Reusable Scopes Research Articles

Comparison of utility and organizational impact of reusable and single-use rhinolaryngoscopes in a tertiary otorhinolaryngology department.

Flexible rhinolaryngoscopes are an important tool in otolaryngology. In recent years, single-use rhinolaryngoscopes (SURLs), which have been developed as an alternative to reusable scopes (RRLs), offer various advantages including less risk of contamination and elimination of the need for cleaning and reprocessing between procedures. This study aimed to compare procedure efficiency, organizational impact, and economic impact between SURLs and RRLs used for elective procedures conducted outside the otorhinolaryngology department in the hospital environment. In this randomized prospective study, either type of endoscope was tested by on-call otolaryngologists over a total of twelve weeks. The organizational impact was investigated using a quantitative research design. All categories of stakeholders responded to specific surveys based on profession; these included doctors (n = 13), those in managerial positions (n = 3), and other healthcare staff including technicians and nurses (n = 11). A micro-costing approach was used to evaluate resource utilization and cost of services. The trial was uploaded to clinicaltrials.gov (ID number: NCT0519821, https://clinicaltrials.gov/study/NCT05198219?intr=rhinolaryngo&rank=1). Overall, 14 and 12 procedures were performed using the SURLs and RRLs, respectively. No significant differences were observed between the endoscopes in terms of procedure duration, reported image quality, or maneuverability. The SURLs were significantly superior in terms of four organizational impact parameters, namely, modes of cooperation and communication, vigilance and monitoring methods, working conditions and safety, and logistics. The estimated per-procedure cost of the RRLs was SEK 536 (€ 34,68). The cost and effectiveness of RRLs and SURLs is influenced by the healthcare setting, procedure volume, and duration of device use. The adoption of SURLs can improve safety, streamline processes, and potentially reduce the risk of disease transmission.

Cost-effectiveness and health economics for ureteral and kidney stone disease: a systematic review of literature.

To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies. A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: 'costs of different procedures: SWL, URS, PCNL', 'costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices', 'costs of KSD treatment in the emergency setting: emergency stenting versus primary URS'. Forty-three papers reported on associated cost for different procedures, revealing URS to be the most cost-effective. PCNL follows with higher hospitalization costs, while SWL appears to be least cost effective due to high need of additional procedures. The role of disposable and reusable scope is investigated by 15 articles, while other 16 reported on the role of different lasers, devices and techniques. The last nine studies included discussed the best and more cost-effective treatment for acute stone presentation, with promising results for primary URS versus emergency stenting and delayed URS. Cost-effective and cost-conscious intervention is equally imperative to consider whilst weighing in clinical efficacy for endourological procedures. When a decision-making choice of SWL, URS or PCNL is offered to a patient, the outcomes must be balanced with a deeper understanding of additional cost burden of retreatment, reimbursement, repeated interventions, and recurrence. In todays' practice, investing in endourological devices for KSD management must consider carefully the direct and hidden costs of using reusable and disposable technology. Cost control measures should not in any way compromise the quality of life or safety of the patient.

The cost-effectiveness of reusable flexible ureteroscopes: An institutional audit.

A flexible ureteroscope (FU) is an important tool in the urologist's armamentarium. This study aims to check the durability and cost-effectiveness of conventional FU. The institution registry of damaged FU over the last 7 years was reviewed. A total of 17 flexible scopes were used. The data of 13 scopes (11 Storz fiberoptic and 2 Seesheen digital) are included in this study. A total of 1905 cases were performed. The cost of scope, duration of use, number of cases done by each scope, and nature of damage were evaluated. We compared the cost-effectiveness of conventional scopes with published costs on disposable scopes. The mean number of cases done by fiberoptic scope was 159 (range 25-334). The total cases done by 2 digital scopes were 135 and 25. The mean life of fiberoptic and digital scopes was 17 (range 4-31) and 8 months, respectively. The mean cost of fiberoptic scope was Indian Rupee (INR) 338,951 ($4082.7221) and INR 525,000 ($6323.7138) for digital scope. The cost per case for reusable scope is calculated by dividing the mean cost of FU by the mean number of cases done. The reprocessing cost of INR 527 was then added. Thus, the average cost per procedure for fiberoptic and digital FU was INR 2658.76 and INR 7089.50, respectively. We compared this cost with a projected cost of disposable FUbased on today's market data, which ranged from INR 60,000 to 107,427. The reusable scopes are durable, cost-effective, and an excellent option for high case-load institutions.

