Chan Kai Siang, Lo Hong Yee, Shelat Vishal G
Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore.
World J Gastrointest Surg. 2023 Jul 27;15(7):1277-1285. doi: 10.4240/wjgs.v15.i7.1277.
Advancements in technology and surgical training programs have increased the adaptability of minimally invasive surgery (MIS). Gastrointestinal MIS is superior to its open counterparts regarding post-operative morbidity and mortality. MIS has become the first-line surgical intervention for some types of gastrointestinal surgery, such as laparoscopic cholecystectomy and appendicectomy. Carbon dioxide (CO) is the main gas used for insufflation in MIS. CO contributes 9%-26% of the greenhouse effect, resulting in global warming. The rise in global CO concentration since 2000 is about 20 ppm per decade, up to 10 times faster than any sustained rise in CO during the past 800000 years. Since 1970, there has been a steady yet worrying increase in average global temperature by 1.7 °C per century. A recent systematic review of the carbon footprint in MIS showed a range of 6-814 kg of CO emission per surgery, with higher CO emission following robotic compared to laparoscopic surgery. However, with superior benefits of MIS over open surgery, this poses an ethical dilemma to surgeons. A recent survey in the United Kingdom of 130 surgeons showed that the majority (94%) were concerned with climate change but felt that the lack of leadership was a barrier to improving environmental sustainability. Given the deleterious environmental effects of MIS, this study aims to summarize the trends of MIS and its carbon footprint, awareness and attitudes towards this issue, and efforts and challenges to ensuring environmental sustainability.
技术和外科培训项目的进步提高了微创手术（MIS）的适应性。在术后发病率和死亡率方面，胃肠道微创手术优于传统开放手术。对于某些类型的胃肠道手术，如腹腔镜胆囊切除术和阑尾切除术，微创手术已成为一线手术干预方式。二氧化碳（CO₂）是微创手术中用于气腹的主要气体。CO₂对温室效应的贡献率为9%-26%，导致全球变暖。自2000年以来，全球CO₂浓度每十年上升约20 ppm，比过去80万年中CO₂的任何持续上升速度快10倍。自1970年以来，全球平均气温以每世纪1.7℃的速度稳步且令人担忧地上升。最近一项关于微创手术碳足迹的系统评价显示，每次手术的CO₂排放量在6-814千克之间，机器人手术的CO₂排放量高于腹腔镜手术。然而，由于微创手术比开放手术具有更大的优势，这给外科医生带来了伦理困境。最近在英国对130名外科医生进行的一项调查显示，大多数（94%）医生关注气候变化，但认为缺乏领导力是改善环境可持续性的障碍。鉴于微创手术对环境的有害影响，本研究旨在总结微创手术的发展趋势及其碳足迹、对该问题的认识和态度，以及确保环境可持续性的努力和挑战。
