vol. 31 № 2 april—june 2017 46 aagl global congress on migs€¦ · 46th aagl global congress...

46th AAGL Global Congress on MIGSEnhancing Minimally Invasive Gynecologic Surgery

through Quality, Patient Safety, and Innovation

President's MessageStrategic planning for the future

of our organization PAGE 5

From the Scientific Program ChairRegister now for the 2017 Annual Meeting

(here's a preview)PAGE 9

JMIG's Impact Factor Soars!We've passed 3.0 for the first time in our historyPAGE 16

New AAGL Practice ReportAn historic collaboration between AAGL and ESGEPAGE 16

AAGL Board NominationsHelp lead the AAGL - submit your interest today!PAGE 8

Vol. 31 № 2April—June 2017

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CONTENTS

NewsScope [Library of Congress Cataloging in Publication Data, Main entry under NewsScope, Vol. 30, No. 3; (ISSN 1094–4672] is published quarterly by the AAGL for ten dollars, paid from members’ dues. Periodicals Postage Paid at Cypress, California. Copyright 2017 AAGL. Publisher AAGL Advancing Minimally Invasive Gynecology Worldwide 6757 Katella Avenue Cypress, California 90630-5105 USA Tel 714.503.6200, 800.554.2245 Fax 714.503.6201, 714.503.6202 E-mail: [email protected] Website: www.aagl.org The views and opinions expressed by the authors in this publication do not necessarily reflect those of NewsScope, its editors, and/or the AAGL.

April — June 2017Focus on AAGL: Update on The Foundation of the AAGL 4Education Calendar 4President’s Message: Planning for the Future 5SIG: Oncology – Clinical Opinion: Time for a Change 7AAGL Board Nominations: Who Will Help Lead AAGL into the Future? 8From the Scientific Program Chair: Elevating the Science at the 46th AAGL Global Congress 9SIG: Hysteroscopy – Cesarean-Induced Isthmocele: Is It on Your Radar? 13The Foundation: Grant Winners Announced (and preview The Foundation Fundraisers at the Global Congress) 14-15JMIG: JMIG’s Impact Factor Soars! 16Practice Guidelines: New AAGL Practice Report 16SIG: Vaginal Surgery – How Does Vaginal Hysterectomy Measure Up in The Era of VBM (Value Based Medicine) 17Louisville Workshop: A Louisville and AAGL Milestone –20 years! 18FMIGS: Advanced Robotics Workshop for FMIGS Fellows 19FMIGS: Announcing FMIGS-International 19AAGL at ACOG: AAGL Subspecialty Session at this Year’s ACOG Annual Meeting 20Member News: 21-23In Memoriam: Ronald Elmer Batt, M.D., Ph.D. 21

19 5

7

1816

ROBOTIC SURGERY

36 Impact of Obesity on Robotic-Assisted Sacrocolpopexy

55 Surgical Competency for Robot-Assisted Hysterectomy: Development

and Validation of a Robotic Hysterectomy Assessment Score (RHAS)

133 Robotic Radical Hysterectomy After Concomitant Chemoradiation in

Locally Advanced Cervical Cancer: A Prospective Phase II Study

UROGYNECOLOGY

41 Assessment of Synthetic Glue for Mesh Attachment in Laparoscopic

Sacrocolpopexy: A Prospective Multicenter Pilot Study

67 Incidence and Risk Factors for Pelvic Pain After Mesh Implant Surgery

for the Treatment of Pelvic Floor Disorders

HYSTEROSCOPY AND ENDOMETRIAL ABLATION

80 Oxidized, Regenerated Cellulose Adhesion Barrier Plus Intrauterine

Device Prevents Recurrence After Adhesiolysis for Moderate to Severe

Intrauterine Adhesions

124 A Randomized Controlled Multicenter US Food and Drug

Administration Trial of the Safety and Efficacy of the Minerva

Endometrial Ablation System: One-Year Follow-Up Results

140 Evaluation of Nickel Allergic Reactions to the Essure Micro Insert:

Theoretical Risk or Daily Practice?

159 Hysteroscopic Tissue Removal Systems: A Randomized In Vitro

Comparison

LAPAROSCOPIC HYSTERECTOMY

62 Physician Education on Controllable Costs Significantly Reduces Cost

of Laparoscopic Hysterectomy

108 The Effect of Vertical Versus Horizontal Vaginal Cuff Closure on Vaginal

Length After Laparoscopic Hysterectomy

151 Inpatient Laparoscopic Hysterectomy in the United States: Trends and

Factors Associated With Approach Selection

LAPAROSCOPIC SURGERY

94 Adnexal Torsion in Postmenopausal Women: Clinical Presentation and

Risk of Ovarian Malignancy

103 Determining a Learning Curve for Contained Hand Tissue Extraction:

Perioperative Outcomes and Operative Time

145 3 to 5 Years Later: Long-term Effects of Prophylactic Bilateral

Salpingectomy on Ovarian Function

GYNECOLOGIC ONCOLOGY

89 Laparoscopic Sentinel Node Mapping in Endometrial Cancer After

Hysteroscopic Injection of Indocyanine Green

98 Minimally Invasive Surgical Staging for Ovarian Carcinoma: A

Propensity-Matched Comparison With Traditional Open Surgery

January 2017 | Volume 24 | Number 1

3www.aagl.org | April—June 2017

AAGL VisionThe AAGL vision is to serve women by advancing the safest and most efficacious diagnostic and therapeutic techniques that provide less invasive treatments for gynecologic conditions through integration of clinical practice, research, innovation, and dialogue.

Editorial Staff

Editor-in-ChiefLinda Michels

Contributing EditorFranklin D. Loffer, M.D., FACOG

EditorJocelyne Fletcher

Art DirectorJoe Neric

Copy EditorsLinda J. Bell “Lynn”Dené Glamuzina

Board of Directors

PresidentJon Ivar Einarsson, M.D., Ph.D., MPHVice PresidentGary N. Frishman, M.D.Secretary-TreasurerMarie Fidela R. Paraiso, M.D.Immediate Past PresidentArnold P. Advincula, M.D.

DirectorsWilliam M. Burke, M.D.Marcello Ceccaroni, M.D., Ph.D.Kathy Huang, M.D.Jin Hee (Jeannie) Kim, M.D.Jing-he Lang, M.D.Ted T.M. Lee, M.D., FACOGRichard B. Rosenfield, M.D., FACOGJuan Diego Villegas-Echeverri, M.D., FACOG

Medical DirectorFranklin D. Loffer, M.D., FACOG

Executive DirectorLinda Michels

Focus on AAGL

The Foundation of the AAGL was established in 1993 by a generous grant from the Board of Directors of the AAGL. Its mission was to support educational courses, awards, scholarships and research grants to advance the use of minimally invasive surgery in women’s healthcare. It is a 501(c)(3) corporation governed by its own Board of Directors.

Recently, The Foundation Board has revised its bylaws to allow it to be even more active in reaching its goals. As an example, this year we are planning multiple fundraising events, including a Silent Auction during the AAGL Global Congress at the Gaylord Hotel in National Harbor, Maryland. The Silent Auction will be held on Wednesday, November 15, 2017. The Foundation will also be establishing new programs in addition to main-taining its longstanding programs. The latter include the following major activities:

Fund for the Future- The Foundation works with a number of corporate sponsors and private donors who fund this program, which supports the Fellow-ship in Minimally Invasive Gynecologic Surgery (FMIGS) training sites. Grantees are selected through a careful and thorough review of the applications by the Grant Selection Committee.

Resident’s Circle Fund- Contributions by indi-vidual AAGL member’s donations to this fund help to support the annual FMIGS Fellows and Residents Surgical Boot Camp. This program is also supported by a volunteer faculty who cover their own expenses, and by educational grants from our industry partners.

Endowments- The Foundation has received funding to establish 6 endowments. They are named for past leaders of the AAGL: Jay M. Cooper, Harrith M. Hasson, Jerome J. Hoffman, Jaroslav F. Hulka, Robert B. Hunt, and Jordan M. Phillips.

Awards– Numerous awards and prizes are made possible from funds provided by the endowments and from direct contributions to The Foundation.

As an AAGL member, you have already shown your dedication to your patients by adopting the tenets of less invasive gynecologic care. Hopefully, you have found your professional journey with the AAGL personally rewarding and will consider making a donation to The Foundation as a way of acknowledging this.

Please visit the Foundation website at http://www.aagl.org/service/foundation

Franklin D. Loffer, M.D., FACOG, is the Medical Director of the AAGL and resides in Phoenix, Arizona.

Update on The Foundation of the AAGL

6757 Katella AvenueCypress, California 90630-5105

Tel: 714.503.6200 | Fax: 714.503.6201E-mail: [email protected] | Web site: www.aagl.org

Franklin D. Loffer

Global Endometriosis SummitJuly 20-21, 2017Jon I. Einarsson, Scientific Program ChairMarcello Ceccaroni, Co-ChairReykjavík, Iceland

FMIGS Fellows and Resident Surgical Boot CampAugust 4-6, 2017Matthew Siedhoff, Scientific Program ChairArnold P. Advincula, Magdy Milad, Co-ChairsNew York, New York

AAGL in Collaboration with ACOGResident Education DayOctober 7, 2017Ted T.M. Lee, ChairNicole M. Donnellan, Noah B. Rindos, Co-ChairsCharlotte, North Carolina

46th AAGL Annual Global Congress on MIGSNovember 12-16, 2017Gaylord National Resort and Convention CenterNational Harbor (Washington, DC), MarylandSawsan As-Sanie, Scientific Program Chair

2nd Annual Workshop on Surgical Anatomy of the Pelvis and Procedures in Patients with Chronic Pelvic PainDecember 8-9, 2017Michael Hibner, M.D., Ph.D., Scientific Program ChairNita A. Desai, M.D., MBA, Co-ChairMark W. Dassel, M.D., Lab ChairPhoenix, Arizona

47th AAGL Annual Global Congress on MIGSNovember 11-15, 2018MGM Grand Hotel Las Vegas, Nevada

EDUCATION CALENDAR

4 April—June 2017 | www.aagl.org

The Board of Directors and AAGL staff recently convened in Orlando for a strategic planning session to re-evaluate the mission and goals of the AAGL and plan for where we envision ourselves to be as an organization in five years.