Disposable Cystoscopes Do Not Decrease Post Renal Transplant Stent Removal Symptomatic Infection Rates

ObjectiveTo evaluate the effect of disposable cystoscopes on the rate of symptomatic urinary tract infections (UTI) following post-renal transplant cystoscopic stent removal. MethodsWe performed a retrospective study of post-renal transplant cystoscopic stent removals in our outpatient clinic from March 2019 to March 2022. Our clinic converted to disposable cystoscopes in October 2021. All outpatient, phone, and portal encounters were reviewed for 30 days following the procedure. The primary outcome was the number of post-procedural symptomatic UTI within 30 days of the procedure. Symptomatic UTI was defined as fever, dysuria, or hematuria accompanied by a positive urine culture. ResultsA total of 323 patients had post-transplant stent removals including 123 with reusable scopes and 200 with disposable scopes. 1.6% (2/123) of patients with a reusable cystoscope experienced symptomatic UTI’s. They had positive urine cultures for E. Coli and Klebsiella. 2.0% (4/200) of patients with a disposable cystoscopy had a symptomatic UTI. The three types of positive urine cultures they experienced were E. Coli, Klebsiella, and Enterococcus. ConclusionsThe conversion from reusable to disposable cystoscopes did not decrease symptomatic UTI following renal transplant stent removal.

Performance of a single-use gastroscope for esophagogastroduodenoscopy: Prospective evaluation.

Background and study aims Reprocessing reusable endoscopes is challenging due to their non-sterilizable nature. Disinfection has been shown to have a significant risk of failure with serious consequences. Single-use endoscopes can eliminate contamination risk and reduce workflow delays caused by reprocessing. This study evaluated the clinical performance of single-use gastroscopes in patients undergoing esophagogastroduodenoscopy (EGD). Patients and methods In this case series, 60 patients underwent EGD using single-use gastroscopes, with 34 procedures in the endoscopy department and 26 in the intensive care unit. The primary outcome was successful completion of the intended EGD objective. Furthermore, certified endoscopists assessed device performance on a five-point Likert scale (ranging from 1-"much worse" to 5-"much better"), considering their experience with a reusable gastroscope. Results Successful completion of EGDs using only the single-use gastroscope was achieved in 58 of 60 cases (96.7%). In two cases, crossover to an ultra-slim endoscope was necessary to either reach the esophageal stenosis or to transverse the stenosis. Overall satisfaction was rated as comparable to reusable scopes in 51 of 56 cases (91.1%) and inferior in five cases (8.9%). The lower weight of the single-use gastroscope was rated as superior in 42 of 60 cases (70.0%). Drawbacks included reduced image quality (23 of 45 cases; 51.1%). Feedback included the absence of a freeze button, lens cleaning issues, and small image size. Conclusions Single-use gastroscopes exhibited a high EGD completion rate and effectiveness for various indications. Further research should focus on evaluating the implementation of single-use gastroscopes in a comprehensive context, considering clinical effectiveness, costs, and environmental impact.

Retrograde intrarenal surgery for asymptomatic incidental renal stones: a retrospective, real-world data analysis.

