Life Cycle Assessment of HoLEP: Quantifying Environmental Impact and Opportunities for Sustainable Urologic Surgery

The healthcare sector faces growing pressure to reduce its environmental impact. In urology, Holmium Laser Enucleation of the Prostate (HoLEP) is a standard treatment for benign prostatic obstruction (BPO), but its procedure-related environmental impact remains unknown.

We aimed to quantify HoLEP's life cycle environmental impacts, identify major environmental hotspots, and evaluate the impact of a fluid management system developed according to sustainable-by-design principles.

We conducted a cradle-to-grave life cycle assessment (LCA) of 20 consecutive HoLEP procedures, following ISO 14040/44 standards and the European Product Environmental Footprint (PEF) methodology. ISO 14040/44 allowed us to structure the study while the 16 PEF indicators ensure comparability with other European medical devices. All perioperative phases (pre-, intra-, and post-operative) were included, encompassing medical devices, consumables, energy use, and waste streams.

Environmental impacts were modeled using SimaPro v9.6 with the Ecoinvent database. Primary outcomes were the PEF score and the carbon footprint (CF). Environmental performance was compared between the 10-L fluid collection canisters and the SUPER S.HO.W. fluid management system. Statistical analyses used non-parametric tests, with significance set at p < 0.05.

The median PEF score per HoLEP procedure was 5.9 points (interquartile range [IQR]: 5.7-6.1), with a CF of 106 kg CO₂-eq (IQR: 102-118). The intra-operative HoLEP phase accounted for 49% of the overall environmental impact. Fluid collection canisters were the main contributors among medical devices (48%). Use of the SUPER S.HO.W. system reduced the PEF score by 21% and the CF by 13%. As a single-center study with a limited sample size, generalizability may be restricted.

HoLEP generates quantifiable life cycle environmental impacts. Optimizing surgical workflows and implementing innovative solutions-such as the closed-circuit SUPER S.HO.W. system-significantly reduce the environmental impact of endourological procedures.