As a rapidly growing global organization, we need to continually re-evaluate the healthcare landscape and develop initiatives to place the AAGL ahead of the curve for patient care, innovation, and the education of our membership.

One of the best ways to advance our initiatives is through collaboration. No single organization can make significant strides in improving healthcare without working with other similarly focused societies. A partic-ular interest of mine is to develop tools to objectively measure surgical skills. The AAGL has developed the Essentials in Minimally Invasive Gynecology (EMIG) cognitive test and we are far along in developing a practical exam. We hope to work with ACOG, ABOG, and other stakeholders to introduce a validated tool to measure surgical skills. This will be an important step forward to enhance optimal patient outcomes.

To better understand how AAGL can focus on shaping their strategic environment over the next 24 months, the Board, along with AAGL’s senior staff members, conducted several discussion blocks focused

Planning for the Futuredeveloping an issues dashboard to incorporate topics into future Board meetings, as appropriate, over the next one to two years, to ensure these topics don’t fall by the wayside.

A few take-away messages from our recent strategic shaping session include ideas for providing all AAGL members exceptional value and benefit from joining and actively participating in our professional community; ideas for AAGL to be a recognized provider of superior opportunities for lifelong learning while establishing a clear career path in the MIGS profession; providing lead-ership opportunities to foster a secure, collaborative, and rewarding environment which is global, inclusive, and diverse, in order to promote development of volunteer leaders for the organization and the profession at-large; and aligning the AAGL Foundation with the overall AAGL vision and mission.

It was truly an honor to have been given the oppor-tunity to work with the AAGL Board and staff at this retreat. I was gratified to see many of the issues discussed in May of 2015 have been resolved, and the Board is moving forward into an even more compelling future. I look forward to sharing many more of these strategic initiatives with you in the coming months and welcome new ideas from our membership.

As always, best wishes.

Jon Ivar Einarsson, M.D., Ph.D., MPH, is President of the AAGL, Director, Division of Minimally Invasive Gynecologic Surgery, Brigham and Women’s Hospital, Associate Professor, Harvard Medical School, Boston, Massachusetts.

Jon Ivar Einarsson

President ’s Message

Our dedicated Board members participate via Skype even when they can't be present in person!

on issues of concern to AAGL. These blocks included such topics as the membership experience, SurgeryU, professional development, collaboration with other medical societies, development of new technology, alignment with The Foundation of the AAGL, improved relations with industry partners, and international and patient outreach. The final discussion block focused on

Dr. Frishman discusses long-term educational goals.

Secretary-Treasurer, Dr. Paraiso, presents ideas for collabo-ration with The Foundation.

Dr. Huang leads an engaging brainstorming session.

Dr. Kim sees many promising plans for continued growth.


New on SurgeryUWorkshop on Surgical Anatomy of the Pelvis and Procedures in Patients with Chronic Pelvic Pain

Scientific Program Chair: Michael Hibner, M.D., Ph.D.Co-Chair: Nita A. Desai, M.D., MBA

Lab Chair: Mark W. Dassel, M.D.

Watch Now on SurgeryUwww.SurgeryU.com

In December of 2016, the AAGL embarked on a new, disease-oriented approach to the treatment of pelvic pain. Now you can experience this

inaugural workshop and earn online CME for up to 16 videos presented at the AAGL’s highest rated course of 2016. Topics covered include:

Pelvic NeuroanatomyNeuropathic Pelvic Pain

Surgery in Patients with Adhesive DiseaseLesser-Known Conditions Causing Pelvic Pain

Treatment of Pelvic Floor Muscle Spasmand much more!

When Jordan M. Phillips founded the AAGL as the American Association of Gynecologic Laparoscopists in 1971, he clearly envisioned a worldwide organization to promote the health of women through minimally invasive gynecologic surgery. Since that time, the AAGL has grown exponentially to include over 7,500 members spanning the globe. Gynecologic oncology has main-tained its role as a subspecialty of surgical prowess, and that has in large part been extended to minimally invasive surgery. How do the gynecologic oncologists of AAGL find their purpose in such a large member organi-zation that includes members with diverse skill sets?

I believe the answer is found in the needs of women and their various geographic locations and resource settings throughout the world. Members of the AAGL are uniquely positioned to share knowledge and engage in group communications as no other organization facili-tates. This is the responsibility of every member of AAGL and may be where gynecologic oncologists in AAGL find their organizational calling.

So often we focus inward on the needs specific to our practice situation. In affluent countries, gynecologic oncologists with MIS interests focus on the minutia of the latest clinical trial - neoadjuvant chemotherapy with MIS interval debulking or lymph node mapping through MIS platforms. In such settings, professional roles are defined

as practitioners implementing modern medicine, innova-tors developing new tools and techniques, and researchers synthesizing newly acquired data to change the world. In settings with more limited resources, surgeons that provide gynecologic oncology care have broader concerns related to policy devel-opment to allow women access to basic care, physician access to the educational materials and equipment necessary for care, and formalized training to narrow the scope of training and elevate the level of care delivered to women who have gynecologic malig-nancies or need complex pelvic surgery.

Lest Americans feel superior, it should be noted that while the United States has the highest per capita expenditure for health care services worldwide, it has recently ranked 37th in patient outcomes,1 and

ranks last in health, even among industrialized nations.2 That said, the number of trained subspecialists is highest in industrialized nations, and members of affluent societies have the privilege of contributing knowledge and time to those in lower resource settings. Gynecologic oncologists, let us come together to see the world as one and use the virtual platforms and in-person meetings that AAGL provides to help each other!

My “clinical opinion” is that it is time to cast our vision outward and forward to work together across the breadth of diversity, experience, geography, skill sets, and resources to elevate the care that women receive everywhere. We must each see this as our responsibility as gynecologic oncologists of AAGL by articulating our needs, communicating with our international colleagues, and working together to meet the collective needs of women in our world.

Jubilee Brown, M.D. is the Chair of the AAGL’s Special Interest Group on Oncology. She is Professor and Associate Director, Gynecologic Oncology, Levine Cancer Institute at the Carolinas HealthCare System, Charlotte, North Carolina.

REFERENCES:

1. The world health report 2000 - health systems: improving performance. Geneva: World Health Organization, 2000.

2. Davis K, et al. 2014 Update. The Commonwealth Fund, June 2014.

SIG: Oncology

Clinical Opinion: Time for a Change

Jubilee BrownLearn more at Congress 2017!

COMPLX-700: Didactic Oncology: Complex Surgical Anatomy and Procedures

COMPLX-701: Cadaveric Lab Complex Surgical Anatomy/Complications

The AAGL SIG on Oncology as developed both this didactic and cadaveric lab to explore the oncologic principles that could benefit the benign pelvic surgeon. Note: These courses are pending approval for ABOG Main-tenance of Certification (MOC) Part IV.


AAGL Board Nominations

SECRETARY-TREASURER Term of Office: 4 years, 2018 – 2021Officer of the Board of Directors

Candidates for this position must have been a previous 2-year member of the Board of Directors. This position leads to Vice-President, President, and Imme-diate Past President. If you would like to be considered for this position, and have met the requirement of previous service to the Board, please review the Conflict of Interest (COI) Disclosure and Disassociation Policy

for Executive Board Members at www.aagl.org/boardcoi then complete the Conflict of Interest Disclosure for AAGL Board Executive Committee questionnaire at http://www.aagl.org/aaglboardcoi/.

You must also submit a one-page vision statement and your curriculum vitae to [email protected].

The AAGL Nominating Committee will soon meet to determine the slate of nominees for the AAGL Board of Directors. The following five positions are open:

It is time to get involved and help lead the AAGL!The deadline to submit your interest is July 24, 2017 by 11:59 pm PDT.

BOARD OF DIRECTORS POSITIONSTerm of Office: 2 years, 2018 – 2019

• Three candidates for the 2 positions from the General Membership

• Two candidates for the 1 position from the Pacific Rim/India/Asia region

• Two candidates for the 1 position from Mexico/Central America/South America regionIf you wish to be considered as a candidate for a

Board of Director position, please submit a one-page vision statement and your curriculum vitae to [email protected]

Who Will Help Lead AAGL into the Future?


AAGL Global Endometriosis Summit

Jon I. Einarsson, Scientific Program ChairMarcello Ceccaroni, Co-Chair

For more information, visit www.aagl.org/iceland

July 20-21, 2017 | Harpa Conference Center | Reykjavik, Iceland

From the Scientific Program Chair

It’s my honor and pleasure to invite you to join us for the 46th AAGL Global Congress on Minimally Invasive Gynecologic Surgery, November 12-16, 2017 at the Gaylord National Resort and Convention Center. The entire Scientific Program Committee has been hard at work since last October to bring you a program that will ensure that all attendees gain some useful teaching points that they’ll be able to apply when they go back home.

The theme of this year’s meeting is Enhancing Minimally Invasive Gynecologic Surgery Through Quality, Patient Safety and Innovation. What this means to us is a focus on issues that we find to be really close to our hearts as MIG surgeons: improving patient outcomes through a patient-centered approach that balances both innovation and technology, as well as quality and safety. We would love to provide with you the skills to make sure that everybody has access to excellent outcomes, whether you are operating in high technology, high resource settings, or in settings where access to these tools and resources are not readily available.

The Postgraduate Courses will include opportunities for both the novice and the more advanced surgeon to expand on their skills. The meeting’s theme is echoed in PG courses focusing on optimizing quality and patient safety, planning your surgical strategy, a patient-cen-tered approach to fibroid care, and a “teach the teacher” course to help you become a master. The always-essential

laparoscopic suturing courses will be offered four times: three sessions in English and one session in Spanish. Collaboration with the AAGL Special Interest Groups has resulted in highly educational courses in areas such as oncology, vaginal hysterectomy, building a world class robotic program, endometriosis treatment, operative hysteroscopy, and more. Advanced courses in complex anatomy and chronic pelvic pain treatment are offered, fellows and residents will again have a dedicated course on developing career tools, and much, much more.

