Editorial Comment on: Micro-Costing Analysis Demonstrates Comparable Costs for LithoVue Compared to Reusable Flexible Fiberoptic Ureteroscopes by Taguchi et al.

We are currently at a crossroads in endourology where we are slowly transitioning from reusable equipment to single use items. Ureteral stents and guidewires are items that have long been single use, but other items that were once reusable, such as baskets and laser fibers, are now becoming predominantly single use. Disposable endoscopes performance has now reached the level that they are a viable alternative to reusable endoscopes. There are numerous reasons for this including concerns regarding sterility, optimal performance of the device, and simply convenience. The benefits of having a flexible ureteroscope with perfect deflection and optimal optics for every procedure is difficult to argue against. Yet, there are costs to consider, in terms of both the purchase price of the product and the environmental impact of using such devices.

Healthcare systems generate a tremendous amount of waste. It is estimated that up to 29 pounds of medical waste is generated per staffed bed per day, which works out to nearly 6 million tons of trash per year in the United States. Approximately 14% of this waste is generated by surgery. In addition, the healthcare sector produces about 8% of the United States greenhouse gas emissions.

As we continue to use more disposable medical equipment, these numbers will rise unless some form of action is taken. In our homes we feel guilty if we do not recycle plastic bottles and tin cans, yet there is a dichotomy in the operating room where we do not think twice about dropping a single use product into the nonrecyclable trash. Surgeons, as end users of the devices, play a critical yet often unaddressed role in waste prevention. We must challenge manufacturers who benefit from our use of these devices to both help develop and assist with recycling plans and environmentally friendly waste disposable. Surgeons should also challenge hospital purchasing and administrative personnel, who often have extreme tunnel vision that focuses only on the bottom line, to consider vendors who promote environmentally friendly practices. The world has become much more ecoaware in many aspects; it is now time for healthcare to catch up.