Standing surgery – who benefits and who pays?

Standing surgery is becoming ever more popular as facilities and expertise improve. Surgical procedures that have always traditionally been performed under general anaesthesia, can now be performed routinely on the standing sedated horse with regional and local anaesthesia. The accompanying article on standing upper airway surgery describes the range of surgical procedures that are performed standing and explains some of the advantages, as well as other procedures such as laparoscopy, fracture repair and some arthroscopies that can be readily performed with the horse standing. The advent of new instruments such as needle arthroscopes, oroscopes and better imaging techniques such as computed tompgraphy and magnetic resonance imaging allow for more accurate diagnoses and better visualisation, which further facilitate standing surgery. The main advantage is clear, in that general anaes-thesia in horses is a risky procedure and if this can be avoided then that has to be a good thing, but it is important to consider - at what cost does this come?