Meissner Markus, Hafermann Juliane, Silas Ubong, Saunders Rhodri
Austrian Institute of Ecology, Vienna, Austria.
Coreva Scientific GmbH & Co. KG, Koenigswinter, Germany.
Risk Manag Healthc Policy. 2023 Aug 4;16:1423-1433. doi: 10.2147/RMHP.S415989. eCollection 2023.
Operation rooms have a large environmental impact. Single-use staplers (SUS) are widely used surgical instruments that contribute to resource consumption and waste generation, whereas multi-use staplers (MUS) can greatly reduce the environmental impact of surgery. The staple lines are often reinforced with buttressing material to prevent leaks and bleeding. We explore current clinical practice and environmental concerns regarding stapling and buttressing, as well as the environmental impact of staple line buttressing in sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Furthermore, we extend this analysis by taking packaging material and the lithium in power supplies into consideration.
A survey of bariatric surgeons was conducted to assess stapler and buttressing use in clinical practice. We deconstructed and analyzed the product and packaging composition of a commonly used SUS with separate staple line reinforcement (Echelon Flex™ with Echelon Endopath™, Ethicon) and MUS (Signia™ with Tri-Staple™ reinforced reloads, Medtronic), where the buttressing material was delivered separately or already incorporated in the reload cartridge, respectively. Both systems were compared regarding total waste generation, resource use (determined as total material requirement), and greenhouse gas emission caused by their lithium content.
60 mm cartridges were most frequently used in bariatric surgery, and 67% of surveyed surgeons applied staple line reinforcement. MUS with pre-attached buttressing resulted in a reduction of waste, material consumption, and greenhouse gas emissions compared to SUS with separate buttressing: they reduced product waste by 40% (SG and RYBG), packaging waste by 60% (SG) and 57% (RYGB), resource consumption by more than 90%, and greenhouse gas emissions related to the lithium in the batteries by 99.7%. Preloaded buttressing produced less waste than separate buttressing per stapler firing.
The environmental impact of surgery can be greatly reduced by using MUS with pre-attached buttressing rather than SUS with separate buttressing.
手术室对环境影响巨大。一次性吻合器（SUS）是广泛使用的手术器械，会造成资源消耗和废物产生，而多次使用的吻合器（MUS）可大幅降低手术对环境的影响。吻合钉线通常用支撑材料加强，以防止渗漏和出血。我们探讨了当前关于吻合和支撑的临床实践及环境问题，以及支撑材料在袖状胃切除术（SG）和 Roux-en-Y 胃旁路术（RYGB）中对吻合钉线的环境影响。此外，我们通过考虑包装材料和电源中的锂来扩展此分析。
对减重外科医生进行了一项调查，以评估吻合器和支撑材料在临床实践中的使用情况。我们解构并分析了一种常用的带单独吻合钉线加强的一次性吻合器（Ethicon 公司的 Echelon Flex™ 搭配 Echelon Endopath™）和多次使用的吻合器（美敦力公司的 Signia™ 搭配 Tri-Staple™ 加强型重新装填组件）的产品及包装成分，其中支撑材料分别是单独提供或已包含在重新装填组件中。比较了这两种系统在总废物产生、资源使用（确定为总材料需求）以及由其锂含量导致的温室气体排放方面的情况。
60 毫米的钉仓在减重手术中使用最为频繁，67% 的受访外科医生使用吻合钉线加强。与带单独支撑的一次性吻合器相比，预先附着支撑材料的多次使用吻合器减少了废物、材料消耗和温室气体排放：它们减少了 40% 的产品废物（SG 和 RYBG）、60% 的包装废物（SG）和 57% 的包装废物（RYGB）、超过 90% 的资源消耗，以及与电池中锂相关的温室气体排放的 99.7%。每次吻合器击发时，预先装填的支撑材料产生的废物比单独支撑材料少。
使用预先附着支撑材料的多次使用吻合器而非带单独支撑的一次性吻合器，可大幅降低手术对环境的影响。
