by Philippe Koninckx | Oct 9, 2012 | 3 Bekkenbodem
Are meshes dangerous for pelvic floor repair ? Hieronder wordt uitgelegd waarom het onverstandig is een ingreep voor bekkenbodemherstel te laten uitvoeren door een niet laparoscopisch chirurg. Why FDA recommendations are insufficient. SUMMARY OF RECOMMENDATIONS (for full data see article ) click to read full article For surgeons who do not currently perform transvaginal placement of surgical mesh for pelvic organ prolapse, but wish to begin performing this procedure: a. General knowledge should be documented either by completing a fellowship training program in Urogynecology, Female Pelvic Medicine and Reconstructive Surgery, or Female Urology or by completing adequate CME in pelvic anatomy and reconstructive pelvic surgery. b. Specific knowledge for a particular procedure should be obtained c. Skill may be documented by surgeons who have completed a Urogynecology, Female Pelvic Medicine and Reconstructive Surgery or Female Urology fellowship program via cases lists showing experience with transvaginal placement of surgical mesh for pelvic organ prolapse. Surgeons who do not have documentation of prior training with a specific transvaginal mesh prolapse procedure should be proctored on no fewer than 5 procedures or as many as is necessary to demonstrate that they can independently perform the specific procedure. d. Experience in treating women with pelvic floor disorders should be documented either by completing a fellowship training program in Urogynecology, Female Pelvic Medicine and Reconstructive Surgery or Female Urology or by demonstrating that they offer a full spectrum of surgical options for pelvic floor disorders and that surgery for pelvic floor disorders represents >50% of their surgical practice including a minimum of 30 surgical cases for pelvic organ prolapse annually. e. Demonstrate experience and...
by Philippe Koninckx | May 16, 2011 | 1 Endometriose, 2 Hysterectomie, 3 Bekkenbodem
Published on AAGL listserv. RCTs have not been performed, nor will be performed , in order to document the incidence and the prevention of small bowel herniation in trocar sites. Indeed it is a rare complication and for obvious ethical reasons trials will not be performed. The evidence therefore can only be circumstantial. We would try to summarise as follows our attitude. 1. The risk of small bowel herniation is believed to depend on trocar diameter and on the surgical lesion caused by trocar insertion. 2. Unfortunately I am not aware of evidence that the risk of small bowel herniation is decreased by the use of conical trocars instead of sharp triangular trocars or by the use of the Termanian trocar. This could be expected given a smaller trauma as demonstrated years ago by Malcom Munro. 3. For the first intra publical trocar the risk seems so low that most of us will not suture the fascia. A plausible explanation could be that the insertion is generally slightly oblique and that hte insertion thus closes by a flap valve mechanism. For this reasons, we only close the fascia of the first trocar insertion when either the patient is extremely thin or afther the incision has been enlarged for specimen retrieval. 4. For the secondary trocars which are inserted perpendicularly (in order to permit eventual backloading of sutures) we do not close the fascia for 5 mm ports but always close them when 10mm or larger ports were used. 5. The biggest clinical challenge, however, is the diagnosis of a small bowel herniation since symptomatology is insidious. For this reason, we advocate an early repeat laparoscopy whenever a patient does not improve progressively after laparoscopic surgery. This will permit...
