Sustainable theatres CO2e per case.7 The carbon footprint of routine
procedures like these reinforces the importance of embedding circular economy principles into procurement and surgical decision-making.
Sustainability and the circular economy The circular economy is an economic model built on keeping products and materials in use for as long as possible. In healthcare, this means shifting away from single-use items and embracing practices like maintenance, reuse, refurbishment, remanufacture and recycling. By designing systems that extend the life of surgical instruments and reduce waste, hospitals can lower emissions, cut costs, and build resilience into their supply chains.8 The Design for Life roadmap, created and published by the Department of Health & Social Care (DHSC) in 2025, emphasises the importance of the circular economy for MedTech to reduce waste and end the reliance on potentially vulnerable supply chains, by focusing on reuse, remanufacture and recycling. Reducing the incineration of single-use surgical instruments can significantly decrease contributions to ambient air pollution. With an estimated 38,000 deaths annually in the UK linked to poor air quality, transitioning to reusable surgical instruments offers a tangible opportunity to enhance population health.5
this shift supports the NHS’s Net Zero ambitions, it also offers potential cost savings by reducing the procurement of single-use equipment and negating waste management expenses.9 By enabling repair, refurbishment and
recycling, the circular economy model helps extend the life of hospital instruments that would otherwise be considered unusable. In a 2021 feasibility study across three hospitals in the Netherlands, researchers collected 1,380 kg
Phase Phase 1: Gynaecological laparoscopic tray Phase 2: General laparoscopic tray
Adjustments to Phase 1 trays to accommodate Gynae-Oncology
Phase 3: Partial implementation of reusable laparoscopic trocars
Phase 4: Complete roll out of all instruments with full uptake of reusable trocars
Table 1: Savings made at each phase Source: Knightley et al 3
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of surgical instrument waste. Of the waste collected, 237 kg was refurbished
and returned for reuse (savings of €38,868), and 1143 kg was recycled into sheet metal to manufacture components for new instrument baskets. The study demonstrated that repair and refurbishment of surgical instruments is not only feasible, but a cost-effective and sustainable alternative to disposal, offering clear financial and environmental benefits.10 For clinicians, the environmental case for
While
reusable instruments is compelling. A life cycle assessment comparing stainless steel disposable scissors with reusable alternatives over 4,500 use cycles found that disposables generate 99% more environmental impact.11 This difference is driven by the repeated material mining, manufacturing, transport, and incineration of single-use products, which consume vast resources and release significant emissions. In contrast, reusable instruments consolidate their footprint into one initial production phase, supported by sterilisation
Annual savings £53,372
£144,713 (in General Surgery) A further £20,034 per year
(in addition to Phase 1savings) Cumulative saving: £218,119
Predicted annual saving of £100,229
(in addition to Phase 1 and 2 savings) Cumulative saving: £318,348
Predicted annual savings of £163,466
(in addition to Phase 1 and 2 savings) Cumulative saving: £381,585
processes that are far less resource-intensive than manufacturing thousands of new items. For surgical teams, this means that choosing reusables supports high clinical standards while helping to reduce healthcare’s carbon footprint and aligning practice with sustainability goals.
The challenge of reusables Reusable surgical instruments offer clear potential to reduce environmental impact and cut costs - aligning with the NHS’s sustainability principles of Reduce, Reuse, Reprocess, Renewable, and Recycle.4
However, this
potential depends on proper maintenance and quality assurance to ensure patient safety and operational reliability. A review of 65 audits across 48 hospitals
over two and a half years, checking 32,000 reusable instruments, found that 31% needed replacement, 33% needed repair, 18% had surface finish issues such as corrosion or water marks - and only 18% were acceptable and deemed fit for use.12
Equipment that has to be
decommissioned due to age, poor maintenance, damage or loss can put patient safety at risk by delaying operations or by forcing cancellation of procedures when instruments aren’t available.12
Building a solution To ensure a long life for reusable surgical instruments, as well as protecting the safety of both patients and healthcare staff, equipment must be inspected, repaired and maintained. This can be preventive or corrective, and both forms of maintenance are vital. Planned preventative maintenance involves servicing the instruments at regular intervals to extend their life and reduce failure rates. Corrective maintenance, sometimes referred to as ad hoc repair, is the process of repairing medical devices after a fault has been detected, restoring its functionality so it can be put back to use.
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