40th Global Congress: So Many Choices - AAGL » AAGL...Fax 714.503.6201, 714.503.6202 E-mail: [email protected] Website: Th e views and opinions expressed by the authors in this publication

The 6th AAGL International C o n g r e s s , h o s t e d b y JSGOE, is held in conjunc-tion with the 12th APAGE

Annual Congress in Osaka, Japan from December 9th to 11th. The Congress is held under the theme “Mankind and Technology in Perfect Harmony.” This slogan means an attempt to harmonize the medical technological advances and the people who benefit from them. In recent years, technologi-cal innovations and instrumen-tal progress have contributed to remarkable development of endo-scopic gynecological surgery. The endoscopic procedures are now being applied to a larger scope in gynecological surgery, therefore it is important to make sure that these

technological advances are ide-ally applied to the clinical field to achieve a healthcare which is more friendly to the patients as well as to the operators.

The pre-congress sessions and opening ceremony are scheduled on December 9th, and the keynote lecture, symposia, and scientific pre-

sentations on the 10th and 11th. Two lecture halls with seating capacity of 500 will be used: one for lectures of beginner and intermediate levels and the other for lectures of interme-diate and advanced levels. This will allow the participants to easily select their appropriate lectures.

Early December when the con-gress is held corresponds to late autumn or early winter in Osaka. The nearby historical tourist sites of Kyoto and Nara will offer you a nice occasion to stroll around in the his-torical atmosphere under autumn tints. Please do not miss this chance to visit Japan in this season.

We look forward to welcom-ing numerous participants to the congress.

Osamu Tsutsumi, M.D., Ph.D., is Chairman of the Organizing Committee for the 6th AAGL International Congress in conjunction with the 12th APAGE Annual Congress.

APR – JUN 2011APR – JUN 2011VOL. 25 NO. 2VOL. 25 NO. 2

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e40th Global Congress: So Many Choices

T h e 4 0 t h AAGL Global Congress will soon be upon us. All abstracts have been sub-m i t t e d a n d again the quan-

tity and quality continues the pattern of previous years. I can assure every-one who attends this year’s annual clinical meeting that you will not be disappointed in the level of sci-ence and education presented. The breadth of participation from our national and international members is remarkable.

One goal for this year’s meeting was to create novel programs that would be of interest to those just beginning their minimally inva-sive gynecology surgery careers to those who are our recognized

experts as well as everyone in between. For the first time, the AAGL Special Interest Group (SIG) in Urogynecology is orga-nizing a cadaver lab to teach and refresh skills on vaginal hysterectomy. For those who want to pol-ish their oral presentation skills, we have organized a postgraduate (PG) course where one will learn and practice the skills of pub-lic speaking. We will hold courses for skilled and experienced surgeons such as advanced laparoscopic suturing in a pig where one will have hands on experience with bladder, ureter and bowel repairs. For the first time, we have a PG course on extreme laparoscopy:

what are we doing to push lapa-roscopy and hysteroscopy to the next level. And for those who just want to practice mental and physi-cal stress relief, you can attend the

(Continued on page 21)

Join Us in Osaka this December

From the Scientific Program Chair

International Meeting Spotlight

Dr. Isaacson

The Westin Diplomat in Hollywood, Florida

Osaka Castle

Dr. Tsutsumi

2 APR - JUN 2011

NewsScope

NewsScope [Library of Congress Cataloging in Publi-cation Data, Main entry under NewsScope, Vol. 25, No. 2; (ISSN 1094–4672)] is published quarterly by the AAGL for ten dollars, paid from member’s dues. Periodicals Postage Paid at Cypress, California.Copyright 2011 AAGL.

PublisherAAGLAdvancing Minimally Invasive Gynecology Worldwide6757 Katella AvenueCypress, California 90630-5105 USATel 714.503.6200, 800.554.2245Fax 714.503.6201, 714.503.6202E-mail: [email protected]: www.aagl.org

Th e views and opinions expressed by the authors in this publication do not necessarily refl ect those of NewsScope, its editors, and/or the AAGL.

editorial staff

the aagl vis ion

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

NewsScope

Linda Michels

Franklin D. Loffer, M.D.

Lynn Bell

Barbara Hodgson

Dené Glamuzina

Jennifer Sanchez

Linda D. Bradley, M.D.

Keith B. Isaacson, M.D.

Javier F. Magrina, M.D.

C.Y. Liu, M.D.

Mauricio S. Abrao, M.D.

Peter J. Maher, M.D.

Harry Reich, M.D.

Edward J. Stanford, M.D.

Assia Stepanian, M.D.

Craig J. Sobolewski, M.D.

Johan Van Der Wat, M.D.

Robert K. Zurawin, M.D.

Franklin D. Loffer, M.D.

Linda Michels

Managing Editors

Editorial Staff

Art Director

President

Vice-President

Secretary-Treasurer

Immediate Past President

Trustees

Executive Vice President,Medical Director

Executive Director

board of trustees

The AAGL is made up of over 5000 members and one of our primary goals is to allow each of our members to be easily located by both patients and colleagues alike. How do we make sure that our new members have the

same voice as someone who has been with us for 20 or 30 or now almost 40 years?

Our AAGL web site team recently launched the AAGL Member Profile, a great addition to our long-standing Physician Finder feature at www.AAGL.org. The Member Profile allows AAGL members to provide their digital picture, select their practice focus and areas of expertise, along with places to enter information about their prac-tice history, education, and awards.

All of this information is then added to our membership database, allowing patients and

colleagues to find your profile and learn more about you. With our Physician Finder we are able to promote you to those patients who come to our site to locate a doctor in their area. Studies have shown that people tend to gravitate towards images over text and will focus their attention on images first. Last but not least, your Member Profile page is also added to search engines on the World Wide Web to make sure that your association with the AAGL can be easily found by those who search for you.

In an effort to encourage all of our members to update their Member Profile, we will be randomly selecting one member to receive a free year of membership to the AAGL who has included a picture, up-to-date contact informa-tion, and practice focus.

To qualify, simply update your Member Profileby July 30, 2011, making sure to include the

The AAGL Board and office have been very busy with a myriad of activities. We often say, “we have many miles to go before we sleep”. I am happy to report that the AAGL tirelessly continues to work on many areas of

importance to its members and the women that we serve globally and locally.

Since my last article, we have developed a MIGS Research Consortium Group charged with maturing the process of selecting appropriate studies for implementation. Committee members include Jon I. Einarsson – Chair, along with Patrick Yeung, Krisztina I. Bajzak, Sarah Cohen, Robert K. Zurawin, and Malcolm G. Munro. The committee met in May and created subcommittees to explore funding, data management, and site selection. We look forward to reporting the various research opportunities that extend from this group.

Increasingly, guidelines and algorithms are an important part of our practice. Utilizing evi-dence-based guidelines, the Practice Committee has actively worked on the following guidelines: submucosal leiomyomas; endometrial and endo-cervical polyps; and intraoperative cystoscopy and laparoscopic hysterectomy. Performing hys-teroscopy safely will be improved by the guide-lines on distending media management, that will facilitate our office and operative hysteroscopic experience. Finally, the much anticipated lapa-roscopic supracervical hysterectomy guideline is also underway. All of these guidelines will be published in The Journal of Minimally Invasive Gynecology and made available to members through our website. I applaud the efforts by our physician champions who are truly our servant leaders. These guidelines will improve the safety and outcomes of our patients who undergo these procedures.

The Spotlight Is on You: AAGL Member Profi les

“And miles to go before I sleep...”Robert Frost (1874–1963)

Focus on AAGL

Dr. Loffer

(Continued on page 15)

(Continued on page 17)

From the President

Dr. Bradley

We are committed to you...and advancing the quality of your patient care.

Caution: Federal Law (USA) restricts this device to sale by or on the order of a physician. The physician using the device must be trained in diagnostic hysteroscopy. Persons depicted are models and used for illustrative purposes only. ©2011 Boston Scientific Corporation or its affiliates. All rights reserved. 6/11

Please visit supporting-women.comgenesyshta.compelvic-floor-institute.com

4 APR - JUN 2011

NewsScope

The AAGL Nominating Committee will soon select eight members of the AAGL as candidates for four trustee positions for the years 2012 and 2013.

Four of the candidates will be from the general mem-bership and four must come from specific regions. This year, two candidates will be from Pacific Rim/India/Asia and two from Mexico/Central America/South America. (Next year, the regional candidates will be

from Europe/Middle East/Africa and from Canada/United States). In addition, two other

members will be selected from the general member-ship to run as candidates for the position of secretary-treasurer. This position leads to vice presidency and then the presidency of the AAGL.

If you wish to be consid-ered as a candidate for one of these positions, you should ask five AAGL members to submit your name along with a short letter or email of support. These should be sent to [email protected]. You are also encouraged to directly contact any member of the Nominating Committee to make your thoughts known. Their email addresses can be found on the AAGL membership list (go to www.aagl.org, log in as a member and enter the person’s name in the search box).

The Nominating Committee will meet in early July 2011. It is time for you to voice your opinion about your future elected officers.

Committee Members are: C.Y. Liu – Immediate Past President – ChairCharles E. Miller – Past PresidentResad P. Pasic – Past PresidentKeith B. Isaacson – Vice President Franklin D. Loffer – Executive Vice President/Medical DirectorLinda Michels – Executive Director

C.Y. Liu, M.D. is the Immediate Past President of the AAGL and also serves on the Faculty for the Fellowship in Minimally Invasive Gynecologic Surgery located at the Women’s Surgery Center in Chattanooga, Tennessee.