The scientific program has been streamlined to offer attendees the high-quality, evidence-based presentations that the AAGL Global Congress has long been known for. We are extremely proud to have received another high number of quality written and video abstracts, elevating the science of our society. Thank you to everyone who submitted your work for consideration of presentation. As session assignments are completed, we will update the Block Program.

As our meeting has come to be known for both outstanding science and entertaining presentations, I’m very excited to announce this year’s “main stage” premier sessions! The edge-of-your-seat intrigue of Stump the Professors is back for a 6th straight year with new course chairs and new stumping cases. And in keeping with the theme of the past few years of creating an educa-tional surgical spin-off of a popular television show, we’ll be taking on the always riveting cooking show, “Chopped.” Three surgeons will be pitted against each other in a surgical show-down of mystery baskets of “ingredients” …but instead of gummy bears and kale, the mystery “ingredients” are surgical procedures. None of the participants will know what’s “in the basket” until

Elevating the Science at the 46th AAGL Global Congress

show time! But the best part is that this year’s session will also be a fundraiser for Fund for the Future, a vitally important fund through The Foundation of the AAGL created to foster interest in MIGS by providing grants to help support fellowships. Congress attendees will have the opportunity to “vote” for their favorite participant by making a tax-deductible donation to the Fund for the Future under that participant’s team name. Read the complete description of this innovative session in the Preliminary Scientific Program, available now on the congress website, and stay tuned for more information to come!

This year, in addition to the “Chopped” session, The Foundation of the AAGL is stepping up its fundraising efforts by offering you several fun, enriching, and educa-tional events to participate in, all for the greater good of raising much needed funds for The Foundation. Visit the congress website for more details, and make sure to sign up for one or more events when you register.

Lastly, we’re very pleased to be returning to the Greater Washington D.C. area for the Congress. National Harbor has been voted one of the Top 50 U.S. Destina-tions for meetings and offers more than 30 dining spots with choices from decadent steakhouses to cozy coffee shops and everything in between; the Tanger Outlets for premium brand name shopping; and the new MGM National Harbor, offering a little taste of Las Vegas on the east coast.

We truly hope you will join us for what will surely be an exceptional Global Congress.

Sawsan As-Sanie, M.D., MPH, is the Scientific Program Committee Chair of the AAGL 46th Global Congress. She is also Associate Professor, Director, Minimally Invasive Gynecologic Surgery Fellowship, and Director, Endometriosis Center, Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan.

Sawsan As-Sanie


Go to www.aagl.org to register

46th AAGL Global Congress on MIGS

Located on the banks of the Potomac River, just minutes from downtown Washington, D.C., the Gaylord National is an ideal venue for the AAGL Global Congress. Explore

National Harbor, voted one of the Top 50 U.S. Destinations for meetings, or enjoy all that the Gaylord, with “everything in one place,” has to offer.

A DESTINATION OF ITS OWN

A Beautiful View InsideThe soaring 19-story glass atrium and stately Federal-style architecture celebrate the spirit and history of our nation’s capital.

Spacious ComfortThe well-appointed guest rooms, many with balconies overlooking the atrium, are a welcoming respite after a full Congress day.

World Class DiningEmbark on a culinary experience you’ll never forget at the Gaylord’s “signature restaurant,” Old Hickory Steakhouse.

Award Winning AmenitiesEnjoy the full-service spa and salon, well-equipped fitness center, and several shopping boutiques during your stay.

Scientific Program ChairSawsan As-Sanie, M.D.

Honorary ChairArnaud Wattiez, M.D.

PresidentJon I. Einarsson, M.D., Ph.D., MPH

November 12-16, 2017Gaylord National Resort & Convention Center, National Harbor, Greater Washington, D.C.

Morning courses 7:00am – 11:00amCOMPLX-700 Didactic: Oncology: Complex Surgical

Anatomy and ProceduresChair: Pamela T. Soliman

HYST-702 Didactic: Laparoscopic Hysterectomy from Basic to ComplexChair: Nash S. Moawad

NEURO-704 6-HOUR COURSE: 7:00am – 2:30pmDidactic w/Live Cadaveric Demo: Neuropelveology: A Systematic Approach to the Diagnosis and Management of Complex Pelvic Pain and Pelvic NeuropathiesCo Chairs: Michael Hibner, Nucelio Lemos

VHYS-705 Didactic w/Live Cadaveric Demo: Vaginal Hysterectomy: Mastering the Most Minimally Invasive Approach to Hysterectomy and Taking It to the Next LevelCo-Chairs: Johnny Yi, Veronica Lerner

SUTR-706 Didactic/Simulation Lab: Laparoscopic Suturing: Practical Applications for Tissue Reapproximation, Intracorporeal and Extracorporeal Knot Tying, Barbed Suture, and Suturing TechnologiesChair: Grace Y. Liu

TEACH-708 Didactic: Become the Master Shifu You Always Wanted to BeChair: Sangeeta Senapati

HSC-710 FULL-DAY COURSE: 7:00am – 3:30pmDidactic/Simulation Lab: Advanced Operative Hysteroscopy: Expect the UnexpectedCo-Chairs: Linda D. Bradley, Aarathi Cholkeri-Singh

Morning courses 7:00am – 11:00amROBO-600 Didactic: Building a World Class Robotic

Program: Simulation, Integration, Application and EvaluationChair: Gaby N. Moawad

ANAT-602 Didactic: A Treasury of Pelvic Anatomy: Sacred Knowledge for Surgical ExpertiseChair: David M. Boruta

URO-604 Didactic: Practical Anatomy for Complex Pelvic Surgeries: Things Every Gynecologist and Urogynecologist Should KnowChair: Anthony G. Visco

SUTR-606 Didactic/Simulation Lab: Laparoscopic Suturing: Practical Applications for Tissue Reapproximation, Intracorporeal and Extracorporeal Knot Tying, Barbed Suture, and Suturing TechnologiesChair: Lydia E. Garcia

FELO-608 Didactic: Career Tools for Life: How to Navigate a Successful MIGS Career of Your DreamsCo-Chairs: Hye-Chun Hur, Warren Volker

SAFE-610 Didactic: Optimizing Quality and Patient SafetyChair: Amanda Nickles Fader

Afternoon courses 12:30pm – 4:30pmCOMPLX-701 Cadaveric Lab: Complex Surgical

Anatomy/ComplicationsChair: Edward J. Tanner

HYST-703 Cadaveric Lab: Laparoscopic Hysterectomy: Navigating the Basic and Complex Disease with EaseChair: Karen C. Wang

SUTR-707 Didactic/Simulation Lab: Laboratorio de Simulación en ESPAÑOL: Sutura Laparoscópica: Aplicación práctica para Reaproximación de tejidos, Nudo Intracorpóreo y Extracorpóreo, Sutura Barbada y Tecnologías de SuturaChair: Jaime A. Albornoz

TEACH-709 Simulation Lab: Teach the TeacherChair: Nicole M. Donnellan

PUSH-711 Didactic: Shoot for the Moon: Surgical Strategy from the StarsChair: Audrey Tsunoda

FIBR-712 Didactic: Contemporary Fibroid Therapies and Musical Hits from the 80s: Might There Be an Association? Chair: M. Jonathon Solnik

Afternoon courses 12:30pm – 4:30pmROBO-601 Cadaveric Lab: Creating Systematic

ProficiencyChair: Devin M. Garza

ANAT-603 Cadaveric Lab: Navigating the Retroperitoneum: The Road to Performing Complex Laparoscopic Gynecologic SurgeryChair: Yukio Sonoda

URO-605 Cadaveric Lab: Complex Surgical Spaces Demystified with Hands-on Experience: Anatomy Every Gynecologist and Urogynecologist Should KnowChair: Marlene Corton

SUTR-607 Didactic/Simulation Lab: Laparoscopic Suturing: Practical Applications for Tissue Reapproximation, Intracorporeal and Extracorporeal Knot Tying, Barbed Suture, and Suturing TechnologiesChair: Jamie Kroft

ENDO-609 Didactic: Minimally Invasive Management of Complex Endometriosis: From Imaging Pearls to Fertility-Sparing Surgery to HysterectomyChair: Ken R. Sinervo

PELV-611 Didactic: Pelvic Pain – Making It Right: Effectively Fixing Painful ComplicationsChair: Mark W. Dassel

A A G L P O S T G R A D U AT E C O U R S E S

PG DAY ONE (NOVEMBER 12, 2017) PG DAY TWO (NOVEMBER 13, 2017)

BEYOND GYNECOLOGIC SURGERY

4TH 5TH 6TH APRIL 2018CONGRESS & EXHIBITION CENTER POLYDÔMECLERMONT-FERRAND FRANCE

CONGRESS PRESIDENTS:Arnaud WATTIEZ

Errico ZUPI

SCIENTIFIC PROGRAM CHAIR:

Michel CANIS

Jon EINARSSONArnold ADVINCULA

Gary FRISHMANIsabel GREEN

Chyi-Long LEEBernard CHERN

Alam LAMHua DUAN

Rudy De WILDERudy CAMPO

Giovanni SCAMBIABenoit RABISCHONG

FROM IMAGINATION TO INNOVATION & EDUCATION

Teaching gynecologic surgery (New tools for training, the ideal curriculum? E learning pitfalls and limits? …)

Quality in surgery

The future or robotic surgery from tele manipulatorsto independent robots

Which image on our screens in 10 years?

The ideal pneumoperitoneum

Will or should the OR become an Airline Cockpit?

Improving surgical safety

Computer Science explained to surgeons

Augmented reality

Surgeon and social networks

THIS MEETING IS NOT JUST ANOTHER ENDOSCOPY MEETING !IT’S ABOUT “THE FUTURE OF GYNECOLOGIC SURGERY”

www.gynecologic-surgery.com

Meeting in English with simultaneous translation

www.gynecologic-surgery.com

MAINS TOPICS

tionally, with SIS, the myometrial thickness overlying the isthmocele is reproducible and provides guidance for the surgical approach or advice regarding future pregnancy.4 The classic appearance includes a typical U-shaped or V-shaped hypoechoic or anechoic fluid accumulation in the region of the cesarean incision.5

Treatment options and surgical techniques for symptomatic isthmocele depend on symptoms and desire for future pregnancy.6 These options include: medical management, robotic, laparoscopic, combined hystero-scopic and laparoscopic approach, endometrial ablation or vaginal approaches. Currently, there is no universally accepted consensus or “best-practice” for the treatment of cesarean-induced isthmocele.

