Department of Surgery, University of Western Ontario, London, Ontario, Canada.
J Endourol. 2012 Dec;26(12):1639-44. doi: 10.1089/end.2012.0298. Epub 2012 Oct 16.
To attempt to quantitate the carbon footprint of minimally invasive surgery (MIS) through approximated scope 1 to 3 CO(2) emissions to identify its potential role in global warming.
To estimate national usage, we determined the number of inpatient and outpatient MIS procedures using International Classification of Diseases, ninth revision-clinical modification codes for all MIS procedures in a 2009 sample collected in national databases. Need for surgery was considered essential, and therefore traditional open surgery was used as the comparator. Scope 1 (direct) CO(2) emissions resulting from CO(2) gas used for insufflation were based on both escaping procedural CO(2) and metabolic CO(2) eliminated via respiration. Scopes 2 and 3 (indirect) emissions related to capture, compression, and transportation of CO(2) to hospitals and the disposal of single-use equipment not used in open surgery were calculated.
The total CO(2) emissions were calculated to be 355,924 tonnes/year. For perspective, if MIS in the United States was considered a country, it would rank 189 th on the United Nations 2008 list of countries' carbon emissions per year. Limitations include the inability to account for uncertainty using the various models and tools for approximating CO(2) emissions.
CO(2) emission of MIS in the United States may have a significant environmental impact. This is the first attempt to quantify CO(2) emissions related to MIS in the United States. Strategies for reduction, while maintaining high quality medical care, should be considered.
通过估算微创外科（MIS）范围 1 到 3 的二氧化碳排放量来量化其温室气体足迹，以确定其在全球变暖中的潜在作用。
为了估计全国的使用量，我们使用国际疾病分类第 9 版临床修正版（ICD-9-CM）的手术代码，从国家数据库中 2009 年收集的样本中确定了所有 MIS 手术的住院和门诊手术数量。我们认为手术是必要的，因此将传统的开放式手术作为对照。范围 1（直接）二氧化碳排放是基于用于充气的二氧化碳气体逸出的程序二氧化碳和通过呼吸排出的代谢二氧化碳。范围 2 和 3（间接）排放与捕获、压缩和运输二氧化碳到医院以及处置未在开放式手术中使用的一次性设备有关。
总二氧化碳排放量估计为 355924 吨/年。如果将美国的 MIS 视为一个国家，它在联合国 2008 年各国年碳排放量名单中排名第 189 位。局限性包括使用各种模型和工具估算二氧化碳排放量时无法考虑不确定性。
美国 MIS 的二氧化碳排放量可能对环境有重大影响。这是首次尝试量化美国 MIS 相关的二氧化碳排放量。应该考虑采取减少排放的策略，同时保持高质量的医疗服务。
