Unintended Consequences

Journal articles on complications always attract my attention, and so it is with this issue. As a busy gynecologic surgeon whose practice is filled with complex cases, I have had my share of surgical complications.

Two aspects of the article by Sarkar et al.—“Adverse Events When Using Advanced Sealing Devices During Vaginal Hysterectomy: An Analysis of the Manufacturer and User Facility Device Experience (MAUDE) Database” (pp. 158–161)—attracted my attention. First was the subject of surgical complications in general and, second, was complications related to the application of new technology to surgical procedures.

The pelvis is a confined space that is characterized by the intimate relationship of portions of the urinary, genital, and intestinal tracts. Surrounding these organ systems is an extensive neural network and the major vascular supply to the pelvic organs and lower extremities. Maintaining the integrity of these structures is a major challenge of pelvic surgery. All surgeons who perform pelvic operations must have a clear understanding of the complications that may arise as well as their prevention, recognition, and management.

Being surgeons carry great responsibilities to our patients. They trust that we know what we are doing and will always do our best. Despite our skill and best efforts, complications will occur and, as surgeons, we must be committed to constantly enhancing our knowledge, skills, and dedication to prevent or manage these potential adverse outcomes.

Technological advances in gynecologic surgery are, so far, a mixed blessing. On the positive side, they have improved the efficiency, precision, and ergonomics of some procedures. On the negative side, these advances may drive up the costs of surgical care, sometimes without proven benefit over more-conventional methods. New surgical technology often becomes available to surgeons before it has been fully vetted. This may influence the likelihood of a surgical complication, either as a result of incomplete understanding of the technology or the technology itself. As surgeons, we must be cautious about incorporating new technologies, and be responsible about adapting them to maximize patient benefit while minimizing the chance of harm.

I invite you, the readers of this journal, to communicate your thoughts regarding surgical complications and the incorporation of new technology to surgical care. The best format for doing this would be a “Letter to the Editor.”

—Mitchel S. Hoffman, MD

Editor-in-Chief