To determine surgical outcomes and stone-free rates (SFRs) when offering upfront retrograde intrarenal surgery (RIRS) to patients with asymptomatic incidental renal stones (AIRS), as active surveillance, shockwave lithotripsy or upfront intervention in patients with AIRS is still a debate among urologists. This retrospective FLEXible Ureteroscopy Outcomes Registry (FLEXOR), supported by the Team of Worldwide Endourological Researchers (TOWER), examines adult patients who underwent RIRS. We analysed a subset of asymptomatic patients with renal stones on imaging who were treated with RIRS. Data includes patient characteristics, stone specifications, anaesthesia type, perioperative details, complications, and SFR. A multivariable logistic regression analysis was performed to assess factors associated with the SFR. Among 679 patients with AIRS, 640 met the inclusion criteria. The median age was 55 years, with 33.4% being female. In all, 22.1% had positive urine cultures. The median stone diameter was 12 mm, commonly in lower and interpolar locations. RIRS was preferentially performed under general anaesthesia using a reusable scope in 443 cases. Prophylactic antibiotics were administered to 314 patients. The median operation time was 58 min and the median laser time was 24 min. The SFR was 68.8%. The use of holmium laser (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.06-0.63; P < 0.01) and multiple stones (OR 0.38, 95% CI 0.19-0.76; P < 0.01) were factors associated with lower odds of being stone free. Overall complications were minimal, with sepsis in 1.6% of patients. Re-interventions were performed in 76 cases (11.8%), with RIRS being the most common in 67 cases (10.6%). Our multicentre real-world study is the first of its kind that highlights the pros and cons of offering RIRS to patients with AIRS and demonstrates a favourable SFR with acceptable complications. Pre-emptively discussing potential re-intervention helps patients make informed decisions, particularly in cases involving large and multiple stones.

Single-use versus reusable rhinolaryngoscopes for inpatient otorhinolaryngology consults: Resident and patient experience.

Single-use rhinolaryngoscopes were brought to market in 2019 as an alternative to traditional reusable scopes and have garnered interest across settings given portability and potential cost advantages. While single-use was previously evaluated compared to traditional devices, the overall impact to the consult experience for both users and patients has not been captured. Eighteen residents performed consults with both single-use and reusable rhinolaryngoscope systems on alternating weeks. A five-question cumulative survey administered across three assessment points over a 12-week period using a five-point rating system to rate favorability. Residents and patients also completed four-point scale surveys following procedure(s) to capture the consult experience. Statistical analyses were performed to measure significance differences between survey responses between the two systems. Single-use rhinolaryngoscopes received higher overall ratings compared with reusables across each metric captured including overall consult time (4.3 vs. 2.2, p < .001), multiscope consults (4.4 vs. 3.1, p < .001), patient communication (4.6 vs. 2.1, p < .001), teaching opportunities (4.6 vs. 2.1, p < .001), and overall ease of use (4.7 vs. 2.6, p < .001). Residents rated single-use higher than reusable after each procedure in terms of ease of use (1.07 vs. 2.68, p < .001) and visual clarity (1.27 vs. 1.89, p = .003), while patients rated single-use higher for understanding of illness (3.9 vs. 3.1, p < .001) and understanding of treatment rationale (3.9 vs. 3.1, p < .001). Resident and patient experience feedback favored single-use rhinolaryngoscopes compared to reusable scope technology across multiple surveyed measurables. Single-use rhinolaryngoscopes provide a viable tool for otorhinolaryngologist and other clinicians to perform rhinolaryngoscopy consults. 4.

Disposable Duodenoscopes: Evidence and Open Issues.

Duodenoscope-related infections are a major concern in medicine and GI endoscopy, especially in fragile patients. Disposable duodenoscopes seem to be the right tool to minimize the problem: a good choice for patients with many comorbidities or with a high risk of carrying multidrug resistant bacteria. Urgent endoscopy could also be a good setting for the use of single-use duodenoscopes, especially when the risk of the infection cannot be evaluated. Their safety and efficacy in performing ERCP has been proven in many studies. However, randomized clinical trials and comparative large studies with reusable scopes are lacking. Moreover, the present early stage of their introduction on the market does not allow a large economical evaluation for each health system. Thus, accurate economical and safety comparisons with cap-disposable duodenoscopes are needed. Moreover, the environmental impact of single-use duodenoscopes should be carefully evaluated, considering the ongoing climate change. In conclusion, definitive guidelines are needed to choose wisely the appropriate patients for ERCP with disposable duodenoscopes as the complete switch to single-use duodenoscopes seems to be difficult, to date. Many issues are still open, and they need to be carefully evaluated in further, larger studies.

HSD40 Workflow Efficiencies for Flexible Cystoscopy: Comparing Single-Use Vs Reusable Cystoscopes

Flexible cystoscopy is a common procedure that is performed to diagnose and treat lower urinary tract conditions. Single-use cystoscopes have been introduced to eliminate time-consuming reprocessing, costly repairs, and potential cross-contamination that occur between cystoscopies with reusable scopes. We aimed to compare the hands-on labor time differences between flexible reusable cystoscopes versus single-use cystoscopes at a large urology Ambulatory Surgery Center (ASC).

