Introduction - Surgical robotic systems are increasingly valued for their precision and benefits to patients and surgeons, yet traditional designs rely on costly, limited-use, cable-driven instruments that require frequent replacement and specialised cleaning equipment. To address these issues, the Sustainable Surgery & Translational Technology group MI & BITE developed the Advanced Laparoscopy Robotic System (AdLap-RS) with modular shaft-actuated tip articulation (SATA) instruments. Their modular design allows for disassembly, easy cleaning, and part replacement, enhancing reuse potential and lowering operational costs. With the substantial environmental impact of surgical activities, reusable SATA instruments also offer promising sustainability benefits. However, inconsistencies in life cycle assessments (LCAs) applied within the surgical field raise concerns about their reliability, complicating accurate environmental assessments of this innovative technology.
Goal - This research aims to assess the environmental impact of the reusable SATA instrument technology for robotic surgery through a robust comparative LCA while simultaneously informing sustainable design choices during the SATA instrument technology’s ongoing development.
Method - The initial phase of this research included a literature review and a survey among European Association of Endoscopic Surgery (EAES) members to identify reliability challenges in applying LCAs to surgical instruments. Insights from this phase informed a robust comparative LCA, assessing the environmental footprint of one of the reusable SATA instruments against its traditional limited-use counterpart, which also functioned as an eco-design evaluation by applying a circular eco-design approach.
Results - Findings from the first part showed a significant gap in LCA usage in surgical decision-making, largely due to limited familiarity and trust in LCA findings. The absence of a standardised, user-friendly LCA methodology tailored to the complexities of surgical instruments further complicates accurate assessments in this specialised domain. Comparative LCA results revealed that the reusable SATA instrument reduces climate change and energy impacts by over 50% compared to its limited-use counterpart. For both instruments, the use phase represented the largest contributor to environmental impact, primarily due to the energy-intensive disinfection and sterilisation cycles required before each reuse. The eco-design evaluation recommends prioritising modularity and disassembly improvements to optimise tray load capacity and reduce reprocessing impacts.
Conclusion - While this study robustly indicates the sustainability benefits of the innovative reusable SATA instrument technology for robotic surgery, capturing the full complexity of surgical instruments in LCAs remains challenging. Addressing this will require stakeholder engagement, targeted LCA training, refined LCA methodologies, and comprehensive review processes tailored to this specialised field.

The sterile packaging of instrument trays containing medical devices is a critical step in the sterilization process for various medical and industrial applications. This process involves wrapping instrument trays with nonwoven polypropylene sterilization wrap, which plays a crucial role during and after sterilization. Traditionally, the loose ends of the wrap are secured using autoclave tape. However, the presence of this tape poses a risk of recycling contamination when the wraps are disposed of for recycling. Additionally, in some cases, the autoclave tape has been found burnt at the end of sterilization due to excessive use during the packaging process. This study aims to design and develop a prototype sealing device that eliminates the need for autoclave tapes while maintaining the integrity of the sterile barrier system. During this study, two prototypes of sealing devices were developed: one utilizing ultrasonic sealing technology and the other using impulse sealing technology. The ultrasonic sealer is sourced from a cold-fusion sealer, while the impulse sealer is obtained from a plastic packaging device. Both devices are upgraded and repurposed as per the drawn-up requirement specifications and development criteria. To validate the prototypes, a product characterization test is conducted optimizing the seal time settings based on seal strength tests following ASTM F88/F88M-21. The optimum seal strength, measured using the T-peel test, is determined to be 1.21±0.05 N/mm for the impulse sealer and 0.93±0.08 N/mm for the ultrasonic sealer at the optimized seal time for a test sample width of 30 mm. This is succeeded by, a demonstration of the prototypes at Maastad CSA in Rotterdam, assessing the usability and functionality of these devices. During the demonstration sealed sterile packages were made following a standard envelope-wrapping approach. Replacing autoclave tapes with the seals at the critical points to secure the wrap. Feedback is collected from employees regarding the new method of packaging. Two sealed sterilization packages produced following the use of both prototypes are subjected to a trial run in an autoclave for sterilization testing. The seals proved to be effective in withstanding the sterilization process without compromising the package's integrity.
The results of this study contribute to sustainability efforts in the healthcare sector by offering a more efficient and environmentally friendly approach to maintaining the sterility of reusable medical devices.