Dr. Liu

7 REASONS TO PUBLISH IN THE JOURNAL OF MINIMALLY INVASIVE

GYNECOLOGY

1 It’s the official Journal of the AAGL Advancing Minimally Invasive Gynecology Worldwide

2 It’s a leading peer-reviewed Journal3 Commitment to swift first-round decision and

publication within 5 months of acceptance

4 Video clips to supplement articles5 All articles are published online ahead of print

(Articles in Press)

6 JMIG’s Impact Factor healthy and growing with a 15% increase in 2009

7 It’s an authoritative source for the latest, cutting-edge developments in this important field

Editor-in-Chief: Stephen L. Corson, MD

www.jmig.org

AAGL Board Nominations Are Open

Region 1

Region 2

From the Nominating Committee

1Payne, T. N. and F. R. Dauterive (2008). “A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice.” J Minim Invasive Gynecol 15(3): 286-291. 2Piquion-Joseph, J. M., A. Nayar, et al. (2009). “Robot-assisted gynecological surgery in a community setting.” Journal of Robotic Surgery: 1-4. 3Payne, T. N., F. R. Dauterive, et al. (2010). “Robotically assisted hysterectomy in patients with large uteri: outcomes in five community practices.” Obstet Gynecol 115(3): 535-542. 4Rebeles, S. A., H. G. Muntz, et al. (2009). “Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women.” Journal of Robotic Surgery 3(3): 141-147. 5Visco, A. G. and A. P. Advincula(2008). “Robotic Gynecologic Surgery.” Obstet Gynecol 112(6): 1369-1384.

The presentations described are for general information only and are not intended to substitute for formal medical training or certification. Independent surgeons, who are not Intuitive Surgical employees, provide procedure descriptions. Intuitive Surgical trains only on the use of its products and is not responsible for surgical credentialing or for training in surgical procedure or technique. As a result, Intuitive is not responsible for procedural content. While clinical studies support the use of the da Vinci Surgical System as an effective tool for minimally invasive surgery, individual results may vary. ©2010 Intuitive Surgical, Inc. All rights reserved. Intuitive, Intuitive Surgical, da Vinci, da Vinci S, da Vinci Si, InSite, and EndoWrist are trademarks or registered trademarks of Intuitive Surgical, Inc. PN 870561 Rev. B, 5/11

Contact Intuitive Surgical to learn more about da Vinci Surgery:Inside U.S.: +1 888 409 4774 or Outside U.S.: +41 21 821 20 00

To learn more about da Vinci Surgery, visit:www.davincisurgery.com

Compared to conventional laparoscopy, the unsurpassed visualization, dexterity and control allow surgeons to:

Treat more pathology minimally invasively — safely, reproducibly and following open surgical technique1 — including patients with:

Adhesive disease1

Large pathology1

Obesity 2

Greater access, precision and control for improved dissections1

Quicker, easier suturing during vaginal cuff closure1

Control of the camera and all three operative arms for the ultimate in surgical autonomy and efficiency1

Eliminate Laparotomy in Your Practice

Reference: GYNECARE THERMACHOICE® III [instructions for use]. Somerville, NJ: Ethicon, Inc; 2009.

© Ethicon, Inc. 2011 TC3-030-10-1/12

For complete contraindications, warnings, precautions, and adverse reactions, see Instructions for Use.

Treats the heavy bleeding she tells you about

Reduces the pain she may not mention

Proven to treat heavy bleeding AND shown to reduce the pain associated with menorrhagia as a secondary quality-of-life end point, GYNECARE THERMACHOICE® III delivers symptom relief your patients will be talking about.

Essential Product Information:

INDICATIONS: The GYNECARE THERMACHOICE® III UBT System is a thermal balloon ablation device intended to ablate the endometrial lining of the uterus in premenopausal women with menorrhagia (excessive uterine bleeding) due to benign causes for whom childbearing is complete. CONTRAINDICATIONS: The device is contraindicated for use in a patient: who is pregnant or who wants to become pregnant in the future; with known or suspected endometrial carcinoma (uterine cancer) or premalignant change of the endometrium, such as unresolved adenomatous hyperplasia; with any anatomic or pathologic condition in which weakness of the myometrium could exist, such as history of previous classical cesarean sections or transmural myomectomy; with active genital or urinary tract infection at the time of procedure (eg, cervicitis, vaginitis, endometritis, salpingitis, or cystitis); with an intrauterine device (IUD) currently in place. ADVERSE EVENTS include: rupture of the uterus; thermal injury to adjacent tissue; heated liquid escaping into the vascular spaces and/or cervix, vagina, fallopian tubes, and abdominal cavity; electrical burn; hemorrhage; infection or sepsis; perforation; post-ablation-tubal sterilization syndrome; complications leading to serious injury or death; complications with pregnancy (Note: pregnancy following ablation is dangerous to both the mother and the fetus); vesico-uterine fi stula formation; cramping/pelvic pain; nausea and vomiting; endometritis and risks associated with hysteroscopy. WARNINGS: Failure to follow all instructions or to heed any warnings or precautions could result in serious patient injury. If uterine perforation is present, and the procedure is not terminated, thermal injury to adjacent tissue may occur if the heater is activated. Endometrial ablation is not a sterilization procedure. Patients who have previously undergone tubal ligation are at increased risk of developing post-ablation-tubal sterilization syndrome which can require hysterectomy. Endometrial ablation procedures using the GYNECARE THERMACHOICE® III UBT System should be performed only by medical professionals who have experience in performing procedures within the uterine cavity, such as IUD insertion or dilation and curettage (D&C), and who have adequate training and familiarity with GYNECARE THERMACHOICE® III UBT System. PRECAUTIONS: Never use other components with the GYNECARE THERMACHOICE® III UBT System. Refer to package insert for complete product information including warnings, precautions, and adverse reactions. RX Only.

7APR - JUN 2011

NewsScope

It’s been an incredible year online for AAGL as we’ve worked to expand the live video offerings available through our SurgeryU video plat-form. As many of you have already seen,

AAGL has staged more live streaming video events in the first half of 2011 than in all of 2010, attracting hundreds of viewers from over 35 countries.

In April, our video team streamed the open-ing ceremonies of the 5th AAGL International Congress on Minimally Invasive Gynecology live from Istanbul, Turkey, followed the same week by a live telesurgery by William Parker on Laparoscopic Myomectomy from Santa Monica, CA.

Then in May, SurgeryU brought our mem-bers live video from the World Robotic Gynecology Conference (WRGC) in Washington, D.C. on May 5th, followed by a live telesurgery on Severe Endometriosis performed by Arnaud Wattiez in Strasbourg, France on May 23rd.

In June, we streamed live video from the 24th International Congress on Technologies for Diagnosis and Treatment of Gynecologic Disease in Moscow, Russia, followed by the launch of a new kind of live video event with Ted Lee and Suketu Mansuria that allowed them to provide a live “surgeon’s commentary” on previously performed surgical cases while answering questions asked through the AAGL web site.

Finally, in addition to our live events, SurgeryU has also been working to “capture”

several lectures and surgical demonstra-tions from AAGL-endorsed educational events worldwide that will be made avail-able for on-demand viewing this summer on SurgeryU (AAGL.org/SurgeryU). We will announce by email those events to our members.

We look forward to continuing to expand our streaming video offerings as it furthers our mission of advancing minimally invasive gynecology worldwide.

Assia A. Stepanian, M.D. is Editor-in-Chief of SurgeryU and serves as a member of the AAGL Board of Trustees. Dr. Stepanian is in private practice at the Center for Women’s Care & Reproductive Surgery in Atlanta, Georgia.

Learning and Connecting Through Live Video

SurgeryU

Dr. Stepanian

The ways in which our Key Partners support the mission of the AAGL include:

• Committing year round support through our Corporate Sponsorship program.

• Funding our fellowship sites. • Giving unrestricted educational grants

to enhance our programs. • Supporting our hands-on seminars

with workstations. • Providing prizes for scholarly activities. • Funding unrestricted grants for the

Patient Education Program. • Advertising in The Journal of Minimally

Invasive Gynecology, the offi cial journal of the AAGL and ordering reprints of articles

to disseminate to physicians.

The support from our Key Partners is in accordance with the Accreditation

Council for Continuing Medical Education guidelines for commercial support.

DIAMOND(Over $300,000)

KEY PARTNERS

SAPPHIRE($150,000-$300,000)

EMERALD($50,000-$150,000)

RUBY($25,000-$50,000)

Keeping the Doors to Education Open

A partner is defi ned as “someone who shares an activity.” The

AAGL acknowledges the corporations who partner with the

AAGL to keep open the doors to educating the next generation

of minimally invasive gynecologists. With their support the AAGL

can provide more programs that will educate physicians and

provide better patient care.

AAGLPresented by the

AAGLAdvancing Minimally Invasive Gynecology Worldwide

9APR - JUN 2011

NewsScope

Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE)The Japan Society has been in existence nearly as long as the AAGL and we recognize the significant contribution they have made over the years in furthering the acceptance of endoscopy. We look forward to our upcoming joint meeting with them and APAGE to exchange ideas and perspectives as endoscopic procedures are applied to the treatment of more gynecologic conditions.

Earlier this year we extended our heartfelt sympathies to our Japanese colleagues, their patients and the people of Japan who were affected by the recent earthquake and tsunami. Since then we have watched with admiration as their resilience, hard work and persistence have been evident in their response. We look forward to joining with them at the meeting in December and seeing firsthand the results of their efforts.

Franklin D. Loffer, M.D.Executive Vice President/Medical Director, AAGL

JSGOE was founded in 1973 and our 51st clinical meeting is going to be held this August. With a current member-ship of 2,460 physicians, our aim is to promote the advancement of

research in the field of endoscopy, gynecol-ogy and obstetrics.

Among the numerous activities of JSGOE, one of our most important initiatives was a program that was developed in 2002 to certify qualified endoscopists who can plan and perform secure endoscopic procedures. This accreditation program began in 2002, and we currently have 292 endoscopists that have been certified, accounting for 12 % of the entire membership.

JSGOE became affiliated with AAGL in 2002, and has engaged ever since in per-sonnel and scientific exchanges. Each year,

a large contingency of JSGOE members present at the AAGL Annual Meeting and it is our hope that the 6th AAGL International Congress to be held this December 9-11 in Osaka will result in many members of the AAGL attending and presenting their scien-tific studies.

We look forward to our continued collab-oration with the AAGL and its membership.

