ENDOSCOPIC SLIDE Flyer - AGES

Australian 

Gynaecological 

Endoscopy 

Society Ltd 

President AGES: 

Dr Robert O'Shea 

in association with the 

Asia Pacific Association 

of Gynecologic Endoscopy and 

Minimally Invasive Therapy 

President APAGE: 

Assoc. Prof. P M Yuen 

Chairman: 

Co-Chairman: 

Scientific Chairman: 

Assoc. Prof. Alan Lam 

Prof. Felix Wong 

Dr Geoffrey Reid 

Organising Committee: 

>>>>THE LIMITS OF 

ENDOSCOPIC SURGERY 

– An AGES Meeting in association with APAGE 

Dr Robert O'Shea 

Prof. Chyi-Long Lee 

Dr Greg Cario 

Dr Jim Tsaltas 

Assoc. Prof. P M Yuen 

18 & 19 AUGUST 2006>>>>>>>>>>> 

Program and Abstracts 

Platinum sponsor of AGES 

Major Sponsor of AGES

AGES gratefully acknowledges the following 

companies which have supported this conference: 

Platinum Sponsor of AGES 

Major Sponsor of AGES 

Major Sponsor of AGES ‘Limits 

of Endoscopic Surgery 2006’ 

Exhibitors 

Fisher & Paykel 

Olympus 

American Medical Systems 

Applied Medical 

B Braun Australia 

Bard Australia 

ConMed Linvatec 

Cook Australia 

Cytyc (Australia) 

Device Technologies 

Endocorp 

Experien 

Gyrus ACMI 

InSight Oceania 

Mayne/Symbion Health 

N. Stenning & Co. 

Smith and Nephew 

Sydmed

CONTENTS 

>>>>>>>>> 

Faculty and Committee Members 2 

Welcome Message 3 

The Limits of Endoscopic Surgery 4 

Conference Program 

Abstracts – Friday 18 August 10 

Abstracts – Saturday 19 August 19 

Abstracts: Free Communications 23 

– Friday 18 August 


– Saturday 19 August 


Poster Exhibition 

PR&CRM Points - CPD Points 

The Conference has been approved as a RANZCOG Approved 

O&G Meeting and eligible Fellows of the College will earn points 

for attendance as follows: 

Full attendance: 18 CPD points in the Meetings category. 

Attendance one day: 9 CPD points 

Attendance at each breakfast session: 1 additional CPD point 

Completion of Pre- and Post- Questionnaires: 5 PR&CRM points 

Delegates will be required to sign the attendance sheet prior to 

morning tea on both Friday 18 and Saturday 19 August. 

Pre- and Post- Questionnaires 

The College approved Pre- and Post- Questionnaires are 

comprised of a number of multiple choice questions from 

lectures to be given on Friday 18 and Saturday 19 August. 

The Pre- Questionnaire is to be handed in at morning tea on 

Friday 18 August. The Post- Questionnaire is to be handed in 

at the close of the Meeting. No exceptions can be made to 

these deadlines. 

Breakfast Sessions 

Please refer to conference program. Pre-booking is essential at 

the registration desk. Hot breakfast is included. 

>>>>>>>> THE LIMITS OF 


1

Conference Committee 

>>>>>>>>>>> 

AGES Board 

Assoc. Professor Alan Lam 

Professor Felix Wong 

Dr Geoff Reid 

Dr Robert O’Shea 

Professor Chyi-Long Lee 

Dr Greg Cario 


Assoc. Professor Pong Mo Yuen 

>>>>>>>>>>> 

International Faculty 

Chairman 

Co-Chairman 

Scientific Chairman 


Assoc. Professor Alan Lam 


Dr Geoffrey Reid 

Dr Greg Cario 

Dr Jenny Cook 

Professor David Healy 

Dr Krish Karthigasu 

Assoc. Professor Chris Maher 

Dr Anusch Yazdani 

Australian Faculty 

President 

Vice President 

Hon. Secretary 

Treasurer 

Professor Masaaki Andou 

Dr Pongsakdi Chaisilwattana 

Dr SM Bernard Chern 

Dr Wachyu Hadisaputra 

Professor Hiroshi Hoshiai 

Professor Kuan-Gen Huang 

Professor Chyi-Long Lee 

Professor Bao-Liang Lin 

Dr Leslie Lo 

Dr Foo Hoe Loh 

Professor Prashant Mangeshikar 

Professor Joo-Hyun Nam 

Dr Regta Pichay 

Dr Shailesh Puntambekar 

Dr Kai Y See Tho 

Professor Osamu Tsutsumi 

Assoc. Professor Pong Mo Yuen 

Professor Enlan Xia 

>>>>>>>>>>> 

AGES Secretariat 

– Conference Organiser 

Michele Bender, Director 

Conference Connection 

Phone: +61 2 9967 2928 

Fax: +61 2 9967 2627 

Mobile: +61 411 110 464 

E-mail: 

Mail: 

Japan 

India 

Singapore 

Indonesia 

Japan 

Taiwan 

Taiwan 

Japan 

Hong Kong 

China 

India 

Korea 

Phillipines 

India 

Singapore 

Japan 

Hong Kong 

China 

conferences@ages.com.au 

282 Edinburgh Road 

CASTLECRAG NSW 2068 AUSTRALIA 

Dr Jason Abbott 

New South Wales 

Dr Alison Brand 


Dr Linda Calabresi 


Dr Greg Cario 


Professor Jonathan Carter New South Wales 

Dr Danny Chou 


Dr George Condous 


Dr Jenny Cook 

South Australia 

Dr Michael Cooper 


Dr Alan Ferrier 


Dr Robert Ford 


Professor Neville Hacker New South Wales 

Professor David Healy 

Victoria 

Professor Roger Houghton New South Wales 

Dr Thomas Hugh 


Professor Robert Jansen New South Wales 

Dr Krish Karthigasu 

Western Australia 

Dr Andrew Korda 


Assoc. Professor Alan Lam New South Wales 

Dr Kenneth Loi 


Assoc. Professor David Lubowski New South Wales 

Dr Stuart Lyon 

Victoria 

Assoc. Professor Chris Maher Queensland 

Dr David Molloy 

Queensland 

Dr Matthew Morgan 


Assoc.Professor Andreas Obermair Queensland 


South Australia 

Dr Geoff Reid 


Dr Frank Stening 


Dr Hugh Torode 



Victoria 

Assoc. Professor Thierry Vancaillie New South Wales 

Professor Felix Wong 


Dr Anusch Yazdani 

Queensland 

2 


ENDOSCOPIC SURGERY

Welcome 

AGES President and Conference Chairman 

Dear Colleagues, 

On behalf of the Australian Gynaecological Endoscopy Society, we would like 

to warmly welcome everyone to the inaugural joint meeting between AGES 

and the Asia-Pacific Association of Gynaecologic Endoscopy and Minimally 

Invasive Therapy (APAGE). 

Together, at this beautiful and luxurious Westin hotel, we will put the LIMITS 

OF ENDOSCOPIC SURGERY under endoscopic scrutiny. 

In the last decade, the practice of gynaecological surgery has witnessed an 

‘endoscopic revolution’, brought about by improved imaging technology, 

advances in surgical skills, modern energy sources, and perhaps most 

importantly a greater understanding of pelvic anatomy. Like pioneers 

exploring the uncharted waters of the world during the last millennium, 

pelvic surgeons have explored, tested, described and successfully 

performed almost every open gynaecological procedure endoscopically. 

How far have we come, what can be done, what should be done, how 

effective, at what costs, risks and benefits are fundamentally important 

questions we hope to address and discuss together at this meeting over 

the next two days. 

We are delighted to have brought together an outstanding faculty of national 

and international speakers to present their techniques, dissect evidence, 

analyse published results, and debate the ‘limits of endoscopic surgery’. We 

are also thrilled to have received an unprecedented number of free 

communications which have filled the 4 sessions on each of the two days of 

the conference. We are delighted that these not only come from AGES 

members, but also from many international registrants to this meeting. 

Once again, our warmest welcome to all AGES members and to all 

colleagues from neighbouring countries who are APAGE members and those 

who are not but have come to participate in this conference and enjoy the 

best harbour city in the world. 

