Sustainable theatres


Managed equipment services provide surgical staff access to high quality equipment, including instruments, endoscopes, trocars and power systems. In the instance of laparoscopic services, they can also help reduce reliance on single-use surgical instruments by providing access to reusable alternatives under a fixed-cost model. This approach not only supports more predictable budgeting, but also enables long-term savings by avoiding the continuous repurchase of disposable items. Services can also help streamline surgical workflows by ensuring that all necessary instruments are provided by a single supplier in a consolidated set, enabling storage in one central location on site. Surgical teams can work with managed equipment service providers to develop instrument sets tailored to clinical needs, with flexibility to add or adjust components as required. Sets are typically recalled at regular intervals for planned maintenance, where instruments are inspected, repaired, refurbished, or replaced if damaged beyond repair.


Solutions in practice In the case of B. Braun’s RENU service, instruments aim to be returned to hospitals within five working days to minimise disruption or delays to surgical schedules. Data from the managed equipment service shows an instrument repair rate of up to 81%,13


with an


average replacement rate of 15%, compared with 34% for those repaired ad hoc.14


Feedback


from healthcare professionals further supports the effectiveness of repaired instruments, a survey conducted at the Association of Surgeons in Training Annual Conference 2025 found that 68% of delegates identified repaired instruments as either ‘new’ or ‘indistinguishable from new’.15


instruments are perceived to meet high standards of performance and appearance, consistent with clinical expectations for safety and reliability.


10000


1000 2000 3000 4000 5000 6000 7000 8000 9000


0


6225 4802


1153 1153


Phase 1


8326 2101


270 4802 270


Figure 1: Comparison of costs and disposals between single-use and reusable laparoscopic instruments across Gynaecology, Gynae-Oncology and General Surgery in Year 1, at Gateshead Health NHS Foundation Trust.


A multidisciplinary team of surgeons,


operating department practitioners and sterile services staff at Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust were struggling with procurement issues post-COVID, failings in the supply chain and uncertainties on instrument availability day-to-day. The team carried out an initial 4-week trial in General Gynaecology of reusable laparoscopic equipment from the RENU service, including a bi-polar device. This was followed by a phased rollout designed to introduce change gradually, maintain training and engagement for both clinical and central sterile services department (CSSD) staff and prioritise patient safety during the transition: l Phase 1: Gynaecological laparoscopic tray implementation


l Phase 2: General laparoscopic tray implementation, and adjustments to Phase 1 trays to accommodate Gynae-Oncology


l Phase 3: Partial implementation of reusable laparoscopic trocars


l Phase 4: Complete roll out of all instruments with full uptake of reusable trocars


These findings indicate that repaired


Number of disposable instruments avoided in each phase of roll-out


Each phase of the rollout avoided the use of a significant number of disposable instruments (Figure 1) with associated savings (Table 1). The annual spending on disposable instruments in Phase 1 and 2 was previously


9227 3002


270 4802


£380,195, which fell to £162,077 in the first year of the RENU service contract, a saving of £218,119 (42.6%) in the 12 months of Phase 2 (Figure 1). The team estimates total annual savings of £381,585 by the end of Phase 4. The savings were not just financial. At the


Queen Elizabeth Hospital, the single-use items were stored separately, requiring around one hour of equipment gathering by two members of the logistics team in preparation for surgery. With the introduction of the RENU service, all instruments were consolidated into a single bespoke tray, reducing preparation time to just 10 minutes for one staff member, freeing up valuable time for other tasks. Adopting reusable laparoscopic instruments


is a pivotal strategy for advancing environmental sustainability in surgical practice. This approach reduces reliance on single-use plastics, minimises waste generation, and supports healthcare systems in meeting carbon reduction targets. Over a year, the hospital performs around 1,152 laparoscopic procedures across General Surgery, General Gynaecology and Gynae- Oncology, with each procedure using between three and seven laparoscopic instruments. By switching from single-use to reusable instruments, the hospital has saved 6,225 instruments from disposal in a year (Figure 1), with a combined weight of 723.2 kg. By Phase 4, an additional 3,000 single-use plastic trocars, weighing around 390 kg, were also avoided. The service would not work, however, without


1153 Phase 2 1153 Phase 3 Gynaecology General surgery Gynae-Oncology 1153


Phase 4 Trocars


Figure 2: Number of disposable instruments avoided in each phase of roll-out


buy-in from the surgical staff. In a survey of 11 general surgeons and gynaecological surgeons, most or all rated the devices as ‘excellent’, ‘very good’ or ‘good’, based on weight/balance, ergonomics, insertion, fixation, transition and performance (Figure 2). Crucially, the feedback confirmed that switching to reusable instruments did not compromise surgical quality – reinforcing that sustainability and high clinical standards can go hand in hand. Similar results have been achieved in


other Trusts, such as Tameside Hospital NHS Foundation Trust. The hospital, which carried out 300 laparoscopic surgeries a year, found that


December 2025 I www.clinicalservicesjournal.com 61


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