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First ever Green Surgery Challenge saves 133 tonnes CO2e a year

04 Nov 2021

First ever Green Surgery Challenge saves 133.4 tonnes CO2e/year

Five surgical teams from across the UK are competing in the first ever ‘Green Surgery Challenge’ to show how, by inventing new devices, switching to re-usable equipment and changing the type of anaesthetic they use, they have successfully reduced the carbon footprint of operations. 

The NHS accounts for 4% of the UK’s carbon footprint, and operating theatres have particularly high energy use. The Green Surgery Challenge is aimed at helping the NHS meet its commitment to achieve net zero by 2040.

A total carbon footprint of 133.4 tonnes CO2e/year has been saved through the 5 projects – the equivalent of 38 return flights from London to Hong Kong.

The five surgical teams all received mentoring from sustainable healthcare specialists at the Centre for Sustainable Healthcare. The winner will be announced at the Green Surgery Conference on Thursday 4 November 2021, where the teams are presenting and discussing how to accelerate adoption of their techniques across the NHS.  The conference is co-hosted by the Royal College of Surgeons of England and the Centre for Sustainable Healthcare,

The 5 teams are:  

  • Derriford Hospital, University Hospitals Plymouth NHS Trust. The team focused on reducing consumption of single-use surgical equipment, as consumables account for one-third of surgical procedure-related emissions. The team replaced single use instruments used in appendectomies with reusables.There is great potential to scale their work up across the NHS, with 42,000 appendectomies taking place annually in the UK

  • Leeds Teaching Hospital NHS Trust. The team modelled using a gasless procedure for laparoscopic appendectomy by carrying out a real-time cadaveric study of a new device developed by The Leeds Global Health Research Group. The RAIS device mechanically creates a space within the abdomen to allow surgery to be carried out, rather than using medical gas.  Medical gas use is the largest contributor to the overall carbon footprint of the procedure, and the team also hope their approach could help improve global surgical access (in countries where access to medical gases is scarce).

  • University Hospitals Sussex NHS Foundation Trust. The team streamlined the pre-operative pathway for elective surgery – including reducing unnecessary blood tests. Particularly in the context of the recent shortages of blood bottles, the approach shows the potential to improve the sustainability of pathology testing, which is the single highest volume clinical activity in the NHS.The impacts included carbon savings, with a reduction in the number of blood tests being processed and patients not travelling to unnecessary appointments for tests, and financial savings for the hospital.

  • Wrexham Maelor and Ysbyty GwyneddHospitals, Betsi Cadwaladr University Health Board in North Wales. The team focused on hand surgery, reducing the consumables used and the volume of clinical waste generated by creating a new, streamlined procedure pack.  The team also reduced the use of ward beds and theatre space, effectively challenging the assumption that all surgical procedures must take place in theatres, when minor surgery can be carried out in rooms with lower energy requirements.

  • Imperial College Healthcare NHS Trust. Following concerns over the high use of disposable PPE during the COVID-19 pandemic, the team successfully championed safe use of re-usable surgical gowns. Additionally, the team switched from general anaesthesia to local anaesthesia for inguinal hernia repair, halving the length of hospital stays and thereby reducing resource use.


Tim Goodacre, Vice President, Royal College of Surgeons of England said:

“It’s been exciting helping to judge these excellent examples of surgical teams taking on the challenge of climate change.  As world leaders come together at the COP26 summit, the pressure is on each and every one of us to look at how we can reduce our carbon footprint, both at home and at work.  The teams have been inventive and focused in their approaches to reducing the carbon footprint of operations.  We are facing a climate emergency, and every sector needs to respond. The NHS is committed to achieve net zero carbon emissions by 2040, so we need to help spread these good ideas and continually look to improve further, if we are going to play our part.”

Dr Olivia Bush, Programme Lead for Sustainable Clinical Practice at the Centre for Sustainable Healthcare, said:

“It's impressive to see how far these surgical teams have reduced the environmental impact of the care they deliver in just 10 weeks.  Healthcare is very resource-intense, so small changes can make a big difference.  It’s great to see the wider surgical community inspired by the work that the teams have carried out. I look forward to seeing more and more surgeons running their own projects and influencing their own organisations to help meet the NHS net zero goals.”


Notes to editors

  • The Green Surgery Conference, co-hosted by the Royal College of Surgeons England and the Centre for Sustainable Healthcare is open to attend (online) on Thursday 4th November, 12 noon to 2.30pm: register here: Green Surgery Conference - Nov 04 | Hopin
  • The Green Surgery Challenge is an adaptation for clinical specialties of the Centre for Sustainable Healthcare’s flagship programme, the Green Ward Competition (an award-winning clinical leadership and engagement programme to improve the environmental sustainability of healthcare). The challenge has been created and delivered through collaboration between a group of support partners including the Centre for Sustainable Healthcare, NIHR MedTech Co-operative in Surgical Technologies, Royal College of Surgeons England, Royal College of Surgeons Edinburgh, The Sustainable Healthcare Coalition, Brighton and Sussex Medical School and the Association for Perioperative Practice. The Challenge has been made possible through the generosity of Gold Funders and Sponsors NIHR MedTech Co-operative in Surgical Technologies and Elemental Healthcare, Silver Sponsors Royal College of Surgeons England and Royal College of Surgeons Edinburgh, Bronze Sponsors the AHSN Network, Vanguard Medical Remanufacturing, and Bowa Medical UK. 
  • The Centre for Sustainable Healthcare (CSH) is an independent charity working on sustainable healthcare in research and practice. CSH has pioneered and is respected nationally for its Sustainable Specialties programme, which is designed to mainstream sustainability within clinical areas so that it is integral to the planning of health systems and the practice of healthcare professionals. This is supported by work in medical education and in carbon modelling of clinical care.
  • The Royal College of Surgeons of England is a professional membership organisation and registered charity. The College provides world-class education, assessment and development to more than 28,000 surgeons, dental professionals and members of the wider surgical and dental care teams, at all stages of their career. The College sets professional standards, facilitates research and champions the best outcomes for patients – with a vision to see excellent surgical care for everyone.
  • For more information, please contact the RCS England Press Office on: 020 7869 6052/6054; or email:

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