Best wishes 

Alan Lam 

Conference Chairman 

AGES Vice President 

Robert O’Shea 

President AGES 



3

THE LIMITS OF 


2006>>>>>>>>> 

FRIDAY 18 AUGUST 2006 

THE BALLROOM 

WESTIN SYDNEY 

0700 – 0800 OPTIONAL BREAKFAST SESSION 

NOVASURE ENDOMETRIAL ABLATION 

SYSTEM INFORMATION & OVERVIEW 

Sponsored by Cytyc 

HERITAGE BALLROOM – LEVEL 6 

Technology overview & contra-indications 

T Vancaillie 

Procedure steps including anaesthesia 

requirements 

J Abbott 

Clinical data and worldwide results 

T Vancaillie 

Post-op care and management of complications 

J Abbott 

0730 – 0800 Conference Registration 

0800 – 0805 WELCOME AND OPENING 

R O’Shea A Lam PM Yuen 

0805 – 0930 SESSION 1 

HYSTERECTOMY 

Sponsored by Stryker 

Chairs: R O’Shea, PM Yuen 

0805 – 0820 DVD presentation on laparoscopic 

hysterectomy 

KY See Tho 

0820 – 0835 Anatomical and technical limits to 

laparoscopic hysterectomy 

A Lam 

0835 – 0850 Limits to the uptake of laparoscopic 

hysterectomy Training, costs and 

consumer demand 

D Molloy 

0850 – 0905 What are the safety concerns with 

laparoscopic hysterectomy, and how can 

they be overcome 

G Cario 

0905 – 0920 The consumer’s view – why should I 

have a laparoscopic hysterectomy, is it 

safe, how many have you done, where 

did you do your training and what are 

your statistics 

L Calabresi 

0920 – 0930 Panel - Questions 

0930 – 1015 SESSION 2 

NOVEL APPROACHES 


Chairs: M Cooper, J Cook 

0930 – 0945 Laparoscopic ovarian transposition 

KG Huang 

0945 – 1000 Laparoscopic ureteric reimplantation 

M Andou 

1000 – 1015 Laparoscopic uterine artery ligation 

CL Lee 

1015 – 1045 Morning Tea and Trade Exhibition 

1045 – 1230 SESSION 3 

UTERINE FIBROIDS 

Sponsored by Johnson & Johnson Medical 

Chairs: H Torode, B Chern 

1045 – 1115 DVD presentations on laparoscopic 

myomectomy and hysteroscopic myomectomy 

The monster myoma 

Hysteroscopic myomectomy 

R Ford 

BL Lin 

1115 – 1135 What are the limits of endoscopic 

myomectomy 

J Tsaltas 

1135 – 1155 Endoscopic myomectomy – outcomes 

and fertility issues 

D Healy 

1155 – 1215 Current non-surgical approaches to fibroids 

S Lyon 

1215 – 1230 Panel-Questions 

1230 – 1330 Lunch and Trade Exhibition 

1330 – 1430 SESSION 4 

4 simultaneous free 

communications sessions 

1330 – 1430 FREE COMMUNICATIONS A 

LAPAROSCOPIC HYSTERECTOMY 

BALLROOM 3 

Chairs: F Wong, R Pichay 

1330 – 1340 Total laparoscopic hysterectomy (type I/II/III): 

A review and complications of 245 cases 

Park Y 

1340 – 1350 The Biswas uterine elevator and cup for use in 


Soo S, Merkur H 

1350 – 1400 The plasma trissector at laparoscopic 

hysterectomy – a video presentation 

Soo S, Merkur H, Hardas G 

1400 – 1410 A modified technique of LAVH using a Biswas 

uterovaginal elevator (BUVE) for uteri weighing 

500 gm or more 

Lee ETC, Wong FWS 

1410 – 1420 Total laparoscopic hysterectomy: Intention to 

treat ongoing prospective trial 

Condous GS, Lam A 

4 



PROGRAM 

1420 – 1430 An enlarged uterus is not a contraindication to 

performing total laparoscopic hysterectomy: 

age matched control study 


1330 – 1430 FREE COMMUNICATIONS B 

LAPAROSCOPIC ONCOLOGY 

BALLROOM 4 

Chairs: C Maher, H Liddell 

1330 – 1340 Laparoscopic Approach to Carcinoma of the 

Endometrium (LACE) 

Obermair A, Gebski V, Forder P, Jackson D, 

Williams G, Janda M 

1340 – 1350 Completely total laparoscopic radical 

hysterectomy for invasive cervical cancer; 

Initial reports 

Lee YS, Lee JM, Kim BS, Cho YL, Park IS 

1350 – 1400 Laroscopic assisted vaginal hysterectomy 

versus abdominal hysterectomy in patients with 

early stage endometrial cancer: 

10 year experience 

Nam JH, Yoon J, Kim DY, Suh DS, Kim JH, 

Kim YM, Kim YT 

1400 – 1410 Laparoscopic Radical Trachelectomy (LRT) 

in Korea 

Nam JH, Kim JH, Kim DY, Suh DS, Kim YM, 

Kim YT, Kim SH, Kim DJ, Kim YB 

1410 – 1420 Comparison of laparoscopically –assisted 

radical vaginal hysterectomy and radical 

abdominal hysterectomy in the treatment of 

cervical cancer 

Lee JW, Kim WY, Choi CH, Kim TJ, Kim BG, 

Lee JH, Bae DS 

1420 – 1430 Successful pregnancy after conservative 

treatment of stage IA endometrial carcinoma 

early detected by hysterofiberscopy 

Matsumi H, Nakabayashi M, Ohnuki H, 

Horiya M, Tajima Y, Mizuguchi K, Nishii O 

1330 – 1430 FREE COMMUNICATIONS C 

HYSTEROSCOPY 


Chairs: A Yazdani, P Chaisilwattana 

1330 – 1340 Hysteroscopic metroplasty for unicornuate 

uterus to improve reproductive outcome 

Tandulwadkar S, Margale A 

1340 – 1350 A randomised controlled trial comparing 

Microwave Endometrial Ablation (MEATM) and 

Mirena® (levonorgestrel-releasing intra-uterine 

device) in the treatment of menorrhagia. 

Behnia-Willison F, Cook J, Seman EI, Lam C, 

Manifold E, Agniewska , O’Shea RT 

1350 – 1400 Endoscopic surgery for previous cesarean 

section scar induce menorrhagia 

Shih CL, Lin WC 

1400 – 1410 Outpatient hysteroscopy: a review of 225 cases 

Cameron M, Bickerstaffe C, Readman E, 

Maher P 

1410 – 1420 The diagnosis & management of 

intra-uterine pathology 

Lyons SD, Kingston AJ, Abbott JA, Vancaillie TG 

1420 – 1430 The occurrence and outcome of 39 pregnancies 

after 1621 cases of transcervical resection of 

endometrium (TCRE) 

Xia E, Li TC, Yu D, Huang X , Zheng J, Liu Y, 

Zhang M 

1330 – 1430 FREE COMMUNICATIONS D 

OVARIAN & ADNEXAL DISEASE 

BARNET ROOM – LEVEL 6 

Chairs: R Ford, S Puntambekar 

1330 – 1340 Role of laparoscopy in ovarian tumours 

Sathe R, Puntambekar S 

1340 – 1350 Preoperative discrimination between benign and 

malignant ovarian cysts treated surgically in an 

Australian tertiary centre 

Daly JO, Huang A, Ang WC, Healey M 

1350 – 1400 Hydrodissection in laparoscopic surgery of 

ovarian pregnancy 

Chang Y 

1400 – 1410 Laparoscopic management of twisted adnexa in 

infertile woman 


1410 – 1420 Laparoscopic detorsion and oophoropexy for 

treatment of ovarian torsion 

Tan YT, Lyons SD, De Decker AP, Vancaillie TG 

1420 – 1430 A medical management of interstitial ectopic 

pregnancy: A five year clinical study 

Tang A, Baartz D, Khoo SK 

1430 – 1600 SESSION 5 

GYNAECOLOGICAL ONCOLOGY 

Sponsored by tyco Healthcare 

Chairs: R Houghton, KG Huang 

1430 – 1500 DVD presentations on aspects of 

laparoscopic oncology 

Radical hysterectomy for cervical cancer 

CL Lee 

Radical surgery for ovarian cancer M Andou 

Pelvic exenteration 

S Puntambekar 



5

THE LIMITS OF 


2006>>>>>>>>> 

1500 – 1515 Comparison of laparoscopic radical 

hysterectomy and abdominal radical 

hysterectomy in patients with early 


JH Nam 

1515 – 1530 Evidence-based approaches to endoscopic 

management of gynaecological cancer 

A Ferrier 

1530 – 1600 Hypothetical issues for debate – What are the 

obstacles to the uptake of laparoscopic surgery 

in gynaecological oncology 

Moderator: N Hacker 

Panel: J Carter, A Brand, JH Nam, 

A Obermair, CL Lee 

1600 – 1630 Afternoon Tea and Trade Exhibition 

1630 – 1800 SESSION 6 

PELVIC FLOOR REPAIR 


Chairs: G Cario, P Chaisilwattana 

1630 – 1700 DVD presentation on laparoscopic pelvic 

floor repair, anterior paravaginal repair 

and total pelvic floor repair with mesh 

D Chou R O’Shea 

1700 – 1715 Evidence-based surgery for pelvic 

organ prolapse 

C Maher 

1715 – 1730 What are the limits of endoscopic surgery for 

pelvic organ prolapse T Vancaillie 

1730 – 1745 Morbidity associated with pelvic floor repair 

A Korda 

1745 – 1800 Panel – Questions 

1800 Close 

SATURDAY 19 AUGUST 2006 

THE BALLROOM 

WESTIN SYDNEY 

0700 – 0800 OPTIONAL BREAKFAST SESSION 

ADVANCES IN LAPAROSCOPIC SURGERY 



0700 – 0715 Total laparoscopic hysterectomy and results 

A Obermair 

0715 – 0730 Total laparoscopic hysterectomy – converting 

from LAVH to TLH with the McCartney Tube 

J Tsaltas 

0730 – 0745 Complications of TLH R O’Shea 

0745 – 0755 Panel discussion 

Convenor: 

