Optimizing surgical instrument sets to reduce carbon footprint in pancreatic surgery

Abstract Introduction This study evaluated the instrument sets used during elective open pancreaticoduodenectomies (PD) in order to identify unused tools. The goal was to quantify the carbon footprint of current instrument sets and explore potential reductions through tray optimization in order to optimize resource use and minimizing the environmental impact. Method The instrument use was assessed during 20 open PDs between May and September 2024. Water and energy consumption needed for sterilization were calculated based on 87 liters and 9 kWh per tray. Carbon emissions were estimated in grams of CO₂ equivalent (gCO₂e), considering 41gCO₂ for KWh for Sweden. For additional instruments not included in standard trays, gCO₂e were sourced from literature. Result In all PDs, both a “laparotomy” and “vascular” tray were routinely opened. On median, 64% (n=50/79) of instruments on the laparotomy tray and 17% (n=5/33) on the vascular tray were used. A median of 2 additional instruments were opened per case, each contributing approximately 145.4 g CO₂e. In one case, an additional tray was opened. The total resource consumption across all PDs was 3,567l of water, 369kWh energy, and 15,129 g CO₂e. Transitioning to an “optimized” tray, containing 55 essential instruments, would decrease consumption to 1,740l water, 180 kWh, and 7,380 gCO₂e— with 51% potential savings (1,827 l water, 189 kWh, and 7,749 gCO₂e). Discussion A significant proportion of instruments on the current tray for open PDs remain unused. Streamlining trays to contain essential instruments could reduce the carbon footprint by 50%, highlighting the importance of adopting sustainable practices in major surgery.