title: Systematic review of reusable versus disposable laparoscopic instruments: costs and safety.
abstract: BACKGROUND
  The quality of instruments and surgical expertise in minimally invasive surgery has developed markedly in the last two decades. Attention is now being turned to ways to allow surgeons to adopt more cost-effective and environmental-friendly approaches. This review explores current evidence on the cost and environmental impact of reusable versus single-use instruments. In addition, we aim to compare their quality, functionality and associated clinical outcomes.
  
  
  METHODS
  The Medline and EMBASE databases were searched for relevant literature from January 2000 to May 2015. Subject headings were Equipment Reuse/, Disposable Equipment/, Cholecystectomy/, Laparoscopic/, Laparoscopy/, Surgical Instruments/, Medical Waste Disposal/, Waste Management/, Medical Waste/, Environmental Sustainability/ and Sterilization/.
  
  
  RESULTS
  There are few objective comparative analyses between single-use versus reusable instruments. Current evidence suggests that limiting use of disposal instruments to necessity may hold both economical and environmental advantages. Theoretical advantages of single-use instruments in quality, safety, sterility, ease of use and importantly patient outcomes have rarely been examined. Cost-saving methods, environmental-friendly methods, global operative costs, hidden costs, sterilization methods and quality assurance systems vary greatly between studies making it difficult to gain an overview of the comparison between single-use and reusable instruments.
  
  
  CONCLUSIONS
  Further examination of cost comparisons between disposable and reusable instruments is necessary while externalized environmental costs, instrument function and safety are also important to consider in future studies.
authors.affiliation: Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand.
authors.forename: Joey
authors.identifier: http://orcid.org/0000-0001-6172-3497
authors.initials: J
authors.lastname: Siu
authors.affiliation: Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
authors.affiliation: Department of Surgery, South Auckland Clinical Campus, The University of Auckland, Auckland, New Zealand.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: MacCormick
mesh_terms: D003362:Cost-Benefit Analysis; D004209:Disposable Equipment / Q000191:economics*; D017743:Equipment Reuse / Q000191:economics*; D006801:Humans; D020706:Laparoscopes / Q000191:economics*; D012449:Safety
keywords: disposable equipment; environmental sustainability; equipment reuse; medical waste; surgical instrument