A Lawrence 

0800 – 1000 SESSION 7 

ENDOMETRIOSIS 


Chairs: O Tsutsumi, J Tsaltas 

0800 – 0830 DVD presentation on the anatomical and 

technical aspects of resection of 

endometriosis – Ovarian, Pouch of 

Douglas, recto-sigmoid and vesicoureteric 

disease 

A Lam 

M Andou 

0830 – 0845 Can endometriosis surgery improve 

quality of life 

J Abbott 

0845 – 0900 Uterine sparing approaches to adenomyosis 

GD Reid 

0900 – 0915 When, how and by whom should bowel 

resection for endometriosis be performed 

M Morgan 

0915 – 0930 Ovarian reserve after endometriosis surgery 

FH Loh 

1900 Coach transportation from 

The Westin Sydney to King Street Wharf 

1930 – 2300 Cocktail Reception 

& Gala Conference Dinner 

Sydney Glass Island 

Harbour Cruise 

2300 Coach transportation from 

King Street Wharf to The Westin Sydney 

0930 – 1000 Should the primary treatment for endometriosisrelated 

infertility be surgery of IVF 

R Jansen 

1000 – 1030 SESSION 8 

PLENARY LECTURE 

Chair: D Healy, EL Xia 

What’s best for our patients 

1030 – 1100 Morning Tea and Trade Exhibition 

A Brand 

6 



PROGRAM 

1100 – 1200 SESSION 9 

LAPAROSCOPY IN DIFFICULT 

CIRCUMSTANCES 


Chairs: C Maher, L Lo 

1100 – 1120 Laparoscopy in pregnancy PM Yuen 

1120 – 1140 Laparoscopy in the morbidly obese patient 

K Loi 

1140 – 1200 The unwell patient after laparoscopy 

F Stening 

1200 – 1300 SESSION 10 

ADHESIONS 


Chair: D Molloy 

Transponder Session 

Case presentation: 

Adhesiolysis for chronic pain – a 

medico-legal dilemma 

Presenter: 

Moderator: 

K Karthigasu 

D Molloy 

Questions to the audience and panel 

Panel: T Hugh, A Korda, 

F Stening, D Lubowski, 

M Cooper, A Lam, 

FH Loh, S Evans 

1300 – 1400 Lunch and Trade Exhibition 

1400 – 1515 SESSION 11 

4 simultaneous free 

communications sessions 

1400 – 1515 FREE COMMUNICATIONS E 

ENDOMETRIOSIS 

BALLROOM 3 

Chairs: O Tsutsumi, J Cook 

1400 – 1410 Is history taking important in women with 

suspected endometriosis 


1410 – 1420 Outpatient pelvic examination in the woman 

with endometriosis – do abnormal findings 

correlate with the presence of rectal disease 

Burke C, Karthigasu K, Hart R, Garry R 

1420 – 1430 Saline infusion vaginography 

(sonovaginography): can we predict rectovaginal 

endometriosis 


1430 – 1440 Laparoscopic resection of bowel endometriosis 

Shukla-Kulkarni A, Johnston K, Cooper M, Reid G 

1440 – 1450 Outcomes of patients requiring surgery for 

rectovaginal endometriosis 

Jagasia N, Ang WC, Chen F, Healey M 

1450 – 1500 Laparoscopic excision of endometriotic urinary 

bladder nodule 

Shashian T, Ahmed H, Tsaltas J 

1500 – 1510 Abdominal wall endometriosis 

Lam C, Seman EI, Behnia-Willison F 

1400 – 1515 FREE COMMUNICATIONS F 

COMPLICATIONS 

BALLROOM 4 

Chairs: G Reid, M Insull 

1400 – 1410 Preliminary experience in colon repair during 

laparoscopic assisted vaginal hysterectomy 

Koh LW, Sun YL, Chen SY, Huang MH 

1410 – 1420 Laparoscopic reanastamosis for low ureter 

injury 

Wu TP, Sa L, Lee CL 

1420 – 1430 Successful repair of vesico-vaginal fistula at the 

critical site under endoscopic guiding - A video 

presentation 

Lee JC, Lin WC, Yeh LS, Shih CL 

1430 – 1440 Vaginal vault evisceration after total 

laparoscopic hysterectomy: A presentation of 

12 cases 

Park Y, Lee CN, Chung C, Kim I, Chang T 

1440 – 1450 Ureteric injuries and their laparoscopic 

management 

Puntambekar S 

1450 – 1500 Complications of advanced gynaecological 

laparoscopic surgery 


1500 – 1510 A prospective multi-centre study of major 

complications experienced during excisional 

laparoscopic surgery for endometriosis 

Shukla-Kulkarni A, Kaloo PD, Cooper MJW, 

Reid G 

1400 – 1515 FREE COMMUNICATIONS G 

PROLAPSE & MISCELLANEOUS 


Chairs: J Abbott, PM Yuen 

1400 – 1410 Pre and post operative Magnetic Resonance 

Imaging (MRI) in women with multicompartment 

pelvic floor prolapse undergoing 

laparoscopic pelvic floor reconstruction 

Johnston KM, Cario G, Carlton M, Rosen D, 

Chou D, Raikes C, Moses D, Masters L 



7

THE LIMITS OF 

ENDOSCOPIC SURGERY2006>>>>>>>>>>> 

PROGRAM 

1410 – 1420 Vagina-assisted laparoscopic hystero-colpopexy 

with bilateral round ligaments shortening-the 

crucial anatomies and simplifying of technique 

Lin WC, Lee JC 

1420 – 1430 Our experiences in treating cases of uterine 

prolapse—Round ligament suspension 

with LAVH 

Wu CM, Kan YY 

1430 – 1440 Techniques of exposure in laparoscopy 

Thoma V, Waters N, Hummel M, Garbin O, 

Wattiez A 

1440 – 1450 Laparoscopic Workshops- Do they Work A 

study of the effectiveness of a laparoscopic 

suturing and knot tying workshop 

Karthigasu K, Hart R 

1450 – 1500 Laparoscopic myomectomy using the ACE 

harmonic scalpel – A video presentation 

Ahmed H, Shashian T, Tsaltas J 

1500 – 1510 Surgical approach and case selection in 

myomectomy 

Waters NV , Thoma V, Wattiez A 

1400 – 1510 FREE COMMUNICATIONS H 

MISCELLANEOUS 

BARNET ROOM – LEVEL 6 

Chairs: J Tsaltas, KY See Tho 

1400 – 1410 The effects of heated, humidified carbon dioxide 

in laparoscopy: a randomized, controlled trial 

Manwaring J, Cameron M, Readman E, Maher P 

1410 – 1420 Laparoscopic cervical cerclage for recurrent 

second trimester miscarriage 

Liddell HS, Stone PR 

1420 – 1430 The operative role of laparoscopy in chronic 

pelvic pain 

Hadisaputra W 

1430 – 1440 The rectus sheath block in preventing postoperative 

wound pain after laparoscopic 

gynaecological surgery 

Ng PS, Chan S, Sahota DS, Yuen PM 

1440 – 1450 Take 500 -the experience of laparoscopic 

entry amongst gynaecological surgeons of a 

single unit 

Burke C, Garry R, Hart R, Karthigasu K 

1450 – 1500 A modified method of laparoscopic 

presacral neurectomy for the treatment of 

midline dysmenorrhea 

Chang Y, Tsai E-M, Long C-Y, Lin W-C 

1500 – 1510 A case of secondary amenorrhea with disorder 

of the uterine cervix 

Lin CP, Chou CY 

1515 – 1545 Afternoon Tea and Trade Exhibition 

1545 – 1600 SESSION 12 

CONGENITAL ABNORMALITIES 

Chairs: H Hoshiai, K Karthigasu 

DVD – anatomical and technical aspects 

of laparoscopic surgery for correction of 

vaginal agenesis 

1545 – 1600 Vecchietti procedure M Cooper 

1600 – 1800 SESSION 13 

THE ADNEXAL MASS 


Chairs: J Carter, W Hadisaputra 

1600 – 1630 DVD presentations on dermoid cysts, 

hydrosalpinges, ovarian cysts including 

borderline ovarian tumours G Condous 

H Hoshiai 

1630 – 1645 The hidden dangers of the entrapped ovary 

P Mangeshikar 

1645 – 1700 Laparoscopic approaches to a suspicious 

adnexal mass 

F Wong 

Transponder Session 

Case presentation: 

1700 – 1745 The “suspicious” ovarian mass 

Presenter: K Karthigasu 

Moderator: R Houghton 

Questions to audience and panel 

Panel: C L Lee, N Hacker, F Wong, 

P M Yuen, D Molloy, FH Loh 

1745 – 1800 Close A Lam 

POSTER EXHIBITION 

BALLROOM 1 & 2 

All poster presentations will be available for viewing 

during morning and afternoon tea and lunch breaks 

during the Conference 

8 



CONFERENCE SOCIAL PROGRAM 

Cocktail Reception and Gala Dinner 

Sydney Glass Island Harbour Cruise 

departing King Street Wharf 

1900 till 2300 

Friday 18 August 2006 

Transportation from The Westin Sydney to King Street Wharf 

departs at 1900. 

