Comment on “Practical Strategies for Environmentally Sustainable Practices in Gynecologic Oncology”

Health care waste is a major contributor to the global climate change crisis, with hospitals emitting large amounts of greenhouse gases and using large amounts of energy. Gynecologic oncology is a field that has a large impact, with surgical procedures, imaging, anesthesia, and hospital-based treatments impacting emissions and energy usage; surgical waste contribute 20% to 30% of overall hospital waste due to single-use and/or disposable instruments used in the operating room. Recent advances in technology and policy offer opportunities to reduce the impact of gynecologic oncology on the environment without impacting patient safety or quality of care. This article is a review of evidence surrounding the main environmental challenges and strategies for sustainability in the field of gynecologic oncology. This was a narrative review, with literature searches conducted using PubMed, Web of Science, and Scopus between 2013 and 2025. Inclusion criteria for studies were topics such as anesthesia, consumables, energy consumption, radiology, surgical procedures, pharmaceuticals, telemedicine, and ERAS protocols in gynecologic oncology. Each area examined in this review presents opportunities for improved sustainability. Anesthetic gases are major contributors to global warming and have high global warming potential (GWP). Telemedicine offers a way to reduce waste from office visits when they are unnecessary, though there remain barriers to the widespread implementation of telemedicine in specialties such as gynecologic oncology. For anesthesia, one improvement that has been proposed is reducing fresh gas flow rates by an estimated 40% to decrease the impact of their emissions without impacting patient safety or the effectiveness of the anesthesia. Other improvements include reducing desflurane use, using total intravenous anesthesia or regional anesthesia as appropriate, and using agents with a lower GWP. Another area of great impact with significant room for improvement is consumable instruments and supplies. More than 60% of the total carbon footprint of surgery can be attributed to disposable surgical products which by virtue of their disposable nature contribute to environmental waste. Options to decrease the environmental impact of consumable instruments and supplies can include adopting reusable instruments when possible, using reusable surgical gowns and drapes, opening items only when needed during surgery, and improving sterilization processes. Recommendations for improving sustainability in energy usage also include adopting smart HVAC systems, using LED lights, managing the use of high-energy equipment, and using minimally invasive surgical techniques when possible. Radiology, sustainability can be improved by strict adherence to evidence-based imaging practices to reduce unnecessary imaging, as well as attempting to use resources responsibly. Pharmaceuticals and waste from chemotherapy treatments also contribute heavily to carbon emissions, and recommendations for sustainability in this area include developing and implementing drug take-back programs, optimizing chemotherapy dosing, developing biodegradable compounds, and abiding by “Choosing Wisely” recommendations. This review highlights how there are many available options in the field of gynecologic oncology to improve sustainability and reduce the carbon footprint without compromising patient quality of care or safety. Some of these recommendations will require research and development of new techniques, but many are easily implemented and will have a far-reaching impact if new habits and policies can be supported. (Summarized from Kahramanoglu I, Kacperczyk-Bartnik J, Nout R, et al. Practical strategies for environmentally sustainable practices in gynecologic oncology. Int J Gynecol Cancer. 2025;35:102648. doi: 10.1016/j.ijgc.2025.102648)