{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T20:54:37Z","timestamp":1783457677036,"version":"3.55.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Adelaide University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Robotic Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Robotic surgery represents a major paradigm shift in surgical care, delivering significant improvements in precision, ergonomics, and postoperative patient outcomes. However, the rapid global proliferation of these systems necessitates a critical evaluation of their environmental sustainability. The healthcare sector, particularly within hospital operating theatres, is already a highly resource-intensive environment contributing substantially to national greenhouse gas emissions. The integration of robotic platforms may further exacerbate this ecological footprint through energy-intensive console and robotic arm operations, high consumption of single-use instruments, complex waste streams, and significant upstream manufacturing emissions. Recent life-cycle assessments indicate that robotic systems draw approximately 3.5\u00a0kW during operation, generating roughly 4\u00a0kg of CO\u2082 per hour. This is markedly higher than the 0.6\u00a0kW and 1\u00a0kg of CO\u2082 per hour associated with conventional laparoscopic equipment. This commentary piece aims to highlight these environmental realities for surgeons and key stakeholders. We do not advocate for the abandonment of robotic surgery, as its clinical benefits remain high. Rather, we issue a call for responsible environmental stewardship and innovation toward ecologically sustainable robotic platforms and components that maintain clinical excellence while mitigating planetary harm.<\/jats:p>","DOI":"10.1007\/s11701-026-03419-0","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T02:29:06Z","timestamp":1776738546000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Environmental stewardship and robotic surgery: innovation without compromise"],"prefix":"10.1007","volume":"20","author":[{"given":"Mathew O.","family":"Jacob","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin J.","family":"Carmichael","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noor","family":"Naqeeb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua G.","family":"Kovoor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kingsley W.","family":"Faulkner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"3419_CR1","doi-asserted-by":"publisher","unstructured":"Rojas Burbano JC, Ruiz NI, Rojas Burbano GA, Guacho Inca JS, Arragan Lezama CA, Gonz\u00e1lez MS Robot-Assisted Surgery: Current Applications and Future Trends in General Surgery. Cureus 17(4):e82318. https:\/\/doi.org\/10.7759\/cureus.82318. PubMed PMID: 40376327; PubMed Central PMCID: PMC12080974.","DOI":"10.7759\/cureus.82318"},{"key":"3419_CR2","doi-asserted-by":"publisher","unstructured":"Reddy K, Gharde P, Tayade H, Patil M, Reddy LS, Surya D Advancements in Robotic Surgery: A Comprehensive Overview of Current Utilizations and Upcoming Frontiers. Cureus 15(12):e50415. https:\/\/doi.org\/10.7759\/cureus.50415. PubMed PMID: 38222213; PubMed Central PMCID: PMC10784205.","DOI":"10.7759\/cureus.50415"},{"issue":"1","key":"3419_CR3","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.1016\/S2542-5196(17)30180-8","volume":"2","author":"A Malik","year":"2018","unstructured":"Malik A, Lenzen M, McAlister S, McGain F (2018) The carbon footprint of Australian health care. Lancet Planet Health 2(1):e27\u201335 https:\/\/doi.org\/10.1016\/S2542-5196(17)30180-8. PubMed PMID: 29615206","journal-title":"Lancet Planet Health"},{"key":"3419_CR4","doi-asserted-by":"publisher","unstructured":"Eames I, Symons A, Wilson D, Rawas Kalaji Y, Muirhead L, Groome J Towards NetZero for hospital operating theatres. J R Soc Interface 22(230):20250048. https:\/\/doi.org\/10.1098\/rsif.2025.0048. PubMed PMID: 40925553; PubMed Central PMCID: PMC12419882.","DOI":"10.1098\/rsif.2025.0048"},{"key":"3419_CR5","doi-asserted-by":"publisher","first-page":"100407","DOI":"10.1016\/j.lanwpc.2022.100407","volume":"22","author":"RX Qin","year":"2022","unstructured":"Qin RX, Velin L, Yates EF, El Omrani O, McLeod