Surgical tray rationalisation in laparoscopic cholecystectomy
Agnes Henson1 – Net Zero & Sustainable Procurement Senior Analyst - NHS England
Adam Peckham-Cooper2 – Consultant Emergency General Surgeon - Leeds Teaching Hospitals Trust (LTHT)
Background & Context
§For surgical setups using reusable surgical instruments, decontamination accounts for approximately 85% of item life cycle emissions3
§Use-audits are rarely conducted, resulting in excess reprocessing of up to 75% of items that are left unused4
Identifying the Opportunity
§LTHT conduct over 800 laparoscopic cholecystectomies a year across four sub-specialties. Each specialty setup is different & contains >100 instruments spread across multiple trays
§Reducing an instrument set by a single standard DIN basket could annually save >1 tCO2e locally or 100 tCO2e nationally. Scaled to all laparoscopic procedures this could save over 2kT CO2e
Methodology
The Audit
§Instrument checklists were developed for each core speciality & completed per procedure to capture instrument use rates
§Data collection (January-March 2023), was completed across 70 cholecystectomy cases
§Qualitative data was collected from surgeons and scrub practitioners on the opportunities or difficulties associated with set streamlining
The ‘Hackathon’
§A ‘Hackathon’ event enabled discussion to curate & confirm the new streamlined setup, featuring representatives from all speciality teams
§Use-data presented in a heatmap enabled triaging of the discussion on instrument inclusion / exclusion
§Reduction opportunities were prioritised by instruments that could be consolidated into fewer & / or smaller trays to maximize savings
Results
Environmental & Cost Savings
§The final consolidated set consisted of 65 items, in one dual-layered reusable container
§The streamlined set is projected to save 2-3 tCO2e6 and £16-22k7 in sterilisation costs annually. Scaled nationally, this could yield over 300 tCO2e and £1.5m in savings
Qualitative findings
§Surgical teams were overwhelmingly positive about the exercise, 96% of respondents reporting additional perceived benefits in time saved counting unused instruments
1agnes.henson@nhs.net; 2adam.peckham-cooper@nhs.net; 3Rizan et al., (2022); 4Stockert & Langerman (2014) ; 5The Intercollegiate Green Theatre Checklist (RCSEng); 6Adjusted savings figures from Rizan et al., (2022); 7Figures from 3rd party sterile services supplier costing structure
