Implementing sustainability in gynecologic surgery: barriers and a roadmap for change

Healthcare generates more than 4% of global greenhouse gas emissions, and the operating room is a disproportionate contributor. Gynecologic surgery is an important target for interventions as a high-volume specialty heavily reliant on disposable trocars, energy devices, and custom packs. Despite growing calls to action and evidence that selected sustainability initiatives can be implemented without compromising patient safety, adoption remains inconsistent and often dependent on local champions.

Barriers span five domains: (a) Organizational and structural obstacles including limited governance, hierarchical decision-making, inconsistent regulatory guidance, and supply chains favoring single-use products. (b) Knowledge and training gaps persisting across perioperative teams and hospital leadership, compounded by the lack of standardized environmental metrics. (c) Cultural resistance reflecting safety concerns about reusables despite demonstrated clinical equivalence. (d) Operational barriers including inadequate infrastructure and upfront costs preceding potential savings. (e) Intervention-specific challenges that limit implementation of waste segregation, reusable transitions, anesthetic gas management, and energy efficiency.

Addressing these barriers requires leadership commitment, clearer regulatory guidance, ongoing education, industry collaboration, stakeholder engagement, and context-specific application of implementation science and quality-improvement methods. Standardized metrics, institution-specific targets, and ongoing monitoring can support phased implementation, track progress, and build institutional support for sustained change.