Monday, January 28, 2013

The vagina

Is a place where other doctors are afraid to go. Do a pelvic exam? As if!

But it is our hallmark. Vaginal surgery is what differentiates us gynecologists from other surgeons. We up the degree of difficulty by operating through it. Vaginal surgery violates many surgical dictums - good visualization (nope), easy access (HA!), good lighting (as I knock the OR light with my head yet again). But we do it. Successfully.

Nowadays, we are retreating from it. Adding laparoscopy, or using the robot. And this is not in the patient's nor our society's best interest.

We need to reclaim the vagina for surgery.


physician activist in training said...

(Vaginal surgery, and how to increase the appeal, is actually one of my research topics for this year.)

Grumpy, M.D. said...

I'm just gonna stay in my comfort zone with my reflex hammer here.

Anonymous said...

Wait wait wait. We need to not use laparoscopy to minimize invasiveness, and not use robotic tools to increase access, visualization, and control?

We need to "reclaim" the area by sticking with bad lighting, bad access, and bad visualization?

What the hell kind of silly idea is that?

ER's Mom said...

Vaginal surgery is the least invasive method of hysterectomy - single incision. TLHs and robotic have between 4-6 incision (3-5 abdominally and the vaginal incision).

We need to ensure that graduating residents feel comfortable enough to do vaginal surgery in order for it to continue.

Literature shows that vag hysts consistently have the fewest major complications - including ureteral injuries, blood transfusions, bowel eviscerations. So yes, it is more difficult to do vaginal surgery - but the benefits to the patient (and ultimately society - fewer complications means fewer $$ paid out as well as faster return to activities).

ACOG and AAGL agree with me - both call for vaginal hysterectomies to be the standard. This is the weakest argument (appealing to authority)