Raimondo7 and colleagues were successful in correcting cesarean induced-isthmocele with operative hysteroscopy. In 80% of patients with abnormal uterine bleeding and suprapubic pain, symptoms improved. In 7% of patients, other symptoms improved; however, 13% did not notice improvement clinically.

To improve the care of women with symptomatic cesarean-induced scars, more quality studies that include longer follow up, including pregnancy and delivery outcomes, post-procedural imaging, increased sample size, and improved description of surgical method-ological techniques employed in treatment will enable clinicians to provide the most robust informed consent. Treatment may not be an “either/or” possibility, but may include multiple modalities including a hysteroscopic approach.8

Linda D. Bradley, M.D. is Chair of the Special Interest Group on Hysteroscopy, and a Past-President of the AAGL. She is Professor of Surgery, Vice Chair Obstetrics/Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio.

1. REFERENCES

1. Tower AM, et al. Cesarean scar defects: an under-recognized cause of abnormal uterine bleeding and other gynecologic complications. J Minim Invasive Gynecol. 2013 Sept-Oct;20(5):562-72.

2. Morris H. Surgical pathology of the lower uterine segment caesarean section scar: is the scar a source of clinical symptoms? Int J Gynecol Pathol. Jan;14(1)16-20.

3. Bij de Vaate AJ, et. al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review. Ultrasound Obstet Gynecol. 2014 Apr;43(4):372-82.

4. Pomorski M, et al. Standardized ultrasonographic approach for the assessment of risk factors of incomplete healing of the cesarean section scar in the uterus. Eur J Obstet Gynecol Reprod Biol. 2016 Oct;205:141-5.

5. O. Vikhareva O. Cesarean section scar defects: agreement between transvaginal sonographic findings with and without saline contrast enhancement. Ultrasound in Obstetrics & Gyne-cology. 2014; 35(1):75-83.

6. Song-jun L. Laparoscopic repair with hysteros-copy of cesarean scar diverticulum. Journal of Obstetrics and Gynaecology Research. 2016 Dec 42(12): 1719-1723.

7. Raimondo G. et al. Hysteroscopic treatment of symptomatic cesarean-induced isthmocele: a prospective study. J Minim Invasive Gynecol. 2015 Feb;22(2):297-301.

8. van der Voet LF. et al. Minimally invasive therapy for gynaecological symptoms related to a niche in the caesarean scar: a systematic review. BJOG. 2014 Jan;121(2):145-56.

An under-recognized cause of post-menstrual spotting, pelvic pain, abnormal uterine bleeding, and secondary infertility, is a cesarean-induced isthmocele. With the increasing number of births worldwide by cesarean deliv-eries, gynecologists must be aware of this novel problem.1

An isthmocele is defined as a triangular defect and reservoir-like pouch of fibrotic tissue involving a prior C-Section scar on the anterior wall of the uterine isthmus. Dr. H. Morris, a pathologist, described signifi-cant pathologic changes in 51 hysterectomy specimens near the region of the post-cesarean section scar. These changes included: distortion and widening of the lower uterine segment (75%); “overhang” of congested endo-metrium above the scar recess (61%); polyp formation within the uterine scar (16%); moderate to marked lymphocytic infiltration (65%); residual suture material with foreign body giant cell reaction (92%); capillary dilation (65%); free red blood cells in the endometrium representing recent hemorrhage (59%); breakdown of the endometrial scar (37%); and adenomyosis confined within the uterine scar (28%).2

Findings are more prevalent during the early prolif-erative phase post-menstrually. While not completely understood, its etiology associated with deficient wound healing after a cesarean section, number of cesarean deliveries, uterine position, labor prior to cesarean section, and surgical closure.

Blood accumulating in the pouch contributes to suprapubic pain, may affect quality of cervical mucus, sperm motility and sperm transport, and may lead to secondary infertility. Embryo transport may be affected due to distortion in the endocervical and endometrial cavity during invitro fertilization. Additional compli-cations may include cesarean scar ectopic pregnancy, increased complications during gynecologic procedures, including uterine evacuation, hysterectomy, insertion of an intrauterine device, or endometrial ablation. Preg-nancy complications include uterine dehiscence and uterine rupture during an ongoing pregnancy.3

The prevalence of clinically symptomatic isthmocele ranges from 19.4% to 88%. Imaging techniques include office hysteroscopy, transvaginal ultrasound (TVUS), saline infusion sonography (SIS), and pelvic MRI. Distention of the uterine cavity during SIS make delin-eation and view of the defect more easily seen than with TVUS alone —and it is less expensive than MRI. Addi-

SIG: Hysteroscopy

Cesarean-Induced Isthmocele: Is It on Your Radar?

Linda D. Bradley

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HSC-710 – Didactic/Simulation Lab Advanced Operative Hysteroscopy: Expect the Unexpected

In this 6.5 hour session, internationally recognized operative hysteroscopists will demon-strate a variety of advanced techniques for treating intracavitary pathology. Expect the unexpecting during this session: clinical pearls, novel hysteroscopic treatments, and strategies to advance your hysteroscopic skills.



Congressional Crawl

Monday, November 13, 2017 (8:30 pm - 12:30 am)

$75.00

No trip to the greater Washington, D.C. Area is complete without touring our national monuments. This evening tour lets you visit them without the usual daytime crowds, allowing you to take in the history and beauty as they’re bathed in bright lights against the dark sky - a truly unique and memorable experience.

LET'S PUT THE "FUN" IN FUNDRAISING

Silent Auction Wednesday, November 15, 2017

(7:00 pm - 9:00 pm) Preceding the Presidential Gala

Imagine yourself on a trip of a lifetime. Or advancing your surgical skills during an observership with a high-profile surgeon. Are championship sports events more your thing? Perhaps you’ve always wanted to buy an original piece of art. All this and more will be available for bid with all proceeds benefiting the Foun-dation. Come see if your dreams can be fulfilled.

This year we’re excited to offer several unique, fun, and fulfilling opportunities to support the efforts of The Foundation through multiple fundraising events and opportunities. All proceeds from each of these events go toward The Foundation’s mission of continued progress in the field of minimally invasive gynecology.

We hope you’ll join us for one or more of these events and enjoy the networking and social atmosphere - all for a greater cause.

What’s new for 2017?

The Foundation

One of the main functions of the mission of The Foun-dation of the AAGL is to provide scholarships, teaching grants, and financial support to worthy research. For the second straight year, The Foundation is proud to announce the recipients of the Exxcellence in Clinical Research Course grants and the MIGS research grants. A sincere thank you to all who submitted their interest in these grants, and congratulations to all the grant recipients.

The following grant recipients will receive a research grant for up to $10,000 to fund a research project related to minimally invasive gynecology. The research must occur between 7/1/2017 and 6/30/2018.

Emily Davidson, Cleveland Clinic“A randomized-controlled trial of post-operative narcotic

quantities after minimally invasive urogynecologic surgery”

Sukhbir “Sony” Singh, The Ottawa Hospital“Predicting the presence of deep infiltrating endometriosis

from routine transvaginal ultrasound images”

Cara King, University of Wisconsin-Madison“Application of motion based technology in the objective

assessment of laparoscopic suturing of a validated vaginal cuff simulation model”

The following grant recipients will receive funding to attend the six-day Exxcellence in Clinical Research Course this August 19-25 in Stevenson Washington. This course is sponsored by The Foundation for Exxcellence in Women’s Health Care.

Sara FaragMiami Lakes, Florida

Nisse ClarkBoston, Massachusetts

Carolyn PiszczekPortland, Oregon

Kristen RileySeattle, Wahsington

Shanti MohlingChattanooga, Tennessee

And The Foundation Grants Go To…


Barre3 Fitness ClassWednesday, November 15, 2017

(6:00 am - 7:00 am)

$25.00

If fitness is more up your alley, then a sunrise Barre3 class will certainly get your day started right. Barre3 delivers a full body workout using only low-impact movements from 3 different disciplines - ballet barre, pilates, and yoga. No experience is required. Do your body some good while you support the Foundation’s efforts. What could be more fulfilling than that?

Urban Pub Crawl

Tuesday, November 14, 2017 (7:30 pm - 12:30 am)

$150.00

Hip and trendy bars, extraordinary restaurants - these are the cornerstones of what night life in DC has come to be known for. Join us as we visit some of DC’s trendiest locales for delicious hors d’oeuvres and creative craft cocktails. Your local hosts will ensure that you have a great time, and a safe time with dedicated shuttle drivers. Networking and fundraising like you’ve never done before!

LET'S PUT THE "FUN" IN FUNDRAISING

JMIG

New AAGL Practice Report: Practice Guidelines on Intrauterine Adhesions, Developed in Collaboration With the European Society of Gynaecological Endoscopy (ESGE)

The AAGL Practice Committee presents the first revised AAGL guideline since its inception more than seven years ago, when it began producing evidence-based guidelines for AAGL members. This revision is also the first to be written in conjunction with a partner organization - the European Society of Gynaecological Endoscopy (ESGE) - bringing together clinicians from the United States, Europe and Australia to examine the evidence available and suggest best practice for clinicians globally.

There have been substantial changes since the first Guidelines, published back in January 2010, with 7 randomized clinical trials (RCTs) examining primary

prevention and demonstrating that the type of surgery is likely to contribute to de novo adhesion formation, and the use of adhesion barriers being effective in adhesion prevention, although the longer-term effect on fertility with the use of these barriers is unknown at this time. When a woman has adhesions that are treated, secondary prevention has also been assessed with 5 RCTs now published recently, reporting that semi-solid barriers, IUDs, stents, and amnion grafts all reduce repeat adhesion formation. Again, the evidence for subsequent pregnancy is not defined, and these treatments should be used in well-conducted clinical studies until the exact benefit is demonstrated.

