A Comprehensive Comparison Of Infection Control, Cost, And Clinical Efficacy

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For a long time, reusable stainless steel trocars were adopted by most hospitals due to their low initial acquisition cost. However, with tightening infection control supervision and improvements in disposable product quality, comparing the pros and cons of both has become a hot industry topic. First is infection risk: reusable trocars require multi-step reprocessing including pre-cleaning, enzymatic washing, ultrasonication, rinsing, drying, packaging, and autoclaving or low-temperature plasma sterilization. In actual clinical settings, approximately 2%–3% of reprocessed instruments are found to have organic residue or denatured protein films; the inner lumen of trocars is especially difficult to clean thoroughly, posing risks of cross-contamination and potential transmission of prions or HBV/HCV. In contrast, disposable trocars are EO-sterilized at the factory, used immediately upon opening, and destroyed after use, fundamentally eliminating reprocessing failure risks-particularly suitable for immunocompromised patients, infectious disease patients, and ambulatory surgery centers.

Second is performance consistency: after repeated autoclaving, metal trocar blades microscopically dull and sealing gaskets age and crack, leading to increased puncture resistance (requiring greater downward force, increasing the risk of accidental deep penetration) and elevated intraoperative CO₂ leakage rates (literature reports reusable airtight failure at ~2.1% vs. disposable at 0.4%). Factory-new blades of disposable trocars reduce insertion force by approximately 30%–40%, and silicone sealing valves are in optimal elastic condition upon first use. Multi-center data show a significantly higher proportion of disposable trocars maintaining pneumoperitoneum pressure fluctuation < 1 mmHg, facilitating clear surgical fields during long, complex procedures.

Third is operating room efficiency: reusable instruments require pre-operative counting, unpacking, inspection, and assembly (some older models require manual installation of sealing caps), followed by post-operative collection, classification, transport to CSSD, and waiting for turnaround. In emergencies or back-to-back surgeries, instrument unavailability may cause delays. Disposable trocars come pre-assembled in sterile packaging and go directly to the surgical field, shortening average pre-operative preparation time by about 4 minutes per case and accelerating OR turnover. Fourth is comprehensive cost: although the single-use consumable fee is higher than the depreciation分摊 (apportionment) of metal trocars, after factoring in reprocessing labor, utilities, sterilization consumables, wear-and-tear replacements (seal rings, broken obturators), and additional treatment costs related to infections, multiple health economic analyses show that high-volume centers (>500 laparoscopic cases/year) actually have a 10%–30% lower Total Cost of Ownership (TCO) when using disposable trocars.

Of course, reusable trocars still have applicable scenarios-resource-limited regions, teaching hospitals demonstrating disassembly structures, or certain special-angle fixed metal cannulas still hold value. However, the current trend in Europe, America, and Chinese tertiary hospitals is to gradually make disposable the mainstream, especially in general surgery and gynecology departments of medium-to-large hospitals, which have largely completed the transition. Procurement decisions should comprehensively evaluate annual surgical volume, infection control rating requirements, CSSD capabilities, and bundled procurement pricing.