Green Surgery: Current Evidence, Challenges, and Future Directions

Climate change has been identified by the World Health Organization (WHO) as "the single greatest health threat to humanity". To investigate this subject, we conducted a narrative review of the literature about sustainability in the OR, with the aim of exploring the existing knowledge and identifying prevailing challenges in the field. A combined automated and manual database search of the literature was performed using Medline (PubMed), Scopus, Ovid, and the Cochrane Library, covering publications available up to and including 21 May 2025. The significance of environmental sustainability is recognized across all healthcare systems. To fulfil the United Nations Sustainable Development Goals, the healthcare sector must undergo a transformation towards more eco-friendly practices, which will also affect clinical decision-making. Net-zero is an internationally agreed goal for avoiding worsening global heating in the second half of the 21st century, as it aims to balance the quantities of greenhouse gases released into and removed from the atmosphere, achieving carbon neutrality. Nevertheless, the operating room (OR) is among the most significant contributors to environmental pollution, with the major carbon hotspots determined by the use of energy, procurement and disposal of consumables and the waste of water. In response to this challenge, leading medical societies, surgical teams, government bodies, and industry stakeholders endorse Green Surgery (GS) by taking steps to address healthcare sustainability and its impact on climate change. Therefore, a movement toward "greening" healthcare, or improving the environmental footprint of healthcare has been built.