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Waste Audit of Robotic Gynecologic Surgery: A Pilot Study
Simone A Sasse1, Amy C Bleasdale1, Justin Zaslavsky2
1Department of Obstetrics and Gynecology, New York University Langone (Drs. Sasse, Bleasdale, and Karpel), New York, New York.
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 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 RMW streams, considering alternative surgical modalities for less complex cases, and exploring reusable or more environmentally-friendly alternatives to cotton and spunbond-meltblown-spunbond polypropylene products.