E, Tudravu J et al (2022) Building sustainable and resilient surgical systems: A narrative review of opportunities to integrate climate change into national surgical planning in the Western Pacific region. Lancet Reg Health - West Pac 22:100407. https:\/\/doi.org\/10.1016\/j.lanwpc.2022.100407","journal-title":"Lancet Reg Health - West Pac"},{"issue":"6","key":"3419_CR6","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1097\/SLA.0000000000003951","volume":"272","author":"C Rizan","year":"2020","unstructured":"Rizan C, Steinbach I, Nicholson R, Lillywhite R, Reed M, Bhutta MF (2020) The Carbon Footprint of Surgical Operations: A Systematic Review. Ann Surg 272(6):986\u2013995 .0000000000003951. PubMed PMID: 32516230","journal-title":"Ann Surg"},{"issue":"2","key":"3419_CR7","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1038\/s41391-023-00672-4","volume":"27","author":"A Fuschi","year":"2024","unstructured":"Fuschi A, Pastore AL, Al Salhi Y, Martoccia A, De Nunzio C, Tema G et al (2024) The impact of radical prostatectomy on global climate: a prospective multicentre study comparing laparoscopic versus robotic surgery. Prostate Cancer Prostatic Dis 27(2):272\u2013278. https:\/\/doi.org\/10.1038\/s41391-023-00672-4","journal-title":"Prostate Cancer Prostatic Dis"},{"issue":"1","key":"3419_CR8","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1007\/s11701-025-02637-2","volume":"19","author":"P Planellas","year":"2025","unstructured":"Planellas P, Cornejo L, Dingelyte J, Sambrano D, Fern\u00e1ndez FA, Luquin J et al (2025) A comparative analysis of the carbon footprint in minimally invasive colorectal surgery: laparoscopic versus robotic\u2014the coloprint pilot study. J Robot Surg 19(1):487. https:\/\/doi.org\/10.1007\/s11701-025-02637-2","journal-title":"J Robot Surg"},{"issue":"5","key":"3419_CR9","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1007\/s13304-025-02221-1","volume":"77","author":"MF Cunha","year":"2025","unstructured":"Cunha MF, Neves JC, Roseira J, Pellino G, Castelo-branco P (2025) Green surgery: a systematic review of the environmental impact of laparotomy, laparoscopy, and robotics. Updat Surg 77(5):1683\u20131692. https:\/\/doi.org\/10.1007\/s13304-025-02221-1","journal-title":"Updat Surg"},{"issue":"10","key":"3419_CR10","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1093\/bjs\/znac191","volume":"109","author":"A Papadopoulou","year":"2022","unstructured":"Papadopoulou A, Kumar NS, Vanhoestenberghe A, Francis NK (2022) Environmental sustainability in robotic and laparoscopic surgery: systematic review. BJS 109(10):921\u2013932. https:\/\/doi.org\/10.1093\/bjs\/znac191","journal-title":"BJS"},{"key":"3419_CR11","doi-asserted-by":"publisher","unstructured":"Akashi Y, Enomoto T, Shikama A, Ichimura H, Ogawa K, Owada Y et al (2025 Nov) Assessing the carbon footprint of surgical materials: a comparative study of open, endoscopic, and robotic approaches in four major operations. Surg Endosc 21. https:\/\/doi.org\/10.1007\/s00464-025-12390-0","DOI":"10.1007\/s00464-025-12390-0"},{"issue":"1","key":"3419_CR12","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s11701-025-02278-5","volume":"19","author":"G Tjahyadi","year":"2025","unstructured":"Tjahyadi G, Treacy PJ, Alexander K, Bird J, Karunaratne S, Leslie S et al (2025) The environmental impact of multi-specialty robotic-assisted surgery: a waste audit analysis. J Robot Surg 19(1):113. https:\/\/doi.org\/10.1007\/s11701-025-02278-5","journal-title":"J Robot Surg"},{"issue":"2","key":"3419_CR13","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1017\/ice.2016.249","volume":"38","author":"Y Saito","year":"2017","unstructured":"Saito Y, Yasuhara H, Murakoshi S, Komatsu T, Fukatsu K, Uetera Y (2017) Challenging Residual Contamination of Instruments for Robotic Surgery in Japan. Infect Control Hosp Epidemiol 38(2):143\u2013146. https:\/\/doi.org\/10.1017\/ice.2016.249. PubMed PMID: 27795211","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"4","key":"3419_CR14","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/j.jhin.2016.04","volume":"93","author":"Y Saito","year":"2016","unstructured":"Saito Y, Yasuhara H, Murakoshi S, Komatsu T, Fukatsu