Establishing Standards in Minimally Invasive Gynecologic Surgery

The second quarter would encompass patient selection, preoperative planning and preparation, and patient counseling. Technical skills for performing safe diagnostic laparoscopy and hysteroscopy would be a focus, along with an understanding of potential complications and appropriate management. The third quarter would be dedicated to acquiring specific surgical skills – knowing the boundaries of pelvic spaces and using techniques such as hydrodissection and traction/countertraction, for instance, as well as performing laparoscopic suturing and using agents for adhesion prevention. By the end of the fourth quarter, the trainee would be able to independently implement appropriate surgical and medical plans as well as teach and assist other surgeons.

It is important to appreciate that robotic surgery is, in fact, a form of laparoscopy, and the best preparation for robotic surgery lies in basic laparoscopic training. There are physicians who are performing both laparoscopic and robotic-assisted laparoscopic surgery without having a basic knowledge of laparoscopy.

Looking back to the general surgery literature of the late 1980s and early 1990s, there were reports of complications relating to laparoscopy that were new to general surgeons but were well known to gynecologists, such as problems with abdominal entry, port-related injuries, and laser and electrosurgery injuries. Currently, a look at the robotic urology literature shows the same known laparoscopy-related complications being reported as robotic surgery complications.

Dr. Nezhat is the current secretary/treasurer of the AAGL; adjunct clinical associate professor of gynecology and obstetrics at Emory University, Atlanta; adjunct clinical associate professor of obstetrics and gynecology, Stanford (Calif.) University; and fellowship director, Center for Special Minimally Invasive Surgery & Reproductive Medicine, Atlanta. He is a pioneer in the field of laparoscopic surgery, specializing in infertility and endometriosis, as well as urologic and pelvic reconstruction. He has authored more than 100 publications including refereed journal articles, book chapters, and two books. Dr. Nezhat is a frequent lecturer and educator and regularly serves as a medical volunteer in underdeveloped countries. He had no disclosures to report.