Greening the OR: 10 Steps Towards Sustainability in Gynecologic Surgery

INTRODUCTION: Surgery is a major driver of climate change due to carbon emissions. Hysterectomies alone contribute an estimated 212,000 metric tons of carbon dioxide equivalents annually. Single-use materials and tools account for the largest environmental impacts. OBJECTIVE: The objectives of this video are to review how our activities in operating room are contributing to the climate crisis, to demonstrate strategies for reducing our carbon footprint during gynecologic surgery, and to highlight data supporting these strategies. METHODS: Educational video highlighting tips and tricks for sustainability in the operating room. RESULTS: We present the following 10 strategies to promote sustainability in the gynecology operating room, with a focus on minimizing single use, disposable products: 1) Reduce glove changes, 2) custom surgical packs, 3) reusable scrub caps, 4) avoid disposable energy devices, 5) stainless steel manipulators, 6) reusable suction irrigators, 7) alternatives to specimen retrieval bags, 8) minimize single-use plastic trocars, 9) avoid advanced access platforms, and 10) make the most of every suture. We demonstrate the assembly and use of various reusable and reprocessed surgical instruments during real surgical cases. We also highlight specific surgical techniques that can reduce waste in the operating room, such as intra-abdominal morcellation, specimen extraction through a sterile glove, trocar fixation with a retractor, “incision hopping” during myomectomy, and using a mini-laparoscopic approach. Throughout the video, we present data to support our recommendations. CONCLUSIONS: We have demonstrated evidence-based strategies for reducing our carbon footprint during gynecologic surgery, with a focus on minimizing single use items. Each of these strategies represents a small step, but added together, they can make a big difference in our environmental impact as surgeons.