A Comparison of Environmental Impacts Between Reusable and Disposable Flexible Laryngoscopes.

Abstract

Introduction: There is increasing prevalence of single-use flexible laryngoscopes in Otolaryngology. This study aims to quantify and compare the environmental outcomes of single-use disposable flexible laryngoscopes (SUD-Ls) and reusable flexible laryngoscope (R-Ls).

Methods: The ISO 14040 standardized Life Cycle Assessment (LCAs) was utilized to estimate the environmental footprint of SUD-L and R-L. Product and packaging material composition, energy and water consumption, and high-level disinfection products were tabulated from on-site observation, manufacturer data, and the Ecoinvent database. Global warming impacts were defined by greenhouse gas emissions (GHGs) quantified by kilograms of carbon dioxide equivalents (kgCO₂-eq) and analyzed using the US EPA's TRACI and SimaPro software. Monte Carlo sensitivity analyses were additionally performed.

Results: Assuming a 6-year lifespan and 218 laryngoscopies/year, the R-L saves 804 kgCO₂-eq compared to SUD-L (1816 vs 2619 kgCO₂-eq). Notably 63% of the R-L total GHGs were due to personal protective equipment (PPE) production and disposal used in reprocessing, whereas 79% of SUD-L total GHGs were attributed to scope manufacturing and production. In a break-even analysis, a R-L produces fewer lifespan GHGs than SUD-Ls after 82 uses.

Conclusion: Reusable flexible laryngoscopes pose an environmental benefit over SUD-Ls across several impact categories when used in high frequency. SUD-Ls have significant advantages in various situations: low utilization settings, in-patient/ED consults, and urgent need for sterile instrumentation. Providers should assess laryngoscope use frequency, site of use, and available resources to balance the environmental consequences. Further areas of sustainable optimization include reducing disposable PPE used in R-L reprocessing.

Level of evidence: N/A Laryngoscope, 2024.