The Carbon Footprint of Robotic-Assisted Surgery: Lifecycle, Scope-Based Accounting, and Emerging AI Contributions

Robot-assisted surgery (RAS) has become an integral component of modern surgical practice, driven by perceived technical advantages and expanding indications. As these systems become increasingly embedded in routine care, their environmental implications warrant closer examination. The concept of a "carbon footprint" provides a useful framework for understanding the total greenhouse gas emissions associated with surgical care, extending beyond intraoperative energy use to encompass manufacturing, supply chains, anesthesia, and waste. Drawing on lifecycle assessments and comparative studies, this review examines the sources and magnitude of carbon emissions associated with RAS. Reported environmental impacts vary by procedure, institutional setting, instrument reuse, and lifecycle boundaries, with individual studies showing both higher and lower emissions for RAS than laparoscopic or open alternatives. However, a recent GRADE-based systematic review found that RAS had the greatest intraoperative environmental impact among evaluated approaches, although evidence quality was low to very low. Major contributors include single-use instrumentation, operating-room infrastructure, and anesthetic practices rather than the robotic platform alone. The increasing complexity of contemporary robotic systems, including their reliance on advanced instrumentation, digital infrastructure, and high-performance computing, further complicates assessment of embedded and downstream emissions, particularly within poorly characterized Scope 3 categories. At the same time, several contributors to the carbon footprint of RAS appear modifiable through changes in peri-operative practice, procurement strategies, and system design. As robotic surgery continues to expand globally, a clearer understanding of its environmental impact is essential to ensure that technological innovation proceeds in parallel with ethical stewardship and sustainable health-system planning.