The carbon footprint of pediatric surgical care: Towards a standardized surgical sustainability index

Pediatric surgery has long been admired for its precision and restraint—small patients, delicate anatomy, minimal trauma. Yet, in the pursuit of innovation and safety, the discipline has embraced a paradoxical excess: the single-use ecosystem of the modern operating room. What began as a genuine quest for sterility and efficiency has evolved into a culture of disposability. Today, most pediatric surgical procedures depend on a high proportion of energy-intensive, single-use devices—endoscopic staplers, trocars, vessel sealers, drapes, and pre-packaged kits—whose environmental burden is rarely quantified.