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Environmental impact and life cycle financial cost of hybrid (reusable/ single-use) instruments versus single-use equivalents in laparoscopic cholecystectomy

By Chantelle Rizan, Mahmood F Bhutta

Posted 12 Mar 2021
medRxiv DOI: 10.1101/2021.03.10.21253268

BackgroundHybrid surgical instruments contain both single-use and reusable components, potentially bringing together advantages from both approaches. MethodsWe used Life Cycle Assessment to evaluate 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 to determine 18 midpoint environmental impacts including the carbon footprint, and three aggregated endpoint impacts. We also conducted life cycle cost analysis, taking into account unit cost, decontamination, and disposal costs. FindingsThe 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%, and costing less than half that of single-use equivalents (GBP {pound}131 versus {pound}282). The carbon footprint of using hybrid versions of all three instruments was around one-quarter of single-use equivalents (1,756 g versus 7,194 g CO2e per operation), and saved an estimated 1.13 e-5 DALYs (disability associated 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 environmental performance of hybrid instruments was better even given 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. InterpretationAdoption of hybrid laparoscopic instruments could play an important role in meeting carbon reduction targets for surgery, whilst saving money. FundingThis work was funded by Surgical Innovations Ltd who manufacture hybrid laparoscopic instruments.

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