Our world is the only planet, as far as we know, which harbors life. The number of humans on our planet has grown tremendously in recent centuries. In 1800 one billion humans occupied our earth; on 15 November 2022, this number reached 8 billion. A result of this growth, the emissions of carbon dioxide (CO2), the primary greenhouse gas emitted by human activities, drastically increased. The increased concentrations of greenhouse gases in our atmosphere foster the long-term increase of our earth’s temperatures, also referred to as global warming. While the earth’s population grew, so did our mass consumption society. After the Second World War humanity witnessed gigantic global economic development with great technological improvements. Computers, laptops, airplanes, tablets and Internet of Things connected humans all over the world. The hunger for plastics and steel grew as all products had to be manufactured in ever-increasing volumes. As the economy developed, our consumption grew apace. The healthcare sector has seen the same increase of consumption. The number of patients grew, and so did the number of single-use medical products. As products become more complex and more different materials were combined., recycling became more difficult. Thus, hospitals transformed into waste factories with ever-growing waste streams. The consumption of (disposable) medical devices takes up scarce raw materials and contributes to the growing CO2 emissions. In this book, Van Straten, Alvino and Horeman present their findings on how to create a sustainable healthcare economy by introducing different circular strategies. In 9 chapters, they present a wide variation of studies as practical cases to show what strategies and actions can be taken in order to implement sustainable strategies for a circular healthcare. This book was written in line with the courses the authors developed at TU Extension School, the open online education edX platform of Delft University of Technology/TU Delft, a leading university in science and technology, recognized for its world-class research. This book is a manual for everyone who follows the online course ‘Circular strategies for a sustainable healthcare’, but certainly also for everyone who wants to discover more about circular strategies and wants to understand the principles and practices of circular economy and urban mining. This book is suitable for students, researchers, policymakers and practitioners in the fields of healthcare sustainability, management, business and economics.@en

Safe insertion of the Veress needle during laparoscopy relies on the surgeons’ technical skills in order to stop needle insertion just in time to prevent overshooting in the underlying organs. To reduce this risk, a wide variety of Veress needle systems were developed with safety mechanisms that limit the insertion speed, insertion depth or decouple the driving force generated by the surgeon’s hand on the needle. The aim of this study is to evaluate current surgeons’ perceptions related to the use of Veress needles and to investigate the relevance of preventing overshooting of Veress needles among members of the European Association of Endoscopic Surgery (EAES). An online survey was distributed by the EAES Executive Office to all active members. The survey consisted of demographic data and 14 questions regarding the use of the Veress needle, the training conducted prior to usage, and the need for any improvement. A total of 365 members residing in 58 different countries responded the survey. Of the responding surgeons, 36% prefer the open method for patients with normal body mass index (BMI), and 22% for patients with high BMI. Of the surgeons using Veress needle, 68% indicated that the reduction of overshoot is beneficial in normal BMI patients, whereas 78% indicated that this is beneficial in high BMI patients. On average, the members using the Veress needle had used it for 1448 (SD 3031) times and felt comfortable on using it after 22,9 (SD 78,9) times. The average years of experience was 17,6 (SD 11,1) and the surgeons think that a maximum overshoot of 9.4 (SD 5.5) mm is acceptable before they can safely use the Veress needle. This survey indicates that despite the risks, Veress needles are still being used by the majority of the laparoscopic surgeons who responded. In addition, the surgeons responded that they were interested in using a Veress needle with an extra safety mechanism if it limits the risk of overshooting into the underlying structures.

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