Abstract Background Minimally invasive surgical (MIS) techniques are considered the gold standard of surgical interventions, but they have a high environmental cost. With global temperatures rising and unmet surgical needs persisting, this review investigates the carbon and material footprint of MIS and summarizes strategies to make MIS greener. Methods The MEDLINE, Embase, and Web of Science databases were interrogated between 1974 and July 2021. The search strategy encompassed surgical setting, waste, carbon footprint, environmental sustainability, and MIS. Two investigators independently performed abstract/full-text reviews. An analysis of disability-adjusted life years (DALYs) averted per ton of carbon dioxide equivalents (CO2e) or waste produced was generated. Results From the 2456 abstracts identified, 16 studies were selected reporting on 5203 MIS procedures. Greenhouse gas (GHG) emissions ranged from 6 kg to 814 kg CO2e per case. Carbon footprint hotspots included production of disposables and anaesthetics. The material footprint of MIS ranged from 0.25 kg to 14.3 kg per case. Waste-reduction strategies included repackaging disposables, limiting open and unused instruments, and educational interventions. Robotic procedures result in 43.5 per cent higher GHG emissions, 24 per cent higher waste production, fewer DALYs averted per ton of CO2, and less waste than laparoscopic alternatives. Conclusion The increased environmental impact of robotic surgery may not sufficiently offset the clinical benefit. Utilizing alternative surgical approaches, reusable equipment, repackaging, surgeon preference cards, and increasing staff awareness on open and unused equipment and desflurane avoidance can reduce GHG emissions and waste.

中文翻译：

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机器人和腹腔镜手术的环境可持续性：系统评价

摘要 背景微创外科（MIS）技术被认为是外科手术的黄金标准，但它们的环境成本很高。随着全球气温上升和未满足的手术需求持续存在，本综述调查了 MIS 的碳和材料足迹，并总结了使 MIS 更加环保的策略。 方法1974 年至 2021 年 7 月期间对 MEDLINE、Embase 和 Web of Science 数据库进行了查询。搜索策略涵盖手术环境、废物、碳足迹、环境可持续性和 MIS。两名研究人员独立进行摘要/全文审查。对每产生一吨二氧化碳当量 (CO2e) 或废物所避免的伤残调整生命年 (DALY) 进行了分析。 结果从确定的 2456 份摘要中，选择了 16 项研究报告 5203 个 MIS 程序。每箱温室气体 (GHG) 排放量为 6 千克至 814 千克二氧化碳当量。碳足迹热点包括一次性用品和麻醉剂的生产。每箱 MIS 的材料足迹范围为 0.25 公斤至 14.3 公斤。减少废物的策略包括重新包装一次性用品、限制开放和未使用的仪器以及教育干预措施。与腹腔镜替代方案相比，机器人手术导致温室气体排放量增加 43.5%，废物产生量增加 24%，每吨二氧化碳避免的伤残调整生命年 (DALY) 减少，废物减少。 结论机器人手术对环境的影响增加可能不足以抵消其临床效益。利用替代手术方法、可重复使用的设备、重新包装、外科医生偏好卡以及提高员工对开放和未使用设备的认识以及避免地氟醚可以减少温室气体排放和浪费。