Device Failure and Adverse Events Related to Single-use and Reusable Flexible Ureteroscopes: Findings and New Insights From an 11-Year Analysis of the Manufacturer and User Facility Device Experience Database

To catalog and characterize device failures and adverse events related to flexible ureteroscopes from a national database. Search of the Manufacturer User and Facility Device Experience database was performed for all recorded events related to flexible ureteroscopes between 2012 and 2022. The following information was collected: Problem and cause, timing, complications and injury, prolonged anesthesia, and early termination of procedure. Event severity was graded using a validated tool. A total of 206 events were identified (reusable/single use ratio, 2.5:1). There were 20 different problem categories reported, which included image loss (26.7%), difficulty removing scope (13.6%), scope damage from basket (4.4%), detachment of scope tip (5.8%) and contamination (4.9%). Faulty device was the predominant cause for an event related to single-use scopes (86.4%); this was seldom the case for reusable (2%). Patient injury occurred in 21.8%, but these were all in reusable scopes. No deaths were reported, but major complications included complete avulsion of the ureter (3.4%) and fully entrapped scope necessitating open surgery (2.9%). While the safety profile for single-use scopes was superior, they were significantly more likely to result in early termination (71.1% vs37.3%, P < .001). This was related to 76.3% of the single-usescopes experiencing sudden image loss. Flexible ureteroscopes are fragile, and a multitude of problems can occur. Many of these can be avoided through correct surgeon technique and robust maintenance services.

MP26-20 RANDOMIZED TRIAL OF SINGLE-USE VERSUS REUSABLE CYSTOSCOPE FOR URETERAL STENT REMOVAL

You have accessJournal of UrologyCME1 Apr 2023MP26-20 RANDOMIZED TRIAL OF SINGLE-USE VERSUS REUSABLE CYSTOSCOPE FOR URETERAL STENT REMOVAL Brett Johnson, Jay Raman, Best Sara, and Yair Lotan Brett JohnsonBrett Johnson More articles by this author , Jay RamanJay Raman More articles by this author , Best SaraBest Sara More articles by this author , and Yair LotanYair Lotan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reusable cystoscopes are associated with risks of cross-contamination, need for chemical reprocessing, mechanical breakdown, manpower for cleaning and maintenance costs. A sterile, single use cystoscope may reduce or eliminate the source of these infections, while also decreasing exposure to reprocessing chemical agents. This multicenter, prospective randomized trial compared single-use vs. reusable endoscope for removal of ureteral stents. METHODS: The evaluation of a single-use cystoscope (Ambu A/S) was completed in a prospective, randomized, dual-arm post-market clinical trial to directly compare its performance to standard of care (SOC) flexible reusable cystoscopes in the removal of ureteral stents in an outpatient setting. 102 patients were evaluated from baseline through day 10 post-procedure at three investigative sites. The primary endpoint was the success rate of the stent removal procedures, delineated by single-use or reusable cystoscope. Secondary endpoints included time from preparation to disposal or reprocessing preparation, urologic adverse events 0-10 days, and a post-procedure clinician satisfaction survey. RESULTS: There were 102 subjects, randomized 1:1 between the single-use scope and SOC reusable scope. The successful stent removal rate was 51/51 for SOC group and 50/51 for single-use group (p=1.00). One patient required the conversion to a reusable scope due to a grasper passage issue with the index scope. There was no statistical difference in the time from scope insertion to procedure completion between the study arms. Median time from prep for the procedure to disposal/prep for reprocessing was 611 sec. for the single-use and 1105 sec. for the reusable (p=0.00). Reprocessing time was not evaluated in study. The 5-point survey demonstrated no difference in clinician satisfaction between both arms across all parameters addressed, as seen in the Clinician Satisfaction Table. There was no difference in adverse events between arms and no device causal attribution for any adverse events reports. One serious adverse event required hospitalization for infection in the SOC arm. CONCLUSIONS: The RCT of single-use cystoscopes vs. reusables showed comparable device success with significant time savings for single-use and equal clinician satisfaction. Source of Funding: Ambu USA sponsored this trial. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e361 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brett Johnson More articles by this author Jay Raman More articles by this author Best Sara More articles by this author Yair Lotan More articles by this author Expand All Advertisement PDF downloadLoading ...

