A Modified Step-Up Approach to Elective Laparoscopic Cholecystectomy Safely Reduces Cost and Carbon Impacts

Contemporary surgery expends often excessive quantities of consumables, resulting in high cost and carbon footprint. This study examined the cost and carbon impacts of elective laparoscopic cholecystectomy (ELC), a common procedure involving near-universal disposable equipment, and whether a modification of approach to minimising these consumables can safely reduce these impacts, alongside rationalised antibiotic and venous thromboembolism (VTE) prophylaxis according to validated risk scoring instead of routine use.

The modified step-up approach to ELC involved rationalised antibiotic and VTE prophylaxis, a minimal operative set-up, and opening of further equipment only as required. Consecutive patients undergoing ELC by this approach by a single surgeon across four metropolitan hospitals, both public and private, were prospectively audited over 12 months, and compared with a retrospective audit of a matched cohort treated by the same surgeon using a custom laparoscopic kit in a previous 12-month period. Primary outcomes were operating time, cost, weight, and carbon footprint of consumables from the custom laparoscopic kit. Secondary outcomes included post-operative complications and length of stay.

Compared with the previous standard approach, the modified step-up approach significantly reduced weight of surgical consumables by 51.9%, carbon footprint by 50.6%, and cost by 43.1%, without increasing operating time, complications or length of stay.

This modified step-up approach to ELC demonstrates how rethinking common surgical practice can reduce consumable waste, carbon footprint, and costs, without compromising patient safety and outcomes or increasing operating time.