OTSR - 2026-05-04 - Journal Article
From cadavers to virtual reality: a carbon footprint analysis of surgical simulation for lumbar spine surgery.
Chatelain LS, Blanié A, Ferrero E, Khalifé M, Lafage R, Benhamou D, Lafage V
Topics
Key Takeaway
Cadaveric simulation carries the highest carbon footprint at 244.0 ± 48.8 kg CO₂e per use, approximately 3,500-fold greater than a single VR simulation session (0.07 ± 0.01 kg CO₂e).
Summary Depth
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Summary
This study quantified the carbon footprint of six simulator categories used in lumbar spine surgery training using Life Cycle Assessment (LCA) per ISO 14040 standards with OpenLCA software, conducted in Paris in January 2025. Cadavers (244.0 ± 48.8 kg CO₂e) and porcine models (223.0 ± 44.6 kg CO₂e) produced the greatest emissions, while screen-based and VR simulators produced 0.07 ± 0.01 kg CO₂e per simulation. Simulator production and instrument sterilization accounted for the majority of emissions across all categories.
Key Limitation
The analysis is geographically constrained to Paris, France, meaning energy grid carbon intensity, sterilization protocols, and cadaver procurement pathways — all major emission drivers — will differ substantially across institutions and countries, limiting direct generalizability.
Original Abstract
BACKGROUND
Simulation plays a fundamental role in lumbar spine surgery training. While many studies focus on the carbon footprint of surgeries, limited information is available on the environmental impact of surgical training. Today, surgical simulators can be categorized into three groups: biological specimens (cadavers and animal models), synthetic physical simulators (bench-top models, 3D-printed, high-fidelity models), and virtual simulators (screen-based and Virtual Reality (VR) simulators). This study analyzed the carbon footprint of the main simulators available for lumbar spine surgery training.
HYPOTHESIS
The hypothesis was that biological and high-fidelity simulators would have the highest environmental impact.
MATERIALS AND METHODS
Available simulators were identified through an extensive digital search, and categorized based on their features. Environmental data from manufacturers' websites were used, and the simulators with the most available data were selected to represent each category. For missing data, the Life Cycle Assessment (LCA) methodology was used, following the ISO 14040 standard, with OpenLCA® software. In cases of uncertainty, data were cross-checked with the Base Empreinte® database (ADEME, France). The setting of the study was conducted in Paris, France, in January 2025. The carbon footprint of digital simulators was reported relative to the device's lifetime. Cadavers were included as a reference, using an environmental study on cremation in the city of Paris. Results were expressed in kg CO 2 e.
RESULTS
Cadavers had the highest carbon footprint (244.0 ± 48.8 kg CO 2 e), followed by porcine models (223.0 ± 44.6 kg CO 2 e) and high-fidelity simulators (36.6 ± 7.3 kg CO 2 e). The carbon footprints of 3D-printed models and bench-top models were similar, at 8.4 ± 1.7 and 10.5 ± 2.1 kg CO 2 e respectively. Screen-based and VR simulators had the lowest footprints, with 0.07 ± 0.01 kg CO 2 e per simulation. Simulator production and the sterilization of instruments accounted for the majority of emissions.
DISCUSSION
Low-carbon-footprint simulators should be favored for early learners, especially for basic procedures and repeated simulations. Virtual training is often perceived as less sustainable due to the use of rare earth materials, but is actually more environmentally friendly because of the unlimited number of simulations and the absence of instrument sterilization. 3D printing enables on-demand production of only the required parts, directly on-site. High-fidelity mannequins should be reserved for advanced users, who can better benefit from their realistic features.
LEVEL OF EVIDENCE
III.