Return transportation to The Westin Sydney departs at 2300. 

AGES PELVIC FLOOR SYMPOSIUM & WORKSHOP VII 2006 

AGES PELVIC FLOOR SYMPOSIUM & WORKSHOP VII 

Anatomy 

& Function 

of the Female Pelvic Floor 

17 & 18 November 2006 

Brisbane Australia 

Hilton Brisbane 

Australian 


Endosocpy 

Society Ltd. 

LIVE SURGERY 

CADAVERIC DISSECTION 

INTERACTIVE DISCUSSIONS 

International Guest Speakers: 

Professor John DeLancey USA 

Professor Michel Cosson FRANCE 

Platinum sponsor of AGES 


Chairman: Assoc. Professor Chris Maher 

Co-Chairman: Dr Anusch Yazdani 



9

PROGRAM ABSTRACTS 

>>>>>>>>>>> THE LIMITS OF ENDOSCOPIC SURGERY 

Laparoscopic hysterectomy 

– a viable surgery 

Friday 18 August / Session 1 / 0805 - 0820 

See Tho KY 

Laparoscopic hysterectomy in its various forms is now 17 years old. 

During these years, much have been written and debated about 

this operation. 

However, it has not established itself as a routine procedure for the 

general gynaecologist. It is still not the gold standard operation in the 

treatment of benign diseases of the female reproduction system. 

This presentation is a personal view and audit on laparascopic 

hysterectomy, and is derived from retrospective analysis of 363 

cases of hysterectomy performed by the author from April 1995 to 

Dec. 2005. 

Results: Hysterectomy by the laparoscopic method, be it 

laparoscopic assisted vaginal hysterectomy (LAVH) or total 

laparoscopic hysterectomy (TLH), was achieved in 303 cases 

(83.5%). Uterine fibroids and adenomyosis comprised some 

70% of cases. There were 5 malignancies. Uterine size ranged 

from 100 grams to 1350 grams, and the operating time from 90- 

210 minutes. 

Major complications were 3 cases of haemorrhage requiring 

transfusion, 2 cases of large bowel injury, 2 cases of ureteric injury 

and 2 bladder lacerations. Intraoperative conversion to laparotomy 

occurred in 9 patients. These conversions were not the result of 

organ injuries. 

Conclusion: Laparoscopic hysterectomy is a viable operation in the 

surgical management of benign pelvic pathology, and may even be the 

preferred method. 

Anatomical and technical limits to 



Lam A 

Laparoscopic hysterectomy is one of the most common major 

operations performed in the developed countries. It is an operation 

which, despite its commonness, continues to generate mixed 

feelings, emotions and perceptions in the mind of the public on the 

one hand, controversies and debates amongst surgeons in relation to 

indications, techniques and outcomes on the other. 

By and large, there is general consensus that the objectives of 

hysterectomy should be: 

• To remove pathology 

• To improve symptoms 

• To prevent or minimise morbidity and complications 

• To improve quality of life 

• In the case of malignancy, to save life 

Amongst the methods available to the surgeon, the choice revolves 

around the 3 routes: 

• Abdominal route 

• Vaginal route 

• Laparoscopic route 

The chosen route offered to every patient should be based on the 

principles of; 

• Safety 

• Efficiency 

• Reproducibility 

• Cost-effectiveness 

• Pain 

• Recovery 

• Length of hospitalization 

• Return to normal life 

• Long-term side-effects 

The evidence in the literature remains controversial and debates 

continue as to which route of hysterectomy is the preferred method. 

The surgeon needs to take into consideration the anatomical and 

technical factors which may present limits to every case in which 

laparoscopic hysterectomy is chosen as the primary approach. 

These may include: 

Anatomical factors: 

• Size 

• Shape 

• Mobility 

• Co-existing pelvic pathology 

• Previous surgery eg. C-section 

Technical factors: 

• Port placement 

• Access 

• Visibility 

• Knowledge and choice of energy sources 

• Dissection skills 

• Bladder dissection 

• Ureteric dissection 

• Suturing skills 

10 



FRIDAY 18 AUGUST 

THE LIMITS OF ENDOSCOPIC SURGERY



procedure into a new unsafe procedure. The pitfalls relate to a 2D 

optical system, an inability to touch and feel in a conventional way and 

also the possibility of being disorientated in this new often “virtual” 

environment. Practise, practise, practise is the way to overcome this 

small pitfall. 

I think that a hidden pitfall of laparoscopic hysterectomy is that 

apart from being trendy and having all the advantages of minimally 

invasive surgery we must make sure that this technique is 

commercially viable and also attractive to our health care dollar 

managers and this means optimising disposables and making sure 

that bed stays are efficient. After the learning curve has been 

negotiated, the operation properly choreographed and a successful 

theatre team established, the procedure should not take any 

longer than the traditional operation and in general patients should 

be discharged in 24-48 hours. 

In summary it is all about training, anatomy, the learning curve 

and practise. 

Author address: Dr Greg Cario. Sydney Womens Endosurgery Centre 

A new approach for laparoscopic ovarian 

transposition 


Huang KG 

Pelvic irradiation of premenopausal female patients with 

gynecological neoplasm constantly induces castration. It is 

justified to attempt to preserve normal ovarian function in these 

patients, because long term hormone replacement therapy is 

expensive and patients' compliance is always poor. For effective 

ovarian function preservation, surgical technique and irradiation 

plan is important. 

Patients under the age of 45 planned for irradiation are suitable 

for laparoscopic ovarian transpositon, and there is more benefit 

for younger females especially under the age of 40. Ovarian 

transposition is absolutely contraindicated for patients with 

carcinomatosis, patients with ovarian or tubal cancer 

metastasis, and patients with positive ascites or positive 

washing cytology. Using Lee-Huang point as the first trocar 

entry, ovaries were seperated and infundibulopelvic ligament 

were dissected as long as ovaries could be fixed to 

anterolateral abdominal wall to avoid direct irradiation and 

scattered irradiation. Metal clips should be placed on the 

ovarian stump to allow radiologic detection. Ovarian function 

is evaluated by symptom/sign and by serial serum FSH, LH and 

E2 levels. 

According to our experience, using Lee-Huang point as the first 

trocar entry, ovaries transposed to anterolateral abdominal wall 

above the level of umbilicus 3-4 cm. by laparoscopy is enough to 

avoid radiation exposure in conventional whole pelvis irradiation. 

Author address: Kuan-Gen Huang, M.D.Taiwan 

Laparoscopic ureteric reimplantation 

Friday 18 Aug / Session 2 / 0945 - 1000 

Andou M, Ikuma K 

Background: We developed a laparoscopic reconstruction 

technique for the urinary tract in the case of accidental injury, or 

ureteral endometriosis. 

Materials and methods: Three cases underwent laparoscopic antivesicoureteral 

reflux ureteroneocystostomy. Case 1 required 

reconstruction of the urinary tract due to accidental transection 

during a laparoscopic hysterectomy for a huge fibroid. Case 2 

suffered from late ureteral stenosis after a laparoscopic 

hysterectomy, probably due to a thermal injury. The stenosis 

improved after conservative management using a double J stent. 

However, one year after the removal of the double J stent, the 

case presented again with right hydronephrosis. We decided to 

perform ureteral reimplantation to secure sufficient blood 

perfusion. The third case was referred from an urologist because 

she was suffering from ureteral endometriosis. On removal of a 

double J stent during a stent exchange, the ureter completely 

became obstructed so that it was impossible for the new stent to 

be inserted. So segmental resection of the lower ureter was 

decided. In in all three procedures we used a newly developed DJ 

stent introducer, which eliminated the need for cystoscopy. 

Results: The post-operative course for all patients was uneventful. 

No blood transfusion or reoperation was required. The patients 

resumed a regular diet and began ambulation the day after surgery. 

Avoidance of tension, torsion and angulation is of paramount 

importance for intact anastomosis. 

Conclusions: To achieve a quality reconstruction it is important to 

master precise suturing techniques. Of course prevention is the best 

tactic, but once injury to the ureter occurs, a minimally invasive 

reimplantation strategy is the second best option. For endometriosis 

cases, removal of questionable tissue is important to eradicate all 

pathology and facilitate intact reconstruction. Laparoscopic ureteric 

reimplantation is safe and feasible. 

12 







2) Cheng YM and Lin BL: Modified sonohysterography immediately 

after hysteroscopy in the diagnosis of submucous myoma. J Am 

Assoc Gynecol Laparosc 9(1):24-28,2002 

3) Yang JH and Lin BL: Changes in myometrial thickness during 

hysteroscopic resection of deeply invasive submucous myomas. J 

Am Assoc Gynecol Laparosc 8(4):501-505,2001. 

4) Lin BL, Akiba Y, Iwata Y: One – step hysteroscopic removal of 

sinking submucous myoma in two infertile patients. Fertil Steril 

74(5):1035-1038,2000 

Author address: Bao-Liang Lin, MD, PhD Kawasaki Municipal 

Hospital, Kawasaki, Japan 

Refererence: 

Eldar - Geva et al .Fert & Steril.1998,70:687 

Pritts.Ob Gyn Survey.2001,56:483. 

Min et al.Human Reprod.2004,19:1. 

