Speed and power. When buying power tools, the more of each, the better. Other factors impact the performance of the tools and the satisfaction of the surgeons who use them, but speed and power top the list. Here's an overview.

How many tools is enough?
Your case mix and case volume will determine how many and what kind of power tools you'll need. If you only do a few procedures a month, then one device with several attachments should be adequate. You can also lend and borrow with other facilities if the need is rare, says Gabrielle White, RN, CASC, the director of the Orthopedic Surgery Center of Orange County, in Newport Beach, Calif.

If you're doing 50 or more cases a month, you'll need at least two or three tools with multiple attachments. Remember that power tools represent a significant investment to your facility, so your budget can also become a determining factor in how many tools you can purchase.

Locate at least three companies and get estimates from each, says Ms. White. After you've evaluated each product, choose the most preferred and best quality, and then work on negotiating the price. "Educate your MDs to never let one vendor know it has the preferred equipment. Otherwise, you have less room to negotiate the price down," Ms. White tells us. "And never pay list price."

Three categories of tools are used in orthopedic, neuro, ENT and oral/maxillofacial procedures.

• Pen-style systems. Used in oral/maxillofacial, hand, podiatric and neuro procedures, these tools are used on small bone surgeries and are generally very high speed and designed to fit easily in the surgeon's hand for maximum control. They're used to power bits and burs and although traditionally pneumatically powered, there are now electric versions available. Micro drills, sagittal saws, oscillating saws, reciprocating saws and wire drivers are common pen-style devices.
• Stand-alone instruments. Stand-alone instruments are used for large bone procedures, typically in orthopedics. They're the largest and most powerful tools and are used for drilling, reaming, sawing and inserting pins. Today, many of these tools are battery-powered, which allows for easy maneuverability. These instruments generally come with a variety of attachments to add even more versatility.
• Modular systems. Modular systems are made up of a single motor unit that can accept a wide variety of attachments to perform multiple tasks. These system attachments typically function as shavers, drills, reamers, wire drivers and small saws. They're very versatile and can be used in small bone procedures and other larger cases. Modular systems also let you cut down on duplication of instruments and free up storage space.

Purchasing pearls
Here are factors to consider when thinking of buying any of these types of tools.

• Power and speed. The more speed a tool has, the faster it can cut through bone, giving a surgeon more control. Depending on the type of procedure, a tool with upwards of 70,000 RPM can significantly help a surgeon by requiring less pressure on the bone. Generally small bone procedures require less speed because the bones are more delicate, while an orthopedic procedure needs a tool with more speed to cut through thicker bones.

Power is also an important feature to consider when purchasing any type of power tool. Power produces speed and torque. If speed isn't combined with enough torque, the tool can burn through the bone (torque provides a clean cut at slower speeds). If a tool is underpowered, the surgeon will have to push more on the bone. A lower-powered tool might stall when cutting dense bone, "jump" and injure surrounding soft tissues, or prick the surgeon's finger. An underpowered tool can also cause fatigue because the surgeon must push harder to achieve the desired result. You want the tool to work for you, not vice versa.

• Ergonomics. Any good power tool should be designed to fit the surgeon's hand, but pen-style systems, because of their use in small bone procedures, should be ergonomically designed. Choosing an instrument that feels comfortable for your surgeons to hold and maneuver will give them more control over the tool, a feature necessary in precision work. Some manufacturers offer convertible designs that let the surgeon change the orientation of the handpiece, giving him the ability to adjust the tool to a specific handgrip.
• Power source. There are three types of power. Pneumatic tools are the oldest type of power tool technology. Their parts include a control valve (foot or hand control), hose, and the tool itself and use nitrogen for power. They're highly reliable and able to achieve high-speed rotation (greater than 60,000 RPM). This type of power source is especially useful when sculpting or dissecting dense bone. However, pneumatic instruments are attached to a bulky, high-pressure nitrogen hose, which can fatigue a surgeon during a long procedure. They are also noisy and can generate a lot of heat while also requiring continuous lubrication

Corded electric motors mean lighter weight and easier maneuverability for surgeons in the OR. They're also quieter than pneumatic tools. On the downside, electric tools, like pneumatic ones, are tethered to something - in this case, a control panel. Also keep in mind that there are many ways that an electric tool can fail; the cords, control panels and footswitches will only work properly if the condition and maintenance of the cords and connectors is kept up.

Having a battery-operated tool means that you can rid your surgical field of cords and hoses, which will greatly enhance mobility and sterilization techniques. New advances in battery life are allowing batteries to last from two to five years depending on their type, frequency of use and care. However, the more power a battery-powered instrument has, the heavier they tend to be, and even though the tools may be reliable, you're at the mercy of the batteries being charged and ready.

• Weight and balance. Because the power source can greatly affect the weight of a tool, it is important to choose a tool that has enough power and speed, but is not so heavy that it becomes a burden on the surgeon. Although in some long cases fatigue may be inevitable, you should still strive to find tools that are fairly lightweight. Pen-style tools are usually lightweight, and electric versions can make them even lighter and easier to use during long procedures.

Balance is another factor to consider. How does the tool feel in the surgeon's hand? The weight should be well distributed and not pull the tool in any direction. This equal weight distribution will help the surgeon keep the tool steady and prevent his having to fight against the tool in long cases.

• Motor variety. Some manufacturers offer more than one motor so you can change them depending on whether you need a smaller profile or improved visualization. Attachments and tools required for any of the motors should be standardized, which will help decrease duplication of instruments. Many pneumatic motors use a lubricant/diffuser cartridge that lubricates the tool while in use and allows the tool to be used longer without stopping.
• Attachments. Many tools today come with different attachments, so it is important to choose a tool based on the variety or attachments and the ease of changing those attachments. Obviously the more attachments your system has, the more versatile it becomes; but you should also make sure that the attachments are useful. How big are they? Can they fit into tight spaces? Do you need all of the attachments, or would it be more cost-effective to purchase the tools you need separately?

