Posts Tagged ‘Gynecology’

Laparoscopy for Gynecologists: LIGO course review

Posted: September 18, 2012 in Gynecology, Health, Uncategorized
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I just returned from the LIGO (Laparoscopic Institute of Gnecologic Oncology) Matsers’ Course in Total Laparoscopic Hysterectomy & Advanced Laparoscopic Procedures in Atlanta, Georgia, USA.

In a nutshell, this conference is a must-attend for any gynecologist who would like to develop or advance their surgical skills in laparoscopic hysterectomies.

I highly recommend it.

I attended LIGO conference in San Francisco last year. This year I got invited to join LIGO team as faculty to help teach laparoscopic suturing on pelvic trainers.

I was happy to accept the offer as I knew the value of such an educational course and its impact on womyn’s health by training more gynecologists to become comfortable and competent in minimally invasive surgery.

I wanted to support it.

The conference spans two days (Friday & Saturday) and offers laparoscopic surgical training that is condensed, comprehensive, high-yield and hands-on using state-of-the-art techniques and equipment. I find this very convenient as one would only need to take Friday off to attend. The condensed material is made easier to absorb by a constantly changing educational format. LIGO has a good balance between lectures, video demonstrations, “lunch with an expert” and hands-on training.

The Holiotomy™ Challenge:

The “Holiotomy™” is a two inch segment of Penrose drain with six dots on each side of the tubing with a one inch hole in the middle. Surgeons are challenged to place three figure of “N”s through each of the dots and to tie each of these with four square knots to close the hole. We call this a “holiotomy™”, in jest, but the process of suturing the “holiotomy™” enhances eye-hand coordination and haptic perception and simulates the essential procedures every laparoscopic surgeon needs: closure of cystotomy or enterotomy or closure of the vagina after total laparoscopic hysterectomy.

Surgeons are asked to perform three “holiotomies™” (6 figure of “N”‘s with 24 knots on two “holiotomies&™” and one “run the cuff” advanced on the third “holiotomy™”) as evidence of their developing laparoscopic skills. This challenge is made easy by the three lectures on suture techniques, the two precepted suture sessions and the 40 pelvic trainers available to you during unrestricted breaks.

Continuing Medical Education Credit (CME) is provided through joint sponsorship with The American College of Obstetricians and Gynecologists (ACOG). ACOG designates

LIGO for a maximum of 17 AMA PRA Category 1 Credits. LIGO offers concentrated learning experience with a high faculty to attendee ratio, individually precepted simulator training and optional cadaver lab (spring course only). It is rated 4.92 (of 5.0) by over 1,250 surgeons trained since it started in 2006 according to their official website.

I have never been in a conference that feeds you that well. Food is served almost constantly throughout the day and is generally healthy (with some unhealthy but refreshing snacks from ice cream, popcorn to freshly made pretzels and the now famous LIGOtini).

A special martini that carried the name and colors of the course. It has Vodka, Orange juice, and Sambuca.

This year, the conference attracted 118 attendees from 7 countries (Canada, Colombia, Bermuda, Turkey, Kuwait, UAE & USA) and 33 American states. In addition to surgeons there were surgical assistants and residents.

Having this number of attendees allows for ample one-on-one time with a faculty member at a pelvic trainer. This hands-on experience makes this course stands out among other similar courses offered across North America.

Follow LIGO on Twitter @LapInstGynOnc
Like LIGO’s Facebook page
The course is given twice a year. To register, go to http://ligocourses.com

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The course offers a discount if you get referred to it. So consider I referred you, use referral code: SF2013 when you register and get 100 USD off.

