ENDOMETRIOSI E CHIRURGIA LAPAROSCOPICA AVANZATA

What is quality surgery ?

ENDOMETRIOSIS IS A SURGICAL DISEASE

Diagnosis Treatment Advanced surgery

CORRECT AND COMPLETE INFORMATION

Informed consent

SURGERY WITHOUT ADHESIONS

Is possible today !

PELVIC PAIN

Diagnosi

Chi Siamo.

Mondo ginecologico e’ un portale dedicato all’endometriosi e alle problematiche ginecologiche. Nasce dall’idea di un gruppo di ginecologi Europei, amici tra di loro, di creare un sito informativo di facile consultazione .Il nome Mondo ginecologico , vuole esprimere la Globalità delle problematiche femminili, la internazionalità degli ideatori e l’apertura a Ginecologi che volessero contribuire con articoli ed opinioni.

Prof. PR Koninckx , pioniere della Chirurgia Laparoscopica Ginecologica, ha  lavorato presso l’Università Cattolica di Leuven (Belgio) e ha insegnato la Chirurgia Endoscopica Ginecologica per 12 anni all’Universita’ di Oxford e 6 anni a Roma presso la Università Cattolica come visiting professor.

Dalla collaborazione con Oxford e’ nato il Gruppo Oxford- Leuven Surgery e dalla Collaborazione con l’Italia ( Crotone e la Cattolica di Roma) è nato il Gruppo Italo-Belga coordinato dalla Dssa Anastasia Ussia

La nostra Missione :   Chirurgia di qualità .  Insegnare e Divulgare la  Tecnica Chirurgica Laparoscopica  in Ginecologia

sedes

Leuven

Oxford university

Oxford

La Cattolica

La Cattolica

Nostri Publicazioni

Per controllare nostri publicazioni su PUBMED, as proof of our expertise and scientific background.

La nostra esperienza

Il premio dell'ASRM,2004

Il premio dell’ASRM,2004  USA

We are an experienced group with over 3000 deep endometriosis surgeries  and over 1000 hysterectomies. With published expertise and published (rare) complications

Il premio dell'ASRM,2004

Dopo il ‘Distinguished surgeon award 2004 Philadelphia

Our congress presentations and live surgery

uSSIA A

Drssa A. USSIA

uSSIA A

Prof Koninckx

Check our numerous presentations over the last years and our live surgery in Moscow, Sydney, Bali, Brazil, and major cities of Europe

Training course HonKong 2009

Training course HonKong 2012

Italia, Roma, Villa del Rosario

Drssa Ussia Anastasia

Coordinatrice del Gruppo

Prof em Koninckx PR

Tel : +39 348 8605222

email : anastasia.ussia@gmail.com

Leuven, Belgium:

Chirurgia : Heilig Hart Ziekenhuis,Naamse straat, Leuven

Visite : Leopold I straat 45

Prof em Koninckx Philippe R

Tel :+32 16 462796

email : pkoninckx@gmail.com

Collaborazione Italiane

Gemelli : Di De Cicco Fiorenzo

Villa del Rosario : Dr

Collaborazione Internationale

Francia : Prof Arnaud Wattiez, Strassburgo

Israële : Dr Schonman Ron, ronschonman@gmail.com

If you have endometriosis and when surgery is proposed : get informed

Definitions

Endometrium is the tissue lining the inside of the uterus. The endometrium is shedded every month, during menstruation.

Endometriosis is by definition endometrial stroma and glands outside the uterus .

Adenomyose is endometrial stroma and glands in the myometrium of the uterus

Endometriosi è variabile

from minor to severe disease

from small and superficial implants to cystic ovarian endometriosis and deep endometriosis .

Endometriosis With Adhesions With Adhesions
Typical endometriosis Typical endometriosis
Subtle endometriosis Subtle endometriosis
deep endometriosis deep endometriosis
cystic ovarian endometriosis cystic ovarian endometriosis

Dolore e Infertilità

Subtle endometriosis is not a pathology and does not cause pain or infertility.

