Life Cycle Assessment of Flexible Ureteroscopy: Analysis of Four Centers and Recommendations for an Eco-Designed Approach

<b><i>Objective:</i></b> This study aims, for the first time, to assess and quantify the environmental impact of ureteroscopy. We conducted a life cycle assessment of flexible ureteroscopy for lithiasis in four different centers, with objective of comparing their respective impacts, determining the most environmentally unsustainable steps of the procedure, and comparing the toll of different medical devices, such as single-use and reusable flexible ureteroscopes (SUFU and RFU). In order to identify eco-designed approaches and to suggest recommendations for sustainable and eco-responsible strategies. <b><i>Methods:</i></b> For each step of the procedure, we collected the reference of every medical device, their quantities, composition, transport, and disposal methods. Reusable devices' impacts were divided by their lifespans, with sterilization processes included. Data analysis was carried out by Agence Primum non nocere-an independent company specialized in sustainable development-using SimaPro 9.5 with the Ecoinvent 3.9 database and assessing 18 environmental impacts. <b><i>Results:</i></b> The steps with the highest environmental cost were equipment installation, surgical staff attire, calculi exploration, and patient setup. There was no clear overall difference between SUFU and RFU regarding global warming, though differences were more significant in certain specific impact categories. Reusable laser fibers exhibit significantly lower environmental impacts compared with single-use fibers. The absence of transparency regarding production data from manufacturers constitutes a significant limitation to our study. We recommend designing optimized ureteroscopy packs, promoting the use of reusable fabric attire, using RFU sterilized with the low-temperature hydrogen peroxide method, prioritizing SUFU with a recycling program, revising disinfection protocols, and increasing waste valorization in operative rooms. We further recommend a hybrid approach to increase the lifespan of reusable ureteroscopes.