DUGi

A comparative analysis of the carbon footprint in minimally invasive colorectal surgery: laparoscopic versus robotic

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Background: Given the growing concern regarding climate change - and the healthcare sector, particularly the operating theatres, being one of the largest contributors to this issue - it is relevant to conduct research in this area. Operating theatres (OT) alone are estimated to produce up to one third of a hospital’s total waste; the increased adoption of minimally invasive surgical (MIS) techniques, considered the gold standard, has further contributed to this high environmental cost. Although previous studies have assessed the carbon footprint in a variety of surgeries, a carbon footprint comparison of the waste streams generated in colorectal MIS remains unaddressed. Aim: This study aims to compare the carbon footprint of the waste generated in both robotic and laparoscopic colorectal surgeries, addressing the current gap in understanding the environmental impact of the minimally invasive techniques in this speciality. Methods: A uni-centered, cross-sectional pilot study was conducted at the Department of Coloproctology at the Hospital Universitari Doctor Josep Trueta (Girona). It was initiated in June 2024 and is expected to continue until February 2025. This investigation includes a total of 30 subjects requiring elective colorectal oncological surgery. Waste was categorized into four streams: paper and plastic, both pertaining to group I waste; group II, consisting of non-specific sanitary waste; and group III encompassing biohazardous medical waste. The weight of each waste stream was recorded, and conversion factors were applied to translate the weight into carbon emissions (carbon footprint). Main outcome: The primary outcome is the carbon footprint generated by the waste produced in each surgical intervention (laparoscopic or robotic surgery). Results: As of now, a total of 16 surgeries have been included in the study, therefore the results presented here reflect the findings up to this point in the investigation. Robotic surgery was the technique with the highest carbon footprint, with a median value of 50.85 kg CO2 compared to the laparoscopic, with 40.5 kg CO2 (p=0.044). A total of 261.25 kg of waste was produced during the study, equivalent to 783.75 kg CO2 attributed only to solid waste disposal. Conclusion: Despite robotic surgery being the major contributor, both techniques revealed as highly polluting. The results underline the importance of considering the adoption of sustainable measures inside the OT. Additionally, establishing new recycling and waste treatment protocols may allow for a reduction of the overall OT’s impact on the environment without compromising patient care

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