X65, is a gas discharge system that provides 160,000 lux with just a 70-watt bulb. There are two 70 watt bulbs in the light, but only one is on at a time. The bulbs alternate use for 10,000 hours between bulb changes. The X65 also has a color-correct temperature of 4,500'K. This is a very bright light, well-suited to long, deep-cavity procedures.
Back at the Steris booth, the manufacturer showed off the LA300, the latest addition to the Harmony series. This small surgical lamp has a 300mm diameter lamp face and delivers 130,000 lux at a color temperature of 4,000'K. This light would be suitable for use in minor procedures and as a high-end, color-corrected exam light. It's available in mobile, ceiling- and wall-mount configurations.
Electrosurgery and radiofrequency ablation
Valley Lab displayed two promising electrosurgery-related accessories. Its new 5mm LigaSure dolphin-nosed combination instrument automatically clamps, dissects, grasps and ligates target tissue. This thumb-switch activated instrument offers a quicker seal time (four seconds to five seconds), compared with earlier-generation LigaSure instruments. Valley Lab also rolled out its new Point microsurgical tungsten needles. These microelectrodes provide improved cutting and coagulation while minimizing thermal spread when doing fine dissection. The Point needles feature high-temperature insulation within 3mm of the tips to guard against the risk of alternate burn sites.
Olympus's SonoSurg is a completely reusable and autoclavable ultrasonic (as opposed to electrosurgical) cutting and coagulating system. It has a rather unique mist-evacuation mechanism geared to maintaining a clear field of vision for the surgeon. The SonoSurg is now available with a curved scissor probe, for laparoscopic procedures. The system also offers a standby mode to reduce accidental output and a warning system to detect possible problems. The company claims that facilities can save about $200 per procedure compared with disposable systems.
Over at Conmed's corner, I saw its new System 5000 electrosurgical unit, a newer device that was not at AORN last year. This all-purpose generator features a general mode and a fluids mode for cystoscopy and arthroscopy underwater work. Specialty modes include laparoscopic mode, pulse cut mode, pulse coag mode and a multiple bipolar mode.
Speaking of bipolar electrosurgery, ACMI featured its new Vist bipolar electrosurgical generator. Indicated for use with bipolar resectoscopes, the company says it provides superior control to the surgeon, resulting in using lower power and causing less decreased collateral tissue trauma from heat.
Meanwhile, a Smith & Nephew rep at AORN told me the company plans to launch a monopolar RF ablation probe geared toward knee and shoulder procedures, including ACL repair notch preparation and meniscal debridement. The system, called the Sculptor, hit the market in May. It has six different probe tip configurations at a variety of angles and other options include suction and tip malleability.
Back to the future
As you know, disposing of biohazardous red bag waste is a major OR expense. Dornoch featured a solution to suction canister disposal cost-containment called the Transposal Safety Station. This device's concept is actually a throwback to yesteryear's biohazard cost management, but with a high-tech twist. The old concept: Why throw away containers you can wash and reuse? The modern touch Dornoch added is that the Transposal system renders sanitary (and legal) the contents you're sending down the drain.
The Transposal system is comprised of reusable clear plastic suction canisters, a disposable single-use lock for the canister and a machine to wash and sanitize the used canisters. The capped, used suction canisters are placed in the Safety Station, which then automatically uncaps the canister, dumps its contents, washes the canister in a high-level disinfectant, rinses the container and then signals the operator. The operator places the sanitized containers on a drying rack and disposes of the single-patient-use cap. The ongoing operational costs for this system, besides maintenance, utilities and staff time, are the single-use caps and the disinfectant solution.
Your initial capital investment for the system would be around $25,000. You may be able to cost-justify the expense by analyzing the equipment expense against your current and projected disposable suction container, gel, red bags and biohazardous disposal costs. The analysis may show the system to be a good investment for busy facilities that do red bag-heavy procedures.
Imagine the possibilities
Let's end our tour of the show floor with an exciting technology, the Pentax EPK1000 digital video processor, a system that could dramatically impact the future of minimally invasive surgery. In coming years, we may see a great advance in the early diagnosis and minimally invasive treatment of cancer in the form of cellular-level tissue visualization and biopsy. This will require an ultra-high resolution digital video, optic and illumination technologies to allow scopes to be manufactured for cellular-level visualization of tissues and a sophisticated display system that can handle the microscopic images. Pentax says the EPK1000 is a platform capable of supporting these images.
Before these groundbreaking procedures can become reality, however, there must still be two additional as-yet-unavailable components incorporated: compatible software and cellular-level endoscopes. A Pentax source told me there's rapid progress being made toward developing new software tools compatible with the processor for visual tissue biopsy. Time will tell if and when the technology lives up to its potential.