VIENNA, AUSTRIA (UroToday.com) - This group from Memorial Sloan-Kettering Cancer Center evaluated carbon dioxide, the principal gas used in laparoscopic procedures for insufflation.
Carbon dioxide contributes 9-26% of the Greenhouse effect, mostly due to fossil fuel use, implicating it in the current global warming trend. Data regarding 
the number of laparoscopic surgeries performed both for inpatient and outpatient settings in the United States are only available for 2006 in national databases. Inpatient common laparoscopic procedures were identified using ICD-9 CM codes in the Nationwide Inpatient Sample collected by the Healthcare Cost and Utilization Project. This data was cross-referenced with inpatient and ambulatory statistics compiled by the United States Department of Health and Human Services and the Centers for Disease Control and Prevention. Outpatient laparoscopic procedures were extracted from this dataset. Average operative times for each procedure were estimated using figures available in the literature and MSKCC data. The number of cylinders and CO2 emissions were calculated from this data. Contributions to indirect CO2 emissions were identified as all other processes involved before and after the actual laparoscopic procedure. Calculable processes prior to surgery were broadly categorized as CO2 capture/compression and transportation of CO2 to hospitals. Post-procedure CO2 emissions were calculated relating to single use equipment unique to laparoscopy and their requirement of incineration as biomedical waste. The Environment Input-Output Life-Cycle Assessment (EIOLCA) model was used to estimate CO2 emission involved in CO2 capture/compression.
There were 2,616,522 procedures included in the analysis. The total number of hours of operative time was estimated at 2,961,498, which translated into 806,948 CO2 cylinders. The total CO2 direct emissions were 56.5 tons. The subtotal of CO2 emission for industrial gas manufacturing, power generation and supply, and gas extraction was calculated as 1,862,700 tons. The overall CO2 emissions from laparoscopic surgery were estimated at 1,866,106.5 tons/year. He pointed out that this is similar to driving a medium sized car 83,626 times around the earth at the equator or 3 million flights from New York City to London. In another comparison, laparoscopy in the United States amounts to more CO2 emission/year than 129 entire country’s yearly CO2 emissions as listed by the UN from 2007 data. It would rank 84th overall - between Estonia and Lithuania.
He concluded that the carbon dioxide emission of laparoscopy in the United States has a significant environmental impact.
Presented by Karim A. Touijer, MD, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria
View EAU 2011 Annual Meeting Coverage
