Beyond single-use: a systematic review of environmental, economic, and clinical impacts of endoscopic surgical instrumentation

Abstract

Background: The evolution of endoscopic surgery has introduced a multitude of instruments, available in both disposable and reusable variants, influencing practices across various surgical specialties. Instrument selection is complex, considering individual preferences and institutional factors such as costs, instrument performance, and factors related to cleaning and sterilization. Notably, environmental sustainability has gained prominence due to the threat of climate change. This review assessed the existing literature to facilitate evidence-informed decision-making, encompassing clinical and economic efficacy, environmental friendliness, and other important criteria. Materials and Methods: Following PRISMA guidelines, searches were conducted in Pubmed, Embase, Web of Science, and The Cochrane Library for studies comparing the environmental impact, costs, instrument performance, and contamination risk of disposable versus reusable instruments or new versus reprocessed disposables in endoscopic surgery. Life-Cycle Assessments (LCAs) were included to quantify the climate impact. Exclusions included veterinary studies, general endoscopic procedures, and novel instruments. Conclusion: The search yielded 15,809 studies, 53 studies meeting the inclusion criteria: 38 compared disposable versus reusable instruments and 15 examined new versus reprocessed disposables. Reusables and/or reprocessed disposables showed favorable environmental and economic outcomes compared to new disposables. Instrument performance was comparable between the two groups. No studies were identified that investigated the clinical implications of contamination risk of disposables versus reusables. Six studies evaluating contamination risk of reusables and reprocessed disposables showed residual pollution after cleaning and sterilization, although data on clinical outcome lacked. Interpretation: This review underscores the environmental benefits of reusables and favors both reusable and reprocessed disposables for their economic advantages. The lack of clear evidence favoring one type over the other in instrument performance necessitates further research. Addressing contamination risks requires additional studies on the clinical impact of residual substances. Future research should report outcomes on environmental sustainability, costs, instrument performance, and contamination risk.