New surgical procedures: can our patients benefit while we learn?

Several forces have combined to encourage gynecologic surgeons to acquire the skills they need to perform new endoscopic procedures. Pressures 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 profession's ability to demonstrate the safety and effectiveness of new procedures through rigorous clinical trials. Early on, the benefits expected from laparoscopic surgery may be limited by harms resulting from surgical inexperience. Physicians will struggle to achieve a balance between their ethical obligation to benefit patients while avoiding harm to them and their professional expectation of continued learning. Acquisition of new techniques involves a learning curve, across which complications and operating time decrease while the potential for benefit rises. To minimize harm to patients during the surgeon's learning process, peer review should play an expanded role. Surgeons should discuss their own surgical experience and level 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.