A project challenging the routine use of sterile drapes and rarely necessary surgical equipment in proctology has been recognised at the RACS Annual Scientific Congress (ASC) 2026 in Perth. It received the inaugural Professor David Fletcher Award for Environmental Sustainability in Surgical Practice.

The award recognises excellence in environmentally sustainable surgery and was established to honour Professor David Fletcher FRACS, a longstanding leader in sustainable surgical practice and a key figure in establishing the RACS Environmental Sustainability in Surgical Practice Working Party (ESSPWP).

The winning presentation, Sterility Theatre: Ditching Drapes Cuts Cost and Carbon in Proctology, authored by Dr Matthew Irwin, Mr David Russell, Ms Irene Sung, Dr Amit Sarkar, Dr Xuanyu Zhou and Professor Margaret Schnitzler, was delivered by Dr Matthew Irwin from Royal North Shore Hospital during the Environmental Sustainability in Surgery session at ASC 2026.

The research examined the routine use of sterile drapes, gowns, PPE and adjunct devices in proctology procedures, despite these operations occurring in a non-sterile field. Through a prospective audit and life cycle assessment, the team identified substantial opportunities to reduce waste, emissions and healthcare costs without compromising patient care.

The study found that diathermy, smoke evacuation and suction equipment were opened but left unused in approximately 50 per cent of cases. By adopting an ‘open-on-demand’ model and replacing sterile consumables with appropriate non-sterile alternatives, the researchers estimated savings of approximately AUD $798,000 annually across Australia’s estimated 20,000 proctology procedures nationwide.

The proposed changes could also prevent around 23 tonnes of landfill waste and reduce emissions by approximately 153 tonnes of CO2e each year.

Presenter Dr Matthew Irwin said the project highlights how reviewing long-standing theatre practices can deliver immediate and measurable sustainability gains.

“This research demonstrates that reducing low-value practices in theatre can lower costs and environmental impact while maintaining safe and effective patient care.”

The award aligns with growing momentum across the surgical profession to address the environmental footprint of healthcare and support evidence-based sustainable practice. The ESSPWP and the Health Policy and Advocacy Committee (HPAC) supported the establishment of the award to recognise practical innovations with measurable environmental benefit.

Professor David Fletcher has been widely recognised for championing sustainability within surgery and encouraging integration of environmental responsibility into clinical practice, education and research.

The Professor David Fletcher Award is an ongoing annual award at future RACS ASCs. 

Left to right: Prof David Fletcher, Dr Matthew Irwin, Dr David Proud