From procurement to disposal: a framework for an activity-based cost analysis of reusable and disposable trocars in laparoscopic cholecystectomy

Abstract Background Operating rooms are responsible for a substantial share of hospital waste, with laparoscopic procedures being particularly resource-intensive due to their reliance on disposable instruments. In a laparoscopic cholecystectomy (LC), disposable products account for approximately 40% of emissions, with trocars being key contributors. Reusable trocars lower environmental impact and evidence suggests that costs can be reduced. Accordingly, this study compares the costs of reusable versus disposable trocars during LC in a Dutch academic hospital and develops an adaptable framework for cost evaluation in other healthcare settings. Methods An activity-based costing analysis was conducted to estimate the per-procedure costs (i.e. per LC), including the costs for acquisition, sterilisation, storage, and waste disposal. This was based on an LC using four trocars: two 5 mm and two 12 mm trocars. Resource use was based on expert input, and unit costs were obtained from hospital procurement data. The costing framework was designed to be adaptable to different institutional contexts. Uncertainty in the cost difference was assessed using probabilistic sensitivity analysis with 1000 Monte Carlo simulations, alongside one-way, two-way, and scenario analyses. Results Acquisition costs per LC were substantially lower for reusable trocars (€8.15) than for disposable trocars (€89.55). Although reusable trocars incurred sterilisation costs (€13.31 per procedure), total costs, including all activities involved in LC, remained lower (€683.00 vs €751.43), resulting in savings of €68.80 per procedure. Reusable trocars were cost-saving in all sensitivity analyses. Estimated annual savings were €10,264 at institutional level (based on 150 procedures) and €1.54 million nationally (based on 22,500 procedures). Conclusion Reusable trocars are cost-saving compared to disposable trocars in LC. The adaptable activity-based costing framework developed in this study enables healthcare institutions to evaluate the economic impact of reusable versus disposable surgical instruments within their own settings, supporting both cost reduction and environmental sustainability.