ArticleSurgical endoscopy2026
Surgical tray optimization: a prospective and survey-based evaluation of environmental and economic outcomes.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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8 authors.
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Abstract
backgroundOperating rooms are resource-intensive environments. While reusable instruments are more sustainable than disposables, sterilization and reprocessing of unused instruments in the trays generate unnecessary environmental and financial burdens. Surgical tray optimization-removal of rarely used instruments-may reduce these impacts. Current evidence is fragmented, with no standard method to identify unused instruments and limited integration of environmental and cost analyses.
methodsWe prospectively recorded instrument use for the Major General Surgery tray (94 reusable instruments) in one academic hospital in the Netherlands during 162 surgical procedures across multiple disciplines (November 2023-May 2024). Instruments used in < 20% of cases were considered for removal by (1) prospective clinical observation and (2) retrospective staff survey (surgeons, residents, scrub nurses). Life cycle assessment (LCA) and activity-based costing quantified the carbon footprint and costs.
resultsOn average, 19 instruments were used per case; 10 were never used. Observation-based optimization reduced tray size and weight by 54%, lowering costs by 55%. Survey-based review achieved smaller reductions (22% in number, 18% in weight, 21% in cost), with surgeons supporting more removals than scrub nurses. The original tray generated 1.25 kg CO
conclusionIn multi-specialty settings, tray optimization offers substantial cost savings and modest but cumulative environmental benefits. Clinical observation identified greater reductions than staff reviews. Combining LCA with cost analysis can provide a transparent framework to guide sustainable surgical practice.
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