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Disclaimer: I do not receive any financial support from the conference, its faculty or display companies in it. I have no conflict of interest or other financial disclosures to be reported. I have volunteered my time with LIGO as a faculty

Chemotherapy safe in pregnancy! العلاج الكيميائي أثناء الحمل لا يؤثر على الجنين

Posted: February 20, 2012 in Health, عربي
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This post is about a recent study released online on Feb. 10th 2012 in The Lancet Oncology as an early publication.  In brief the study assessed “children who were prenatally exposed to maternal cancer staging and treatment, including chemotherapy.” They examined 68 pregnancies who were exposed to 236 cycles of different kinds of chemotherapies. 70 children were assessed at age 18 months, 5—6, 8—9, 11—12, 14—15, and 18 years. Assessment included examining neurological and cognitive functioning or IQ, heart functioning, general health and development, hearing, memory, attention and behaviour.

The study concluded that “fetal exposure to chemotherapy was not associated with increased CNS, cardiac or auditory morbidity, or with impairments to general health and growth compared with the general population.”

The importance of this study lies in providing a perspective on long-term outcomes of newborns after exposure to chemotherapy during pregnancy. With such reassuring findings, we should consider avoiding early deliveries that subjects those newborns to risks of prematurity.

It is important to realize that not all chemotherapies are safe and the ones included in this study are those that are know to be tolerated during pregnancy.

Below is an Arabic version:

أثبتت دراسة أوروبية حديثة أن إخضاع السيدة الحامل للعلاج الكيميائي لا يؤثر على صحة الجنين، خاصة إذا حدث ذلك في الفترة الممتدة ما بين الشهر الرابع والسادس من الحمل.حيث قام أخصائيون أوروبيون تابعون لـLeuven Catholic University في علاج السرطان بمراجعة حالة 68 سيدة حامل أنجبن 70 طفلا بعد أن خضعن لعلاج الكيميائي ضد السرطان، وفحصوا صحة الأطفال عند مولدهم كما عند بلوغهم 18 شهرا، ثم بعد ذلك عند بلوغهم سن الخامسة وحتى بلوغهم 18 عاما.وقد شمل الفحص الحالة الصحية العامة للأطفال، كما تم تفحص ما إذا كان لديهم قصور في الجهاز العصبي المركزي أو القلب أو السمع وتم اختبار مهاراتهم المعرفية والعقلية كذلك.

وقد تبين للباحثين عدم وجود أي دليل على تضرر صحة الأطفال من جراء العلاج الكيميائي الذي خضعت له والداتهن أثناء الحمل بهم، إلا أن الأطفال الذين ولدوا قبل الميعاد الطبيعي أظهروا مهارات معرفية أقل من الباقين، ولكن هذه مشكلة عادة ما تصيب كل الأطفال الذين يولدون قبل الميعاد، حتى دون تعرضهم لعلاج كيميائي.

وقد أوصت الدراسة بعدم القلق في إخضاع الأم الحامل للعلاج الكيميائي، ونصحت الأطباء بألا يحثوا المرأة الحامل المصابة بالسرطان بالولادة قبل ميعادها لإخضاعها لاحقاً للعلاج.

وأشارت الدراسة إلى أنه “يمكن إخضاع السيدة الحامل للعلاج الكيميائي بدءاً من الأسبوع الرابع عشر من الحمل، ولكن كي يستعيد النخاع العظمي قوته ولتقليل مخاطر تسمم الأم والجنين أو حدوث نزيف يجب أن يتم التخطيط للولادة على الأقل بعد ثلاثة أسابيع من آخر جرعة كيماوية تعطى للحامل، كما يجب أن تتوقف الجرعات عند الأسبوع الـ35 وذلك تلافيا لحدوث ولادة تلقائية في ذلك الوقت”.

ولكن يقر فريق الباحثين بوجود حاجة لعمل المزيد من الدراسات لمعرفة ما إذا كان للعلاج الكيميائي تأثير على هؤلاء الأولاد في الأمد البعيد. المصدر

من المهم أن نتذكر أن هذا الحديث لا ينطبق على كل علاج كيميائي انما على بعض الأدوية التي كنا نعتقد أنها أمنة، فتأتي هذه الدراسة الآن لتؤكد ذلك.

