OBJECTIVE: To compare the cost and performance of 2 types of laparosco
pic instrumentation: reusable laparoscopic book cautery instruments an
d curved scissors, or limited-reuse laparoscopic hook cautery instrume
nts and curved scissors.DESIGN: A randomized trial. SETTING: The opera
ting room of a tertiary care hospital. METHOD: All general surgeons pe
rforming laparoscopic procedures at the hospital were randomized to be
supplied with either reusable or limited-reuse hook cautery and curve
d scissors. Instrument use was recorded, together with principal outco
me measures. OUTCOME MEASURES: Life expectancy of the instruments, the
number of cases for which they were used, the number, nature and cost
of repairs, their purchase cost and surgeon satisfaction. RESULTS: Re
usable hook cautery instruments were less expensive than their limited
-reuse counterparts. Excellent surgeon satisfaction a as reported with
the use of this type of instrument. The limited-reuse curs ed scissor
s arm of the study was terminated early because of a breach in study p
rotocol. CONCLUSIONS: Reusable hook cautery instruments were better th
an their limited-reuse counterparts. Rigorous attempts to compare the
cost of laparoscopic instruments may be limited by their rapid evoluti
on in design and the availability of many types of instruments on the
market.