CYPRESS, Calif., Nov. 6 A steady march toward using ever-more "patient-friendly" procedures in gynecological care was reflected in the proceedings of the 37th Global Congress of Minimally Invasive Gynecology, hosted by the AAGL, the international professional society for specialists in minimally invasive gynecological techniques. Minimally invasive procedures are aimed at preserving the highest possible quality of life for women by using smaller and fewer incisions (or no incisions), reducing pain and trauma to the body, enabling quicker recovery, and reducing cost.
According to Resad Pasic, MD, Vice President of the AAGL and Scientific Program Chair, "Technological advances in diagnostic and therapeutic techniques are at the heart of minimally invasive care. We structured this Congress to give practitioners the best of today's knowledge along with glimpses of what tomorrow will bring: remote surgery, nano-surgery, incision-less surgery and more."
A groundbreaking general session, "Film and Medicine: Entertainment and Technology from Yesterday to the Future," traced the partnership of film and medicine in surgical treatment of patients. Whereas film and video have been used as teaching tools for decades, the application of new 4K digital technologies will enhance visualization beyond the limits of the human eye.
Other new uses of film and video showcased at the Congress included live, interactive telesurgery sessions wherein two surgeries were performed side by side using different techniques to treat the same condition.
The first telesurgery session compared different ways of repairing vaginal vault prolapse, a condition where the top of the vagina protrudes into the lower portion of the vagina in women who have had hysterectomies. The second telesurgery session compared different approaches for performing hysterectomies. Participants were able to provide ongoing feedback as the procedures progressed. Additionally, there was also a radical laparoscopic hysterectomy for cervical cancer that was broadcasted live from India to the conference in Las Vegas, Nevada.
Other cutting-edge highlights included:
Robotics. Use of robotic instruments helps surgeons perform minimally invasive gynecologic procedures with greater precision and less fatigue. A number of studies were presented on the experience of surgeons using robotics to treat a variety of gynecological problems, including hysterectomies, myomectomies (removal of fibroids), ovarian cystectomies (removal of ovarian cysts), oophorectomies (removal of the ovaries), salpingectomies (removal of the fallopian tubes), adhesiolysis (removal of scar tissue), peritoneal biopsies (taking tissue samples), and endometrial cancer.
These sessions provided evidence that robotic-assisted operative laparoscopy is feasible and effective in multiple conditions. The technology enables more surgeons to perform endoscopic surgery because of its advantages in 3-dimensional visualization, improved dexterity, reduced tension tremor for the surgeon, and shorter learning curve. Because the surgeon manipulates the instruments remotely while watching a monitor, robotics may usher in a new era of telesurgery that will enable surgeons to treat patients who are physically removed from them by hours and miles.
Single Port Access. This novel surgical technique employs one small incision instead of the three small ("keyhole") incisions usually employed in laparoscopic surgery. Several presentations demonstrated how standard laparoscopic procedures can be performed through a single one-inch incision in the navel, including removal of the ovaries and fallopian tubes, correction of stress urinary incontinence, hysterectomy, and treatment of various gynecological cancers. The single point of entry offers cosmetic advantages to the patient, since the small scar of the incision is hidden in the navel.
N.O.T.E.S. Taking the minimally invasive principle even further, N.O.T.E.S. (Natural Orifices Translumenal Endoscopic Surgery) procedures do not use any incisions at all. Instead, a specialized scope and flexible surgical instruments are passed through the body's natural openings such as the mouth or vagina to access internal organs. This very new field stands to revolutionize endoscopic surgery. Experience with applying the N.O.T.E.S. techniques in gynecology was presented by French surgeons.
Outpatient Procedures. Because of minimally invasive techniques, many procedures that previously required hospitalization can now be done on an outpatient basis, including hysterectomies. Data were presented on hundreds of cases of both total and supracervical hysterectomies that were successfully completed as same-day surgeries. The doctors reported low rates of complications and high rates of patient satisfaction and concluded that outpatient hysterectomy is feasible, safe, and suitable for a large number of patients.
"Technology has radically changed the way surgeons practice medicine," said Dr. Pasic. "The AAGL Congress is an international forum where specialists in minimally invasive gynecology not only learn about today's cutting-edge techniques, but also become inspired for tomorrow."
The 37th annual Global Congress of Minimally Invasive Gynecology was held by the AAGL October 28 through November 1.
The AAGL is the first and largest organization in the world dedicated to gynecologic endoscopic surgery. Founded in 1971, AAGL works to advance the safest and most efficacious diagnostic and therapeutic techniques that afford less invasive treatments for gynecologic conditions through the integration of clinical practice, research, innovation, and dialogue. For the past 36 years, the organization has educated the world's finest surgeons while improving the lives of women everywhere. This global commitment to women's health care is embodied in their continuing medical education of physicians and professionals to further promote the well-documented high standards of minimally invasive gynecologic surgery. The organization currently has 33 affiliated societies worldwide and 3,500 physician members. For more information visit www.aagl.org.
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