Ambulatory Surgery

This unique new book provides state-of-the-art, current guidance for every aspect of ambulatory surgery - from how to establish an ambulatory surgical unit to how to deliver anesthetic and surgical care for common outpatient procedures. Featuring authoritative contributions from leading experts in the field its user-friendly, "how to do it" approach focuses on the needs of the practicing general surgeon and presents all of the information necessary to offer outstanding care in the ambulatory setting.

Addresses basic anaesthesia principles and specific anesthetic techniques, enabling readers to better understand the capabilities and limitations of ambulatory surgery.

Includes coverage of the administrative, operational, and financial aspects of an ambulatory surgery center.

Provides illustrated, detailed descriptions for all of the procedures including: indications, differential diagnosis, special equipment, preoperative preparation, postoperative follow-up, evaluation and more.

Extensive coverage of laparoscopic and endoscopic surgery, devoting entire chapters to specific outpatient procedures.

Offers a selected reading list for every chapter for additional research and study.

Multiple procedure for hernias, cholecystectomy, etc...

Wound healing and other skin problems covered in detail.

Discusses new technology such as lasers and Transanal Excision.

In the past decade there has been explosive growth in the use of ambulatory surgery, stimulated by the development of noninvasive surgical techniques, such as endoscopy and laser surgery, and short-acting anesthetic agents with few side effects, such as propofol, and by the emphasis on cost containment. Currently, more than 50 percent of surgical procedures are performed on an ambulatory basis. This trend has resulted in the movement of surgery out of the hospital to free-standing ambulatory surgery units or medical offices, where the participation of physicians in planning, staffing, and equipment decisions and in the development of practice standards and financial accountability has become routine. Patient care in the outpatient setting differs substantially from that in the inpatient setting, with greater emphasis on ensuring practicality and efficiency, while maintaining the quality of care.

The topic of ambulatory surgery has been addressed with increasing frequency in surgical and anesthesia literature, but there are few textbooks on the subject. In their introduction to Ambulatory Surgery, the authors state that the book was written to provide general surgeons and allied health professionals with a comprehensive view of the practice of ambulatory surgery. The authors acknowledge the key role of the anesthesiologist in ambulatory surgery and devote a section of the book to issues related to anesthesia. The first half of the book is composed of five sections: an introduction and sections on economics, standards, administration, and anesthesia. The second half of the book covers procedures and techniques of general surgery and the subspecialties of laparoscopic, vascular, plastic, colorectal, endoscopic, and pediatric surgery.

Although the book's 63 contributors have made a noble effort, redundancy prevails. Chapters suffer from variations in quality and style, and those covering the same topics could have been consolidated. Exceedingly brief chapters on the integration of ambulatory surgery into the health care system and plastic surgery for subcutaneous nodules could have been incorporated into other chapters or eliminated. The chapter on the use of lasers in endoscopic surgery should have been expanded to cover the characteristics and use of various types of lasers for ambulatory surgery. Some chapters are well written and informative: "Economic Incentives and Cost Effectiveness," "Conscious Sedation," "Local and Regional Anesthesia," "Managing the Pediatric Outpatient," "Special Considerations for Laparoscopic Surgery," "Pitfalls in Ambulatory Vascular Access Surgery," "Venous Diseases," and "Perianal Disease." Rather than providing practical information for the general surgeon engaged in the practice of ambulatory surgery, much of the second half of the book ignores ambulatory surgical aspects except in brief introductory or concluding paragraphs in some chapters. In fact, some topics such as laparoscopy for acute abdominal pain and acute abdomen, chronic abdominal pain, and gynecologic emergencies and therapeutic upper endoscopy seem irrelevant to ambulatory surgery.

In summary, this book provides information that may prove useful for anesthesiologists or surgeons just setting out in the field of ambulatory surgery, but it cannot be considered a high-quality textbook for experienced physicians.

Reviewed by Carolyn Greenberg, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.