Advance your laparoscopic hysterectomy skills

Posted: February 8, 2012 in Health
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This post was edited on Feb 13th, 2012. See footnote note in red.

Are you looking to advance your surgical skills in Gynecological laparoscopy?

Medicine is evolving at a fast pace. It is important to stay up to date and to offer our patients the most advanced and least invasive options available.

Hysterectomy is the second most common surgery performed on womyn in USA and Canada, Cesarean delivery being the first. There are different routes to performing a hysterectomy: Laparoscopic (LH), Vaginal (VH), and Abdominal (AH) among others.

Here is a comparison from The American College of Obstetricians and Gynecologists (ACOG) Committee Opinion #444, November 2009:

Here is The American Association of Gynecologic Laparoscopists (AAGL) position statement in 2010:

It is the position of the AAGL that most hysterectomies for benign disease should be performed either vaginally or laparoscopically and that continued efforts should be taken to facilitate these approaches. Surgeons without the requisite training and skills required for the safe performance of vaginal or laparoscopic hysterectomies should enlist the aid of colleagues who do or should refer patients requiring hysterectomy to such individuals for their surgical care.

In other words: VH should always be your first choice. When VH is not feasible, the patient should be offered LH. A surgeon should make every effort to avoid AH by either improving her/his laparoscopic skills or referring the patient.

Surgeon’s experience should no longer be a factor that influences route of hysterectomy unless referral of the patient, or access to a training course is not a viable option.

There are plenty of advanced surgical courses that are scheduled annually. in 2010, I attended Harvard’s Minimally Invasive Gynecologic Surgery conference in Boston, Massachusetts, USA. In 2011, I attended the Laparoscopic Institute for Gynecologic Oncology LIGO’s 
Surgical Masters’ Course in Total Laparoscopic Hysterectomy in 
San Francisco, California, USA.

Hasan Abdessamad, MD, FRCSC, FACOG at LIGO Masters’ Course in San Francisco, Sept. 2011

In comparison, the LIGO course provides a larger opportunity for hands-on training with multiple simulated laparoscopy stations and one-on-one guidance from a mentor.

I enjoyed the intense nature of the course. Day 1 starts at 7 AM and adjourns at 9 PM. Day 2 starts at 7 AM and adjourn that 5PM. This provides ample time to explore the beautiful city of San Francisco.

Another success point for the course is that it is “newbie-friendly”. Even though the course teaches advanced skills, the training is usually tailored to your level of expertise. If you have not trained to do Laparoscopic hysterectomies the course will prepare you to start performing them.

It was pleasant to meet Dr. O’Hanlan and her partner Leoni Walker. I learned about Dr. O’Hanlan as an authority on lesbian health issues. I read her studies/articles during my literature review for my lesbian health research. It is impressive that she is an authority in two different medical fields.

Besides all the education, the course was fun. The Heliotomy Challenge was a laparoscopic suturing contest in a very laid back atmosphere. It was the perfect way to conclude the course. With alcohol being served, the contest turned into a nice evening to unwind among pleasant people, and spending the last hours of the course laughing and cheering for contestants.

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You might be interested in reading a similar post: Bigger surgeries. Smaller incisions! Oct. 26th 2010

P.S. This blog post was transcribed by Siri after I broke my arm, and recently edited for posting.

Footnote (Added Feb 13th 2012): This blog post was dictated and transcribed shortly after the LIGO course I attended in Sept. 2011. I recently edited and posted it before I receive an official invitation from the Laparoscopic Institute of Gynecologic Oncology to join them in Atlanta as a LIGO preceptor. After the invitation no content was changed in the above post besides removing the following phrase “Always in San Francisco” as indicated above.

I am now American and Canadian board-certified Gynecologist

Posted: January 17, 2012 in Personal
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I just passed the oral examination for the American Board of Obstetrics and Gynecology (ABOG). I am now an American board-certified Obstetrician and Gynecologist.