Professor Osamu Tsutsumi, M.D., Ph.D., is President of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy.

Offiers of the Japan Society of Gynecologic and Obstetric Endoscopy President: Osamu Tsutsumi Vice President: Mitsuru Shiota Treasurer: Mineto Morita Secretary: Toshio Matsuzaki

Affiliated Societies Spotlight

Dr. Tsutsumi

MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMaaaaaaaaaaaaaaaaaaaaaaaaaaaaannnnnnnnnnnnnnnnnnnnnnnnnnnnkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiinnnnnnnnnnnnnnnnnnnnnnnnnnnnnnddddddddddddddddddddddddddddddddddddddddddddddd aaaaaaaaaaaaaaaaannnnnnnnnnnnnnnnndddddddddddddddddddddddddd TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTeeeeeeeeeeeeecccccccccccccchhhhhhhhhhhhhhhhhhnnnnnnnnnnnnnnnnnoooooooooooooooooolllllllllllllllllllllllllooooooooooooggggggggggggggggggggyyyyyyyyyyyyyyyyy iiiiiiiiiiiiiinnnnnnnnnnnnn PPPPPPPPPPPPPPPPeeeeeeeeerrrfffffffffeeecccctttt HHHHaaaarrrmmmoonnyyyyyyyyyyyMMMMMMaaaannnnkkkkkiiiinnnnddddd aaaannnnddddd TTTTeeeccchhhhnnnnooollllooogggyyyy iiiinnnnn PPPPeeerrrrffffeeeccctttt HHHHaaaarrrrmmmmmooonnnnyyyyHosted by Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy

6th AAGL International Congress on Minimally Invasive Gynecologyin partnership with JSGOEin association with

12th APAGE Annual Congress

December 9 (Fri.) - 11 (Sun.) 2011Osaka International Convention Center (Grand Cube Osaka ) Osaka, Japan

C O N G R E S S S E C R E T A R I A TMedical Supply Japan Co., Ltd.　2-18-6 Yushima, Bunkyo-ku, Tokyo 113-0034, Japan Tel: +81-3-5842-9771 Fax: +81-3-5842-9791

e-mail: [email protected] URL: http://www.aagl-apage-2011-osaka.com

10 APR - JUN 2011

NewsScope

Pelvic organ prolapse (POP) is a growing prob-lem worldwide particu-larly as the baby boomer generation ages and as more advanced medical care is offered in devel-oping countries.

Beginning with the introduction of the mesh sling in the mid-1990s, the surgical treatment of POP has seen a 15 year period in which mesh augmented repairs have become commonplace. The most common reason given for the use of graft augmenta-tion is a higher failure rate attributed to native tissue repairs including more frequent recurrence of POP and a more common need for repeat surgeries. However, a close review of the literature does not support sev-eral commonly held notions. One widely quoted study stated that the lifetime risk of undergoing surgery for POP or incontinence is 11% with a recurrence rate for native tissue POP repairs of 29%.1 However, a reevaluation of the same database shows the reoperation rate was reported to be 12% after the first operation.2

When looking at the role of mesh com-pared to traditional repairs, a multitude of factors that must be considered.

What is the ideal mesh?Mesh use in vaginal surgery first surfaced

in the 1930s and about every 20 years since then. Earlier mesh was not suitable for vaginal implantation and erosions were com-mon. The current preference is macroporous, monofilament, light-weight, polypropylene mesh however, mesh-related complications are still common mostly due to mesh expo-sure which is reported in between 1-25% which fortunately is most often treated in the office setting. The overall complication rate for traditional repairs is around 8%. Patients receiving either mesh or traditional repairs will potentially suffer fever, URI, blood loss, transfusion, dyspareunia, vagina scarring, fistula, neural, vascular, or visceral injury.

The decision for surgi-cal treatment of endo-metriosis must be taken according to the symp-toms of the patient, with different therapeutic options related to pain or infertility complaints.1

The flowchart (Figure 1) shows that patients with relevant pain and suspicion of endo-metriosis must be submitted to a meticulous clinical exam, followed by an imaging method that can provide important informa-tion about ovarian and deep endometriosis. Imaging with transvaginal ultrasound per-formed by a specialist trained on endome-triosis or MRI will allow the gynecologist to think properly about the best strategy while avoiding over or under diagnosis of the disease.2,3 Normal clinical and imaging exams do not mean absence of disease, since superficial endometriosis can only be

diagnosed by surgical procedures. On the other hand, clinical exam showing uterosa-cal ligaments, vaginal or rectal thickness or nodules or adnexal enlargements correlated to an imaging method suggesting ovarian endometriomas or deep disease in various sites have a high and relevant accuracy on the diagnosis of the disease.4,5

Clinical treatment without surgery may be a good option for patients with pain, when the patient does not desire to be pregnant,

News from the SIGs

Surgical Treatment of Endometriosis Must Have a Precise Indication

Dr. Abrão Dr. Stanford

Figure 1 – Therapeutic strategy for patients with endometriosis and pelvic pain

Pelvic Organ Prolapse Surgery: Multi-Compartmental and Multi-Faceted

SIGNew Kid on the Block:Pelvic Pain

We are pleased to announce the forma-tion of an AAGL Special Interest Group on Pelvic Pain. Chronic pelvic pain afflicts women of all age groups, but espe-cially young women,

with a mean age around 30 years. Its preva-lence is estimated at 4-16% of the female population. It accounts for about 20% of all hysterectomies performed for benign disease and at least 40% of gynecologic laparoscopies performed in the United States. Direct and indirect health care costs total over $2 billion per year. Almost all minimally invasive gynecologic surgeons find themselves caring for and operating on women with pelvic pain.

Yet, there are many non-gynecologic sources of pelvic pain that the gynecolo-gist must be knowledgeable about if s/he is going to provide optimal care to patients. The mission of the Special Interest Group on Pelvic Pain is to improve the knowledge and education of all AAGL members on this important subject, to facilitate interactions of members with particular interest in pelvic pain, to advance research in treatment of pelvic pain (especially surgical treatment), and to assist AAGL in developing programs and projects relating to pelvic pain.

The members of the Pelvic Pain SIG are as follows: Chair: Fred M. Howard; Vice-Chair: Michael Hibner; Board Members: John F. Steege and Eduardo Schor. We welcome member participation, advice, and com-ments. We are looking forward to develop-ing the Special Interest Group on Pelvic Pain. Please feel free to contact us at [email protected] with any comments, questions. You can easily join the Pelvic Pain SIG by visiting www.aagl.org/SIG.

Fred M. Howard, MD, practices at Strong Memorial Hospital in Rochester, New York.This article is presented on behalf of the AAGL’s Special Interest Group on Pelvic Pain.

Dr. Howard

(Continued on page 16) (Continued on page 20)

11APR - JUN 2011

NewsScope

www.hologic.com | [email protected] | 781.999.7453

Visit us at the 2011 AAGL Annual Meeting to learn more.

Top Reasons for OB/GYN Visits

82%

29%

21%

9%

6%

Annual exam and Pap test

Problems/changes with periods

Painful periods or other pelvic pain

Contraception

Side effects from hormones/birth control pills

Survey of 1,300 women suffering from heavy menstrual bleeding. Hologic Inc., 2009.Base: Visited OB/GYN Past 12 MonthsQ4: Why did you visit your OB/GYN on these occasions? (Select all that apply.)

Your patients come to you for many reasons. Now you can address their important gynecologic health issues with a broad range of solutions from Hologic.

A single source for your patients’ surgical needs

Scienti c Program Chair – Keith B. Isaccson, M.D.Honorary Chair – Barbara S. Levy, M.D.

President – Linda D. Bradley, M.D.

MEETING REGISTRATION OPENS ON JULY 15, 2011 at www.aagl.org. Register early for the postgraduate courses you want before they are full.

Excellent Education in a Tranquil SettingPremier gynecologists will meet at the spectacular Westin Diplomat in Hollywood Florida this November 6-10, 2011. Excellent education will be offered in:

• 7 telesurgeries• 8 surgical tutorials• 7 panels• 29 Postgraduate courses including: 5 hands-on cadaver labs 4 hands-on suturing labs• 80+ exhibitors displaying the latest technology• 8 industry-sponsored symposia• 1800+ of your peers• 33.5 hours of Continuing Education

Jordan M. Phillips, M.D., Keynote Address:

In 2009, Ms. Lakshmi alongside world renowned advanced gynecological surgeon and AAGL member, Tamer Seckin, MD, co-founded the Endometriosis Foundation of America after suffering from the disease for decades herself. She has been able to make amazing strides with the Foundation such as launching the rst interdisciplinary research facility in the country for Gynopathology as a joint project between Harvard Medical School and MIT.

Dr. Grif th leads the Center for Gynopathology Research at the Massachusetts Institute of Technology, devoted to better understanding and ultimately nding treatments for endometriosis. Under her direction, the MIT team will begin looking at samples of uid from the abdominal cavity of women with endometriosis, using new tools that help them nd rare cells and understand their function. Ultimately, they want to build a three-dimensional model of the membrane inside the abdominal cavity that becomes home to the displaced tissue. Dr. Grif th’s speech, Endometriosis is Not a Benign Disease, will focus on the need to treat endometriosis.

Padma LakshmiHost of Bravo TV’s Top Chef All Stars

Co-founder, Endometriosis Foundation of America

Linda G. Grif th, Ph.D.S.E.I.T. Professor of Biological

and Mechanical EngineeringDirector, Center for

Gynopathology Research, MIT

14 APR - JUN 2011

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MIGS Fellowship Gett ing Stronger Everyday

In the last 10 years, the Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) has grown from 7 sites to its current 40 training sites; 38 within the USA and 2 in Canada. I am

proud to acknowledge that we now have 122 Fellows who successfully completed the FMIGS program and 27 more scheduled to graduate in June 2011.

With the increase of FMIGS graduates, the Fellowship is fulfilling its commitment of educating the surgeons of tomorrow and although we added 5 new training sites in 2011, every year, we have a large number of Fellow applicants that must be turned away because of a lack of Fellowship sites. If you have ever considered being a precep-tor, we encourage you to come forth and submit an application. The experience of running a Fellowship is both stimulating and rewarding.

