# Carbon Footprint of Laparoscopic Appendicectomy: A Prospective Observational Study at a Tertiary Care NHS Trust Hospital

## TL;DR

This study calculates the carbon footprint of laparoscopic appendicectomy and identifies ways to reduce emissions in hospital surgeries.

## Contribution

The study provides the first detailed carbon footprint analysis of laparoscopic appendicectomy and identifies key contributors to emissions.

## Key findings

- The average CO2 emission for a laparoscopic appendicectomy was 28,258 grams.
- Disposable items and theatre overheads were the largest contributors to the carbon footprint.
- Prolonged operations due to technical difficulties significantly increased emissions.

## Abstract

Introduction

Climate change is a significant global challenge as a result of rising greenhouse gas emissions. The National Health Service (NHS), as one of the biggest contributors to the United Kingdom's emissions, has a net-zero carbon emissions target. Operating theatres have a large resource burden in hospitals, and the laparoscopic appendicectomy (LA) is one of the most commonly performed procedures. As of yet, the laparoscopic appendicectomy has not been effectively carbon footprinted.

Aims

The objective of this study is to calculate the carbon footprint of the laparoscopic appendicectomy (LA) in grams of carbon dioxide (CO2) produced that results in an environmental impact. In addition, we also identify the biggest contributors to the carbon footprint and create a set of recommendations for CO2 emission reduction.

Methods

Carbon footprint-related data was collected for using surgical equipment, electricity utilisation and consumption of CO2 used for pneumoperitoneum, over 23 consecutive LAs. Peer-reviewed literature was used to determine the footprint of the equipment via a lifecycle assessment. The average carbon emissions for pneumoperitoneum, theatre overheads (mainly heating, ventilation and air conditioning (HVAC)) and electrical equipment were calculated.

Results

The average CO2 emission for an appendicectomy was 28258±1256 (24381-36267) grams. Variation was largely secondary to prolonged operations (Spearman's rank correlation coefficient = 0.95) due to technical difficulties. Major contributors in carbon footprinting were pre-set (reusable items) (23%), pre-set (disposable items) (40%), theatre overheads (HVAC and lights) (16%), CO2 pneumoperitoneum (9%), scrubs and personal protective equipment (PPE) (6%), additional equipment (5%) and utilisation of electrical equipment (1%).

Conclusion

The LA is a carbon-intensive procedure. CO2 emissions from LAs may be reduced by switching over to reusable equipment and increasing operating room efficiency. The green theatre checklist provides excellent guidelines on this. More research is needed into less environmentally impactful gases to achieve a pneumoperitoneum. This study provides data to guide targeted interventions and quantify the degree of offsetting needed to achieve net-zero emissions for laparoscopic surgery.