The carbon footprint of laparoscopic and robotic radical prostatectomy in Italy

Research highlights

• "Focusing on the environmental impact of minimally invasive surgery, we assessed and compared the CO2 emissions between Robot-assisted (RALP) and Laparoscopic Radical Prostatectomy (LRP)." 
• "The total CO2 emissions were ~47 kg and ~60 kg per procedure in the robot-assisted and laparoscopic groups, respectively."
  
• "The CO2 emissions due to instrumentation were higher in the laparoscopic group, with the majority coming from plastic and composite fiber components. The CO2 emissions for metal components were higher in the robotic group."
  
• "The operating time was longer in the laparoscopic group, resulting in higher CO2 emissions. CO2 emissions from hospital room energy consumption were lower in the robot-assisted group."
  
• "RALP generates substantially less CO2 than Laparoscopic Radical Prostatectomy (LRP) owing to the use of more reusable surgical supplies, shorter operative time and hospital stay."
  

Abstract

More than 4% of the global greenhouse gas emissions are generated by healthcare system. Focusing on the environmental impact of minimally invasive surgery, we assessed and compared the CO emissions between Robot-assisted (RALP) and Laparoscopic Radical Prostatectomy (LRP). In patients prospectively enrolled, we evaluated the age, surgical and anesthesiologic time, postoperative intensive care unit and hospital stay, blood transfusion, pre- and postoperative hemoglobin and Gleason score, open conversion need, and complications (Clavien-Dindo classification). We assessed the life cycle to estimate the energy consumption for surgical procedures and hospital stays. We reported the materials, CO produced, and fluid quantity infused and dispersed. Disposable and reusable materials and instruments were weighed and divided into metal, plastic, and composite fibers. The CO consumption for disposal and decontamination was also evaluated. Of the 223 patients investigated, 119 and 104 patients underwent RALP and LRP, respectively. The two groups were comparable as regards age and preoperative Gleason score. The laparoscopic and robotic instruments weighed 1733 g and 1737 g, respectively. The CO emissions due to instrumentation were higher in the laparoscopic group, with the majority coming from plastic and composite fiber components. The CO emissions for metal components were higher in the robotic group. The robot functioned at 3.5 kW/h, producing 4 kg/h of CO . The laparoscopic column operated at 600 W/h, emitting ~1 kg/h of CO . The operating room operated at 3,0 kW/h. The operating time was longer in the laparoscopic group, resulting in higher CO emissions. CO emissions from hospital room energy consumption were lower in the robot-assisted group. The total CO emissions were ~47 kg and ~60 kg per procedure in the robot-assisted and laparoscopic groups, respectively. RALP generates substantially less CO than LRP owing to the use of more reusable surgical supplies, shorter operative time and hospital stay.

Methods & Results

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Citation

Fuschi A, Pastore AL, Al Salhi Y, Martoccia A, De Nunzio C, Tema G, Rera OA, Carbone F, Asimakopoulos AD, Sequi MB, Valenzi FM. The impact of radical prostatectomy on global climate: a prospective multicentre study comparing laparoscopic versus robotic surgery. Prostate Cancer and Prostatic Diseases. 2023 Apr 21:1-7.