Abstract
BackgroundHybrid surgical instruments contain both single-use and reusable components, potentially bringing together advantages from both approaches. The environmental and financial costs of such instruments have not previously been evaluated.MethodsWe used Life Cycle Assessment to evaluate the environmental impact of hybrid laparoscopic clip appliers, scissors, and ports used for a laparoscopic cholecystectomy, comparing these with single-use equivalents. We modelled this using SimaPro and ReCiPe midpoint and endpoint methods to determine 18 midpoint environmental impacts including the carbon footprint, and three aggregated endpoint impacts. We also conducted life cycle cost analysis of products, taking into account unit cost, decontamination, and disposal costs.ResultsThe environmental impact of using hybrid instruments for a laparoscopic cholecystectomy was lower than single-use equivalents across 17 midpoint environmental impacts, with mean average reductions of 60%. The carbon footprint of using hybrid versions of all three instruments was around one-quarter of single-use equivalents (1756 g vs 7194 g CO2e per operation) and saved an estimated 1.13 e−5 DALYs (disability adjusted life years, 74% reduction), 2.37 e−8 species.year (loss of local species per year, 76% reduction), and US $ 0.6 in impact on resource depletion (78% reduction). Scenario modelling indicated that environmental performance of hybrid instruments was better even if there was low number of reuses of instruments, decontamination with separate packaging of certain instruments, decontamination using fossil-fuel-rich energy sources, or changing carbon intensity of instrument transportation. Total financial cost of using a combination of hybrid laparoscopic instruments was less than half that of single-use equivalents (GBP £131 vs £282).ConclusionAdoption of hybrid laparoscopic instruments could play an important role in meeting carbon reduction targets for surgery and also save money.
Highlights
Hybrid surgical instruments contain both single-use and reusable components, potentially bringing together advantages from both approaches
The carbon footprint per operation of a laparoscopic hybrid instrument compared to its single-use equivalent was 17% for a clip applier (445 g vs 2559 g C O2e), 33% for scissors (378 g vs 1139 g CO2e), and 27% for four ports (933 g CO2e vs 3495 g CO2e/ operation) (Fig. 1)
Hotspot analysis indicated that the majority of the carbon footprint of hybrid instruments was due to the singleuse components, followed by decontamination of reusable components (Supplementary Table 4)
Summary
Hybrid surgical instruments contain both single-use and reusable components, potentially bringing together advantages from both approaches. The environmental and financial costs of such instruments have not previously been evaluated. Methods We used Life Cycle Assessment to evaluate the environmental impact of hybrid laparoscopic clip appliers, scissors, and ports used for a laparoscopic cholecystectomy, comparing these with single-use equivalents. We modelled this using SimaPro and ReCiPe midpoint and endpoint methods to determine 18 midpoint environmental impacts including the carbon footprint, and three aggregated endpoint impacts. Results The environmental impact of using hybrid instruments for a laparoscopic cholecystectomy was lower than singleuse equivalents across 17 midpoint environmental impacts, with mean average reductions of 60%. Conclusion Adoption of hybrid laparoscopic instruments could play an important role in meeting carbon reduction targets for surgery and save money
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