Designing sustainable robotic surgery for NHS scale-up: direct electricity measurement and an implementation-ready energy mitigation bundle in colorectal cancer resections
S Lodhia, V Pegna, T RockallIntroduction
Robotic-assisted surgery is expanding across specialties due to advantages including instrument dexterity, depth perception and improved ergonomics. NHS England projections indicate rapid scale-up of robotic surgery to ∼500,000 robot-supported operations annually by 2035, with robotic assistance becoming the default for ∼90% of keyhole procedures. Operating theatres are a key focus for decarbonisation, and equipment energy demand represents an actionable lever. This study quantified electricity consumption for robotic versus laparoscopic cancer surgery, translating to an implementation-ready mitigation bundle to support robotic programme expansion while minimising avoidable energy use.
Methods
Electricity consumption on robotic and laparoscopic equipment was measured during colorectal cancer resections, capturing standby during setup/turnover, in-use during operating and out-of-hours standby. Readings were obtained during defined operating states, then modelled using prespecified setup, operative and clear-away durations based on local theatre workflow observations and published evidence of longer operative times associated with robotic colorectal surgery. Energy consumption, costs and annualised projections were calculated.
Results
Robotic equipment drew substantially higher power than laparoscopic stacks in both standby and in-use states. Robotic cases used over six times more electricity per operation than laparoscopic cases, driven by longer operative duration and higher system power. Out-of-hours standby for robotic components contributed materially to annual electricity use and cost.
Conclusions
Alongside clinical outcomes and productivity metrics, energy use and carbon implications should be incorporated into robotic surgery programme governance. Mitigations include routine measurement, standby power management within manufacturer constraints, theatre workflow optimisation and procurement standards aligned to sustainable operating theatre guidance.