A comparative analysis of the carbon footprint in minimally invasive colorectal surgery: laparoscopic versus robotic-the coloprint pilot study.

Climate change is a growing concern, and operating theaters are major contributors, generating up to one-third of hospital waste. The increasing use of minimally invasive surgical (MIS) techniques has further added to this environmental burden. While some studies have assessed the carbon footprint of various surgical procedures, a direct comparison between laparoscopic and robotic colorectal cancer surgery remains unexplored. The objective is to compare the environmental impact-expressed as the carbon footprint-of solid waste generated during colorectal cancer MIS, according to the surgical approach (laparoscopic vs. robotic). This cross-sectional observational pilot study was conducted at the Josep Trueta University Hospital of Girona between October 2024 and March 2025. A total of 24 patients were included. Solid surgical waste (SSW) was classified into two categories: Group I-II (non-hazardous) and Group III (hazardous) and measured. Standardized conversion factors were applied to calculate the associated carbon emissions. The total SSW generated was 461.30 kg, 267.05 kg (57.9%) from the robotic group and 194.25 kg (42.1%) from the laparoscopic group (p < 0.001). Mean CO₂ emissions were significantly higher in the robotic group than laparoscopic (p = 0.001). On multivariate analysis, robotic surgery was associated with higher SSW and CO₂ emissions (β = 0.49, p = 0.021). A 57.7% reduction in CO₂ emissions could be achieved by implementing less polluting waste disposal methods. Robotic colorectal surgery generates a higher carbon footprint than laparoscopic surgery, although both contribute significantly to environmental impact. These findings underscore the urgent need for sustainable waste management and recycling protocols in surgical practice.