To the Editor.—There is a widespread belief, fostered by the Joint Commission on Accreditation of Hospitals and also by the American Hospital Association, that it is mandatory to have a qualified surgical assistant present at all "major" operations. This rule has been incorporated into the bylaws of most hospitals and covers all operations on body cavities.
No sensible surgeon would undertake a major procedure without an assistant, and the more serious or involved the procedure, the more likely is he to choose an experienced assistant. This may be especially true in community practice where surgeons are in the habit of assisting each other.
One of the reasons for insisting on an assistant at a surgical procedure is the possibility that the operating surgeon may suffer a sudden severe illness that would incapacitate him. In such circumstances, of course, the assistant would be able to continue the procedure and invoke