Newsletter: FALL 2019 Note from the Editor Message from SRS President, Dear SRS Members: Dr. Bala Bhagavath I am very excited to bring you the Fall 2019 edition of the SRS newsletter. Dear Friends: tissue models for myomectomy and microsurgery. This newsletter includes an exciting It has been a pleasure to serve you as “Surgical Innovations” article President this past year. It has been We are party to the International on non-obstetric surgery in the a busy year for SRS. The Society of Endometriosis Classification Initiative. pregnant woman with a focus on Reproductive Surgeons’ plenary lecture The first meeting was at ESHRE, where on Innovation for Surgery: Surgical representatives from ESIG, AAGL, World adnexal masses. We also reflect Robotics and The Fifth Generation – Non- Endometriosis Society, and European on the successful SRS-SREI Fellows Invasive Procedures will be given by Dr. Association of Endoscopic Surgery groups Bootcamp that was held earlier this Richard Satava at the 2019 Congress in met. Dr. John Petrozza represented SRS. year in Houston, TX. The feedback Philadelphia. The Society will conduct The second meeting will take place at from the trainees and faculty was two pre-Congress courses (one full-day the ASRM Congress in Philadelphia. very positive. We are excited for and one half-day), multiple interactive The initiative is still in early stages, and another great boot camp in January sessions and symposia, a surgical it is expected to be completed in two 2020! tutorial, and multiple roundtables. years. I am representing SRS in the Please mark your calendars and benefit Society of Interventional Radiology’s If you are looking for opportunities from the wonderful programming that Guideline Committee on Uterine Fibroid for SRS involvement, consider sharing has been designed with you in mind. Embolization. your challenging or interesting cases I can share that programming for the The SRS website is undergoing through the SRS discussion forum on 2020 ASRM congress is well underway. improvements. As Dr. Parry has taken on the SRS website. Please feel free to In particular, the two proposed talks a new position on the board, Dr. Zaraq reach out to me if you are interested highlight the current interests – Gender Khan has been appointed as the new in contributing to the newsletter! Confirmation Surgery and Fertility Website Committee Chair beginning at Thank you to Dr. Rebecca Flyckt Outlook in These Patients and Closing the ASRM annual Congress in October. for her help with organizing our Access to ART and Reproductive Surgery. He is enthusiastic, and we look forward newsletters this past year. to many positive changes to the website. The SRS/SREI Surgical Boot Camp for The SRS programs for the upcoming fellows continues to be an important I look forward to seeing you all in Congress in Philadelphia are going educational activity of the society. Philadelphia! to be amazing, and I look forward to Every year, we have been tweaking the seeing you all soon! program to make it even better. The Sincerely, innovation for the 2020 SRS/SREI Surgical Bala Bhagavath Boot Camp will be using animal Best regards, Mindy S. Christianson, M.D. Inside This Issue SRS Surgical Boot Camp 2 SRS at ASRM 2019 10 Innovations 3 Minimally Invasive Reproductive SRS Website Update 9 Surgery Fellowship Update 12 SRS Board of Directors 12 SRS Surgical Boot Camp Fourth Annual SRS-SREI Surgical Boot Camp The Fourth Annual SRS- Ten cadaver stations allowed SREI Surgical Boot Camp for for laparoscopic dissection REI fellows took place on and exercises, and two January 25th and 26th, 2019 cadavers for robotic surgery at the Houston Methodist exercises. Institute for Technology, Innovation & Education At the laparoscopic (MITIE) in Houston, Texas. cadaver stations, trainees The successful course was practiced dissection in the directed by Drs. Steven retroperitoneal space and R. Lindheim, Wright State performed suturing tasks University, Boonshoft School mimicking myometrial of Medicine, and John closure and cystotomy Petrozza, Massachusetts repairs. At the robotic General Hospital Fertility surgery cadaver station, Top: Group photo of fellows and Center, Harvard School attendees practiced repair of faculty. Middle left: Laparoscopy dry of Medicine. Many other the myometrium and tubal lab. Bottom left: Fellows developing faculty committed their time anastomosis. skills in the cadaver lab. Above: Dr. and energy to make this the Richard Reindollar leads the embryo most successful program The fellows also transfer simulator station. yet. The response from enthusiastically participated attendees was tremendous, in suturing tasks in the and the event was very dry lab. An element of wellattended. competition was introduced