mechanical performance of a self-unplugging surgical suction instrument: a randomized controlled trial

Introduction: Obstruction of the surgical suction instrument is a common problem in orthopaedic surgery. Previous attempts have tried to address this problem. The ‘Super Sucker’ has a screen compartment that can be unclogged upon disassembly. The Yankauer sucker has small holes in its tip that strain larger bits of debris. The aim of this study is to clinically evaluate a new gas-actuated suction instrument in which a special screen at its tip is cleared, as needed, by a rapid burst of pressurized carbon dioxide gas. Methods: This IRB-approved, prospective, randomized study compared a gas-actuated suction instrument with the Super Sucker and Yankauer in 70 consecutive primary total joint arthroplasty cases. Outcome measures included: incidence of complete suction loss due to suction instrument obstruction; time lost while unplugging the suction instrument; number of additional suction instruments needed; and a subjective surgeon-assessed performance score (1 to 5, with 5 being most favorable) for type of suction instrument.  Results: There were no cases in which the gas-actuated suction instrument could not be rapidly cleared of debris. The Super Sucker completely plugged in 71% of cases, requiring 67 minutes total to unplug (3.9 minutes per case, range 0 to 12 minutes). In four cases, replacement Super Suckers were required to finish the case. The Yankauer completely plugged in 47% of cases, requiring 52 minutes total to unplug (2.8 minutes per case, range 0 to 10 minutes). In three cases, replacement Yankauers were required to finish the case. The average performance score was 2.7 for the Super Sucker, 3.6 for the Yankauer, and 5 for the gas-actuated suction instrument on a scale of 1 to 5, with 5 being most favorable. Discussion: This study evaluated a suction instrument in which a screen tip prevents obstruction, and a burst of pressurized carbon dioxide gas clears debris from the tip. The new suction instrument was successful in 100% of cases, with considerably less time lost compared to the other suction instruments. The gas-actuated suction tool actively and rapidly cleared obstructive debris with minimal disruption to the surgical flow. Recent clinical experience has shown the gas-actuated suction tool to be particularly enabling in the settings of tourniquet-free total knee replacement, small incision total hip replacement, bipolar hemiarthroplasty, and revision total hip replacement. Keywords: suction, total joint arthroplasty, tourniquet-less, carbon dioxide gas