I am pleased to also report that the Fellowship Board is very actively engaged in improving the Fellowship program. We meet monthly by conference call and recently held an in person meeting to keep our pulse on the activities of the Preceptors and Fellows. In addition, the Board meets annually with the Fellowship Preceptors to get their feedback on how to improve the FMIGS program. The Board/Preceptor meet-ing at last year’s annual meeting resulted in a number of valuable recommendations including the unification and standardization

of educational objectives; implementation of an electronic case list reporting program to monitor procedures performed by the Fellows; and that all Fellowship sites offer 2-year training programs rather than 1. These suggestions were reviewed by the Board and the subcommittees below were established to implement changes. I would like to acknowledge the efficient and timely work performed by the sub-committees. Their dedicated efforts over the past 6 months will have a major impact on the growth and development of the FMIGS program.

Educational Objectives Committee – with devotion and many working hours, this committee, developed the Educational Objectives, Procedures List, Case Reporting Forms and Standard Program Description Forms. These developments are the basis of the MIGS Fellowship and will be instrumen-tal in helping us obtain accreditation from Accreditation Council for Graduate Medical Education (ACGME).

Fellowship Education Committee – charged with developing educational courses for the FMIGS Fellows that will meet the overall educational objectives of the program. The committee will review needs assessment surveys and past evalua-tion reports from courses that have already been held and make recommendations for future educational programs.

International Fellowship Committee – charged with developing guidelines and providing assistance to programs outside the US that are interested in becoming affiliated with the FMIGS.

Grant Review Committee – charged with reviewing grant applications submitted by the Fellowship programs through the new “Fund for the Future” (FFTF) grant program. This new online grant submission program was established to create a blinded process for awarding grants to FMIGS sites. We are pleased to acknowledge the generous support of our corporate sponsors. For the 2011-2012 Fellowship year, they include:

Ethicon Endo-Surgery, Inc.Ethicon Women’s Health & UrologyOlympus (Gyrus ACMI)Karl Storz Endoscopy-AmericaAs we instituted the “Fund for the Future”

we received a generous grant from Ethicon Endo-Surgery for the 2012-2013 Fellowship year with many more companies expressing interest in supporting our program.

If you would like to donate funds to assist us with our program, additional informa-tion is available at: http://fundforthefuture.aagl.org/).

We have made much progress in a very short time and I must express my sincere thanks to the FMIGS Board mem-bers, Committee members and the FMIGS Preceptors for their dedication and hard work in making our Fellowship successful and for striving to provide the best educa-tional environment for our Fellows.

Resad P. Pasic, M.D., Ph.D., is President of the FMIGS Board, Co-Director of the FMIGS at the University of Louisville School of Medicine, Louisville, Kentucky, and former President of the AAGL.

Dr. Pasic

Fellowship Update

15APR - JUN 2011

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Hysterectomy and Beyond...The “Innovations in Minimally Invasive Gynecologic Surgery: Hys te rec tomy and Beyond…” workshop was held at Magee-Wo m e n s H o s p i t a l of the University of

Pittsburgh Medical Center on June 4-6. Scientific Program Chair, Ted Lee, and other world-renowned minimally inva-sive gynecologic surgeons including C.Y. Liu, Rosanne Kho and Kevin Stepp were among the esteemed faculty in addition to many talented alumni from the Fellowship

in Minimally Invasive Gynecologic Surgery. The workshop drew over 60 participants from 12 different countries.

At the Winter Inst i tute for Simulation Education and Research (WISER) facility of the University of Pittsburgh, workshop participants enjoyed expert didactics on mini-mally invasive gynecologic surgery. Topics included laparoscopic suturing, pelvic and retroperitoneal anatomy, surgi-cal energy sources, and emerging trends in robotics and single incision procedures. The course gave participants the necessary

tools with which to approach laparo-scopic hysterectomy, as well as tips for preventing, diagnosing, and managing laparoscopic complications.

Didactic lectures were reinforced with over 8 hours of proctored hands-on experience in various stations including basic and advanced suturing and knot-tying, morcellation, surgi-cal energy sources, a test drive of a DaVinci robot, and single-port surgery

simulation. The participants received one-on-one instruction throughout the workshop.

The workshop concluded with two live surgeries: a laparoscopic supracervical hys-terectomy performed by Suketu Mansuria, and a total laparoscopic hysterectomy per-formed by Ted Lee. These expertly per-formed minimally invasive procedures brought the contents of the entire workshop to life, and are available for viewing on the AAGL website under SurgeryU.

Ted Lee, M.D., is Director of Minimally Invasive Gynecology at the Magee Womens Hospital in Pittsburgh, Pennsylvania and on the Advisory Committee of AAGL.

Dr. Lee

Workshop Update

From the President (Continued from Page 2) The AAGL has also been active in pro-

viding teaching modules in gynecologic endoscopic surgery in Mexico and just had its first teaching module completed. A teaching module consists of four separate events in an area of the country. The first teaching module trained 7 physicians in Mexico to perform specific procedures and additionally, we had up to 30 observers from the area watching the surgeries. The AAGL would like to thank the faculty who participated in these courses over the last six months: Rafael F. Valle (Chair) – (Chicago, Illinois); Fernando Malavasi (Costa Rica); Hector Navarro Perez (Monterey, Mexico); C.Y. Liu (Chattanooga, Tennessee); Thomas L. Lyons (Atlanta, Georgia); Harry Reich (Dallas, Pennsylvania); Roberto Jose Sainz (Buenos Aires, Argentina). These courses are made possible by a generous educational grant from Karl Storz Endoscopy-America, Inc. Our goal is to circle the globe with innovative lectures, dynamic surgical pro-cedures, and motivating physicians around

the world to offer minimally invasive surgi-cal procedures. I can think of no better way to influence and change physician behavior than scrubbing with colleagues around the world. I give our team in Mexico an A+.

Our global reach also included a phe-nomenal meeting in Istanbul, Turkey. The 5th AAGL International Congress on MIG in conjunction with the Turkish Society of Gynecologic Endoscopy was a great suc-cess. There were well over 500 physicians in attendance. The congress was flawless and perfectly executed under the direction of Dr. Fatih Sendag and Dr. Onur Bilgin. The scientific presentations were well received and the AAGL streamed the live surger-ies on SurgeryU to both the attendees of the congress as well as to those members that were not in attendance. Our statistics reflected that 262 physicians from 33 coun-tries watched the surgeries live. We would also like to acknowledge the excellent work of Edis Sakic and Kivanc Ayli from the Opteamist Tourism & Organization team for

their oversight of the congress.If you have not made your plans yet to

attend the “6th AAGL International Congress on MIG in conjunction with the Japanese Gynecological Society and APAGE, Osaka, Japan – Mankind and Technology in Perfect Harmony”, December 9-11, 2011, we encourage you to do so. We recognize that some of you may feel uncomfortable about traveling to Japan due to the tsunami, however, the location for our international meeting is in Osaka which is 350 miles from the Fukushima Nuclear Power Plant. The State Deparment website does indicate that traveling to Japan and especially Osaka, is safe. The organizers are busy preparing a robust program for us.

Linda D. Bradley, M.D. is the President of the AAGL and Vice Chair of Ob/Gyn and Women’s Health Institute and Director, Center for Menstrual Disorders, Fibroids & Hysteroscopic Services at the Cleveland Clinic in Cleveland, Ohio.

16 APR - JUN 2011

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does not have clinical or imaging signs sug-gesting endometriomas larger than 3 cm and/or deep endometriosis. Laparoscopy should be indicated when the patient does not show improvement after 6 months to one year or develops clinical and/or imag-ing evidences of endometriomas larger than 3cm or deep endometriosis,. Special considerations must be taken in some spe-cific situations such as the age of the patient, ovarian reserve, the suspicion of cancer and the presence of the disease infiltrating the bowel. The indication for laparoscopy without evidence of advanced disease is controversial for infertile patients.6,7 Perhaps for patients less than 35 years of age, lapa-roscopy should be indicated only after 6 months of clinical treatment.

Some recent studies showed that the clinical treatment may reduce pain, but rarely reduce the amount of endometrio-sis.8 Symptom relief is noted mainly during the time of medical treatment and is not secondary to the reduction of the disease. In some cases, disease progression occured during clinical treatment. The patient must, therefore, be followed closely with clincial and imaging exams to control the evolution of the endometriosis.

In terms of the surgical technique, super-ficial and deep foci of disease in the pelvis must be completely excised. The removal of ovarian endometriomas, on the other hand, is still controversial. We suggest nowadays the removal of the capsule of endometromas larger than 3 cm, with special efforts to be very gentle with the normal ovary, trying to preserve the normal folicles. Some authors suggest the removal of the capsule of the cyst, preserving only the portion of the endo-metrioma close to the ovarian hilum, and should be coagulated or vaporized. Another option for patients older than 35 years with unique ovaries or with low ovarian reserve is to drain the cyst during the laparoscopy. Emergency in vitro fertilization may be an option for these cases.9

Endometriotic lesions compromising the retrocervical region, the vaginal fornix, the rectovaginal septum or periureteral region should be completely excised,. The surgeon must be trained to perform these procedures, due to the increased risks of complica-tions of this type of surgeries. Undoubtedly

laparoscopy povides a better visualization and magnification of the lesions, allowing a better visualization, with better surgical approach. Special care must be taken con-cerning the use of monopolar energy; the surgeon must avoid causing thermal damage to vital structures in the pelvis. Another con-troversial decision is how to manage bowel lesions. For this purpose, a well-performed imaging method is very helpful for us to plan the treatment approach properly. For multi-focal bowel lesions or unifocal foci of more than 3 cm extension or compromisse of the submucosa in symptomatic patients, seg-mental resection of the rectum/sigmoid may be considered.10 For unifocal lesions with

less than 3 cm compromise of the serosa or muscularis, nodule resection may be the best option. But if the patient is asymptom-atic without signs of bowel stenosis, clinical treatment must be considered, with a clini-cal and imaging surveillance only.

