To end this section on OB/GYN, I wanted to mention some things about the schedule in this profession. There were many things about the life of an OB/GYN that I never thought about before and experienced during this rotation. On another note, I wanted to highlight some of the common surgeries. The text does a great job mentioning these surgeries but I did not know how they were performed. Three weeks in, I have seen a handful of these surgeries and still find them relatively interesting and fascinating, so I figured I would do a blog entry describing the differences between them.
Schedule of OB/GYN
Unlike pediatrics, OB/GYN is very unpredictable. Many appointments are scheduled but babies come when they want to, meaning that the doc has to answer his phone nearly every time in rings in case a patient is about to deliver a baby. At that point, he can try to finish as many patients for the day that he can but he has to be ready in the hospital for the mom to give birth. Within the first week, he had two deliveries that were relatively unplanned causing him to cancel all of his other appointments. This was not a concept that I was aware of prior to rotation. I always knew that OB/GYN's delivered babies and that its unexpected, but I guess I never gave too much thought to their schedules and what happens when they are called into the hospital. Unfortunately, this doctor does a lot of deliveries which causes him to reschedule some patients up to 3 or 4 times! However, many of them are still willing to wait to see him because they appreciate his willingness to take time with them and make the most of their appointments when he is able to keep them. I take that as a sign that they really like him as a doctor even if they have to be rescheduled many times before they can get into their appointments.
Video driven telescope introduced into the cervical os to examine the intrauterine cavity
Diagnostic: examine cavity for abnormalities, polyps, fibroids, or abnormal linings and sample for pathology
Therapeutic: removal of abnormalities
Common uses: (also applicable to some of the other types of surgeries below)
Asherman syndrome (to cut uterine adhesions)
Polyps (removal, polypectomy)
Firboids (removal, myomectomy)
Congenital malformations (uterine septums)
Video driven telescope placed through the abdominal wall into peritoneal cavity
Diagnostic: same as above but instead examining outisde the uterus
Therapeutic: removal of fibroids, fallopian tubes, ovaries, uterus, etc.
Davincii Robotic Assisted Laparoscopy (Xi (newer) or Si(older))
Similar to regular laparoscopy, but 5 different robotic arms are introduced into abdominal cavity
Physician sits at controlling station with video screen to control robotic arms
The PA assists at the bedside with other robotic arms/instruments to help sample tissues and aid in surgery.
Minimally invasive and much more flexible in comparison to traditional laparoscopy.
Must be performed by trained professional, not all OB/GYN doctors can perform these surgeries.
Personally, I thought this was truly amazing! The view from the robotic cameras is incredible and the physician is able to do so many things with the different robotic arms!
Device is inserted through cervical os to ablate the uterine lining with lasers.
Treats post menopausal bleeding
Typically only performed after child bearing age as it cauterizes the uterine lining to prevent proliferation and bleeding
Dilation & Curettage
Curette is inserted into cervical os and then scraped against the endometrial lining for sampling
Performed to examine cells for pathology such as uterine cancer or hyperplasia
Many of these procedures can be done together/at the same time. For example, it is common to have hysteroscopy with polypectomy/myomectomy and finally a D&C.
For the most part the pictures are labeled below. The pictures are not my own. They are free images retrieved from Google searches on the topics listed above.