Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Watt-level 10-gigahertz solid-state laser enabled by self-defocusing nonlinearities in an aperiodically poled crystal

Femtosecond modelocked lasers with multi-gigahertz pulse repetition rates are attractive sources for all applications that require individually resolvable frequency comb lines or high sampling rates. However, the modelocked laser architectures demonstrated so far have several issues, including the need for single-mode pump lasers, limited output power, Q-switching instabilities and challenging cavity geometries. Here, we introduce a technique that solves these issues. In a two-dimensionally patterned quasi-phase-matching (QPM) device, we create a large, low-loss self-defocusing nonlinearity, which simultaneously provides SESAM-assisted soliton modelocking in the normal dispersion regime and suppresses Q-switching induced damage. We demonstrate femtosecond passive modelocking at 10-GHz pulse repetition rates from a simple straight laser cavity, directly pumped by a low-cost highly spatially multimode pump diode. The 10.6-GHz Yb:CaGdAlO4 (Yb:CALGO) laser delivers 166-fs pulses at 1.2 W of average output power. This enables a new class of femtosecond modelocked diode-pumped solid-state lasers with repetition rates at 10 GHz and beyond.ISSN:2041-172