The newest innovation is a study that uses intrauterine stem cells following surgery, with pregnancies reported. In accordance with the pyramid of evidence, it is impera-tive that this be recognized as a potential only, and not be undertaken outside of rigorous research protocols, until safety and efficacy can be firmly established.

Dissemination of this Practice Guideline would not have been possible without the collegiate spirit of Elsevier and Springer publishing houses, which have allowed dual simultaneous publication. It is clear that the evidence is the same the world over, and that we all want to practice optimal and evidence based gynecology. Any guideline team will also tell you that there is a substantial volume of work involved in their production, and inter-society collaborations that promote cooperation, unity, and reduce duplication, are clearly advantageous. I look forward to future combined Guidelines that may be endorsed by many, for the benefit of women everywhere.

Jason Abbott is Associate Professor Gynaecological Surgery, School of Women’s and Children’s Health, The University of New South Wales in Sydney, Australia, and the Chair of the AAGL Practice Committee that was responsible for this project.

Jason Abbott

The Impact Factor for Ob/Gyn Journals has been released and we are proud to announce that for the first time in JMIG’s history our impact factor passed 3. The stats for JMIG are as follows:

YEARIMPACT FACTOR

RANKING (Ob/Gyn Journals)

2016 3.061 16

2015 2.390 23

This is an amazing success that can be attributed to the high-quality articles that we accepted that reflect a greater emphasis on surgical trials. Surgical research is arguably more difficult to accomplish as there are fewer clinical trials but we were able to attract a high number.

The number of manuscripts submitted continues to increase, but we only accept approximately 20% and few

case reports. We must also remember that an excellent journal is the result of an engaged Editorial Board, excel-lent reviewers, and a dedicated editorial staff. Our thanks to all who have contributed to this success and we look forward to celebrating together at our annual meeting this November.

Tommaso Falcone, M.D., FRCSC, FACOG, is Editor-in-Chief, The Journal of Minimally Invasive Gynecology. He is also Professor of Surgery at the Cleveland Clinic Lerner College of Medicine, and Chairman of the Obstetrics, Gynecology and Women’s Health Institute at the Cleveland Clinic in Cleveland, Ohio.

JMIG’s Impact Factor Soars!

Tommaso Falcone"This is an amazing success that can be attributed to the high-quality articles"

ROBOTIC SURGERY36 Impact of Obesity on Robotic-Assisted Sacrocolpopexy

55 Surgical Competency for Robot-Assisted Hysterectomy: Development and Validation of a Robotic Hysterectomy Assessment Score (RHAS)

133 Robotic Radical Hysterectomy After Concomitant Chemoradiation in Locally Advanced Cervical Cancer: A Prospective Phase II Study

UROGYNECOLOGY41 Assessment of Synthetic Glue for Mesh Attachment in Laparoscopic

Sacrocolpopexy: A Prospective Multicenter Pilot Study

67 Incidence and Risk Factors for Pelvic Pain After Mesh Implant Surgery for the Treatment of Pelvic Floor Disorders

HYSTEROSCOPY AND ENDOMETRIAL ABLATION80 Oxidized, Regenerated Cellulose Adhesion Barrier Plus Intrauterine

Device Prevents Recurrence After Adhesiolysis for Moderate to Severe Intrauterine Adhesions

124 A Randomized Controlled Multicenter US Food and Drug Administration Trial of the Safety and Efficacy of the Minerva Endometrial Ablation System: One-Year Follow-Up Results

140 Evaluation of Nickel Allergic Reactions to the Essure Micro Insert: Theoretical Risk or Daily Practice?

159 Hysteroscopic Tissue Removal Systems: A Randomized In Vitro Comparison

LAPAROSCOPIC HYSTERECTOMY62 Physician Education on Controllable Costs Significantly Reduces Cost

of Laparoscopic Hysterectomy

108 The Effect of Vertical Versus Horizontal Vaginal Cuff Closure on Vaginal Length After Laparoscopic Hysterectomy

151 Inpatient Laparoscopic Hysterectomy in the United States: Trends and Factors Associated With Approach Selection

LAPAROSCOPIC SURGERY94 Adnexal Torsion in Postmenopausal Women: Clinical Presentation and

Risk of Ovarian Malignancy

103 Determining a Learning Curve for Contained Hand Tissue Extraction: Perioperative Outcomes and Operative Time

145 3 to 5 Years Later: Long-term Effects of Prophylactic Bilateral Salpingectomy on Ovarian Function

GYNECOLOGIC ONCOLOGY89 Laparoscopic Sentinel Node Mapping in Endometrial Cancer After

Hysteroscopic Injection of Indocyanine Green

98 Minimally Invasive Surgical Staging for Ovarian Carcinoma: A Propensity-Matched Comparison With Traditional Open Surgery

January 2017 | Volume 24 | Number 1


are lower overall since these procedures are typically performed in an outpatient setting despite the fact that they commonly require more intraoperative time, effort, and “work.” They require advanced skills, which now often means additional training. Without question, the cost of healthcare in the US is too high, and value-based payment systems are coming. When hysterectomy for benign conditions is the right choice, the vaginal approach – which has been proven to be feasible under most circumstances – will be the clear winner. It is our job now to ensure that minimally invasive surgeons have the skills and experience necessary to counsel our patients well and choose the route of hysterectomy wisely.

Veronica Lerner, M.D., FACOG is Director of Simulation at Department of Obstetrics & Gynecology NYU Medical Center, New York, New York, and Chair of the AAGL’s Special Interest Group on Vaginal Surgery

Barbara Levy, M.D., FACOG, is Vice President for Health Policy, The American College of Obstetricians and Gynecologists, Washington, D.C., and Past-President of the AAGL

REFERENCES:

1. ACOG Committee Opinion No. 444: Choosing the route of hysterectomy for benign disease. Obstet

The preferred approach to hysterectomy for benign indi-cations is vaginal because of low-cost and overall safety.1-2 Unfortunately, vaginal hysterectomy rates remain low at around 20%.3 In the prior issues of NewsScope we addressed potential reasons why, but now we are taking a closer look at finances.4-5

The meaning of “value” in medicine continues to be debated as multiple factors and obstacles make the economists’ formula of quality÷cost quite difficult6 to compare across institutions and geographic regions. Yet, given the direction our healthcare system is taking, it is important to consider.

First, with regard to “quality,” it has been well estab-lished across multiple studies that the vaginal approach is associated with the lowest cost, shortest operating time and fewest complications overall. That said, there are almost no true randomized trials in which the surgical teams have equal proficiency in all approaches. In addition, no “standard” exists when it comes to surgical technique. A recent systematic review attempted to create evidence-based clinical practice guidelines when comparing vaginal hysterectomy techniques. Authors reported their results in several domains, but noted that minimal data exist to guide surgeons, and that further study was needed.7

Second, with regard to cost, one problem is clear: estimates vary widely based on how calculations were made. Factors such as patient selection, surgical expe-rience, OR time and staffing, use of disposable devices, trainees’ involvement, study periods, length of follow up, inpatient vs. outpatient setting, health systems, countries, regions, and viewpoints (societal and institutional) differ greatly.12-13 Other tangible factors such as marketing and patient demand are hard to quantify. Still, however limited, most trials consistently demonstrate that vaginal hysterectomy is the most cost-effective route, with some estimates showing that the robotic route costs, on average, $2,253 more per patient than vaginal hysterectomy.8-10,11,13 With laws and regulations affecting payments that are ever changing, and political instability in health care, these calculations are even more challenging.

Consider the broader picture. We would argue that the “decision for surgery” is the most important consid-eration in managing benign uterine disease. Since the current reimbursement system is fee-for-service (RVUs for surgeons, DRGs for hospitals), high surgical volume is incentivized over conservative management. Let’s also not forget that RVUs for minimally invasive approaches

SIG: Vaginal Surgery

How Does Vaginal Hysterectomy Measure Up in The Era of VBM (Value-Based Medicine)?

Veronica LernerBarbara Levy

"The meaning of 'value' in medicine continues to be debated, as multiple factors and obstacles make the economists' formula of quality ÷ cost quite difficult to compare across institutions and geographic regions."

Learn more at Congress 2017!

VHYS-705: Didactic w/Live Cadaveric Demo

Vaginal Hysterectomy: Mastering the Most Minimally Invasive Approach to Hysterectomy and Taking It to the Next Level

Presented in affiliation with ACOG, SGS, and in cooperation with the AAGL SIG on Vaginal Surgery, this unique course will include not only anatomy relevant to the vaginal surgeon, but will also include a live cadaveric demonstration of both vaginal and abdominal perspectives of vaginal surgery.

Gynecol. 2009. Nov; 114 (5): 1156-8. 2. AAGL Position Statement: Route of hysterectomy

to treat benign uterine disease. J Minim Invasive Gynecol. 2011. Jan-Feb. 18 (1): 1-3.

3. Wright JD, Herzog TJ, Tsui J, Ananth CV, Lewin SN, Lu YS, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol 2013; 122:233–41.

4. Walter AJ, MD. NewsScope Article: Vaginal Hyster-ectomy Is Safe and Cost-Efficient, Why Aren’t More Surgeons Performing It? July-Sept 2014.

5. Lerner VT, Kammire L. Newscope Article: To Sim Or Not To Sim? Teaching Vaginal Hysterectomy Via Simulation Is The Answer! July-Sept 2016.

6. Porter, ME. What Is Value in Health Care? NEJM. 2010; 363:2477-2481.

7. Jeppson, PC et al. Comparison of Vaginal Hyster-ectomy Techniques and Interventions for Benign Indications: A Systematic Review. Obstet Genecol. 2017 May; 129 (5): 877-886.

8. Dorsey JH, et al. Costs and Charges Associated with Three Alternative Techniques of Hysterectomy. NEJM. 1996; Aug; 335(7):476-82.

9. Sculpher, AU et al. Cost effectiveness analysis of laparoscopic hysterectomy compared with stan-dard hysterectomy: results from a randomized trial. BMJ. 2004; 328(7432): 134.

