TITLE:
Minor Gynecologic Surgery: A Review of the Training Experience and Skill Building Opportunities for Providers in Low and Middle Income Countries
AUTHORS:
Rachel Marie Clark, Leslie Siriya Bradford, Jessica Opoku-Anane, Joseph Ngonzi, Ferdous Islam, Mithila Faruque, Annekathryn Goodman
KEYWORDS:
Minor Surgery, Gynecology, Dilation and Curettage, Hysteroscopy, Cone Biopsy, Residency Training, LMICs
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.7,
May
30,
2014
ABSTRACT:
Purpose: Minor
gynecologic surgery is the cornerstone of gynecologic evaluation and
intervention in countries with a well-established medical infrastructure.
Surgical training and exposure to minor procedures are not available in low and
middle-income countries due to the complex challenges of patient delay and lack
of access to healthcare, physician shortages, and the lack of ancillary
services such as pathology and radiology. This paper reviews current training
statistics, the international literature on minor gynecologic surgery and
training strategies. Methods:
PubMed searches using MESH terms cone biopsy, dilation and curettage, and loop
electrosurgical excision procedure were performed. Statistics of minor surgical
procedures among US Obstetrics and Gynecology Residency programs were
tabulated. We then searched for data of training programs and surgical
statistics in low resource countries. Results:Dilation and curettage is the
most common minor gynecologic procedure in the United States but is performed
with significantly lower frequency in low and middle-income countries. The most
common procedure for the treatment of preinvasive disease was cryotherapy
followed by loop electrosurgical excision procedure. There was no information
about minor surgical procedures performed in hospitals in low and middle-income
countries. Statistics from four-year American training programs showed an
average of 209 minor cervical procedures performed annually. Conclusion: Expertise in minor
gynecologic procedures is vital and requires the development of both adequate
training programs and local medical infrastructure. Strategies for training in
minor surgery for providers in low and middle-income countries include online
curriculums, mentored relationships with senior physicians, and simulation
models.