Environmental impact of laparoscopic and robotic colorectal surgery: a systematic review

Laparoscopic and robotic colorectal surgeries are being increasingly performed to achieve improved patient outcomes. The National Health Service (NHS) committed to a net-zero policy in 2020, emphasizing the need for sustainable healthcare. However, the environmental impact of laparoscopic and robotic colorectal surgeries is unclear. This review aimed to systematically evaluate the environmental impact of these surgical modalities. MEDLINE (via EBSCOhost), Embase (via Ovid), and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched between 1 January 2000 and 31 March 2026 to identify primary English-language studies reporting quantifiable environmental metrics for laparoscopic and/or robotic colorectal surgery. Titles and abstracts were screened, and full-text assessments were performed. Quality assessment was performed using the Quality Appraisal for Diverse Studies (QuADS) tool. We screened 932 records and identified an additional study through citation searching. Ultimately, 6 articles were included in the narrative synthesis. QuADS score was between 26 and 36 (out of 39). Two studies found that waste generation and carbon emissions were higher for robotic surgery than laparoscopic surgery. Surgical consumables, operative waste generation, supply chains, and theatre resource utilisation were major contributors to environmental burden. However, heterogeneity in study design and environmental metrics limited further assessments. Both laparoscopic and robotic colorectal surgeries are associated with measurable impacts across multiple reported outcomes. This review highlights the need for standardised metrics to evaluate the environmental impact of these approaches and the need for further research and increased awareness, particularly regarding healthcare sustainability initiatives and NHS net zero commitments.