Waste Audit of Robotic Gynecologic Surgery: A Pilot Study
- PMID: 40897210
- DOI: 10.1016/j.jmig.2025.08.029
Waste Audit of Robotic Gynecologic Surgery: A Pilot Study
Abstract
Study objective: To quantify and characterize waste generated in robotic gynecologic surgery and assess its environmental impact, with the goal of identifying strategies to reduce waste and improve sustainability.
Design: Waste audit and life cycle impact assessment of robotic gynecologic surgery.
Setting: Single academic institution.
Patients: Twenty robotic gynecologic surgery cases, including hysterectomies (n=10), myomectomies (n=6), and tubal, ovarian, or endometriosis surgeries (n=4).
Interventions: A detailed waste audit of all surgical waste to categorize materials into municipal solid waste (MSW) and regulated medical waste (RMW), allowing for subsequent life cycle impact assessment.
Measurements and main results: The 20 audited cases produced 367.02 kg of MSW and 9.68 kg of RMW, averaging 18.35 kg (standard deviation, SD, 2.63 kg) of MSW and 0.48 kg (SD 0.52 kg) of RMW per case. The largest contributor by weight was surgical gowns and drapes composed of spunbond-meltblown-spunbond (SMS) polypropylene. An average of 0.59 kg (SD 0.25 kg) of recyclable plastics and 11.85 batteries (SD 4.09) per case were discarded as MSW. No RMW met biohazard criteria. Unused surgical supplies accounted for 1.11 kg (SD 0.56 kg) of waste per case. Cases produced an average of 0.70 kg CO2e (SD 0.27) per minute of operative time, with shorter surgeries producing the most emissions per minute. Cotton products contributed up to almost one-third of an impact category despite accounting for 5% of the total waste by weight.
Conclusion: Opportunities to reduce the environmental impact of robotic gynecologic surgeries include reorganizing surgical kits to avoid the unnecessary opening of commonly unused items, increasing reprocessing of single-use devices, properly sorting recyclable plastics and paper products, appropriately using regulated medical waste streams, considering alternative surgical modalities for less complex cases, and exploring reusable or more environmentally-friendly alternatives to cotton and SMS polypropylene products.
Keywords: Impact Assessment; Robotic Surgery; Sustainability; Waste Audit.
Copyright © 2025. Published by Elsevier Inc.
Conflict of interest statement
Declaration of competing interest Dr. Kathy Huang has received consulting fees from Intuitive Surgical and Johnson and Johnson. Dr. Cassie Thiel owns Clinically Sustainable Consulting LLC and has received consulting fees from the Association for Medical Device eprocessors, Boston Medical Center, Philips, Becton Dickinson, Veterans Education and Research Association of Northern New England, EarthShift Global, Stryker Corporation, CUE Health, Anthesis, Zasti Inc., Sustainable Solutions Corporation, Apiject, Kimberly-Clark Corporation, Sphera, the Institute for Healthcare Improvement, New York University Stern School of Business, Columbia University’s SHARP program, and the University of California San Francisco. She has also received honoraria and travel reimbursements from 3M, Stryker Corporation, Vizient, Columbia University, and the University of Colorado, served as a paid advisor to The Sean N. Parker Center for Allergy and Asthma Research at Stanford University, an unpaid advisory board member for the Massachusetts General Center for Climate and Health, and received stock options for advisory roles with Zabble Inc. and Rebisken Inc.
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