Typical endometriosis  can cause moderate pain and/or infertility in 50%.  Without a laparoscopy the diagnosis cannot be made and during this laparoscopy tyical endometriosis is vaporised.  Medical therapy should not be given without a diagnosis for many years.

Cystic ovarian endometriosis / chocolate cysts  cause pain and infertility in most women. Diagnosis is made by ultrasound and surgery is the only therapy, medical treatment being ineffective.

Deep Endometriosis causes severe pain in mot women although 5% is pain free. It is unclear whether it causes infertility  if no adhesions.  The only treatment is surgery which is difficult level III surgery and swhich hould not be performed without the necessary expertise. Indication for surgery is clinical, but ultrasound and MRI can be useful for preoperative counseling. They should not be used as an indication for surgery.  Surgery rarely requires a bowel resection if the surgeon has the expertise. Endometriosis is not a cancer and the increased association between endometriosis and cancer is erroneous.

Endometriosis is a surgical disease

Women with severe pain and or infertility deserve a laparoscopy,which will

  • diagnose the disease without delay
  • treat the disease and avoid medical treatment without a diagnosis
  • prevent progression
  • permit treatment during diagnostic laparoscopy if the surgeon has the expertise

But no surgery is better than bad surgery :the first surgery should be the last

What is quality Surgery ?

Quality begins with a correct indication  ie no unnecessary interventions

And a skilled surgeon : if the surgery of deep endometriosis or severe adhesions exceed the skill of the surgeon no surgery should be performed.  For severe endometriosis this means a low number of bowel resections.

Laparoscopic surgery is better than open surgery since less pain, shorter hospitalisation and smaller incicions.

Control of quality needs Videoregistration . That the surgeon makes a full videoregistration with a copy to the patient, is a strong indication that he feels confident.

No complications. The surgeon should know HIS complications as evidenced from publications and presentations.

Litle pain and few adhesions : this requires a skilled surgeon, a shorter intervention with little bleeding and conditioning-cfr EndoSAT NV.

Applied to gynecology

Hysterectomy : can always be done by laparoscopy unless the uterus is bigger than 1500 grams. Requires a level 1 surgeon.

Urinary incontinence : the surgeon should master both vaginal (eg TOT) and laparoscopic techniques as promontofication (level II)

Adhesiolysis can be very difficult (level III)

Endometriosis varies from superficial lesions (level I) to very difficult deep endometriosis (level III). Ovarian endometriosis is level III since the risk of ovarian damage is high if unskilled

Oncologic surgery : will not be discussed

If you have pain or infertility : get informed

Pain

Chronic pelvic pain has many causes and needs a correct diagnosis. At the right a list the main causes of pelvic pain. For endometriosis, the relationship between the severity of the pain and the lesions is variable .

The same lesion may cause a lot of pain whereas other women are pain free.

It is important to understand the pathophysiology of pelvic pain : visceral pain is more sensitive to distension (like a full bladder) than to lesion .

Endometriosis is an important cause of pain.

Deep endometriosis causes a lot of pain but 5-7% of women are pain free,

cystic endometriosis also causes severe pain but not in 25 %,

typical endometriosis is a cause of pain but 50% is pain free. Important is to realize that pain is not always cycle dependent.

Subtle endometriosis and stromatosis or endosalpingiosis are not a cause of pain.

Pain in adenomyosis is variable

Infertility

Fundamental to understand fertility and infertility are MFR (monthly fecundity rate ) and CPR (cumulative pregnancy rate).

MFR (monthly fecundity rate ): is the probability of conception in one month. CPR (cumulative pregnancy rate : is the cumulative probability of conception over the next 6 or 12 months.

