This article by Lawrentschuk and Chamberlain describes an initial use of a flexible cystoscope (CST-2000, Vision Sciences, Natick, MA) with a disposable sheath (EndoSheath® Technology, Vision Sciences) in a urologic office setting. In a series of 200 patients, no breaches of the EndoSheath® Technology, instances of contamination of the cystoscope, or cases of infection occurred. Within the first 100 procedures, nine sheaths were damaged because the physician had difficulty placing the sheath over the cystoscope. In all nine cases, a second EndoSheath® barrier was obtained and used successfully. All patients who were surveyed were satisfied with their procedure, and many commented on the reassurance with respect to sterility that was provided by witnessing the application and disposal of the EndoSheath® Technology. An analysis that considered the purchase price of flexible cystoscopes and EndoSheath® Technology, cystoscope repair costs, and sterilization expenses (staff salaries and equipment) found that the cost per use of a cystoscope with EndoSheath® Technology was about $3 less than that of a standard cystoscope.
Lawrentschuk and Chamberlain commented that the strength of the sheathed endoscope system is that the endoscope itself does not contact bodily fluids or environmental contaminants. They also noted that intermediate-level disinfection between uses of an endoscope covered with EndoSheath® Technology is recommended, whereas unsheathed instruments require high-level disinfection. The authors concluded that the EndoSheath® System has several possible advantages, including simplicity, a reduction in exposure to sterilizing agents, time savings, and the opportunity to own only one cystoscope. Moreover, according to the authors, improvements such as video camera attachments will likely enhance the ergonomics of the system and expand its use in surgery.