Advancing Sustainability in Robotic Surgery: A Robust Comparative and Eco-Design Life Cycle Assessment of the Innovative Reusable SATA Instrument Technology

Abstract

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.