Sustainable theatres
Circular economy in the operating theatre
Sophie Spencer and Beth Greenhough discuss how transitioning to reusable surgical instruments, through a managed equipment service, can dramatically reduce theatres’ environmental impact. They consider how hospitals can embrace ‘Design for Life’ principles and circular economy thinking.
Healthcare is evolving, and the operating theatre is central to that shift. As a hub for life-saving care, it also offers a powerful opportunity to lead on sustainability. Every single-use instrument carries a hidden cost that is not just financial, but environmental. With surgical volumes rising and supply chains under strain, the NHS is well-placed to drive more sustainable practices. By rethinking procurement, investing in reusables, and empowering clinical teams, we can cut waste, protect budgets, and advance the NHS’s Net Zero goals. A single laparoscopic cholecystectomy can generate up to 56.5 kg CO2
e, with 22.7 kg
attributed to single-use instruments alone.1 Harmonic shears, costing over £500 each, are discarded after one use in 90% of cases2 - highlighting the scale of opportunity for innovation and smarter resource use. This article introduces a practical, proven solution: transitioning from single-use to reusable surgical instruments through managed equipment services. Circular economy models like B. Braun’s RENU Service have helped NHS hospitals avoid over 6,000 single-use instruments in a single year, saving more than £218,000 and 723 kg of waste.3
Adopting
approaches like this can dramatically reduce environmental impact, unlock significant cost savings, and improve patient experience - without compromising clinical quality. Every single-use item in surgery carries a hidden cost - not just financial, but environmental. As the climate crisis intensifies, healthcare must evolve and the operating theatre stands out as
both a challenge and a catalyst for change. By embracing ‘design for life’ principles and circular economy thinking, hospitals can transform surgical practice - reducing waste, cutting costs, and protecting both people and the planet.
The impact of healthcare on the climate Despite being the first healthcare system in the world to have Net Zero goals embedded into legislation from the Health and Care Act 2022, the NHS is responsible for around 4% of England’s carbon footprint, with up to 66% of the emissions coming from the supply chain.4
equipment and devices with sustainability in mind. As of September 2025, clinical equipment accounted for 8% of emissions within the NHS Carbon Footprint Plus highlighting the ongoing need to reduce emissions through more sustainable procurement of medical devices.5 Operating rooms account for 20-30% of hospital waste, largely due to the widespread use of single-use items such a surgical steel instruments, including scalpels, forceps and scissors - carrying significant financial and environmental impact.6
A practical example of To
combat this, the NHS has set a target to achieve Net Zero by 2045 for emissions of all scopes, referred to as the NHS Carbon Footprint Plus. To reach this goal, the NHS must procure medical
By embracing ‘design for life’ principles and circular economy thinking, hospitals can transform surgical practice - reducing waste, cutting costs, and protecting both people and the planet.
this can be seen in the NHS’s use of harmonic shears, which cost of over £500 each. Shockingly, around 90% of these devices are discarded after a single use.2
This practice contributes
significantly to both financial waste and environmental harm. Looking at the impact of specific procedures on carbon emissions, a laparoscopic cholecystectomy produces around 56.5 CO2
case, with the main sources being single-use tools, packaging materials and disposable drapes and gowns; single-use instruments are estimated to account for 22.7 kg CO2
In laparoscopic appendectomies, single-use instruments account for an average 27.68 kg
December 2025 I
www.clinicalservicesjournal.com 59
e per
e per case.1
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