The role of planetary health in urologic oncology

Figures & data

Figure 1. CO₂–emissions of healthcare sector divided into the major contributive factors [3].

CO₂ = carbon dioxide.

Figure 2. Carbon dioxide (CO₂) footprint of diagnostic imaging compared to the CO₂ footprint of driving a car in kilometers (km) [1,25].

MRI = Magnetic resonance imaging; CT = Computed tomography.

Table 1. Carbon footprint of reusable and single-use ureteroscopes in kilogram of carbon dioxide (kg CO₂) per case [8,70].

	Reusable ureteroscope [8,70]	Single-use ureteroscope [8,70]
Life cycle (per case)	4.47 kg CO2	4.43 kg CO2
Manufacturing (per case)	0.06 kg CO2	3.45 kg CO2

Table 2. Carbon footprint of reusable and single-use cystoscopes in kilogram of carbon dioxide (kg CO₂) per case or in kilogram (kg) per kg device for manufacturing [71].

	Reusable cystoscope [71]	Single-use cystoscope [71]
Manufacturing	11.49 kg CO2/kg device	8.54 kg CO2/kg device
Per case	0.53 kg CO2	2.4 kg CO2

Figure 3. Total carbon footprint of robot-assisted minimally invasive surgery, laparoscopic surgery and laparotomy in kilogram carbon dioxide equivalent (kg CO₂e) per patient [9].

Table 3. Carbon footprint compared between surgical approaches in kilogram carbon dioxide equivalent (kg CO₂e) [9].

	Total carbon footprint in kg CO2e/patient [9]	Solid waste In kg CO2e/patient [9]
Robot-assisted minimally invasive surgery	40.3	14.3
Laparoscopic surgery	29.2	11.24
Open surgery	22.7	8.3

Table 4. Carbon footprint of surgical treatment versus radiation therapy in kilogram carbon dioxide equivalent (kg CO₂e) per patient in the literature [9,79].

Surgical treatment [9]		Radiation therapy [79]
Robot-assisted minimally invasive procedure	40.3 kg CO2e/patient	Conventional radiation therapy	17.34 kg CO2e/patient
Laparoscopic surgery	29.2 kg CO2e/patient	Prostate SBRT	2.18 kg CO2e/patient
Open surgery	22.7 kg CO2e/patient

SBRT = stereotactic body radiation therapy.

Table 5. Recommendations for healthcare professionals and cancer patients to choose environmentally friendly options for action [1,3,7,8,18–20,25–27,29,49,50,70–72,80–82].

Recommendations for healthcare professionals	Recommendations for cancer patients	Recommendations for both
Avoid unnecessary blood tests [1,26]	Consider active modes of transport by increasing physical activity [7]	Consider environmentally friendly food choices [7,27]
Avoid unnecessary imaging [1,25]	Reduce tobacco use [7,29]	Consider telemedicine/virtual consultations [80]
Shortening length of inpatient stay [82]	Consider care for patients close to home [80–82]
Using reusable and energy-efficient surgical devices [8,70–72]
Consider active surveillance concepts/conservative procedures [49,50]
Review local manufacturing of drugs [81]
Reduce general waste and water consumption [18,19]
Participate in climate change task forces [3]
Increase use of renewable energy that is generated on-site [18–20]

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