Streamlining the Tray, Sustaining the Future: Instrument Utilization in Gynecologic Surgery

INTRODUCTION: Climate change poses a major threat to global health, with healthcare itself contributing an estimated 5% of worldwide greenhouse gas emissions. Operating rooms are particularly resource-intensive, producing disproportionate emissions and hospital waste. Some studies estimate up to 50–70% of all hospital waste is from the operating room. Efforts to mitigate this impact have emphasized sustainable surgical practices, including optimization of pre-packaged surgical trays. Frequently unused and overpacked surgical trays result in unnecessary sterilization, processing, and resource consumption. Streamlining surgical trays reduces waste, greenhouse gases, and costs without requiring additional investments. As such, tray optimization offers a high-yield, practical intervention to advance environmental stewardship while maintaining surgical quality and safety. OBJECTIVE: Evaluate the frequency of use of reusable instruments in universal hysteroscopy and laparoscopy surgical trays at our institution, to determine if modifications can be made to decrease waste. METHODS: Prospective observational study, at a single-site tertiary academic center. All scheduled benign gynecologic laparoscopic and hysteroscopic cases from July 2024 to January 2025 were eligible. This included diagnostic and operative hysteroscopies, diagnostic laparoscopies, ovarian cystectomy, salpingo-oophorectomies, and laparoscopic hysterectomies. Cases were excluded if they were converted to an open approach or were completed in combination with oncology or urogynecology procedures. An inventory was created for the surgical trays opened for both laparoscopic and hysteroscopic cases. The resident on the surgical team documented which instruments were used via an inventory survey. Residents were provided with a picture atlas of the surgical instruments to ensure the use of instruments was properly documented. RESULTS: 27 laparoscopic cases were included in our study, including 16 laparoscopic hysterectomies, and 11 other laparoscopic procedures. 24 hysteroscopic cases were included. For hysteroscopic cases, 1 tray containing 58 reusable instruments is opened for each case. The average number of instruments used was 8.5/58, or 15% of the tray. The maximum number of instruments used in any of the recorded cases was 13/58 instruments. For laparoscopic cases, 3 trays containing 72 reusable instruments are opened for each case. The average number of instruments used was 20/72, or 27% of all opened instruments. The maximum number of instruments used in any of the recorded cases was 31/72 instruments. CONCLUSIONS: Our study demonstrates that over two-thirds of reusable surgical instruments for both hysteroscopy and gynecologic laparoscopy go unused at our institution, which contributes to waste within the operating room and during sterilization procedures. Our findings highlight a substantial opportunity to reformat gynecologic surgical trays. Streamlining trays could decrease waste, reduce costs, and improve environmental sustainability in the operating room.