December 2014

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Number 3/14, December 2014

​​News from the president


Another year is nearly finished and so 2015 and our next International Congress in Barcelona rapidly approaches. Have you considered submitting a free paper for the meeting? We would love to hear about the work you are doing – indeed I believe that there are people doing fantastic work in ambulatory surgery all across the globe and this needs sharing. I know from my own experience that the sharing of experience and spread of good practice is a challenge even in our own countries, however the IAAS exists to help share this good practice on the international stage – so please contact me to let me know what you are doing in your units. Remember our Journal Ambulatory Surgery also provides an excellent opportunity for you to publish your work to a wider audience.
This year has been another busy one for the IAAS as we have published the 2nd edition of the handbook on our website, held 3 training courses (Greece, Serbia and Croatia) and met with representatives of the OECD, the London School of Economics and the London School of Hygiene & Tropical Medicine to discuss potentially working together in the future. This last meeting was extremely positive and I’m sure will lead to future joint projects. I thank everyone who has been involved in our work plan – it is their time and the expertise they bring that offers so much for the future of our organisation.
I hope you all have a lovely festive season.

Ian Jackson, President

International News and Comments
Training Workshop – Athens, Greece

The IAAS held a training workshop in Athens on the 17th and 18th of October 2014 entitled ‘Day Surgery: Making it Happen’ for 18 multidisciplinary delegates comprising surgeons, anaesthetists, nurses, trainees and business managers. The faculty consisted of President Ian Jackson, Immediate Past President Carlo Castoro and Journal Editor Doug McWhinnie. 
The course began with a fact-finding session to ascertain the state of play of ambulatory surgery in Greece. Interestingly, the law in Greece had only recently changed to allow a patient having a general anaesthetic to be discharged on the same day. Not surprisingly, the delegates were enthusiastic to understand and endorse ambulatory principles and plan for the future of day surgery within Greece.
The workshop was held in the Offices of the National Organisation of Health in Masouri, Athens in pleasant surroundings to create an ideal environment for learning. On the second day of the course, the teaching became interactive, with the delegates discussing the ‘next steps’ to introduce quality patient centred ambulatory surgery in the country. The training workshop concluded with a planned follow up date in three months time to monitor progress and assess further input, if required, from IAAS.

Doug McWhinnie, 
IAAS Trainer and Journal Editor

In Greece, the concept of day surgery is not widespread or accepted by health professionals. Practically, one center implements the Day Surgery concept but not in a systematic way. 
The 18 participants were at first hesitant but eager to learn more and by the end of the course were all very enthusiastic from the concept and willing to try to convince the hospital managers to apply the concept. 
The course is already paying out as “Konstantopouleio” General Hospital of Athens, under the leadership of Prof. C. Dervenis and it’s manager, has included in its business plan for the next three years the concept of Day Surgery as one of the main aims.
Everybody was totally satisfied and impressed by the course as the lectures, the trainers and the organization were scored as excellent. The Greek health professionals all agreed upon the need of founding a National Society and the repetition of the course with many more motivated participants.

Christos Dervenis, 
Local Training Workshop Coordinator

Thinking the Future of Ambulatory Surgery – London, UK

This year IAAS has dedicated its efforts in liaising with the academic institutions in order to further stimulate international research in the area of AS. To that purpose, on October 31, a joint workshop was held with the London School of Economics, the London School of Hygiene & Tropical Medicine, OECD and Executive committee members aiming at developing a common research framework which identifies the main areas for mutual collaboration. The document includes, among other project ideas, the following priorities: 
-    Establishment of an international network whose main focus will be international benchmarking
-    Analysis of the impact of health policies on the implementation of AS
-    Research work on the cost effectiveness of AS services and their impact on the reduction of waiting lists
This event represents an important milestone for the stimulation of research in AS and will followed by an expert meeting on December 19 aimed at developing a proposal on the development of an international network on benchmarking to be presented to the COST programme of the EU Commission.

Silva Mitro,
IAAS Program Coordinator

IAAS Train The Trainers Course in Day Surgery in former Yugoslavia: Thou shalt sow and reap

A follow-up course to last year’s training workshop was held in Belgrade, Serbia, 14-15 November. It was heartwarming to see that both the Serbian Association for Ambulatory Surgery (SAAS) has emerged and ambulatory surgery had really started in Serbia. Protagonist is our Serbian colleague, Dr. Jelena Petrovic (awarded Honorary Member of the Hungarian Association for Ambulatory Surgery), strongly supported by the remarkable Prof. Marinko Zuvela, both surgeons. Last year the training workshop laid fertile ground for Day Surgery and it was delightful to see the results!

Immediately after Serbia, Dr. Gamal Mohamed, surgeon in Budapest and President Elect of IAAS, Dr. Paulo Lemos, anesthesiologist from Porto and Dr Jan Eshuis, anesthesiologist from Amsterdam, both members of the Executive of IAAS, continued on to Zagreb for another training workshop. Twenty-six participants spent their weekend enthusiastically on a two-day course of lectures and workshops. A site visit to a starting day surgery unit was included. Local hosts in Croatia were Prof. A. Antabak and Dr. J. Deutsch. Surgical, anesthesiological and especially organizational topics with regard to day surgery were discussed in a very lively and eager-to-learn atmosphere.  For us, as IAAS officers, it was clear that there are still many obstacles to be overcome; unfortunately there were no hospital managers, insurers and politicians in the audience who could pick up the justified enthusiasm of participating doctors in their future policy. It was striking for us to see how much enthusiasm there was to achieve expansion of day surgery! IAAS offered one-week fellowships in established Day Surgery Units to local colleagues.
In both countries the IAAS officers were received with overwhelming hospitality!