A normal couple in Europe will have a nearly 50% of conception the first month (MFR). Since the most fertile will be pregnant the remaining population will be less fertile, and after 1 year of infertility the MFR has dropped to 10%. Yet after 1 year of infertility still 80% of couples will get pregnant spontaneously over the following years after 2 years of infertility the cumulative pregnancy rate drops to 50%.

after 5 years : less than 20% will get pregnant spontaneously.

A major cause of infertility is inadequate surgery with ovarian damage and adhesion formation.

During surgery adhesion formation should be prevented.

Unless severe male infertility, IVF should not be started without a diagnostic laparoscopy. Non invasive techniques as ultrasound and MRI are unable to diagnose adhesions, mild endometrioses etc.

Get informed - break the circle of desinformation

 

What is menopause

menopMenopause is when the ovaries stop to produce female hormones (estrogens and progestagens). Generally around 50 years but as late as 65 and as early as 35 During the transition from a regular cycle to the menopause, ovarian function and menstrual cycles become irregular. After menopause the women has very low levels of oestrogens with all consequences. After menopause the ovaries continue to produce androgens as before.

Why women should take hormone replacement therapy

menop2The advantages are

  • on the brain : less flushes, sweats, insomnia and better memory
  • on the support tissue : less wrinkles, less osteoporosis, less pelvic floor descent
  • on the heart and vessels : 50% less accidents if taken from the beginning
  • on bowel cancer : 50% less bowel cancers
  • on cancer of the uterus : less cancers
  • on cancer of the breast : no induction of cancers but an acceleration of growth. Thus a better cancer but 7 years earlier

What is hormone replacement therapy (HRT)

The intake of hormones as produced before - comparable to reading glasses Dosis vary and they can be given as pills, as a cream or vaginally, with and without menstruation

Why many doctors oppose HRT?

It requires a profound knowledge of endocrinology and pharmacology Afraid to change nature The fear of breast cancer : because of the accelerated growth (of existing cancers), the diagnoss of breast cancer is slichtly higher (OR=1.25) which by non-experts is considered more cancers

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Il consento informato

  •  correct information of
  • the indication of surgery
  • the planned surgery
  • Terapie e Tecniche Alternative con vantaggi e svantaggi
  • L’Esperienza del chirurgo e la personale casistica operatoria riguardo il particolare intervento

Videoregistration is an indication that the surgeon feels confident.

Rules of thumb to judge information

  • L’Informazione nei siti web e nella stampa non sono controllate. Navigando in Internet e digitando una malattia ginecologica come l’Endometriosi troviamo centinaia di siti e informazioni spesso contrastanti tra di loro.E’ difficile , per i pazienti, ed i meno esperti capire quali sono quelle corrette.
  • Il punto di riferimento dovrebbe essere la revisione della letteratura degli articoli scientifici pubblicati, quindi una verifica in Pubmed, ma ciò è impossibile da comprendere per un “non specialista” del settore ed inoltre degli oltre 20.000 articoli pubblicati, la maggior parte non ha alcuna utilità nella pratica clinica e molti sono solo ipotesi speculative che possono creare false speranze.
  • Bisogna saper giudicare la Credibilità dell’autore controllando, biografia e Curriculum , pubblicazioni e casistica operatoria e risultati personali.
  • Those who do not do surgery could give a biased information on surgery.
  • Controversies should be explained Even well performed Randomized Controlled Trials can be interpreted differently. HRT is a typical example. It is useful to understand the background of the controversy and to know what the position is of a doctor.
  • Avere FIDUCIA CIECA nel chirurgo è sbagliato.

    Il Consenso all’intervento e’ un contratto tra il chirurgo e il paziente e scaturisce dal rapporto Fiduciario Medico/Paziente basato essenzialmente sulla onestà reciproca, e nasce dalla conversazione continua e significativa che precede la decisione di sottoporsi all’intervento.Non è solo un foglio di carta con un elenco di situazioni avverse spesso incomprensibili per il paziente ma in esso vi sono contenuti di valore etico e morale che vanno ben aldilà del significato medico-legale.

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