These recommendations of procedures are made with the ultimate goal of improv-ing the quality of life of patients with endo-metriosis. The proposal of a “one shot surgery,” reducing the number of reinter-ventions is key. The recent improvement of imaging methods have been useful for us to reduce the so called “recurrence” of the disease, since most of these cases more than likely correspond to persistent disease that was not diagnosed prior to the surgery. Moreover, with the modern approach of pre-operative imaging, not only can we bet-ter develop a strategy for treatment, we can also better counsel our patients regarding the possible complications, and prepare the surgical team for the appropriate pr ocedure.

References:1. Piketty M, Chopin N, Dousset B, Millischer-

Bellaische AE, Roseau G, Leconte M, Borghese B,

Chapron C. Preoperative work-up for patients with

deeply infi ltrating endometriosis: transvaginal ultra-

sonography must defi nitely be the fi rst-line imaging

examination. Hum Reprod. 2009,24(3):602-7.

2. Abrao MS, Gonçalves MO, Dias JA Jr, Podgaec S,

Chamie LP, Blasbalg R. Comparison between clinical

examination, transvaginal sonography and magnetic

resonance imaging for the diagnosis of deep endome-

triosis. Hum Reprod. 2007, 22:3092-7.

3. Goncalves MO, Dias JA Jr, Podgaec S, Averbach

M, Abrão MS. Transvaginal ultrasound for diagnosis of

deeply infi ltrating endometriosis. Int J Gynaecol Obstet.

2009,104:156-60.

4. Goncalves MO, Podgaec S, Dias JA Jr, Gonzalez

M, Abrao MS. Transvaginal ultrasonography with bowel

preparation is able to predict the number of lesions and

rectosigmoid layers affected in cases of deep endome-

triosis, defi ning surgical strategy. Hum Reprod. 2010,

25:665-71.

5. Hudelist G, Ballard K, English J, Wright J, Banerjee

S, Mastoroudes H, Thomas A, Singer CF, Keckstein J.

Transvaginal sonography vs. clinical examination in the

preoperative diagnosis of deep infi ltrating endometriosis.

Ultrasound Obstet Gynecol. 2011, 37(4):480-7.

6. Marcoux S, Maheux R, Bérubé S. Laparoscopic

surgery in infertile women with minimal or mild

endometriosis. Canadian Collaborative Group on

Endometriosis. N Engl J Med. 1997, 337:217-22.

7. Parazzini F. Ablation of lesions or no treatment

in minimal-mild endometriosis in infertile women:

a randomized trial. Gruppo Italiano per lo Studio

dell’Endometriosi. Hum Reprod. 1999, 14:1332-4.

8. Vercellini P, Crosignani P, Somigliana E, Viganò

P, Frattaruolo MP, Fedele L. ‘Waiting for Godot’: a

commonsense approach to the medical treatment of

endometriosis. Hum Reprod. 2011, 26:3-13.

9. de Ziegler D, Borghese B, Chapron C.

Endometriosis and infertility: pathophysiology and

management. Lancet. 2010, 28;376:730-8.

10. Abrão MS, Podgaec S, Dias JA Jr, Averbach M,

Silva LF, Marino de Carvalho F. Endometriosis lesions

that compromise the rectum deeper than the inner mus-

cularis layer have more than 40% of the circumference

of the rectum affected by the disease. J Minim Invasive

Gynecol. 2008, 15:280-5.

Mauricio S. Abrão, M.D. is a Trustee on the AAGL Board representing Mexico/Central America/South America. He is Director, Endometriosis Unit at São Paulo University in São Paulo, Brazil.This article is presented on behalf of the AAGL’s Special Interest Group on Reproductive Surgery/Endometriosis.

Surgical Treatment of Endometriosis Must Have a Precise Indication (Continued from Page 10)

Moreover, with the modern approach of pre-operative imaging, not only can we

bett er develop a strategy for treatment, we can also bett er

counsel our patients regarding the possible complications,

and prepare the surgical team for the appropriate procedure.

17APR - JUN 2011

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The Spotlight Is on You: AAGL Member Profi les (Continued from Page 2)

aforementioned information.Updating your profile is simple. Just fol-

low these four easy steps:• Go to AAGL.org and click on Sign In• Enter your Last Name and PIN (we will

remind you if you have forgotten your PIN) and click on Submit to sign in

• Click on Edit Profile beneath your mem-bership information to update your infor-mation

• Once you have updated your information, be sure to click Save to make sure your information is saved.AAGL Member Profiles are a great way

for you to profile yourself to patients and colleagues. I strongly encourage you to avail yourself of this excellent resource.

Franklin D. Loffer, M.D. is the Executive Vice President/Medical Director of the AAGL. An example of an AAGL Member Profile

18 APR - JUN 2011

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AAGL and RSGE Celebrate 20 Years of CooperationThe XXIVth International Congress on New Technologies for Diagnosis and Treatment of Gynecologic Diseases was held in Moscow, Russia, June 6-9, 2011. This con-gress marked the 20th anniversary of coop-eration between the Russian Society of Gynecological Endoscopists (RSGE) and the AAGL. It also signified the first collab-orative meeting between the RSGE, AAGL, and the European Society of Gynecological Endoscopy (ESGE).

P r o f e s s o r G e n n a d i y Sukhikh, Chai rman of the Congress Organizing Committee and Professor Leila Adamyan, Congress President and Head Specialist in Ob/Gyn of Ministry of Healthcare and Social Development of the Russian Federation are to be congratulated for their organization of an exciting congress that covered the gamut of minimally invasive gynecologic surgery. Through their efforts more than 90 presentations that consisted of invited lectures, abstracts and videos were delivered. It is to be noted that this con-gress was ordered by The Ministry of Health and Social Development of the Russian Federation. As such, the government supported the attendance of 927 leading specialists and heads of research institu-tions from the 69 subjects of the Russian Federation and CIS countries, including the Republics of Belarus, Armenia, Azerbaijan, Kazakhstan, Ukraine and Moldova.

Many leading experts and members of the AAGL and ESGE took part in the congress including: Harry Reich, Arnaud Wattiez, Denis Querleu, Ceana Nezhat, Linda D. Bradley, Mario Malzoni, Franklin D. Loffer, Jacques Hamou, John R. Miklos, Robert Moore, Enda McVeigh, Philippe

Koninckx, Thomas L. Lyons, Stefano Bettocchi, Anastasia Ussia, Antonio Setubal, Assia Stepanian, Jon Einarsson and Robert Zurawin.

The Opening Ceremonies included a special performance of a piece from Madame Butterfly

by the principal opera singer and orchestra who perform with the Bolshoi Ballet. This exciting performance was followed by a

moving tribute by Professor Adamyan to the many physicians who have contributed their time and expertise over the last 20 years. Many people were acknowledged including Jordan M. Phillips, the AAGL Founder, who assisted Professor Adamyan in establishing the first congress in Moscow and was also instrumental in developing the RSGE.

In addition, 18 patients were operated on in the new operating rooms of the Federal State Institution “Academician V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of RF MHSD”. These live interactive surgeries performed by recognized experts demonstrated innovative methods of reconstructive plastic surgery of the repro-ductive organs, uterine fibroids, intrauterine synechiae, endometriosis, benign ovarian pathology, cervical and endometrial cancer, genital prolapse and stress incontinence. Some of the surgeries were broadcast live through the AAGL on SurgeryU and are now archived on SurgeryU for viewing by our members.

One of the highlights of the meeting was the presentation of the honorary title of Professor Emeritus of the FSI Academician V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of the RF MHSD to: Professors Franklin D. Loffer, Assia Stepanian, Harry Reich and Denis Querleu (not pictured). This special designation is bestowed to those physicians who have shown a dedication to the field of minimally invasive gynecology and who have also been active in the annual congress of the RSGE.

The XXVth International Congress of the RSGE will be held June 4-7, 2012 in Moscow. If you are interested in attending, please contact us at [email protected].

Professor Leila Adamyan

XXIVth International Congress Faculty and Organizers

Affiliated Meeting Highlight

ONLY ONE PERMANENT BIRTH CONTROL CAN BE THE MOST EFFECTIVE.†Based on three years of clinical data, Essure had the lowest failure rate of all permanent birth control methods.* It’s also the only one with the Essure Confi rmation Test that lets you actually see the inserts in place and confi rm that her fallopian tubes are fully occluded. Since 2002, nearly a half million women have trusted Essure. There’s simply no better way to be sure.

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pregnancies2

pregnancies3

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FAILURE RATES PER 1,000 WOMEN*

Indications for Use: The Essure system is indicated for women who desire permanent birth control. Contraindications: The Essure system should not be used in any patient who is uncertain about her desire to end her fertility, can have only one micro-insert placed, has undergone a previous tubal ligation, or has any of the following conditions: Pregnancy, delivery or termination less than six weeks prior to Essure placement, active or recent upper or lower pelvic infection, known allergy to contrast media, or known hypersensitivity to nickel confi rmed by skin test. Warnings and Precautions: For a complete list of warnings and precautions, see Instructions for Use. Adverse events and side effects include: Failure to place both micro-inserts, initial tubal patency, expulsion, perforation, and other unsatisfactory micro-insert location. Day of procedure side effects include cramping pain, nausea/vomiting, dizziness/lightheadedness, and bleeding/spotting. For complete product information, see Instructions for Use.

©2011 All rights reserved. Conceptus and Essure are registered trademarks of Conceptus, Inc. All other trademarks are property of their respective owners. CC-2661 17MAR11F

References: 1. Essure Effectiveness Report (data December 16, 2004), page 14. Data on fi le.2. Peterson HB, et al. The risk of pregnancy after tubal sterilization: fi ndings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol. 1996Apr:

174(4):1161-8.3. Jamieson DJ, et al. For the U.S. Collaborative Review of Sterilization Working Group. The Risk of Pregnancy After Vasectomy. Obstet Gynecol. 2004:103:848-50.

