Environmental Impact of Minimally Invasive Surgery in the United States: An Estimate of the Carbon Dioxide Footprint

Purpose: To attempt to quantitate the carbon footprint of minimally invasive surgery (MIS) through approximated scope 1 to 3 CO2 emissions to identify its potential role in global warming. Patients and Methods: To estimate national usage, we determined the number of inpatient and outpatient MIS procedures using International Classification of Diseases, ninth revision-clinical modification codes for all MIS procedures in a 2009 sample collected in national databases. Need for surgery was considered essential, and therefore traditional open surgery was used as the comparator. Scope 1 (direct) CO2 emissions resulting from CO2 gas used for insufflation were based on both escaping procedural CO2 and metabolic CO2 eliminated via respiration. Scopes 2 and 3 (indirect) emissions related to capture, compression, and transportation of CO2 to hospitals and the disposal of single-use equipment not used in open surgery were calculated. Results: The total CO2 emissions were calculated to be 355,924 tonnes/year. For perspective, if MIS in the United States was considered a country, it would rank 189th on the United Nations 2008 list of countries' carbon emissions per year. Limitations include the inability to account for uncertainty using the various models and tools for approximating CO2 emissions. Conclusion: CO2 emission of MIS in the United States may have a significant environmental impact. This is the first attempt to quantify CO2 emissions related to MIS in the United States. Strategies for reduction, while maintaining high quality medical care, should be considered.