Balancing quality care with ecological responsibility: Future directions in green surgery

The environmental impact of surgical care is a growing concern, yet the field of green surgery lacks a systematic understanding of its intellectual structure and evolution. This study addresses that gap through a bibliometric analysis of 2,720 documents published between 2013 and 2024 from the Web of Science Core Collection. We apply Social network analysis and keyword co-occurrence mapping to identify dominant research themes, leading contributors, and patterns of international collaboration. Research priorities have shifted progressively from technical concerns such as waste disposal and surgical efficiency toward broader systemic issues including carbon footprint assessment, resource optimization, and circular economy principles. Three distinct thematic clusters emerge from the keyword analysis, reflecting the interdisciplinary nature of the field across clinical, environmental, and engineering domains. A notable finding concerns the relationship between institutional research output and sustainability performance: the most prolific contributors to the green surgery literature do not necessarily rank among the most sustainable institutions, suggesting a disconnect between knowledge production and operational commitment. Based on these findings, we propose a unified definition of green surgery and discuss its implications for clinical practice, education, and policy. Ultimately, this study offers the first comprehensive science mapping of the field, providing a structured foundation to bridge academic output with sustainable practice.