A member of the Reviews in Obstetrics & Gynecology editorial board reviewed the following devices. The views of the author are personal opinions and do not necessarily represent the views of Reviews in Obstetrics & Gynecology or MedReviews®, LLC.
Design/Functionality Scale
1 = Poor design; Many deficits
2 = Solid design; Many deficits
3 = Good design; Few flaws
4 = Excellent design; Few flaws
5 = Excellent design; Flaws not apparent
Innovation Scale
1 = Nothing new
2 = Small twist on standard technology
3 = Major twist on standard technology
4 = Significant new technology
5 = Game changer
Value Scale
1 = Added cost with limited benefit
2 = Added cost with some benefit
3 = Added cost but significant benefit
4 = Marginal added cost but significant benefit
5 = Significant cost savings
Overall Scale
1 = Don’t bother
2 = Niche product
3 = Worth a try
4 = Must try
5 = Must have
Design/Functionality: 4.8
Innovation: 2
Value: 2
Overall Score: 4
Design/Functionality: 4.5
Innovation: 4
Value: 3
Overall Score: 4.8
Background
I think hysteroscopic fluid management systems should be thought of like umpires—they are only really doing a good job if you do not notice them. As an essential but tangential piece of equipment in the operating room, the fluid pump should not be the focus of a hysteroscopic procedure; yet, all too often these devices find the spotlight. In large part, this is because most of the pumps on the market today rely on core technologies that are more than a decade old. Most of our hysteroscopic fluid management systems were designed when cell phones still came in suitcases.
With the introduction of hysteroscopic morcellation procedures, the need for a better pump quickly became apparent. To address this need, Hologic, Inc. (Marlborough, MA) studied the need for fluid management in these procedures and introduced the Aquilex™ Fluid Control System in March 2012.
Design/Functionality
Aquilex looks a lot like every other fluid management system, with a platform for the actual pump, a wheel base interspaced with fluid collection canisters, and bag hooks dangling from a central pole over the top. But, many of the similarities end there.
First, and perhaps most importantly, Aquilex eliminates the traditional weight-based inflow volume measurement system in favor of a more accurate and dependable pump rotation calculation system. For anyone who has ever experienced a massive change in fluid deficits related to bumping or moving a traditional fluid management system, this new feature is quickly appreciated.
One advantage of using the roller rotations is that the pump does not need to be paused whenever bags are changed. The staff should no longer worry about the sudden deficit jumps that so commonly plague the traditional weight-based systems during fluid bag exchanges.
Second, the Aquilex introduces two integrated vacu um pumps, one designated for draining of the under buttock drape and the second designed for use with the Hologic’s MyoSure™ morcellation system. The morcellator vacuum pump is capable of generating up to 500 mm Hg of suction. This convenient feature eliminates another piece of tubing to connect the pump to wall suction and allows the Aquilex to be used even when there is no external suction available (ie, an office setting). And, the vacuums aren’t noisy; the Aquilex vacuum pumps operate so quietly that it can be difficult to hear them and may lead you to believe that they are not operating.
Third, this new system provides automatic lumen calibration to insure proper inflow rates even when different caliber hysteroscopes and hysteroscopic devices are used. Remember Bernoulli’s equation? Well, I don’t. But this machine does, and it quickly adapts its pressure control to match the hysteroscope caliber.
Finally, the Aquilex cranks out fluid with an inflow rate of up to 800 mL/min. This tops all other pumps such as the Stryker (Kalamazoo, MI) Fluid Safe™ (500 mL/min), the Richard Wolf (Vernon Hills, IL) Fluid Manager (500 mL/min), the Storz (Tuttlingen, Germany) Hamou EndomatTM System (500 mL/min), and even the Smith & Nephew (Memphis, TN) hysteroscopic fluid management system (700 mL/min).
In testing, using the Aquilex was a little rocky at first due to unfamiliar new features. For example, initially we didn’t realize that because the pump counts rotations rather than weight in calculating fluid deficits, the pump requires an unrestricted inflow of fluid or the deficits will appear larger than they actually are. We had a situation in which one of the staff did not fully open the bag clamps and thus the restricted inflow resulted in a large deficit reading. It’s not a big deal and it’s easy to do, but you have to know to do it. Also, like every other pump on the market (except the Olympus/Gyrus ACMI Dolphin® II; Southborough, MA), the Aquilex pump’s flow is pulsatile. Again, not a super big deal, but I prefer continuous flow to pulsatile flow.
Aside from the early misunderstanding about the pump’s inflow needs and my nitpicky preference for nonpulsatile flow, the Aquilex pump outperformed every other pump I have ever tried in almost every category. Faster response rates. Easier to use. Easier to setup. Smaller footprint. More accurate.
Design/Functionality Score: 4.5
Innovation
The Aquilex™ is a 21st century remake of 20th century technology. In this case, hindsight enabled Hologic’s engineers to understand where the older technology was lacking and redesign the new pump to overcome these drawbacks. The elimination of weight-based inflow volume measure is huge. The integrated vacuum is an excellent feature and automated setup features are fresh.
Innovation Score: 4
Value
At the risk of sounding too old fashioned, I think $15,000 for a hysteroscopy pump sounds like a lot of money. That said, because most hysteroscopy pump prices are negotiated as part of a contract for tubing, the actual cost to any given hospital will likely vary based on volume. Either way, Aquilex is unlikely to represent a savings. But, because this pump actually works, there is probably a lot of benefit to be gained over older, less reliable technologies.
Value Score: 3
Summary
The Aquilex Fluid Control System is a long overdue remastering of an essential piece of equipment in operative hysteroscopy. It has the highest flow rates, the quickest response times, the only built-in suction and- trumpets, please-it does away with weight-based deficit calculations. All-in-all, this is an iPhone in a world dominated by Motorola (Libertyville, IL) DynaTACs.
Overall Score: 4.8
Figure 1.
Aquilex™ Fluid Control System. Image courtesy of Hologic, Inc. (Marlborough, MA).
Footnotes
Dr. Greenberg reports no personal financial relationships with any of the companies whose products he reviews in this column.