by Anne Reed, vice president, Mobile Instrument Service & Repair

Hospitals nationwide are discarding thousands of dollars worth of good reusable instruments annually. An old rule of thumb still prevails in the minds of buyers: If the repair cost of an item exceeds a minimum of 50 to 70% of its replacement cost, then it’s smarter to buy a new one. Old habits die hard. Because of enhanced technologies in the repair industry and greater access to replacement parts, much of their equipment does not need to be replaced.

Endoscopic instruments for use in Urology, Arthroscopy, Laparoscopy, Gynecology, Bronchoscopy, ENT, and General Surgery are among the most costly in inventory, and by their very design, inherently easy to damage. There are more moving parts that are likely to break than in most instruments, and far more materials that are subject to disintegration.

Because most MIS instruments are made up of a number of replaceable components, the potential for preserving them is practically infinite. Though repair costs sometimes seem high when compared to the cost of general instrumentation repair, MIS instruments are categorically more complex, and repairs require a higher degree of skill and expertise. The reward in decreased capital expenditures will be noticeable.

• Deflecting bridges retail for as much as $1,500, and new working elements cost between $1,200-$2,800, yet they can be repaired for an average of $100-$500, including parts.

• Similar savings of up to 90% of the replacement cost are realizable on the full line of MIS instruments including forceps, scissors, graspers, punches, trocars, cannulas, sheaths, bipolar tubal forceps, retractors, obturators, hooks, spatulas, probes, etc.

• When sinuscopy instruments become stiff and dull, and won’t perform like new, the most common reaction has been to replace the entire tray at a cost of about $15,000. A qualified repair provider would give the hospital the same result - functionally new instruments with the same expected life span - at about $2,000, an 86% savings.

The rigid endoscope, one of the most fragile and sophisticated instruments in the operating room, is subject to more frequent damage than most other equipment because of its delicate lens system.

• Most damage results from fluid invasions or trauma to the internal optics system. Approximately 90% of these parts can be replaced at a charge far less than expensive repair/exchange options.

• To capitalize on the potential efficiency of an original investment in the endoscope, the hospital or surgery center is economically better served to repair it until it has sustained damage genuinely beyond repair or has become technically obsolete.

• Even a scope that is broken in half can be repaired to a like-new condition at a cost of up to 60% less than a replacement.

Like rigid endoscopes, with today’s enhanced repair technologies, there is very little that cannot be repaired on a flexible unit. Most working elements can be replaced for significant savings.

Most of the power equipment no longer serviced by the OEM can effectively be made fully functioning by a competent repair source at a fraction of its replacement cost.

• The replacement of some power hand pieces also necessitates the purchase of all new support components like cords, consoles, and attachments – if there’s no real technical gain in the newer system, then repairing the broken hand piece is wise.

• The vigilant buyer will seek second opinions for the repair of motor drives, attachments, burr guards, duraguards, instrument power cords, shavers, etc. to help curb capital expenditures.

• Even some battery packs can now be refurbished.

• Preventable factors contributing to power equipment failure, such as over/under lubrication, immersion, etc., are often identified during the repair analysis, and armed with this information the facility can take steps to troubleshoot the abuse to help reduce repair frequency.

General instruments, the workhorses of the operating room, need routine care and maintenance to ensure their stamina. Regular sharpening and alignment will not only ensure optimum surgical effectiveness, it will also keep them functioning. While users can expect a long life, there will ultimately come a time when most general instruments should be retired:

• Cracked box locks on ring-handled instruments prevent the jaws or tips from aligning properly.

• Needleholders have an indefinite life span because the tungsten carbide inserts can be replaced repeatedly, however, if the jays are stressed, or the metal becomes too pitted, replacement is recommended.

• Instruments with a cutting edge or shearing action can be sharpened over and over until the blades no longer have enough surface to overlap properly. To prevent premature replacement, only experienced repair technicians should sharpen instruments so they don’t remove more of the edge than necessary.

• Despite their durability, most general surgical instruments will eventually succumb to the stress of metal fatigue caused by user abuse or the repeated assault of corrosive chemicals, but it’s important not to reject them based on cosmetic value alone.

There is a time when an instrument should be replaced and a reputable repair company will always give this advice. For example, older laparoscopy forceps could not be dissembled for cleaning. Sterility measures encourage the use of the newer style which can be taken apart, therefore, replacement should be considered. Some manufacturers have upgraded older standard sterilizable scopes to newer models that are fully autoclavable. Given current sterility issues and anticipated sterility mandates, this could be a good opportunity to upgrade and take advantage of available trade-in allowances or rebates when these break down. Technical improvements have also been made in video endoscopes, so when there is CCD chip damage, one might consider upgrading.

Many instruments, if not processed correctly, will corrode over a period of time. Once the metal deteriorates and functional integrity has been compromised, then replacement becomes necessary.

• Make instruments last