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Published on: January 17, 2019
A Comparative Carbon Footprint and Cost Analysis of Uterine Manipulators for Hysterectomy
Alexandra I Melnyk1, Nathalia Silva de Souza Lima Cano, Stephanie Glass Clark
1Ob/Gyn & Women's Health Institute, Division of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic, Cleveland, Ohio; and the Department of Civil and Environmental Engineering, Swanson School of Engineering, and the Mascaro Center for Sustainable Innovation, University of Pittsburgh, the Division of Urogynecology and Pelvic Reconstructive Surgery, Magee-Womens Hospital, University of Pittsburgh Medical Center, and the Magee-Womens Research Institute, Pittsburgh, Pennsylvania.
Objective:
To evaluate the environmental effects and cost of four different uterine manipulators using life cycle assessment and life cycle costing.
Methods:
Life cycle assessment, which evaluates the environmental effects of a product or process throughout its life cycle, including production, use, and disposal, was performed on a reusable stainless-steel manipulator, two disposable manipulators, and a hybrid manipulator with both reusable and disposable pieces. Uncertainty in data was addressed through Monte Carlo analysis. Life cycle costing was conducted concurrently, incorporating procurement, sterilization, and waste removal costs and excluding capital equipment costs. Costs were estimated from institutional contracts, labor, materials, and energy use. The primary outcome of this study was the environmental footprint of four uterine manipulators. Secondarily, we compared the global warming potential (kilograms of CO 2 -equivalents) and costs (U.S. dollars) associated with the production, use, sterilization, and disposal of these manipulators over 300 hysterectomies, the approximate life of the reusable manipulator.
Results:
The reusable stainless-steel manipulator had the lowest carbon footprint and environmental effect in every category. The disposable manipulators had global warming emissions 4.24 and 2.39 times higher than the reusable manipulator, and the hybrid had emissions 3.76 times higher at 15 uses. Sterilization contributed most of the effects for the reusable manipulator, and production contributed the most for the other devices. The reusable manipulator had the highest up-front costs, but over 300 uses saved the institution $16,000-43,000 compared with the other devices.
Conclusion:
The reusable stainless-steel uterine manipulator had the lowest carbon footprint and cost compared with the disposable and hybrid devices over their life cycles. Health care leadership should invest in reusable devices; clinicians should prioritize reusable options; and industry partners should innovate and manufacture stainless-steel instruments to help decarbonize the health care system.
