Background

Minimally invasive surgical (MIS) techniques are the gold standard for bariatric surgery. However, this comes at an environmental cost with a high carbon footprint. With climate change as an imminent global threat, this systematic literature review aims to elucidate the current carbon footprint of MIS and summarizes comprehensive sustainability initiatives relevant to bariatric surgery.

Methods

The systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, Ovid MEDLINE and Embase databases in addition to a manual search were utilized in the search strategy, looking at articles from 1980 to December 2023. The search strategy included carbon footprint, environmental sustainability, laparoscopy, robotic, MIS, and bariatric surgery. Two investigators independently performed abstract and full-text reviews.

Results

Of the 3927 abstracts identified, 16 articles were selected after appraisal based on relevance, inclusion, and exclusion criteria looking at both robotic and laparoscopic procedures. The most significant contributors to MIS carbon footprint were anesthetics, energy consumption, device packaging, and single-use surgical instruments such as surgical staplers and robotic surgery equipment.

Conclusions

Climate change is a public health crisis. There is a great paucity and need for scientific data published evaluating the environmental impact of bariatric surgery. From a surgical standpoint, targeted sustainability recommendations include surgical equipment procurement, lean operating room, energy use interventions, and waste reduction initiatives in collaboration with hospital stakeholders and medical technology industry.