Reproductive surgery: decreasing skills and advancing technology—an existential conundrum

Abstract

Our article endeavors to be both a review of the recent past and a preview of the future of reproductive surgery. By reflecting on the rate of technological advancement over the past decade, we attempt to predict the trajectory of the next. We also delve into the changing nature and practical challenges of the practice of gynecologic surgery for the reproductive endocrinology and infertility subspecialist. We will explain how technological advances may alter our perception and expectations regarding the indications, timing and extent of surgical intervention in the infertile patient and in the patient seeking preservation of fertility. This review does not aim to be comprehensive, choosing instead to focus on those innovations that hold, in our view, true potential to shape the future of surgical practice. Ours is primarily a technology review. As such, it does not focus on novel surgical techniques, including uterine transplantation and ovarian tissue transplantation. Our article endeavors to be both a review of the recent past and a preview of the future of reproductive surgery. By reflecting on the rate of technological advancement over the past decade, we attempt to predict the trajectory of the next. We also delve into the changing nature and practical challenges of the practice of gynecologic surgery for the reproductive endocrinology and infertility subspecialist. We will explain how technological advances may alter our perception and expectations regarding the indications, timing and extent of surgical intervention in the infertile patient and in the patient seeking preservation of fertility. This review does not aim to be comprehensive, choosing instead to focus on those innovations that hold, in our view, true potential to shape the future of surgical practice. Ours is primarily a technology review. As such, it does not focus on novel surgical techniques, including uterine transplantation and ovarian tissue transplantation. Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/50694-28523 Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/users/16110-fertility-and-sterility/posts/50694-28523 Reproductive surgeons were instrumental in advancing the fields of microsurgery and laparoscopic surgery. The seminal works of reproductive surgeons like Raoul Palmer, Kurt Semm, and Victor Gomel laid the ground work for not only minimally invasive gynecologic surgery as it is practiced today, but also for minimally invasive surgery in all other disciplines. It is ironic therefore that we are at a crossroads in the history of reproductive surgery where we ask ourselves the question, what is the future of reproductive surgery? Reproductive endocrinology and infertility (REI) is a vast and evolving field, where multiple ever-expanding fields of knowledge converge. The modern practice of reproductive endocrinology and infertility is now completely dependent on the combined expertise of clinical embryologists, geneticists, andrologists, and reproductive surgeons. That is because the proficiency expected in any one of these fields has reached levels that are impossible for a single provider to achieve and maintain. If most reproductive endocrinologists cannot be reproductive surgeons, then it goes without saying that the definition of a reproductive surgeon must evolve. Is the reproductive surgeon still a reproductive endocrinologist who focuses on the surgical aspects of this field? Or rather a general gynecologist with special training in laparoscopy, to whom REI subspecialists can outsource the minimally invasive microsurgery that they can no longer perform? This is not a matter of semantics. Definitions, standardization, and certifications are an essential feature of patient-centered care in developed countries. We should recognize however that cultural differences do exist betwee