Minor Gynecologic Surgery: A Review of the Training Experience and Skill Building Opportunities for Providers in Low and Middle Income Countries
Minor Gynecologic Surgery: A Review of the Training Experience and Skill Building Opportunities for Providers in Low and Middle Income Countries作者机构：Department of Obstetrics and Gynecology Birdem Hospital Dhaka Bangladesh Department of Obstetrics and Gynecology Dhaka Medical College Hospital Dhaka Bangladesh Department of Obstetrics and Gynecology Division of Gynecology Oncology Massachusetts General Hospital Boston USA Department of Obstetrics and Gynecology Division of Gynecology Oncology University of Massachusetts Worcester USA Department of Obstetrics and Gynecology George Washington University Hospital Washington D.C. USA Department of Obstetrics and Gynecology Mbarara University Teaching Hospital Mbarara Uganda
出 版 物：《Open Journal of Obstetrics and Gynecology》 (妇产科期刊（英文）)
年 卷 期：2014年第4卷第7期
页 面：432-444页
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题：Minor Surgery Gynecology Dilation and Curettage Hysteroscopy Cone Biopsy Residency Training LMICs
摘 要：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.
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