K, Uetera Y (2016) Novel concept of cleanliness of instruments for robotic surgery. J Hosp Infect 93(4):360\u2013361. https:\/\/doi.org\/10.1016\/j.jhin.2016.04.009. PubMed PMID: 27177694","journal-title":"J Hosp Infect"},{"issue":"1","key":"3419_CR15","doi-asserted-by":"publisher","first-page":"e132","DOI":"10.1017\/ash.2025.186","volume":"5","author":"SS Doerstling","year":"2025","unstructured":"Doerstling SS, Fox PM, Salinas JL, Sampson MM (2025) Striking a balance: strategies for addressing single-use surgical equipment in infection prevention. Antimicrob Steward Healthc Epidemiol ASHE 5(1):e132. https:\/\/doi.org\/10.1017\/ash.2025.186. PubMed PMID: 40567397; PubMed Central PMCID: PMC12188274","journal-title":"Antimicrob Steward Healthc Epidemiol ASHE"},{"issue":"4","key":"3419_CR16","doi-asserted-by":"publisher","first-page":"e0300355","DOI":"10.1371\/journal.pone.0300355","volume":"19","author":"RJ Pelzer","year":"2024","unstructured":"Pelzer RJ, van der Zwet WC, Eggen MMEG, Beard A, Savelkoul PHM, Dirks JAMC (2024) Evaluation of microbial occurrence in reusable robotic instruments for minimally invasive surgery: A pilot study. PLoS ONE 19(4):e0300355. https:\/\/doi.org\/10.1371\/journal.pone.0300355. PubMed PMID: 38573892; PubMed Central PMCID: PMC10994333","journal-title":"PLoS ONE"},{"issue":"8","key":"3419_CR17","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1001\/jama","volume":"320","author":"CP Childers","year":"2018","unstructured":"Childers CP, Maggard-Gibbons M (2018) Estimation of the Acquisition and Operating Costs for Robotic Surgery. JAMA 320(8):835\u2013836. https:\/\/doi.org\/10.1001\/jama.2018.9219. PubMed PMID: 30167686; PubMed Central PMCID: PMC6142989","journal-title":"JAMA"},{"issue":"5","key":"3419_CR18","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1007\/s11701-023-01618-7","volume":"17","author":"SW Wong","year":"2023","unstructured":"Wong SW, Crowe P (2023) Visualisation ergonomics and robotic surgery. J Robot Surg 17(5):1873\u20131878. https:\/\/doi.org\/10.1007\/s11701-023-01618-7. PubMed PMID: 37204648; PubMed Central PMCID: PMC10492791","journal-title":"J Robot Surg"},{"key":"3419_CR19","doi-asserted-by":"publisher","unstructured":"Rivero-Moreno Y, Echevarria S, Vidal-Valderrama C, Pianetti L, Cordova-Guilarte J, Navarro-Gonzalez J et al Robotic Surgery: A Comprehensive Review of the Literature and Current Trends. Cureus 15(7):e42370. https:\/\/doi.org\/10.7759\/cureus.42370. PubMed PMID: 37621804; PubMed Central PMCID: PMC10445506.","DOI":"10.7759\/cureus.42370"},{"key":"3419_CR20","doi-asserted-by":"publisher","unstructured":"Rafaih AB, Ari K Sustainability in Surgery: Problems, Solutions, and Recommendations. Cureus 17(10):e94010. https:\/\/doi.org\/10.7759\/cureus.94010. PubMed PMID: 41209917; PubMed Central PMCID: PMC12590301.","DOI":"10.7759\/cureus.94010"},{"issue":"1","key":"3419_CR21","doi-asserted-by":"publisher","first-page":"6","DOI":"10.3390\/recycling7010006","volume":"7","author":"K Kooduvalli","year":"2022","unstructured":"Kooduvalli K, Unser J, Ozcan S, Vaidya UK (2022) Embodied Energy in Pyrolysis and Solvolysis Approaches to Recycling for Carbon Fiber-Epoxy Reinforced Composite Waste Streams. Recycling 7(1):6. https:\/\/doi.org\/10.3390\/recycling7010006","journal-title":"Recycling"},{"issue":"2","key":"3419_CR22","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1016\/j.cirp.2024.06.002","volume":"73","author":"T Sakao","year":"2024","unstructured":"Sakao T, Bocken N, Nasr N, Umeda Y (2024) Implementing circular economy activities in manufacturing for environmental sustainability. CIRP Ann 73(2):457\u2013481. https:\/\/doi.org\/10.1016\/j.cirp.2024.06.002","journal-title":"CIRP Ann"},{"issue":"1","key":"3419_CR23","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s40942-020-00215-2","volume":"6","author":"JD Grodsky","year":"2020","unstructured":"Grodsky JD, Theophanous CN, Schechet SA, Veldman PB, Hariprasad SM (2020) Reducing instruments in a vitrectomy surgical tray: cost savings and results from a major academic hospital. Int J Retina Vitr 6(1):12. https:\/\/doi.org\/10.1186\/s40942-020-00215-2","journal-title":"Int J Retina