Pressione peritoneale ed aderenze.

Pressione peritoneale ed aderenze. From: “AAGL-ENDO-EXCHANGE automatic digest system” < LISTSERV@listserv.brown.edu> Date: Jun 20, 2012 6:01 AM Subject: AAGL-ENDO-EXCHANGE Digest - 18 Jun 2012 to 19 Jun 2012 (#2012-112) To: <AAGL-ENDO-EXCHANGE@listserv.brown.edu> Date: Tue, 19 Jun 2012 18:33:03 -0400 From: Philippe R Koninckx and Anastasia Ussia <Gary_Frishman@BROWN.EDU> Subject: Ideal intraabdominal pressure at laparoscopy to minimize adhesion In animal models the mesothelial hypoxic effect of pure CO2 increases with duration and pressure of pneumoperitoneum as we demonstrated some 10 years ago. In the human however this type of experiment cannot be performed and thus there are no data. Extrapolating from all other the data available today I would summarise as follows. Surgical lesions alone are only slightly adhesiogenic although essential to start the adhesion process. Some 20 times more important is the enhancing effect of the entire peritoneal cavity. The key mechanism is acute inflammation of the cavity of which pressure alone is a minor contributing factor. With full conditioning however preventing as much as possible this acute inflammation we actually in the human can reduce postperative pain while adhesions are virtually absent and this in surgery of long duration as deep endometriosis excision. Philippe R. Koninckx*,** and Anastasia Ussia* Gruppo Italo Belga, Leuven-Rome, Europe EndoSAT NV, Leuven,...

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...

idronefosi, resezione intestinale inutile e endometriosi profonda

idronefosi, resezione intestinale inutile e endometriosi profonda per vedere la discussione completa in inglese AAGL-ENDO-EXCHANGE Digest - 28 Dec 2010 to 29 Dec 2010 (#2010-156)Date: Wed, 29 Dec 2010 20:00:34 -0500 From: Philippe R Koninckx Subject: 31 y.o. with firm rectovaginal mass and intermittent hydronephrosis To the ongoing discussion we would like to add some remarks, backed up with direct links to the articles referred to. 1. We fully agree with David Redwine that this lady needs surgical excision of all deep endometriosis. It is unclear whether LHRH agonists may be usefull. We do not recommend this since we have the impreesion that planes of cleavage become more difficult. 2. We do consider it a mistake to do IVF in a woman with a rectovaginal nodule as presented at the ESGE meeting in Amsterdam 2008. 3. In addition if the hydronefroses would not regress during an eventual pregnancy, it will become a painful decision what to do.(as I saw once) 4. We stronly oppose the concept of at team is required to treat the ureter. First for the lower ureter as written in Fertil steril last year ( http://www.gynsurgery.org/ols/pdf/2009_decicco_ureter.pdf ) any lesion can be treated conservatively and ureter reimplantation has no place anymore as a first line of treatment. Since in Europe mainly gynaecologists have the required skills and expertise for an eventual ureter reanastomosis, we recommended that the lower ureter should be considered part of gynaecology. Anyway the patient should be informed about the available skills otherwise informed consent cannot be obtained. ( http://www.gynsurgery.org/hysterectomy-myomectomy/surgical-mistakes-and-surgical-quality/ ) 5. In over 2000 deep endometriosis excisions of the rectum or rectosigmoid, a...

Isterectomia laparoscopica, utero grande e chirurgia robotica

Nella discussione sulla chirurgia laparoscopica per l’isterectomia in uteri molto voluminosi e nella discussione sulla utilità della chirurgia robotica abbiamo fatto un commento completo in inglese In breve……. Date: Tue, 10 Nov 2009 19:45:30 -0500 From: “Philippe R. Koninckx and Anastasia Ussia” Subject: Laparoscopic hysterectomy on the large fibroid uterus Find below some comments to the discussion on large uteri and on robotic surgery on the AAGL listserv. 1. The first and single most important instrument for a large uterus is a decent manipulator. The uterine rotator, which I patented back in 1991, and which only recently has been finalised into a strong manipulator, permits in addition to other movements as push/pull, ante/retroflexion, rotation of the uterus. The bigger the uterus the more important this is. (This manipulator is actually distributed by Storz ; for videos of its use 2. Ligation of the uterine artery at the origin is a technique which is mandatory to master when really big uteri are tackled. Occasionally, the uterine artery at the level of the uterus can be very difficult to reach, especially when a myoma in the broad ligament makes its access difficult 3. We do appreciate and want to endorse John’s comments on robotic surgery (see below). I have a robot in Leuven and still have not found out what I could use it for, except eventually for tubal reanastomosis. Considering the results (eg of Charles Koh and ours) of laparoscopic reanastomosis it will be very hard to prove superiority of the robot. I do not need it for ureter reanastomosis, and also for endometriosis or myoma’s I do not see...

Endometriosi profonda dell’intestino

Abbiamo visto molte pazienti che  hanno subito una resezione intestinale per endometriosi profonda retto-vaginale, nelle quali non è stata confermata istologicamente l’endometriosi nel segmento resecato. Vedere qui sotto il testo in inglese. I asked at listserv of AAGL the question how frequently endometriosis was not confirmed after a segmental bowel resection. In the literature the incidence ranges from 0 to 15% and it would not be surprising that we only see the tip of the iceberg since not everyone will report these mistakes. Sun, 18 Oct 2009 06 David Redwine answered I’m not sure I understand your question. I don’t get any scans, imaging, colonoscopy, or barium studies on any patient, ever. I diagnose bowel endometriosis in the most accurate way possible: by looking at the bowel during surgery and then operating on it if I find it, whether it requires a superficial disc resection, full thickness disc resection, or segmental resection. In over 800 bowel resections for apparent endometriosis, the incidence of a negative path report in my hands is less than 0.05%. I’m certain that the results of imaging will never approach the accuracy of this approach, which is also the least expensive approach since surgery need not be preceded by any tests at all. Are you concerned that preop imaging may be misleading and could result in excessive surgery being done (such as a segmental resection when nothing is present?). Or are you concerned that surgery itself is being done improperly too often? Or are you concerned that segmental resections are being done when a disc resection might suffice? David Redwine, M.D. Bend, Oregon Comment Reading the...

Shiny Trinket

Shiny trinkets are shiny.