Direct Carbon Dioxide Emissions in Robotic Lung Resection–Analysis of a Prospective Cohort

INTRODUCTION: Climate change is one of the most significant global health threats of the 21st century. Environmental concerns have led to increasing interest in reducing the carbon footprint of surgical procedures. However, there is a paucity of data evaluating direct carbon dioxide (CO2) emissions associated with robotic lung resection. This study aims to quantify direct CO2 emissions in robotic lung surgery. MATERIALS AND METHODS: Patients were identified from a prospectively maintained robotic thoracic database. Those undergoing either robotic segmentectomy or lobectomy for suspected or confirmed lung cancer from December 2017 to December 2022 were included. CO2 volume (liters; L) was used to calculate the weight (grams; g) of CO2 delivered into the chest cavity. Descriptive statistics were used to characterize CO2 utilization and linear regression was performed to identify factors associated with increased CO2 utilization. RESULTS: Of 528 patients identified, 421 had documented CO2 insufflation data and 90.97% (383/421) underwent either robotic segmentectomy or lobectomy. The mean weight of CO2 utilized was 756.52 (±409.86) g per patient and the weight of CO2 for the entire cohort was 0.29 metric tonnes. This is equivalent to a one-way flight from Toronto, Canada to Salt Lake City, USA. Segmentectomy, increased BMI, increased nodal harvest, and larger tumors were associated with reduced CO2 utilization. CONCLUSIONS: Direct CO2 emissions in robotic lung resection may be lower than previously assumed. While strategies to reduce CO2 utilization ought to be pursued, future studies should be aimed at establishing the optimal approach to mitigating the environmental impact of robotic lung resection.