848-50.4. Adiana Instructions for Use, Rev 3.

*No direct comparative data exists.†Based on four years of clinical data.

20 APR - JUN 2011

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Vaginal Dissection and Standardization of Surgical Techniques

It is difficult to compare outcomes from many studies due to a lack of standardization of surgical techniques and the combination of multi-compartmental repairs. It is becom-ing more evident that mesh implantation done properly by well-trained and experi-ence surgeons can be done safely. Magnetic resonance, ultrasound, and histologic stud-ies have given us a better understanding of pelvic anatomy related to incontinence and POP. We now know that the subepithelial tissue in not a true surgical fascia rather it is composed mainly of fibroelastic tissue and smooth muscle. Further, tears in the apical connective tissue and the levator ani muscles are associated with prolapse.

While traditional repairs are not described using apical support, we understand now that without apical support, both mesh and native repairs are more likely to fail. Also, proper full-thickness dissection of the vaginal wall when entering the vesicovaginal and rectovaginal spaces is extremely important. It is not uncommon for dissection to be too superficial leaving a potentially devascular-ized and thinned out epithelium.

Multi-compartmental repairs are common and are further confounded by the role of hysterectomy or incontinence procedures. Factors such as whether to deliver mesh with trocars, to deliver mesh under the levator muscles via transobturator or ischiorectal fossa routes, to place mesh transvaginally, to use total vaginal mesh, or to use biologic graft materials are all areas of needed research and discussion. No doubt, we all want the repair or repairs to address the patient’s underlying prolapse-related problems.

Reporting Surgical OutcomesCurrently, anatomic failure of the spe-

cific vaginal compartment is defined as POP-Q > stage II. Recently more clini-

cally applicable subjective criteria were proposed in which a successful outcome would include non-bothersome prolapse to the hymen. A prospective, randomized trial3 originally reporting 30% anatomic success was reevaluated using revised criteria and reported approximately 80% success with no difference in traditional or mesh implant treatment arms in either study.4 This issue is open for debate since comparisons will become increasingly more difficult to make if the outcome parameters continue to change.

A recent comprehensive literature review5

shows that there is a wide range for ana-tomic success traditional anterior compartment repairs (30-97%). When the apex is concomi-tantly supported the success is 88-97%. This compares favorably to mesh augmented repairs showing over 90% success (range 61-96%) not controlling for technique. The same compara-ble success is true for the apical compartment. Success rates for traditional sacrospinous fixa-tions and uterosacral plications are 94-97% compared to mesh augmented sacrocolpopexy at 93-98%. Success for posterior compartment defects is 75 - 86% which is slightly less than the 92-97% reported with mesh augmented repairs. For the posterior compartment, symp-tomatic improvement such as rectal emptying, an improved sense of incomplete evacuation, a decreased need to manually assist defecation, decreased symptoms of pelvic heaviness and improved symptom questionnaire scores are statistically improved.

Patient FactorsWhat is the success rate of native tissue

or graft augmented surgery in a 55 year old, Caucasian female with a prior hysterectomy presenting with bulge symptoms related to a combined posterior and anterior compart-ment prolapse with associated incontinence who has a history of deep vein thrombosis and who lifts heavy objects regularly at her workplace? Obviously, answering these questions requires a clear understanding of patient factors such as age, race, menopause and estrogen status, the stage of prolapse, a history of prior repairs, anticoagulation, smoking history, among others. It is also becoming clear that pelvic reconstructive surgery is complex and that surgeon experi-ence and training play a significant role in the success of any repair.6 It is important that future research address these factors so that we can more adequately provide informed

consent to our patients about the actual success rates of the POP surgery their pelvic surgeon is offering them.

AAGL and the Urogynecology SIGIt is most important to consider the patient,

the informed consent process, and surgical expertise particularly in light of the FDA warnings regarding vaginal mesh implanta-tion for POP and incontinence. Recently, the AAGL published a position statement on hysterectomy promoting not only that lapa-roscopic and vaginal approaches are pre-ferred but also that surgeons should strive to improve their skills or refer the patient. The Urogynecology Special Interest Group (SIG) of AAGL is looking for methods to improve education in vaginal surgical techniques to AAGL members. Working with our industry partners and special interest groups, AAGL can strive to teach and promote proper vaginal surgical techniques and safe and effective evidence-based POP surgery.

References:1. Olsen AL, Smith VJ, Bergstrom JO, et al.

Epidemiology of surgically managed pelvic organ

prolapse and urinary incontinence. Obstet Gynecol.

1997;8:501-6.

2. Clark AL, Gregory T, Smith VJ, Edwards R.

Epidemiologic evaluation of reoperation for surgically

treated pelvic organ prolapse and urinary incontinence.

AM J Obstet Gynecol. 2003 Nov;189(5):1261-7.

3. Chmielewski L, Walter MD, Weber AM, Barber

MD. Reanalysis of a randomized trial of 3 techniques of

anterior colporrhaphy using clinically relevant defi ni-

tions of success. Am J Obstet Gynecol. 2011 Mar 22

(Epub).

4. Chmielewski L, Walter MD, Weber AM, Barber

MD. Reanalysis of a randomized trial of 3 techniques of

anterior colporrhaphy using clinically relevant defi ni-

tions of success. Am J Obstet Gynecol. 2011 Mar 22

(Epub).

5. Stanford EJ, Cassidenti A, Moen M. Traditional

native tissue versus mesh augmented pelvic organ

repairs: providing an accurate interpretation of current

literature. Int Urogyn J (pending).

6. Roman H, Narpeau L, Hulsey TC. Surgeons’ experi-

ence and interaction effect in randomized controlled trials

regarding new surgical procedures. Am J Obstet Gynecol

2008;199:108.e1-108.e6.

Edward J. Stanford, M.D., practices at the Delta County Memorial Hospital in Delta, Colorado.This article is presented on behalf of the AAGL’s Special Interest Group on Urogynecology.

Pelvic Organ Prolapse Surgery: Multi-Compartmental and Multi-Faceted (Continued from Page 10)

It is also becoming clear that pelvic reconstructive surgery is complex and that surgeon experience and training play

a signifi cant role in the success of any repair.

21APR - JUN 2011

NewsScope

New Products

AMS MiniArt® Precise Sling SystemThe MiniArc® Precise Sling System is the next generation in the MiniArc family of products. Built on the success of the original MiniArc sling, the MiniArc Precise sling provides even greater control and delivery. Featuring a fixed needle to sling connection and an improved ability to tension, the MiniArc Precise sling further simplifies the ease of use. For more information, please visit www.amsminiarc.com.

Richard Wolf MorcePowerPlusThe MorcePowerPlus is the latest generation of reusable morcellator from Richard Wolf. It’s small, light-weight design makes it easy to handle, yet powerful enough to cut through dense fibrous tissue. The Morce-PowerPlus also has the lowest cost per case, as it can accommodate different-sized blades in one unit (12, 15, and 20 mm). For more information, please call 800-323-WOLF (9563) or www.richardwolfusa.com.

half day PG course on the value of yoga and meditation.

The Global Congress will begin with the focus on endometriosis. Two women who suffered from the disease, Emmy® award winner, Padma Lakshmi, and McArthur Genius Grant awardee, Prof. Linda Griffith, will describe their contributions made to enhance patient awareness and the scien-tific understanding of the disease. This is followed by live endometriosis surgery by past AAGL president Grace Janik and finally a presentation of the new AAGL endome-triosis classification system by Mauricio Abrão, Chair of the Reproductive Surgery/Endometriosis SIG.

We have significantly raised the number of courses eligible for CME hours offered in the 2 days of postgraduate courses and throughout the 3-day Global Congress. Each live telesurgery, surgical tutorial and the video challenges will have specific leaning objec-tives so that CME credits can be obtained. The live telesurgeries will include cases of severe endometriosis, large uterine fibroids, vaginal reconstruction for congenital mullar-ian anomalies, laparoscopic pelvic exentera-tion, “see and treat” hysteroscopy, advanced laparoscopic surgery without disposable instruments and others.

Special programs at the ACM will include a live demonstration/competition of manikin

simulation technology, an international dis-cussion on surgeon credentialing, highlights from our ListServe and a scientific session in Spanish only which is of particular interest to our members from South Florida, Central and South America.

The scientific program committee’s mis-sion is to ensure the 40th AAGL Global Congress contains all the basic educational material that has been proven to be valuable over the past 40 years and at the same time introduce new, exciting and entertaining programs. I anticipate the most common complaint from the participants to be that

there were too many interesting programs scheduled at the same time and that one could not attend them all. If this is the case, the scientific program committee will have accomplished its mission.

See you all in November.

Keith B. Isaacson, M.D. is the Vice President of the AAGL and Scientific Program Chair for the 40th AAGL Global Congress on Minimally Invasive Gynecology. He is an Associate Professor of Ob/Gyn at Harvard Medical School and the Director of Partners Center for Reproductive Medicine and Surgery at Newton Wellesley Hospital MIGS Center in Newton, Massachusetts.

