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Nicoll lecture


The concept of Ambulatory Surgery and the 12th International Congress    Beijing (May, 4th – 7th, 2017)

The concept of ambulatory surgery means that the patient receives his surgery without a postoperative overnight stay:  this concept is nowadays spread worldwide.

The reasons for the spread of Ambulatory Surgery are multiple, new surgical techniques and new insights in the functioning of the human body, coupled with the introduction of new anaesthetic techniques, are basically most important.

It is also important to recognise that teamwork is vital between the different participants in the process and the fact that surgery on a patient is merely part of a multidisciplinary pathway and not a single act, by a single surgeon and his anaesthetist but requires the support of other staff especially the often-underestimated nursing staff. Everyone involved in the process, starting at the moment of the diagnosis and the decision to operate and ending when the patient is back to work, has his responsibility in the good functioning and the result.

And that is why James H. Nicoll was appointed as the father of Day Surgery: “he developed the concept of a team, working closely with the others, involved in the process”.

James H. Nicoll (1863 – 1921) was a surgeon whose early interests were in the field of urology but soon extended to a more general surgery and in particular to children’s surgery. He graduated at the University of Glasgow, Scotland,  in 1886. He travelled widely to foreign medical schools and in 1894 he was appointed to the Dispensary in West Graham Street, Glasgow, which was the outpatient department of the Glasgow Hospital for Sick Children.

From 1891 to 1914 he was a surgeon to the Dispensary and in 1909 he published a report about 7392 operations performed between 1899 and 1908 by himself in this “Day Centre”: cleft lip, cleft palate, spina bifida, pyloric stenosis, etc….. Then, at the beginning of the First World War, he was dispatched to France and when President Poincaré of France returned to his country, he awarded Nicoll the Cross of the Legion of Honour for his work.

In 1909, James Nicoll enunciated his conclusions about day surgery in the British Medical Journal and he stated  that :
- children were best nursed at home by their mother
- the concept of bed rest was impractical and not necessary
- nurses were employed to visit children postoperatively at home
- treatment in an out-patient setting  was of higher quality and  less expensive
- and the outpatient surgery was a valuable teaching resource.

His house, providing accommodation for mothers and their children and the Dispensary, situated at 5 min walk from the Hospital, were the forerunners of the” hospital hotel” and the “free standing” Ambulatory Surgery Unit.

In the following decades the concept was spread all over the world, the IAAS (International Association for Ambulatory Surgery) was established, the idea was promoted to Central and Eastern Europe countries and in 2013 China (China Ambulatory Surgery Alliance, CASA) joined.

Together with CASA and other Chinese co-organizers, IAAS will launch a new appeal to the world in favour of the Ambulatory Surgery concept by accepting the “Beijing declaration “ and starting up training courses in clinical technology, medical management and supervision for the trainers .

It is always a great honour to be appointed for the “Nicoll lecture” at the occasion of an International Ambulatory Surgery Congress. It gives the orator the occasion to compare the principles of ambulatory surgery as seen by James Nicoll more than 100 years ago, with the situation of today. It gives the possibility to correct the vision about this concept and to adapt it to the typical regional cultures of the different countries in the world. But at every single occasion there is the ascertainment that Nicoll’s ideas are right and modern and that they need to be promoted amongst all those who are involved in giving care to people. Especially the leading bodies in the world are to be convinced of those basic and clear principles.

This year the influence of the new surgical, anaesthetical and management techniques on the concept will be discussed. Or is it vice versa: is it the ambulatory surgery concept that gives rise to new techniques in surgery, anaesthesia and care management?


James H. Nicoll , AS  7, (1999), 63-64 P.E.M. Jarrett
James H. Nicoll, Legion of Honour France, Father of Day Surgery, SMJ, 50, 1 (March 2006) DG Young, R Carachi

Dr. Luc VAN OUTRYVE, MD, General surgery
Honorary Treasurer I.A.A.S.

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