Urologie最新文献

As part of the improvement of perioperative standards the preoperative period before major urosurgical procedures is becoming increasingly more important. The concept of prehabilitation aims to raise the physical and mental capacities of patients to a higher level before the surgery in order to minimize postoperative decline. The intervention options include physical training, nutritional counselling, psychological support, patient education, optimization of sleep hygiene and the improvement of other preoperative parameters, such as existing anemia. It is important to recognize the existing deficits in each individual patient and to create a prehabilitation concept tailored to the patient. The concepts must also be cost-efficient and capable of being integrated into everyday clinical practice.

Operating rooms are among the most resource-intensive areas of hospitals and generate significant amounts of waste and carbon emissions. Single-use surgical textiles contribute significantly to the ecological footprint of surgical procedures. As a surgical discipline, urology makes a significant contribution to the volume of surgical procedures. The goal of this study was to quantify the contribution of surgical textiles to overall resource consumption and to analyze the extent to which ecological and economic savings can be achieved through standardized use. The study used data on surgeries and consumption of surgical textiles from 25 hospitals (in four tier levels) that belong to a privately owned hospital chain operating throughout Germany. Actual consumption of surgical textiles in 2022 was compared against a target scenario based on predefined surgical standards. For each surgical standard, carbon emissions were calculated using a life cycle assessment and was then allocated to the respective surgeries. In 2022, 213,048 surgeries were performed in the 25 hospitals. A total of 352.7 tons of single-use surgical textiles were used, which corresponds to 1997 tons of CO₂ equivalents. Raw materials accounted for the largest share of emissions, while local transport made only a minor contribution. Consistent standardization could reduce CO₂ emissions by up to 8%. Particularly high savings potential was identified in orthopedic (up to 23.4%) and cardiology (up to 20.6%) clinics. The results show that a fraction of the resource consumption in the operating room is avoidable. Standardized use of single-use surgical textiles might offer both ecological and economic advantages.

Background: Single-use endoscopes have become widely established in urology. They are advocated due to the rapid integration of technological advances, the possibility of bypassing reprocessing requirements, and their potential to address gaps in availability. At the same time, their ecological impact in the context of sustainability is receiving increasing attention.

Objective: This article critically compares the advantages and disadvantages of single-use endoscopes versus reusable systems, with a particular focus on sustainability and resource consumption.

Materials and methods: Discussion of fundamental studies and expert recommendations, supplemented by comparisons with data from nonmedical sources on energy and material use as well as waste management.

Results: Production, packaging, and distribution of single-use endoscopes require considerable resources, since not only plastic elements but also electronic components, image sensors, and sterilization processes are involved. In contrast, reusable systems entail significantly higher consumption of water and chemicals during reprocessing. Evidence from other industries highlights the importance of closed-loop systems and recycling strategies, which are still scarcely implemented for single-use endoscopes.

Conclusion: Current data suggest that single-use endoscopes may have a worse impact on the environment compared to reusable endoscopes. However, current data do not yet allow for definitive conclusions. Further analyses are required to comprehensively assess resource and energy demands. Introduction of recycling strategies and reuse of particularly resource-intensive components represent promising approaches towards a more sustainable application of single-use endoscopes.

Background and objective of the study: Hospitals, especially surgical departments, are among the largest producers of waste in Germany. Data on waste management in the operating room (OR) are largely lacking. The aim of this study was to assess and discuss the possibilities of reducing waste and recovering recyclable materials in general surgery against the background of current practice.

Methodology: Surgical departments throughout Germany were surveyed on waste management. First, the theoretical waste separation possibilities for laparoscopic appendectomy were determined. Subsequently, a simple system for the separation of recyclables was established and practically tested in 35 operations. These were compared with 35 appendectomies without separation.

Results: Only 25.7% of hospitals perform waste separation. Theoretically, 20.7% of waste can be recycled, in practice up to 18.9%. Paper, cardboard and plastics, especially polyethylene terephthalate (PET) and high-density polyethylene (HDPE) were separated. This leads to a significant reduction in residual waste without extending the operation time.

Discussion: Separation of recyclables can contribute to more sustainable waste management in the OR. High-value recyclables can be recycled and the residual waste mass can be significantly reduced. This is possible without special effort and does not delay the processes in the OR. The opportunities for this have hardly been used in Germany to date.