Also consider the ease of changing attachments on a tool. Some systems use keys to change attachments, which can cost surgeons time in the OR. Newer systems use simple twist-and-lock mechanisms for a quick change of burs during surgery to reduce surgery time and ensure safer procedures.

• Switches. You should also consider how easy it is to turn the tool on and off and regulate it during use. Where are these switches on the tool and are they easy to find and use? If you are thinking of buying devices with a foot pedal, let your surgeons evaluate the device before purchase to determine if tool offers simple regulation in both variable and constant speeds.

A few other factors to keep in mind...

• Cost. Buying new tools can cut into your budget. Many facilities buy refurbished tools, and the market for these products is steadily growing.
• Maintenance. How easy is to clean and maintain the instrument? For tools with electric parts, you must be able to wipe the device down. Some require you to sterilize batteries; others provide a sterile transfer case. You must remove and sterilize the cord on pneumatic models. Consult with your infection control team so it can evaluate the device.
• Customer service. This includes in-service, repairs and replacement. There's no use having the latest and greatest with no one to in-service or help out when the product doesn't work, says Ms. White. Keep in mind that if you do purchase a refurbished power tool with a warranty, you'll forego the assistance of a vendor rep.

The Anspach Effort
XMax
(800) 327-6887
www.anspach.com
Price: Not disclosed
FYI: Anspach's XMax offers the ultimate combination of high power, smooth operation, low noise level and small size, says the company. The Xmax can |handle a complete range of surgical procedures ranging from power-demanding applications to the most delicate dissection. With an operating speed of 80,000 rpm at 90-120 psi input pressure, the Xmax system is the quietest pneumatic motor available, claims the company.

Arthrex
ClearCut Burrs
(800) 934-4404
www.arthrex.com
Price: Not disclosed
FYI: Arthrex's new line of ClearCut Burrs features a clear, high-strength polycarbonate hood covering the cutting surface of the burr tip which allows for increased visibility, says the company. The ClearCut Burr has a reduced size outer tube that allows the user increased access and improved cutting angles while continuing the "no-clog" outer tube design with suction pathways beneath the burr head and another through the outer tube, says Arthrex.

Brasseler USA Surgical
Power and Accessories
PneuMicro Small Bone Power System
(800) 535-6638
www.brasselerusamedical.com
Price: $2,260 to $2,620 price range for each hand piece
FYI: Brasseler's PneuMicro can be used for all small bone procedures to include orthopedic, oral, maxillofacial, otology and podiatric techniques, says the company. The PneuMicro is equipped with a high speed drill, medium speed drill, sagittal saw, oscillating saw, reciprocating saw and a soon-to-be-released wire driver. All handpieces are ergonomically designed, balanced and compact to allow easier access and greater visibility to the smaller working areas.

ConMed Linvatec
Hall Mpower Battery Powered Instruments
(800) 237-0169
www.conmed.com
Price: Not disclosed
FYI: ConMed's Hall Mpower system merges the power needed for the most demanding large bone procedures with a compact and lightweight design that is ideal for delicate hand and foot surgery. In addition to its unique size and performance, the Hall Mpower system is a full sealed powered instrument system that can be cleaned in a washer/sanitizer.

Medtronic
XPS 3000 Powered ENT System
(800) 874-5797
www.medtronicent.com
Price: $10,164 (console and two pumps) $11,464 to $12,010 (Visao High-Speed Otologic Drill) $8,220 (Straightshot M4 Microdebrider)
FYI: Medtronic's XPS 3000 Powered ENT System lets surgeons choose the amount of power needed for various ENT procedures, from high-performance to ultra-low speed oscillation, says the company. The XPS 3000 also offers a wide array of sub-specialty blades and burs, including an ergonomic microdebrider and a water-cooled high-speed otologic drill, and has an intuitive interface that allows OR staff to adjust irrigation levels and bur or blade speed with the touch of a button.

MicroAire Surgical Instruments
MicroAire Battery SmartDriver XT
(800) 722-0822
www.microaire.com
Price: $5,244.75
FYI: MicroAire's SmartDriver features a powerful, long-lasting 14.4-volt nickel metalhydride (NiMH) battery that provides longer run time than conventional NiCd batteries provided with other systems. Its pure power and the versatility it provides for various procedures makes the SmartDriver an excellent choice for a wide range of surgical procedures, says the company. The system also offers a complete compliment of attachments.

OsteoMed
OsteoPower Surgical Handpiece System
(800) 456-7779
www.osteomedcorp.com
Price: Not disclosed
FYI: OsteoMed's OsteoPower Surgical Handpiece System is a high-speed electric power system designed to accommodate a wide range of small bone specialties. The hand control handpiece has surface integrated sensors that let the surgeon control the power level, forward/reverse and speed from the sterile field. In addition, the fully modular system offers not only dual handpiece capabilities, but dual footswitch capabilities as well.

Stryker
System 6 Surgical
Handpieces
(800) 253-3210
www.stryker.com
Price: Not disclosed
FYI: Stryker's sixth-generation battery powered handpieces provide more options for great versatility and surgeon preference, says the company. One handpiece allows for both high speed drilling and high-torque reaming and can be converted to high-torque reaming without changing attachments. The saw attachments provide rotating heads, smaller size and new and improved motors that allow for faster, more efficient cutting action.