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Vaginal closure after hysterectomy

The AAGL listserv has an ongoing discussion on techniques of cuff closure during hysterectomy. The main conclusion is that we have several opinions but no data Below a comment written by the Gruppo Italo Belga. Date: Mon, 17 Dec 2012 18:38:49 -0500 From: Philippe R Koninckx and Anastasia Ussia Subject: Recurrent prolapse following LSH/cervicosacropexy Vaginal Cuff This has been a nice discussion. * We have to realize that we are discussing rare events of a few percent incidence, for which RCT are vitually impossible to perform. Indeed the rule of thumb that meaningful statistics need 30 cases, learns that to evaluate a 1% event a rct of 6000 (3000 cases and 3000 comparators) interventions would be necessary. * Most comments therefore reflect opinions based on personal experience, meetings and ‘table’ discussions. These not only are the best we have, these opinions reflect honest experience and should be considered thoughtfully. In addition we should try to understand them based upon our growing knowledge of surgery. Let us try. * What has emerged over the last decades for prolapse prevention/surgery is the importance of the support structures and of the vagina resting on the levator plate. This knowledge has not been the consequence of MIS but development was simultaneous. As an example, I did see for the first time the levator ani muscle at the Rome meeting in the early nineties during a lecture by Harry. It made me think and probably others too. My translation today is that repair/attachment of the pubo vesical fascia to the uterosacrals is important. When we realized the importance of the vagina resting on the...

How does a digital operating room improve quality of surgery ?

“Digital Operating Room” is used to suggest better surgery through a better surgical environment. In a recent article we discussed this in detail . –The basic “Digital operating room” integrates 1 operating room. This generally indicates that in 1 operating room endoscopic images can be shown to the surgeon on any screen in that room (routing and switching). In addition images from previous exams such as X-rays, or the patient file can be displayed for review by the surgeon. For the surgeon it is useful if more information is easily available. In addition most digital operating rooms offer the possibility of recording operating images, and of broadcasting surgery. The latter however, generally need dedicated assistance for conferencing. The underlying technology is similar to a television studio where a technician chooses which image of the several camera’s will be shown to the public. Since a (video) cable needs to connect every source and every screen with the broadband switch, this results in a bunch of cables and a rather static configuration with little intelligence. Indeed a new device or screen will need a new cable set of cables. - The advanced digital operating room integrates the hospital . Similar to the intranet of most hospitals, which connects every computer, printer etc with the computer room, the advanced digital operating room will use an internet platform to connect all devices from 1 or all operating rooms using the IT network of the hospital. The advantages and the differences from the older solution are obvious. Since many signals can be transported over 1 internet cable, this system needs only 1 cable instead...

Is there a role for robotic surgery in endometriosis?

Robotic surgery has no proven advantages but is much more expensive. This is something that should be considered in these times of crisis. It is unfair that the tax payer has to pay for robotic surgery, for the only reason that some gynecologists cannot do the surgery by laparoscopy. In addition as written before a robotic surgeon who cannot do laparoscopic surgery is potentially dangerous when dealing with advanced endoscopic surgery. for a full discussion see the article by Steege and Koninckx Prof Philippe R Koninckx and Drssa Anastasia Ussia European group for advanced endoscopic...

Are meshes dangerous for pelvic floor repair ? Why FDA recommendations are unsatisfactory.

Are meshes dangerous for pelvic floor repair ? Why FDA recommendations are insufficient. SUMMARY OF RECOMMENDATIONS (for full data see article ) click to read full article For surgeons who do not currently perform transvaginal placement of surgical mesh for pelvic organ prolapse, but wish to begin performing this procedure: a. General knowledge should be documented either by completing a fellowship training program in Urogynecology, Female Pelvic Medicine and Reconstructive Surgery, or Female Urology or by completing adequate CME in pelvic anatomy and reconstructive pelvic surgery. b. Specific knowledge for a particular procedure should be obtained c. Skill may be documented by surgeons who have completed a Urogynecology, Female Pelvic Medicine and Reconstructive Surgery or Female Urology fellowship program via cases lists showing experience with transvaginal placement of surgical mesh for pelvic organ prolapse. Surgeons who do not have documentation of prior training with a specific transvaginal mesh prolapse procedure should be proctored on no fewer than 5 procedures or as many as is necessary to demonstrate that they can independently perform the specific procedure. d. Experience in treating women with pelvic floor disorders should be documented either by completing a fellowship training program in Urogynecology, Female Pelvic Medicine and Reconstructive Surgery or Female Urology or by demonstrating that they offer a full spectrum of surgical options for pelvic floor disorders and that surgery for pelvic floor disorders represents >50% of their surgical practice including a minimum of 30 surgical cases for pelvic organ prolapse annually. e. Demonstrate experience and privileges in nonmesh vaginal repair of prolapse including anterior colporrhaphy, posterior colporrhaphy, and vaginal colpopexy (eg, uterosacral or sacrospinous...

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