by Philippe Koninckx | Mar 7, 2018 | chirurgia laparoscopica |
Qualità della chirurgia endometriosi Quality of surgery is variable In Belgium we are having a discussion on quality of surgery and cost for the patient. At the University hospital gasthuisberg, patients were informed that for private patiens the Professor would do the intervention himself; otherwise it would be done by a registrar in training. This has been widely considered unethical and socially unacceptable since equal quality for everybody is a dogma of Belgian medicine. In a press release, the conclusion was that quality was the same for everybody since the registrars in training were well supervised and since all gynecologist or surgeon are considered equal because of their diploma. Unfortunateoly this is not true and the quality of diagnosis and of treatment can be very variable. This is easy to illustrate for surgery and the examples given are restricted to comments made before during presentations or in publications. Quality is variable “We only recognize what we know ”. This is well known for the diagnosis of endometriosis. Even large and vaginally visible nodules are often missed during clinical exam. Even during surgery many severe deep endometriosis nodules of the sigmoid will be missed. ‘The best technique is the one the surgeon is familiar with ”, is often heard at meetings . This is unacceptable. If the superiority of a technique has been demonstrated, the surgeon should be obliged to use it. The advantages of a laparoscopic treatment of an extra-uterine pregnancy in comparison with a laparotomy are well demonstrated. Yet so many women are still treated by laparotomy because the gynecologist on duty does not have the skills.“Do...
by Philippe Koninckx | Oct 9, 2012 | chirurgia laparoscopica |
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,...
by Philippe Koninckx | Oct 9, 2012 | chirurgia laparoscopica, incontinenza urinaria |
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...
by Philippe Koninckx | Jan 4, 2011 | chirurgia laparoscopica, endometriosi |
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...
by Philippe Koninckx | Dec 19, 2010 | chirurgia laparoscopica |
Errore e qualità in chirurgia ginecologica Surgical mistakes and surgical quality Recently, surgical mistakes have been highlighted in the Belgian press because of some “forgotten ” surgical instruments in the abdomen of patients. Fortunately this occurs very rarely. It has been said that more people die every year because of surgical mistakes than by car accidents ( Google ‘surgical mistakes’ ) and the problem and the stakeholders become clear. This however is only the tip of the iceberg. The most frequent problem indeed in surgery is informed consent based upon incomplete information and lack of information concerning surgical quality. For most patients it is not very clear which quality of surgical care will be given this varies from the best available to the current practice, which is the medio legal standard. This can be highlighted by the observation that it takes between 10 and 20 years or longer before innovation is introduced; the slow introduction of laparoscopic surgery is an example of this. This website principal aim therefore is information of the patient. Surgical quality often is suboptimal There is no quality control for the individual surgical intervention . National statistics only reveal complications, while it is very hard to demonstrate the eventually underlying mistake. For this reason we published a few years ago the recommendation that systematic videoregistration of complete interventions should be mandatory. Although this would permit evaluation afterwards, videoregistration is strongly opposed for various reasons, medico legal considerations being one of them. One aspect, however should be crystal clear,and that is the the price which cannot be a problem since the cost of a DVD, sufficient...
by Philippe Koninckx | Nov 10, 2009 | chirurgia laparoscopica |
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...
