Munster L, van der Zwet B, de Groof J, Mundt M, van Ruler O, D'Haens G, Bemelman W, Buskens C, Duijvestein M, Stobernack T, van der Bilt J
Department of Surgery, Flevoziekenhuis, Almere, The Netherlands.
Department of Surgery, Amsterdam UMC (Location VUmc), Amsterdam, The Netherlands.
Tech Coloproctol. 2025 May 30;29(1):127. doi: 10.1007/s10151-025-03123-5.
The aim of this study was to assess the environmental impact, primarily the carbon footprint of the most common procedures in inflammatory bowel disease (IBD).
In this study, all processes and products used during a total of eight laparoscopic ileocecal resections (ICRs) in patients with Crohn's disease (CD), eight laparoscopic subtotal colectomies (STCs) for ulcerative colitis (UC), and eight ligation of the intersphincteric fistula tract (LIFT) procedures in patients with Crohn's perianal fistula (PAF) (all in adults ≥ 16 years) between March 2023 and May 2024 were collected. A life cycle assessment (LCA) was conducted, mean CO emission rates were calculated, the major contributors ("hotspots") were determined, and midpoint/endpoint analysis was performed.
The mean total carbon footprints of laparoscopic ICR, STC, and LIFT were, respectively, 104 kg, 116 kg, and 43.6 kg COeq, equaling one-way trips by airplane from Amsterdam to Paris, to Manchester, and to Düsseldorf, respectively. The main contributors in laparoscopic ICR and STC were transport of employees and patients (48% and 49%, respectively), energy use in the theater (21% and 27%, respectively), and the use of surgical equipment (14% and 17%, respectively). In LIFT procedures, transport of employees/patients accounted for 47% of total emission rates, followed by the use of surgical equipment (28%), and electricity use in the theater (13%). Besides the impact on global warming, significant impact on fine particulate matter formation, land use, terrestrial acidification, and fossil resource scarcity was identified. Endpoint analysis showed an amount of disability-adjusted life years (DALYs) of approximately 2 h of health damage per laparoscopic ICR/STC and 47 min per LIFT.
The carbon footprint of three commonly performed IBD surgeries is mainly determined by transportation of patients/healthcare personnel, followed by electricity and material use. The latter two vary with the complexity of the surgeries. IBD surgeons should focus on minimizing energy resources and using standard surgical materials. Also, employees should be encouraged to travel by foot/bicycle/public transport/carpooling/electric car.
本研究的目的是评估环境影响，主要是炎症性肠病（IBD）最常见手术的碳足迹。
在本研究中，收集了2023年3月至2024年5月期间，对8例克罗恩病（CD）患者进行的腹腔镜回盲部切除术（ICR）、8例溃疡性结肠炎（UC）患者进行的腹腔镜次全结肠切除术（STC）以及8例克罗恩肛周瘘（PAF）患者进行的括约肌间瘘管结扎术（LIFT）（所有患者均为≥16岁的成年人）过程中使用的所有流程和产品。进行了生命周期评估（LCA），计算了平均二氧化碳排放率，确定了主要贡献者（“热点”），并进行了中点/终点分析。
腹腔镜ICR、STC和LIFT的平均总碳足迹分别为104千克、116千克和43.6千克二氧化碳当量，分别相当于从阿姆斯特丹到巴黎、到曼彻斯特和到杜塞尔多夫的单程飞机旅行。腹腔镜ICR和STC的主要贡献者是员工和患者的运输（分别为48%和49%）、手术室的能源使用（分别为21%和27%）以及手术设备的使用（分别为14%和17%）。在LIFT手术中，员工/患者的运输占总排放率的47%，其次是手术设备的使用（28%）和手术室的电力使用（13%）。除了对全球变暖的影响外，还发现了对细颗粒物形成、土地利用、陆地酸化和化石资源稀缺的重大影响。终点分析显示，每例腹腔镜ICR/STC的伤残调整生命年（DALY）约为2小时的健康损害，每例LIFT为47分钟。
三种常见的IBD手术的碳足迹主要由患者/医护人员的运输决定，其次是电力和材料的使用。后两者因手术的复杂性而异。IBD外科医生应专注于减少能源消耗并使用标准手术材料。此外，应鼓励员工步行/骑自行车/乘坐公共交通工具/拼车/驾驶电动汽车出行。
