Background <p>Surgery is an energy-intensive medical field, and its contribution to the environment is significant. Robotic surgery (RS) may generate a greater carbon footprint than open surgery (OS) or endoscopic surgery (ES). However, the extent of this impact has not been fully evaluated in major cancer surgeries.</p> Methods <p>We focused on surgical materials (classified as Scope 3 in the greenhouse gas protocol) and compared the carbon footprints of RS, ES (laparoscopy or video-assisted thoracoscopy), and OS across four major cancer-related procedures. An approximate process-based life cycle assessment approach was used to calculate the carbon footprint (CO₂ equivalent, CO₂e). Simulations of replacing single-use trocars and staplers with reusable ones were also evaluated.</p> Results <p>RS had a higher carbon footprint than ES and OS in all four procedures, and robot-assisted low anterior resection had the highest carbon footprint (27.89&#xa0;kg CO₂e) among all 12 procedures. The difference in the carbon footprint between RS and the lowest procedure was 3.29–6.38&#xa0;kg CO₂e. The higher carbon footprint of RS was mainly attributable to surgical drapes and personal protective equipment, whereas staplers and energy devices, despite their substantial overall contribution, had a limited impact on the differences between the approaches. When single-use materials are replaced with reusable ones, a 90% reduction is anticipated for trocars (0.55&#xa0;kg CO₂e per case) and a 15% reduction for staplers (0.33&#xa0;kg CO₂e per case).</p> Conclusion <p>Robotic approach had the highest carbon footprint in all four cancer surgeries, and alternatives using only reusable products are insufficient to offset the increase. To ensure the sustainability of robotic surgery, all stakeholders must continue to implement environmental initiatives, such as optimizing surgical materials and developing eco-friendly products.</p> Graphic Abstract <p></p>