Patrick ASHINZE, Gabriel ADEDOYIN, Peter AYODELE, Eniola AKANDE, Bethrand CHUKWU, Alexander ENONU, Ambrose OGBUE, Mayowa OLAGOKE, Aishat MAHMOUD, Adeshina AZEEZ, Oluwatosin AFOLABI, Eniola OBAFEMI, Godwin CHIAZOR, Adeshina AHMED
Journal of Comprehensive Surgery - 2026;4(2):41-50
Aims: Surgery is a major contributor to greenhouse gas emissions, especially through anesthetic gases, energy use from machines, and disposable materials. In low- and middle-income countries (LMICs) like Nigeria with limited access to surgery, its environmental impact further challenges already strained systems. This scoping review aims to map the current evidence on the feasibility, strategies, and future directions for implementing environmentally sustainable (green) surgical practices in resource-constrained settings. It also examines its potential role in promoting equity, reducing costs, and supporting ecological conservation. Methods: We conducted a scoping review following methodological guidance for this study type. A structured search of peer-reviewed articles, global health reports, and case studies was performed using PubMed, Google Scholar, and Scopus. Key concepts and evidence were charted and synthesized thematically. Tools such as the PIPES instrument and Green Surgery Checklist were analyzed for their applicability in LMICs. Results: Green surgical practices, which include reuse models, solar-powered theatres, digital health, and waste segregation, have been shown to reduce costs, improve outcomes, and cut emissions by up to 97%. The green channel model demonstrated reduced postoperative complications without compromising care. Tools like the PIPES assessment and 5Rs-based checklists support implementation. Climate-resilient infrastructure, ethical frameworks, and global collaborations, including WHO's three-bin waste system, further strengthen sustainability in surgical care. Conclusion: Green surgery is both feasible and beneficial in LMICs. It aligns environmental goals with surgical equity, cost-effectiveness, and quality care. Embedding sustainable practices into health systems through innovation, policy, and global cooperation is essential for building climate-resilient surgical services and mitigating healthcare's environmental footprint.