Annually, around 180,000 cardiac ablation procedures are performed as a result of people experiencing cardiac arrhythmia’s. During this ablation procedure, an ablation catheter is used to scar the problematic cardiac tissue after which the arrhythmia will stop. The ablation catheter is discarded after one single use. Incineration of these ablation catheters not only means destruction of valuable product, but also additional carbon emissions and pollution. The goal of this research is to design a novel disassembly method for the Thermocool Smarttouch SF Uni-directional Catheter (TAC) to enable extraction of the most yielding parts and/or materials. By means of a Hotspot Map and a part-specific cost estimation the most yielding parts (or PoIs) of the TAC were determined to be the shell, the ring electrodes and the electronics unit. The novel disassembly method was designed with those PoIs in mind and consists of two separate entities: a disassembly prototype (designed to enable extraction of the determined PoIs) and an ultrasonic cleaning stage (to further purify the extracted PoIs). The novel disassembly method was validated and indeed proved to be extracting the PoIs in a more successful, pure, and reasonably timely way compared to a previously performed rough disassembly. Therefore, the outcome of project is successful. However, a critical note must be introduced. Sustainability-wise the outcome is promising, however, from a business standpoint this could be more difficult. Almost all extracted PoIs will be damaged to some extent, and rules say only virgin materials can be used for the development of new catheters: only the costs of the extracted raw material will be yielded. All value added during the manufacturing stage is lost. Taking into account the additional costs of disinfection, shipping, labour and further reprocessing methods, this novel disassembly method would possibly cost more than it would recover. Other opportunities like multiple uses, detachable (sub)assemblies or alternative business cases should be explored.

This paper addresses the urgent need to optimize the GreenCycl facilities energy utilization, by harnessing heat from the effluent of three thermal washing-disinfection machines into the preheating of cold clean water. Currently for every washing-disinfection cleaning program, 60 times a week, 105 liters of water with a temperature of 60 \degree Celsius is discharged in the drain. This is not in line with the goals setup by the government and the mindset of GreenCycl.

The study begins with a comprehensive analysis of the current situation, while documenting the properties and conditions. Subsequently concepts are generated with help of a morphological chart and a Harris profile is employed to select the most promising concept, this is further elaborated. Computational Fluid Dynamics (CFD) simulations are conducted to optimize the performance of the heat reclaiming system. Finally, the results of the CFD simulations are validated with experimental research.

By reintroducing 67\% of the effluent back into the heat exchange system, a continuous flow across the heat exchanger of 35 liters per minute can be established with an operation duration of 2.5 minutes per washing-disinfection machine. Resulting in the heat reclaiming system to only operate when cold clean water is flowing through the HEX. If implemented at the GreenCycl facility, this innovation could potentially save approximately 7600 kW of electrical energy and reduce Carbon Dioxide emission by 1129 kg annually.

This study not only addresses a pressing environmental concern but also offers an easy and efficient solution with significant economic and ecological benefits.

There is an incentive in society to go towards a circular economy to prevent the depletion of resources and prevent climate change. The medical industry generates a large amount of waste, much of which are disposable medical instruments and consumables, of which some are not reused. In the context of creating more circularity, an “all-in-one” process has been designed for the reprocessing of the Rüsch Polaris Fiber Optic Laryngoscope Blades made from Zamak. A system was designed where blades were reprocessed by means of melting into new raw material which was used to make new products. The blades are melted in a receptacle containing a grate with 3 mm x 3mm holes which acts as a filter. This receptacle is connected to a mold where the liquid Zamak can subsequently flow into. As the holes of the filter are too small for many of the impurities to pass through, the filter prevents most non-Zamak particles on the blades from flowing into the mold along with the liquid Zamak. Multiple ingots were casted using this setup. The amount of Zamak extracted from the blades was analyzed by weighing the Zamak before and after melting. The purity of the processed material and its mechanical properties were also evaluated. Through XRF tests, it was found that the ingots had a purity of 99.6% on average in respect to 100% pure Zamak. Using the final iteration of the melting setup, the ingots were found to have an ultimate tensile strength of 223 MPa and a yield strength of 124 MPa on average. It was also possible to recover about 93% of the Zamak from the blades. To exemplify the possibility of directly creating new products with the “all-in-one” process, a rotation knob for a laparoscopic instrument named “SATA grasper” was additionally casted. The flat surfaces on the rotation knobs were grainy, while the curved surfaces were smooth. The edges of the rotation knob were sharp with a 90oC angle. After cooling down, pattern shrink was found in different sections of the rotation knobs. The shrink was not uniform and varied between 0% - 1.2% between the different sections. To achieve the previously mentioned mechanical qualities and recovery rate of Zamak, a melting temperature of 420oC was applied and the ingot mold was designed with a riser and rounded edges. It is recommended to implement these factors in the final iteration of the melting setup when reprocessing Zamak with an all-in one process. The Zamak laryngoscope blades were found to be suitable for reprocessing with the “all-in-one” process if the recommendations are followed. More widespread implementation of “all-in-one” reprocessing can contribute to higher sustainability in the medical field.