10. Swenson CW, et al. Comparison of robotic and other minimally invasive routes of hysterectomy for benign indications. Am J Obstet Gynecol. 2016; 214(4): S458.

11. Woelk JL, et al. Cost Differences Among Robotic, Vaginal and Abdominal Hysterectomy. Obstet Gynecol. 2014 Feb; 123(2 Pt 1): 255-62.

12. Martino MA, et al. A comparison of quality outcome measures in patients having a hysterec-tomy for benign disease: robotic vs. non-robotic approaches. J Minim Invasive Gynecol. 2014 May-Jun; 21(3): 389-93.

13. Shevn D, et al. Geographic Variance of Cost Associ-ated With Hysterectomy. Obstet Gynecol. 2017 May; 129(5): 844-853.


Louisville Workshop

In the city of Louisville, after the dust settled from the Kentucky Derby, another ongoing tradition was in full-swing – the 20th Annual AAGL Advanced Workshop on Gynecologic Laparoscopic Anatomy and Minimally Invasive Surgery Including Pelvic Floor Reconstruction. This is the longest running cadaver course in the world, and has attracted over 550 attendees from more than 34 countries since 1998.

The director of the course, Dr. Resad Pasic, intends for this course to solidify knowledge of pelvic anatomy and improve surgical technique. He also believes that gynecologists are sometimes confined to the intra- peritoneal space of the pelvis. You can often times hear him telling his fellows: “Familiarity of the pelvic sidewall and retroperitoneal spaces is crucial. Go beyond! Explore these spaces; this is how you will become an expert surgeon.” He envisions the same goals for the attendees of this conference.

This year, there were 27 participants from 7 coun-tries, including the United States, Canada, Costa Rica, Australia, the United Kingdon, Brazil, and Peru. The two-day course was comprised of didactics and hands-on cadaveric dissection. Lecture topics included basic anatomy, hysterectomy, laparoscopic myomectomy,

A Louisville and AAGL Milestone – 20 years!

Traci E. Ito

retroperitoneal dissection, pelvic sidewall dissection, laparoscopic suturing, pelvic floor reconstruction, and incontinence procedures.

A unique feature of this year’s course was the involve-ment of past fellows. Seven former fellows and two current fellows served as faculty, along with Dr. Pasic, Dr. Shan Biscette, Lab Director for the course, and Dr. Sean Francis, Chair of the Obstetrics and Gynecology Depart-ment at the University of Louisville. This arrangement catered to intimate instruction for participants, who were divided by skill level, to enhance the learning experi-ence for each individual. There were three participants for each cadaver, allowing each person ample time to practice surgical technique, ask questions, and review

A successful cadaver lab makes Dr. Pasic feel like a champion!

Faculty, industry representatives, and guests enjoy a beautiful Spring evening as Dr. Pasic graciously opens his home for a lively dinner party.

Our zen faculty, back row l-r: Daniel Ginn, Linda-Dalal Shiber, Pasic, Jay Hudgens, Francis, Mark Dassel. Front row l-r: Jessica Shepherd, Ito, Ambereen Jan, Biscette, Thomas Lang.

pertinent anatomy. In addition, various companies made their products available for trial. This included instru-ments for intra-abdominal entry, assorted electrosurgical tools, and even samples of hemostatic agents and adhe-sion barriers. The course also offered a station dedicated to laparoscopic suturing and knot tying with one-on-one instruction, which many found extremely helpful.

Course attendee, Dr. Amy McGaragham from Boston, appreciated the in-depth review of the retroperitoneal anatomy, stating, “Even those who are comfortable with laparoscopy can attend this course to advance their skills and knowledge of spaces that we do not enter every day.” Dr. Aishawarya Sarkar graduated residency in 2015 and felt this course gave her great tips on surgical technique and anatomy. She exclaimed, “I would recommend this course to everyone!”

Despite 20 years, and counting, we are constantly evolving. Dr. Biscette, who has been integral to the implementation of this course, says she is “always amazed by the attendance from participants both nationally and internationally. The enthusiasm from these colleagues continues to fuel our passion for surgery and encourages us to pass on our pearls of wisdom.” We incorporate the feedback of both the faculty and attendees to make each year better than the last. We are thankful to AAGL for this ongoing partnership and are already preparing for next year!

Traci E. Ito, M.D., is a first-year Fellow in Minimally Invasive Gynecologic Surgery at the University of Louisville in Louisville, Kentucky.

Dr. Hudgens and Dr. Shiber share pearls with attendee.


FMIGS

This past March 2017, the AAGL hosted its first Advanced Robotics Workshop for FMIGS Fellows under the leadership of Drs. Arnold Advincula and Gerald Harkins. After applications were submitted and reviewed, 24 FMIGS fellows were eventually selected to participate in a 2-day intensive and interactive deep dive into the advanced applications of robotics in minimally invasive gynecologic surgery. A combination of didactics and small group discussions complemented the hands-on cadaveric component on six robotic surgical systems.

Highlights included strategic port placement and docking demonstrations, tips and tricks for single site and reduced port robotics, cost containment strategies, and trouble-shooting. Advanced robotic suturing and dissection techniques were also addressed and applied in the cadaveric setting. Enhancing the program were the dedicated faculty who possessed years of experience performing robotic surgery for complex gynecologic conditions.

A heartfelt thanks goes out to our key industry partners whose in-kind product support and unrestricted educational grants make endeavors such as the Advanced Robotics Workshop for FMIGS Fellows possible. Intuitive Surgical also deserves a special thank you for allowing the AAGL to have this event at their state-of-the-art robotic surgery training facility in Norcross, Georgia. Given the overwhelmingly positive feedback regarding this focused robotics experience, planning for our next workshop is already underway with the hopes of increasing the number of fellows able to participate. We look forward to

Advanced Robotics Workshop for FMIGS Fellows

Arnold P. Advincula

Announcing FMIGS-International

A 2017 initiative approved by the FMIGS Board will allow non-US and Canadian fellowship programs to apply for FMIGS-International (FMIGS-I) designation. A committee composed of a diverse group of clinician- educators has worked hard to establish standards by which international fellowship sites can be recognized for their educational training capacity.

The mission of FMIGS-I is to provide a uniform training program for gynecologists who have completed her/his residency in obstetrics and gynecology and desire additional knowledge and surgical skills in minimally invasive gynecologic surgery so they may: (a) serve as a scholarly and surgical resource for patients and referring physicians; (b) have the ability to care for patients with complex gynecologic surgical disease via minimally invasive techniques; (c) establish sites that will serve a leadership role in advanced endoscopic and reproductive surgery; and (d) further research in minimally invasive gynecologic surgery. International fellowship programs will have similar requirements as those in the United States and Canada that include a 2-year curriculum, didactics, minimum case experience, competency-based training, assessment, and research.

FMIGS-I training is not a substitute for FMIGS training and is not intended to prepare minimally inva-sive gynecologic surgeons to provide clinical care in the US or Canada.

Interested programs can find the link on the aagl.org website under “fellowships,” to be posted in July 2017. Interested candidates can also find the application on the same page. Thank you to all the committee and staff members for their work on seeing this exciting initiative come to fruition.

Magdy Milad, M.D., MS is the Immediate Past-President of the Board for the Fellowship in Minimally Invasive Gynecologic Surgery . He is the Albert B. Gerbie Professor of Obstetrics and Gynecology at Northwestern Feinberg School of Medicine, Chief of Gynecology and Gynecologic Surgery at Northwestern Memorial Hospital, Chicago, Illinois.

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Magdy MiladDr. Advincula presents strategic port placement.

Dr. Xiao Ming Guan discusses the finer points of single port robotics.

Fellows have plenty of time to improve their skills.

an even bigger and better course in 2018.

Arnold P. Advincula, M.D., FACOG, FACS, is the Immediate Past-President of the AAGL. He is Levine Family Professor of Women’s Health, Vice-Chair, Department of Obstetrics & Gynecology, Chief of Gynecology, Sloan Hospital for Women, Medical Director, Mary & Michael Jaharis Simulation Center, Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York


AAGL at ACOG

AAGL Subspecialty Session at this Year’s ACOG Annual Meeting

Pamela T. Soliman

The AAGL had the opportunity to host a subspecialty session for the second consecutive year. The session, entitled Minimally Invasive Approaches to Gynecologic Procedures, was presented on Sunday, May 7 at the 2017 ACOG Annual Meeting: Next Generation of Health Care, in San Diego, California. Together with Drs. Ted Lee and

Michael Frumovitz, we were able to address important issues in gynecologic surgery. We reviewed current guidelines for making the best decision about who needs surgery and what is the best procedure. This included strategies to avoid a chance encounter with a gynecologic malignancy, as well as current guidelines for elective oophorectomy and salpingectomy.

Participants watched surgical videos on the key anatomic structures within the pelvis and retroperito-neum, and learned how to use this knowledge to gain access to the pelvis during a difficult hysterectomy. This included innovative options for tissue extraction and morcellation in the current era. We discussed difficult surgical decision-making, and how best to provide safe care for obese women undergoing minimally invasive surgery. And finally, we offered tips to avoid bowel and bladder complications, as well as advice on managing complications.

Overall, the course was well attended and well received. The audience was engaged and asked a lot of great questions. The AAGL looks forward to hosting another subspecialty session at next year’s ACOG Annual meeting.

Pamela T. Soliman, M.D., MPH is Associate Professor and Deputy Cha ir, Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center, Houston, Texas, and a past AAGL Board member.

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6th Annual “Stump the Professors” Call for CasesEveryone loves a good mystery! Especially one that can lead to the

right diagnosis and treatment plan for a patient in need.

If you’ve ever been stumped by a case, had a case that was challenging and exciting to manage, or just walked away thinking “that was an amazing case”, come share that experience with your peers in this engaging and informative format. Three intriguing, mind-boggling, complex cases will be presented to a panel of recognized experts. Based on their vast clinical knowledge and experience, the panelists will try to accurately assess the correct treatment and diagnosis. Your job is to make it as challenging as possible for the panelists…to stump the professors! Get creative in this no holds barred presentation.

