GATHERING OF GYNECOLOGISTS IN BEIRUT

Asst. Nebojša Zečević, MD, PhD at the Gynecologists" Meeting in Lebanon

The capital of Lebanon, Beirut, hosted world-renowned and recognized experts in the field of gynecological laparoscopy. Through the accompanying workshops or hands-on programmes, the participants had the opopeningunity to try the latest techniques on endoscopic simulators.

The first day of the meeting was dedicated to hysteroscopy, laparoscopic suturing and minimally invasive total laparoscopic hysterectomy.

“After the lectures, in the same room we were able to have on-site simulation of all the options of histeroscopy, as well as new techniques of laparoscopic suturing, including extra and intracorporeal knots, various techniques of laparoscopic knot - tying with the latest suture material and threads.“

The last session of the first day of the meeting was dedicated to Total Laparoscopic Histerectomy (TLH).

This is a minimally invasive surgical procedure when 3 small openings (openings) are made to perform surgery of uterine and ovary removal due to various pathological conditions (malignant or benign). This procedure has been significantly improved in the last decades as well as the equipment. Thus, today it is being routinely implemented.

The duration of the operation is about 40-50 minutes depending on the case, and the recovery is extremely short, as the patients recovered leave the hospital the next day, only 24 hours after surgery.

New techniques are also interesting. HALS (Hand Assisted Laparoscopic Surgey) where a new opening for the arm (or part of the hand, fingers) is added to the standard laparoscopic openings, assisting in laparoscopic surgery. This laparoscopy option is particularly applicable for large uterine and ovarian tumors.

A very noteworthy lecture on the first day of the meeting was the extraction of large samples from the abdomen, through a small aperture (laparoscopic opening). The company Applied Medical constructed a special bag and ring and Dr Grover May from the United States of America showed how, in a very simple and practical way, a large tissue sample (usually a solid tumor) can be extracted (removed) from the abdomen through a small cut, only 2 cm.

With this new special cutting technique, a large sample of tissue is removed, and there is no waste of tissue for the extraction in the abdomen.

In this way, a solid and cumbersome part of the tissue can be transformed into an elongated, striped tissue of diameter of only 2 cm and a length of up to about 1 meter ...

Аfter the lecture, we practiced this new extraction technique оn beef tongues weighing about 1,500gr, about 20 x 15 cm in size, which we turned into a long striped tissue ...

This simple manual technique completely changes the power morselator, which has so far been the standard for tissue removal through small laparoscopic openings.

A special session was dedicated to reducing the number of openings through which laparoscopic operations are performed. Once again, the single opening approach has been used.

The second day of the meeting was dedicated to endometriosis sessions, the pelvic organ prolapse and laparoscopic solutions for myiomas.

In the myoma session, there was a lot of talk about the increasing role of laparoscopy in the solution of the uterine myomas, where it is concluded that virtually all types of myomas, other than giant, can be resolved endoscopically, laparoscopically and hysteroscopically, and that the outcomes of this type of treatment are the same or better in relation to open operations. This also applies to the outcomes of these operations and later to pregnancy.

The complications of these operations were descussed in particular, as well as modern methods for suppression of small adhesions using special gels after surgery. The use of these special gels proved particularly useful during and after myoma and endometriosis surgery, which reduces the number of adhesions.

On the third day of the meeting, he dealt with topics from urology, oncology and neuropelveology.

Especially new and interesting was the latest topic, neuropelveology, where a lot of attention is paid to preservation (nerve guarding) during laparoscopic surgeries and their functions, as well as solving painful conditions in gynecology by better understanding of inertia in pathological conditions, especially in chronic pelvic pain syndrome, which is highly represented in the population of women.