The "Ruston Stretch": a simple way to get a large specimen out through a small hole.

The balance between port-site size and ease of specimen removal is often a challenge in laparoscopic surgery. Herein we describe a simple technique that circumvents this dilemma by means of port-site dilation using Hegar dilators.

Why we are wasting time in the operating theatre?

OBJECTIVES: To determine reasons for delay during elective operating lists and suggest solutions. DESIGN: Prospective observational study. SETTING: A large under-graduate teaching hospital. PARTICIPANTS: Fifty-five consecutive women undergoing elective gynaecological surgery under general anaesthesia. INTERVENTIONS: Every time point of individual patient's passage through the operating theatre (patients sent for, arrival in the anaesthetic room, general anaesthetic commenced, transfer to the operating theatre, surgery started, surgery completed, anaesthetic reversed, patient taken to recovery area) was documented. MAIN OUTCOME MEASURES: Time intervals between the various time points with particular reference to wait by the anaesthetist and surgeon between cases. RESULTS: We monitored 55 operations carried out during 22 operating lists. Apart from the surgery itself (median 81 min per procedure), the longest interval was the time taken to get patients into the anaesthetic room from the ward (median 20 min). Although patients waited a median of 10 min before the start of anaesthesia, if the first procedure on the list was excluded, the anaesthetist was waiting for the patient to arrive in the anaesthetic room in 13/30 (43%) cases, wasting a median of 7 min per case. The surgeon had to wait a median of 22.5 min between operations. CONCLUSIONS: Considerable operating theatre time is wasted while patients are transferred to and from the operating theatre resulting in both anaesthetists and surgeons having to wait between patients in a high proportion of cases, averaging 1 h during a 4 h operating list. Surgery could be made more time efficient by ensuring that patients arrive in the operating theatre complex early enough (to reduce time wasted for anaesthetists and surgeons), and by having two anaesthetists available at the end of surgery, one to reverse the anaesthetic while the other starts the next induction (to reduce time waste for the surgeon), coupled to adequate recovery area capacity.