Development of an Environmental Impact Calculator for Minimally Invasive Cholecystectomy: Protocol and Methodological Framework of the ECOMIS Project

One of the greatest threats to public health in the 21st century is anthropogenic climate change. Healthcare services worldwide account for 4.9% of global CO2 emissions, with operating rooms being the most resource-intensive areas of the hospital. The need for environmentally sustainable change is a priority. Reliable quantitative data on emissions remain limited, which may hinder informed decision-making on surgical sustainability. The aim of this study is to develop and validate an easily accessible and user-friendly calculator to quantitatively estimate procedure-related carbon dioxide equivalent (CO2-eq) emissions of minimally invasive cholecystectomy across a range of countries, hospital volumes, and healthcare settings. The ECOMIS project follows a multiphase, stepwise design. The present study will focus on minimally invasive cholecystectomies. The calculator variables will be selected based on a systematic literature review of factors influencing CO2-eq emissions, with life cycle assessment (LCA) considered an established and comprehensive methodology for assessing CO2-eq emissions. The project will generate a comprehensive quantitative overview of the environmental impact associated with key variables involved in minimally invasive surgery. This tool has the potential to facilitate tailor-made and evidence-based decision-making and promote more sustainable surgical practices.