[Medico-legal implications of ambulatory surgery]

Public opinion maintains the myth that ambulatory surgery is a benign operation. Although it may not be the ideal moment for demonstrating exceptional technical skill, there are unpredictable factors and certain limitations. To date, no specific legal concept of medical appraisal applicable to ambulatory surgery has been developed in France. Nevertheless, the nation that the surgeon is required to use all possible means is keenly accentuated because in a very short delay of a few hours the patient no longer is under direct management of the surgeon or his health care team. The aim of this work was to summarize the mandatory techniques for quality care and safety adapted to the lesions and the circumstances and taking into account accepted procedure, the current state of the art and the socio-familial environment. Two specific problems are encountered in the medical appraisal: a) defining whether the complication is inherent to ambulatory surgery, b) deciding how the responsibility could be shared. The possibility of special insurance for demonstrated non-fault surgical risk would be an elegant solution to avoid legal bias and facilitate controlled development of ambulatory surgery units.