Thursday June 27, 2019 from

Kevin C. C. Zorn, Canada

Associate Professor, Director of Robotic Surgery - CHUM, Minimally Invasive Uro-Oncologist

Section of Urology

University of Montreal Hospital Center (CHUM)


Carbon footprint of disposable BPH minimally-invasive surgical devices: A standardized method for transurethral prostate surgery

Kevin C. Zorn1, Enrique Rijo3, D Enikeev4, Dean S. Elterman5, Naeem Bhojani1, Alex De La Taille6, Thomas Herrmann7, Benjamin Pradere8, Gregoire Robert9, Ahmed Zakaria1, Vincent Misrai2.

1Urology, CHUM - University of Montreal Hospital Center, Montreal, QC, Canada; 2Clinique Pasteur, Dept. of Urology, Telouse, France; 3Hospital Quiron Barcelona, Dept. of Urology, Barcelona, Spain; 4Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation; 5University Health Network, University of Toronto, Toronto, ON, Canada; 6Assistance Publique Des Hopitaux de Paris, Creteil, France; 7 Spital Thurgau AG, Dept. of Urology, Frauenfeld, Switzerland; 8Bordeaux University Hospital, Dept. of Urology, Bordeaux, France; 9Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

Introduction: The healthcare sector accounts for 4.4% of annual human-induced CO2 net emissions (CO2e).Operating rooms are facing the arrival of a plethora of disposable mini-invasive surgical devices (MISDs) made from nonbiodegradable materials with negative environmental impact. A standardized methodology for estimating the embodied carbon footprint(CF) of MISDs for transurethral BPH surgery is needed.

Methods: The proposed methodology relied on a partial product lifecycle assessment and was restricted to a specific part of Scope 3, which comprised the manufacturing of MISDs- and non-device-associated products (packaging and user manual)(NDAPs).The process-sum inventory method was used, which involves collecting data on all the component processes underpinning disposable MISDs. The 7 latest disposable MISDs  were dismantled, and each piece was categorized, sorted into the appropriate raw material group, and weighed. The CF was estimated according to the formula: activity data(wt raw material) x emission factors of the corresponding raw material(kg CO2e/kg).

Results: Total weights of disposable packaging &user manuals ranged from 0.062 to 1,492 kg. Plastic was the most common and least emissive raw material(2.38 kg CO2e/kg) identified.The estimated embodied CF of MISDs ranged from 0.07-3.3 kg CO2e, of which 9 to 86% was attributed to NDAPs.Among the 2 heaviest-weighted devices,Rezūm had the most CO2e due to the multiplicity of components. Despite its technical simplicity, the disposable plasma loop was found to have the third highest CF due to the manufacturing of cables designed to support a high electric amperage. The lowest use of raw materials was found for the iTind & HoLEP devices, which were also found to have the lowest estimated CO2e.

Conclusions: This study described a simple and independent calculation method for estimating the embodied CF of MISDs,regardless of country specifications.Using this method, our results showed a wide discrepancy in the estimated CO2 emissions of the most recent disposable MISDs for transurethral BPH surgery.

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