From the Scientifi c Program Chair (Continued from Page 1)

Infinity Pool at the Westin Diplomat

22 APR - JUN 2011

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Welcome New MembersMarch 15, 2011 - June 15, 2011Marian G. Acevedo Alvarez, M.D.Oluyemisi A. Adeyemi, M.D.Ceobanu Adina, Jr., M.D.Mariam Hamad Alkhaldi, M.D.Tahani Abdullah Almotrafi, M.D.Luis Alonso Pacheco, M.D.Rosalie O. Alvarado, M.D.Ganya Alvarado-Reagans, M.D.J. Alves, M.D.Mussarrat Ammad, M.D.Clark O. Andelin, M.D.Amy Anderson, M.D.Kristen Anderson, M.D., Ph.DSara Lynn Anderson, M.D.Sonia Aneja, M.D.Laviniu Anghel, M.D.Melissa Anglero, D.O.Natasha Archer, M.D.Jennifer Jo Arnhold, M.D.Shant Ashdjian, M.D.Azita Aslian, M.D.Teodoro Astudillo, M.D.Senem Ates, B.Sc, M.D.Khadija Awan, M.D.Jack P. Ayoub, M.D., FACOGAndres Ayuso, M.D.Homayara Aziz, M.D.Diane Bamgbade, M.D.Benjamin Joseph Barenberg, M.D.Tiziana Bartolotti, M.D.Stephen Bates, M.D.Tiffany Beck, M.D.Jodi Berendzen, M.D.Elizabeth Berger, D.O.Leah Berkowitz, D.O.Blake Berryhill, M.D.Megan Billow, D.O.Angela D. Bohr, M.D.Justin Bohrer, M.D.Ani Boicea, M.D.Corey Bolac, M.D.Jared N.R. Bolton, M.D.Jonathan David Boone, M.D.Hobson G. Booth, M.D.Marianne Boutet, M.D.Sarah Danielle Bowen-Pasfield, M.D.

Allie Bowman Giddings, M.D.Richard S.A. Braham, M.D., FACOGStacie Braswell, M.D.Petre Cornel Bratila, M.D.Martha Briggs, M.D.Samuel Floyd Brown, M.D.Joseph Brett Bryant, M.D.Tara Hope Budinetz, D.O.Cindy Bui, M.D.Jennifer Michele Bump, M.D., MBAArin Bunchien, M.D.Alson Burke, M.D.Kelley Burkett, M.D.Jessica E. Bury, M.D., MPHYvonne Sonia Butler, M.D.Ronny Calderon, M.D.German D. Calonje, M.D.Paulo Cesar Camara, M.D.Elizabeth Campbell, M.D.Xuan Cao, M.D.Theresa J. Carducci, M.D.Daniela Carlos, M.D.Michele C. Carney, M.D.Maria Giovanna Carracino, M.D.Guillermo Castrejon Rodriguez, M.D.Paul N. Cervone, M.D., LTCRichard Steele Chalfant, M.D.Lisa Mika Chan, PA-CRachel E. Chan Seay, M.D.Viviana Chang, BSc, M.D., FRCSCAnushka Chellian, M.D.Andrea Lee Chen, M.D.Christine Chen, BMBChKathleen Chin, M.D.Ina N. Cholst, M.D.Etem Tabogho Chu, M.D.Christine Cimo-Hemphill, M.D.Jean Paul Clark, M.D.Portia N. Cohens, M.D.Joni Coker, D.O.Joshua C. Combs, M.D.Shanna Marie Combs, M.D.Tera Sue Conway, M.D.Lawrence Scott Cook, D.O.Lisa M. Cookingham, M.D.Cheri Rose Cranston, M.D.

Abigail Joanna Creighton, M.B.B.SEve Samantha Cunningham, M.D.Rachel M. Hatfield Dalton, D.O.Claire Danby, M.D.Minh Dao, M.D.Babita Datta, M.D.Shekar Davarya, M.D.Brian Day, M.D.Lyndsey Day, M.D.Tarek Dbouk, M.D.Laura De La Luz Morley, M.D.Philip Thiem Deibel, M.D.Jacqueline Dela Merced, M.D.Mary Andrea S. Dela Torre, M.D.Carolyn E. Delk, D.O.Katherine Laura Dengler, M.D.Lizzy Devadas, M.D.Jill Alyse Devlin, D.O.Virginia Diaz, M.D.Jessica Marie Dickes, M.D.Elizabeth Louise Dickson, M.D.Laura Didomizio, M.D.Miguel Angel Dominguez Mena, M.D.Abigail Drucker, M.D.Marilla Druitt, M.D.Adam R. Duke, M.D.Evelyn Louise Dunn, M.D.Nichole Duran Mahnert, M.D.Sadia A. Durrani, M.DLina Ea, D.O.Amanda Ecker, M.D.Jaime Marguerite Edwards, M.D.James Edwards, M.D.Maria Cecilia Eguiguren, M.D.Katarina Eisinger, M.D.Sherif El Nashar, M.B., B.Ch.Tollie Burke Elliott, M.D., FACOGWilliam S. Ellis, M.D.Cihan Esitken, M.D.Katharine McKinley Esselen, M.D., MBAEmily Evans-Hoeker, M.D.Hanna Ezzat, M.D.Oluwaseun O. Fadare, M.DSeema Faiyaz, M.D.Catherine Faucher, M.D.Peter Fayez Guirguis, M.D.

Terri Febbraro, M.D.Johanna G. Finkle, M.D.Saroj A. Fleming, M.D.Jose Gerardo Flores Penilla, M.D.Adam Footer, M.D.Cassandra Dawn Foss, M.D.Caroline E. Foust-Wright, M.D.Recia FrennToby Frescholtz, M.D.Mylene LM Gagne, M.DElizabeth M. Gaida, M.D.Ashwin Gaitonde, M.D.Lisa Garcia, M.D.Andrea Garland, M.D., MPHMaria Aina Gaspar-Oishi, M.D.Kimberly S. Gecsi, M.D.Elizabeth J. Geller, M.D.Yvette Marcella Gentry, M.D.Iralia Georgiou, M.D.Armine Ghazaryan, M.D.Lauren Gibson, M.D.Arie Gillen, M.D.Ashley Gilman, M.D.Michelle A. Glasgow, M.D.Anar Gojayev, M.D.Cara Teresa Golish, D.O.Angela Gonzalez, M.D.Delia Ann Gonzalez, M.D.Julia Goodwin, M.D.Kristin A.S. Gorelik, M.D.Amanda Rose Gorman, M.D.Shannon Grabosch, M.D.Leszek Grabowski, M.D.Sarah E. Graceffa, M.D.Alonzo Leonard Grant, III, M.D.Jewel T. Grant, D.O.Whitney S. Graybill, M.D.Beena Green, M.D.Gabrielle Grundy, M.DMaureen Elise Grundy, M.D.Emil L. Gurshumov, M.D.Eline Haenebalcke, M.D.Hannah Morgan Hall, M.D.Tracilyn R. Hall, M.D.William K. Hamilton, M.D.

(Continued on page 23)

For the 4th year, the AAGL will be awarding a deserving member with the prestigious Violet Bowen-Hugh, M.D. Award for Women’s Health Awareness. The award is sponsored by the National Women’s Health Resource Center with funding from Ethicon Women’s Health and Urology.

In 1988, Violet Bowen-Hugh founded the National Women’s Health Resource Center

(NWHRC) with the mission to educate women about their health care options from an objective, comprehensive and supportive source. Today it is the premier, not-for-profit, one-stop source for women’s health information on the Web www.healthywomen.org. The NWHRC’s publications

and national health campaigns undertaken with a variety of nonprofit and corporate

partners, including the AAGL, reach women nationwide and internationally.

You can nominate a deserving member for the award. The criteria for the award is: a physician who has demonstrated long-term commitment or outstanding endeavors to increase women’s awareness of healthcare options especially in underserved areas.

Please submit your nominations to [email protected] for the committee to consider.

Women Healthcare Awareness Award Nominations Open

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23APR - JUN 2011

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Jennifer Hamm, M.D.Gerhardus Jakobus Hanekom, MBChBBrooke Hansen, M.D.Jessica Hardesty, M.D.Soyini Mattis Hawkins, M.D., MPHJennifer S. Hayes, D.O., FACOOGKendra D. Hayslett, M.D.Cpt Ryan J. Heitmann, M.D.Michelle S. Hellman, M.D.Craig Scott Herring, M.D., FACOGSarah Hessler, M.D.Karina E. Hew, M.D.Laurel Hibbs, M.D.Hiilary D. Hinshaw, M.D.Nina Hinting, M.D.Mai Phuong Hoang, MDAngela S. Holdman, M.D.Eun-Kyung Hong, M.D.Kathleen Hong, M.D.Shelly Yvonne Hook, M.D.Erica Hope, M.D.Jingwen Hou, M.D.Comfort Ibe, M.D.Azza Gouda Ibrahim, M.D.Katheryn Dixon Isham, M.D.Mohamedali Ismailjee, M.D.Olga Jackson, M.D.Clyde Tyrone Jacob, III, M.D., FACOGTorri Janecek, D.O.Bryan S. Jick, M.D.Zhang Jie, M.D.Kelly Jirschele, D.O.Jennifer A. Jocko, M.D.Andreana Johnson, M.D.Marian Symmes Johnson, M.D.Dawn Janelle Jones, M.D.Jason M. Joseph, M.D.Renu Joshi, M.D.Natalie Milagros Jouve, M.D.Michele Justice, M.D.Amanda Nicole Kallen, M.D.Dhivya Kannabiran, M.D.Joshua D. Kapfhamer, M.D.Amanda L. Kappenman, M.D.James Kappenman, M.D.Kathryn Anne Karges, M.D.Brian Alan Karre, M.D.Jennifer Kawwass-Thompson, M.D.Andrea L. Keller, M.D.William J. Kellett, D.O.Vanessa Kennedy, M.D.Staci Nichole Kenner, M.D.Emily Iris Kenny, M.D.Christina Kerr, B.Sc., M.D.Behrooz Khalili, M.D.Aliya Ibrahim Khan, M.D.Shaheen Khazali, M.D.Kimberly Kilfoyle, M.D.S. Kin, M.D.Jordana Kincey, M.D.Taras P. Kindrat, M.D.Annaliese Elaine Kistler, M.D.Vanessa L. Knoedler, M.D.Guillermo Kohn, M.D.Helen Kok, M.D., Ph.DChristine Koo, M.D.Logan John Kracht, M.D.Sandra Krizmanich, M.D.Pradeep Kulkarni, M.D.Christina L. Kushnir, M.D.

