Reducing the carbon footprint and costs of laparoscopic cholecystectomy: a modelling study on interventions for sustainable surgery.

BACKGROUND

Reducing the carbon footprint of surgical care requires carbon and economic evaluations to guide and support effective sustainability initiatives. This study aims to quantify the carbon footprint (CO₂-eq.) and financial (euros) impact of targeted interventions in laparoscopic cholecystectomy (LC).

METHODS

This modelling study evaluated the carbon and financial impact of sustainability interventions in LC, structured within the 10R circularity framework. Key contributors to emissions (disposables, anaesthesia, and energy) were addressed through seven mitigation strategies switching to (1) reusable trocars; (2) a reusable clip applicator; (3) reusable drapes; (4) reusable gowns; (5) refusing a forced-air heating device; (6) switching to total intravenous anaesthesia (TIVA); and (7) transitioning to 100% renewable electricity. The carbon impact was assessed via life cycle assessment (LCA) following ISO 14040, using the ReCiPe 2016 method to calculate cradle-to-grave CO₂-eq. Cost analysis compared acquisition and sterilization costs of disposable and reusable trocars and a clip applicator. Comparison between reusable and disposable products was done by Monte Carlo simulation.

RESULTS

Switching to reusables and avoiding the forced-air heating device reduced emissions by 9.5 kg CO₂-eq. per LC (- 21%). Switching to TIVA saved 2.9 kg CO₂-eq. (- 7%) and using renewable electricity saved 4.0 kg CO₂-eq. (- 9%). Combined, these interventions achieved a 36% emission reduction (16.5 kg CO₂-eq.) per LC. Reusable trocars and clip applicators were cost-saving in > 93% of simulations, with break-even reached after 9 and 20 uses.

CONCLUSION

Targeted mitigation strategies can substantially reduce the carbon footprint of laparoscopic procedures, and switching to reusable trocars and a clip applicator can reduce cost. These findings provide actionable insights for implementing sustainable practices in surgical care.