Reusable Laryngoscopes Pose an Environmental Benefit Over Single-Use Disposable Counterparts

Clinical Question

How do reusable flexible laryngoscopes (R-Ls) compare to single-use disposable laryngoscopes (SUD-Ls) in terms of environmental impacts?

Bottom Line

When used at a high frequency, R-Ls pose an environmental benefit over SUD-Ls, although SUD-Ls have significant advantages in various situations.

Background: The introduction of miniature electronic image sensors has allowed for the mass production of single-use, disposable flexible laryngoscopes. Benefits of SUD-Ls include remedying of supply-demand mismatch, saving time and money. However, the increasing prevalence of single-use devices has raised concerns surrounding their carbon footprint and environmental health impacts.

Study design: Comparative study

Setting: Caruso Department of Otolaryngology–Head and Neck Surgery, University of Southern California, Los Angeles

Synopsis: Researchers used life cycle assessments (LCAs) to quantify the carbon emissions and associated environmental health impacts of R-Ls versus SUD-Ls. Product and packaging material composition, energy and water consumption, and high-level disinfection products were tabulated from on-site observation, manufacturer data, and the Ecoinvent database. Global warming impacts were defined by greenhouse gas emissions (GHGs). Findings showed that, assuming a six-year lifespan and 218 laryngoscopies per year, SUD-Ls produce 2,619 kilograms of carbon dioxide equivalents (kg CO₂-eq) compared to R-Ls, which produce 1,816 kg CO2-eq, representing a 31% reduction. A composition analysis showed that 63% of the R-L total GHGs were due to personal protective equipment production and disposal used in reprocessing, whereas 79% of SUD-L total GHGs were attributed to scope manufacturing and production. In a break-even analysis, the reusable device was shown to produce fewer lifespan GHGs than SUD-Ls after 82 uses. Authors note that these differences are magnified when the per-scope emissions are multiplied by the projected 645,000 annual billed flexible laryngoscopies in the U.S., but add that SUD-Ls have certain advantages in areas of efficiency and certain low-resource settings. Study limitations included the exclusion of repairs, recycling, and other factors.

Citation: Kidane J, et al. A comparison of environmental impacts between reusable and disposable flexible laryngoscopes. Laryngoscope. 2025;135:1666-1673. doi:10.1002/lary.31927.

Comment: This article stood out to me because it provides the first ISO 14040-standardized LCA directly comparing the environmental impacts of SUD-Ls and R-Ls in otolaryngology. The study quantifies GHGs and other environmental outcomes, demonstrating that R-Ls, when used at high frequency, have a substantially lower carbon footprint than SUD-Ls. The analysis also identifies the main contributors to GHGs for each device type—PPE use in reprocessing for R-Ls and manufacturing for SUD-Ls—highlighting actionable targets for further sustainability improvements. This work is clinically relevant, as it informs procurement and infection control decisions by balancing environmental impact with operational needs. It also provides a nuanced perspective: While R-Ls are environmentally preferable in high-utilization settings, SUD-Ls may be justified in low-utilization, emergency, or high-sterility scenarios. The findings align with broader systematic reviews and LCAs in the medical literature, which consistently show that reusable devices generally have a lower environmental impact than single-use alternatives when used appropriately and reprocessed efficiently. Sarah Rapoport, MD