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• W4232439824 abstract "Reply to the Editor:We believe, for many well-documented reasons, that hysterectomy is best accomplished by the vaginal route whenever the indications are suitable and the surgeon's skill is commensurate with the task. We also believe that many gynecologists need further training if they are to be able to perform difficult vaginal surgery comfortably and safely.Until recently the residency in obstetrics and gynecology consisted of 4 years of training equally divided between the two disciplines. Now, with the mandatory addition of 6 months in general medicine to this curriculum, only 3.5 years remains for training in obstetrics and gynecology together. It is painfully obvious to those of us who perform peer review or who write about surgical complications that 1.5 years (or even 2 years) of general gynecology residency training is inadequate to prepare a young pelvic surgeon in the challenging techniques of difficult abdominal, vaginal, and laparoscopic surgery.Yet the majority of residents who complete approved training programs are subsequently certified by the American Board of Obstetrics and Gynecology. The American Board does not “credential” gynecologists to perform surgery. Credentialing in this country is carried out by the hospital corporate entity, usually after the surgeon submits a “Delineation of Privileges” form, which serves as a formal request to perform specific types of surgical procedures in that hospital. However, as graduates of an approved residency program and Diplomates of the American Board, the majority of these physicians are credentialed by our hospitals to perform pelvic surgical procedures. This system does injustice to both patients and surgeons.Certainly, there are a number of competent pelvic surgeons ready to train younger gynecologists in surgical decision making and technique. However, in a country where >600,000 hysterectomies are performed each year, only a relatively small percentage of these patients will find a gynecologist who is capable of removing a large myomatous uterus vaginally by morcellation or “coring” techniques.1Pratt JH Vaginal hysterectomy by morcellation.Mayo Clin Proc. 1970; 43: 374-387Google Scholar, 2Kovac RS Intramyometrial coring as an adjunct to vaginal hysterectomy.Obstet Gynecol. 1986; 67: 131-136PubMed Google ScholarEvidence-based guidelines for surgical procedures are useful only when the study population on which they are based is truly representative. Additionally, these guidelines will have to take into account the abilities of the surgeons who are expected to conform to them.At this time the experience and outcomes of a relatively few excellent surgeons dealing with the vaginal removal of large uteri may have little application for many gynecologists. Until our specialty mandates longer and better surgical training for our residents, the hysterectomy patient may be best served by a surgeon who selects the route with which he or she is most comfortable.6/8/74259 Reply to the Editor:We believe, for many well-documented reasons, that hysterectomy is best accomplished by the vaginal route whenever the indications are suitable and the surgeon's skill is commensurate with the task. We also believe that many gynecologists need further training if they are to be able to perform difficult vaginal surgery comfortably and safely.Until recently the residency in obstetrics and gynecology consisted of 4 years of training equally divided between the two disciplines. Now, with the mandatory addition of 6 months in general medicine to this curriculum, only 3.5 years remains for training in obstetrics and gynecology together. It is painfully obvious to those of us who perform peer review or who write about surgical complications that 1.5 years (or even 2 years) of general gynecology residency training is inadequate to prepare a young pelvic surgeon in the challenging techniques of difficult abdominal, vaginal, and laparoscopic surgery.Yet the majority of residents who complete approved training programs are subsequently certified by the American Board of Obstetrics and Gynecology. The American Board does not “credential” gynecologists to perform surgery. Credentialing in this country is carried out by the hospital corporate entity, usually after the surgeon submits a “Delineation of Privileges” form, which serves as a formal request to perform specific types of surgical procedures in that hospital. However, as graduates of an approved residency program and Diplomates of the American Board, the majority of these physicians are credentialed by our hospitals to perform pelvic surgical procedures. This system does injustice to both patients and surgeons.Certainly, there are a number of competent pelvic surgeons ready to train younger gynecologists in surgical decision making and technique. However, in a country where >600,000 hysterectomies are performed each year, only a relatively small percentage of these patients will find a gynecologist who is capable of removing a large myomatous uterus vaginally by morcellation or “coring” techniques.1Pratt JH Vaginal hysterectomy by morcellation.Mayo Clin Proc. 1970; 43: 374-387Google Scholar, 2Kovac RS Intramyometrial coring as an adjunct to vaginal hysterectomy.Obstet Gynecol. 1986; 67: 131-136PubMed Google ScholarEvidence-based guidelines for surgical procedures are useful only when the study population on which they are based is truly representative. Additionally, these guidelines will have to take into account the abilities of the surgeons who are expected to conform to them.At this time the experience and outcomes of a relatively few excellent surgeons dealing with the vaginal removal of large uteri may have little application for many gynecologists. Until our specialty mandates longer and better surgical training for our residents, the hysterectomy patient may be best served by a surgeon who selects the route with which he or she is most comfortable. We believe, for many well-documented reasons, that hysterectomy is best accomplished by the vaginal route whenever the indications are suitable and the surgeon's skill is commensurate with the task. We also believe that many gynecologists need further training if they are to be able to perform difficult vaginal surgery comfortably and safely. Until recently the residency in obstetrics and gynecology consisted of 4 years of training equally divided between the two disciplines. Now, with the mandatory addition of 6 months in general medicine to this curriculum, only 3.5 years remains for training in obstetrics and gynecology together. It is painfully obvious to those of us who perform peer review or who write about surgical complications that 1.5 years (or even 2 years) of general gynecology residency training is inadequate to prepare a young pelvic surgeon in the challenging techniques of difficult abdominal, vaginal, and laparoscopic surgery. Yet the majority of residents who complete approved training programs are subsequently certified by the American Board of Obstetrics and Gynecology. The American Board does not “credential” gynecologists to perform surgery. Credentialing in this country is carried out by the hospital corporate entity, usually after the surgeon submits a “Delineation of Privileges” form, which serves as a formal request to perform specific types of surgical procedures in that hospital. However, as graduates of an approved residency program and Diplomates of the American Board, the majority of these physicians are credentialed by our hospitals to perform pelvic surgical procedures. This system does injustice to both patients and surgeons. Certainly, there are a number of competent pelvic surgeons ready to train younger gynecologists in surgical decision making and technique. However, in a country where >600,000 hysterectomies are performed each year, only a relatively small percentage of these patients will find a gynecologist who is capable of removing a large myomatous uterus vaginally by morcellation or “coring” techniques.1Pratt JH Vaginal hysterectomy by morcellation.Mayo Clin Proc. 1970; 43: 374-387Google Scholar, 2Kovac RS Intramyometrial coring as an adjunct to vaginal hysterectomy.Obstet Gynecol. 1986; 67: 131-136PubMed Google Scholar Evidence-based guidelines for surgical procedures are useful only when the study population on which they are based is truly representative. Additionally, these guidelines will have to take into account the abilities of the surgeons who are expected to conform to them. At this time the experience and outcomes of a relatively few excellent surgeons dealing with the vaginal removal of large uteri may have little application for many gynecologists. Until our specialty mandates longer and better surgical training for our residents, the hysterectomy patient may be best served by a surgeon who selects the route with which he or she is most comfortable. 6/8/74259" @default.
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