WHO IS ELIGIBLE:All AAGL members

(domestic or international)

OUTLINE:One-page case

summary, including final diagnosis

(750 word MAX)

SUBMIT:Email to Art Arellano, [email protected]

Welcome New MembersMarch 1, 2017 — May 31, 2017

Member News

Karim Abdallah, M.D.Joanna Abiola, M.D.Brett Adair, D.O.Pelumi Adedayo, M.D.Tania Aftandilians, M.D.Silvia Agramunt, M.D.Sarita Agrawal, M.D.Rimsha Ahmed, M.D.Mireille Akilian, Ph.D.Dennis J. Albino, M.D.Jonathan Alford, M.D.Hanan Habeeb Alshankiti, M.D.Ramiro Ampuero, M.D.Nicholas Andrews, M.D., Ph.D.Juliana Anquandah, M.D.Anubha Arora, M.D.Divya Arunachalam, M.D.Humera Asem, M.D.Lorraine Atilano, M.D.Karen Austin-Smith, M.D.Abryl Mariana Avitia, M.D.Michael Awadalla, M.D.Elolo Felix Awouya, M.D.Mallika Azizia, M.D.Hyo Sook Bae, M.D.Maria Rica Arandia Baltazar, M.D.Rosa Umer Barrenachea Salas, M.D.

Maya Barsk, M.D.Pablo Santiago Bassante Cruz, M.D.Tiffany Bates, M.D.Mohamed Battah, M.D.Sara Baumgartner, M.D.Gabilio Bayona Guardia, M.D.David Andrew Becker, M.D.J. Jenna Beckham, M.D.Drew Daniel Benac, M.D.Dante Juan Benavides Morales, M.D.Judith Berger, M.D.Daxina Bhatt, M.D.Steven Bisch, M.D.Aleksander Bodnar, M.D.Joseph Bouganim, M.D.Bennett Boyd, M.D.Bethany Brady, D.O.Jennifer Brantley, M.D.C. Emi Bretschneider, M.D.Christopher Brewer, M.D.Anthony Brignoni, M.D.Johanna Cubelli Bringley, D.O.Paula A. Bruckler, D.O.Alison Bryant-Smith, M.D.Joanna Beata Bubak-Dawidziuk, M.D.Aaron Kristofer Budden, BMed, MMedRiza Bueser, M.D.

Kerry Bullerdick, M.D.Gustavo Caicedo Duran, M.D.Leonardo Martins Campbell, M.D.Eva Cantor, M.D.Matthew Cantor, M.D.Mario Cardinale, M.D.Katherine Carranza Vega, M.D.Bruno Casanova, M.D., MSCEDeborah M. Cassis, M.D.Olivia Castillo De La Fuente, M.D.Javier Castro Solis, M.D.Christine Simone Cave, M.D.Arif Serhan Cevrioglu, M.D.Rima Chakrabarti, M.D.Wilson Ventura Chan, M.D.Donald Irwin Chandranath, MBBSIan Chang, M.D.Luke Chatburn, M.D.Sudeshna Chatterjee-Paer, M.D.Estrella Nathalie Chavez Benzaquen, M.D.Nelly Y. Chavista Gutierrez, M.D.Masroor Cheema, M.D.Amanda Christian, M.D.Martha Carolina Cifuentes Pardo, M.D.Christopher Clark, M.D.David Clay, M.D.Gemma Clemente, M.D.

Elissa Cohen, M.D.Rebecca Collins, M.D.Dean Conrad, M.D.Jennifer Ann Conwell, M.D., FACOGJohanna L. Cook, M.D.Adam Corcovilos, M.D.Jeremiah Cox, M.D.Callie Cox Bauer , D.O.Meagan S. Cramer, M.D.Tamika K. Cross, M.D.William Fernando Cueva Estela, M.D.Kristin Cutler, M.D.Amina Dafalla, M.D.Yair Daykan, M.D.Stephanie Rae DeJong, M.D.Hemikaa Devakumar, M.D., FACOGGurdial Dhillon, M.D.Amanda Dickerson, M.D.Kristin DiGregorio, M.D.Yan Ding, M.D.Kinsey I. Dinnel, M.D.Giovanni D’Ippolito, M.D.Samfee Doe, M.D.Sarah Marie Dolan, M.D.Michael P. Dougherty, M.D.Robert Drenchko, D.O.Pascale Tufau Duroseau, M.D.

Dr. Ronald Elmer Batt died Apri l 25, 2017 after a short illness. He is survived by his wife, 12 children and step-children; 31 grandchildren and step-grandchildren; 6 step-great-grandchildren; and 3 sisters.

Ron was raised near Buffalo, New York and attended the University of Buffalo School of Medicine. After graduation, he served as Research Fellow in reproductive endocrinology at Harvard Medical School, Assistant-in-Surgery at Peter Bent Brigham Hospital, and as a Clinical Fellow at the Mayo Clinic in Rochester, Minnesota. He was a lieutenant in the US Navy Medical Corp 1960-1962. He returned to Buffalo in private practice in 1970 and was affiliated with the University of Buffalo School of Medicine since 1972. Ron joined the University of Buffalo School of Medicine’s full-time faculty in 1995. He was honored by UB with the Medical Alumni Lifetime Achievement Award in 1998.

In Memoriam: Ronald Elmer Batt, M.D., Ph.D.1933 - 2017

a scientist, and an historian. He was an excellent clinician with boundless energy and perennial cheerfulness. He will be missed by his friends, his students and those who benefit from his contributions to medical knowledge.

He began publications on endometriosis in 1977 with ‘‘Conservative Surgery for Endometriosis in the Infertile Couple.’’ Dr. Jordan Phillips invited him to an AAGL conference in Beijing, China, where he presented a keynote lecture on June 19, 1985.

Following his trip with Dr. Phillips, Ron continued to be a loyal supporter of the AAGL and served as a book reviewer, editorial board member, member of the advi-sory board, and ad-hoc reviewer. He enjoyed intellectual contacts, personal friendships, and the propagation of information in his many years of attending the AAGL meetings. Ron was also honored with the 2015 Harry Reich Award by the Endometriosis Foundation of America.

Ron is missed by those who had the privilege and pleasure of knowing him. Ron was a kind and thoughtful member of our community, a friend, a mentor, a scholar,



Dana Elborno, M.D.Hiba Elhassan, M.D.Sara Elhusein, D.O.Holly Eliason, D.O.Hala Elyas Elkatin, M.D.Angel J. Enciso, M.D.Anne Erickson, M.D.Samantha Lauren Estevez, M.D.Karen Estrada-Stephen, M.D.Christy Evans, M.D.Juman Farjo, MBBS, FRANZCOGMustabshera Fayyaz, M.D.Marina Fernando, M.D.Deneishia Shramaine Fisher, M.D.Thomas B. FitzGerald, D.O.Jaclyn G. Flickinger, D.O.Patricia Frey, M.D.Sarah L. Froman, M.D.Ethan Gable, M.D.Renu Singh Gahlaut, M.D.Laura R.W. Gainey, M.D.Sheena Galhotra, M.D.Anjalika Gandhi, M.D.Paige Ganske, D.O.Thomas Frederic Ganz, M.D.Rolando Octavio Garay Villavicencio, M.D.Aster Gebrekidan, M.D.Elizabeth Gelner, M.D.Dimitra Georgiou, M.D.Jose Alejandro Gonzales, M.D.Oscar Gonzalez Armella, M.D.Keith Gordon, M.D.Margaret C. Gorman, M.D.Kyle Graham, M.D.Panagiotis Grapsas, M.D.Elizabeth Greenstein Clement, M.D.Kara Griffiths, M.D.Jason R. Gronert, M.D.Rachel Guild, M.D.Nipun Gupta, M.D.Jon Torfi Gylfason, M.D.Emma Hackett, M.D.Dorota Hardy, M.D.Malcolm W.G. Hardy, M.D.Shanan Harkness, D.O.Joseph Robert Harmon, M.D.Michael L. Haugsdal, M.D.Karen P. Haverly, M.D.Marcus Hemesath, D.O.Ronald Hernandez Alarcon, M.D.Caela Hesano, M.D.Nicholas Hijaz, M.D.Martin Hirsch, M.D.Stephen Holzapfel, M.D.Nina Hooshvar, M.D.Lacey Renea Howard, D.O.

Anne Hutchinson, M.D.Loliya Idoniboye, M.D.Cringu Antoniu Ionescu, M.D.Patricia Irvine, M.D.Katheryn Dixon Isham, M.D.Manisha Jain, M.D.Tae-Kyu Jang, M.D.John Jarrell, M.D.Lingyu Jiang, M.D.Solimar Jimenez-Diaz, M.D.Cherynne Johansson, MBBS, FRACGPTiffanny L. Jones, M.D.Naana Afua Jumah, M.D.Trisha Sarit Kadakia, M.D.Sandesh Dnyanoba Kade, M.D.Murat Kale, M.D.Wioletta Kapadia, M.D.Meredith Kapner, M.D.Dorigen Kasparek, M.D.Lirona Katzir, M.D.Manpreet Kaur, M.D.Maeghan Keddy, M.D.Barbara Alexa Kerkhoff, M.D.E. Denali Kerr, M.D.Patimat Khirieva, M.D.Annie Juhae Kim, M.D.Jiyoung Kim, M.D.Tana Kim, M.D.Amanda Nicole King, M.D.Nikolaos Kiouranakis, M.D.Juliana Kitahara Mizumoto, M.D.Annie Kathleen Knight, M.D.Nadya Kondrashov, M.D.Ryan Kooperman, D.O.Nicole Kretzer, M.D.Sarah Marie Kruger, M.D.Jessica Kuperstock, M.D.Hasan Volkan Kurtaran, M.D.Grazelda Kwakye-Ackah, M.D.Satoru Kyo, M.D.Christofer Jaya Hardayus Ladja, M.D.Tara Lal, M.D.Stephanie Langsam, M.D.Jannet Lara, M.D.Sarah Larkin Evans, M.D.Alexandros Lazaridis, M.D.Amy Le, M.D.Hazel Isabella Learner, M.D.Soyoun Lee, M.D.Yoon Hee Lee , M.D.Nikki Lee, M.D.Cilmario Leite Da Silva Filho, M.D.Stacy Marie Lenger, M.D.Mike Leovic, M.D.Michael Leung, M.D.Sara Lillo, M.D.

