Central Sterilising Club
reprocessing both with robust audit trails and full management, Pat wondered whether it was time to explore the ‘clinically clean’ option for items that need to be sterilised but do not need to be sterile at the point of use. In Sussex, they have started to investigate new technologies such as UV cabinets for nasendoscope disinfection and reusable anaesthetic masks. Pat commented that perhaps we need to
re-evaluate some of our beliefs and re-examine some of the processes with the aid of modern technology to keep our patients and the planet safe. ‘Risk is a balance’ and with the sustainability platform growing in strength, we have to weigh up and balance infection risks vs environmental risks.
The Present: sustainability and decontamination Moving on to ‘The Present’, Associate Professor, Tim Horeman, presented the work he started in 2015 on ‘Sustainable Surgery and Translational Technology.’ The TU Delft researcher gave an insight into a sustainability project undertaken in Rotterdam. In Dutch hospitals, over a million kilos of blue ‘wrapping paper’ are used each year to keep medical instruments sterile. After they have been used, they create significant volumes of waste. The sustainability project involved melting down the blue polypropylene wrapping paper and turning it into a new medical device. Tim showed a slide demonstrating the full 360-degree life cycle of the blue wrapping paper – transitioning from the theatre, through to melting and shredding, the conversion of the product to granules which are fed into an injection moulding process, the manufacture of new products from the raw product, and then their reuse as medical devices in theatre. The approach has been given a Trade Marked name of “Urban Hospital Mining”. A growing number of Dutch hospitals are now adopting this approach. This work progressed to the development of the first ‘waste free’ robotic platform (ADLAP).
The growth of robotic surgery has led to an increase in waste and environmental pollution due to high numbers of single-use items used in the process. Tim highlighted that two-thirds of the market leader’s income in this field comes from single-use items. If you compare two procedures (conventional laparoscopy vs robot-assisted surgery) there is a 43.5% increase in greenhouse gases (GHG) for robotic, a 40% increase in procedure costs, and a 24% increase in waste production. Tim collaborated with Johnson and Johnson (J&J) on a project to create a validated process to recycle the J&J Echelon Flex Endopath Stapler. He showed a video demonstrating the multiple steps taken from the operating theatre to the collection point in the hospital, from the hospital to the decontamination unit, to the recovery and harvesting of the components for reuse within the medical chain. The components are quality assessed and sent back to the manufacturer for reuse, which has much more value than simply recycling the materials. The process has also been validated at Delft University of Technology. “We have now reprocessed over 150,000 instruments, since starting last year.” One of the challenges around robotic instruments and the move to single use has
been the use of cable technology. A return to reusable has been achieved with a new instrument (SATA). While there have been many product enhancements on the robotics market, “no one has been looking at the sustainability aspect,” he explained. In addition, the technology has not been designed for global use (i.e. the cost of purchasing single-use instruments is a cost barrier for some geographies). The ADLAP Robot Platform for sustainable and global surgery has been developed to tackle the issues. The solution is described as “a versatile modular advanced laparoscopy robot platform with fully reusable cable-less instrument actuators with interaction force sensing.” Beyond the financial impact, the development
of a new generation of instruments with a longer lifespan and fewer components could have a huge impact on the amount of waste associated with robotic surgery and be a step towards a more circular healthcare economy. Approximately one in three laparoscopic
procedures are performed using articulating instruments, which is forecast rise to 7.5 million procedures per year by 2025. If a minimum of three SATA instruments are used per procedure (e.g. for incisions, manipulations and closures) and each can be reused 100 times instead of the usual 10, then at least 5 million instruments a year could potentially be reused rather than discarded.1 Other advances include integrating ‘sensor- less sensing’ (by using actuators as sensors) and the development of reusable drapes for the robot, which help to promote sustainability. He went on to describe other future design
advances for sustainable robotic surgery – such as a multi-modal instrument tip to drive a needle. Normally, you would need two instruments, but this design means the robot requires just one. The use of smart energy harvesting systems could further add to the sustainability. Tim concluded that, with a vision for global
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www.clinicalservicesjournal.com I April 2025
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