Design: A modified MFA was performed for TLH in April and May of 2023, in which analysis of operating room protocols, staff interviews, desk research, and observation of surgical cases were combined to generate a comprehensive map of materials entering and leaving the operating suite.

Setting: Operating suite of a large academic medical center

Patients or Participants: 5 surgical TLH cases were observed and 5 operating room staff members were interviewed.

Interventions: A modified MFA was conducted for TLH.

Measurements and Main Results: An average total mass of 48.8 kg of materials per patient entered and left the operating suite for each TLH, including 21.4 kg (43.9%) of reusable surgical instruments, 3.1 kg (6.4%) of washable linens, and 24.3 kg (49.8%) of single-use disposable items. The quantity by mass of packaging materials was 1.8 kg (3.7%). To complete a single TLH, a total of 460 individual items are opened, however many are never used, resulting in unnecessary waste generation. Of the 121 reusable surgical instruments that were opened, an average of only 28 (23.1%) were actually used during surgery. Of the 330 opened single-use items, an average of 36 (10.9%) were discarded unused. Target areas identified for optimization included refusal of single-use items and tools, consideration of single-field sterile technique for reduction in item redundancies and waste, and consideration of reusable clothing and draping items.

Conclusion: TLH contributes to climate impact largely by creating demand for single-use items and through immoderation in operation set-up. Re-design of operating room protocols and procurement priorities is essential in achieving environmental sustainability in surgery.