Carbon footprint of disposable, hybrid, and reusable trocars in diverse hospital settings: a life cycle assessment

Abstract Background Trocars are essential instruments in laparoscopic surgery, including high-volume procedures such as laparoscopic cholecystectomy. Although reusable trocars are generally assumed to be more environmentally sustainable than disposable or hybrid variants, previous life cycle assessments (LCAs) have relied on manufacturer-supplied data and rarely account for variation in hospital practices. This study provides the first LCA of disposable, hybrid, and reusable trocars based on independently verified material composition and multiple real-world clinical processing settings. Methods A cradle-to-grave LCA was performed following ISO 14040/14044 standards. The material composition was determined by Fourier-transform infrared spectroscopy. The functional unit was defined as four trocars (2 × 5 mm, 2 × 12 mm) required for one laparoscopic cholecystectomy. Environmental impacts were evaluated across three hospital settings: an academic hospital with in-house sterilization, an academic hospital with outsourced sterilization, and a general hospital with in-house sterilization. Inventory data were derived from hospital-specific questionnaires, interviews, manufacturer contact, and published sources. Impacts were assessed using ReCiPe 2016 (hierarchical perspective). Results Reusable trocars consistently showed the lowest carbon footprint across settings (0.33–0.94 kg CO 2 -eq per procedure), followed by hybrid trocars (0.64–1.50 kg CO 2 -eq). Disposable trocars had the highest impacts (1.37–1.74 kg CO 2 -eq). Manufacturing was the dominant source of emissions for disposable devices, whereas sterilization processes dominated for reusable instruments. The contribution of sterilization and waste processing differed between hospital settings. Conclusion Reusable trocars demonstrated the lowest environmental impact in most evaluated settings, outperforming disposable and hybrid alternatives. In certain settings, hybrid trocars also offered environmental advantages. Improving sterilization efficiency and expanding reuse-compatible device design can further reduce the environmental impact of laparoscopic surgery.