Use less, waste less: Rethinking consumable use in proctology

Proctology is a useful test case for low-waste surgery because the central premise of routine sterile set-up is contestable. These procedures are common, short and material intensive, but they are performed at a mucocutaneous site that cannot be rendered sterile. The distal gut contains thousands of bacterial species, with one third of them potential pathogens. Antiseptic preparation reduces this burden, but does not eliminate it. In this context, the relevant question is not whether every opened sterile item can be recycled, but whether it needed to be opened at all. This article argues for a disciplined, indication-based approach to benign anorectal surgery. Instrument sterility, aseptic handling, skin preparation, sharps safety and antibiotic prophylaxis should remain unchanged. The proposed change is narrower: avoid routine drapes where they do not alter the operation, use clean non-sterile protective equipment for proceduralists where appropriate, and keep suction and diathermy immediately available but unopened until required. Infection prevention objections deserve respect, and selected cases will still require conventional sterile set-up. However, routine sterile consumables should not be defended by habit when the field itself is already contaminated. Proctology should lead a simple hierarchy: use less, open on demand and recycle only where true material recovery is available.