Purpose: Proctology is performed in a non-sterile field, yet sterile drapes, gowns and personal protective equipment (PPE), plus adjuncts (diathermy, smoke evacuation and suction), are commonly opened by default. We quantified the avoidable cost and environmental burden and modelled pragmatic de-implementation strategies. Methodology: A prospective utilisation audit with cost analysis and life cycle assessment (LCA) was undertaken for the estimated 6,000 annual proctology cases in New South Wales. Billing records, procurement contracts, manufacturer specifications and emissions factors were integrated to calculate per-case and annual cost, landfill mass and carbon dioxide equivalents (CO2e). Current practice was compared with (i) targeted recycling of sterile consumables and (ii) a low-waste set-up: open-on-demand adjuncts and substitution of sterile drapes/gowns/PPE with non-sterile alternatives. Results: Diathermy, smoke evacuation and suction were opened but unused in 50% of cases. Targeted recycling reduced cost by AUD 0.86 and landfill by 0.47 kg per case (AUD 17,000 and 9.3 tonnes landfill annually in Australia). The low-waste set-up reduced cost by AUD 40, landfill by 1.13 kg and emissions by 7.6 kg CO2e per case, equating to AUD 798,000, 23 tonnes landfill and 153 tonnes CO2e annually across Australia’s ~20,000 proctology cases. Extrapolated internationally, annual savings were GBP 1.0 million (UK), USD 6.6 million (USA) and EUR 12.6 million (Europe), with 1,081 tonnes landfill and 6,759 tonnes CO2e avoided. Conclusion: In high-volume proctology, default sterile draping and routine opening of adjunct devices represent measurable low-value care. Sterile drape use should be avoided, and open-on-demand set-ups implemented to deliver immediate and scalable reductions in cost, waste and carbon emissions.