Single-Use Endoscopes: A Greener Solution?
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This article illustrates why developers of single-use endoscopes should consider sustainability concerns. It also presents counter-intuitive potential benefits for this sector and outlines Cambridge Design Partnership’s recommended framework for designing a greener solution.
Bronchoscopy, duodenoscopy and arthroscopy are just a few of the procedures being served by a growing device market segment: single-use endoscopes. Development in this space is active, with companies such as IQ Endoscopes and Pristine Surgical seeking to join market leaders like Boston Scientific, Olympus, and Ambu. With the size of its addressable markets and technical opportunities, I can see why this medical visualization segment is expected to grow significantly, with projected sales reaching $710 million in 2024 and potentially soaring to $3 billion by 2033.1
Clinical and Care Provider Benefits
There are multiple clinical and stakeholder benefits of single-use endoscopes, with the primary one being reducing infection risks. For example, reusable bronchoscopes are particularly hard to disinfect due to their long, narrow channels, which have historically led to notable rates of infection and hospital readmission2. For duodenoscopy, infection from ineffective decontamination of reusable scopes is so concerning for the FDA that they issued a communication to support the transition to fully or partially single-use versions.3
Removing the need for disinfection can also deliver benefits to healthcare providers. It will simplify device handling workflows by reducing user steps, eliminating maintenance, and requiring fewer personnel, capital equipment, facility space, quality processes, and training typically needed for disinfection.
As a result of these eliminations, the transition to single-use endoscopes is also expected to reduce total costs for certain procedures, as highlighted by some manufacturers. This shift could also improve provision for smaller population centres and future care pathways, such as the increased adoption of diagnostic clinics and ambulatory surgical centres.
“The transition to single-use endoscopes is also expected to reduce total costs for certain procedures, as highlighted by some manufacturers.”
Addressing Sustainability Concerns
While the benefits of single-use scopes appear clear, there are concerns about sustainability. The increased material usage and disposal of electronic components after a single use may seem to contradict sustainability goals, such as UK’s National Health Service 2045 net zero target for indirect emissions.
Can we reconcile the use of single-use disposable endoscopes with sustainability?
This question can be tackled from two angles:
The Strategy Angle
Given the contamination risks associated with reusable endoscopes, it’s understandable to question the emphasis on sustainability. Would you subject a loved one to a procedure with high risks of hospitalization and death, just to be environmentally friendly?4 Considering this, some might think that sustainability can be sidelined.
However, this approach doesn’t address the concerns of medical equipment buyers and other stakeholders – with evolving environmental policies and competition from the “greenest” manufacturers, ignoring sustainability could be costly. Moreover, our experience shows that designing for sustainability can bring commercial advantages, such as lower manufacturing costs and more streamlined supply chains.
Therefore, innovators of single-use endoscope should not become complacent about sustainability. Embracing design for sustainability is crucial to stay ahead of future policy and competitive forces.
The Measured Greener Angle
Endoscope innovators looking to incorporate sustainability thinking for their solution may wonder if single-use endoscopes can ever be greener than reusable versions. Surprisingly, the answer is “yes”, in some cases, single-use endoscopes might be better for the environment.
This seems to contradict the traditional “Reduce, Reuse, Recycle” principle. However, you cannot solely rely on the 3 R’s and have a narrow perspective. To accurately measure environmental impact, a comprehensive and systematic approach is necessary. Life Cycle Assessment (LCA) is a valuable methodology for this purpose.
“Ignoring sustainability could be costly due to evolving environmental policies and competition from the ‘greenest’ manufacturers.”
Life Cycle Assessment
Life Cycle Assessment (LCA) involves assessing the environmental impacts associated with all stages of a product’s life cycle, including material usage, energy consumption, transportation and other metrics from production to end of use. By using specialized databases, LCA estimates environmental factors such as carbon footprint, water usage, resource use, and toxicity levels.
With this method, it is possible to conduct an impact analysis of a new product in comparison to an existing one to determine if the new proposition is more sustainable.
While we understand the limitations of LCA calculations, such as the accuracy of inventory data, challenges in addressing unknowns, complex transportation and establishing boundaries, it remains an appropriately credible approach with guidance available in the ISO 14044 standard.
Consider the comparison between single-use endoscopes and reusable ones in terms of sustainability factors, as outlined in Table 1.
| Positive Sustainability Factors of Single-Use Scopes | Negative Sustainability Factors of Single-Use Scopes |
|---|---|
| Reduced material due to lack of need to withstand multiple uses and decontamination steps | Increased production of scopes and packaging |
| Decreased energy, water, and material usage as well as reduced need for personal protection equipment, due to elimination of decontamination cycle for each scope use | Higher transportation requirements for the increased number of scopes |
| Elimination of impacts for maintenance effort | Increased scope disposal |
| Reduced hospital re-admission due to reduced infection risks |
The information in the table above might suggest that a reusable scope could be greener. However, conducting an LCA would be needed and can often yield surprising results.
