166. Baguio Day 4: TVH

top: me, flanked by residents; bottom: student nurses 

Nancy, 48, was scheduled for an abdominal hysterectomy (TAH) because of a fibroid that had prolapsed (think “deli vered”) though the cer vix and into the vagina, still attached to the uterine lining by a half-inch diameter stalk.  With four vaginal deliveries and an otherwise normal uterus, I rescheduled her for a vaginal hysterectomy (TVH).

This is a teaching hospital, student nurses everywhere, and 12 ob-gyn residents--all women; the last male was 2 years ago. When I asked why there are no male residents and answer was predictable: “women want women for their doctors.”  So I’m working with 3^rd and 4^th year residents, who are quite competent with TAH, but have little experience with a vaginal approach.  One told me that the preop diagnosis of a fibroid automatically excludes a TVH. Most of them have assisted a couple but never performed a TVH.

So while I may be demonstrating just alternative techniques or short-cuts TAH, with Nancy the residents are learning a new procedure.  Is one experience enough to make for a long-term learning experience?  I’ve adopted new techniques from single observations (I’m taking home a few things I picked up here); I trust they can also.