Environmental Impact of Minimally Invasive Radical and Partial Nephrectomy: A Multicenter Prospective Comparative Study Comparing Robot-Assisted and Laparoscopic Surgical Approaches
2025
Andrea Fuschi | Yazan Al Salhi | Antonio Luigi Pastore | Manfredi Bruno Sequi | Cosimo De Nunzio | Riccardo Lombardo | Onofrio Antonio Rera | Flavia Carbone | Anastasios D. Asimakopoulos | Fabio Maria Valenzi | Paolo Pietro Suraci | Alice Antonioni | Stefano Nardecchia | Giorgio Bozzini | Alessandro Corsini | Damiano Graziani | Giuseppe Candita | Filippo Gianfrancesco | Giorgio Martino | Alessandro Zucchi | Matteo Pacini | Alessandro Sciarra | Antonio Carbone
Background: Minimally invasive surgery has improved patient outcomes but raises environmental concerns due to carbon emissions from disposable instruments, energy consumption, and hospital resource use. This study evaluates the carbon footprint of robot-assisted and laparoscopic nephrectomies. Methods: A multicenter prospective study analyzed 162 patients undergoing robot-assisted or laparoscopic partial (RAPN, LPN) and radical nephrectomy (RARN, LRN). Life cycle assessment (LCA) quantified CO<sub>2</sub> emissions from instrument use, sterilization, and energy consumption. Results: Robot-assisted procedures had lower CO<sub>2</sub> emissions than laparoscopic approaches. Emissions from instrument disposal were 9.04 kg in RAPN vs. 12.14 kg in LPN (<i>p</i> = 0.02) and 8.74 kg in RARN vs. 11.45 kg in LRN (<i>p</i> = 0.03). Despite higher intraoperative energy use, robot-assisted surgery produced 3–4 kg less CO<sub>2</sub> per procedure due to reusable instruments and shorter hospitalization. Conclusions: Robot-assisted nephrectomy reduces environmental impact by minimizing waste and hospital stays. Efforts should focus on reusable instruments, energy efficiency, and sustainability initiatives to mitigate surgical carbon footprints while ensuring high-quality care.
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