Nathan D. Kwan, M.D.Kyeung Ik Kwon, M.D.Michelle Monique Lacasse, M.D.Avani Lakhani, M.D.Mary Ramez Langenstroer, M.D.Michael Lanham, M.D.Kathryn Lannert, M.D.Marilyn K. Laughead, M.D., FACOGAntonella Lavelanet, D.O., JDTien Le, M.D., FACOG, FRCSCPaul Le Roux, M.D.Melissa Lee, M.D.Xing Leng, M.D.Tamara Ann Leonard, M.D.Tammy Leriche, M.D.Collette Lessard, M.D.Courtney Habbersett Levenson, M.D.Heather Ilyssa Levin, M.D.Christa Lewis, D.O.Jane Serene Limmer, M.D.Stephanie Norris Lin, M.D.Emily Linklater, D.O.Thomas Patrick Littlefield, M.D., MPHLindsey Longerot, M.D.Megan Loring, M.D.Kimberley Louie, M.D.Amy L. Lysy, M.D.James A. MacDonald, M.D.Haroldo Macedo, M.D.Natashia Madrid, D.O.Rosa Magalios, M.D.Anil Ashok Magdum, M.D.Alexandra Mainiero, M.D., MPHRavindhra C. Mamilla, M.D.Sharon Elizabeth Marcanthony, M.D.Becca J. Marks, M.D.Ballarin Martin, M.D.Johnny Lee Mayes, Jr., M.D.Sheri Maynard, M.D.Craig A. Mayr, M.D., Ph.DRuth McGaffigan, M.D.Garth McIntyre, M.D.Rosa Alicia J. Melendrez, M.D.Joselyn Mercado, M.D.Megan Mietelski, M.D.Audrey Frances Miller, M.D.Ashley Miller Canizaro, M.D.Nicholas Mills, M.D.Vineet V. Mishra, M.D.Sheona Mitchell, M.D.Michelle H. Moniz, M.D.Enrique Montanez Nucamendi, M.D.Obiamaka Mora, M.D.Tatiana Morales, D.O.Yusef Morant-WadeMolly Moravek, M.D., M.P.H.Veronique G. Moreau, M.D.Jaime Roberto Mosquera, M.D.Colleen Mullin, M.D.Andrew M. Muskus, II, M.D., FACOGBrandi Michelle Musselman, M.D.Nimesh P. Nagarsheth, M.D.Deepti Nahar, M.D.Reina Nakamura, D.O.Sarah Newbold Cross, M.D.Song Le Nguyen, M.D., FACOGCaroline Nitschmann, M.D.Aisha Nnoli, M.D.James Leonard Nodler, M.D.Nkechinyere Nwaobasi, M.D.

Albert E. Odom, Jr., M.D.Jacqueline O. Ogutha, M.D.Sallie Oliphant, M.D.Ceyda Oner, M.D.Shaun Erin O’Toole, M.D.Kellee Ott, M.D.Tracey L. Owensby, M.D.Trina Pagano, M.D., FACOGDaniel Paik, M.D.Ashwini Prakash Pandit, M.D.Hyun Jong Park, M.D.Meera Patel, D.O.Rachel Paulino, M.D.Kiran Perkins, M.D.Tabitha Perry, M.D.Stephanie Pickett, M.D.Bruce R. Pierce, M.D., FACOGMark Allen Plunkett, M.D.Ireneusz Polac, M.D.Eugenia Politis, M.D.Borzouyeh Poursharif, M.D.Rebecca Previs, M.D.Stefano Prigione, M.D.Afshan Fadel Qazi, M.D.Mohammad Quayyum, M.D.Yarini Quezada, M.D.Michelle Quinones, M.D.Michal Radwan, M.D., Ph.D.Sheila Ramgopal, M.D., MAOlga A. Ramm, M.D.Raschelle Leanne Ramsey, M.D.Meghan Rattigan, D.O.Adrienne L. Ray, M.D.Erin D. Reardon, D.O., MPHJennifer P. Reason, D.O.David E. Reichman, M.D.Marie Claude Renaud, M.D.Aldo Meneses Rios, Jr., M.D.Colleen Rivard, M.D.Fernando Jose Roca, M.D.Ana M. Rodriguez, M.D.Ednise M. Roman-Ruperto, M.D.Pierina Rosales, M.D.Kari Rudinsky, M.D.Shawna Marie Ruple, M.D.Rachel Ruskin, M.D.Kerry Rut, D.O.Miriam Ruth, M.D.Marianne Ryan, PT, OCSSara Sakamoto, M.D.Amber Saloum, M.D.Adam Thomas Sandlin, M.D.Suma Shastry Satya, M.D.Joycelyn Schindler, M.D.Jennifer Renee Schmidt, D.O.Elise Schnose, MFDavid B. Schwartz, M.D.Katherine Scolari, M.D.Eirwen M. Scott , M.D.Erin Seifert, M.D.Kavita Shah, M.D., MBENeel T. Shah, M.D., M.P.P.Marianne Shantillo, D.O.Sa Cara Danielle Shaw, M.D.Rachel Shepherd, M.D.Amanda Gail Sherman, D.O.Seunghyuk Shim, M.D.Mamdouh Shoukrey, M.D.Raj Shree, M.D.Jessica Buczek Shuman, M.D.

Mark Silvestri, M.D.Elise Jensen Simons, M.D.Sareena Singh, M.D.Amita Arun Singla, M.D., FRACOGKaren Slabas, M.D.D. David Snider, M.D., FACOG, FRCSCEvelen Soliman, D.O.Sara J. Soto, M.D.Luigi Spagna, M.D.Carissa Sparrow, M.D.Catherine Marie Stark, M.D.Latasha Kaye Steele, M.D.Amanda Stevens, M.D.Ashley-Ann Storms, M.D.Brayan Stuart, M.D.Olga Swanson, M.D.James B. Szender, M.D.Baby Sireesha Talapaneni, M.D.Elena Tanner, M.D.Flavia Wajnsztajn Theil, M.D.May S. Thomassee, M.D.Cara Thompson, D.O.Lisa Ann Thum, M.D.Sarah Todd, M.D.Tatsuhiko Tokumine, M.D.Karen A. Toppi, M.D.Pai Jong Stacy Tsai, M.D., MPHEnrica Tse, M.D.Jack W. Tubbs, Jr., M.D.Randi Turkewitz, M.D.Lindsay Turner, M.D.Morris Edward Turner, M.D.Nancy Parrish Utley, M.D.David Uyeno, M.D.Cord R. Valentine, M.D.Jenny Leigh Van Winkle, M.D.Usha Verma, M.D.Marco Villalobos-Cid, M.D.Sonali Vora, M.D.Patrice C. Walker, M.D.Janelle Jana Warmington, M.D.Michiaki Watanabe, M.D., Ph.D.Erin Megan Watson, M.D.Sacha Junius Wax, M.D.Kristi Lyn Weaver, D.O.Kim Westbrook, M.D.Joy Elizabeth Wheat, M.D.D’Nyce L. Williams, M.D., FACOGOlufolakemi Williams, M.D.Megan Shaw Wilson, M.D.Stacy E. Wilson, M.D.Heather Sue Wolff, M.D.Kathy Wood, M.D.Kerry Wright, D.O.Michelle Wright, M.D.Alison Wu, M.D.Sabrina Yan, M.D.Shih-Ern Yao, M.D.Christina Yarrington, M.D.Jessica Ybanez- Morano, M.D.Robert Ware Yelverton, Jr., M.D.Nuri Yildirim, M.D.Linda Yu, D.O.Bohyon Yun, M.D.Anat Zelmanovich, M.D.Richard James Zigrossi, M.D.Alissa Zuellig, M.D.Hallina Maria Zyczynski, M.D.

Welcome New Members (Continued from Page 22)

PERIODICALS

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CYPRESS, CA

6757 Katella AvenueCypress, California 90630-5105Tel 714.503.6200 Fax 714.503.6201E-mail [email protected] • Web site www.aagl.org

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The following educational meetings are sponsored by, in affi liation with, or endorsed by the AAGL.

Offered Each Month in 20111st International Post Graduate Course

in Minimally Invasive GynecologySirio Libanes Hospital • Sao Paulo, Brazil

August 19, 2011Comprehensive Program in Operative

Hysteroscopy and Endometrial AblationLong Island Marriott Hotel and Conference Center

Uniondale, New York

August 26-27, 20112nd Annual Course in Minimally Invasive

Hysterectomy: A Comprehensive Review of Techniques including Live Telesurgeries & Laparoscopic Suturing

University of Louisville/21C Museum Hotel Louisville, Kentucky

September 17, 2011Adding Offi ce Hysteroscopy to Your Practice

(Non CME • Residents Only)The Advanced Gynecologic Surgery Institute

Chicago, Illinois

October 14-17, 2011Update in Minimally Invasive

Gynecologic SurgeryFairmont Copley PlazaBoston, Massachusetts

December 9-11, 20116th AAGL International Meeting in partnership

with the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy

and in association with the 12th APAGE Annual Scientifi c Meeting

Osaka, Japan

January 20-23, 20128th Annual Optimizing Minimal

Access GynecologyMarriott Harbor BeachFort Lauderdale, Florida

April 25-28, 20127th AAGL International Congress on Minimally Invasive Gynecology in conjunction with the

Argentine Society of Laparoscopic Surgery (SACiL)Buenos Aires, Argentina

June 27-July 1, 20128th AAGL International Congress on

Minimally Invasive Gynecology in conjunction with the

Romanian Society of Minimally Invasive Surgery in Gynecology

Bucharest, Romania

April 9-13, 20139th AAGL International Congress on

Minimally Invasive Gynecology in conjunction with the South African Society of Reproductive Medicine and

Gynaecological EndoscopyCape Town, South Africa

Education Calendar

November 6-10, 201140th AAGL Global Congress of

Minimally Invasive GynecologyThe Westin Diplomat • Hollywood, Florida

November 5-9, 201241st AAGL Global Congress of

Minimally Invasive GynecologyCaesars Palace • Las Vegas, Nevada

November 10-14, 2013 42nd AAGL Global Congress of Minimally Invasive Gynecology

Gaylord National Resort & Convention Center on the Potomoc • National Harbor, Maryland

Registration OpensJuly 15, 2011 www.aagl.org

AAGL Annual Meetings