Coblator Wand Comparative Analysis

Reprocessed operating room tools offer surgeons an opportunity to use equipment that have been inferenced to incur lower hospital and environmental costs. Tools that are "disposable" are collected by reprocessing companies that then refurbish and sterilize the instrument and sell it back to the hospital at a reduced cost. Advocates argue that they may serve as a means of controlling increasing healthcare costs and further, because few if any new raw materials are needed for the reprocessing, environmental costs are also hypothesized to be reduced. However, the use of reprocessed tools has demonstrated variable results in clinical performance across different surgical domains. Comparable performance of reprocessed orthopedic drill bits to new ones in terms of force, heat, and usability has been demonstrated (see References). It has been shown that blinded surgeons could not distinguish between new and reprocessed arthroscopic shavers and found equivalent sharpness on engineering tests. In contrast, it has been found that reprocessed laparoscopic trocars had more imperfections and higher leak rates (see References) reported more abnormalities in reprocessed harmonic scalpels with poorer tissue handling outcomes. There remains a lack of consensus about the reliability of reprocessed surgical tools, including coblator wands.

• New Coblator Ablation Wands (Device), also known as Coblator II EVac 70 Plasma Wand: New, unused coblator ablation wands from Arthrocare
• Reprocessed Medline Coblator Ablation Wands (Device), also known as ReNewal Reprocessed Arthrocare Ablation Wand: Reprocessed coblator ablation wands from Medline

Primary outcomes

• Surgeon Comfort [Following the procedure, up to 4 hours]: The primary outcome for this study is surgeon comfort in terms of using the new or reprocessed coblator wand again based on data collected from the post-procedure surveys. Surgeon comfort will be assessed as a dichotomous (yes/no) measure following the procedure. The number of instances for which the surgeon is comfortable using the new or reprocessed coblator wand will be summarized by study arm using descriptive statistics.

Sex: All, ages: 1 Year to 18 Years

Inclusion Criteria:

* Pediatric patients scheduled for tonsillectomy and/or adenoidectomy
* Parental consent and child assent (when applicable)

Exclusion Criteria:

* Pregnancy

• Myers R, Kim H, Hsieh AH, O'Toole RV, Sciadini MF. When Should We Change Drill Bits? A Mechanical Comparison of New, Reprocessed, and Damaged Bits. J Orthop Trauma. 2017 May;31(5):281-286. doi: 10.1097/BOT.0000000000000812. PMID 28166171
• Ledonio CG, Arendt EA, Adams JE, Matz J, Boers A, Miller K, Lester BR. Reprocessed arthroscopic shavers: evaluation of sharpness and function in a cadaver model. Orthopedics. 2014 Jan;37(1):e1-9. doi: 10.3928/01477447-20131219-09. PMID 24683649
• Mues AC, Haramis G, Casazza C, Okhunov Z, Badani KK, Landman J. Prospective randomized single-blinded in vitro and ex vivo evaluation of new and reprocessed laparoscopic trocars. J Am Coll Surg. 2010 Dec;211(6):738-43. doi: 10.1016/j.jamcollsurg.2010.08.003. Epub 2010 Oct 30. PMID 21036630
• Weld KJ, Dryer S, Hruby G, Ames CD, Venkatesh R, Matthews BD, Landman J. Comparison of mechanical and in vivo performance of new and reprocessed harmonic scalpels. Urology. 2006 May;67(5):898-903. doi: 10.1016/j.urology.2005.11.027. PMID 16698349
• Jin T, Huang W, Jiang K, Xiong JJ, Xue P, Javed MA, Yang XN, Xia Q. Urinary trypsinogen-2 for diagnosing acute pancreatitis: a meta-analysis. Hepatobiliary Pancreat Dis Int. 2013 Aug;12(4):355-62. doi: 10.1016/s1499-3872(13)60056-9. PMID 23924492

• John Bent, MD, Principal investigator, Montefiore Medical Center

NIH grants: 2025