Jan H Eshuis, 
Hon. Secretary IAAS

The IAAS Training Course, “Day Surgery: Make It Happen“ was held in Zagreb on 16-17 November 2014, at the Hotel Rebro Zagreb, at the Clinical Hospital Center. Twenty-six participants from 4 countries attended the workshop: 15 surgeons, 5 anesthesiologists, 5 residents, and one dental surgeon. The majority were from Croatia (20 participants), coming from ten of the largest surgical departments throughout the country and, among the foreign participants, 3 were from Slovenia, 2 from Latvia and one from Bosnia and Herzegovina. The welcome speech, on behalf of the President of the Croatian Medical Association prof. Krznarić, was held by prof. Anko Antabak, head of the ambulatory surgery department at the Clinical Hospital Center Zagreb. 
This course was a first of its kind to be held in Croatia. In fact, Croatian doctors still do not have a national association of ambulatory surgery. This course came at the right time. The announcement of its presence aroused the interest of the professional public. Participants evaluated the course as being very useful and practical. The lecturers were real experts, with excellent communication skills and knowledge in the field. Four lectures were given by local colleagues to show important aspects of ambulatory surgery in Croatia. The course was held in a friendly atmosphere, which established a good basis for continued cooperation. The vast majority of participants noted their lack of knowledge, and the need for continuing education within the exchange program.

Anko Antabak,
Local Training Workshop Coordinator

News from Member Associations

The Indian Association of Day Surgery

The 1st Prince Sultan Military Medical City’s Symposium on Ambulatory Surgery for Medical Practitioners was held on 20th & 21st August in Riyadh, Kingdom of Saudi Arabia.
Theme of this meeting was ‘New Directions: Diversity in Day Surgery’. Speakers were among local and international surgeons and nurses/nurse-administrators. Target audience were mostly nurses and some surgeons of the Medical City, of which the Day Surgery unit was a new part. The unit has 13 recovery beds with two OT’s and a small Post-op recovery area.
Not a very high volume unit, but doing fair numbers of Laparoscopic Cholecystectomy as part of routine list. 
Amongst the International Speakers, I was one of the invitees and gave four lectures, 30 min each on the topics: Diabetic foot as Day Case; Protocols of DSC, Setting up of DSC and Accreditation of DSC. The other three speakers were from USA and Nurse-Administrators, who spoke on several issues: Infection control, Attitude of staff, Fire hazards in OR, How to increase efficiency in a DS unit, and so on. Locally, we heard 5 years’ experience of Day Surgery cases, Anaesthesia in Day Surgery and Nursing experience in DS set-up. 
This being the first such meet in the Kingdom, the enthusiasm of the organisers was evident. Initially, several of our IAAS members were also invited to lecture, but, due a change in dates, twice, only I could make it.
During Chairing a Plenary session, I had the opportunity to speak about IAAS and its activities. Also, during my presentation, I announced the 11th IAAS Congress in Barcelona, and on behalf of IAAS, invited them to attend and become members.
All in all, it was a unique experience in itself; the no ‘alcohol policy’ and all women (including foreigners) in black robes created a sobering effect!

Dr. T. Naresh Row
President, The Indian Association of Day Surgery
Editor, Day Surgery Journal of India

ASECMA INFORMATION: IAAS 11th World Congress - May 10-12, 2015

On behalf of the Local Organizing Committee, we invite you to join us in Barcelona for the IAAS 11th World Congress, the 12th Congress of the Spanish Association and the 4th Iberian Congress on Ambulatory Surgery with the Portuguese Association (APCA).
We have created a scientific program that fulfills the basic aim for the congress: the continuous interaction between speakers and audience. Furthermore, several workshops, courses, visits to Day Surgery Units and more sessions where attendees will be able to practice and learn in an interactive way are planned. Other types of sessions have also been planned: lectures, symposia, pro/con debates, panel discussions, special workshops, symposia and, of course, free paper and poster presentations.  
The Nicoll Lecture will be given by Fernando Docobo, former President of ASECMA (Spanish Association on Day Surgery).
Attending the Congress will be both educational - earning CME accreditation points - and entertaining. Attendees will have the chance to catch up on international developments in day surgery from surgical, nursing and anaesthetic perspectives. Specific sessions on these issues and transversal sessions are included in the program. 
Barcelona, with an excellent weather in the month of May and with a multicultural and modern lifestyle, offers many options. 
Keep updated by visiting the congress website
We look forward to welcoming you to Barcelona and to a very successful Congress.

Miquel Prats Maeso, Fernando Docobo Durántez, Luis Hidalgo Grau
Chairman, Local Organizing Committee 
Chairman, Scientific Committee
Secretary, Spanish National Association on Day Surgery

Ambulatory Surgery

Volume 20.3 - now available


140 Adult Knee Arthroscopies Under Intra-Articular Local Anaesthetic
J .Tyler, C. Davies, C. Toner, A. Gupta, R. Shrivastava,

Experience in Day Surgery with prolene hernia system (PHS) 
J.M. Suárez-Grau, F. Docobo-Durántez, J. Mena, M.J. Tamayo, F.J. Padillo

Submucosal Ligation Of Fistula Tract (SLOFT) for ano-rectal fistula: An effective and easy technique
D.U. Pathak, V. Agrawal, V.K. Taneja

Day surgery in a developing country – the Malaysian experience
C.Y. Foo, S. Sivasampu

Carlo Castoro, Newsletter Editor-in-Chief

Paulo Lemos Portugal, Beverly Philip USA, Ian Jackson UK, Co-Editors

International Association for Ambulatory Surgery IAAS
President: Ian Jackson            
IAAS registered address: Tichelrei, 1 B-9000 GENT (Belgium) IAAS registered Number 0458.707.654
Email:                                                                     Internet:

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