Background: Surgery as an important part of the healthcare sector contributes to environmental pollution and therefore to the climate crisis. The aim of this review is to create an overview of the current data situation and possibilities for improvement., Methods: A literature search was performed in PubMed/MEDLINE using the following five terms: "carbon footprint and surgery", "climate change and surgery", "waste and surgery" and "greening the operating room" focusing on energy, waste, water and anesthesia., Results: The greatest part of emissions in surgery is generated by the use of energy. The operating rooms (OR) need 3-6 times more energy than the other hospital rooms. Of the total hospital waste 20-30% is produced during operations, which is particularly due to the increasing use of disposable articles and 50-90% of waste classified as hazardous is incorrectly sorted. The disposal of this waste is not only more environmentally harmful but also much more expensive. The processing of surgical items by autoclaving consumes large amounts of water. Modern sterilization methods, for example using plasma could be future alternatives. Up to 20% of volatile nonmetabolized anesthetic agents are vented into the stratosphere and destroy the ozone layer. Intravenous anesthetic drugs should be used whenever possible instead. The choice of operating method can also contribute to the environmental impact of an operation., Conclusion: The surgical disciplines are a relevant producer of environmental pollutants. Through diverse interdisciplinary approaches surgery can also contribute to protecting the environment., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)