Surgically speaking, history is likely to dub the 1990s as 'the laparoscopic years', as changes in surgical practice cause one of the biggest revolutions in our hospitals since the arrival of general anaesthesia. As a result, surgeons are having to re-examine their skills and training, while managers need to update their infrastructure for budgets and funding. Both purchasers and providers of surgical services need to ensure that they are not tied down to 'historic' contracts.