Streamlining surgical trays for video-assisted thoracoscopic surgery (VATS) wedge resections of the lung to improve sustainability

Project completed as part of the Calgary Zone, Alberta Health Services Green Team Competition, 2025.

Team members

• Andrew Graham (Thoracic Surgeon) 
• Rajajee Selvam (Thoracic Surgery Fellow)
• Megan Muir (OR Nurse Clinician) 
• Hector Gomez (MDRD Manager) 
• Jennifer Bolt (Analyst)
• Francisco Aguirre (QI Consultant) 
• Crispin Russell (Thoracic Surgeon) 

Setting: Video-assisted thoracoscopic surgery (VATS) lung wedge resection procedures

Issue:

The service performs a high volume of VATS lung wedge resections, but these were conducted with the same full surgical tray used for complex procedures like lobectomies. As a result, many instruments went unused, leading to unnecessary reprocessing and waste. Each full tray contributes an estimated 2–4 kg CO₂e through sterilization and reprocessing (Polden et al., 2021), highlighting a clear opportunity for improvement.

Intervention:

Aim: Implement and evaluate a streamlined surgical tray for VATS lung wedge resections without compromising patient care.

The team conducted a one-month audit of 17 cases where OR nurses documented instrument usage. A staff survey identified perceptions and barriers, and findings were reviewed in a multidisciplinary focus group, which refined a streamlined tray design. Supported by operational leaders, the new tray was tested from March to May 2025 using a Plan-Do-Study-Act (PDSA) cycle.

Outcomes:

Clinical:

• Pre-intervention (103 patients): median length of stay 1.41 days.
• Post-intervention (41 patients): median length of stay 1.21 days.
• No empyema cases occurred in either group.
• Patient outcomes remained stable, with efficiency gains noted: setup time decreased, allowing potential for higher case throughput.

Environmental:

• Consumables reduced from 24 to 8 per case.
• MDRD sets processed reduced from 3 to 1.
• Annual savings estimated at 946 kg CO₂e (equivalent to driving 3,641 km in an average car).
• Breakdown of savings: 36% consumables, 25% detergent, 20% natural gas, 17% electricity, 2% water.

Financial:

• $35,099 CAD annual savings at Foothills Medical Centre, primarily from reduced MDRD labour and OR setup/cleanup time.

Social:

• Pre-intervention: all surgeons underestimated instrument use; nurses had more accurate perceptions, strengthening the case for change.
• Post-intervention:
  
  • 60% reported improved learning opportunities for rotating/non-specialized staff.
  • 70% noted greater procedural efficiency (faster setup, easier counts, less clutter).
  • OR setup/cleanup reduced by 27 minutes (~16% of procedure time).
  • 90% agreed that reducing healthcare’s environmental impact is important.

Key Learning

Success was enabled by a multidisciplinary, collaborative approach involving surgeons, nursing staff, MDRD, and the QI team, alongside mentorship from the AHS SusQI lead and input from the NHS Centre for Sustainable Healthcare. Strong staff commitment to sustainability - combined with alignment of environmental, social, and operational benefits - proved central to engagement and long-term adoption.