Carbon Dioxide Emissions and Environmental Impact of Different Surgical Modalities of Hysterectomies

Abstract

Background and objectives: The objectives of this study were to determine carbon dioxide (CO₂) emissions generated from nonreusable waste and compare across different types of hysterectomies for benign and malignant indications. Overall greenhouse gas emissions were not examined.

Methods: This is a prospective cohort study that identified women undergoing a robotic assisted, laparoscopic, vaginal, or abdominal hysterectomy for any indication. The amount of waste generated was collected for each case, along with patient demographics, and details of the procedure. Weight of waste was converted to kilograms of CO₂ emissions using the following formula: $\text{Carbon dioxide emissions}=\text{Waste in pounds}\mathrm{\times \; 1\; Short\; ton}/2000\text{pounds}\mathrm{\times \; Emission\; factor}\left(\text{kg C}{\text{O}}_2/\text{short ton}\right)\text{× Global warming potential (GWP)}$We extrapolated the amount of CO₂ emissions produced to the number of hysterectomies performed annually in the United States.

Results: We found that robotic hysterectomies generated the highest mean CO₂ emissions (12.01 kg CO₂), while vaginal hysterectomies produced the lowest mean CO₂ emissions of 4.48 kg (p < .0001).Our sample size of 100 hysterectomies was equivalent to 1099.4 kg CO₂ emissions. When our results were extrapolated, all hysterectomies in the United States produce 5.7 million kg of CO₂ emissions. This is equivalent to 234,513 airplane miles, and 95 trips cross-country across the USA from New York, New York to Los Angeles, California.

Conclusion: Robotic hysterectomies generated a statistically significant majority of CO₂ emissions. Therefore, robotic surgery, as currently practiced, may offer a good initial opportunity for decreasing the carbon footprint of surgery.

Keywords: Environmental sustainability; Hysterectomy; Laparoscopy; Minimally invasive gynecologic surgery; Robotic surgery.