Surgical tray leaning: carbon, efficiency and cost-savings in MAKO robotic-assisted total knee arthroplasty

Robotic-assisted total knee arthroplasty (RA-TKA) is associated with a higher carbon footprint compared with manual TKA. This review sought to reduce the carbon and financial costs associated with MAKO RA-TKA by 'leaning' surgical trays.

Surgeons routinely performing MAKO RA-TKA were consulted, and a consensus was reached on items from the standard knee instrument trays that were redundant and could be removed. Two new 'lean trays' were then introduced for MAKO RA-TKA. Carbon and financial savings were calculated based on the reduction in the number of trays requiring decontamination, sterilisation and repackaging.

Implementing lean methodology has reduced the tray count by one, by removing 36 out of 152 instruments per case. In five months, the use of lean trays resulted in saving 115 trays being opened, reprocessed and sterilised. This project has resulted in numerous benefits, including a total carbon saving of 220.85kgCO2e (carbon dioxide equivalent) due to reduced use of sterilisation processes (176kgCO2e) and tray wraps (44.85kgCO2). Staff feedback was positive, noting the ability to count instruments more quickly, increased space in theatre and reduced learning curve for new staff. Additionally, there was a financial saving of approximately £5,750 due to reduced burden on sterilisation services.

It is imperative that innovative technologies are implemented with sustainability in mind and that any potential environmental harm is mitigated wherever possible. In this regard, the implementation of 'lean' surgical instrument trays should be considered to minimise the environmental impact of surgery while also improving efficiency and lowering costs.