Day 2: Postgraduate Course - Sunday November 10, 2019

PUSH-710: Pushing the Surgical Envelope: The Methods to Our Madness


Sunday, November 10, 2019


12:30 pm – 4:30 pm


Room 110






Ted T.M. Lee, Arnaud Wattiez


Amy N. Broach, Hiroyuki Kanao, Marco Puga

Course Description

As gynecologic surgeons mature in experience and skill, few will leave their comfort zone and push the surgical envelope to tackle challenges that they most fear and avoid. Those who do push the surgical envelope with sheer bravado alone risk failure and infamy. Surgeons who do succeed are those who adopt a methodical and systematic approach. Anatomy and exposure are frequently cited as the foundation of pelvic surgery. Faithful practice of the principles of surgical dissection is paramount for the surgeon to venture to the next level. True mastery occurs in those who develop the ability to quickly formulate various strategic plans when confronted with anticipated as well as unexpected surgical difficulties.

There is certainly no shortage of challenging pathology to push our surgical envelope in laparoscopic surgery. The obliterated anterior cul-de-sac from previous cesarean deliveries and a frozen pelvis as a result of advanced endometriosis can both present very perplexing clinical quandaries. Broad ligament or cervical fibroids and ovarian remnants can present different sets of challenges. The skills to repair visceral injuries, control hemorrhage, and maintain hemostasis laparoscopically will help surgeons to minimize morbidities and decrease conversions to laparotomy.

This course will explore these skills through the use of surgical video footage to illustrate the strategies and techniques necessary to overcome the difficulties associated with various anatomy-distorting pathologies. Participants in this course will develop a greater understanding of safe and effective approaches to the challenging surgical scenarios through lectures that are both evidence- and experience-based.

Course Objectives

At the conclusion of this activity, the participant will be able to: 1) Articulate techniques to achieve peritoneal access in patients with extensive anterior abdominal wall adhesions, as well as techniques necessary to overcome difficulties associated with laparoscopy in obese patients; 2) formulate anatomy-based strategies when confronting various challenging surgical scenarios such as frozen pelvis, cervical fibroids, and dense uterine adhesions; 3) apply the principles behind the techniques in the identification and dissection of the ureter and difficult ureterolysis; 4) integrate various techniques to optimize exposure during complex pelvic surgeries; 5) articulate the principles of advanced dissection of a pelvic side wall in diseased state; and 6) apply a holistic approach to self-improvement as a surgeon.

Course Outline

12:30Welcome, Introductions, and Course OverviewT.T.M. Lee
12:35Troubleshooting Approaches for Challenging Peritoneal Access and Optimizing Exposure in Gynecologic LaparoscopyA.N. Broach
1:00Ureteral Dissection, Ureterolysis, and Ureteral Reconstruction in EndometriosisM. Puga
1:25The Essence of Laparoscopic DissectionT.T.M. Lee
1:50Methodical Approach to the Obliterated Anterior Cul-de-Sac—Aftermath of Prior Cesarean SectionA.N. Broach
2:15Questions & Answers and BreakAll Faculty
2:25Unraveling the Frozen Pelvis: Fertility-Sparing Option and HysterectomyA. Wattiez
2:50Techniques and Strategies of Extreme Pelvic Sidewall Dissection in Malignancy—Applications in Complex Benign Pelvic SurgeryH. Kanao
3:15Laparoscopic Approach to Rectus Muscle Endometriosis and Inguinal EndometriosisT.T.M. Lee
3:40Pushing the Surgical Envelope—a Personal JourneyA. Wattiez
4:15Questions & AnswersAll Faculty