Some keyhole surgery kit "out of date"

4 November 2010, 16:35 | Updated: 4 November 2010, 17:40

Three hospitals in the Thames Valley are warned over old equipment for keyhole surgery. Two are praised for their "gold" standard.

More than 1-in-4 hospitals performing keyhole surgery are using out-of-date and potentially unsafe equipment,
according to a new report out today.

The first ever UK audit of laparoscopic operating theatres found 28% were using obsolete equipment including three in the Thames Valley and, in some cases, instruments that may cause harm.

Some 19% were using old-style reusable surgical instruments which carry extra risks for patients.  "Trocars" are sharp and made of metal, which increases the risk of accidentally puncturing organs or spreading infection.  The recommendation now is to use of blunt, disposable Trocars.

Just over 1-in-10 hospitals were operating with the highest standard of equipment for carrying out safe, advanced laparoscopic (keyhole) surgery, the audit found.  Some 3% were not using modern technologies such as ultrasound in their operations and almost one in four hospitals did not have a maintenance contract to replace broken tools.

The National Audit of Theatre Equipment asked staff about the age, standard and type of equipment used and how it was powered and maintained. Hospitals were graded bronze, silver or gold depending on the equipment used.

According to today's report, those using gold equipment are:
Churchill Hospital, Oxford (NHS)
John Radcliffe Hospital, Oxford (NHS)

Those using bronze equipment are:
The Chiltern Hospital, Bucks (BMI)
The Horton Hospital, Banbury (NHS)
The Foscote Hospital, Banbury (BMI)

A spokesperson for BMI said: "A report based on a survey (rather than an audit) mainly on the age of equipment does not provide valid data on the quality of care being delivered to patients, which in fact depends on many factors such as the skills of the surgeons and other clinicians.  All our equipment is fit for the procedures undertaken in our hospital, complies with the quality standards demanded by our regulators and is effectively maintained. We are also confident that the surgeons and staff at our hospital are highly skilled and delivering safe and effective surgery. Foscote Hospital achieves excellent outcomes for our patients, over 97% of whom rate the care they receive as good to excellent.”

A spokesperson for Oxford Radcliffe Hospitals said: “We are pleased that this report recognises that the vast majority of laparoscopic (keyhole) systems across our three hospitals are of the highest standard. We regularly use three systems at the Horton General Hospital, all of which have been installed in the last four years. There is a fourth system that is used only as a back-up.

This system does have an older ‘one chip’ camera, but all of our scopes have regular maintenance contracts to ensure that they are reliable and safe for use. We spend several millions of pounds each year on upgrading medical equipment, the purchase of which is prioritised with input from clinical teams. 

A trocar is a hollow tube that allows the introduction of instruments, including a scope, into the abdominal space for surgery. Different types of trocar can be used on different laparoscopic systems.

We are moving towards replacing metal trocars with single use disposable models, and we recognise that across the NHS, older equipment does need to be replaced over time to make sure that it conforms to the latest standards and guidance issued by professional bodies.”

Keyhole surgery is used for almost all gastrointestinal and abdominal operations and is less painful for patients, leading to speedier recovery and smaller scars.

In recent years, surgeons have been using high definition camera equipment, which offers better images, to perform complex surgery and can lead to shorter operations.

Mike Parker, past president of the Association of Laparoscopic Surgeons, said: "The view from the original laparoscopic cameras was like squinting through a goldfish bowl. In comparison, high definition equipment has revolutionised practice. It is unbelievable that some surgeons are still having to use equipment which limits the operations they can perform safely.

We hope the result of this audit encourages surgeons and management to discuss upgrading their equipment to improve standards and to reassure patients that the best service is being provided.''