Eliane M. Shore

Gynecology resident laparoscopy training: present and future

Simulator education is essential to surgical training and it should be a requirement at all training programs across North America. Yet, in a survey of North American obstetrics and gynecology program directors (response rate 52%), we found that while 73% (n = 98) of programs teach laparoscopic skills, only 59% (n = 81) were satisfied with their curriculum. Most programs lacked standard setting in the form of theoretical examinations (94%, n = 127) or skills assessments (91%, n = 123) prior to residents performing surgery on patients in the operating room. Most programs (97%, n = 131) were interested in standardizing laparoscopy education by implementing a common curriculum. We present 3 core recommendations to ensure that gynecologists across North America are receiving adequate training in gynecologic laparoscopic surgery as residents: (1) uniform simulator education should be implemented at all training programs across North American residency programs; (2) a standardized curriculum should be developed using evidence-based techniques; and (3) standardized assessments should take place prior to operating room performance and specialty certification. Future collaborative research initiatives should focus on establishing the content of a standardized laparoscopy curriculum for gynecology residents utilizing a consensus method approach.

Avoiding complications by a hands-on mentor programme

The complexity of gynaecologic surgery has increased in recent years, while the duration of residency training has remained fixed with reduced work hours compared with our predecessors. Residents may not be graduating with the advanced surgical skill set required for complex cases, which are now considered standard of care. The ever-changing advancements in the field of gynaecologic surgery warrant the development of training programmes for practicing surgeons to incorporate recent advances and best practices. This can be accomplished through mentorship in training residents as well as the continuing professional development of safe gynaecologic surgeons. This review outlines the process of mentorship to enhance surgical skills, and objective feedback tools for surgeons seeking to improve performance. Mentorship programmes can help surgeons incorporate new technologies in a structured environment, which seeks to decrease the risk of complications for our patients.

Uterine lymphangioma in pregnancy.

BACKGROUND: Uterine lymphangiomas are rare benign tumors of the lymphatic system that are commonly congenital. CASE: A 36-year-old woman was diagnosed with an asymptomatic cystic mass of unclear etiology before pregnancy. It was thought to be an adnexal mass and managed conservatively during the antepartum period with ultrasonography and magnetic resonance imaging. Her pregnancy was otherwise uncomplicated. Postpartum she underwent a diagnostic laparoscopy that revealed that the cystic mass originated from the uterus. Hysterectomy histopathology revealed a vascular lesion consistent with a uterine lymphangioma. There were no adverse pregnancy outcomes associated with the presence of the uterine lymphangioma. CONCLUSION: Lack of adverse pregnancy outcomes in this case suggests the consideration of conservative management of uterine lymphangiomas during pregnancy. Surgical resection is usually necessary to confirm the diagnosis of lymphangioma.