Vitr"},{"issue":"7","key":"3419_CR24","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1177\/000313481307900708","volume":"79","author":"BA Wormer","year":"2013","unstructured":"Wormer BA, Augenstein VA, Carpenter CL, Burton PV, Yokeley WT, Prabhu AS et al (2013) The Green Operating Room: Simple Changes to Reduce Cost and Our Carbon Footprint. Am Surg 79(7):666\u2013671. https:\/\/doi.org\/10.1177\/000313481307900708","journal-title":"Am Surg"},{"issue":"2","key":"3419_CR25","doi-asserted-by":"publisher","first-page":"103215","DOI":"10.1016\/j.cpcardiol.2025.103215","volume":"51","author":"IMF Al-Shahwani","year":"2026","unstructured":"Al-Shahwani IMF, Nawwar DAA (2026) Reducing carbon emissions through remote patient interview: A quality improvement initiative. Curr Probl Cardiol 51(2):103215. https:\/\/doi.org\/10.1016\/j.cpcardiol.2025.103215. PubMed PMID: 41297648","journal-title":"Curr Probl Cardiol"},{"key":"3419_CR26","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.2147\/RMHP.S415989","volume":"16","author":"M Meissner","year":"2023","unstructured":"Meissner M, Hafermann J, Silas U, Saunders R (2023) Evaluating the Environmental Impact of Single-Use and Multi-Use Surgical Staplers with Staple Line Buttressing in Laparoscopic Bariatric Surgery. Risk Manag Healthc Policy 16:1423\u20131433. PubMed PMID: 37560134; PubMed Central PMCID: PMC10408667","journal-title":"Risk Manag Healthc Policy"},{"issue":"1","key":"3419_CR27","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1038\/s41591-023-02732-7","volume":"30","author":"HJ Marcus","year":"2024","unstructured":"Marcus HJ, Ramirez PT, Khan DZ, Layard Horsfall H, Hanrahan JG, Williams SC et al (2024) The IDEAL framework for surgical robotics: development, comparative evaluation and long-term monitoring. Nat Med 30(1):61\u201375. https:\/\/doi.org\/10.1038\/s41591-023-02732-7","journal-title":"Nat Med"},{"issue":"1","key":"3419_CR28","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.jacceco.2018.02.001","volume":"66","author":"R Zhong","year":"2018","unstructured":"Zhong R, Irene (2018) Transparency and firm innovation. J Acc Econ 66(1):67\u201393. https:\/\/doi.org\/10.1016\/j.jacceco.2018.02.001","journal-title":"J Acc Econ"},{"key":"3419_CR29","doi-asserted-by":"publisher","unstructured":"Liao H, Lyon CJ, Ying B, Hu T Climate change, its impact on emerging infectious diseases and new technologies to combat the challenge. Emerg Microbes Infect 13(1):2356143. https:\/\/doi.org\/10.1080\/22221751.2024.2356143. PubMed PMID: 38767202; PubMed Central PMCID: PMC11138229.","DOI":"10.1080\/22221751.2024.2356143"},{"key":"3419_CR30","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1186\/s13031-025-00707-8","volume":"19","author":"ME Lasater","year":"2025","unstructured":"Lasater ME, Prager G, Choi YA, Groteclaes T, Rao D, Kamps SP et al (2025) Understanding relationships among climate change, conflict, migration\/displacement and health in humanitarian settings: a scoping review. Confl Health 19:73. https:\/\/doi.org\/10.1186\/s13031-025-00707-8. PubMed PMID: 41084022; PubMed Central PMCID: PMC12519749","journal-title":"Confl Health"},{"issue":"1","key":"3419_CR31","doi-asserted-by":"publisher","first-page":"7","DOI":"10.31486\/toj.23","volume":"23","author":"K Conrad","year":"2023","unstructured":"Conrad K (2023) The Era of Climate Change Medicine\u2014Challenges to Health Care Systems. Ochsner J 23(1):7\u20138. https:\/\/doi.org\/10.31486\/toj.23.5033. PubMed PMID: 36936481; PubMed Central PMCID: PMC10016220","journal-title":"Ochsner J"}],"container-title":["Journal of Robotic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03419-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11701-026-03419-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03419-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:27:20Z","timestamp":1781648840000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11701-026-03419-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3419"],"URL":"https:\/\/doi.org\/10.1007\/s11701-026-03419-0","relation":{},"ISSN":["1863-2491"],"issn-type":[{"value":"1863-2491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]},"assertion":[{"value":"6 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"442"}}