European urology open science · 2026
Life Cycle Assessment of HoLEP: Quantifying Environmental Impact and Opportunities for Sustainable Urologic Surgery.
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Klein Clément, Humbert Véronique, Meune Mathieu, Tubiana-Dussin Françoise, Charon Stéphanie, Lamouroux Karin, Capon Grégoire, Alezra Eric, Estrade Vincent, Blanc Peggy, Margue Gaelle, Bernhard Jean-Christophe, Robert Grégoire, Bladou Franck
Аннотация
BACKGROUND: The healthcare sector faces growing pressure to reduce its environmental impact. In urology, Holmium Laser Enucleation of the Prostate (HoLEP) is a standard treatment for benign prostatic obstruction (BPO), but its procedure-related environmental impact remains unknown.
OBJECTIVE: We aimed to quantify HoLEP's life cycle environmental impacts, identify major environmental hotspots, and evaluate the impact of a fluid management system developed according to sustainable-by-design principles.
DESIGN SETTING AND PARTICIPANTS: We conducted a cradle-to-grave life cycle assessment (LCA) of 20 consecutive HoLEP procedures, following ISO 14040/44 standards and the European Product Environmental Footprint (PEF) methodology. ISO 14040/44 allowed us to structure the study while the 16 PEF indicators ensure comparability with other European medical devices. All perioperative phases (pre-, intra-, and post-operative) were included, encompassing medical devices, consumables, energy use, and waste streams.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Environmental impacts were modeled using SimaPro v9.6 with the Ecoinvent database. Primary outcomes were the PEF score and the carbon footprint (CF). Environmental performance was compared between the 10-L fluid collection canisters and the SUPER S.HO.W. fluid management system. Statistical analyses used non-parametric tests, with significance set at p < 0.05.
RESULTS AND LIMITATIONS: The median PEF score per HoLEP procedure was 5.9 points (interquartile range [IQR]: 5.7-6.1), with a CF of 106 kg CO2-eq (IQR: 102-118). The intra-operative HoLEP phase accounted for 49% of the overall environmental impact. Fluid collection canisters were the main contributors among medical devices (48%). Use of the SUPER S.HO.W. system reduced the PEF score by 21% and the CF by 13%. As a single-center study with a limited sample size, generalizability may be restricted.
CONCLUSIONS: HoLEP generates quantifiable life cycle environmental impacts. Optimizing surgical workflows and implementing innovative solutions-such as the closed-circuit SUPER S.HO.W. system-significantly reduce the environmental impact of endourological procedures.
OBJECTIVE: We aimed to quantify HoLEP's life cycle environmental impacts, identify major environmental hotspots, and evaluate the impact of a fluid management system developed according to sustainable-by-design principles.
DESIGN SETTING AND PARTICIPANTS: We conducted a cradle-to-grave life cycle assessment (LCA) of 20 consecutive HoLEP procedures, following ISO 14040/44 standards and the European Product Environmental Footprint (PEF) methodology. ISO 14040/44 allowed us to structure the study while the 16 PEF indicators ensure comparability with other European medical devices. All perioperative phases (pre-, intra-, and post-operative) were included, encompassing medical devices, consumables, energy use, and waste streams.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Environmental impacts were modeled using SimaPro v9.6 with the Ecoinvent database. Primary outcomes were the PEF score and the carbon footprint (CF). Environmental performance was compared between the 10-L fluid collection canisters and the SUPER S.HO.W. fluid management system. Statistical analyses used non-parametric tests, with significance set at p < 0.05.
RESULTS AND LIMITATIONS: The median PEF score per HoLEP procedure was 5.9 points (interquartile range [IQR]: 5.7-6.1), with a CF of 106 kg CO2-eq (IQR: 102-118). The intra-operative HoLEP phase accounted for 49% of the overall environmental impact. Fluid collection canisters were the main contributors among medical devices (48%). Use of the SUPER S.HO.W. system reduced the PEF score by 21% and the CF by 13%. As a single-center study with a limited sample size, generalizability may be restricted.
CONCLUSIONS: HoLEP generates quantifiable life cycle environmental impacts. Optimizing surgical workflows and implementing innovative solutions-such as the closed-circuit SUPER S.HO.W. system-significantly reduce the environmental impact of endourological procedures.