Challenging Residual Contamination of Instruments for Robotic Surgery in Japan

Priority of Patient Safety Associated With Robotic Surgical Instruments—Response to Landenberg et al

“…To the Editor-We read with interest the letter by Landenberg et al 1 We would like to respond to the questions raised by the authors regarding our article. 2 The authors expressed concerns about the size or surface area of the instruments.…”

“…2 The authors expressed concerns about the size or surface area of the instruments. 1 They claimed that the assessment should have been confined to the area in direct contact with patients. This critique would be reasonable only if there were no transfer of contamination from the distal part to the proximal part.…”

“…The authors claimed that the total protein from all the instruments used in a single operation should be compared rather than per-instrument protein. 1 However, methods based on per-instrument measurement have been established to evaluate the cleanliness or cleaning efficacy of surgical instruments. [3][4][5][6] The authors did not cite any relevant articles justifying their proposal; there is no basis for their claim.…”

“…We agree with the authors that protein itself does not have the ability to cause wound infections. 1 Risk of infection associated with surgical instruments should be linked to the bacterial number and strain at the point of use. However, these do not necessarily persist for a long time, and they fluctuate over time.…”

“…Decreased incidence of surgical site infection by robotic surgery has been reported, as stated in the articles cited by the authors of the letter. 1,7 However, the incidence of infection could be affected by publication bias. 8 It is not possible to determine the actual incidence of infection related to accidental events because they tend not to be reported.…”