Dr. James Greenberg's thoughts on the HTx Single-Use Scope System
James Greenberg, MD, shares his thoughts on the HTx Single-Use Scope System from Hologic.
HTx Single-Use Scope System from Hologic
Background
When the first fully disposable hysteroscopes were introduced several years back, I made a point to anyone who would listen that I would–read my lips – “NEVER…N-E-V-E-R replace my reusable, glass rod hysteroscope with a disposable.” Why would I? As my argument went at the time, the picture from a CMOS scope would not be as good as my glass rod scope, it wasn’t cost-effective, and disposables were bad for the environment. Thank you very much, but I’m good.
Design/Functionality
The HTx Single-Use Scope System consists of a portfolio of disposable hysteroscopy products built around AcuVu Medical’s HummingScopes HTx40 and HTx60s hysteroscopes, and the HTx2000 imaging processing system. The hysteroscopes weigh about 145 grams (5.1 oz). Each is constructed from molded PVC with an Omnivision OVM6946 CMOS image sensor on the tip surrounded by LEDs that produce illuminance up to 4,000 Lux at 10 mm with a 120˚ field of view. HTx40 has an outer diameter of 4.5 mm with a 5 Fr working channel while the HTx60s has an outer diameter of 6.2 mm with a 9 Fr working channel. The Htx2000 screen has a resolution of 1920 x 1080.
In my experience, the system setup and usage could not be easier. Open the sterile package, plug one cord into the all-in-one image processing system, connect the inflow tubing, and you are ready to go. The HTx40 is small enough to pass through most undilated cervixes with a minimum of discomfort (or so the patients say). The distention media flow characteristics are more than adequate, and the picture is superb.
Innovation
With most CMOS image sensor-based technologies, the real innovation is the chips themselves, but that should not entirely detract from the companies that make the best products in this space (and I think the Hummingbird hysteroscope is currently one of the best products in this space). Specifically, configuring the chips to optimize the picture and designing the manufacturing pathways to produce functional and cost-effective scopes is a huge challenge that many others have not mastered.
Summary
When my children were young, I frequently told them, “It’s always important to never say always and never” because always is a long time and never doesn’t leave a lot of room for change. Regarding my prior NEVER statement about disposable hysteroscopes, I am now fully in the ALWAYS camp. Soon after trialing the Hummingbird hysteroscope, our office made a 180˚turn, packed away our steel and glass rod scopes, and went all-in with this disposable hysteroscope and never looked back. From a picture quality perspective, we lost nothing. Maintenance and sterilization are straight-up wins for disposables over reusables, and the disposables are low-cost enough to be justified by improved efficiency of doing office hysteroscopy without worrying about equipment set-up or availability. Finally, regarding the environmental impact, my initial hesitations were overcome when I dove deeper into the issue. Sterilizing reusable hysteroscopes has real energy, chemical, and water requirements that are not trivial and should not be ignored but rather balanced against the landfill/incineration environmental impact of 5 oz of PVC. This is especially important when blue wrap is added to the equation. Blue wrap is the ubiquitous single-use polypropylene packaging that covers instrument kits after they come out of the sterilizers so they can be stored and transported. After unpacking, the blue wrap is discarded and accounts for up to 11.5% of all OR waste1 and needs to be added to this environmental equation.
All-in-all, for those doctors who perform office hysteroscopy, I love Hologic’s HTx Single-Use Scope System and think it is worth considering. Nothing changes if nothing changes.
