VERSAJET™ Hydrosurgery System
Value Analysis
VERSAJET™
• General Technology Overview
• Features/Benefits
• Summary of Evidence
The VERSAJET◊ II Hydrosurgery System
• A revolutionary wound excision
technology from Smith & Nephew
Wound Management.
• Uses Hydrosurgery technology
(water cutting) similar to that used in
the cutting of materials during mining
and manufacturing.
• Consists of a powered console and
single use disposable hand pieces.
• FDA cleared and launched in the
United States in 2002.
VERSAJET™ II benefits
VERSAJET™ Hydrosurgery System
Venturi Effect
The design of the VERSAJET is such that the high
velocity fluid jet passes across the operating window and
into the evacuation collector creating a localized vacuum
to hold and excise targeted tissue while aspirating debris
from the site.
Tissue Excision
Additional design attributes allow the user to finely control
excision. Orienting the operating window parallel to the
tissue optimizes the VERSAJET’s performance for tissue
excision aspiration.
Contaminant Evacuation
Alternatively, orienting the operating window obliquely to
the tissue optimizes the VERSAJET’s performance for
contaminant removal – irrigation and vacuuming.
The VERSAJET™ II Hydrosurgery
System
The VERSAJET II system
enables a surgeon to precisely
select, excise and evacuate
nonviable tissue, bacteria and
contaminants from wounds,
burns and soft tissue injuries
using a tissue-sparing
technique1-2,4-5
Advanced hydrosurgery
technology helps reduce time
to closure, which may reduce
overall treatment cost.1,2,3
Precision to preserve
Principles of Hydrosurgical Debridement
• Complete removal of undesirable tissue
• Maximum preservation of collateral tissue
• Wound closure
Courtesy of Dr. Jeff Nelson
Courtesy of Dr. Jeff Nelson
The Clinical Benefits of Debridement
• Removes necrotic tissue that impairs wound healing
• Creates bacterial balance in the wound
• Results in controlled bleeding that stimulates the production of bloodborne growth factors
• Removes the senescent fibroblasts – leaving younger, more viable
cells
• Removes the hyperproliferative, non-migratory wound edge that slows
healing
Thorough debridement is paramount for the wound repair
process.
Classic Methods of Debridement
• Radical excision is required for complex wounds
• Scalpels are non-selective
• Limitation exist for pulse lavage
• Other invasive modalities cause collateral injury
Courtesy of Dr. Mark Granick
• CLEAN, FAST, and PRECISE
• Tangentially removes tissue
• Operation is clearly visible
• No thermal effects
• Time and cost savings
• Improves patient outcomes
Surgical Debridement Literature
• Improves host defense mechanisms and reduces active
infection (Elek 1956)
• May enhance chronic wound healing (Steed et al 1996)
• Reduces dysfunctional cell populations (Hasan et al 1997, Vande Berg et
al 1998)
• Promotes release of tissue cytokines and growth factors
(Enoch & Harding 2003)
VERSAJET™ Features and Benefits
Features
Precision
Safety
Benefits
Economic Impact
• Completely removes non-viable • Fewer surgical procedures required to
tissue and particulate
close the wound
contaminants
• Allows maximal preservation of • Less complex procedure required to
viable tissue
close the wound allowing for closure
during the same encounter
• ~40% to 60% faster procedural • Shorter healing time and reduced
time than conventional
length of stay
techniques
• Faster operating room turnover
• Alleviates sharps injuries
• Minimizes need for pulse
lavage devices – less risk of
splash back exposure and
cross contamination
• Reduced blood loss
• Reduced costs of sharps injuries and
contamination
• Reduced risks to medical and nursing
staff
• Reduced risks to patients
VERSAJET™ Summary of Evidence
Clinical Study
Granick, 2006 – Wound Repair
and Regeneration; 14:394-396
Wound Type
Chronic and Acute wounds
VERSAJET™ [n=45] vs
conventional debridement [n=22]
In the O.R.
Mosti, 2006 – Wounds; 18(8):
227-237
VERSAJET™ debridement
[n=142] vs conventional
debridemen [moist wound
dressings, n=327] at bedside
Outcome
Fewer excision procedures
required to close the wound
[mean=1.2 Versajet –vs- 1.9
conventional]
Net saving of $1900 per
patient
Chronic (hard to heal) leg ulcers
76% of patients achieved
complete debridement with a
single procedure.
Pain was well tolerated with
local anesthetic
Shorter time to clean wound
bed (1.3 days –vs- 4.3 days)
Reduced hospital length of
stay
VERSAJET™ Summary of Evidence
Clinical Study
Dalla Paola, 2005 (poster at Turin)
Wound Type
Diabetic patients with amputation
stub dehiscence.
VERSAJET™ group had fewer
subsequent amputations [2 vs 4],
quicker healing [46 days vs 58
days] and fewer surgical
procedures [2 vs. 3.5]
Burn wounds. Removal of eschar to
eyelids, fingers, web spaces
More effective excision in difficult
areas [cf Goulian and Watson
knives]
No patient required re-excision.
