Development of the environmental impact calculator for minimally invasive cholecystectomies
Minimally invasive cholecystectomies
This study will follow a multiphase, stepped approach to develop a sustainability calculator for minimally invasive cholecystectomy (MIC). The calculator is part of the Environmental Impact Calculator for Minimally Invasive Surgery (ECOMIS) project. The study protocol was developed in accordance with i) the PRISMA-P guidelines for literature reviews, ii) ACCORD guidelines for consensus studies, and iii) SPIRIT-Outcomes guidelines for reporting study outcomes. The present study consists of three main phases: calculator development, expert Delphi consensus survey, and external validation. Phase I: Literature review and variable selection A systematic literature review will be conducted to identify factors contributing to the CO2-eq of minimally invasive cholecystectomy. The review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. The primary search will be performed in the Healthcare Life Cycle Assessment (HealthcareLCA) database, a comprehensive and globally recognized repository for LCA studies in healthcare. A complementary literature review will be performed in Embase, PubMed and Google Scholar to identify potentially relevant studies not indexed in the HealthcareLCA database. The full search strategy will be provided as supplementary material. Studies published from database inception up to 01 April 2026 will be eligible for inclusion. Inclusion criteria comprise original studies performing an LCA of healthcare-related interventions, procedures, logistics, or equipment, reporting environmental impact as kilograms of carbon dioxide equivalents (CO2-eq). Environmental impact is defined as CO2-eq, as this is the most widely accepted and standardized metric for healthcare-related environmental assessments. Studies focusing on cholecystectomy-related procedures or equipment will be prioritized. Exclusion criteria include LCAs of non-medical interventions, non-human studies, studies lacking a clear LCA
The Delphi consensus study participants will be recruited through professional networks within the European Association for Endoscopic Surgery (EAES) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
1. Experts still in training or specialization 2. Lack of experience (<2 years) with minimally invasive cholecystectomies 3. Experts not involved in the medical care, logistical or product pathway of minimally invasive surgery