The decision to proceed to surgery is one that must be taken with care and responsibility, as life-threatening complications, though rare, can arise after even the most minor of operations. It is therefore essential that the patient has been adequately prepared for the operation, and that consent has been obtained by someone capable of weighing up the risks and the benefits. Careful preoperative counselling will enhance the patient’s experience and, along with good communication, adequate surgical time and continuity of care, maximize the chance of a successful outcome. This chapter will address the issues surrounding good surgical practice in patients undergoing gynaecological procedures.

Risk can be a difficult concept to communicate with a patient, and sensitivity is required to balance a discussion of the serious nature of adverse outcomes in a manner that will not detract from the patient’s confidence in their doctor’s abilities. Trust is the cornerstone of the partnership between doctor and patient, and erosion of this at an early stage, will increase the likelihood of longer-term dissatisfaction.

The gynaecologist needs to consider comorbidities of any patient being considered for surgery and general anaesthesia. Are there less invasive and safer alternatives? Examples may include, ring pessaries instead of pelvic floor surgery for prolapse; levo-norgestrel intrauterine system (LNG-IUS) instead of hysterectomy for heavy menstrual bleeding; medical therapy for endometriosis; and implant, vasectomy or LNG-IUS instead of laparoscopic tubal ligation.

If surgery is to proceed, comorbidities should be communicated to the anaesthetist to allow satisfactory preparation and to avoid anaesthetic complications. Liaison with other specialties may be helpful to make the postoperative course run smoothly and clear management plans put in place, e.g. with haematology in patients requiring anticoagulation.