Table 1.

Recommendations for Physicians and Healthcare Systems. A summary of recommendations for improving environmental sustainability in gynecologic oncology, with mitigation opportunities for major contributors highlighted for both physicians and healthcare systems/governments.

Level of Impact	Topic Area	Key Recommendations
Physician Level	Surgery/Anesthesia	Practice red bag stewardship Limit excess single-use supplies Procedure trays > Peel packs Shut down robot console when not in use Limit use of desflurane, sevoflurane, and nitrous oxide
	Radiology	Limit use of CT and MRI Power down machines, workstations when idle
	Chemotherapy/Radiation	Support clinical trials for alternative dosing schedules and hypofractionation
	Infrastructure	Use telemedicine when able
Hospital & Government Level	Surgery/Anesthesia	HVAC efficiency/Idle time shut off Encourage industry extended use programs, limited packaging, and recycling Purchase reprocessed devices Convert to reusable textiles and materials when able Invest in gas capture technology research and utilization
	Radiology	Use abbreviated protocols and efficient scheduling Invest in GABA contrast recycling research
	Chemotherapy/Radiation	Support clinical trials for alternative dosing schedules and hypofractionation Invest in chemotherapy pollution research and recycling technology
	Infrastructure	Purchase renewable energy sources Invest in widespread solar and wind infrastructure Electrical grid investment Sign on to HHS Climate Pledge