The operating theatre is the most resource intensive area in hospitals, consuming energy, producing greenhouse gasses (GHG) and sending waste to landfill (1). Tertiary plastic and reconstructive surgery teams usually have a high volume of short elective and emergency hand procedures, each using medicines, instruments and consumables. Quick and safe changes exist to reduce waste and GHG emissions from these cases. A team meeting at the start of each list communicates the order of cases, desired anaesthetic modality, maximises team efficiency, and provides a list of instruments and consumables required. Adopt an ‘open-when-needed’ approach to avoid unnecessary waste and reprocessing of instruments and choose reusable instruments where possible over single use. Utilise smaller procedure rooms for minor cases that don’t require an operating theatre, such as minor lacerations or nailbed repairs. Disposable ‘blueys’ can be safely swapped for commercially laundered cotton towels. Setting up solid waste segregation and recycling facilities in theatre for appropriate paper, glass, plastic and metal recycling. By changing our own practice, we can reduce GHG emissions and waste, which often results in cost savings for hospitals. References: 1) Rizan C, Steinbach I, Nicholson R, Lillywhite R, Reed M, Bhutta M, 2020. ‘The Carbon Footprint of Surgical Operations: A Systematic Review’. Annals of Surgery 272(6): pp. 986-995. 2) Asfaw SH, Galway U, Hata T, Moyle J, Gordon IO, 2021. ‘Surgery, anesthesia, and pathology: A practical primer on greening the delivery of surgical care’. The Journal of Climate Change and Health volume 4, 100076.