Case Studies
An analysis published in the American Journal of Environmental Protection illustrated that the material and usage impact of decontamination of reusable scopes is so significant that Ambu’s single-use scope, the aScope 4 Cysto, has a lower carbon footprint when LCA-calculated.5
In another analysis where the effects of hospital re-admission were considered, Boston Scientific claims a 65% greenhouse gas reduction with their SpyGlass™ DS Cholangioscope, which incorporates a single-use disposable scope as part of the solution.6
While these examples show the potential for greener practices, it’s important to acknowledge that achieving sustainability may be challenging in other scenarios. Nevertheless, the key point is about environmental impact reduction, which is crucial for safeguarding the future market and conveying a compelling message to stakeholders.
https://www.ambu.co.uk/endoscopy/urology/cystoscopes/product/ambu-ascope-4-cysto
“The American Journal of Environmental Protection illustrated that Ambu’s single-use scope, the aScope 4 Cysto, has a lower carbon footprint when LCA-calculated.”
How to Make a Single-Use Scope Greener
For the successful sustainability-driven evolution of an existing single-use endoscope or the development of a new one, it is essential to have a structured process that provides essential market-related insights to the development team. This process should encourage creative exploration and enable credible evaluation of sustainability decisions, while ensuring clinical and commercial objectives are met.
Cambridge Design Partnership’s Approach
With our extensive experience in developing more sustainable products, including medical devices, the following outlines our approach, specifically related to this segment.
Prepare
Research & Define: Understand the environmental impacts that are important to your customers, such as carbon footprint, total waste, toxicity, or a combination of these factors.
Establish: Identify which endoscope and use cases you would like to be greener than.
Target: Define the extent to which you aim to improve environmental performance for each metric.
Equip: Gain an understanding of all design techniques for sustainability, going behind the conventional “reduce, reuse, recycle” approach.
Create
Imagine: Explore various design architectures for partially or fully disposable scopes and evaluate the inclusion of non-essential features in the design.
Explore: Identify potential waste management partners to find single-use scope recycling solutions.
Calculate: Conduct rough LCAs during the design phase using user-friendly tools to guide decision making.
Deliver
Test: Gather user feedback in real-world settings to validate the proposed design.
Check: Ensure that the design meets or surpasses performance, usability, cost, and stakeholder requirements to create the right product.
Sharpen: Once closer to finalizing a design, perform a more detailed LCA using ISO 14044 guidance and iterate as needed to achieve targets.
Conclusion
Single-use endoscopes is an exciting and growing domain with opportunities for developing new products to target new indications, offer cost reductions for care providers, improve hospital workflows and, critically, achieve better clinical outcomes by mitigating infection risks.
While pursuing these goals, innovators should not overlook the potential to create more sustainable solutions, which can yield environmental benefits, deliver commercial opportunities, and ensure market protection.
Addressing sustainability requires a departure from the conventional “reduce, reuse, recycle” mindset and a shift toward an informed, creative, and data-driven approach to developing sustainable offerings.
Connect with CDP
At Cambridge Design Partnership, our proven track record in enhancing the sustainability of medical devices can help you meet both regulatory and market demands.
If you have any questions about the content of this article, please get in touch with Sergio Malorni, Surgical Segment Lead at Cambridge Design Partnership: sergio.malorni@cambridge-design.com.
References
- https://www.precedenceresearch.com/disposable-endoscopes-market
- 5709_bsc_sustainability_storybook_aw_final
- https://www.fda.gov/medical-devices/safety-communications/use-duodenoscopes-innovative-designs-enhance-safety-fda-safety-communication
- https://ambu.co.uk/Files/Files/Downloads/Ambu%20UK/COVID-19/aScope-4-Broncho-Is-Clean-Really-Clean-brochure.pdf
- https://d1jhm577bx9zey.cloudfront.net/Files/Images/ambu/Visualisation/In_Focus/Environmental_impact/Comparative%20study%20on%20Envoronmental%20impacts%20of%20reusable%20and%20Single-USe%20bronschopes.pdf
- https://www.bostonscientific.com/en-EU/medical-specialties/gastroenterology/hpb-portfolio/expanding-partnership/sustainability.html
Sergio Malorni
Surgical Segment Lead