Technology and the ob/gyn

Dr Einarsson, Deputy Editor, is Associate Professor of Obstetrics and Gynecology, Harvard Medical School, Boston,

Massachusetts, and Director, Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts.

We are completely surrounded by technology in our personal and professional lives. While technology may be helpful, it can also complicate tasks that used to be simple. As an example, consider the evolution of the surgical removal of a uterus. The first such procedure was performed in a living room without anesthesia and with very simple instrumentation. While the patient survived, the modern performance of a hysterectomy has become much safer, in large part thanks to the evolution of technology. This evolution has given surgeons myriad complex tools and several options for modes of access, but it has also made it challenging for gynecologists to remain proficient in the safe use of all instruments and surgical methods.

In the surgical technology supplement in the October 2013 issue of Contemporary OB/GYN we explore important technology principles that are relevant to day-today clinical practice.

Dr. Peter Lim outlines some tips and tricks for the successful implementation of a robotic surgery program. Since its US Food and Drug Administration approval for gynecologic applications in 2005, robot-assisted laparoscopy has enjoyed a rapid rise in utilization, to the point where robotic hysterectomy has replaced robotic prostatectomy as the most common robotically assisted laparoscopic procedure in the United States.

While the use of robotics may enable certain surgical tasks, the robotic system adds a layer of complexity due to unique instrumentation, a large footprint, and a physical distance between surgeon and patient. It is important that surgeons are aware of these issues and take steps to avoid any undue effects that may arise as a result.

This piece on robotic surgery discusses important principles such as port placement, instrument choices, and robotic docking, all of which are critical to safe robotic surgery.

Dr. Craig Sobolewski discusses the use of electrosurgery. While all gynecologic surgeons utilize electrosurgery regularly, many do not understand the basic principles behind this technology. This is unfortunate because improper use of electrosurgery is one of the leading causes of patient injury at the time of surgery.

The segment on electrosurgery will help the reader to better understand and implement the safe utilization of electrical energy in his or her surgical practice.

In the next segment, Dr. Rosanne Kho debates Drs. Ted Lee and Cara King on the subject of whether surgeons should choose the laparoscopic or vaginal approach when performing a minimally invasive hysterectomy. While the American College of Obstetricians and Gynecologists currently recommends the vaginal approach as the primary mode of access, the implementation of vaginal hysterectomy in clinical practice has been stagnant for decades. This is unfortunate because this approach is the most cost-effective, and several authors have published extensively on its safety even in situations with challenging pathologies.

Dr. Kho describes current efforts and strategies to change this trend, as well as the importance of several technical approaches to increase surgeon success and decrease complications.

On the other hand, Drs. Lee and King discuss how, considering the complexity of gynecologic surgery and the wealth of surgical options available, it is impossible for the average practitioner to remain competent in all surgical approaches. They also argue that the laparoscopic approach is the more logical choice in light of recent reports of lower postoperative morbidity as compared with vaginal hysterectomy.

Furthermore, laparoscopic hysterectomy may be more universally applicable than vaginal hysterectomy in a variety of clinical scenarios. Readers will undoubtedly come to different conclusions based on their own surgical experience, but this debate provides food for thought for all gynecologic surgeons.

Finally, the Contemporary OB/GYN Tech Tools columnists, Dr. Brian Levine and Dr. Dan Goldschlag, discuss the latest technologies that cross the boundaries between personal and professional applications. New devices and apps that open new avenues to connectivity, synching, and 3-D mapping will one day-perhaps much sooner than we expect-affect the ways we all practice.

It is an interesting time to be a gynecologic surgeon. While the variety of complex technology may seem daunting at first, it is exciting to witness the rapid evolution and refinement of our surgical field.

It will be interesting to look back 10 years from now. I predict that the surgical landscape will have changed dramatically by then. Regardless, it seems inevitable that technological advances will continue to enable surgeons to perform complicated gynecologic procedures safely and in a minimally invasive fashion, which will ultimately greatly benefit our patients.