Laparoscopic versus robot-assisted left hemicolectomy: A pilot study on sustainability.

BACKGROUND: The National Health System is responsible for 8-10% of total greenhouse gas emissions. Operating rooms are responsible for 60-70% of all hospital waste. Over the last 30 years abdominal surgery transcended from a laparoscopic approach toward a robot-assisted approach. The role of robot-assisted laparoscopic surgery is still debated in some procedures, such as colorectal surgery. The studies available in scientific literature comparing laparoscopic and robot-assisted left hemicolectomy are focused on clinical outcomes. The environmental sustainability of these procedures remains largely unexplored, representing a key area that our study seeks to investigate. METHODS: In this pilot study consecutive patients scheduled for a minimally invasive left hemicolectomy for diverticular disease or cancer were recruited and randomly assigned 1:1 to the laparoscopic or robotic groups. The "Green Team" supported the operating room staff in separate waste collection during the surgical procedures. Primary end point was CO2 consumption and secondary endpoints the specific mass of the most important waste stream. RESULTS: Ten patients were enrolled. Robot-assisted left hemicolectomy required more CO2 consumption in liters to maintain pneumoperitoneum (p = 0.03) compared with laparoscopic left hemicolectomy and required a longer operation time (p = 0.04). In total, the robot and laparoscopic approaches produced a total of 74.5 and 54 kg of plastic, non-woven fabric (TNT), unsorted waste bins, and biohazardous waste combined, which cost €92 and €71 to dispose of. CONCLUSION: Robot-assisted left hemicolectomy seems to have a greater environmental impact compared with laparoscopic left hemicolectomy in terms of both CO2 emissions and waste production. Given the growing focus on operating room sustainability, further studies are needed to compare laparoscopic and robotic techniques to inform surgical decisions.