Editorial: Do you want a surgeon to practice on your mother?

April 15, 2005

The airline industry didn't wait for validation before they employed simulation in their credentialing program, and surgeons shouldn't either.

In the first article in this special issue, Drs. Samantha Pulliam and Anthony DiSciullo describe the latest virtual reality (VR) simulators that will help shape the future of surgical training. While the development of these tools is in its infancy, surgical simulators will soon be a requirement for training and credentialing. In fact, the FDA recently mandated that interventional radiologists must pass simulator training before placing carotid stents. Training in new techniques for general surgery and gynecology can't be far behind.

There are, however, critical questions that need answers: Are these tools validated, and should we wait for validation studies? The airline industry didn't wait for validation before they employed simulation in their credentialing program, and in my opinion, surgeons shouldn't either. As one pilot put it: "No randomized placebo trial was done on the efficacy of parachutes." We can't afford to wait for validation studies to employ these important teaching and credentialing tools.

The final article in this special technology issue addresses the best surgical approach to vaginal prolapse. Among the questions that need consideration: Are clinical outcomes better with vaginal or laparoscopic repair? What new technologies can assist the gynecologic surgeon in providing patients with the optimal result, the lowest morbidity, and the lowest rate of recurrence? Dr. Richard Bercik provides an excellent summary of this condition, as well as his opinions on these important clinical questions. Dr. Bercik has had extensive experience with the use of these new technologies and explains the advantages and disadvantages in their early adoption.

So within this one issue, we see the value of using old technology for new applications, as in the case of breast MRIs , the value of immediately deploying new technology for the repair of vaginal vault prolapse, and the value of an infant technology that I believe will revolutionize the way we train future gynecologic surgeons. And while most new surgeons will still have to practice on our mothers, sisters, and wives, at least we have the comfort of knowing that many of these clinicians are getting their initial training on a virtual patient.