NEW SURGICAL-PROCEDURES - CAN OUR PATIENTS BENEFIT WHILE WE LEARN

Several forces have combined to encourage gynecologic surgeons to acqu ire the skills they need to perform new endoscopic procedures. Pressur es from health care institutions, industry, and, most important, from patients lead to increased demand for less invasive approaches to the treatment of gynecologic conditions. This demand may outstrip the prof ession's ability to demonstrate the safety and effectiveness of new pr ocedures through rigorous clinical trials. Early on, the benefits expe cted from laparoscopic surgery may be limited by harms resulting from surgical inexperience. Physicians will struggle to achieve a balance b etween their ethical obligation to benefit patients while avoiding har m to them and their professional expectation of continued learning. Ac quisition of new techniques involves a learning curve, across which co mplications and operating time decrease while the potential for benefi t rises. To minimize harm to patients during the surgeon's learning pr ocess, peer review should play an expanded role. Surgeons should discu ss their own surgical experience and lever of skill openly with their patients as part of the process of informed consent. A relationship of trust is vital when one engages patients in a cooperative educational venture.