Hospitals operate at the intersection of safety, efficiency and sustainability, with device selection often reflecting these competing priorities. Surgical devices and scopes, essential for a range of diagnostic and therapeutic procedures, can be purchased as single-use or reused and reprocessed. Each option carries distinct implications for infection control, financial management and environmental responsibility. Single-use devices are designed to minimise risks of contamination, yet they also generate substantial waste and higher long-term expenditure. Reusable and reprocessed devices can reduce costs and environmental impact but demand rigorous cleaning and disinfection processes to ensure patient safety. The available evidence is mixed and often limited, making hospital decision-making particularly complex.
Clinical Outcomes Across Device Types
Clinical performance varies across devices, with evidence often fragmented or inconclusive. For laryngoscopes used in intubation, single-use models performed better in terms of reducing failed intubations. Some studies suggested fewer complications, though the data were insufficient to attribute outcomes solely to device type. Bronchoscopes also showed advantages for disposables, particularly in eliminating cross-contamination risk, though findings were drawn from studies with methodological weaknesses. For cystoscopes, clinical outcomes were similar between disposable and reusable models, with no significant difference in complication rates or operative times. Ureteroscopes demonstrated the most variation: some analyses reported higher stone-free rates and lower infection rates with single-use devices, while others found no statistical difference. Laparoscopic devices, including scissors, trocars and staplers, presented mixed results. Some evidence suggested reusable trocars may reduce complications, whereas disposable staplers appeared to provide greater safety in certain procedures. These differences highlight the absence of a consistent clinical advantage across categories, reinforcing that patient outcomes cannot yet be reliably linked to the choice between disposable or reusable devices.
Economic Considerations for Hospitals
Cost evaluations provide stronger distinctions, though results remain context-specific. Laryngoscopes demonstrate clear financial advantages for reuse, with multiple studies showing lower costs per procedure. Even when reprocessing and disinfection expenses are included, reusables proved more economical, particularly when used frequently. Flexible nasopharyngolaryngoscopes, however, presented mixed outcomes, with results heavily influenced by repair costs. Studies conducted in both the United States and the United Kingdom showed that frequent breakdowns and high repair charges could make single-use alternatives appear more cost-effective, though this was not universally observed. For bronchoscopes, overall procedure costs were similar between models, yet when infection-related costs were considered, single-use devices became more economically favourable. In the case of cystoscopes, no clear cost data were reported, leaving hospitals without guidance in this area. Ureteroscope studies mostly concluded that reusables were less costly, though the balance could shift when devices were prone to frequent breakage, especially in complex cases involving larger stones. Laparoscopic devices demonstrated the strongest financial case for reuse, with large-scale analyses showing considerable per-procedure savings. In some cases, reusable laparoscopic cannulas cost only a fraction of their disposable equivalents. Despite these findings, the economic balance depends heavily on hospital-specific factors, including supplier contracts, reprocessing infrastructure, procedure volumes and local labour costs.
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Environmental Impact and Sustainability
The environmental dimension is increasingly shaping device selection. Laryngoscopes and laparoscopic devices consistently showed lower greenhouse gas emissions and reduced waste when reused. Life cycle analyses demonstrated that single-use blades and handles generated significantly more emissions, with reprocessing offering clear sustainability benefits even after accounting for disinfection chemicals and sterilisation processes. Bronchoscopes presented a more complex picture, as reprocessing requires disposable equipment, water, energy and chemicals, while disposables create waste after every use. Some studies suggested single-use bronchoscopes may result in lower overall impact, though findings varied depending on assumptions about cleaning methods and device lifespan. For cystoscopes, conclusions were inconsistent. Several studies reported reusable models had a smaller carbon footprint and produced less waste, while others, sometimes funded by manufacturers of disposables, found the opposite. Ureteroscopes showed little difference between single-use and reusable models in terms of emissions, with results largely dependent on how many times reusables were used before disposal. For laparoscopic devices, studies found that single-use instruments produced considerably higher emissions than hybrid or reusable models, reinforcing the environmental advantage of reuse. Overall, while methods and assumptions varied, the evidence consistently indicated that widespread reliance on disposable devices increases healthcare’s carbon footprint and plastic waste burden.
The choice between single-use and reusable surgical devices remains one of balance rather than clear superiority. Clinical outcomes suggest modest advantages for disposables in certain areas, such as laryngoscopes and bronchoscopes, but offer little distinction for cystoscopes, ureteroscopes and laparoscopic tools. Economic evidence favours reusables in most cases, particularly for laryngoscopes and laparoscopic devices, though variability in repair and breakage rates complicates the picture for flexible scopes and ureteroscopes. Environmental analyses strongly support reuse, especially for high-use devices, even as debates continue around bronchoscopes and cystoscopes. In the absence of definitive evidence, hospitals must weigh local infection risks, resource capacity and sustainability goals when making procurement decisions. Collaboration between clinical leaders, administrators and environmental specialists is essential to ensure choices align with patient safety, financial responsibility and environmental stewardship. Future research, particularly large-scale randomised trials and more transparent environmental assessments, will be crucial to providing clearer guidance. Until then, the trade-offs remain a matter of institutional priorities and strategic decision-making.
Source: ECRI
Image Credit: iStock
