Fig. 2. Surgical carbon footprint.

Surgical environmental impact can be evaluated before, during and after surgery. Patient and staff transport is responsible for 18% of all health-care emissions. The diagnostic work-up before surgery accounts for a significant impact driven by CT scans, MRI and endoscopy. During surgery, there are multiple vectors to consider: water waste due to hand disinfection; anaesthetic gases are responsible for 40% of ‘surgical emissions’; operating theatre energy and temperature conditioning; disposable surgical linens; and single-use devices. Moreover, different surgical approaches have different carbon footprints. Data on hysterectomy show that laparotomy has a lesser carbon footprint, followed by laparoscopy and robotics. CO_2e, carbon dioxide equivalent.