Single Use, Multiple Benefits

Five years ago, I performed my first nano laser cataract surgery. This novel technology and a switch to customizable single-use procedure packs with all the essential instruments allowed us to offer the first all-single-use-instrument cataract surgery in Germany.

There has been great debate over the use of reusable versus single-use instruments (SUIs) and the reasons for and against the switch. Factors often queried include the instruments’ quality, sterility, and effectiveness – but, after evaluating SUIs in clinical practice, many surgeons attest to their precision, safety, and reliability. SUIs do not need to be re-sterilized and processed. In this way, you tie up significantly fewer personnel resources and create a faster and smoother, and therefore more effective surgical workflow possible. Technological advances have led to the development of SUIs that more effectively prevent the cross-contamination possible with reusable instruments. The new manufacturing technologies made SUIs affordable for everyday use. SUIs give patients a sense of security, because they know that the instruments being used have never touched another eye.

Growing concerns over ineffective instrument sterilization and the development of drug-resistant pathogens have led to a need for optimal protection against infection in every surgery – and SUIs offer that protection. They are now widely available and, with advancements in surgical technology and an increasingly aging population, now is the time to consider making the switch.

My journey toward single-use instruments
 

In my private practice, we perform up to 200 surgeries per month. These include cataract surgery, ICL, refractive lens exchange, laser procedures, corneal surgery, retinal procedures, and cosmetic eyelid surgery. I had been using reusable instruments, but since 2019, much has changed. The introduction of nano laser with a disposable handpiece opened doors to creating an entire set of SUIs for all our nano laser procedures. It was a long-awaited invention that we needed, and greatly altered how we dealt with our patients.

SUIs correspond to most patients’ understanding of hygiene and infection protection in modern medicine. In fact, our patients tend to assume we are using SUIs, and are surprised if that is not the case. I would want the same if I were the patient having a procedure done.

Talking to patients about SUIs turns a small technical detail into a selling point for the clinic, which has also proven to be incredibly valuable in patients’ own eyecare hygiene practices.

Key considerations for single-use instruments 
 

For cataract operations, the most common surgery we perform, I almost always opt for SUIs. When using the traditional phacoemulsification method, the handpiece is reusable and thus requires proper sterilization and reprocessing. 

The combination of the nano laser, which is a gentler surgical approach, with the more hygienic SUIs has become our patients’ first choice. Since 2019, 75 percent of our patients chose laser surgery using SUIs over conventional reusable instruments. My patients feel that SUIs are more hygienic – and, in any procedure, more hygiene equals more safety.

Since the introduction of full-SUI procedures, we have been much more flexible in planning surgeries and no longer need to concern ourselves with burdensome sterilization cycles. Significantly fewer staff are involved in reprocessing instruments and our highly qualified professionals can be deployed in other areas.

When dealing with reusable instruments, it is vital to provide for their effective sterilization – a multistep process engaging much time and extra cost for replacing instruments damaged during decontamination. By offering a simple, single-use solution, SUIs have solved many of these problems. Also, we now have customized SUI packs for each surgical procedure, which has eliminated the need to arrange and collect instruments for each procedure, bringing increased safety and flexibility to the surgeries I perform.

When I am asked about switching to SUIs, I say it is just as simple as changing your clothes. The switch from reusable instruments to SUIs was quick and easy. After testing many suppliers to make a suitable and economical choice, we found that BVI’s high-quality SUIs offer flexibility and reliability in the design of the procedure sets. The instruments are equivalent to their reusable predecessors and, in some cases (such as the lens manipulator and eyelid retractor), the SUI versions are even better. One of my go-to instruments is the Kuglen hook. I use it as my standard nucleus manipulator and for all intraocular maneuvers, such as IOL rotation, iris refraction, and more. At this point, I feel a lot more comfortable with SUIs than with reusable ones, because they always give me the feeling that I am using a brand-new instrument with no wear or damage.

Ask your patients what they would prefer and whether they are willing to accept some additional cost for improved safety and hygiene. My patients have always been very clear on these points. It has been two years since I fully switched to SUIs in response to my patients’ preferences but, for now, I limit their use to cataract surgery, because it is the most common surgery at our clinic. I would like to switch my ICL procedures to SUIs as well, but it is not yet possible due to a lack of single-use ICL loading forceps options. An SUI set for ICL implants would be my first choice for a new product, because ICL is the fastest growing sector in refractive surgery.

Financial disclosure: Consultant for BVI.