MP06-17 CONVERSION TO DISPOSABLE CYSTOSCOPES DECREASED POST-PROCEDURE ENCOUNTERS AND INFECTIONS COMPARED TO REUSABLE CYSTOSCOPES

You have accessJournal of UrologyCME1 Apr 2023MP06-17 CONVERSION TO DISPOSABLE CYSTOSCOPES DECREASED POST-PROCEDURE ENCOUNTERS AND INFECTIONS COMPARED TO REUSABLE CYSTOSCOPES Laura Geldmaker, Bryce Baird, Steven Petrou, Eric Regele, Daniela Haehn, Ethan Wajswol, Nikunj Gajarawala, Colleen Ball, Gregory Broderick, Timothy Lyon, and David Thiel Laura GeldmakerLaura Geldmaker More articles by this author , Bryce BairdBryce Baird More articles by this author , Steven PetrouSteven Petrou More articles by this author , Eric RegeleEric Regele More articles by this author , Daniela HaehnDaniela Haehn More articles by this author , Ethan WajswolEthan Wajswol More articles by this author , Nikunj GajarawalaNikunj Gajarawala More articles by this author , Colleen BallColleen Ball More articles by this author , Gregory BroderickGregory Broderick More articles by this author , Timothy LyonTimothy Lyon More articles by this author , and David ThielDavid Thiel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Given the current challenges in the sterile processing of surgical equipment, our Urology practice converted to single-use cystoscopes. Our objective was to evaluate differences in post-procedure encounters and infections following cystoscopies using disposable and reusable cystoscopes. METHODS: Cystoscopies performed from June 2020 through August 2020 and February 2021 through April 2021 were retrospectively reviewed. The 2020 cystoscopies were performed with reusable cystoscopes and the 2021 cystoscopies were performed with disposable cystoscopes (Ambu Inc., Columbia, MD, USA). Our primary analysis compared post-procedural encounters and infections for reusable and disposable cystoscopes. Encounters were defined as all phone calls, Emergency department visits, or clinic appointments related to post-procedural complications such as pain, hematuria, or fever within 30 days of the cystoscopy. RESULTS: 1,051 cystoscopies were included in our four-month retrospective analysis. 533 cystoscopies utilized disposable cystoscopes and 518 utilized reusable cystoscopes. In the disposable scope group, 380 (71.3%) patients were male and 153 (28.7%) were female. In the reusable scope group, 356 (68.7%) patients were male and 162 (31.3%) were female. Overall median age was 71 years for both groups [range: 20-97 (disposable), 23-98 (reusable)]. The most common indication for cystoscopy in both groups was suspicion of bladder cancer [disposable: 152 (28.5%) and reusable: 144 (27.8%)]. The reusable cystoscope group had a higher percent of encounters [87 (16.8%) vs. 12 (2.3%), p<0.001], urine cultures [83 (16.0%) vs. 4 (0.8%), p<0.001], positive urine cultures [23 (4.4%) vs. 2 (0.4%), p<0.001], and hospitalizations [3 (0.6%) vs. 1 (0.2%), p=0.367] when compared to the disposable scope group. CONCLUSIONS: The use of disposable cystoscopes decreased the number of post-procedure encounters, ordered urine cultures, positive urine cultures, and hospitalizations. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e60 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Geldmaker More articles by this author Bryce Baird More articles by this author Steven Petrou More articles by this author Eric Regele More articles by this author Daniela Haehn More articles by this author Ethan Wajswol More articles by this author Nikunj Gajarawala More articles by this author Colleen Ball More articles by this author Gregory Broderick More articles by this author Timothy Lyon More articles by this author David Thiel More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of single-use flexible ureteroscopes with a reusable ureteroscope for the management of paediatric urolithiasis

