. 2024 Oct;38(10):5483-5504.

doi: 10.1007/s00464-024-11141-x. Epub 2024 Aug 22.

Scoping review for the SAGES EAES joint collaborative on sustainability in surgical practice

Bright Huo¹, M M M Eussen^{2

3}, Stefania Marconi^{4

5}, Shaneeta M Johnson⁶, Nader Francis⁷, Wendelyn M Oslock^{8

9}, Nana Marfo¹⁰, Oleksii Potapov¹¹, Ricardo J Bello¹², Robert B Lim¹³, Jonathan Vandeberg¹⁴, Ryan P Hall¹⁵, Adnan Alseidi M D EdM¹⁶, Manuel Sanchez-Casalongue¹⁷, Yewande R Alimi¹⁸, Andrea Pietrabissa¹⁹, Alberto Arezzo²⁰, Maximos Frountzas²¹, Vittoria Bellato²², Paul Barach^{23

24}, Miran Rems²⁵, Sheetal Nijihawan²⁶, Tejas S Sathe¹⁵, Benjamin Miller²⁷, Sarah Samreen²⁸, Jimmy Chung^{2

3

29}, N D Bouvy^{29

30}, Patricia Sylla³⁰

Affiliations

¹ Department of General Surgery, McMaster University, Ontario, CA, USA.
² Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
³ NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
⁴ Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy.
⁵ IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
⁶ Department of Surgery, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA. smjohnsonmd@aol.com.
⁷ Griffin Institute, London, UK.
⁸ Department of Surgery, University of Alabama Birmingham, Birmingham, AL, USA.
⁹ Department of Quality, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
¹⁰ Department of General Surgery, College of Medicine, University of Rzeszow, Rzeszow, Poland.
¹¹ Ross University School of Medicine, Miramar, FL, USA.
¹² Department of Surgery, Medical College of Wisconsin, Milwaukee, NC, USA.
¹³ Department of Surgery, Atrium Carolinas Medical Center, Wake Forest University, Charlotte, USA.
¹⁴ Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
¹⁵ Department of Surgery, Tufts Medical Center, Boston, USA.
¹⁶ Department of Surgery, University of California San Francisco, San Francisco, USA.
¹⁷ Department of Surgery, Clinica San Camilo, Buenos Aires, Argentina.
¹⁸ Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.
¹⁹ Department of General Surgery, University of Pavia, Pavia, Italy.
²⁰ Department of Surgical Sciences, University of Turin, Turin, Italy.
²¹ First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
²² Department of Minimally Invasive Surgery, University Hospital of Rome Tor Vergata, Rome, Italy.
²³ Thomas Jefferson University School of Medicine, Philadelphia, USA.
²⁴ Department of General Surgery, Imperial College London, London, UK.
²⁵ Department of General and Abdominal Surgery, General Hospital Jesenice, Jesenice, Slovenia.
²⁶ Department of Surgery, Sharon Regional Medical Center, Sharon, PA, USA.
²⁷ Cleveland Clinic Foundation, Cleveland, OH, USA.
²⁸ Division of Minimally Invasive Surgery, University of Texas Medical Branch, Galveston, TX, USA.
²⁹ Adventus Health Partners, Cincinnati, OH, USA.
³⁰ Division of Colon and Rectal Surgery, Mount Sinai Health System, New York, NY, USA.

PMID: 39174709
PMCID: PMC11458728
DOI: 10.1007/s00464-024-11141-x

Scoping review for the SAGES EAES joint collaborative on sustainability in surgical practice

Bright Huo et al. Surg Endosc. 2024 Oct.

. 2024 Oct;38(10):5483-5504.

doi: 10.1007/s00464-024-11141-x. Epub 2024 Aug 22.

Authors

Affiliations

¹ Department of General Surgery, McMaster University, Ontario, CA, USA.
² Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
³ NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
⁴ Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy.
⁵ IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
⁶ Department of Surgery, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA, 30310, USA. smjohnsonmd@aol.com.
⁷ Griffin Institute, London, UK.
⁸ Department of Surgery, University of Alabama Birmingham, Birmingham, AL, USA.
⁹ Department of Quality, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
¹⁰ Department of General Surgery, College of Medicine, University of Rzeszow, Rzeszow, Poland.
¹¹ Ross University School of Medicine, Miramar, FL, USA.
¹² Department of Surgery, Medical College of Wisconsin, Milwaukee, NC, USA.
¹³ Department of Surgery, Atrium Carolinas Medical Center, Wake Forest University, Charlotte, USA.
¹⁴ Department of Surgery, Mayo Clinic Florida, Jacksonville, FL, USA.
¹⁵ Department of Surgery, Tufts Medical Center, Boston, USA.
¹⁶ Department of Surgery, University of California San Francisco, San Francisco, USA.
¹⁷ Department of Surgery, Clinica San Camilo, Buenos Aires, Argentina.
¹⁸ Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.
¹⁹ Department of General Surgery, University of Pavia, Pavia, Italy.
²⁰ Department of Surgical Sciences, University of Turin, Turin, Italy.
²¹ First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
²² Department of Minimally Invasive Surgery, University Hospital of Rome Tor Vergata, Rome, Italy.
²³ Thomas Jefferson University School of Medicine, Philadelphia, USA.
²⁴ Department of General Surgery, Imperial College London, London, UK.
²⁵ Department of General and Abdominal Surgery, General Hospital Jesenice, Jesenice, Slovenia.
²⁶ Department of Surgery, Sharon Regional Medical Center, Sharon, PA, USA.
²⁷ Cleveland Clinic Foundation, Cleveland, OH, USA.
²⁸ Division of Minimally Invasive Surgery, University of Texas Medical Branch, Galveston, TX, USA.
²⁹ Adventus Health Partners, Cincinnati, OH, USA.
³⁰ Division of Colon and Rectal Surgery, Mount Sinai Health System, New York, NY, USA.

