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“YOU SAY YOU WANT A REVOLUTION. WELL…”
CHARLES E. MILLER, MD (JULY 2010)

Gynecologic surgeons need more than a curriculum

Dr. Miller expresses my sentiments exactly when he laments the reluctance of gynecologists to adopt minimally invasive therapies. I am a proud minimally invasive surgeon, and I have wholeheartedly adopted minimally invasive techniques.

However, Dr. Miller misses the most important point when he proposes that the solution to the problem of under utilization of minimally invasive gynecologic surgery (MIGS) is an advanced curriculum for laparoscopy for our residents.

Clearly, it’s true that our residents need better training in MIGS, but a better curriculum would barely begin to solve the problem. The problem is that our specialty has advanced surgically to a point where a 4-year residency program—focusing on two mostly separate fields of obstetrics and gynecology—is seriously inadequate time to learn the advanced skills that a modern gynecologist needs.

To be a minimally invasive surgeon, you need more cases, more time, more training. To understand pelvic floor anatomy and urinary tract disorders, you need more time, more cases, more training. It is simply impossible to accomplish this in a 4-year ObGyn residency.

Our field is at least as complicated as other surgical subspecialties, virtually all of which require at least 5 years of training. But a gynecologist essentially gets only 2 years! I agree that we need a curriculum, but our residents simply can’t gain the experience necessary to be a 21st century gynecologist in the time we give them.

We need to seriously rethink how we train ObGyns. Then, we may be able to bring our field into the MIGS “revolution.”

Saul Weinreb, MD
Director, Minimally Invasive Gynecologic Surgical Training
Franklin Square Hospital
Baltimore, Md

Dr. Miller responds: Postgraduate training can enhance adoption of minimally invasive techniques

I appreciate Dr. Weinreb’s comments on how to encourage gynecologists to adopt minimally invasive surgery. I agree that it is difficult to advance a curriculum in MIGS when ObGyn residencies provide only 24 months of training in gynecology. Nevertheless, I do believe that if we can provide our residents with a well-thought-out curriculum in operative laparoscopy and hysteroscopy, they will adopt these modalities after training. Such a curriculum should involve not only didactic lectures, but work in a skills lab and mentored surgery.

I have long stated the importance of postgraduate training. The AAGL/ ASRM Fellowship in MIGS that I mentioned in my commentary has proved to be an excellent way for young physicians to hone their skills. Many program graduates have gone on to faculty positions teaching operative laparoscopy and hysteroscopy and become busy minimally invasive gynecologic surgeons in private practice.

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