Sign Out: To a hammer, everything looks like a nail

I got to thinking about the many surgical approaches to gynecologic problems we have today and the implications of new advances to those of us who are already well along in our surgical careers. Hysterectomy, in particular, can be done vaginally, laparoscopically, with laparoscopic assistance, or as an open procedure. Should we abandon the vaginal and open approaches? Or conversely, is it necessary to routinely use an open incision for hysterectomy on a normal to moderately enlarged uterus? Current medical evidence argues against eliminating open hysterectomy, and patient comfort, cosmetics, and recovery time all argue for the vaginal or laparoscopic approach.

In my estimation, routine use of total abdominal hysterectomy has more to do with the surgeon's comfort level than with the patient's. I believe that the surgical approach chosen for a particular patient should be in keeping with that individual's needs, desires-and most of all-her best health interests, not the surgeon's personal limitations. The operative technique should fit the patient and the clinical setting, not the other way around.

During residency, most ob/gyns get only limited experience in one or another of the surgical techniques we have available. And as clinicians go out into practice, the procedures and instruments continue to evolve. If you feel undertrained in vaginal hysterectomy or laparoscopic surgery, one way to gain some experience is to find a colleague in your general area who is adept and ask him or her for help in improving your skills. Hands-on surgical courses such as the one I recently attended can also be of enormous benefit.

As surgeons, we need to be lifelong learners. Take a little time off to learn a new technique or refine an old one. Seek out colleagues who have experience with instruments that are new to you. Spend some time teaching a colleague or a resident what you are particularly good at. Such active learning can make a big difference to your comfort level in the operating room, enhance your surgical skills, and help ensure the comfort and well-being of both current and future patients.