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Prevention and Management of Complications from Gynecologic Surgery

Preface Surgical Complications

Howard T. Sharp, MD Guest Editor

It is more enjoyable to read about complications than to manage them. Surgical complications are challenging for several reasons. It is difficult to watch patients and their families suffer. Although some complications are minor setbacks that resolve over time, some lead to longstanding disability. As surgeons, we sometimes doubt ourselves in the wake of a complication and lose confidence in our abilities. In some cases, surgeons avoid surgery or practice heightened defensive surgery, rendering them surgically dysfunctional. We should ask ourselves, ‘‘Is there something I should have done differently?’’ ‘‘Could this have been avoided?’’ and ‘‘Should I have recognized something earlier?’’ These are questions I ask each week at our institution’s morbidity and mortality conference. One of my favorite surgical mentors, the great, late Gary Johnson, MD, would lament, ‘‘If you don’t want surgical complications, don’t do surgery.’’ He had figured out that complications happen. I do not know that he was any more comfortable with complications than I, but he recognized an important truth: there is a complication rate for each surgery performed. Are there ways to reduce complication rates? I think so. Can all complications be eliminated? I think not. It has always sounded a bit ridiculous to me when someone says, ‘‘He or she has the hands of a surgeon,’’ as if the hands have so much to do with being a good surgeon. Having a steady hand and knowing the patient and how to perform surgery are given basic prerequisites for taking a patient to the operating room. But there is much more to being a good surgeon. Surgeons must know anatomy and anatomic variation, be familiar with surgical instrumentation and its technology, have situational awareness, and be ever vigilant to recognize risks for complications preoperatively, intraoperatively, and postoperatively. Some have said it is good to have a little healthy paranoia. The reason for vigilance is the recurrent theme of early recognition and management of complications associated with better outcomes. If there were anything

Obstet Gynecol Clin N Am 37 (2010) xiii–xiv doi:10.1016/j.ogc.2010.05.005 0889-8545/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved.



to stress in the volume, it is that avoiding complications is much more than just having ‘‘good hands.’’ It is my sincere hope that the words of these fine authors will allow the readers to avoid and manage complications to the best of their ability. Howard T. Sharp, MD Department of Obstetrics and Gynecology University of Utah Health Sciences Center Room 2B-200, 1900 East, 30 North Salt Lake City, UT 84132, USA E-mail address: