WCE 2019: Debate - Disposable vs. Reusable Flexible Ureteroscopes

Abu Dhabi, United Arab Emirates (UAE) (UroToday.com) In this session, Dr. Panagiotis Mourmouris and Dr. Evangelos Liatsikos debated the pros and cons of disposable single-use versus reusable multiuse ureteroscopes. Dr. Liatsikos, who was in favor of reusable scopes, began the debate by introducing the four categories every ureteroscope should satisfy: small caliber, good visualization, high deflection, and safety. Dr. Liatsikos stated that the smallest scopes currently on the market are the multiuse optic fiberscopes. The best visualization is provided by multiuse digital scopes. Dr. Liatsikos acknowledges that single-use scopes may be enough for stone surgeries; however, if a surgeon is dealing with tumors of the upper tract, a multiuse scope is necessary because he or she will need to see every detail of the mass and surrounding structures clearly.

Furthermore, multiuse scopes are more durable than single-use scopes are in Dr. Liatsikos’ opinion. Single-use scopes are meant to only be used a few times – the deflection wears down quickly. In some cases, single-use scopes break in the operating room.  In these cases, back-up scopes need to be multi-use scopes, as surgeons’ universally agree that a durable, dependable scope with proven efficacy should always be a standby.

Dr. Liatsikos also brought up the critical topic of the ecological impact of single-use scopes. Because operating room equipment is not recycled, single-use scopes often end up in a landfill. Furthermore, single-use scopes can be used up to a dozen times in the OR, so the ecological impact of resterilization and decontamination of these scopes still exists.

Lastly, multiuse scopes may be more cost-effective than single-use scopes, especially at a large center. Dr. Liatsikos reported that after 99 ureteroscopic cases, a Mayo Clinic study determined that reusable scopes are actually more cost saving than disposable scopes.1 As a parting thought, Dr. Liatsikos concedes that every institution may need a mixture of both types of scopes. The greatest advantage to single-use scopes may be their use in surgical training as Dr. Liatsikos would much rather his residents break a cheaper scope than a high-end, reusable scope.

Dr. Mourmouris, who was in favor of single-use scopes, began his portion of the debate by stating that there are many different components of the evaluation of image quality in scopes. For example, field of view and distortion of the image are part of quality evaluation, and single-use scopes are not worse than reusable scopes in these regards. Furthermore, he believes that deflection-wise, disposable scopes are actually performing better than reusable scopes. Lastly, one study showed that reusable scopes and single-use scopes have a comparable ecological impact.2

However the biggest benefit of single-use scopes, in Dr. Mourmouris’s opinion, is that they are much lighter and easier to maneuver than reusable scopes are. If, for example, a surgeon performs three to four cases per day and spends one to two hours per case, the lightness and easy disposable scopes are lighter and easier to use than reusable scopes. If surgeons are more comfortable, may perform better with better patient outcomes.

Presented by: Panagiotis Mourmouris, Msc PhD, FEBU, Division of Urology II, National and Kapodistrian University of Athens, Greece, and Evangelos Liatsikos, MD, Chairman of the European Association of Urology Section of Uro- Technology (ESUT), Professor of Urology at the University, Patras, Greece; Guest Professor, University of Leipzig, Germany; Adjunct Professor, Medical University of Vienna, Austria ()

Written by: Lillian Xie, BA, Department of Urology, University of California, Irvine, California at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates

References:

  1. Martin CJ, McAdams SB, Abdul-Muhsin H, et al. The economic implications of a reusable flexible digital ureteroscope: A cost–benefit analysis. J Urol 2017;197(3 Pt. 1):730–735.
  2. Davis NF, Mcgrath S, Quinlan M, Jack G, Lawrentschuk N, Bolton DM. Carbon Footprint in Flexible Ureteroscopy: A Comparative Study on the Environmental Impact of Reusable and Single-Use Ureteroscopes. J Endourol. 2018;32(3):214-217.