To compare the efficacy, side effects, and cost-effectiveness between a single-use digital flexible ureteroscope and a reusable flexible ureteroscope in the treatment of paediatric renal stones. This analytic, case-control, monocentric study included all patients undergoing flexible ureterosopies for stone treatment. Between April 2016 and February 2019, a reusable (Flex-XC®, Karl Storz) flexible ureteroscope was used (control group), whereas a single-use (Uscope®, PUSEN Medical©) flexible ureteroscope was used in all procedures from March 2019 to April 2021. Clinical and procedural outcomes, operative times, complication rates, hospital stay, and costs per procedure were evaluated. Forty-three cases using a reusable flexible ureteroscope and thirty-nine using a single-use flexible ureteroscope were included in the study. Demographic patient characteristics, stone burden, location and composition, preoperative presence of a double-J stent, procedural outcomes, mean length of postoperative hospital stay, and complications (4.6% versus 5%, p=0.81) were comparable between the two groups. Median operative duration for stone removal was 93min (20-170) with reusable versus 81min (55-107) with the single-use scope (p=0.18). Scope failure occurred four times with the reusable scope and in no case with the single-use. The total cost per procedure associated with the use of single-use scopes (798 Euros) was lower than a reusable scope (1483.23 Euros). Single-use flexible ureteroscopes were created to bypass the problems incurred when reusable scopes were damaged and therefore not available for use in surgical procedures. Single-use flexible ureteroscopes are always immediately available and ready to be used, even in urgent cases, as they typically do not require maintenance or sterilization. Compared with their reusable counterparts, single-use flexible ureteroscopes have similar digital performance (270°), image quality and we found no difference in the success and complication rates. Cost analysis of a reusable flexible ureteroscope must consider the purchase price, maintenance and repair costs, and decontamination costs (including handling, detergent, bacterial culture, transportation, and storage costs). In contrast, only purchase price is included in cost analysis for single-use flexible ureteroscopes. Our study suggests that single-use flexible ureteroscopes may be associated with lower costs per procedure than their reusable counterparts. Single-use flexible ureteroscopes are an interesting alternative to their reusable counterparts, particularly in terms of material resource management. Cost analyses conducted using a low volume of cases representative of a paediatric urology division favour the use of single-use ureteroscopes.

RIRS with disposable or reusable scopes: does it make a difference? Results from the multicenter FLEXOR study.

With several single-use ureteroscopes now available, our aim was to analyze and compare data obtained globally from high-volume centers using both disposable and reusable flexible ureteroscopes and see if indeed in real-world practice either scope has a distinct advantage. Retrospective analysis was performed on the FLEXOR registry, which was created as a TOWER group (Team of Worldwide Endourological Researchers, research wing of the Endourological Society) endeavor. Patients who underwent retrograde intrarenal surgery (RIRS) for renal stones from January 2018 to August 2021 were enrolled from 20 centers globally. A total of 6663 patients whose data were available for analysis were divided into Group 1 (Reusable scopes, 4808 patients) versus Group 2 (Disposable scopes, 1855 patients). The age and gender distribution were similar in both groups. The mean stone size was 11.8 mm and 9.6 mm in Groups 2 and 1, respectively (p < 0.001). Group 2 had more patients with >2 cm stones, lower pole stones and of higher Hounsfield unit. Thulium fiber laser (TFL) was used more in Group 2 (p < 0.001). Patients in Group 2 had a slightly higher stone-free rate (SFR) (78.22%) and a lower number of residual fragments (RFs) compared with Group 1 (p < 0.001). The need for further treatments for RF and overall complications was comparable between groups. On multivariate analysis, overall complications were more likely to occur in elderly patients, larger stone size, lower pole stones, and were also more when using disposable scopes with longer operative time. RFs were significantly higher (p < 0.001) for lower pole, larger, harder, multiple stones and in elderly. Our real-world practice observations suggest that urologists choose disposable scopes for bigger, lower pole, and harder stones, and it does indeed help in improving the single-stage SFR if used correctly, with the appropriate lasers and lasing techniques in expert hands.

