Advice

Expert comments

Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three experts commented on this briefing. All of the experts were experienced in using single-use flexible rhinolaryngoscopes, and 2 were experienced in using Ambu aScope 4 RhinoLaryngo.

Level of innovation

Two experts said that the technology is a new concept for both diagnostic and therapeutic services. Comments from the experts included that the technology:

  • opens up avenues for further endoscopic innovation and clinical research

  • is a minor variation on an existing procedure and so is unlikely to alter the procedure's safety and efficacy

  • is already established in practice

  • is likely to replace current standard care because of its cost and clinical effectiveness, as well as patient-centric diagnostics and patient and clinician safety.

One expert said that the technology is most likely to be used as an addition to other procedures because the quality of the procedure is not as good as specialist examinations (such as laryngostroboscopy and chromoendoscopy) and procedures.

Potential patient impact

All experts said that Ambu aScope 4 RhinoLaryngo helps to avoid cross-contamination. One expert said that the connection to the electronic healthcare records is likely to lead to a speedier diagnosis and reduced anxiety for the person having the procedure. Another expert said this procedure is simpler and less convoluted, benefitting people who may find it difficult to navigate existing complex care pathways. This includes people with a developmental delay or impaired physical mobility, and older people.

Potential system impact

One expert said this technology would benefit people requiring any form of luminal navigation and visualisation of the upper airways. They said that it would also benefit people who require functional endoscopic evaluation of swallowing and voice. They said that it would benefit people who require evaluation of the airway during difficult airway endotracheal tube intubations and those who may require a nasogastric feeding tube to be passed into the oesophagus under direct vision. All experts said that the portable system is easy to use in a hospital environment, especially for bed-bound or frailer people, or people with a brain injury, as well as those who cannot attend upper airway assessments in hospital environments, such as older people.

All experts said that the procedure has the potential to change the current pathway to benefit the healthcare system. All experts said the technology allows for people to be seen in single visits, with better streamlined working. People can be routed to the appropriate specialist more quickly and so standards for faster diagnosis are met. One expert also said it would be useful in any potential future COVID‑19 pandemics.

The experts differed in their thoughts on the cost of the procedure compared to standard care. One expert said the procedure would cost less than standard care because servicing and maintenance costs would be avoided. This expert also said saved costs can be redirected at upskilling healthcare professionals to carry out upper airway diagnostic endoscopy. One expert said that the cost would be the same as or less than standard care because there is no need for capital investment in camera stack systems, but another expert said that this could lead to a higher cost as the procedure will not replace existing stack systems but will be used in addition to them. Another expert referred to a study in which single-use rhinolaryngoscopes were shown to be cost-minimising compared with reusable rhinolaryngoscopes.

One expert said that changes to existing facilities would depend on the demand for endoscopy of the upper airways, which would likely increase with the uptake of this technology. Another said that there would be minimal change, apart from to the procedure for disposal.

General comments

One expert said that single-use rhinolaryngoscopes may be a little stiffer than traditional reusable rhinolaryngoscopes, but that this is compensated by them having a narrower diameter. In relation to sustainability and disposal of rhinolaryngoscopes, 1 expert said that there are company plans to recycle plastics with an industry partner but that further health economic research is needed to compare reusable and single-use rhinolaryngoscopes. All of the experts agreed on the safety and efficacy of the procedure. Two experts also flagged issues with data capture through audio and video and linkage with electronic healthcare records.

Two experts said that cost and potential environmental impact are reasons why hospital trusts may choose not to use the technology. One expert said that digital illiteracy or anxiety around using new, potentially disruptive technologies may be a problem.

All experts agree the technology could be used in clinical practice, although 1 expert said as an addition to existing reusable rhinolaryngoscopes.