Dustin Lima, D.O.Yusan Lin, M.D.Caitlin Linscheid, M.D., Ph.D.Cocoa Liu, M.D.Mary Christine Livergood, M.D.Lydia Lo, M.D.Claudia Cristina Lopez Ruiz, M.D.Jacqueline Lou, M.D.Maria Alexandra Madariaga La Roche, M.D.Manohar Mahadeva, M.D.Argyrios Makris, M.D.Louisa Manning, M.D.Sumina Mannur, M.D.Cynthia Melissa Marrou Porras, M.D.Alexandra Martin, M.D.Andrea Massad Ribeiro, M.D.Horace G. Matthews, III, M.D.Jordan Mattson, M.D.Dennis Mauricio, M.D.Lindsey Marie McAlpin, M.D.Sarah McBride, M.D.Katherine McDowell, M.D.Ainsley McFadgen, M.D.Melissa McGann, D.O.Megan McMahon, M.D.Kendra McQuerry Conklin, M.D.Colleen McSherry, M.D.Grant McWilliams, D.O., FACOGKaren Meadley, M.D.Nadia Noor Megahed, M.D.Alexandra Melnyk, M.D., M.Ed.Lindsey Michel, M.D.April Rose Mikes, D.O.Daniel Miller, M.D.Emily Mills, M.D.Rachel Mirsky, M.D.Meenal Misal, M.D.Shachi Mishra, M.D.Monica June Mitchum, M.D.Cristina Mitric, M.D.Maryam Modarres, M.D.Sujana Molakatalla, MBBSLeyla Mollamehmetoglu, M.D.Monique Monard, M.D.Peter R. Movilla, M.D.Elizabeth Moynier, M.D.Tariro Mupombwa, M.D.Marie-Eve Murray, M.D.Htwe Htwe Myint, M.D.Idunn Myklebust, M.D.Triveni Nanda, M.D.Kavita Narang, M.D.Aliya Nausheen, M.D.Blanca Helena Navarrete Hernandez, M.D.Guillermo Alfonso Navarro Naranjo, M.D.David Christopher Nelson, M.D.

Theodoor Elbert Nieboer, M.D.Heidi Nilsson, M.D.Mariana B. Noguiera, M.D.Adam Brandon OBrien, M.D.John Richard Ogorek, M.D.Ashley Erin O’Keefe, M.D.Carlos J. Olivares, M.D.Dulce Salazar Ortiz, M.D.Nohora Isabel Oyarce Reyes, M.D.Rie Ozaki, M.D.Ioannis Pagkalos, M.D.Oscar Eduardo Palacios Agurto, M.D.Maria Alejandra Palomino Zuluaga, M.D.Konstantinos Papadakis, M.D.Hoon Park, M.D.Robert Parker, M.D.Irene Peregrin-Alvarez, M.D.Logan Peterson, M.D.Tom Pettinger, M.D.Jaclyn M. Phillips, M.D.Alyson Buick Pico, M.D.Sabrina Piedimonte, MDCM, MSc.Yeisman Pineda Lechuga, M.D.Sholah Pittman, M.D.Sara Pizzacalla, M.D.Jana Platz, M.D.Eladio Edisson Ponce Pajuelo, M.D.Keren Porat, M.D.Melissa Alia Preyss, M.D.Lizzie Prowess, M.D.Javier Renato Puma Medina, M.D.Amira Quevedo, M.D.Mick Isaias Quispe Cuestas, M.D.Carmen Luz Quispe Hidalgo, M.D.Johanna Quist-Nelson, M.D.Marika Raff, M.D.Cassandra Ellen Ragsdale, M.D.Priti Rajpurohit, M.D.David Patrick Rakoff, M.D.Ankita Raman, M.D.Ferdinand Rambu, M.D.Diego Ramirez, M.D.Neha Rana, M.D.Ritu Rana, M.D.Sanjay Rao, M.D.Alex Raw, M.D.Juan Carlos Rengifo Mendoza, M.D.Malte Renz, M.D.Gianina Alejandra Retana Espinoza, M.D.Veronica N. Reyes Santillan, M.D.Jessica Rhodes, M.D.Guillermo Alberto Rios Montemiranda, M.D.Eder Gabriel Rivera, M.D.Maureen Roberts, M.D.Lindsay Marie Robinson, M.D.Sophia Rodriguez, M.D.

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Vladimir Romanov, M.D.Marcie Rome, M.D.Sara Roper, M.D.Jessica Steele Rose, M.D.Malanie Rousseau, M.D.Melissa A. Rowe, M.D.Nicole Rubin, M.D.Maria Paula Ruiz, D.O.Kamran Safdar Rao, M.D.Sumi Saha, M.D.Tarek Saleh, M.D.Luis Alfredo Sanchez, M.D.Roberto Mario Ernesto Sandoval Jimenez, M.D.Josephine Sandwell, M.D.Ajesh Sankar, M.D.Eshanjit Singh Sapra, M.D.Aparna Sarangapani, M.D.Brandon Sass, M.D.Jessica Sassani, M.D.Jenna Sassie, M.D.Virginia Avelar Savala, D.O.Leah Savitsky, M.D.Santiago Scasso, M.D.Arielle Schaeffer, M.D.Roberta Schiemer, M.D.Mark Schnee, D.O.Alexandriia See, M.D.Niki Sekandari, M.D.

Niladri Sengupta, M.D.Partha Sengupta, M.D.Anastasia Shabalova, M.D.Susan Shafik, M.D.Renae Kae Shibata, M.D.Abiola Shitta-Bey, M.D., MPH, FACOGMichael Kee-Ming Shu, M.D.Anshumala Shukla Kulkarni, M.D.Ghadear Shukr, M.D.Sukhdeep Singh, M.D.Vanitha Sivalingam, M.D.Robin Skory, M.D., Ph.D.Alyssa Small Layne, M.D.Evan Scott Smith, M.D.Lauren E. Sobel, D.O.Ana Maria Sotelo Alvarado, M.D.Kezia Spencer, M.D.Abhishek Sripad, M.D.Laura Stacey, M.D.Andrew Stewart, M.D.Peter Lloyd Sticco, M.D.Megan Stoller, M.D.Claudine Storness-Bliss, M.D.Angela Strang, M.D.Courtney Strickland, M.D.Alison Maria Sullivan, D.O.Ann M. Sullivan, M.D.Meenakshi Sundaram, M.D.

Angelica Sze, M.D.Mahino Talib, M.D.Shawn Tassone, M.D.Leah Tatum, M.D.Danielle Lynn Taylor, D.O.Sherryann C. Taylor-Santos, M.D.Lorie Ann Thomas, D.O.Makoto Tokiwa, M.D.Nikolaos Tsampras, M.D.Gokce Turan, M.D.Ruchi Upadhyay, M.D.Radhakrishn Upputuri, M.D.Richard Edgar Urviola Laura, M.D.Roberto Valdes, III, M.D.Jeanine Valdez, M.D.Claudio Vallejo Flores, M.D.Diego Vasquez De Bracamonte, M.D.Gabriela Vazquez, RNEnrique Vazquez Vera, M.D.Ferenc Vecsei, M.D.Kenny Paola Vereau Morales, M.D.Jessica Vernon, M.D.Mathieu Viau, M.D.Monica Vielman, M.D.Sergio Vignali, M.D., FACOGAndrej M. Vogler, M.D., Ph.D.Johanna Voutyras, M.D.Nicolas Vulliemoz, M.D.

Jamila Wade, M.D.Elena Michelle Wagner, M.D.Brian Wakefield, M.D.Alexander Wang, M.D.Sally Watkinson, M.D.Lindsey M. Webb, M.D.Allison Lane Welch, D.O.Lindsay Wheeler, M.D.Michael Paul White, M.D.Jennifer Whitelock, M.D.Mark Wilcox, M.D.William D. Winkelman, M.D.Craig J. Wolf, M.D.Nicolette Wolters, M.D., MPHSarah Woodman, M.D.Tiffany Denise Woods, M.D.Lia N. Wrenn, M.D.Danielle Wright, M.D.Micah Ray Wright, D.O.Julian Yanez Hartman, M.D.Omar Fernando Yanque Robles, M.D.Qin Yao, M.D.Cassandra Yoder, M.D.Fiona Young, M.D.Omari J. Young, M.D.Roshini Zachariah, M.D.Austin Zanelotti, M.D.


SCIENTIFIC PROGRAM CHAIR Michael Hibner, M.D., Ph.D.CO-CHAIR Nita A. Desai, M.D., MBA

LAB CHAIR Mark W. Dassel, M.D.

DECEMBER 8-9, 2017St. Joseph’s Hospital and Medical Center Phoenix, Arizona

2ⁿd Annual Workshop on Surgical Anatomy of the Pelvis and Procedures in Patients with Chronic Pelvic Pain

DILATE LESS. RESECTMORE.

Introducing the TruClear™ ULTRA Mini device

© 2017 Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company. 06/2017 – US170042 – [WF# 1862112]

1. Shveiky D, Rojansky N, Revel A, Benshushan A, Laufer N, Shushan A. Complications of hysteroscopic surgery: Beyond the learning curve. J Minim Invasive Gynecol. 2007;14(2):218-222.2. Based on internal report #15003596, Preclinical test using analog tissue. 2016.

The TruClear™ system is manufactured by Smith & Nephew and distributed exclusively by Medtronic. For more information, visit sntruclear.com.

555 Long Wharf DriveNew Haven, CT 06511

800.722.8772508.261.8000

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Cervical dilation is the primary risk associated with hysteroscopy.1 Why chance it? The new TruClear™ ULTRA Mini device offers impressive fibroid resection (avg. 4.4 g/min)2 with little-to-no dilation. Plus, you get:

■ The 5 mm solution to fibroid resection

■ The one-scope solution for see-and-treat procedures

■ The simple solution for in-office myomectomies

vol. 31 № 2 april—june 2017 46 aagl global congress on migs€¦ · 46th aagl global congress...

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