Reducing the carbon footprint of laparoscopic appendicectomy

Project completed as part of the 2021 Green Surgery Challenge.

Setting/Patient Group: Operating theatre

Issue to be addressed:

Appendicectomy remains the most performed acute general surgical operation. Streamlining procedures has potential for significant environmental savings.

Intervention:

1. Process mapping of each step of laparoscopic appendicectomy identified key opportunities for interventions including;
   1. Introduction of pre-operative bladder checklist to eliminate unnecessary patient catheterisation (unless otherwise indicated)
   2. Elimination equipment wastage by creating of a “Green Tray” reducing instrument use from 119 to 49 items per operation
   3. Low carbon reusable switches including surgical drapes/ gowns, gallipots, kidney dishes
2. Trial of Retractor for Abdominal Insufflation-Less Surgery through cadaveric demonstration which would expand global surgical access.

Outcome:

Clinical

• No implications for clinical outcomes noted (from surgeon view and ability to perform operation).

Social

• Increased access to laparoscopic surgery from RAIS in low-resource settings
• Potential reduction in supply chain labour abuses with move away from single-use surgical equipment
• Surgical colleagues and Trust representatives expressed motivation to implement green equipment rosters in their specialties

Environmental

• An estimated 417kgCO2e reduction was achieved, mostly attributable to avoided insufflator gas use. Scaled up to potential annual savings of 108.9 tonnesCO2e/year

Economic

• With 80% applicability, green equipment trays could reduce sterilisation costs by £9,567 for this single operation.
• RAIS slightly increases sterilisation requirements, however this is offset substantially by reduced procurement cost. The cost of the device is recuperated after fewer than 10 uses.

Key learning point

Innovations such as the RAIS device can enhance sustainable approaches in the global surgical community; highlighting the potential to transfer resource-efficient processes into major financial and environmental savings.