SDU researchers help dermatologist develop a greener skin biopsy
Dermatologist Kristine Pallesen was puzzled that steel scissors and forceps were discarded after a single skin biopsy. Together with researchers from SDU, she has developed prototypes and analysed the carbon footprint and material choices for this greener skin biopsy, a reusable instrument that combines several functions.
When Kristine Pallesen worked as a consultant at the Department of Dermatology at Aarhus University Hospital, she was puzzled by the sight of steel forceps and surgical scissors being thrown into waste containers after a single skin biopsy.
The instruments were fully functional. Even so, discarding them was more economical than putting them through the hospital’s cleaning and sterilisation system.
- I found it both strange and a waste of resources. In the past, instruments were cleaned and sterilised locally. When the process was centralised and labour became more expensive, steel instruments began to be discarded after a single procedure, says Kristine Pallesen.
When she later opened her own dermatology clinic in Haderslev, the challenge became even clearer. Biopsy punches had to be ordered and purchased before being discarded as clinical waste, while scissors and forceps had to be cleaned and sterilised after use.
This prompted her to ask a simple question: Could the different functions be combined in one durable instrument that could be used repeatedly?
The answer was a sustainable skin biopsy.
In a conventional procedure, the doctor first cuts into the skin with a circular biopsy punch. The tissue is then lifted with forceps and separated using surgical scissors.
This new sustainable skin biopsy combines all three functions in one instrument. It can collect tissue samples ranging from three to eight millimetres, and every component is designed to be cleaned, autoclaved and reused.
- The aim was to develop an instrument that fits naturally into everyday clinical practice. It simplifies the procedure for the doctor, reduces the need for several separate instruments and lowers both resource consumption and environmental impact, says Kristine Pallesen.
The instrument is also designed to address a practical challenge familiar to many dermatologists. When the tissue sample is lifted with forceps, it can be compressed. This may affect the quality of the sample when it is subsequently examined by a pathologist. It can also be difficult to position surgical scissors beneath the biopsy and separate the tissue cleanly.
The new sustainable skin biopsy uses a small integrated cutting mechanism to release the sample.
- For the patient, the aim is a smoother procedure that produces a high-quality tissue sample. For the doctor, the workflow becomes simpler and more functional, says Kristine Pallesen.
The researchers specialize in life cycle assessments, also known as LCAs. The method is used to calculate a product’s environmental impact throughout its lifetime, from raw materials and manufacturing to use, cleaning and disposal.
- You can expect a product to be sustainable, but I wanted to know whether the calculations actually supported that expectation. The healthcare sector needs solutions built on a solid scientific foundation, says Kristine Pallesen.
Together with postdoctoral researcher Styrmir Gislason and the rest of the research group, she has worked on material selection, functionality, design and environmental impact. The prototypes were manufactured in the workshops at SDU’s Faculty of Engineering and continuously refined based on testing and feedback from doctors.
- Environmental impact was considered while the instrument was still being developed. This enabled us to compare different materials and design solutions and actively use the results throughout the development process, says Styrmir Gislason.
She carried out ten sampling procedures with each of five biopsy punches. Between every procedure, the instruments were cleaned, autoclaved and packaged in the same way as reusable clinical instruments.
During the experiments, she measured the force required to cut each sample. The results gave the team insight into the durability of the cutting mechanism and informed the further development of this new sustainable biopsy.
The research group also assessed which materials were suitable for repeated cleaning and sterilisation. The fully developed prototype is made entirely from steel and aluminium. The instrument can be disassembled, allowing its individual components to be cleaned, sterilised and replaced.
- The combined knowledge from the investigations led to several redesigns of the new sustainable biopsy. The materials were changed to reusable metals such as aluminium and steel, increasing the product’s durability and improving its sustainability, says Kristine Pallesen.
Preliminary results awaiting peer review indicate that the new biopsy instrument has a lower carbon footprint than conventional single-use instruments. The carbon footprint per procedure decreases as the instrument is reused, and the results suggest that, after 100 uses, the carbon footprint per procedure could be around one-tenth of that associated with a procedure based on single-use instruments.
The total environmental benefit depends on factors including the number of times the instrument can be used, how it is manufactured, and how it is cleaned and sterilised.
- Durability is crucial. The longer the instrument can remain in use, the lower its environmental impact per biopsy. We have therefore worked with a robust design and components that can be replaced when required, says Styrmir Gislason.
