After the Operation

wvei uie pasi coupie oi yeais aueiuiun nas oeen increasingly focused on greater use of day surgery. It has been estimated that up to 50% of surgical cases could potentially be treated as day cases. At the same time we have seen the emergence of "minimally invasive surgery". Essentially based on laparoscopic techniques, this rapidly developing concept has certainly caught the imagination and an increasing number of operations are being performed via the laparoscope, either as day cases or with an overnight stay. Operations include cholescystectomy, appendicectomy and hernia repair, oophorectomy, salpingectomy and even hysterectomy and nephrectomy. We now have Associations for those with a particular interest in day surgery and minimal invasive surgery. The advantages of these techniques to the patient are obvious, with a much shorter stay in hospital and, where minimal invasive techniques are used, there are smaller scars. The benefits to the hospital are rather less clear cut. Certainly there is potentially a lesser need for nursing staff at night and weekends but day surgery techniques demand a high level of expertise from both surgeon and anaesthetist and, unless one is going to appoint additional staff, it is not going to make a major impact on the waiting list, as one is merely transferring the patient from one operating list to another. The "minimally invasive" techniques demand a much greater level of expertise and after the initial explosion of interest and "band wagon" effect, we are now beginning to see notes of caution sounded as the complications become apparent (Observer Sunday 22 September 1991). One also hears increasingly of complications which Gynaecologists were experiencing 20 years ago when laparoscopy was introduced into that speciality and which prompted the report published by the Royal College of Obstetricians and Gynaecologists in 1977. There is no doubt that laparoscopic surgical techniques in general take much longer than the traditional laparotomy procedures, thus far less operating can be performed on each operating list. This is likely to have an adverse effect on waiting lists. During the time these developments have been occurring, we have heard little of the "traditional" surgical techniques for these operations which are now being offered laparoscopically. They still represent the majority of day to day surgery and will probably continue to do so. There may have been a slight reduction in the length of post operative stay but, in general, laparotomies are associated with a significant …