Instrument Life for Robot-assisted Laparoscopic Radical Prostatectomy and Partial Nephrectomy: Are Ten Lives for Most Instruments Justified?
OBJECTIVE
To investigate the rate of premature instrument exchange during robot-assisted laparoscopic radical prostatectomy (RALRP) and robot-assisted partial nephrectomy (RAPN). The majority of robotic instruments have a predetermined lifespan of 10 uses; however, it is unknown if instruments are routinely exchanged before 10 uses in clinical practice.


METHODS
We retrospectively reviewed instrument use in consecutive RALRP and RAPN cases performed by high-volume robotic surgeons at 1 tertiary care center between January 2011 and October 2014. The number of instruments used per case was evaluated and instances of additional instrument utilization were noted. Exchange number was compared between the first and second half of cases performed. Operative times were compared between cases with and without exchange. Student's t-test and Pearson's χ(2)-test were used to determine statistical significance.


RESULTS
Three surgeons performed 1579 RALRP procedures and 2 surgeons performed 313 RAPN procedures. During RALRP, monopolar curved scissors required exchange in 12.4% cases. Other instruments were exchanged in less than 2% of cases. Exchange rates were similar to those for RAPN. Only exchange of Prograsp forceps decreased with increasing surgeon experience (P = .02) and instrument exchange did not lengthen operative times (P >.05 for all instruments).


CONCLUSIONS
During RALRP and RAPN, monopolar curved scissors required exchange in approximately 10% of cases whereas other instruments were rarely exchanged. Robotic instrument lifetime may not uniformly be 10 uses. The preset lifetime of robotic instruments and/or pricing should be reevaluated.
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: wludwig1@jhmi.edu.
Wesley W
WW
Ludwig
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Michael A
MA
Gorin
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Mark W
MW
Ball
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Edward M
EM
Schaeffer
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Misop
M
Han
Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Mohamad E
ME
Allaf
D000368:Aged; D000369:Aged, 80 and over; D019544:Equipment Failure Analysis; D017743:Equipment Reuse / Q000706:statistics & numerical data; D004869:Equipment Safety; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods; D011468:Prostatectomy / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors