Be prepared for the inevitable surgical injuries, emergencies. (Know Limitations, when to call for Help).

BIG SKY, MONT. -- A double standard exists in obstetrics and gynecology regarding preparedness for emergencies, Dr. Eric J. Bieber said at an ob.gyn. update sponsored by the Geisinger Health System.

From early in residency, faculty physicians hammer into ob.gyn. trainees the absolute necessity of having specific advance plans in mind to manage the unexpectedly arising case of shoulder dystocia, placental abruption, cord prolapse, and other obstetric emergencies.

That's not true for gynecologic surgery.

"We don't do well in preparing for gynecologic urgencies or emergencies. We tend not to anticipate them. We just kind of wait until they happen and then hope for the best," he said.

That approach makes no sense. Particularly in the realm of laparoscopic surgery, injuries are inevitable even for the most experienced surgeons.

"I can show you the data that say in your career, you will probably end up inadvertently injuring bowel and looking at villi. It's just a question of when. It could be next week, or next month, or in 3 or 4 years. You have to be prepared. Know that bad things are going to happen--and know what you're going to do when they do," urged Dr. Bieber, chairman of ob.gyn. at Geisinger Medical Center, Danville, Pa.

That means knowing your limitations in terms of training, ability, and hospital privileges for repair of vascular or bowel perforations of various complexity. A laparoscopic surgeon has to know when to call for help, whom to call, and what the bail-out surgeon will do.