{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T12:17:07Z","timestamp":1788178627312,"version":"build-2803163510"},"reference-count":48,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"unspecified","delay-in-days":30,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007308","name":"Arthrex GmbH","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100007308","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,11]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"\n Objective<\/jats:title>\n To evaluate greenhouse gas (GHG) emissions from procedure room NanoNeedle arthroscopy (NA) and its associated clinical pathway, compared with conventional arthroscopy (CA) delivered in an operating room, focusing on non-complex knee arthroscopy procedures.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Hybrid carbon footprint analysis using process-based life-cycle methods combined with economy-wide input-output data that include environmental impact factors for medical devices and components of patient care pathways. Three care pathways were evaluated: (1) CA in an OR with preoperative MRI, (2) NA in a procedure room with MRI and (3) NA in a procedure room without MRI. Emissions were calculated for all pathway components, including patient and staff travel, diagnostic imaging, medical devices, the procedure itself and postoperative care.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n UK National Health Service-based care pathway model for non-complex knee arthroscopy procedures.<\/jats:p>\n <\/jats:sec>\n \n Primary and secondary outcome measures<\/jats:title>\n \n The primary outcome was GHG emissions (kgCO\n 2<\/jats:sub>\n e) per procedure pathway. Additional analyses assessed emissions by pathway component, adoption scenarios, conversion rates from NA to CA and sensitivity analyses for selected assumptions and input parameters.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The CA pathway generated 77.0 kgCO\n \u2082<\/jats:sub>\n e per procedure, whereas the NA with MRI produced 45.0 kgCO\n 2<\/jats:sub>\n e and NA without MRI 35.3 kgCO\n 2<\/jats:sub>\n e, representing reductions of 42% and 54% of kgCO\n 2<\/jats:sub>\n e, respectively. Major emission contributors for CA were patient travel, consumable items and general anaesthesia; for NA pathways, patient travel and the device itself were the leading contributors. Adoption modelling indicated that using NA without MRI for 5000\u201320\u2009000\u2009knee arthroscopy procedures could yield annual CO\n 2<\/jats:sub>\n e savings ranging from 208 tons to 834 tons.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Knee arthroscopy delivered via the NA procedure room pathway has the potential to substantially reduce environmental impact compared with conventional OR-based care. As healthcare providers and policymakers increasingly consider environmental sustainability, technologies that enable alternative care models, such as NA in a procedure room setting, may represent a promising approach for reducing the carbon footprint of selected procedures.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119428","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:40:23Z","timestamp":1788176423000},"page":"e119428","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Environmental impact of NanoNeedle arthroscopy versus conventional knee arthroscopy: a hybrid carbon footprint analysis"],"prefix":"10.1136","volume":"16","author":[{"given":"Evan","family":"Argintar","sequence":"first","affiliation":[{"name":"Elite Orthopedics, Silver Spring, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3798-5793","authenticated-orcid":false,"given":"Chiara-Maria","family":"Homann","sequence":"additional","affiliation":[{"name":"Arthrex GmbH, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosie","family":"Hillson","sequence":"additional","affiliation":[{"name":"Unit 4F, Green Frog Connect, North Somerset, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6326-9651","authenticated-orcid":false,"given":"Ingeborg","family":"Steinbach","sequence":"additional","affiliation":[{"name":"Centre for Sustainable Healthcare, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher W","family":"Gee","sequence":"additional","affiliation":[{"name":"Golden Jubilee National Hospital, Clydebank, UK"},{"name":"Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Rossettie","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Burnett","sequence":"additional","affiliation":[{"name":"MedStar Georgetown University Hospital, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Wigham","sequence":"additional","affiliation":[{"name":"Unit 1, Arthrex UK, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"2026083104402501000_16.8.e119428.1","unstructured":"Brighton & Sussex Medical School, Centre for Sustainable Healthcare, UK Health Alliance on Climate Change . 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