Use of Capsule Instrument Sets to Reduce Environmental Impact of Total Vaginal Hysterectomy

INTRODUCTION: Despite global efforts to combat climate change, the healthcare industry remains a significant contributor to carbon output. Approximately 4.4% of all global emissions are a result of healthcare-related activities with an annual carbon footprint equivalent to that of 514 coal-fired power plants. 71% of this output is related to processing products in the healthcare supply chain, primarily from surgical procedures and operating rooms. Hysterectomies produce a yearly carbon footprint of 212,000 metric tons in the United States alone. While the majority of the environmental impact of these procedures is attributable to the use of disposable surgical instruments and tools, optimization of reusable surgical tools in the operating room poses a clear area for intervention. OBJECTIVE: The purpose of this study was to quantify the environmental impact of total vaginal hysterectomy (TVH) at an academic tertiary care center. Using these findings, we proposed methods to decrease carbon output by creation of a capsule total vaginal hysterectomy set with only the necessary surgical tools used to perform a TVH. METHODS: This is a descriptive study using observation of materials and instruments used during five vaginal hysterectomies. Carbon outputs were derived from quantification of surgical tool weights and established energy requirements for sterile processing at the facility. A capsule instrument set was composed by eliminating all instruments from the institution’s standardized trays that were not utilized across the five observed cases. RESULTS: The average total weight of surgical sterile instruments used per case was 41.472 kg, using 1.513 watts of energy to autoclave. In contrast, the capsule instrument set weighs 6.45 kg, requiring the use of 0.235 watts of energy to autoclave. The relative difference of surgical instrument weight between the composite and capsule set is 35.022 kg, which translates into a 1.278-watt or 84.4% difference in energy use. CONCLUSIONS: Developing a capsule instrument set that includes only essential tools for performing a TVH could significantly reduce the environmental impact by reducing energy consumption. Additionally, implementing this instrument set could substantially reduce setup time, streamline the surgical process, and improve overall operating room efficiency (Table 1).