What a great way to start the new year, potentially adding a third title to my name:
Hasan Abdessamad, MD, FRCSC, “FACOG”

FRCSC: Fellow of the Royal College of Surgeons of Canada
FACOG: Fellow of the American Congress of Obstetricians and Gynecologists (application pending)

In USA, board certification involves a two-part exam, usually taken over a two-year period. The first part is a written exam, which is taken when the candidate is still considered board “eligible”. The second part is an oral exam, taken the year after the written exam is passed. The oral examination is based largely on a collection of a year’s worth of medical and surgical cases known as the “case list”. The oral exam is offered once a year in Dallas.

In Canada, both the written and oral examinations are done simultaneously over 2 days in Ottawa. The Canadian oral examination is based largely on performance with simulated patients. There is no assessment of previous performance or “case list”. The Canadian written exam has multiple choice questions like the American exam but in addition it has has a section for short answered questions.

In USA, residency training for Obstetrics and Gynecology (ObGyn) requires four years. In Canada, 5 years of training are needed. This limits the chance for any AMerican trained ObGyn to sit for the Canadian exam without having to train for one additional year. I was eligible to sit for the Canadian exam even though I trained in USA because the Canadian board took into account the year of ObGyn internship I did in Lebanon (The American University of Beirut 2003-2004).

FDA warning fuels debate: Mesh use in vaginal prolapse surgery

Posted: August 18, 2011 in Health
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Pelvic organ prolapse is a common problem that I see daily in my office.

I start my management by counselling my patient about all her available options. This usually includes a discussion about conservative management, behaviour modification, pessary trial and surgical options.

For surgery, there has been a debate between “mesh-supporters” and “mesh-avoiders”, as I like to call them. In a nutshell, using mesh increases complications and avoiding mesh increases failure.

In my opinion, the core of the discussion should always remain: what is the right option for the patient that will maximize benefits and minimizes risks? The question is easy to formulate, the answer remains more complicated.

During my training, I only learned the traditional mesh-free surgery. I also learned the arguments for and against mesh surgery.

In June 2011, I was invited to a workshop in Halifax on the application of Elevate® Anterior and Posterior Prolapse Repair Systems by American Medical Systems (AMS). This is one of many available mesh systems.

In July 2011, still before I book my first patient for the procedure, the U.S. Food and Drug Administration (FDA) released a Safety Notification regarding the use of vaginal mesh for the repair of prolapse identifying this as an area of “continuing serious concern.” Since then, the debate has fueled.

This is the second time FDA tackles mesh. In Oct. 2008, the FDA released a Public Health Notification regarding the use of mesh for the treatment of prolapse and incontinence. The report was criticized by mesh-supporters for reasons that I find valid.

The new report focuses only on prolapse treatment and states that:

  1. Mesh use is not proven to provide improved outcomes when compared with native tissue repairs
  2. Serious complications with mesh use are not rare

The American College of Obstetricians ad Gynecologists (The College) responded by advising all its fellows to read the 2011 FDA Safety Notification. The College notes that “given the limited data and frequent changes in the marketed products for vaginal surgery for prolapse repair (particularly with regard to type of mesh material itself, which is associated with several of the postoperative risks, especially mesh erosion), patients should consent to surgery with an understanding of the postoperative risks and complications and lack of long-term outcomes data.”

I like what Dr. Rebecca Rogers said in her Green Journal editorial published ahead-of-print (October 2011):

As surgeons, we want to be neither dinosaurs who are out of date with current therapies, nor cowboys, jumping on the bandwagon of new therapies the minute they become available, particularly when clinical data do not exist to inform our decisions.

At this time, we should offer our patients a detailed discussion of the risks, benefits and alternatives to the best of our knowledge with current available data. The patient will then be able to make a well informed and educated decision.