Sistema de Salut de Catalunya
Institut Català de la Salut
[Cunha MF] Surgery Department, Colorectal Surgery, Algarve Local Health Unit, Portimão, Portugal. Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Faro, Portugal. [Neves JC] Gastroenterology Department, Algarve Local Health Unit, Portimão, Portugal. [Roseira J] Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Faro, Portugal. Gastroenterology Department, Algarve Local Health Unit, Portimão, Portugal. [Pellino G] Unitat de Cirurgia de Còlon i Recte, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona UAB, Barcelona, Spain. [Castelo branco P] Gastroenterology Department, Algarve Local Health Unit, Portimão, Portugal. Algarve Biomedical Center (ABC), University of Algarve, Faro, Portugal. Algarve Biomedical Center Research Institute (ABC-RI), University of Algarve, Faro, Portugal
Vall d'Hebron Barcelona Hospital Campus
2025-10-30T12:52:42Z
2025-10-30T12:52:42Z
2025-09
Carbon footprint; Minimally invasive surgery; Open surgery
Huella de carbono; Cirugía mínimamente invasiva; Cirugía abierta
Petjada de carboni; Cirurgia mínimament invasiva; Cirurgia oberta
Surgery is the most energy-intensive healthcare sector, but data on the environmental impact of abdominal surgical techniques are limited. This systematic review aims to identify the most sustainable approach among open, laparoscopic, and robotic surgeries. We searched MEDLINE, Cochrane, and Web of Science databases (inception to March 2024) for studies on the carbon footprint of abdominal surgery, focusing on carbon dioxide equivalents (CO2e) or CO2 emissions. The Joanna Briggs Institute checklist was used to assess bias. (PROSPERO: 298486). Of 2155 records, eight cohort studies were included, showing low to moderate risk of bias but high heterogeneity. Two studies on hysterectomy found robotic surgery had the highest carbon footprint (12.0-40.3 kgCO2e) compared to laparoscopic (10.7-29.2 kgCO2e) and open surgery (7.1-22.7 kgCO2e). Another study found laparoscopic prostatectomy produced more emissions than robotic surgery (59.7 vs. 47.3 kgCO2e) due to higher disposable devices, surgery time and length of stay. Single-use devices in laparoscopic cholecystectomy emitted more CO2e than hybrid devices (7.194 vs. 1.756 kgCO2e). CO2 used in minimally invasive surgery had negligible environmental effects (0.9 kgCO2e). Qualitative subgroup analyses revealed significant differences between surgery types and measurement methodologies, contributing to data heterogeneity. Minimally invasive surgeries often have higher carbon footprints due to disposable tools and waste. However, one study showed robotic surgery may reduce the overall environmental impact by shortening hospital stays. Due to methodological heterogeneity across studies, definitive conclusions remain limited. Standardized life-cycle assessment methodologies and inclusion of clinical outcomes in future studies are urgently needed to clarify the environmental sustainability of surgical practices.
Open access funding provided by FCT|FCCN (b-on). None.
Article
Published version
English
Medi ambient; Abdomen - Cirurgia; Robòtica en medicina; Anhídrid carbònic; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Therapy, Computer-Assisted::Surgery, Computer-Assisted::Robotic Surgical Procedures; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Laparotomy; PHENOMENA AND PROCESSES::Biological Phenomena::Ecological and Environmental Phenomena::Environment::Carbon Footprint; PHENOMENA AND PROCESSES::Biological Phenomena::Ecological and Environmental Phenomena::Environment; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::tratamiento asistido por ordenador::cirugía asistida por ordenador::procedimientos quirúrgicos robotizados; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::laparotomía; FENÓMENOS Y PROCESOS::fenómenos biológicos::fenómenos ecológicos y ambientales::ambiente::huella de carbono; FENÓMENOS Y PROCESOS::fenómenos biológicos::fenómenos ecológicos y ambientales::ambiente
Springer
Updates in Surgery;77
https://doi.org/10.1007/s13304-025-02221-1
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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