67 ENVIRONMENTAL IMPACT OF MINIMALLY INVASIVE SURGERY IN THE UNITED STATES: AN ESTIMATE OF DIRECT AND INDIRECT CO2 FOOTPRINT (2011)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 201167 ENVIRONMENTAL IMPACT OF MINIMALLY INVASIVE SURGERY IN THE UNITED STATES: AN ESTIMATE OF DIRECT AND INDIRECT CO2 FOOTPRINT Nicholas Power, Jonathan Silberstein, Tarek Ghoneim, Bertrand Guillonneau, and Karim Touijer Nicholas PowerNicholas Power New York, NY More articles by this author , Jonathan SilbersteinJonathan Silberstein New York, NY More articles by this author , Tarek GhoneimTarek Ghoneim New York, NY More articles by this author , Bertrand GuillonneauBertrand Guillonneau New York, NY More articles by this author , and Karim TouijerKarim Touijer New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.131AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Minimally invasive surgery (MIS) has led to a paradigm shift in surgically treated conditions over the past 30 years. Carbon dioxide (CO2) is the principle gas used in these procedures for insufflation. The levels of CO2 emission are projected to be 250% increased in the year 2100 compared to baseline levels in 1750. Increase in CO2 production may lead to global warming due to the Greenhouse effect with potentially dire environmental consequences. The aim of this analysis is an attempt to quantitate the carbon footprint of MIS in order to identify its potential role in global warming in comparison to open surgery. METHODS The number of MIS procedures was determined from ICD-9 CM codes in the 2006 Nationwide Inpatient Sample collected by the Healthcare Cost and Utilization Project. Direct CO2 emissions are a result of CO2 gas that is used during MIS procedures for insufflation. Calculations were based on both escaping procedural CO2 and eliminated metabolic CO2 via respiration into the atmosphere. Indirect calculations used the Environment Input-Output Life-Cycle Assessment model and publicly available carbon emission calculators. Calculable processes prior to surgery were broadly categorized as CO2 capture/compression and transportation to hospitals. Post-procedure CO2 emissions were calculated relating to single use equipment unique to MIS (not used in open surgery). All other emissions were considered to be equivalent to open surgery for purposes of comparison. RESULTS There were 2,616,522 procedures included. The total number of hours of operative time was estimated at 2,961,498 that translated into 806,948 CO2 cylinders. The total CO2 direct emissions were 56.5 tons. The subtotal of CO2 emissions for industrial gas manufacturing, power generation and supply, and gas extraction was calculated as 1,862,700 tons. The overall CO2 emissions from MIS were estimated at 1,866,106.5 tons/year. While this totals only 0.4% of the entire calculated US healthcare carbon emission, it amounts 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. Still another way, MIS in the US 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. CONCLUSIONS The CO2 emission of MIS in the US has a significant environmental impact. This should be considered in larger strategies to reduce healthcare's carbon footprint while maximizing healthcare quality. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e29 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nicholas Power New York, NY More articles by this author Jonathan Silberstein New York, NY More articles by this author Tarek Ghoneim New York, NY More articles by this author Bertrand Guillonneau New York, NY More articles by this author Karim Touijer New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...