The operating room is a hot spot of environmental impact within the hospital due to resource use, procurement of consumables, and anesthesia. This lecture highlights areas where changes can be made to mitigate these impacts. The concepts surrounding the Principles of Sustainable Surgery and Lean Service delivery will be introduced, with examples of how they apply in different settings. The lecture is illustrated with case examples from the human and veterinary sector in his emerging field of Sustainable Surgery. Attendees learn about the inclusion of sustainability as a domain of quality improvement and be prompted to critically evaluate the rationale behind use of some single use consumables with regards to infection control and surgical asepsis. This lecture highlights the alignment between environmental sustainability and operational resilience for the veterinary hospital and raise the global social responsibility and influence we have when purchasing consumables or engaging the procurement team.