Objective To reduce the difficulty and fatigue associated with long and complex laparoscopic procedures; to protect the face and airway of the patient from pressure from the surgeon's arms, and to allow easy operating from directly over the head end of the operating table, whilst maintaining access for the anaesthetist and monitoring equipment. Design We designed and patented the Smith Shield, a perspex ‘box’ with three rectangular sides that attaches over the anaesthetized patient's head. It functions as a Mayo table and surgeon's arm rest and holds equipment quivers for keeping laparoscopic instruments ready for use. Subjects and settings We have used the Smith Shield for all the minimal access procedures performed in our unit between January 1997 and June 1998. Other teams have also used the shield in place of the Mayo table for open procedures, most notably colposuspension. Results Most of the surgeons in our directorate now choose to use the shield for all but the most simple of laparoscopic procedures, as they have been so impressed with its advantages. All of our regular anaesthetists, after gaining familiarity with the correct positioning of the patient's arms and intravenous lines, comment that access to the patient for monitoring is satisfactory, and they commend the protection offered to the patient by the shield. Conclusion We now regard the Smith Shield as an essential part of our standard laparoscopic equipment as the ability to operate comfortably from the head end of the table has greatly reduced the difficulty of complex procedures.