No graft loss.
Leg and foot ulcers
Shorter procedure time in the O.R
(39% quicker)
Saving on pulse lavage (not
required with VERSAJET™)
Saving on instrument sets
required ($500 instead of $21,000
VERSAJET™ [N=12] vs historical
controls with conventional excision in
the O.R
Klein, 2005- J Burn Care Rehabil;
32(1): 64-69
VERSAJET™ excision of burn
wounds [n=44]. Non-comparative
Caputo, 2008 – Int wound J 5(2):
288-294
Randomized trial of VERSAJET™ vs
conventional debridement in the O.R
[n=41]
Outcome
Other Hospitals Using VERSAJET™
• Cleveland Clinic Foundation – Cleveland, Ohio
• Washington Hospital Center – Washington, DC
• The Ohio State University Medical Center –
Columbus, Ohio
• University of Medicine and Dentistry in New
Jersey
• Akron Children’s – Akron, Ohio
• Mercer Medical Center Hospital – New Jersey
• University of California – San Francisco (UCSF) • Clara Maass Medical Center – New Jersey
• University of California, San Diego (UCSD)
• Methodist Hospital – Minnesota
• Wishard Memorial Hospital – Indiana
• Johns Hopkins – Maryland
• West Pennsylvania Hospital – Pennsylvania
• Mayo Clinic – Minnesota
• Duke University Health System – North
Carolina
• University of Illinois Medical Center – Illinois
• Lehigh Valley Hospital - Pennsylvania
• Long Island Jewish Medical Center – New
Hyde Park, New York
• Stony Brook University Hospital – Stony Brook,
New York
VERSAJET™ Financial Impact
Debridement for certain patients (e.g. Medicare) is typically not profitable for hospitals
• This is because patients typically require multiple operative procedures
VERSAJET™ has the potential to:
• Free-up operating room time, which frees resource to treat more profitable cases
• In the Granick study the saving was equivalent to 45 minutes per patient
• Reduce resource costs per patient and offset the cost of the handpiece in the Granick
study:
• Net saving $1900 per patient, including $127 reduction in materials spend
• 1.9 and 1.2 debridements per patient mean the following:
• The group of 10 patients may require 19 or 12 debridement procedures on average
for traditional debridement approach and VERSAJET™ respectively
• The first debridement is unavoidable; however, VERSAJET™ decreases the
number of “second” debridement procedures
• Thus, VERSAJET™ saves 7 out of 9 “second” or “repeated” debridement
procedures
Economic Model Disclaimer
• The amount of savings is based on a peer-reviewed article entitled, “Efficacy and
cost-effectiveness of a high-powered parallel waterjet for wound debridement.”
Granick MS, Posnett J, Jacoby M, Noruthun S, Ganchi PA, Datiashvili RO. Wound
Repair Regen. 2006 Jul-Aug; 14(4): 394-7. The savings are estimated for hospital
operating expenses. To the bes of our abilities, we estimate the budget impact using
available public and proprietary data and disclose all pertinent assumptions.
• The new technology (VERSAJET™) may trigger changes in coding (i.e. excisional
debridement 86.22 → non-excisional debridement 86.28). This may result in a lower
reimbursed amount from either public or commercial payers.
• Under no circumstances should this presentation be used by a health care provider
for coding, payment or verification purposes AND Smith & Nephew is not responsible
for any overpayment for health care services that may result from the use of this
presentation. The Corporate Reimbursement Disclaimer provided at the end of the
presentation prevails.
Corporate Reimbursement Disclaimer
The information provided with this notice is general reimbursement
information only. It is not legal advice, nor is it advice about how to code,
complete or submit any particular claim for payment. Although we supply this
information to the best of our current knowledge, it is always the provider’s
responsibility to determine and submit appropriate codes, charges, modifiers,
and bills for services rendered. The coding and reimbursement information
is subject to change without notice. Payers or their local branches may have
their own coding and reimbursement requirements and policies. Before filing
any claims, providers should verify current requirements and policies with the
payer.
References
1.
Granick MS, Posnett J, et al. Efficacy and cost-effectiveness of a high-powered parallel waterjet for wound debridement. Wound Rep Reg 2006a;14:394-397
2.
Granick MS, Boykin, Gamelli R, et al. Toward a common language: surgical would bed preparation and debridement. Wound Rep Reg 2006; 14 S1-S10
3.
Cubison TCS, Pape SA, Jeffery SLA. Dermal preservation using the VERSAJET hydrosurgery system for debridement of paediatric burns. Burns 2006;32:714-720
4.
Duteille F. et al. Management of 2nd-degree facial burns using the VERSAJET hydrosurgery system and xenograft: A prospective evaluation of 20 cases. BURNS.
2012;38(5):724-9.
5.
Matsumura H. et al. The estimation of Tissue Loss During Tangential Hydrosurgical Debridement. Annals of Plastic Surgery. 2012:69(5):521-525