Safety and training.

Provided progress is made systematically, the surgeon never attempts to perform operations that are too difficult, and all the safety protocols are adhered to, hysteroscopic surgery should be within the capabilities of most gynaecologists. Failure to appreciate the risks and failure to undergo continuous training in the learning period will inevitably lead to complications which should otherwise be avoidable. Hysteroscopic surgery offers many advantages over conventional surgery and, like many other types of minimal access surgery, appears to be the surgery of the future. Endoscopic surgery will not supplant open surgery but will become another essential part of our practice which the patient will expect and, indeed, demand. There will be problems. Training programmes must be established to try to prevent complications which will be encountered if inadequately trained surgeons perform these new forms of surgery. There must be continuous education in existing methods and research into value and results of new techniques and instruments both for laser and electrosurgery. It is possible that in the future new biophysical or pharmacological approaches may render laser and electrosurgery obsolete. Safer forms of physical energy, photosynthesis and new forms of hormone therapy are all undergoing trials with preliminary results which are encouraging. Whichever techniques eventually prove to be the most effective and safe, we must learn to use them because we owe to our patients the opportunity to benefit from them.