REPLACE AND REUSE Reposable laparoscopic instruments often let you remove and dispose of interchangeable tips, like scissors, while sterilizing and reusing the handle.

Reposable instruments — limited-use devices that some say are the perfect compromise between reusable and disposable ones — have been around for more than a decade. But has your facility realized their advantages? These ergonomic, take-apart instruments can cut costs and reduce waste while keeping your surgeons satisfied with their performance.

The No. 1 benefit of reposables is cost, says Vangie Dennis, RN, BSN, CNOR, CMLSO, administrative director of Spivey Station Surgery Center in Jonesboro, Ga. "We are in a time of dwindling reimbursements and higher quality demands," she says. "Reposable instruments maintain quality and keep costs down." Ms. Dennis, who has been using reposables for more than 15 years, says the savings vary depending on the reposable used. Reposable laser fibers, which are nearly identical to disposable ones, save her facility the most. Laparoscopic instruments that have disposable tips placed on multi-use handles are also budget-friendly, she says.

Reposable steel knives, while more expensive up front, can be a few dollars cheaper per case than disposable ones, since they are reused several times, and can eliminate maintenance costs associated with diamond blades. These reposable blades may also have other features, like safety shields. You can also save per case by using reposable phaco tips, infusion sleeves and tubing sets.

Reposables can also cut costs for traditionally expensive surgeries. Take single-port access surgery, for example. Paul Curcillo, MD, FACS, chief of the division of minimally invasive surgery at Fox Chase Cancer Center in Philadelphia, conducted a study that found a savings of more than $40,000 on 200 single-port access laparoscopic procedures by switching to reposables. "So while everybody else is saying that, for single-site surgery, costs increase for the instruments, we've actually been doing single-port access surgery and saving money by using reposables," he says.

David Renton, MD, FACS, MPH, assistant professor of surgery at Ohio State University's Center for Minimally Invasive Surgery in Columbus, notes that maintenance costs are much less for reposables when compared to reusable instruments. For example, experts say centers can save a significant amount of money using reposable versions of diamond paracentesis and trapezoid incision blades, which promise the durability of reusable without the associated special care and maintenance costs — which can total up to $1,000 a year, not including any major repairs. "I know the costs of reusable and I know the costs of a disposable instrument, but what few surgeons understand is the cost of repairing the reusable," says Dr. Curcillo.

Save while going green
Another benefit of reposables is that they can let you go green while saving green, if you're primarily using disposables. "The benefits aren't just economic," says Dr. Curcillo. "They're ecologic as well." Instead of throwing away an instrument after each case with reposables, you'll either be throwing away a smaller piece of it or disposing of the instrument after several cases. Ms. Dennis compares throwing out disposables versus reposables to throwing out "a cardboard box versus a napkin." With healthcare facilities one of the biggest contributors to waste, reposables can be a great way to help reduce your footprint. "I always say, our grandchildren are going to be digging up these devices when they're building their houses," says Dr. Curcillo.

You can also save money in medical waste disposal costs. With an average cost of 28 cents a pound for medical waste disposal, Dr. Curcillo notes that reposables can be a "huge money saver" for some facilities. "Disposable medical waste is incredibly expensive. It's a lot," adds Dr. Renton. "When you just have to throw out the scissor tip, and not the entire handle along with it, it saves money. Now we're only throwing away this little piece every time instead of this big thing."

Don't think that you'll be sacrificing quality for a cheaper and greener product. Dr. Renton says reposables, "perform exactly the same" as their well-known counterparts. "There's absolutely no difference in the feel of the instruments," agrees Dr. Curcillo. "A surgeon is likely not going to know the difference," says Ms. Dennis. "I have not had one surgeon complain when I went to reposable."

Dr. Curcillo says that if a surgeon does notice a difference, it likely is a positive one. Reposables' quality is high since manufacturers guarantee the instruments for the number of uses specified, says Ms. Dennis. Some devices, especially laparoscopic and tissue-sealing ones, allow for surgeons to reuse more durable parts of the instrument while getting a fresh new tip or electrode each time. "For scissors, where the shaft and handle are reusable and you screw on the sharp tips to the end, it makes sense because those things dull every case, so you get the durable shaft and handle and a fresh sharp pair of scissors each time," says Dr. Renton.

Reposables stem from the rise of third-party reprocessing of single-use instruments, which made people "rethink disposables and reusables," says Dr. Curcillo. "We started reprocessing disposables and for some instruments, that wasn't making sense," he says. That led to some desiring a solution that combined the best parts of disposables and reusables. "That's where reposable instruments came to light," says Dr. Curcillo. "They're the best of both worlds."

Thinking of adding reposables?
If you're considering reposables, the experts say there are a couple of things to keep in mind. Ms. Dennis notes that because reposables are limited-use — with manufacturers specifying the number of times they can be reused before they must be disposed of — you have to have a plan in place to track their uses.

It's not as complicated as it sounds. Dr. Curcillo says that he's seen facilities track uses "every way" from marking small dots on the device after each case to using specialized computer systems to record the instrument use in each procedure. Ms. Dennis says a previous facility she worked at had a computer system that scanned bar-coded instruments to track the number of sterilizations, but notes for smaller centers, a manual count is "doable."

Involving your surgeons in the transition is also crucial, says Ms. Dennis. Get them on board by selling the benefits for the surgeon, she suggests — especially if you've been getting complaints of warped electrodes or dull blades.

An even better thing to do, says Dr. Curcillo, is to gather all of the stakeholders at once — staff, surgeons, management and owners — and give them the benefits. "Usually if someone is interested in changing something at the facility, that person or group will first talk to the surgeons, and then to the management," says Dr. Curcillo. "That means a lot of back and forth. By talking to everyone at the same time, you can say, 'Look, we're giving you all something you want.'"

Showing that it costs less money, requires minimal effort from staff and solves some surgeons' complaints will make for a smoother transition. "Reposables make sense for everybody — the nurses, the surgeons and the administrators," says Dr. Curcillo. "It's all good things."