The carbon footprint of a laparoscopic cholecystectomy.

BACKGROUND: Gallbladder removal is one of the most common surgical procedures worldwide. The keyhole operation treats patients with symptomatic gallstones. This procedure uses many single-use tools and results in a lot of waste. Before we can make this operation more sustainable, we need to assess the amount of waste and CO2 emissions. AIM: The aim of this study was to identify the types of waste and measure the CO2 emissions created by a gallbladder removal. METHOD: We collected waste from 15 gallbladder operations at three hospitals. We noted the medications used and measured the surgery duration to estimate electricity consumption. We also asked all the staff how they travelled to the hospital that day. FINDINGS AND CONCLUSION: The operation produces about 56.5 kg of CO2. The main sources of CO2 are single-use tools, packaging materials and disposable drapes and gowns. This study helps us understand where most CO2 is produced, so we can work on reducing it more effectively.^ieng

A systematic review on the detection of volatile organic compounds in exhaled breath in experimental animals in the context of gastrointestinal and hepatic diseases.

BACKGROUND: Analysis of volatile organic compounds (VOCs) in exhaled breath has the potential to serve as an accurate diagnostic tool for gastro-intestinal diseases. Animal studies could be instrumental as a preclinical base and subsequent clinical translation to humans, as they are easier to standardize and better equipped to relate specific VOCs to metabolic and pathological processes. This review provides an overview of the study design, characteristics and methodological quality of previously published animal studies on analysis of exhaled breath in gastrointestinal and hepatic diseases. Guidelines are provided for standardization in study design and breath collection methods to improve comparability, avoid duplication of research and reduce discomfort of animals in future studies. METHODS: PubMed and Embase database were searched for animal studies using exhaled breath analysis to detect gastro-intestinal diseases. Risk of bias was assessed using the SYRCLE's risk of bias tool for animal studies. Information on study design, standardization methods, animal models, breath collection methods and identified VOCs were extracted from the included studies. RESULTS: 10 studies were included (acute liver failure n = 1, non-alcoholic steatohepatitis n = 1, hepatic ischemia n = 2, mesenteric ischemia n = 2, sepsis and peritonitis n = 3, colitis n = 1). Rats were used in most of the studies. Exhaled breath was mostly collected using invasive procedures as tracheal cannulation or tracheostomy. Poor reporting on standardization, breath collection methods, analytical techniques, as well as heterogeneity of the studies, complicate comparison of the different studies. CONCLUSION: Poor reporting of essential methodological details impaired comprehensive summarizing the various studies on exhaled breath in gastrointestinal and hepatic diseases. Potential pitfalls in study design, and suggestions for improvement of study design are discussed which, when applied, lead to consistent and generalizable results and a reduction in the use of laboratory animals. Refining the methodological quality of animal studies has the potential to improve subsequent clinical trial design.