The new sustainable biopsy has now been fully developed as a prototype. Kristine Pallesen is seeking an industrial partner from the medical device industry to take the instrument through the necessary testing, approvals and manufacturing stages towards a launch for clinics and hospitals.
Their projects include comparisons between single-use and reusable instruments, the environmental impact of different methods of administering medicine, and emissions throughout healthcare supply chains.
In an ongoing research project, SDU has collected data from dermatology departments at five Danish hospitals. The researchers have mapped the instruments, packaging, transport, washing and sterilisation associated with skin biopsies.
- A single instrument represents a very small part of a hospital’s overall carbon footprint. However, the healthcare system performs a very large number of procedures, so small changes to each procedure can add up to a significant overall impact, says Styrmir Gislason.
The researchers see considerable potential in bringing engineers and healthcare professionals together to address specific clinical challenges.
- Doctors and nurses understand the needs that arise in daily clinical practice. We can contribute expertise in product development, material selection and environmental assessment. When these disciplines come together early, we can develop solutions that work in practice and use resources more efficiently, says Styrmir Gislason.
The initiative aims to bring clinical needs, research and companies closer together, enabling new solutions to progress from an initial idea to testing, approval and implementation in the healthcare system.
Researchers at the Department of Green Technology aim to contribute expertise in materials, resource consumption and environmental impact.
SDU and Odense University Hospital are also bringing researchers and healthcare professionals together for a workshop on sustainability in the healthcare sector. The aim is to create an overview of existing research and develop new interdisciplinary collaborations.
For Kristine Pallesen, this sustainable skin biopsy demonstrates what can emerge when a specific clinical problem meets engineering and environmental research.
- I hope the invention, the development process and the research from SDU can inspire other clinicians, researchers and companies. We need more solutions that can support a more sustainable healthcare sector, she says.
The instruments were fully functional. Even so, discarding them was more economical than putting them through the hospital’s cleaning and sterilisation system.
- I found it both strange and a waste of resources. In the past, instruments were cleaned and sterilised locally. When the process was centralised and labour became more expensive, steel instruments began to be discarded after a single procedure, says Kristine Pallesen.
When she later opened her own dermatology clinic in Haderslev, the challenge became even clearer. Biopsy punches had to be ordered and purchased before being discarded as clinical waste, while scissors and forceps had to be cleaned and sterilised after use.
This prompted her to ask a simple question: Could the different functions be combined in one durable instrument that could be used repeatedly?
The answer was a sustainable skin biopsy.
Three instruments combined in one
A skin biopsy is used when doctors suspect skin cancer or other skin diseases. The doctor removes a small cylindrical tissue sample, which is sent to a pathologist and examined under a microscope.In a conventional procedure, the doctor first cuts into the skin with a circular biopsy punch. The tissue is then lifted with forceps and separated using surgical scissors.
This new sustainable skin biopsy combines all three functions in one instrument. It can collect tissue samples ranging from three to eight millimetres, and every component is designed to be cleaned, autoclaved and reused.
- The aim was to develop an instrument that fits naturally into everyday clinical practice. It simplifies the procedure for the doctor, reduces the need for several separate instruments and lowers both resource consumption and environmental impact, says Kristine Pallesen.
The instrument is also designed to address a practical challenge familiar to many dermatologists. When the tissue sample is lifted with forceps, it can be compressed. This may affect the quality of the sample when it is subsequently examined by a pathologist. It can also be difficult to position surgical scissors beneath the biopsy and separate the tissue cleanly.
The new sustainable skin biopsy uses a small integrated cutting mechanism to release the sample.
- For the patient, the aim is a smoother procedure that produces a high-quality tissue sample. For the doctor, the workflow becomes simpler and more functional, says Kristine Pallesen.
Sustainability required scientific evidence
From the outset, Kristine Pallesen wanted scientific evidence to support the product’s environmental credentials. She therefore contacted Professor Morten Birkved and his research group at the Department of Green Technology at the University of Southern Denmark.The researchers specialize in life cycle assessments, also known as LCAs. The method is used to calculate a product’s environmental impact throughout its lifetime, from raw materials and manufacturing to use, cleaning and disposal.
- You can expect a product to be sustainable, but I wanted to know whether the calculations actually supported that expectation. The healthcare sector needs solutions built on a solid scientific foundation, says Kristine Pallesen.
