Female Pelvic Medicine and Reconstructive Surgery: Routes of Surgery and Related Differences Among Training Programs

Abstract

Female pelvic medicine and reconstructive surgery (FPMRS) relies on a range of surgical approaches to treat pelvic-floor disorders. Concomitant hysterectomy is involved in many of these approaches. In general, due to advances in nonsurgical treatment of benign conditions, the hysterectomy rate has decreased in the United States. Moreover, when hysterectomy is performed, the trend now favors minimally invasive laparoscopy and robotic-assisted techniques, while abdominal and vaginal approaches are less common. Mirroring national trends, studies examining trainee case logs have reported decreased volumes of vaginal hysterectomies. Surveys of trainees and program directors show wide variability in preparedness and case numbers, highlighting the lack of uniformity in training and expectations. To augment vaginal hysterectomy training, many efforts have been developed to enhance trainee education and simulation for vaginal surgery. Fidelity, cost, and validation vary in these simulation models. By simulating different steps of a vaginal hysterectomy, many models have been validated by trainees and expert surgeons to be accurate and helpful, but limited data exist on applications to FPMRS training. For FPMRS, limited studies cover training variability in vaginal, laparoscopic, and robotic approaches to prolapse repair. A 2020 Accreditation Council for Graduate Medical Education update on case minimums for FPMRS detailed the requirements for each procedure even more. As FPMRS adapts to growth of the field, surgeons must continue to educate the next generation of trainees on various routes, such as conventional laparoscopic, robotic-assisted laparoscopic, and vaginal surgery. (J GYNECOL SURG 20XX:000)