PMID: 39174709
PMCID: PMC11458728
DOI: 10.1007/s00464-024-11141-x

Abstract

Background: Surgical care in the operating room (OR) contributes one-third of the greenhouse gas (GHG) emissions in healthcare. The European Association of Endoscopic Surgery (EAES) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) initiated a joint Task Force to promote sustainability within minimally invasive gastrointestinal surgery.

Methods: A scoping review was conducted by searching MEDLINE via Ovid, Embase via Elsevier, Cochrane Central Register of Controlled Trials, and Scopus on August 25th, 2023 to identify articles reporting on the impact of gastrointestinal surgical care on the environment. The objectives were to establish the terminology, outcome measures, and scope associated with sustainable surgical practice. Quantitative data were summarized using descriptive statistics.

Results: We screened 22,439 articles to identify 85 articles relevant to anesthesia, general surgical practice, and gastrointestinal surgery. There were 58/85 (68.2%) cohort studies and 12/85 (14.1%) Life Cycle Assessment (LCA) studies. The most commonly measured outcomes were kilograms of carbon dioxide equivalents (kg CO₂eq), cost of resource consumption in US dollars or euros, surgical waste in kg, water consumption in liters, and energy consumption in kilowatt-hours. Surgical waste production and the use of anesthetic gases were among the largest contributors to the climate impact of surgical practice. Educational initiatives to educate surgical staff on the climate impact of surgery, recycling programs, and strategies to restrict the use of noxious anesthetic gases had the highest impact in reducing the carbon footprint of surgical care. Establishing green teams with multidisciplinary champions is an effective strategy to initiate a sustainability program in gastrointestinal surgery.

Conclusion: This review establishes standard terminology and outcome measures used to define the environmental footprint of surgical practices. Impactful initiatives to achieve sustainability in surgical practice will require education and multidisciplinary collaborations among key stakeholders including surgeons, researchers, operating room staff, hospital managers, industry partners, and policymakers.

Keywords: Climate change; Greenhouse gas emissions; Minimally invasive surgery; Recycling; Surgical waste; Sustainability.

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Conflict of interest statement

Patricia Sylla is a consultant for Ethicon, Safeheal, Tissium, and Stryker. Nader Francis has consulted for Medtronic, Olympus, Applied Medical, Pharmacosmos and Fisher & Paykel Healthcare. Robert Lim is a consultant for Up-to-date. Shaneeta Johnson is a consultant for Baxter and Intuitive Surgical. Yewande Alimi is a consultant for Medtronic. Sheetal Nijihawan is a consultant for Smart SurgN. Benjamin Miller has research funding from the American Hernia Society. Drs. Bright Huo, M.M.M. Eussen, Stefania Marconi, Wendelyn M. Oslock, Nana Marfo, Oleksii Potapov, Ricardo J. Bello, Jonathan Vandeberg, Ryan P. Hall, Adnan Alseidi, Manuel Sanchez-Casalongue, Andrea Pietrabissa, Alberto Arezzo, Maximos Frountzas, Vittoria Bellatot, Paul Barach, Miran Rems, Sheetal Nijihhawan, Tejas S. Sathe, Benjamin Miller, Sarah Samreen, Jimmy Chung, and N.D. Bouvy have no conflicts of interest to disclose.

Figures

**Fig. 2**
Overview of life-cycle assessment

**Fig. 3.**
10R model of circular economy

**Fig. 4**
Study findings aligned with the 10R model

**Fig. 5**
Hierarchy of evidence for sustainability research in surgery

See this image and copyright information in PMC

References

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Scoping review for the SAGES EAES joint collaborative on sustainability in surgical practice

Affiliations

Scoping review for the SAGES EAES joint collaborative on sustainability in surgical practice

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Research Materials