Reducing the carbon footprint of a laparoscopic appendectomy: A life cycle assessment

The operating room has a large contribution to health care's carbon footprint. We aimed to evaluate the environmental impact of equally safe and effective approaches to a laparoscopic appendectomy through life cycle assessment.

Three common approaches to dividing the appendix and mesoappendix were evaluated using life cycle assessment: (1) ENDOLOOP for the appendix and electrocautery for the mesentery (ENDOLOOP approach), (2) endoscopic stapler with one staple load for the appendix and mesentery each (stapler approach), and (3) endoscopic stapler for the appendix and LigaSure for the mesentery (stapler/LigaSure approach). The life cycle stages measured for each product included raw material extraction and production, energy use of devices in the operating room, and disposal. Life cycle inventory (Ecoinvent v3.10) and life cycle assessment (IMPACT World+ v2.0.1) databases were accessed using the ActivityBrowser software to calculate each method's carbon footprint and human health damage from environmental impact.

The ENDOLOOP approach produced up to 81% fewer greenhouse gas emissions than the stapler approach and 89% fewer emissions than the stapler/LigaSure approach. The ENDOLOOP approach additionally had a 6- and 10-fold lower cost to human health through environmental damage compared to the stapler approach and stapler/LigaSure approaches, respectively. The majority of emissions for all approaches came from raw material extraction and production.

Where clinically equivalent techniques exist in procedures, there are potential opportunities to minimize impacts on both planetary and human health.