Últimas mini-conferencias IRCAD/EITS

Doctor B Gabriel (France)

September 2010

In this lecture, the anatomy of the female pelvic floor is presented laying the emphasis on pelvic floor muscles, fasciae, and ligaments. The anatomical terms “fasciae” and “ligaments” are scrutinized critically in this context, and the different levels of pelvic floor support are presented from a clinical point of view. An answer is provided on where the “White line” is and what exactly constitutes the “endopelvic fascia”. Clinical examples for pelvic floor defects considering the different levels of support are shown. The summary points out that pelvic floor reconstructive surgery should not only restore the anatomy, but also the primary function.

Doctor B Gabriel (France)

September 2010

In this lecture, the three different approaches to hysterectomy, i.e. abdominal, vaginal, and laparoscopic, are presented laying the emphasis on the laparoscopic technique. The classification of laparoscopic hysterectomy is provided and the most important functional outcome parameters are discussed in the context of an evidence-based comparison between these three approaches. The learning curve for laparoscopic hysterectomy is emphasized and the corresponding data are presented. A take home message is conveyed.

Doctor T Lee (United States)

September 2010

In this lecture, Dr. Ted Lee, MD, director of the department of minimally invasive gynecologic surgery in Pittsburgh, Pennsylvania, USA, focuses on the sacrocolpopexy procedure in relation to his experience in the treatment of genital organ prolapse. He highlights some important key steps of the procedure, together with some tips and tricks on optimizing exposure, facilitating dissection, suturing of the mesh and how to minimize complications.
The first step of the procedure is an adequate exposure with bowel retraction in order to have sufficient space to work in the sacral promontory area.
The next step is the rectovaginal dissection, with caution to keep the dissection close to the vagina, leave enough adipose tissue to the rectum, and dissect the pararectal spaces until the levator ani muscles. Dr. Lee stresses the fact that the depth of the dissection depends on the posterior wall defect. So in patients with a posterior defect not protruding outside the hymen, the dissection should stop at the level of the midvagina. This is in order to avoid future constipation with deep dissection. Only in patients with large posterior wall defects, the dissection should be performed at the level of the levator ani. Dr. Lee indicates some surgical instruments, such as the rectal probes and retractors, that are useful for the dissection of the rectovaginal space.
Next step is the vesicovaginal dissection, which can be very challenging, especially in patients with previous hysterectomy. Some tips and tricks such as the use of a Foley catheter or the use of a large probe to distend the vagina in order to facilitate dissection are demonstrated.
Next is the presacral dissection with skeletonization of the fibrofatty tissue, dissection from right to left to preserve the hypogastric nerve, and identification of a good plane of dissection to avoid bleeding, especially from the left common iliac vein, but also from sacral vessels, which can be dissected.
The last step is the suturing of the mesh. He explains that there is no longer the need to use non-absorbable sutures together with the use of tackers in order to secure the mesh to the sacrum without complications. A nice technique of suturing and knotting is demonstrated during mesh peritonization.
Finally, in patients where the uterus needs to be preserved for fertility purposes (sacrohysteropexy), Dr. Lee explains an alternative method to place the mesh medial to the uterine vessels in order to perform, if need be, a hysterectomy more easily later on. He also demonstrates a nice uterosacral suspension technique used in patients who do not wish to be treated with a mesh for their prolapse.

Doctor T Lee (United States)

September 2010

In gynecologic surgery, hysterectomy is the most important procedure. Sometimes, however, hysterectomy can be a very difficult and challenging operation, and even more so if performed laparoscopically. Situations that distort the pelvic anatomy such as large fibroids, severe endometriosis, postoperative adhesions and morbid obesity make surgery much more difficult. Dr Lee analyses in a very didactic way all these situations, gives valuable directions and surgical strategies in order to overcome difficulties, and uses specific rules to obtain the best result as much safely as possible. Very useful are the different approaches, namely anterior, posterior and lateral, for patients with big fibroids, for adhesions and for fibrosis originating from severe endometriosis respectively.

Professor J Morcos (United States)

September 2010

In this key lecture, Professor Jacques Morcos presents surgical strategies for the different subtypes of petroclival meningiomas based on a selection of clinical cases.

Professor A Chays (France)

September 2010

In this key lecture, Professor Andre Chays shares his experience when using the endoscope for microvascular decompression for trigeminal neuralgia and hemifacial spasm.

Professor B George (France)

September 2010

In this key lecture, Professor Bernard George presents his experience and strategy for the management of internal carotid artery (ICA) infiltration in different types of skull base tumors. He also focuses on the use and importance of the preoperative balloon occlusion test (BOT).