"Green-path": planting seeds for environmental sustainability in diagnostic and research surgical pathology

Surgical pathology represents a resource-intensive component of healthcare systems due to continuous operation, energy-demanding infrastructure, extensive use of hazardous chemicals, and high volumes of single-use consumables. Despite this, surgical pathology has historically received limited attention within sustainability research and policy frameworks. This narrative review examines the concept of green pathology, defined as the practice of pathology in a manner that minimizes environmental impact while preserving diagnostic accuracy, patient safety, and regulatory compliance. We first contextualized green pathology within the broader sustainability movement in healthcare and laboratory medicine and then proceeded to summarize transferable lessons from sustainability initiatives implemented in non-pathology laboratories and related medical disciplines, including energy management, green chemistry, waste reduction, digital transformation, and governance frameworks. Subsequently, we focused on surgical pathology-specific opportunities for sustainability across the pre-analytical, analytical, and post-analytical phases. Key interventions include optimization of energy consumption and laboratory infrastructure, chemical stewardship in histopathology, solvent recovery and reduction of hazardous waste, rational use of consumables, diagnostic stewardship, and the responsible adoption of ancillary techniques and digital pathology. Within this framework, education, workforce engagement, and Environmental Management Systems emerge as critical enablers for sustained change. Our overall aim is to present green pathology as a natural extension of pathology's commitment to quality, safety, and long-term healthcare sustainability rather than as an optional environmental initiative.