polyps. future jobs, academics vs by timing participants, which The embryo transfer station private sector, and what The agenda of the boot allowed for self-evaluation was very popular, with they should look for when camp was built upon a and feedback. Further, trainees requesting that they go job hunting. Next comprehensive mix of a computerized robotic time allotted be increased in year, the plan is to augment lectures and hands-on simulation station allowed the future. this session. activities. The hands-on fellows to hone their skills. activities included cadaveric On a social level, a All hands on deck, as Drs. dissection, laparoscopic Lastly, the many networking event allowed Petrozza and Hwang will suturing in the box trainer, hysteroscopic stations faculty and fellow trainees be running the program in multiple hysteroscopic allowed for the practice to interact, allowing each 2020 to make it even better! training activities, embryo of hysteroscopic assembly to learn about the other Lastly, we thank those transfer simulation for each with application of scissors and the trainees to share behind the scenes including attendee in the hands-on and graspers to remove their goals and aspirations. Suzanna Scarbrough, stations, and insightful bell pepper seed “polyps”, One of the favorites added Dani Mosley, Keith Ray, lectures. This resulted resectoscopes to shave this year was “Meet the and all the vendors for in an enhanced learning potato “fibroids”, and the Professor” where fellows their support in this most experience for trainees and hysteroscopic morcellator to could semi-privately chat successful program! faculty. remove model fibroids and and ask questions about SRS NEWSLETTER | FALL 2019 2 Innovations Non-Obstetric Surgery During Pregnancy: Focus on Adnexal Mass Management Leigh Ann Humphries, MD; Ceana H. Nezhat, MD Introduction Maternal mortality in the United States is the highest among developed countries.1,2 About one in 200 pregnant women may need surgery during pregnancy annually.1,3 Even with clear indications, surgeons may be hesitant to operate on pregnant women for non- obstetric reasons due to concerns about fetal teratogenicity, preterm birth, and uncertainty about surgical timing and approach. If surgery is indicated, it should not be denied or delayed, regardless of the trimester, in order to avoid potential adverse outcomes for mother and fetus.4 Several criteria should be met, including availability of obstetric and neonatal care providers, careful positioning, prophylaxis for venous thromboembolism, and, if indicated, perioperative fetal monitoring and administration of corticosteroids for fetal lung maturity.1,4 Anesthesia in these cases is generally safe, and the use of anesthetic agents at standard doses has not been associated with teratogenic effects. The decision to proceed with surgery is not always obvious, and the potential indications are diverse. The most common indications for non-obstetric surgery during pregnancy are appendicitis, cholecystitis, trauma, and adnexal masses/torsion, as well as dental, skin, and orthopedic conditions.5 Appendectomy accounts for 44% of non-obstetric surgeries during pregnancy in the United States, and the majority of these cases are performed laparoscopically.6 Open surgery for appendectomy and cholecystectomy has been associated with increased maternal morbidity, e.g. wound complications, as well as worse perinatal outcomes, e.g. miscarriage and preterm birth, compared with laparoscopy.6,7 Laparoscopy in pregnancy also results in a shorter hospital stay, earlier ambulation, and decreased pain and narcotic use, thus, this approach is preferable when addressing abdominal and pelvic pathology.8,9 Theoretically, pneumoperitoneum may decrease blood flow to the fetus and increase absorption of carbon dioxide, therefore intraabdominal pressure should 3 be maintained at 8 to 12 mmHg and not exceed 15 mmHg. Of note, port placement should be adapted to the size of Figure 1: Uterine septum, ASRM PC, Fertil Steril 2016 the uterus and placed farther cephalad to avoid uterine injury. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) has developed additional evidence-based guidelines for the use of laparoscopy for surgical indications during pregnancy (Table 1).10 Regardless of the approach, surgery during pregnancy carries added risks to the mother and fetus. In some series, pregnant patients have experienced more complications than nonpregnant patients after surgery, including septicemia, pneumonia, urinary tract infections, and in-hospital mortality.11 Yet, in the United States, a study of the National Surgical Quality Improvement Program (NSQIP) database showed no differences in morbidity and mortality for matched pregnant and nonpregnant women