Author address: David Healy, Monash University Department of 

Obstetrics and Gynaecology 

Current non surgical approaches to fibroids 


Endoscopic myomectomy - outcomes & 

fertility issues 


Healy D 

Governments demand Evidence-Based Medicine(EBM). I will 

discuss application of EBM to uterine fibroids in 4 ways. Firstly, 

our retrospective study of the effect of subserosal (SS), intramural 

(IM), & submucosal (SM) fibroids on the outcome of assisted 

reproductive technology(ART) treatment. We compared treatment 

outcome of 106 ART cycles in 88 patients with uterine fibroids. 

Pregnancy rates per transfer were 34, 16, 10 & 30 % 

respectively in patients with SS, IM, SM & no fibroids. Implantation 

rates were 15, 6, 4 & 16% respectively. Both rates were 

significantly lower in patients with SM & IM fibroids than in those 

with SS fibroids or no fibroids, even when there was no 

deformation of the uterine cavity. A subsequent meta-analysis of 

fibroids & infertility showed gynecologists had poor quality EBM 

data for this issue. This meta-analysis found no confirmation 

between IM fibroids & infertility. 

Indeed, no evidence that myomectomy will enhance pregnancy 

rates for fibroids of any size- unless they distort the uterine cavity. 

Thirdly, the endpoint chosen is vital in any analysis of fibroid 

surgery outcome. We suggest that the endpoint in such fibroid & 

infertile patients must be Birth Emphasizing a Successful Singleton 

delivery at Term gestation( BESST). Future directions for AGES 

could be a prospective, randomised study of endoscopic 

myomectomy, or not, for infertile patients with BESST as the 

outcome. We estimate, at alpha = 0.05,and 80% power, and a 

relative sample size of 6 patients without fibroids to 1 fibroid 

patient, that the required sample size would be 100 in the fibroid 

group and 600 controls. 

Lyon SM 

Over the last decade uterine artery embolization has become a real 

alternative for women either wishing to preserve their uterus or a 

less invasive approach to surgery. More than 30,000 women have 

undergone this procedure worldwide and currently, between 13,000 

to 14,000 uterine artery embolization's are being performed in the 

United States annually. 

More recently, a number of medical therapies as well as, image 

guided high intensity focused ultrasound (HIFU) have entered trials 

overseas. HIFU is already being used clinically to treat myoma, 

prostate cancer and pancreatic cancer. Although, some of these 

technologies are in their infancy, the future is suggesting truly noninvasive 

approaches to many traditionally surgical diseases. 

Author address: Dr Stuart M Lyon. Head of Interventional Radiology, 

The Alfred Hospital. Honorary Senior Lecturer, Department of Medicine, 

Monash University. Melbourne, Victoria 

Laparoscopy in treating gynecologic cancer 


Lee CL 

Cervical cancer is one of the most frequent malignancies of the lower 

female genital tract. Though there are many debates in treating 

gynecologic cancer by laparotomy or laparoscopy, evidences have 

mounted that surgical management in gynecologic cancer not only 

could decrease either mortality or recurrence rate, it would also 

14 







and only one case experienced bowel obstruction. One case 

experienced bowel injury and another two cases experienced bladder 

injury. They were repaired intraoperatively without any sequel. 

Conclusion: Laparoscopic management of early, and in selected 

cases, advanced ovarian cancer is safe and feasible and may be as 

efficacious as the traditional laparotomy with the advantage of being 

minimally invasive. 

Author address: M. Andou M.D, Ph.D. Kurashiki Medical Center 

Laparoscopic Radical Hysterectomy (LRH): 

Evaluation of 203 patients with early 


Comparison with Abdominal Radical 

Hysterectomy and analysis by time periods 


Nam JH 

Laparoscopic pelvic exenteration for 

advanced pelvic cancers : A review of 

16 cases 


Puntambekar S, Sathe R 

Objective: The aim of this study was to retrospectively evaluate, 

in a series of 16 patients, the technique, feasibility and Oncological 

safety of laparoscopic anterior exenteration for locally advanced 

pelvic cancers. 

Study design: Since August 2003, 16 patients with locally 

advanced pelvic cancer were considered. All patients were in a good 

general condition, in the age group of 50-50 yrs of which 12 had 

cervical cancer and 4 had bladder cancer. 

Results: The median operative time was 180 min. The mean 

number of harvested pelvic iliac nodes was 14. All margins were 

tumor free. The median postoperative hospital stay was 3 days. 

Three patients had postoperative complications; two had sub acute 

intestinal obstruction and one had ureteric leak. The median follow up 

was 15 months. 

Conclusions: Our results have demonstrated the feasibility and 

Oncological safety of performing anterior exenteration laparoscopically 

in advanced pelvic cancer patients with acceptable morbidity. 

Intermediate term follow up validates the adequacy of this procedure. 

With recent advances of laparoscopic surgery in gynecology, 

laparoscopic radical hysterectomy (LRH) with lymphadenectomy 

has become a new surgical procedure in the management of 

patients with early cervical cancer. However, laparoscopic 

surgery for cervical cancer has not been widely used, despite of 

many advantages in terms of less pain, short hospital stay, 

rapid recovery and so on. Difficulties in learning surgical 

techniques and uncertainty in outcomes of surgery were main 

obstacles for wide use of this new surgical option. It is true that 

only a few reports have published on the survival of LRH in 

patients with cervical cancer with long-term follow-up. 

The objectives of this study were to evaluate the outcomes of 

patients treated by LRH, to compare surgical parameters and 

recurrence rates with those of patients treated by conventional 

abdominal radical hysterectomy (ARH) and to analyze 

perioperative complications and survival trends over the time 

periods for investigating learning curve. 

From 1997 to 2005, we performed 203 cases of LRH + PLA 

(pelvic lymphadenectomy ± paraaortic lymph node sampling). 

Inclusion criteria for the laparoscopic surgery were patients with 

FIGO stage IA to IIA. Of 203 patients, 155 patients with stage Ib1 

patients were compared to 102 patients who undertaken ARH in 

the same period. Also, we divided the LRH patients into two period 

groups: the first period from 1997 to 2000 (65 patients) and the 

second period from 2001 to 2005 (138 patients). 

The number of lymph nodes and the rate of intraoperative and 

postoperative complications were similar in both the 

laparoscopic and the conventional laparotomy group. The mean 

surgery duration and the median length of hospital stay was 

significantly shorter in patients treated by laparoscopic surgery 

LRH vs. ARH ; 219.3 vs. 238.2 min. and 13 vs. 21 days. Five 

(3.2of 155 LRH patients and four (2.8of 142 RH patients 

had recurrences. The five year progression-free survival rates 

were 96.2 in the LRH group and 96.8in the RH group 

(p0.316). 

Considering the time period, the mean duration of surgery was 

significantly shorter (212.8 vs. 233.9 min) and the numbers of 

lymph nodes obtained were also significantly more (36 vs. 27.5) 

in the second time period. The median hospital stay and the 

number of transfusion were similar in both time periods. 

Overall, there were fourteen (14/203, 6.9%) major 

perioperative complications including bladder, ureter, vessels 

16 







10% of women developed new symptoms after surgery. However, 

more women with occult stress urinary incontinence developed 

postoperative stress urinary incontinence after endopelvic fascia 

plication alone than after endopelvic fascia plication and tensionfree 

vaginal tape (RR 5.5, 95% CI 1.36 to 22.32). 

Reviewers' conclusions: Abdominal sacrocolpopexy is 

associated with a lower rate of recurrent vault prolapse and 

dyspareunia than the vaginal sacrospinous colpopexy. These 

benefits must be balanced against a longer operating time, longer 

time to return to activities of daily living and increased cost of the 

abdominal approach. The use of a polyglactin mesh overlay at the 

time of anterior vaginal wall repair may reduce the risk of 

recurrent cystocele. Posterior vaginal wall repair may be better 

than transanal repair in the management of rectoceles in terms of 

recurrence of prolapse. Adequately powered randomised controlled 

clinical trials are urgently needed. 

Author address: Assoc. Professor Christopher Maher. Mater, 

Women’s and Wesley Urogynaecology Units, Brisbane 

ages 

ranzcog 

Platinum Sponsor of AGES 


Trainee 

Workshop 

1& 2 

september 

2006 

THE BOARDROOM LEVEL 1 

ST GEORGE PRIVATE HOSPITAL 

1 SOUTH ST, KOGARAH 

SYDNEY NSW 

18 



SATURDAY 19 AUGUST 




Laparoscopy in pregnancy 

Saturday 19 August / Session 9 / 1100 - 1120 

Yuen PM 

complications. The prevention, recognition and management of 

these problems are essential for this surgery to be acceptable. 

Methods include the broad use of minimally invasive reinvestigation 

as indicated, and that delay in recognising and managing 

complications can result in significant morbidity and mortality. 

Background: Pregnancy, especially in more advanced gestation, 

was considered as an absolute contraindication for laparoscopy. With 

the advance in technology and improvement in surgical skill, 

laparoscopy has also been employed in advanced pregnancy, mostly 

for removal of persistent adnexal mass. We evaluated our 10 years 

experience in the performance of laparoscopy for removal of 

persistent adnexal mass in the second trimester of pregnancy. 

