In this large, randomized trial, laparoscopic cholecystectomy within 24 hours of hospital admission was shown to be superior to the conservative approach concerning morbidity and costs. Therefore, we believe that immediate laparoscopic cholecystectomy should become therapy of choice for acute cholecystitis in operable patients. (NCT00447304).

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Because the perforation rate and thus the time for glove changing depend on the type of the surgery, the results found in visceral surgery can not be transferred to other surgical special-ties without additional scientific evidence. Further studies are needed that correlate the types of surgical procedures with specific perforation rates in order to provide basis for solid -recommendations helping to improve patients' and medical staff's safety.

These data do not suggest that septic and aseptic procedure rooms need to be separated. In interpreting the findings, one should recall that the study was not planned as an equivalence or non-inferiority study. Wherever patient safety is concerned, high-level safety concepts should only be demoted to lower levels if new and convincing evidence becomes available.