In this issue of TechNation, industry veterans share expert insight on endoscope advances and key tips. The panel of roundtable participants for the endoscope discussion is made up of KARL STORZ Endoscopy-America Inc. Director of Field Operations, PROTECTION1 Crit Fisher, CST, FAST; Capital Medical Resources LLC Owner Lee Ann Purtell; and Ampronix Medical Imaging Technology Director of Marketing Michael Thomas.
Q: What are the latest advances in endoscopes in the past year?
Fisher: We (KARL STORZ) recently introduced an FDA-cleared flexible video neuro-endoscope and comprehensive hydrocephalus portfolio. The device is designed to enhance visualization and access during diagnostic and therapeutic use in cranial procedures. The flexible video neuro-endoscope has a smaller outer diameter (with a shaft outer diameter of 2.90 mm and a 2.42 mm x 3.22 mm elliptical endtip), making it particularly useful for treating both adult and pediatric patients with a narrow foramen of Monro. Studies have found that flexible endoscopes can enhance the ease of endoscopic third ventriculostomy with endoscopic tumor biopsy (ETV/ETB) procedures.
Purtell: While not many changes have come in terms of imagining technology or design within the past year, you may find changes to the manufacturers’ instructions for use (IFUs) that warrant attention. For instance, several IFUs recommend regular visual inspection of the internal lumens of flexible endoscopes to validate cleaning processes and channel condition using a microflex or lumen inspection device. With some of the recent challenges and news around duodenoscope-related infections, we expect to see some technological and design changes to enhance the cleaning capability of these scopes including disposable distal ends, etc.
Thomas: Endoscopic visualization has significantly evolved within the past few years. For example, Toshiba has developed an innovative micro camera called the IK-CT2 Chip-on-Tip camera. This small camera provides crisp, ultra-HD 4K image quality and vivid color. The COT system differs from other endoscopic cameras because of its three high-mega-pixel sensors and stellar image processing that combines with the optics alignment to get the most out of the 220 x 220 pixel sensor.
Q: What factors should HTM consider to determine cost of ownership?
Fisher: It is critical to understand that, in addition to purchase price and other common factors, the total cost of ownership for endoscopes also includes a critical service component. Service and repair programs should be selected that will offer a high degree of predictability and confidence in protecting your equipment investment. It is also important to partner with providers who can deliver data-driven cost savings and performance enhancement measures.
Purtell: Two obvious considerations in cost of ownership are the purchase price (scope, video accessories/instrumentation needed and potential disposables) and maintenance. Maintenance of scopes may well exceed the original purchase price so factoring this into the cost of ownership is important, whether that be from the original equipment manufacturer (OEM) or an independent service organization (ISO). Frequency of maintenance is also key. Facilities that tend to be harder on their equipment, such as teaching facilities, may want to consider a point-of-sale OEM service contract with unlimited repairs. Facilities with historically lesser repair frequency, may be able to use transactional repairs with an OEM or ISO. Either way it is good to discuss average and not-to-exceed costs per repair and understand what is and what is not covered under warranty.
Some not-so-obvious, but related, costs that can affect the total life cycle costs include:
- Cost of personnel (sterile processing, OR, HTM, or other sub-contracted staff that clean, set up, use, reprocess, inspect scopes). Factors such as frequent turnover, staff competency on use and reprocessing or having dedicated personnel for cleaning and disinfecting can affect life-cycle costs.
- Cost of cleaning, sterilizing equipment and consumables.
- Cost of equipment and training needed to properly inspect scopes (such as leak testers, illumination testers, scope image testers, conferences, staff certifications, etc.)
- Cost of shipping scopes out for repair.
- Loaner/rental costs.
- Cost of rescheduling or missed cases if scopes are not available for use.
TIP: Consider closely analyzing and matching your inventory to potential usage/volume as you don’t want to get too few scopes, and overuse or flash sterilize them to the point of requiring premature service or replacement.
- End-of-life or trade-in value? What can you expect to get for cash or trade-in value of old equipment toward new purchases?