Methods: Between April 1994 and December 2005, 75 

consecutive women underwent laparoscopic removal of adnexal 

masses that had persisted into the second trimester of pregnancy 

in an academic tertiary referral centre. Operative complications, 

pregnancy and labor outcomes were evaluated. 

Results: The median gestation was 10.5 weeks (range 5-25) at 

diagnosis and 16 weeks (range 12-25) at the time of operation. 

Only two women required conversion to laparotomy. Cystectomy 

was performed in 62 women, oophorectomy in 10 and fenestration 

in 3. The median operating time was 50 minutes (range 30-120). 

There were no intra-operative complications or major 

postoperative complications. No women were given tocolytic 

therapy and none developed uterine contractions. There was one 

spontaneous abortion 6 weeks after the operation and one woman 

was lost to follow up. Of the remaining 73 women, the median 

gestation at delivery was 39 weeks (range 33-42) and the median 

birthweight was 3155 gms (range 2220 – 4200). Conclusions: 

Laparosocpic surgery for persistent adnexal masses in the second 

trimester of pregnancy is safe with low maternal and perinatal 

morbidity and mortality when performed by experienced surgeons. 

Author address: Professor Pong Mo Yuen President of Asia-Pacific 

Association of Gynecologic Endoscopy and Minimally Invasive Therapy 

(APAGE). Consultant and Honorary Clinical Associate Professor, 

Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The 

Chinese University of Hong Kong, Hong Kong 

The unwell patient after laparoscopy 


Stening F 

Laparoscopy has revolutionised abdominal surgery and, as a 

result, has been associated with some unique post operative 

Case presentation: Adhesiolysis for chronic 

pain – a medico-legal dilemma 


Karthigasu K 

Adhesions:- Adhesions are a difficult dilemma for all 

gynaecologists. Do they cause symptoms Do they cause pain 

How can we distinguish which adhesions cause pain Will operating 

on them provide relief of symptoms Will operating make the 

patients worse Do the risks of surgery outweigh benefits All 

these questions we ask ourselves when faced with patients with 

possible adhesions. In this session we present a number of cases 

and ask an expert panel their opinions on management. 

Vecchietti procedure 


Cooper M 

Mayer-Von Rokitansky-Kuster-Hauser (MRKH) Syndrome is a 

rare congenital abnormality characterised by normal secondary 

sexual characteristics, vaginal aplasia, normal ovaries and a 

rudimentary uterus. The prevalence of this anomaly is one case 

per 4-5,000 live female births. To produce a functioning 

neovagina in affected subjects, management relies on one of 

several approaches; non-surgical i.e. Frank technique (1), a 

split-thickness skin graft i.e. McIndoes technique (2), sigmoid 

colon grafts (3,4) or a combination of surgical and non-surgical 

(Vecchietti technique). Numerous variations of these techniques 

have also been described. 

Giuseppe Vecchietti first described his technique for creating a 

neovagina in subjects with Mayer-Von Rokitansky-Kuster-Hauser 

Syndrome (MRKH) in 1965 (5). The initial description was of an 

open abdominal procedure involving a Pfannenstiel incision, 

20 



SATURDAY 19 AUGUST 




suspicious ovarian cysts/tumours, debate on the choices of 

optimal procedures in their management remains unabated. 

After a pre-operative evaluation, the laparoscopic diagnosis of nonmalignancy 

is usually reliable. In some centre, there are increasing 

uses of intraoperative use of ultrasound scan to further improve 

the sonographic diagnosis of pathological characteristics of 

adnexal mass prior to the operation. The usefulness and 

practicality of intraoperative ultrasonogram will be discussed. 

With increasing experience and technological advances, 

laparoscopic management of early ovarian cancer is now feasible in 

some tertiary centres, this minimally access surgery can 

sometimes avoid the need for laparotomy without compromising 

on the prognosis provided adequate staging, proper training can 

ensure a complete removal. 

Conclusions: Regarding the strategies to management 

unexpected ovarian malignancy, it must rely on a more stringent 

selection of patients to reduce the incidence of unexpected 

malignant ovarian tumour diagnosed at laparoscopic procedures. 

The gynaecologist, even faced with this situation must be able to 

manage appropriately. The appropriate management includes 

Case presentation: The ‘suspicious’ 

ovarian mass 


Karthigasu K 

Suspicious mass- complex ovarian masses by ultrasound are 

not an uncommon presentation to the gynaecologist. One the 

first questions we ask ourselves is: could this be cancer 

Should I be treating this Is the laparoscope appropriate In this 

session we present a number of cases and ask the expert panel 

advice in trying to determine what mass is most likely to be 

neoplastic and requires referral to a gynaecology oncologist, 

which masses require open surgery and which are suitable for 

laparoscopic surgery. 

1. Full preoperative discussion and counseling with all patients with 

a likelihood of malignancy. The extent of surgery to be taken if 

malignancy is found and its impact on fertility and subsequent 

chemotherapy have to be discussed. 

2. There should be frozen section facility and gynaecological 

oncologist to stand by especially if the preoperative assessment 

with ultrasound scan or tumour markers raises any clinical 

suspicions of malignancy. 

3. Avoid uncontrolled puncture and spillage of any suspicious 

adnexal mass if at all possible 

4. Liberal use of endoscopic bag for specimen retrieval to avoid 

future port site metastasis. 

5. If malignancy encountered at laparoscopy or confirmed 

pathologically by frozen section, ensure adequate staging and 

cytoreductive procedures are performed by laparotomy as soon 

as possible 

Author addess: Felix Wong WS, Tel: 02-98285686 Mobile: 

0418207049 Address: University of New South Wales, Liverpool 

Hospital, Liverpool, NSW 2170, Australia 

22 



FREE COMMUNICATIONS 




A 

and cup in use at Laparoscopic Hysterectomy and a short tribute 

to the late Dr Nicholas Biswas. 

Author address: Samuel Soo Endoscopic Gynaecological Surgery 

Fellow, Harry Merkur 

Sydney West Advance Gynaecological Endoscopy Unit 

Sydney West Advance Pelvic Surgery Unit 

Sydney West Area Health Service 

A modified technique of LAVH using a 

Biswas uterovaginal elevator (BUVE) for 

uteri weighing 500 gm or more 

Friday 18 August / Free Communications A / 1400 - 1410 

Lee ETC, Wong FWS 

Objectives: The objective is to evaluate the surgical outcome 

of a new technique of LAVH using the BUVE for uteri weighing 

500 gm or more. 

The plasma trissector at laparoscopic 

hysterectomy – a video presentation 

Friday 18 August / Free Communications A / 1350 - 1400 

Soo S, Merkur H, Hardas G 

Introduction: Bipolar in the form of PK technology from Gyrus 

ACMI has been available for a few years now with variable uptake 

in Gynaecological Surgery units across Australia. The main claimed 

advantage to PK technology is the use of pulsatile bipolar 

diathermy to minimize lateral tissue spread with optimal sealing of 

vascular pedicles. The introduction of the new Plasma Trissector 

allows vascular pedicles to be sealed and cut with the same 

instrument. This may have implications towards reduced operating 

times and the safety of using one power source. 

Video objective: To discuss the physics of the delivery of 

electrical energy in PK technology. To demonstrate our 

experience with the use of the Plasma Trissector at 

Laparoscopic Assisted Vaginal Hysterectomy and Total 

Laparoscopic Hysterectomy. To discuss the advantages, 

disadvantages and limitations of the instrument. 

Setting: Advanced gynecological endoscopy teaching hospitals. 

Author address: Samuel SOO Endoscopic Gynaecological Surgery 

Fellow, Harry Merkur, George Hardas 

Sydney West Advance Gynaecological Endoscopy Unit 

Sydney West Advance Pelvic Surgery Unit 


Methods: This was a retrospective review of 31 consecutive 

cases of LAVH involving uteri weighing 500 gm or more using the 

BUVE between October 2003 and May 2006. Variables analysed 

included patient demographics, operative time, concomitant 

surgeries, uterine weight, hospital stay, intraoperative and 

postoperative complications. The laparoscopic part included the 

securing of upper uterine pedicle, bladder flap preparation, and 

anterior and posterior colpotomies. Vaginal removal of the large 

uteri was performed using the morcellation technique of `rotational 

deep spiral cut’. 

Results: The mean operative times for the laparoscopic part, 

vaginal part and the total procedure were 25.55 + 12 minutes, 

55 + 16 minutes, and 95 + 27 minutes respectively. The mean 

uterine weight was 668 +/- 158 grams (range 500 - 1100 

grams). The mean blood loss was 217.74 +150.86 ml (range 50 

- 800 ml). The mean length of hospital stay was 1.45 + 0.623 

days (range 1 – 3 days). There was no major intraoperative or 

postoperative complication in these patients. Three patients had 

intraoperative haemorrhage requiring blood transfusion (10%). 

Postoperative complication included 1 postoperative bleeding which 

did not require surgical intervention. No febrile morbidity or injury 

to ureter, bowel, major vessels or bleeding or haematoma 

requiring conversion, readmission or re-operation. 

