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Conference report: Research for Greener Surgery 2023 at the University of Birmingham

Authors: Virginia Ledda
NIHR Global Health Research Unit on Global Surgery
Institute of Applied Health Research
University of Birmingham, UK


The inaugural Research for Greener Surgery Conference took place at the University of Birmingham on 13 December 2023, attended by 290 delegates in-person and over 800 people online. The Conference aimed to build knowledge around sustainability in operating theatres and to raise awareness of a new body of research funded by the NIHR aiming to create environmentally sustainable operating theatres in the NHS. We explored the challenges of implementing and evaluating sustainability initiatives and of translating research into policy.

Sustainable surgery research

The Conference was opened by Prof Aneel Bhangu with an overview of the NIHR-funded research programme. He highlighted the importance of cross-cutting themes and multidisciplinary collaboration, including health economics, behavioural change and implementation science, and environmental science. Prof Lucy Chappell, Chief Scientific Adviser to the Department of Health followed with a presentation focussing on developments at COP28 and how the NIHR is supporting climate change mitigation and adaptation.

Building knowledge

CPD accredited training was provided covering carbon literacy, carbon accounting, and behavioural change and implementation science. This consisted of a variety of formats (presentations, panel discussion, and interviews) with and contributions from experts including Prof Hugh Montgomery (University College London), Prof Rob Lillywhite (University of Warwick) and Dr Laura Kudrna (University of Birmingham). This training will underpin the robust, high-quality research needed to inform implementation of sustainable practices.

New research

A spotlight was focussed on the newly-funded NIHR green surgery programmes including:

  • DRAGON RCT: a large, cluster-randomised trial of reusable versus disposable drapes and gowns. The trial will include 26,800 patients across 134 hospitals to report clinical, cost and carbon outcomes.
  • Anaesthesia: focusing on the use of nitrous oxide in anaesthesia.
  • Waste management: optimisation of waste management (‘reduce, reuse, recycle’).

The potential for research to improve patient and planetary outcomes was further explored through discussion with a panel of surgical research leaders from Benin, India, Mexico, and Nigeria.

Future perspectives

The Conference concluded with an interview with Miss Deena Harji, who provided insight into the opportunities and challenges of implementing robotic surgery.

Calls to action

To close the Conference, Prof Aneel Bhangu summarised the following calls to action which emerged from the meeting:

  • New worldwide community: convene and grow a new multidisciplinary community to develop robust research and innovations that can be rapidly implemented and scaled globally.
  • Personal action: consider lifestyle changes including in transportation and travel, meat consumption, energy supplier, banking.
  • Professional action: consider how you can reduce the environmental impact of your day to day practice – for example by reducing your use of single-use items and your energy use.
  • Research action: Take part in research with the potential to influence global practice – for example, this includes the DRAGON trial for surgeons and the nitrous project for anaesthetists;
  • Reduce, reuse, and recycle across all these domains.

Recordings of key sessions will soon be available from the BJS Academy (, @BJSAcademy). Progress will be reviewed at the 2nd Research for Greener Surgery Conference, to be held in December 2024. This is likely to focus on sustainable energy use across patient, industry, and hospital pathways.


Part of the charitable activity of the Foundation, BJS Academy is an online educational resource for current and future surgeons.

The Academy is comprised of five distinct sections: Continuing surgical education, Young BJS, Cutting edge, Scientific surgery and Surgical news. Although the majority of this is open access, additional content is available to BJS subscribers and strategic partners.

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