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Navigating Complex Surgical Scenarios: It’S All About Options

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43rd AAGL GLOBAL CONGRESS ON MINIMALLY INVASIVE GYNECOLOGY NOV. 17-21, 2014 | Vancouver, British Columbia Didactic: Navigating Complex Surgical Scenarios: It’s All about Options PROGRAM CHAIR Ted T.M. Lee, MD PROGRAM CO-CHAIR Arnaud Wattiez, MD Matthew T. Siedhoff, MD Sponsored by Advancing MinimallyAAGL Invasive Gynecology Worldwide Professional Education Information Target Audience This educational activity is developed to meet the needs of residents, fellows and new minimally invasive specialists in the field of gynecology. Accreditation AAGL is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AAGL designates this live activity for a maximum of 3.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS As a provider accredited by the Accreditation Council for Continuing Medical Education, AAGL must ensure balance, independence, and objectivity in all CME activities to promote improvements in health care and not proprietary interests of a commercial interest. The provider controls all decisions related to identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the activity. Course chairs, planning committee members, presenters, authors, moderators, panel members, and others in a position to control the content of this activity are required to disclose relevant financial relationships with commercial interests related to the subject matter of this educational activity. Learners are able to assess the potential for commercial bias in information when complete disclosure, resolution of conflicts of interest, and acknowledgment of commercial support are provided prior to the activity. Informed learners are the final safeguards in assuring that a CME activity is independent from commercial support. We believe this mechanism contributes to the transparency and accountability of CME. Table of Contents Course Description ........................................................................................................................................ 1 Disclosure ...................................................................................................................................................... 2 Before the Game Begins: Entry Challenges, Port Placement, and Lysis Abdominal Wall Adhesions M.T. Siedhoff ................................................................................................................................................. 3 Laparoscopy in the Obese Patient: Strategies for Success from Start to Finish M.T. Siedhoff ............................................................................................................................................... 10 Optimizing Exposure in Challenging Surgical Scenarios in Gynecologic Laparoscopy A. Wattiez .................................................................................................................................................... 15 Methodical Approach to the Obliterated Anterior Cul‐de‐Sac in the Aftermath of Prior Cesarean Section T.T.M. Lee .................................................................................................................................................... 23 Interactive Case Presentation 1 M.T. Siedhoff ............................................................................................................................................... 27 Unfreeze the Frozen Pelvis A. Wattiez .................................................................................................................................................... 28 Location Is Everything – The Challenges of Broad Ligament and Cervical Fibroids T.T.M. Lee .................................................................................................................................................... 46 Laparoscopic Repair of GI and GU Injuries – A Game Changer A. Wattiez .................................................................................................................................................... 50 Ovarian Remnant – Prevention and Management T.T.M. Lee .................................................................................................................................................... 61 Cultural and Linguistics Competency ......................................................................................................... 65 COMPLX-714 Didactic: Navigating Complex Surgical Scenarios: It’s All about Options Ted T.M. Lee, Chair Arnaud Wattiez, Co-Chair Faculty: Matthew T. Siedhoff Although anatomy and exposure are pillars of pelvic surgery, so is the ability to quickly formulate various strategic approaches when confronted with anticipated, as well as unexpected, surgical obstacles. The obliterated anterior cul-de-sac from previous cesarean deliveries and a frozen pelvis as a result of advanced endometriosis can both present very perplexing clinical conundrums. Similarly, broad ligament or cervical fibroids and ovarian remnants can present similar difficulties. In these challenging surgical scenarios, familiarity with several approaches to dissection and various strategies to optimize exposure will be necessary to ensure safe and effective outcome. Abundant surgical video footage will be used to illustrate the strategies and techniques necessary to overcome the difficulties associated with various anatomy-distorting pathologies. Participants of this course will apply safe and effective approaches to these challenging surgical scenarios that are evidence and experience based. Learning Objectives: At the conclusion of this course, the clinician will be able to: 1) Articulate techniques to achieve peritoneal access in patients with extensive anterior abdominal wall adhesions as well as techniques necessary to overcome difficulties associated with laparoscopy in obese patients; 2) formulate anatomy-based strategies when confronting various challenging surgical scenarios such as frozen pelvis, cervical fibroids and dense uterine adhesions; and 3) integrate various techniques to optimize exposure during complex pelvic surgeries. Course Outline 12:30 Welcome, Introductions and Course Overview T.T.M. Lee 12:35 Before the Game Begins: Entry Challenges, Port Placement, and Lysis Abdominal Wall Adhesions M.T. Siedhoff 12:55 Laparoscopy in the Obese Patient: Strategies for Success from Start to Finish M.T. Siedhoff 1:15 Optimizing Exposure in Challenging Surgical Scenarios in Gynecologic Laparoscopy A. Wattiez 1:35 Methodical Approach to the Obliterated Anterior Cul-de-Sac in the Aftermath of Prior Cesarean Section T.T.M. Lee 1:55 Interactive Case Presentation 1 M.T. Siedhoff Moderated by A. Wattiez, T.T.M. Lee 2:15 Questions & Answers All Faculty 2:25 Break 2:40 Unfreeze the Frozen Pelvis A. Wattiez 3:00 Location Is Everything – The Challenges of Broad Ligament and Cervical Fibroids T.T.M. Lee 3:20 Laparoscopic Repair of GI and GU Injuries – A Game Changer A. Wattiez 3:40 Ovarian Remnant – Prevention and Management T.T.M. Lee 4:00 Interactive Case Presentation 2 T.T.M. Lee Moderated by M.T. Siedhoff, A. Wattiez 4:20 Questions & Answers All Faculty 4:30 Adjourn Page 1 PLANNER DISCLOSURE The following members of AAGL have been involved in the educational planning of this workshop and have no conflict of interest to disclose (in alphabetical order by last name). Art Arellano, Professional Education Manager, AAGL* Viviane F. Connor* Kimberly A. Kho* Frank D. Loffer, Medical Director, AAGL* Linda Michels, Executive Director, AAGL* M. Jonathon Solnik* Johnny Yi* SCIENTIFIC PROGRAM COMMITTEE Arnold P. Advincula Consultant: Blue Endo, Intuitive Surgical, SurgiQuest Other: Royalties: CooperSurgical William M. Burke* Rosanne M. Kho* Ted T.M. Lee Consultant: Ethicon Endo-Surgery Javier F. Magrina* Ceana H. Nezhat Consultant: Karl Storz Other: Medical Advisor: Plasma Surgical Other: Scientific Advisory Board: SurgiQuest Kevin J.E. Stepp Consultant: CONMED Corporation, Teleflex Other: Stock Ownership: Titan Medical Robert K. Zurawin Consultant: Bayer Healthcare Corp., CONMED Corporation, Ethicon Endo-Surgery, Hologic, Intuitive Surgical FACULTY DISCLOSURE The following have agreed to provide verbal disclosure of their relationships prior to their presentations. They have also agreed to support their presentations and clinical recommendations with the “best available evidence” from medical literature (in alphabetical order by last name). Ted T.M. Lee Consultant: Ethicon Endo-Surgery Matthew T. Siedhoff* Arnaud Wattiez Consultant: Karl Storz Asterisk (*) denotes no financial relationships to disclose. Page 2 Disclosure I have no relevant financial relationships with the manufacturers of any commercial products and/or providers of commercial services discussed in this CME activity. Before the game begins: Neither I nor any member of my immediate family has a financial relationship or interest Entry challenges, port placement, and lysis of with any proprietary entity producing health care goods or services related to the abdominal wall adhesions content of this CME activity. My content will include reference to commercial products; however, generic and alternative products will be discussed
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