Conclusions: LAVH using the BUVE can eliminate the need for 

laparotomy in performing hysterectomies even for large uteri 

weighing > 500 grams. The BUVE can serve to steady the cervix 

and can achieve a full range of uterine manipulation. It also allows 

safe and easy dissection of the bladder and avoids ureteric injury 

as the surgical field is far from the ureters. The uterosacral 

ligaments become obvious to identify while they are placed under 

tension thus allowing intrafascial type of hysterectomy to be 

performed. The BUVE also provides an absolute vaginal seal and 

the pneumoperitoneum is maintained at all times. The technique 

described incorporates the merits of both laparoscopic and vaginal 

approaches with a unique uterine morcellation technique for large 

uteri. In the surgeon’s own experience, the procedure is 

reproducible, safe and versatile. 

Author address: Eric T C Lee, Tel: 852-25212567 Department of 

O&G, Canossa Hospital, Old Peak Road, Hong Kong, China. Felix W S 

Wong, University of New South Wales, Liverpool Hospital, Liverpool, NSW 

2170, Australia 

24 







B 

Conclusions: Uterine morcellation is a safe approach to the 

piecemeal removal an enlarged uterus at time of TLH. Although 

the uterine morcellation is peformed for larger specimens, it is not 

associated with longer operating times or greater EBLs. An 

enlarged uterus alone is not a contra-indication to TLH. We 

acknowledge that sample sizes are small and therefore p-values 

are not easily significant. 

Author address: George S Condous and Alan Lam. Centre for 

Advanced Reproductive Endosurgery, Royal North Shore Hospital, 

University of Sydney, Sydney 

FREE COMMUNICATIONS B 

LAPAROSCOPIC ONCOLOGY 

respect to disease free survival with 80% power and · = 0.05. 

Equivalence will be assumed if the difference in DFS does not 

exceed 7 per cent at 4 years. Secondary outcomes include 

treatment related morbidity, postoperative pain and analgesic 

consumption; costs and cost-effectiveness; patterns of recurrence 

(date and localisation of first recurrence – local, vault, pelvis, 

distal); and overall survival. All data from this multicentre 

study will be entered using online electronic case report forms (e- 

CRF), allowing real time assessment of data completeness and 

patient follow-up. 

Conclusions: The LACE trial will allow to establish the 

equivalence of a total laparascopic surgical approach for patients 

with stage 1 endometrial cancer following a two stage protocol to 

accommodate potential windfalls to patient recruitment. 

Author address: Andreas Obermair, Val Gebski, Peta Forder, Dan 

Jackson, Gail Williams and Monika Janda for the LACE Trialists Group 

Laparoscopic Approach to Carcinoma of the 

Endometrium (LACE) 

Friday 18 August / Free Communications B / 1330 - 1340 

Obermair A, Gebski V, Forder P, Jackson D, 

Williams G, Janda M 

Purpose: Endometrial cancer is the most common gynaecological 

malignancy in Australia and in other countries of the developed 

world. Current standard treatment involves open surgery to 

remove the uterus, and both tubes and ovaries (TAH). The 

Laparoscopic Approach to Cancer of the Endometrium (LACE) trial 

was designed and implemented to assess equivalence of 

performing this in a total laparoscopic approach (TLH). 

Laparoscopic procedures appeal to patients and patients 

frequently request to be treated by laparoscopic procedures even 

if these are not proven to be equivalent. 

Methods: Patient recruitment for this trial was designed to 

proceed along two stages to accommodate for a potential increase 

in patient requests of laparoscopic surgery. During the first stage, 

patients are randomised in a 2:1 allocation to receive TLH or TAH. 

The primary endpoint for this stage is quality of life (QoL) at 6 

month post-surgery, requiring 180 patients to be enrolled to have 

80% power at · = 0.05 to detect a clinically significant difference 

of 8 points on the Functional Assessment of Cancer General 

(FACT-G) QoL measurement instruments. If additional recruitment 

of patients seems impossible after accrual of 180 patients, this 

cohort will be followed for 4 years, and disease free survival (DFS) 

of patients treated by TLH will be compared to disease free 

survival within the population of endometrial cancer patients. 

During the second stage, recruitment will be extended to a total of 

590 patients in a 1:1 TLH: TAH allocation. This sample size will 

allow to assess the equivalence of these two procedures with 

Completely total laparoscopic radical 

hysterectomy for invasive cervical cancer; 

Initial reports 


Lee YS, Lee JM, Kim BS, Cho YL, Park IS 

Objectives: The purposes of this study were to evaluate the 

surgical outcomes and to discuss the role of completely total 

laparoscopic radical hysterectomy in the cervical cancer. 

Methods: Among the 63 patients of cervical cancer patients, 

forty five patients who underwent total laparoscopic radical 

hysterectomy between November 2003 and April 2005 in the 

Kyungpook national university hospital were studied prospectively. 

Among them, 40 patients had completely total laparoscopic 

radical hysterectomy (89%), including laparoscopic removal of 

upper vagina and closure of vaginal stump but five patients needed 

upper vaginal incision and suturing through vagina (11%). 

Results: Mean age was 47.2. Mean BMI was 24.1±2.8. FIGO 

stage were stage 1, 37cases and IIA were 3 cases. Mean 

operative time was 215.4±51.1 (84-280) minutes and mean 

blood loss was 186.5±155.3 (40-800) mL. Mean time for 

laparoscopic closure of vaginal stump was 15.4±5.3 (8-30) min. 

There was one bladder injury in intraoperative. There were one 

ileus and one vesicovaginal fistula and 2 vaginal stump infection at 

the postoperative period. Mean postoperative hospital stay were 

8.6±3.1 (5~20) days. Mean self voiding day was 11.4±6.3 

(4~29)days. All resected margins were tumor free. The mean 

number of retrieved pelvic and paraaortic lymph nodes were 

26 







B 

Laparoscopic assisted vaginal hysterectomy 

versus abdominal hysterectomy in patients 

with early stage endometrial cancer: 10 

year experience 


Nam JH, Yoon J, Kim DY, Suh DS, Kim JH, 

Kim YM, Kim YT 

Objective: To evaluate the outcomes of laparoscopic surgery and 

to compare surgical parameters and recurrence rate of these with 

those of conventional abdominal surgery in patients with 

endometrial cancer. 

Methods: From August 1997 to June 2006, we have performed 

163 cases of LAVH (laparoscope-assisted vaginal hysterectomy) 

with or without lymph node dissection. Laparoscopic approach was 

adapted in patients with FIGO clinical stage I by imaging study. Of 

the 163 patients, 150 patients who were proved to be surgical 

stage I and II were enrolled in this comparative study. As a control 

group, we selected 168 cases for the laparotomy group of the 

same stages. 

Results: The mean duration of surgery, the amount of blood 

transfusion and hemoglobin changes were similar in both the 

laparoscopic and the conventional laparotomy group. The mean 

duration of hospital stay was significantly shorter in patients 

treated by laparoscopic surgery (10.1 vs. 15.6 days). The number 

of lymph node obtained was significantly higher in the laparoscopic 

group. three year recurrence-free survival rates were 97.4% in 

laparoscopic group and 98.3% in laparotomy group. (p=0.451) 

Conclusion: Laparoscopic surgery for the treatment of early 

stage endometrial cancer is safe and effective alternatives in 

terms of perioperative complications. Overall and recurrence-free 

survival did not differ significantly in both groups, however long 

term risk for recurrence and survival has yet to be defined. 

Author address: Joon Yoon, M.D. Dept. of OB/GYN, Asan medical 

Center, 388-1 Poongnap-dong, Songpa-gu, 138-736, Seoul, Korea Tel : 

+82 2 3010 3628, E-mail: bestjuny@hanmail.net Joo-Hyun Nam, Joon 

Yoon, Dae-Yeon Kim, Dae-Sik Suh, Jong-Hyeok Kim, Yong-Man Kim, Young- 

Tak Kim Department of Obstetrics and Gynecology, University of Ulsan 

College of Medicine, Asan Medical Center, Seoul, Korea 

Laparoscopic Radical Trachelectomy (LRT) 

in Korea 


Nam JH, Kim JH, Kim DY, Suh DS, Kim YM, 

Kim YT, Kim SH, Kim DJ, Kim YB 

Objectives: Laparoscopic radical trachelectomy with pelvic 

lymphadenectomy(LRH) is now increasingly performed in Korea for 

the young patients with early-stage cervical cancer. We evaluated 

the feasibility and the outcome of LRH performed in Korea. 

Methods: We performed retrospective chart review of the 

patients who received LRH at the representative centers in Korea 

between January 1995 and June 2006. 

Results: Thirty-one patients were enrolled in this study. Median 

age of the patients was twenty-nine years (range 25-36). Number 

of patients was three in stage Ia1 (9%), five in stage Ia2 (16%), 

twenty-two in stage Ib1 (69%) and one in stage IIa (3%). Twentysix 

patients were squamous cell carcinoma (81%), four patients 

were adenocarcinoma (13%) and one patient was adenosquamous 

carcinoma. Median operation length was 263 minutes (range 120- 

494). Median blood loss was 290cc (range 60-1600). LRH were 

changed to laparoscopic radical hysterectomy in three patients 

because of positive lymph node (two patients) and parametrial 

invasion and they all received chemoradiation. Median hospital stay 

was 8.5 days and there was no intraoperative or postoperative 

complication. Three patients tried pregnancy and two patients 

succeeded in delivery. Three patients who were successful in LRH 

received adjuvant chemotherapy. Two patients were recurred, but 

treated successfully by chemoradiation and 2-year disease-free 

survival was 100%. 

