Challenge
Coronary artery bypass surgery is one of the most common operations worldwide, helping hundreds of thousands of patients each year with serious heart problems. There are different ways to perform this surgery: the traditional method using a heart-lung machine (CABG), a version performed without it (OPCAB), and a newer, minimally invasive robotic technique (RA-MIDCAB).
While most studies compare these surgeries based on patient recovery and healthcare costs, little is known about their environment impact. Given the significant energy, water, and disposable materials used in hospitals, it is vital to understand how surgical practices contribute to pollution and resource consumption. This study aimed to fill that gap by comparing the environmental footprint of these three coronary artery bypass techniques—and offering new insight into sustainable healthcare.
Approach
In collaboration with UMC Utrecht, we assessed the environmental impact of CABG, OPCAB, and RA-MIDCAB using a life cycle assessment (LCA). For each technique, we analyzed everything involved in the operation—from instruments and chemicals to electricity use, water consumption, and waste generation. The analysis was limited to the surgery itself, from the patient’s entry into the operating room until the procedure’s end. Common items used across all surgeries, such as gloves and masks, were excluded.
LCA, widely used in manufacturing and product design, is increasingly being applied in healthcare to support more environmentally responsible choices.
Results
CABG had the highest environmental impact, primarily due to its reliance on the heart-lung machine, which requires many single-use plastic components and consumes considerable energy and water.
OPCAB showed a moderate impact by eliminating the heart-lung machine, though it still involves open-chest surgery and substantial material use.
RA-MIDCAB had the lowest footprint. Its minimally invasive nature reduced the need for disposable instruments and energy. However, the environmental impact of robotic systems themselves, including their energy demands and specialized equipment, warrants further research.
Across all methods, sterilisation of reusable instruments emerged as a significant contributor to overall environmental burden.
This study demonstrates that surgical technique matters not only for patients but also for the planet. Choosing approaches that reduce waste and resource use can help hospitals deliver high-quality care while aligning with climate goals.
Beyond surgical technique, broader sustainability strategies—such as optimizing cleaning processes, minimizing disposables, and transitioning to renewable energy—offer promising pathways for greener operating rooms.
As the healthcare sector confronts its climate responsibilities, studies like this help broaden the definition of “health”—to include the wellbeing of both people and the planet.
