title: Carbon footprint of robotically-assisted laparoscopy, laparoscopy and laparotomy: a comparison.
abstract: BACKGROUND
  To date there have been no comprehensive, comparative assessments of the environmental impact of surgical modalities. Our study seeks to quantify and compare the total greenhouse gas emissions, or 'carbon footprint', attributable to three surgical modalities.
  
  
  METHODS
  A review of 150 staging procedures, employing laparotomy (LAP), conventional laparoscopy (LSC) or robotically-assisted laparoscopy (RA-LSC), was performed. The solid waste generated (kg) and energy consumed (kWh) during each case were quantified and converted into their equivalent mass of carbon dioxide (kg CO(2) e) release into the environment. The carbon footprint is the sum of the waste production and energy consumption during each surgery (kg CO(2) e).
  
  
  RESULTS
  The total carbon footprint of a RA-LSC procedure is 40.3 kg CO(2) e/patient (p < 0.01). This represents a 38% increase over that of LSC (29.2 kg CO(2) e/patient; p < 0.01) and a 77% increase over LAP (22.7 kg CO(2) e/patient; p < 0.01).
  
  
  CONCLUSIONS
  Our results provide clinicians, administrators and policy-makers with knowledge of the environmental impact of their decisions to facilitate adoption of sustainable practices.
authors.affiliation: Emory University School of Medicine, Department of Obstetrics and Gynecology, Emory Midtown Hospital, Atlanta, GA, 30308, USA.
authors.forename: Demetrius L
authors.initials: DL
authors.lastname: Woods
authors.affiliation: Albert Einstein College of Medicine, Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: McAndrew
authors.affiliation: Albert Einstein College of Medicine, Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Nevadunsky
authors.affiliation: Albert Einstein College of Medicine, Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: June Y
authors.initials: JY
authors.lastname: Hou
authors.affiliation: Albert Einstein College of Medicine, Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Goldberg
authors.affiliation: Albert Einstein College of Medicine, Division of Gynecologic Oncology, Montefiore Medical Center, Department of Obstetrics and Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Yi-Shin Kuo
authors.affiliation: Robert Wood Johnson Medical School, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, New Brunswick, NJ, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Isani
mesh_terms: D002245:Carbon Dioxide / Q000032:analysis*; D058572:Carbon Footprint / Q000706:statistics & numerical data*; D020706:Laparoscopes / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000295:instrumentation / Q000706:statistics & numerical data*; D065287:Robotic Surgical Procedures / Q000295:instrumentation* / Q000706:statistics & numerical data*
chemical_list: D002245:Carbon Dioxide
keywords: endometrial cancer; gynaecology; robotic surgery; sustainability