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首页> 外文期刊>Surgical Endoscopy >The clinical suitability of laparoscopic instrumentation. A prospective clinical study of function and hygiene.
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The clinical suitability of laparoscopic instrumentation. A prospective clinical study of function and hygiene.

机译：腹腔镜器械的临床适用性。功能和卫生的前瞻性临床研究。

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On the basis of experience gained from 6,000 laparoscopies (73% cholecystectomies) at the Moabit Hospital in Berlin, we carried out a cohort study to analyze the failure rate and decontamination of labeled "tracer" instruments processed in three test trays that were each subjected to 100 cycles. The majority of repairs focused on the functional parts of separable scissors and damaged or lost components. At 4%, the repair index after laparascopic use was less than that of a previously documented investigation period covering 1990 to 1996. A comparison of the costs of disposable and reusable instruments showed that reusable instruments were more cost-effective by a factor of > or =10, indicating that the price gap reported in our previous calculation for 1992 and 1994 has closed only slightly. After 100 cycles, we found traces of proteinaceous material in the eluate on every fourth instrument inspected (eight of 32); half of them (four) gave a positive reading when tested with a hemoglobin pseudoperoxidase test stick. It must be said, however, that similar residual contamination has been found on instruments used in conventional open surgery, with no indication of clinical relevance. This study was designed to examine the clinical suitability of laparoscopic instruments in terms of function and hygiene. Improvements in instrument design and cleanability must focus in particular on the reproducibility of cleaning results, because cleaning is the most important step in processing sterile supplies. As the number of minimally invasive operations has risen considerably, a mere visual check no longer meets the requirements prescribed by modern quality assurance. A multicenter study of residual proteins found on tracer instruments in all surgical fields is now in progress.
机译：根据在柏林Moabit医院进行的6,000例腹腔镜检查（73％胆囊切除术）获得的经验，我们进行了一项队列研究，分析了在三个测试盘中处理过的带标记“示踪剂”仪器的故障率和去污力100个循环。大部分维修集中在可分离剪刀的功能部件以及损坏或丢失的部件上。腹腔镜使用后的修复指数为4％，低于先前记录的1990年至1996年的调查期间。一次性和可重复使用器械的成本比较表明，可重复使用器械的成本效益更高，≥或= 10，表明我们之前的1992年和1994年计算中报告的价格差距仅略有缩小。经过100个循环后，每检查四台仪器（32支仪器中的八支），在洗脱液中都发现了微量的蛋白质物质。当使用血红蛋白假过氧化物酶测试棒测试时，其中一半（四个）的读数为阳性。但是，必须说，在传统的开放式手术中使用的器械上也发现了类似的残留污染，没有任何临床意义。这项研究旨在检查腹腔镜器械在功能和卫生方面的临床适用性。仪器设计和清洁性的改进必须特别关注清洁结果的可重复性，因为清洁是处理无菌耗材的最重要步骤。由于微创手术的数量已大大增加，仅凭肉眼检查就不再符合现代质量保证规定的要求。目前正在对在所有手术领域中在示踪仪器上发现的残留蛋白质进行多中心研究。

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