ArticleAnnals of the Royal College of Surgeons of England2025
Surgical tray leaning: carbon, efficiency and cost-savings in MAKO robotic-assisted total knee arthroplasty.
Article in Annals of the Royal College of Surgeons of England, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Time neutrality and reduced ecological burden - handheld robotic-assisted total knee arthroplasty improves operating room efficiency compared with manual total knee arthroplasty.International orthopaedics · 2026Article
- Robotic-assisted total knee arthroplasty: radiological precision, clinical outcomes, and benchmarks for emerging systems.Journal of robotic surgery · 2026Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionRobotic-assisted total knee arthroplasty (RA-TKA) is associated with a higher carbon footprint compared with manual TKA. This review sought to reduce the carbon and financial costs associated with MAKO RA-TKA by 'leaning' surgical trays.
methodsSurgeons routinely performing MAKO RA-TKA were consulted, and a consensus was reached on items from the standard knee instrument trays that were redundant and could be removed. Two new 'lean trays' were then introduced for MAKO RA-TKA. Carbon and financial savings were calculated based on the reduction in the number of trays requiring decontamination, sterilisation and repackaging.
resultsImplementing lean methodology has reduced the tray count by one, by removing 36 out of 152 instruments per case. In five months, the use of lean trays resulted in saving 115 trays being opened, reprocessed and sterilised. This project has resulted in numerous benefits, including a total carbon saving of 220.85kgCO2e (carbon dioxide equivalent) due to reduced use of sterilisation processes (176kgCO2e) and tray wraps (44.85kgCO2). Staff feedback was positive, noting the ability to count instruments more quickly, increased space in theatre and reduced learning curve for new staff. Additionally, there was a financial saving of approximately £5,750 due to reduced burden on sterilisation services.
conclusionsIt is imperative that innovative technologies are implemented with sustainability in mind and that any potential environmental harm is mitigated wherever possible. In this regard, the implementation of 'lean' surgical instrument trays should be considered to minimise the environmental impact of surgery while also improving efficiency and lowering costs.
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