MTP4.04 Decarbonisation of Surgery - Making the laparoscopic cholecystectomy tray smaller, undertaken as prospective audit leading to quality improvement by reducing unjustified energy wastage and reducing cost

Abstract Aim To cut down the size of the upper GI general tray (UGIGT) used in laparoscopic cholecystectomy containing around 63 instruments to a much lesser by removing the ones that are never used in LC but sterilized and packed every time the tray is prepared. The intended effect of the project is to prevent wastage of water, carbon emissions, cost by avoiding sterilisation of instruments that are never used but packed and sterilised each time. Method Our sample size was 100 LC, in which we included 90 elective and 10 emergency cases. We recorded the type and the number of each instrument that were used from the UGIGT with the help of scrub nurses in each surgery. A survey was also done to make sure all the surgeons were happy with with the contents of the new tray. Results We found that out of 63 instruments on the tray we used maximum of 19 instruments and minimum of 7 in those 100 LC that we audited. Most of the instruments that were used were common, however, there were some rare occasions when few other instruments were used from the tray. Around 5000 liters of water and carbon emissions of 220kgs were unjustified waste in 100 surgeries in around the period of 5 months. Conclusion Created a new smaller tray called 'Lap general tray' (60% lesser instruments), to be used for LC and can also be used of appendicectomy and laparoscopic inguinal hernias as the principle remains the same.