Environmental impact of single-use and reusable flexible cystoscopes

Objectives: To compare the carbon footprint and environmental impact of single-use and reusable flexible cystoscopes. Materials and Methods: We analysed the expected clinical lifecycle of single-use (Ambu aScope™ 4 Cysto) and reusable (Olympus CYF-V2) flexible cystoscopes, from manufacture to disposal. Performance data on cumulative procedures between repairs and before decommissioning were derived from a high-volume multispecialty practice. We estimated carbon expenditures per-case using published data on endoscope manufacturing, energy consumption during transportation and reprocessing, and solid waste disposal. Results: A fleet of 16 reusable cystoscopes in service for up to 135 months averaged 207 cases between repairs and 3920 cases per lifecycle. Based on a manufacturing carbon footprint of 11.49 kg CO₂/kg device for reusable flexible endoscopes and 8.54 kg CO₂/kg device for single-use endoscopes, the per-case manufacturing cost was 1.37 kg CO₂ for single-use devices and 0.0017 kg CO₂ for reusable devices. The solid mass of single-use and reusable devices was 0.16 and 0.57 kg, respectively. For reusable devices, the energy consumption of reusable device reprocessing using an automated endoscope reprocessor was 0.20 kg CO₂, and per-case costs of device repackaging and repair were 0.005 and 0.02 kg CO₂, respectively. The total estimated per-case carbon footprint of single-use and reusable devices was 2.40 and 0.53 kg CO₂, respectively, favouring reusable devices. Conclusion: In this lifecycle analysis, the environmental impact of reusable flexible cystoscopes is markedly less than single-use cystoscopes. The primary contributor to the per-case carbon cost of reusable devices is energy consumption of reprocessing.