Background <p>The 2015 Paris Agreement set the goal of limiting global warming to 1.5&#xa0;°C. At COP26, the link between planetary and Human health was emphasised, with over 75 countries committed to transforming healthcare systems towards sustainability (Alliance for Transformative Action on Climate and Health, ATACH). However, some signatories of the Agreement did not join the ATACH initiative, slowing the development of a global healthcare programme to address climate change. Owing to their high environmental footprint, operating theatres (OTs) are a key area for sustainability interventions. This study explores how OTs can contribute to more sustainable healthcare systems by reducing the sector’s ecological footprint.</p> Methods <p>A scoping review was conducted on international scientific databases (Scopus, Web of Science, Embase, and PubMed) using the keywords “sustainable operating theatre, surgical waste, sterilisation, surgical energy, and anaesthetic gas.” Two authors selected the abstracts, with the support of a third author in case of divergences.</p> Results <p>The review identified 4.734 relevant abstracts. Among these, only 17 met the selection criteria and were, therefore, analysed in detail. Only studies conducted in ATACH member countries in Europe were considered. These countries have developed and adopted innovative solutions to decrease the environmental impact of OTs in their national healthcare systems, aiming to meet the climate targets set by the agreements through more sustainable resource and healthcare process management. Preliminary data suggest that innovative management of OTs can reduce environmental impacts and improve human health.</p> Conclusions <p>Strategies such as improved waste disposal, optimisation of sterilisation procedures, and efficient use of anaesthetic gases promote healthcare resilience, scale down GHG emissions and support the fight against climate change and healthcare inequalities.</p>