Disposable Vs. Reusable Trocars

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 In-Depth Comparison of Infection Control, Cost Models, and Operating Room Efficiency

In laparoscopic consumables management, the debate between "disposable or reusable" remains ongoing. However, with escalating infection control standards and the advancement of DRG/DIP payment reforms, the balance is clearly tipping toward disposable trocars. This article provides a systematic comparison across three major dimensions.

① Infection Control and Patient Safety

Reusable metal trocars require eight steps after each procedure: sorting, cleaning, enzymatic washing, rinsing, drying, packaging, autoclaving or low-temperature plasma sterilization, storage, and distribution. Even with standardized protocols, microscopic lumens and valve crevices may retain protein biofilms or prions. Literature reports indicate that while the potential risk of SSI (surgical site infection) related to reusable trocars is low, it is non-zero. Particularly against the backdrop of multidrug-resistant organism prevalence, disposable pre-sterilized (EO/Gamma) products provide deterministic "zero cross-contamination" assurance - a key reason why JCI-accredited and most tertiary hospital infection control departments prefer disposable solutions.

② Total Cost of Ownership (TCO) Analysis

Reusable trocars carry high unit prices (often RMB 800–2,000 each) but can be cycled hundreds of times. However, one must factor in: CSSD labor and equipment depreciation, detergent and packaging consumables, reprocessing costs for sterilization failures, replenishment for lost or damaged units, inventory carrying costs, and opportunity costs from turnover delays. Based on calculations from domestic tertiary hospitals, the amortized cost per use of a single reusable trocar is approximately RMB 15–30, which is comparable to or even higher than that of mid-range disposable products post-VBP (RMB 20–60). Factoring in隐性 (hidden) costs such as OR delays due to awaiting sterilized packs, disposable trocars actually reduce overall expenses. ASCs, lacking CSSD facilities, find disposables the only economically viable option.

③ Operating Room Efficiency and Standardization

Disposable trocars come in individual sterile packages, ready for use within their shelf life. The workflow is open - puncture - discard, eliminating the need for pre-operative counting, post-operative collection, or registration, and avoiding situations where surgeries are forced to halt due to sterilization failures. Some manufacturers provide Trocar Kits tailored to specific procedure types (e.g., 2×5 mm + 1×10 mm + 1×12 mm with converters), further reducing scrub nurse setup time. Seal valve performance is consistent across every unit, with no issues of aging-induced hardening causing leaks or instrument sticking, making them more reliable for lengthy, complex procedures.

Of course, reusable trocars still hold value in environmental protection (reducing medical waste) and certain special large-size/custom-angle configurations, with some teaching hospitals retaining a small inventory for demonstration purposes. However, from the perspective of mainstream clinical practice, the transition toward disposables - exceeding 70% in Europe and America, and gradually in Chinese tertiary hospitals - is a clear trend, especially after VBP substantially weakens the price barrier.

Procurement recommendation: Hospitals can adopt a hybrid strategy of "fully equipping basic procedures with disposable mid-range kits + keeping a small reserve of high-end optical trocars + retaining a minimal quantity of reusable Hasson types," balancing cost control with contingency coverage. Acceptance inspections should focus on ISO 13485 certificates, EO residual test reports, and random airtightness inspection data.