dc.contributor
Institut Català de la Salut
dc.contributor
[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
dc.contributor
Vall d'Hebron Barcelona Hospital Campus
dc.contributor.author
Neves, João
dc.contributor.author
Roseira, Joana
dc.contributor.author
Castelo-Branco, Pedro
dc.contributor.author
Cunha, Miguel F.
dc.contributor.author
Pellino, Gianluca
dc.date.accessioned
2025-10-31T04:45:44Z
dc.date.available
2025-10-31T04:45:44Z
dc.date.issued
2025-10-30T12:52:42Z
dc.date.issued
2025-10-30T12:52:42Z
dc.identifier
Cunha MF, Neves JC, Roseira J, Pellino G, Castelo-branco P. Green surgery: a systematic review of the environmental impact of laparotomy, laparoscopy, and robotics. Updates Surg. 2025 Sep;77:1683-92.
dc.identifier
http://hdl.handle.net/11351/13984
dc.identifier
10.1007/s13304-025-02221-1
dc.identifier.uri
http://hdl.handle.net/11351/13984
dc.description.abstract
Carbon footprint; Minimally invasive surgery; Open surgery
dc.description.abstract
Huella de carbono; Cirugía mínimamente invasiva; Cirugía abierta
dc.description.abstract
Petjada de carboni; Cirurgia mínimament invasiva; Cirurgia oberta
dc.description.abstract
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.
dc.description.abstract
Open access funding provided by FCT|FCCN (b-on). None.
dc.format
application/pdf
dc.relation
Updates in Surgery;77
dc.relation
https://doi.org/10.1007/s13304-025-02221-1
dc.rights
Attribution 4.0 International
dc.rights
http://creativecommons.org/licenses/by/4.0/
dc.rights
info:eu-repo/semantics/openAccess
dc.subject
Abdomen - Cirurgia
dc.subject
Robòtica en medicina
dc.subject
Anhídrid carbònic
dc.subject
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Therapy, Computer-Assisted::Surgery, Computer-Assisted::Robotic Surgical Procedures
dc.subject
ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Laparotomy
dc.subject
PHENOMENA AND PROCESSES::Biological Phenomena::Ecological and Environmental Phenomena::Environment::Carbon Footprint
dc.subject
PHENOMENA AND PROCESSES::Biological Phenomena::Ecological and Environmental Phenomena::Environment
dc.subject
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::tratamiento asistido por ordenador::cirugía asistida por ordenador::procedimientos quirúrgicos robotizados
dc.subject
TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::laparotomía
dc.subject
FENÓMENOS Y PROCESOS::fenómenos biológicos::fenómenos ecológicos y ambientales::ambiente::huella de carbono
dc.subject
FENÓMENOS Y PROCESOS::fenómenos biológicos::fenómenos ecológicos y ambientales::ambiente
dc.title
Green surgery: a systematic review of the environmental impact of laparotomy, laparoscopy, and robotics
dc.type
info:eu-repo/semantics/article
dc.type
info:eu-repo/semantics/publishedVersion