Together with postdoctoral researcher Styrmir Gislason and the rest of the research group, she has worked on material selection, functionality, design and environmental impact. The prototypes were manufactured in the workshops at SDU’s Faculty of Engineering and continuously refined based on testing and feedback from doctors.
- Environmental impact was considered while the instrument was still being developed. This enabled us to compare different materials and design solutions and actively use the results throughout the development process, says Styrmir Gislason.
Cutting performance tested through repeated use
As part of the development process, Kristine Pallesen conducted a series of experiments using conventional biopsy punches. The primary aim was to investigate whether the steel blade retained its sharpness through repeated use and sterilisation.She carried out ten sampling procedures with each of five biopsy punches. Between every procedure, the instruments were cleaned, autoclaved and packaged in the same way as reusable clinical instruments.
During the experiments, she measured the force required to cut each sample. The results gave the team insight into the durability of the cutting mechanism and informed the further development of this new sustainable biopsy.
The research group also assessed which materials were suitable for repeated cleaning and sterilisation. The fully developed prototype is made entirely from steel and aluminium. The instrument can be disassembled, allowing its individual components to be cleaned, sterilised and replaced.
- The combined knowledge from the investigations led to several redesigns of the new sustainable biopsy. The materials were changed to reusable metals such as aluminium and steel, increasing the product’s durability and improving its sustainability, says Kristine Pallesen.
Repeated use reduces the carbon footprint
SDU researchers have conducted a preliminary life cycle assessment of the new sustainable biopsy. The calculation covers materials, manufacturing, sterilisation and disposal.Preliminary results awaiting peer review indicate that the new biopsy instrument has a lower carbon footprint than conventional single-use instruments. The carbon footprint per procedure decreases as the instrument is reused, and the results suggest that, after 100 uses, the carbon footprint per procedure could be around one-tenth of that associated with a procedure based on single-use instruments.
The total environmental benefit depends on factors including the number of times the instrument can be used, how it is manufactured, and how it is cleaned and sterilised.
- Durability is crucial. The longer the instrument can remain in use, the lower its environmental impact per biopsy. We have therefore worked with a robust design and components that can be replaced when required, says Styrmir Gislason.
The new sustainable biopsy has now been fully developed as a prototype. Kristine Pallesen is seeking an industrial partner from the medical device industry to take the instrument through the necessary testing, approvals and manufacturing stages towards a launch for clinics and hospitals.
A growing research field at SDU
The work on this sustainable punch biopsy forms part of a broader research field at the Department of Green Technology. Several researchers and PhD students are currently investigating how the healthcare sector can reduce its environmental impact.Their projects include comparisons between single-use and reusable instruments, the environmental impact of different methods of administering medicine, and emissions throughout healthcare supply chains.
In an ongoing research project, SDU has collected data from dermatology departments at five Danish hospitals. The researchers have mapped the instruments, packaging, transport, washing and sterilisation associated with skin biopsies.
- A single instrument represents a very small part of a hospital’s overall carbon footprint. However, the healthcare system performs a very large number of procedures, so small changes to each procedure can add up to a significant overall impact, says Styrmir Gislason.
The researchers see considerable potential in bringing engineers and healthcare professionals together to address specific clinical challenges.
- Doctors and nurses understand the needs that arise in daily clinical practice. We can contribute expertise in product development, material selection and environmental assessment. When these disciplines come together early, we can develop solutions that work in practice and use resources more efficiently, says Styrmir Gislason.
Aligned with MedTech Odense
The collaboration behind this sustainable skin biopsy closely reflects the ambitions of MedTech Odense, where SDU, the Region of Southern Denmark, Odense University Hospital, the region’s other hospitals and Odense Municipality work together to develop the healthcare technologies of the future.The initiative aims to bring clinical needs, research and companies closer together, enabling new solutions to progress from an initial idea to testing, approval and implementation in the healthcare system.
Researchers at the Department of Green Technology aim to contribute expertise in materials, resource consumption and environmental impact.
SDU and Odense University Hospital are also bringing researchers and healthcare professionals together for a workshop on sustainability in the healthcare sector. The aim is to create an overview of existing research and develop new interdisciplinary collaborations.
For Kristine Pallesen, this sustainable skin biopsy demonstrates what can emerge when a specific clinical problem meets engineering and environmental research.
- I hope the invention, the development process and the research from SDU can inspire other clinicians, researchers and companies. We need more solutions that can support a more sustainable healthcare sector, she says.