Aim: To reduce the carbon footprint of one of the most common procedures in ENT: the tonsillectomy. Methods: A questionnaire was launched among ENT-surgeons in the Netherlands (n=268) to assess surgeon preferences regarding the use of sterile drapes, gowns, reusable and disposable instruments as well as the overall opinion on the sustainability of current practice. A waste audit was performed following a tonsillectomy by 18 ENT-surgeons in various centers. The corresponding amount of CO2-equivalent produced by the surgical waste of one tonsillectomy was calculated. Results: The survey demonstrated a large variability in common practices during a tonsillectomy in the Netherlands. This was also reflected by the large range of CO2-equivalent produced by the surgical waste of one tonsillectomy: between 2.8kg and 8.9kg CO2-equivalent. If all tonsillectomy procedures were performed as the “best-in-class”, a 47% reduction could be achieved on average. This reduction would save 86,800 kg CO2-equivalent annually in the Netherlands. This is comparable to the carbon footprint of 10.6 laps around the earth in a petrol-powered mid-size SUV, requiring roughly 3472 trees to absorb CO2 for one year. The four largest contributors to the carbon footprint of the surgical waste were disposable gowns, sterile cotton gauzes, plastic suction tubing and sterile gloves. After consulting with the national infection prevention committee, a novel tonsillectomy protocol was launched in the Netherlands. Conclusion: A national survey and a waste audit can provide useful insights to revise surgical protocols, aiming to reduce the carbon footprint of a procedure.