Standards for Gynecologic Surgery

Abstract

There are significant problems to consider when we reflect on ''Standards for Gynecologic Surgery.'' Surely most professional standards are already in place, or are they? Are standards already available, locally, nationally, or internationally? Where those standards are not already available will it be possible set new standards for the multiplicity of operative interventions, performed by an array of trainees, specialists, and colleagues many of whom are outside of our remit and spread over the continents? If we do set standards how do we audit outcomes to gynecologic surgery and insure that the standards are being complied with? How do we tutor our trainees effectively and also insure that established specialists retain their skill base, are up-to-date, and compliant with continuing medical education? It is important to realize that the success or failure of a modern surgical investigation or procedure will now be judged not on the pure surgical outcome alone, but will also need to reflect patient focus through excellence in the areas of communication, patient information, informed consent and confidentiality. The accessibility to services, appropriate environment, and processes being offered by trained and competent staff members-who are supervised when required-should all be included in audits of outcomes set against agreed auditable standards.

A case report of thrombosed varicosities of pubic collateral veins: Ideal treatment strategy and contribution of era imaging technologies in diagnosis

“… 1 – 3 The former is also described as May–Thurner syndrome and consists of compression of the left CIV by the overlying right common iliac artery against the vertebral column, whereas the latter is a clinical entity, still not fully understood and sometimes tricky even to diagnose. 2 , 3 Pubic crossover veins usually appear as varicosities above the pubic bone and serve as superficial collateral pathways that create an alternative outflow in cases of deep vein obstruction. Their existence is of high importance due to the relief they provided to the patient with deep vein occlusion and their positive predictive value for the diagnosis of the underlying cause.…”

“…These plexuses are usually formed by swollen superficial external pudenda, superficial epigastric and superficial circumflex iliac veins. 2 , 4 …”

“… 1 Rates increase in case of hospitalization, surgery, immobility, trauma, pregnancy, obesity, cancer and a lot of secondary reasons of hypercoagulation. 2 In the majority of these cases (25%–40%), patients can develop vein recanalization, post-thrombotic syndrome (PTS) and transition to chronic deep venous obstruction. In general, collateral circulation is an anatomical terminology and concerns an alternative path occurring in case of various vascular disorders, such as venous or artery obstruction.…”

“… 3 , 5 , 6 Surgical removal of collateral veins is contraindicated since this could worsen the deep venous circulation, except cases with inflammation and erosion. 2 , 3 Treatment of choice is usually conservative, with compression socks, mobilization and anticoagulation. 3 Although in case of treatment failure, more invasive methods, such as percutaneous transluminal angioplasty and stenting, may have clinical success.…”

“… 3 Clinical examination, surgeon suspicion and Clinical–Etiology–Anatomy–Pathophysiology (CEAP) classification of lower extremity chronic venous disorders (C0–C6), is determinant for ideal treatment strategy. 2 , 3 …”