Determining the Operative Efficiency of Ankle Arthroscopy with a Standard Arthroscope vs Nanoscope

Category: Arthroscopy; Ankle Introduction/Purpose: Ankle arthroscopy is a commonly performed surgical procedure. Needle arthroscopy - performed with a nanoscope (Arthrex, Naples, FL) - has recently been introduced as an alternative to traditional arthroscopy, with goals of reducing pre-procedure set-up time, size of incisions, and minimizing soft tissue injury. To date, the efficiency of nanoscope use in ankle arthroscopy has not been investigated. The purpose of this study is to use time-driven activity-based costing (TDABC) to compare the single-use nanoscope to the reusable 2.7-millimeter small joint arthroscope in performing ankle arthroscopy procedures to understand cost and efficiency. We hypothesize that the nanoscope is the more cost-effective approach because it is not associated with the costs of reprocessing and allows for quicker operating room (OR) setup time. Methods: This is a prospective study of hand-timed collection of procedure times and a retrospective review of procedure costs. Four authors directly hand-timed ankle arthroscopy procedure setup and operative cases performed by one of two fellowship- trained foot and ankle surgeons at a single academic medical center. In total, 21 procedures were timed (arthroscope=10, nanoscope=11). Furthermore, using TDABC, we calculated procedure costs with each device. Costs of reprocessing reusable equipment, operating room time per minute (mean, $36.14/min), sterile processing, department and operating room labor, and maintenance were gathered from literature values and facility accounting systems. These direct and indirect costs were summed into the total cost for each of the surgical techniques, and a sensitivity analysis was performed to determine which of the variables had the most significant effect on overall procedure cost. Results: There was a statistically significant difference in OR opening time (arthroscope=10.28 minutes, nanoscope=4.83 minutes; p=.021) and incision to joint space time (arthroscope=2.19 minutes, nanoscope=1.26 minutes; p=.007) between devices, but no difference concerning set-up or total case intraoperative times. (Table 1) There was no difference in total OR time cost, though the nanoscope group was lower than the arthroscope group (arthroscope= $1,171.48, nanoscope=$916.60; p=.066). With regard to the costs of instrument cleaning, OR turnover, and device setup, the total cost for standard arthroscope use was $1,265.73, as compared to $968.28 for the nanoscope (p=.038). However, the use of the standard arthroscope was less costly when the OR turnover time was less than 24.18 minutes or the OR time costs were less than $26.96 per minute. Conclusion: Overall, the nanoscope was significantly more efficient than the 2.7-millimeter reusable scope regarding opening time and incision to joint space time in the OR. Ankle arthroscopy utilizing a traditional arthroscope is 30.7% more expensive than with the use of a nanoscope and takes longer to set up. Operating room cost per minute and room turnover time are the primary factors driving procedural cost. Given the similar clinical indications of both devices, understanding the cost differences between devices may assist in clinician decision-making to guide the optimization of facility procedures in the operating room.

Cost-Effectiveness of 90-day Single-use Flexible Cystoscope Trial: Single Center Micro-Costing Analysis and User Satisfaction

To evaluate cost-effectiveness and user satisfaction of a single-use flexible cystoscope at a tertiary care center we conducted a 90-day trial. Single-use flexible cystoscope advancements have introduced alternative options to reusable scopes. However, there is a paucity of cost-effectiveness and provider satisfaction studies examining the implementation of a hospital-based transition to single-use cystoscopes. Following institutional device-approval we initiated a 90-day trial period (November 1, 2020-January 29, 2021) where all flexible, transurethral, and percutaneous, urologic care was provided with a disposable AMBU aScope. We performed a micro-costing analysis examining payor per case cost of the reusable flexible cystoscope (including servicing and processing) to the disposable units. Provider surveys assessed visual quality, deflection, ease of working channel and overall satisfaction on a 10-point Likert scale. Over the 90-day period, we encountered 84 cases (78 operative, 5 inpatient, 1 emergency department) where flexible cystoscopy was required. One disposable flexible cystoscope was successfully used in 78 of 84 (93%) cases. Of the 6 failures, 2 were due to an inability to access a disposable scope/monitor. Per use cost of the reusable flexible cystoscope at our center was $272.41 versus $185.00 for the single use. Extrapolating our average case volume and conservative failure rate (3 single use failures/month, requiring reusable), transitioning to predominately single use scopes results in $39,142.84 annual cost savings. This single center 90-day trial of disposable flexible cystoscopy identified per-use costs to be less when a single-use flexible cystoscope was utilized at a high-volume tertiary care center.

Single-use flexible ureteroscopes: update and perspective in developing countries. A narrative review.

