[CO2 utilization in minimally invasive surgery]

Over the course of a year, in a medium-sized operating theatre, the amount of CO₂ used to create an intra-abdominal pneumoperitoneum during minimally invasive surgical procedures is equivalent to the emissions produced by driving round the world along the equator. The aim of this study was to determine the factors influencing CO₂ consumption.

We conducted a single-centre, retrospective observational study at the CHU Sud Réunion, aimed at analysing the factors influencing CO₂ consumption in the operating theatre during minimally invasive surgery. This was supplemented by a descriptive prospective analysis carried out over a one-week period across all operating theatres, during which CO₂ consumption of each minimally invasive intervention was recorded every two minutes from the time of incision until closure, whilst noting any complications arising during the procedure.

The observational study involved 521 patients who underwent surgery during the study period in the operating theatre of the CHU Sud de Saint-Pierre. The volume of CO₂ insufflated ranged from 21 L to 50 L for a vNOTEs salpingectomy up to 903 L for a robotic hysterectomy. CO₂ consumption was strongly associated with operative time (p < 0.001) and intra-abdominal insufflation pressure (p = 0.004). The descriptive study of 23 patients revealed avoidable CO₂ consumption, mainly due to valves not being fully closed or to the continuation of insufflation when it was no longer necessary for the procedure to continue.

CO₂ consumption in the operating theatre depends mainly on technical and organisational factors, rather than on patient characteristics. The entire operating theatre team must be made aware of environmental issues, as every action counts towards reducing our carbon footprint.