The concept of minimally invasive surgery has been associated with a large increase in the number and type of procedures carried out in ambulatory surgical units. The caseload has given an impression to the public and to patients of a minimal level of risk. We in anesthesiology are not of the same opinion and are striving to find a balance between expectations of patients, surgical needs and what we believe is safe for patients to endure, and at the same time reassessing preanesthetic evaluation, which is the basis of optimal patient care. The challenge is to continue to decrease morbidity and mortality in the new approaches to care so that cost savings and increases in productivity do not impinge on patient benefit or comfort.