Carbon Footprint in Hepatectomy Increases as the Approach Shifts From Open to Laparoscopic and Robot-Assisted Surgery

This study evaluated the environmental impact of hepatectomy approaches-open, laparoscopic, and robot-assisted-in terms of carbon footprint (CFP).

Thirty patients undergoing partial hepatectomy were divided equally into open (n = 10), laparoscopic (n = 10), and robot-assisted (n = 10) groups. CFP was calculated by considering disposable device production, operating room energy consumption, and disposal stages based on device characteristics, energy measurements, and surgical video analysis.

The robot-assisted group (median [range], 59.7 [41.8-100.4] kg-CO₂) demonstrated a significantly higher total CFP than the laparoscopic group (46.1 [31.6-58.3] kg-CO₂, p = 0.041) and the open group (32.3 [20.2-45.8] kg-CO₂, p < 0.001). The service stage contributed the largest share of total emissions across all groups. However, the proportion of CFP attributable to procurement and decommissioning of disposable devices tended to increase as the approach shifted from open to laparoscopic and then robot-assisted surgery. CFP increased with prolonged operative time, particularly in robot-assisted hepatectomy.

Minimally invasive hepatectomy approaches increase CFP, with robot-assisted procedures producing approximately 1.5 times more emissions than open surgery. For surgical sustainability, unnecessary prolonged laparoscopic and robotic surgeries should be avoided, along with efforts to reduce the use of disposable devices.