Objectives: Robotic surgery has become increasingly popular in recent years; however, the environmental impact of robotic surgery remains unclear. This literature review aims to highlight the different methodologies used to measure the environmental impact of robotic surgery and investigate the sustainability of robotic surgery.
Methods: A structured literature review was conducted using the PubMed, Web of Science and Cochrane databases with no limits in timeline. The search criteria included a combination of the following keywords: "robot-assisted," "robotic surgery," "sustainability," "carbon footprint," "greenhouse gas," and "environmental impact." Studies that did not focus on robotic surgeries nor their associated environmental sustainability were excluded.
Results: Out of the 386 publications identified using the search terms, however, only 7 were included in the literature review. Four of the studies utilized Life-Cycle Assessments (LCA) to estimate greenhouse gas emissions associated with robotic surgery, which is a method to estimate the environmental burdens caused by a product or process by using different parameters as inputs. A study found that the total carbon footprint of a robot-assisted laparoscopy was 40.3kg equivalent of CO2 emission, 38% higher than conventional laparoscopy and 77% higher than laparotomy. Another study found that robotic hysterectomies are associated with 30% more total weight of waste when compared to the average of the non-robotic approaches and 43.5% higher greenhouse gas emission when compared to laparoscopic hysterectomies. Another found the total annual CO2 emissions associated with both robotic and laparoscopic surgeries occurring in the United States to be 355,924 tonnes per year.
Conclusions: This review found that robotic surgeries are associated with greater environmental impact compared to non-robotic surgical approaches however, there is significant variation in the methodology and efforts should be made to incorporate a more objective and reproducible method to accurately measure the environmental impact of robotic surgeries.