Built-in waste: a narrative analysis of the hidden environmental impact of battery-containing surgical devices.

Abstract

Background: Efforts to align surgical practice with environmental sustainability has highlighted the need to address overlooked sources of waste in surgical practice. Single-use surgical devices containing embedded batteries are widely used across specialties and are frequently discarded in clinical waste streams without separation or recycling. The environmental and regulatory implications of this practice remain poorly characterized.

Methods: We conducted a structured exploratory mapping of battery-containing single-use surgical devices currently in clinical use across multiple surgical specialties. Devices were identified through a combination of clinical expertise, targeted web-based searches, and review of publicly available manufacturer documentation, including instructions for use (IFU), product catalogues, and technical data sheets. For each device, battery chemistry, integration type, removability, and availability of manufacturer-provided disposal instructions were recorded based solely on publicly accessible documentation.

Results: A total of 23 battery-containing single-use surgical devices were identified across 9 technological categories. Battery chemistry was specified in publicly accessible documentation for 13 devices (alkaline, n = 7; lithium-based primary cells, n = 3; silver oxide, n = 3). Explicit manufacturer-provided disposal instructions were available for 9 devices (39%), partial guidance for 9 (39%), and no guidance was identified for 5 (22%). A marked disparity was observed between integration types: devices with user-removable batteries provided explicit disposal guidance in 88% of cases (7/8), whereas no sealed single-use device provided explicit guidance (0/11). In 3 of 23 devices, no publicly accessible regulatory documentation was retrievable. Regulatory analysis revealed a structural tension between mandatory separate battery collection under EU regulation 2023/1542 and the infectious waste exemption that permits routine incineration of contaminated surgical devices, resulting in systematic loss of recoverable battery materials.

Conclusions: Battery-containing surgical disposables represent a regulatory and environmental blind spot at the intersection of infection control and circular economy policy. Clearer reporting standards, improved device design, and stronger manufacturer accountability are required to reconcile patient safety with sustainable resource management. Professional societies, regulators, and procurement bodies should prioritize transparent battery disclosure and explicit end-of-life guidance as part of sustainability frameworks for surgical care.