Environmental considerations in the selection of medical staplers: A comparative life cycle assessment

Freund, Julissa; Gast, Katherine M.; Zuegge, Karin L.; Hicks, Andrea

doi:10.1016/j.jclepro.2022.133490

Cited by 7 publications

(7 citation statements)

References 15 publications

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“…The consequence is that few studies have been carried out on complex product systems. Popular healthcare candidates tend to be simple with relatively few components, for example, face masks [59], surgical scissors [60], and staplers [61], to name a few. In contrast, electrical medical devices are rarely featured (e.g., bronchoscopes [55]).…”

Section: Related Workmentioning

confidence: 99%

Assessing Long-Term Medical Remanufacturing Emissions with Life Cycle Analysis

Meister¹,

Sharp²,

Wang³

et al. 2022

Processes

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The unsustainable take-make-dispose linear economy prevalent in healthcare contributes 4.4% to global Greenhouse Gas emissions. A popular but not yet widely-embraced solution is to remanufacture common single-use medical devices like electrophysiology catheters, significantly extending their lifetimes by enabling a circular life cycle. To support the adoption of catheter remanufacturing, we propose a comprehensive emission framework and carry out a holistic evaluation of virgin manufactured and remanufactured carbon emissions with Life Cycle Analysis (LCA). We followed ISO modelling standards and NHS reporting guidelines to ensure industry relevance. We conclude that remanufacturing may lead to a reduction of up to 60% per turn (−1.92 kg CO2eq, burden-free) and 57% per life (−1.87 kg CO2eq, burdened). Our extensive sensitivity analysis and industry-informed buy-back scheme simulation revealed long-term emission reductions of up to 48% per remanufactured catheter life (−1.73 kg CO2eq). Our comprehensive results encourage the adoption of electrophysiology catheter remanufacturing, and highlight the importance of estimating long-term emissions in addition to traditional emission metrics.

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Section: Related Workmentioning

confidence: 99%

Assessing Long-Term Medical Remanufacturing Emissions with Life Cycle Analysis

Meister¹,

Sharp²,

Wang³

et al. 2022

Processes

View full text Add to dashboard Cite

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“…All studies have applied the same method, based on Life Cycle Assessment (LCA); therefore, to highlight the different methods and approaches used for environmental assessment, these papers have been grouped into a single category. Only a few of the most significant ones are reported [33][34]. The main topics of remaining 31 studies are included in Figure 2.…”

Section: Resultsmentioning

confidence: 99%

Sustainability in Healthcare: Methods and Tools for the Assessment

2023

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Background: Healthcare sector has a significant impact on the environment and people well-being. Therefore, it is interesting to understand how healthcare contributes to sustainable development. Objective: The study aims to perform a literature review on the methodologies applied to quantify environmental impact in healthcare with an attention to telemedicine activities. Methods: Scopus and PubMed databases were investigated between 2018 and 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) frameworks was followed for article selection. Results: From initial 183 articles, 50 full-studies were included. Life-cycle assessment method proved to be a standard for assessing the impact of devices used in clinical practice. Indeed, for the investigation of care activities a unique methodology was not defined. The assessment of telemedicine is mainly based on avoided travels, and a standard methodology is still missing. Conclusions: To move toward a sustainable development other aspects of sustainability should be investigated.

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“…Finally, an assessment of the ecological impact caused by production, use, and disposal of all components of SUS and MUS in the form of a life-cycle analysis was outside the scope of this study. The present analysis did not consider the environmental impact of the cleaning and sterilization process that is required to safely reuse surgical instruments, 15 , 41 the recycling process of lithium-ion batteries, 36 or the reprocessing process that would make single-use items reusable. 13 A complete life-cycle analysis of the stapling systems used in clinical practice would be needed to fully understand all relevant processes, environmental impacts, consumed resources, and waste streams.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Environmental Impact of Single-Use and Multi-Use Surgical Staplers with Staple Line Buttressing in Laparoscopic Bariatric Surgery

Meissner¹,

Hafermann²,

Veloz³

et al. 2023

RMHP

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Operation rooms have a large environmental impact. Single-use staplers (SUS) are widely used surgical instruments that contribute to resource consumption and waste generation, whereas multi-use staplers (MUS) can greatly reduce the environmental impact of surgery. The staple lines are often reinforced with buttressing material to prevent leaks and bleeding. We explore current clinical practice and environmental concerns regarding stapling and buttressing, as well as the environmental impact of staple line buttressing in sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Furthermore, we extend this analysis by taking packaging material and the lithium in power supplies into consideration. Materials and Methods: A survey of bariatric surgeons was conducted to assess stapler and buttressing use in clinical practice. We deconstructed and analyzed the product and packaging composition of a commonly used SUS with separate staple line reinforcement (Echelon Flex™ with Echelon Endopath™, Ethicon) and MUS (Signia™ with Tri-Staple™ reinforced reloads, Medtronic), where the buttressing material was delivered separately or already incorporated in the reload cartridge, respectively. Both systems were compared regarding total waste generation, resource use (determined as total material requirement), and greenhouse gas emission caused by their lithium content. Results: 60 mm cartridges were most frequently used in bariatric surgery, and 67% of surveyed surgeons applied staple line reinforcement. MUS with pre-attached buttressing resulted in a reduction of waste, material consumption, and greenhouse gas emissions compared to SUS with separate buttressing: they reduced product waste by 40% (SG and RYBG), packaging waste by 60% (SG) and 57% (RYGB), resource consumption by more than 90%, and greenhouse gas emissions related to the lithium in the batteries by 99.7%. Preloaded buttressing produced less waste than separate buttressing per stapler firing. Conclusion:The environmental impact of surgery can be greatly reduced by using MUS with pre-attached buttressing rather than SUS with separate buttressing.

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Environmental considerations in the selection of medical staplers: A comparative life cycle assessment

Cited by 7 publications

References 15 publications

Assessing Long-Term Medical Remanufacturing Emissions with Life Cycle Analysis

Assessing Long-Term Medical Remanufacturing Emissions with Life Cycle Analysis

Sustainability in Healthcare: Methods and Tools for the Assessment

Evaluating the Environmental Impact of Single-Use and Multi-Use Surgical Staplers with Staple Line Buttressing in Laparoscopic Bariatric Surgery

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