How often are instruments changed in RALP & RAPN?
Reviewed by Gokul Vignesh Kanda Swamy

This study investigates how often the robotic instruments are exchanged during robotic-assisted laparoscopic prostatectomy (RALP) and robot-assisted partial nephrectomy (RAPN). They presently come with a life span of 10 uses but whether all instruments are used fully on 10 different patients is unknown. This retrospective study was conducted in Baltimore in a single tertiary care centre where three surgeons performed 1579 RALP and two surgeons performed 313 RAPN procedures between January 2011 and October 2014. During RALP, 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=0.02) and instrument exchange did not lengthen operative times (P>0.05 for all instruments). An instrument on average costs $2500 or $250 per use. Exchange number was compared between the first and second half of cases performed. The rate of monopolar curved scissors, large needle drivers, and fenestrated bipolar graspers exchange remained stable in time, suggesting no association with surgeon learning curve. Exchange of Prograsp forceps did occur more frequently in the first half of cases, implying that less exchange occurred as surgeon experience increased. Perhaps Prograsp forceps were increasingly used more appropriately, and techniques that induced excessive wear were eliminated. Regardless of reason, the authors suggest that the true lifetime of monopolar curved scissors in both RALP and RAPN is less than the 10 lives attributed to them by the manufacturer. In contrast, the three other instruments could potentially be viable for many uses beyond 10. Based on this instrument usage has to be revisited and this could help in reducing the running cost of this service. 

Instrument life for robot-assisted laparoscopic radical prostatectomy and partial nephrectomy: are ten lives for most instruments justified?
Ludwig WW, Gorin MA, Ball MW, et al.
UROLOGY 
2015;86(5):942-6.