Carbon footprint of laparoscopic right hemicolectomy

Greenhouse gas emissions, driven primarily by CO2 production, contribute to the ever-increasing climate crisis that threatens the health of the planet and its inhabitants. Emissions from the global healthcare industry represent 4–5% of this total, with acute services being the largest emitting source1,2. Compared with other areas, operating theatres, which are resource-intensive, account for disproportionately high waste generation and energy usage2,3. Evaluating and quantifying contributing emission sources within surgery will focus effective action. Studies of carbon footprint in general surgery are scarce. The aim of this study was to quantify the impact on the climate (using CO2 emissions as a common equivalence; CO2e) of performing a relatively common and so far unanalysed procedure—laparoscopic right hemicolectomy (LRH). Within a single hospital, a mean of 39 LRH cases were performed annually between 2019 and 2021. A total of four cases (10) were analysed over a 5-month interval. Mean emissions were calculated, which included: inventory and quantification of single-use surgical consumables using a process-based (‘cradle-to-grave’) approach (Tables S1, S2); weight and disposal of theatre waste stratified into four distinct streams (Table S3); CO2 volume used for abdominal insufflation (Table S4); and approximate energy use of the theatre environment for the duration of the LRH procedure (Table S5)1. Emissions resulting from anaesthetic and perioperative materials, deemed beyond the scope of this study, were excluded from the calculation. The full methadology is available within Supplementary Methods. The total mean carbon footprint was 22.81 kgCO2e per LRH case (Table S6), a comparatively low and likely underestimated emission total amongst the literature2. Procurement and upstream carbon production from consumable manufacturing contributed the largest share at 12.38 kgCO2e (54%) of total emissions (Fig. 1). Mean waste per LRH was 6.52 kg of clinical waste, 1.72 kg of domestic waste, and 1.3 kg of heavy metal recycling. A reusable laparoscopic surgical tray, requiring off-site decontamination, weighed 5 kg. The mean total proportion of recycled single-use waste was 13%. Extrapolating emission data to a mean of 39 cases per year represents a total emission burden of 889.59 kgCO2­e; the equivalent emissions of driving a petrol car from Kirkcaldy, Scotland (the site of this study) to Doha, Qatar (approximately 7100 km)4. Proportion of kgCO2e contributed from each measured sector in a typical laparoscopic right hemicolectomy case The pneumoperitoneum contribution is insignificant and therefore is not clearly visible in the pie chart (0.002% of total). Direct comparison between surgical emission studies is often difficult given the heterogenicity of methodology and boundaries set for data inclusion2. The results presented support other research findings that supply chains and single-use consumables contribute the majority of CO2e when measuring the carbon footprint of surgical cases1,2. The process-based approach utilized for calculating surgical consumable emissions, although more detailed, relies on manufacturer transparency with regards to raw material and component information. Where available, mean raw material CO2e coefficients were applied to products consisting of multiple material components using an embodied carbon database5. Improving the carbon footprint within surgery requires a collaborate approach between healthcare providers, procurement teams, and manufacturers. Development of reusable tools and an emphasis on recycling when reusable tools are unavailable are priorities3. Awareness of the effect that single-use materials have on the environment should be raised and the authors therefore suggest that carbon emission data should be made available for disposable equipment (either on such products or in the consumer information provided with such products). Furthermore, manufacturers of surgical tools and materials should be encouraged to be transparent with regard to emission contributions and such data should be made publicly available. As research in sustainable healthcare gathers pace, consensus on a uniform methodology to evaluate carbon emissions in healthcare will be needed to properly compare techniques, materials, and surgical sites. The authors have no funding to declare. Aaron Saul Taylor (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Writing—original draft, Writing—review & editing), Stephanie Au (Data curation, Methodology, Supervision, Writing—review & editing), Barbora Krivankova (Data curation), Khlud Asanai (Data curation), and Natarajan Manimaran (Conceptualization, Supervision, Writing—review & editing) The authors declare no conflict of interest. Supplementary material is available at BJS online. Data used to support the findings of this research are included in the main text or as Supplementary material.