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Comment and Controversy

Is vaginal hysterectomy a dying art?

May 2006 · Vol. 18, No. 5
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“Vaginal hysterectomy: Is skill the limiting factor?” by Dr. Carl W. Zimmerman (March), was not only a great paper, it was especially timely in light of our specialty’s reduced resident work hours, diminishing number of surgical procedures, and increasing time restraints. Vaginal hysterectomies are commonly performed by gynecologists and no other specialties. They are often referred to as “bread and butter” procedures because of their common use.

Most ObGyn training programs are in tertiary referral centers. Women go to these centers for cancer surgery and major pelvic reconstruction, not vaginal hysterectomies for uterovaginal prolapse, abnormal uterine bleeding, and other benign reasons. Thus, residents in training get less and less exposure to pelvic surgery, including vaginal hysterectomy. Less work time and fewer procedures confound this issue.

I recently attended a clinical meeting of the American College of Obstetricians and Gynecologists in which removing vaginal surgery—including vaginal hysterectomies—from training programs was proposed. The rationale behind this proposal: If one were interested in pelvic surgery, he or she would consider a pelvic surgery fellowship.

Dr. Zimmerman’s paper is well put. Skill is truly the limiting factor. If residents are not exposed to sufficient numbers of vaginal hysterectomies in training, how can they be proficient at more adept vaginal surgery such as Dr. Zimmerman describes? Many of us older gynecologists are concerned that vaginal surgery may be a dying art!

Daniel M. Avery, MD
Associate Professor and Chairman
Obstetrics and Gynecology
University of Alabama School of Medicine

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