Ea. Gates, NEW SURGICAL-PROCEDURES - CAN OUR PATIENTS BENEFIT WHILE WE LEARN, American journal of obstetrics and gynecology, 176(6), 1997, pp. 1293-1298
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.