The quality of our journey

As we embark on our twenty-fifth year let's take a few moments to evaluate our course. Can we measure our progress in real improvement in health care for women, or are we looking at shadows on the sand? Medicine has changed dramatically since the AAGL was founded in 1971. Laparoscopy has been transformed from a diagnostic tool into an approach for even the most complex of operative procedures. Reflections, however, give us pause to evaluate the direction of our journey. What roads have we traveled and where are we headed? Have we defined our goals and do we know which way to go? Is all this progress benefiting our patients? How do we measure the success of our journey? Over the past century medicine evolved from Sir William Osler's study of the diagnosis and prognosis of disease to the science of treating and curing disease using technologies and pharmacology beyond comprehension only a few decades--and sometimes only a few years--ago. The extraordinary pace of development has left little time for us to contemplate or evaluate our achievements. Without question we have successfully accomplished remarkable technologic feats. Surgical practice, the art, the craft, and more recently the science, has always been defined by its tools. Let us remember, however, that the quality of our journey will not be measured by new inventions. Ultimately it will be measured by our ability to affect the health and well-being of our patients and to improve the quality of their lives. We risk falling in love with technology, but will this compromise the care we provide? As technology swiftly develops we must understand the difference between seeing and vision. Only vision will enable us to incorporate these advances appropriately as instruments for healing. Endoscopy began as a relatively crude and invasive diagnostic procedure. The ability to harness and amplify light triggered provided an impetus for advances in the firle. We have come a great distance from Max Nitze's electrically lighted cystoscope in 1879 to the fiberoptic microendoscope in 1995. Surgery, which began as a magical art, changed and grew into a science with the integration of physiology, pathology, and technology. Endoscopic surgery was initiated by Nitze's adaptation of electric light for the cystoscope. He performed endoscopic excision of bladder tumors in situ in the 1890s, but his tools were crude by our standards. Progress in surgical instrumentation and surgical techniques went hand in hand. 1 Yet many surgeons continue to function as technicians, incorporating new procedures without first subjecting them to the rigors of scientific study. Science and technology enable us to perform intricate surgical procedures successfully. We have demonstrated that many things can be done endoscopically, but should they be? We now have smaller, clearer, cheaper instruments with which to view and manipulate the organs of the human body. Have they improved the health of patients? Are they safe, useful, or cost effective? Is our ability to look directly at the abdomen, pelvis, and uterus an advantage? We can easily be seduced by more refined technology, computerized tomographic scans, magnetic resonance imaging, and endoscopy. However, our enthusiasm for everything new must be justified with