Thomas: Traditionally, HTM should consider the total cost of ownership before deciding if a certain endoscope is right for their facility. The TCO includes the initial cost, the cost of operation, maintenance cost, downtime cost, production cost and the remaining value. These factors represent the estimate of the collective expenses associated with purchasing and operating a piece of equipment.
Q: What are the pros and cons of buying brand new versus buying refurbished units?
Purtell: The pros of buying new include:
- New equipment is the best way to tap into the most current technologies in the market.
- Extended warranties and factory service agreements.
- Financing options.
Some cons of buying new are:
- Higher initial acquisition cost.
- Possible limitations on where equipment can be serviced.
- May need to upgrade additional equipment such as video towers, mating instrumentation if new models are not compatible with existing equipment you had planned on keeping.
Pros of buying refurbished:
- Substantially lower acquisition cost in many cases
- Can acquire through an OEM or reputable re-seller
- Some resellers offer financing
- You can “add” additional equipment compatible with your existing video equipment and instrumentation
- Wide range of service options from ISO
Some cons of buying refurbished:
- Older technology that is closer to obsolescence
- Possible variances in equipment condition
- Due diligence is required to find a reputable re-seller – look closely at credentials, years in business, expertise and online ratings.
Thomas: Generally, to get the most for your money, buying refurbished products can save the average buyer between 40 to 80 percent. However, because endoscopes are fragile, buying new is sometimes a safer option so you can guarantee the quality and care of the endoscope throughout its lifespan. While it might be more money up front, the equipment will pay for itself over time.
Q: Can you explain the importance of holding an in-service or clinician training on how to properly handle endoscopes to prevent damage?
Fisher: Education and training are key aspects of managing endoscope handling, processing and storage. Each hospital employee who comes into contact with endoscopes must be thoroughly informed and trained on using proper techniques in transporting and handling these expensive devices. It is equally important for periodic re-training and refresher courses to be required as well.
Purtell: Mistakes made in the care and handling of medical devices, particularly scopes, can add significant cost. It’s important to not only train the staff during installation, but to also provide continuing education throughout the life of the equipment. This includes proper usage in the clinical setting, as well as following the recommended cleaning, disinfection and sterilization parameters established in the IFUs. Since most maintenance-related costs are associated with errors during use, sterilization or care and handling (aka people-factor), regular and comprehensive training can greatly reduce the overall cost of ownership related specifically to maintenance.
Thomas: Proper training on endoscope usage and care is essential. It is incredibly easy to damage an endoscope with improper care, so it is vital they are handled and cleaned regularly and thoroughly. While there are plenty of published articles describing how to care and clean for an endoscope, an in-person clinician training is the best way to fully understand your equipment.
Q: What else do you think TechNation readers need to know about purchasing and servicing endoscopes?
Fisher: High-quality surgical equipment and specialty endoscopes represent a significant investment for health care providers, so it is important to recognize that selecting and working with the appropriate vendor when making endoscope purchases and service decisions can pay off in the long run. Another essential part of this process is for customers to fully assess the total cost of ownership of endoscopes being purchased. It is equally important to understand that the repair and service of this costly, delicate equipment represents a critical component of the total cost of ownership.
Purtell: Scopes can be intimidating because of the high cost and complexity of the design. Having one or two “endoscope specialists” within your staff that are highly trained on endoscope care, inspection and testing can be a huge advantage. Endoscope technician certification is on the horizon. To learn more, one source you can check out is the certified endoscope reprocessor certification from IAHCSMM.
Thomas: When purchasing an endoscope, companies should keep renting or financing options in mind – especially if they are a newer company. Some endoscopes can cost upwards of $10,000, so while it is usually preferred to buy new, that isn’t always possible. Additionally, buying multiple pieces of equipment from the same company can save time and money. Rather than spreading your equipment purchases among several companies, try to purchase from one company and you are more likely to receive preferred pricing, convenient installation and other value-added services.