ABSTRACTFlexible ureteroscopy is a well-established method for treatment of urinary stones but flexible ureteroscopes are expensive and fragile devices with a very limited lifetime. Since 2006 with the advent of digital flexible ureteroscopes a great evolution has occurred. The first single-use flexible ureteroscope was launched in 2011 and new models are coming to the market. The aim of this article is to review the characteristics of these devices, compare their results with the reusable devices and evaluate the cost-benefits of adopting single-use flexible ureteroscopes in developing countries.Materials and Methods:an extensive review of articles listed at PubMed and published between 2000 and 2021 was performed.Results:Single-use flexible ureteroscopes have a shaft with 65 to 68cm length and weight between 119 and 277g. Their deflection goes up to 300 degrees. Their stone-free rates vary between 60 and 95% which is comparable to reusable scopes and operative times ranges from 54 to 86 minutes which are lower when compared to reusable flexible scopes. Their costs vary between 800 and 3180 US dollars.Conclusion:single-use flexible ureteroscopes are lighter and have superior quality of image when compared to fiberoptic ones. There are no definite data showing a higher stone-free rate or less complications with the use of single-use flexible ureteroscopes. Each institution must perform a cost-benefit analysis before making the decision of adopting or not such devices depending on the local circumstances.

339 Single Use Flexible Scopes in Percutaneous Renal Surgery

Abstract Introduction Flexible nephroscopy is performed at the end of percutaneous nephrolithotomy (PCNL) to confirm stone clearance. Flexible cystoscopes are commonly used to perform nephroscopy through the PCNL tract, however reusable scopes can provide limited optics due to procedural factors such as renal bleeding and scope factors such as fibre-optic damage. The Ambu® aScope™ 4 Cysto (AmbuScope) is a single-use disposable, video flexible cystoscope which has been solely used in the outpatient setting for bladder visualisation. We describe the first experience of the single use scope in nephroscopy during PCNL. Method Retrospective data was collected and analysed in a 6-month period from 13 consecutive patients undergoing PCNL using the AmbuScope for flexible nephroscopy. Stone free rates on nephroscopy, post-op complications, surgeons’ useability scores and theatre staff opinions were collated. Results All procedures were completed without complication or scope malfunctions. One patient died 27 days post operatively from urosepsis and osteomyelitis: unrelated to the single use scope. All other cases had an uncomplicated recovery. Surgeon useability scores rated the scope as easy (40%) or very easy (60%) to access, very user friendly (100%) and had good (20%) and very good (80%) image quality. 60% of respondents preferred to use the Ambu® aScope™ over the reusable scope. The single scope was found to be more cost-effective at £135 compared to £166 for reusable scopes. Conclusions This study is the first to show that single use scopes are safe, user friendly and cost effectively used during percutaneous nephroscopy.

POSA298 Economic Burden from Reusable Scope Repairs: A Literature Review

Repair costs are a hidden component of reusable scopes and the true economic burden of maintaining and repairing these expensive and highly utilized devices is not well-described in the literature. To better understand the ongoing repair expenses to a hospital’s scope fleet, a literature search was conducted to review the published evidence.

Single-Use or Disposable Flexible Bronchoscopy in Advanced Bronchoscopy Procedures: Experience in a Quaternary Referral Centre.

The development of single-use flexible or disposable bronchoscopes (SUFBs) has accelerated in recent years, with the reduced risk of infectious transmission and reduced need for endoscopy staffing particularly advantageous in the COVID-19 pandemic era. The objective of this study was to assess the performance of a novel single-use bronchoscope in an academic quaternary referral centre with on-site interventional pulmonology programme. With ethical approval in a quaternary referral centre, we prospectively collected data on sequential bronchoscopy procedures using The Surgical Company Broncoflex© range of SUFBs. Data collected included demographic, procedural, scope performance, user satisfaction, and complication parameters in a tertiary bronchoscopy service. 139 procedures were performed by five pulmonology faculty from January to July 2021. The majority were carried out for infection (45%) and malignancy (32%). Most were performed in the endoscopy suite and 8% were COVID positive or suspected. Most procedures reported the highest score in satisfaction (85%) with technical limitations reported in 15% (predominately related to scope suction or inadequate image quality) reverting to a reusable scope in 2.8 %. In our subset of patients in a bronchoscopy unit, SUFBs are safe, and both routine and advanced bronchoscopy procedures can be performed with high satisfaction reported.