Professor Andrea Pietrabissa talks about what he's doing to make surgery more sustainable in his hospital and what you can do.

Andrea Pietrabissa is a lead surgeon at the Fondazione IRCCS Policlinico San Matteo di Pavia, and Professor of Surgery at the University of Pavia, Italy.

Below are the questions Andrea was given and, in short form, his answers.

What does sustainability in surgery mean for you?

I think that sustainability is to do with respect for the environment and nature which supports us all. This has been overlooked for far too long.

Should sustainability be mainly driven by governments, doctors and patients or companies?

I think that it has to be a partnership - the wider the better. Having said that, surgeons are in a key position within our hospitals to drive this change, as natural leaders, particularly the new generation.

In your opinion, what is the biggest misconception about sustainability in medicine?

There is no misconception about sustainability in medicine, it is simply a neglected and overlooked concept. I witnessed the change in the 80s from re-useable devices in surgery to today where almost everything is single use. This happened very quickly and we need to do something now. It's not too late so long as we are able to drive change.

Have any goals been achieved to date regarding sustainable surgery?

I'm afraid there are no goals set yet. We are in the middle of a storm and we need to find an exit strategy, both for sustainability in surgery and also equitable access to surgical and anaesthesia care worldwide.

In your experience, which nations have implemented sustainable practices in the surgical field?

As far as I know, Australia, because its national regulations are more flexible than the ones we have in Europe, has made significant progress in terms of recycling single-use devices and in sorting items in the OR to give them a second life.

Can you think of examples where national policies have been made to implement sustainability in this field?

There are several examples in Australia and New Zealand. To my knowledge, they've also been able to partner with major players in the industry of single use devices.

Medical equipment accounts for 10% of the carbon footprint of NHS, which is 4% of England’s overall carbon footprint. Operating theatre is the most resource intensive area of the hospital, and account for 25-30% total hospital waste. Do you think surgeons are aware of the situation and actively searching for green solutions?

I'm not sure but I'm aware of the problem and I'm trying to do my best to spread awareness. It is a huge paradox that the operating theatre, the centre of high-tech care, is also the top polluter in the healthcare sector. So we need to fix this, and there are ways that we can manage this problem.

How can a surgeon contribute individually and what steps can they take to get involved?

The best thing that you can do is to create a Green Team inside your hospital. This is a multi-speciality team of doctors, nurses, clinicians, engineers and so on, based in your hospital, which aims to address environmental issues. These could be: transport, fighting the use of plastics, and trying to recycle as much as possible in the OR.

We need to engage with the new generation of surgeons because they are our future decision-makers, and they are targeted by single-use device companies.

We could increase the proportion of reusable instruments and devices that we use in our practice, when it is safe for the patient, of course.

We need spread awareness and trigger a cultural transformation.

How can companies ensure a more sustainable surgical practice in the future?

The big players in the market of single-use devices are already focusing on this topic because they know that medical device procurement will take sustainability into account in the future. The way for them is to partner with surgeons. We are doing this in my hospital in two ways:

  1. Sorting all packaging before the patient enters the OR. We have now saved one third of waste labelled biohazard.
  2. Partnering with producers of single-use devices to collect used items and make sure they are given a second life, not by cleaning but by disassembling used items for re-use.

What steps can be made to encourage affordable surgery in low-income countries?

We need to give money to those countries to create small hospitals, capable of delivering simple procedures like Cesarean section, laparotomy and bone fractures. These will address many other problems in low and middle-income countries including vaccination, to give an example which is very close to our thoughts today.