Conclusions: LRH is supposed to be a safe and effective 

treatment modality for the young patients with early cervical cancer 

and conventional laparoscopic radical hysterectomy may be able to 

be substituted with LRH for such patients. But more follow-up is 

required to evaluate the ability of LRH to preserve fertility. 

Author address: Jong Hyeok Kim, M.D. Dept. of OB/GYN, Asan 

medical Center, 388-1 Poongnap-dong, Songpa-gu, 138-736, Seoul, Korea. 

Tel : +82 2 3010 3643 E-mail: hyeokkim@amc.seoul.kr Joo Hyun Nam 1 , 

Jong Hyeok Kim 1 , Dae Yeon Kim 1 , Dae Sik Suh 1 , Yong Man Kim 1 , Young Tak 

Kim 1 , Sung Han Kim 2 , Dong Jin Kim 3 , Yong Bong Kim 4 Department of 

Obstetrics and Gynecology, Asan Medical Center 1 , Kosin University Gospel 

Hospital 2 , Seoul Medical Center 3 , Inje University Seoul Paik Hospital 4 , Korea 

28 







C 

FREE COMMUNICATIONS C 

HYSTEROSCOPY 

Hysteroscopic metroplasty for unicornuate 

uterus to improve reproductive outcome 

Friday 18 August / Free Communications C / 1330 - 1340 


A video of an Innovative Surgery in case of unicornuate uterus with 

recurrent pregnancy losses at 16 –20 weeks will be presented. 

With the help of versa point hysteroscopic metroplasty has been 

performed so as to convert tubular cavity into a triangular cavity 

resembling normal cavity. 

Conclusion: Reduced intrauterine capacity is the probable cause 

for recurrent abortions or preterm delivery in case of unicornuate 

uterus. Keeping this in mind, we have innovated this hysteroscopic 

surgery to improve the reproductive outcome in case of 

unicornuate uterus. Our patient had a successful 33 weeks 

delivery after this reconstructive surgery that had previous 3 

pregnancy losses between 16-20 weeks of gestation inspite of 

cervical encircalage. 

Author address: Dr. Sunita Tandulwadkar, Chief, Ruby Hall IVF and 

Endoscopy Centre, Pune, India. 

Dr. Ashwini Margale, DNB Student, Ruby Hall IVF and Endoscopy Centre, 

Pune, India. 

Affiliation: Ruby Hall IVF and Endoscopy Centre, Pune, India 

A randomised controlled trial comparing 

Microwave Endometrial Ablation (MEA ) 

and Mirena ® (levonorgestrel-releasing 

intra-uterine device) in the treatment 

of menorrhagia. 

Friday 18 August / Free Communications C / 1340 - 1350 

Behnia-Willison F, Cook J, Seman EI, Lam C, 

Manifold E, Agniewska, O’Shea RT 

Background: Heavy menstrual bleeding is a major clinical 

problem, with significant effects on quality of life. It accoun 

ts for 12% of referrals to gynaecological outpatients in 

Western countries.1 

Objective: To compare the subjective and objective outcomes for 

two methods for the management of heavy menstrual bleeding; 

I) Mirena ® (levonorgestrel-releasing intrauterine device) 

II) 

MEA (microwave endometrial ablation) 

Method: 90 women presenting to the gynaecology outpatients 

department with heavy menstrual bleeding were assigned to one of 

two treatment arms. Three quality of life questionnaires were 

administered pre-operatively and at 3 monthly intervals postoperatively 

up to 2 years. These included two condition specific 

QOL questionnaires (Menstrual Severity Scale, Pictorial Blood Loss 

Assessment Chart) and a generalised QOL questionnaire 

(WHOQOL-BREF). 

Results: There was one major complication in the MEA group 

(haematometra) and no major complications in the Mirena ® 

group.The MEA group demonstrated a higher satisfaction rate 

and lower objective measurement of blood loss as determined by 

quality of life questionnaires. 

Conclusion: MEA achieved a greater improvement in quality of 

life parameters than Mirena ® . 

Reference: 

1. Cooper KG, Parkin DE, Garratt AM, Grant AM. A randomised 

comparison of medical and hysteroscopic management in 

women consulting a gynaecologist for treatment of heavy 

menstrual loss. Br J Obstet Gynaecol 1997;104:1360-6 

30 







D 

Method: Retrospective study of 39 pregnancies after 1621 

procedures of TCRE. 

Results: Among 1621 women who were successful followedup 

after TCRE, there were 39 pregnancies in 32 women, 

including five ectopic pregnancies (12.8%) and 34 intrauterine 

pregnancies (87.2%). The majority of pregnancies (84.6%) 

occurred within the first two years. In the first year after TCRE, 

the incidence of pregnancy was 1.5%. 32 cases with 

intrauterine pregnancy were terminated under ultrasound 

guidance with 2 difficult procedures. Only one pregnancy in our 

study resulted in spontaneous miscarriage which was managed 

by suction curettage. One term pregnancy had placenta increta 

resulting in caesarean hysterectomy. 

Conclusions: Pregnancies after TCRE are associated with 

increased risk and Clinicians should be aware of the various 

complications of pregnancy that may occur after TCRE, including 

an increased risk of ectopic pregnancy. Surgical termination of 

pregnancy after TCRE is potentially a difficult procedure and should 

be carried out under ultrasound guidance. 

Author address: Enlan Xia 1, 3 ; Tin-Chiu Li 2 ; Dan Yu 1, 2 ; Xiaowu Huang 

1; Jie Zheng 1 ; Yuhuan Liu 1 and Mei Zhang 1 

1 Hysteroscopic Center, Fuxing Hospital affiliate of Capital University of 

Medical Sciences, Beijing 100038, China. 

2 The Jessop Wing, Royal Hallamshire Hospital, Sheffield, S10 2SF, UK 

3 To whom correspondence should be addressed. 

Email: xiaenlan@public.bta.net.cn 

Stage IIA – IIIA: a) No role of laparoscopy as a primary modality. 

b) Chances of transcoelomic spread. 

c) Following down-staging – following anterior 

chemo therapy or as a second look in patients 

with chemical recurrence(CA-125 rising) 

Stage IIIC: All patients who have peritoneal deposits. CO2 

insufflation is not going to add to further transcoelomic spread. So 

if optimal debulking can be achieved with minimal residual disease 

by laparoscopy then early adjuvent therapy namely chemo therapy 

can be given. In all of the cases tumours are removed per vaginally 

to prevent port metastasis. 

Retroperitoneal and Para- aortic dissection: Laparoscopy is the best 

and minimal invasive method for para aortic lymphnode dissection in 

post chemotherapy patients with nodes positive status. 

Conclusion: We have the experience of doing laparoscopy in 

every stage of ovarian cancers as listed above. In conclusion there 

is a definite role of laparoscopy at every stage of ovarian cancers, 

especially in later stages also. Judiciousness and rationalism 

should be the key factors in deciding the final outcome. 

Author address: Dr. Ravi Sathe. Dr. Shailesh Puntambekar. Galaxy 

Laparoscopy Institute, Pune. India 

FREE COMMUNICATIONS D 

OVARIAN AND ADNEXAL DISEASE 

Preoperative discrimination between benign 

and malignant ovarian cysts treated 

surgically in an Australian tertiary centre 

Friday 18 August / Free Communications D / 1340 - 1350 

Role of laparoscopy in ovarian tumours 

Daly JO, Huang A, Ang WC, Healey M. 

Friday 18 August / Free Communication D / 1330 - 1340 


Introduction: Laparoscopy has proved to be the preferred 

modality for all types of gynaecological surgeries, but literature 

says it has no use in ovarian tumours because of chances of 

metastasis.The study was designed to find out if there was any 

role of laparoscopy in the management of ovarian cancers. 

Materials and Methods: 

Role of laparoscopy in various stages: 

Stage IA : Non-epithelial –Stromal and Germ cell tumours. 

Accidentally found tumours, total excision without spillage possible. 

Objective: To report a series of surgically treated ovarian cysts 

and analysis of the characteristics associated with benign and 

malignant cases. 

Population/Setting: All public patients diagnosed with an 

ovarian cyst undergoing surgery at the Royal Women’s Hospital, 

Melbourne, Australia, between July 2001 and June 2003. 

Methods and Materials: Patients were identified through the 

operating theatre reporting system and their medical records 

reviewed. Information was collated regarding their clinical and 

ultrasonographic features, tumour markers and final diagnosis. 

The Risk of Malignancy Index (RMI) was calculated for each 

patient. These data were analysed to identify those features 

associated most strongly with benign or malignant cysts. 

32 







D 

Author address: Dr. Sunita Tandulwadkar, Chief, Ruby Hall IVF and 

Endoscopy Centre, Pune, India. Dr. Ashwini Margale, DNB Student, Ruby 

Hall IVF and Endoscopy Centre, Pune, India. 

Affiliation: Ruby Hall IVF and Endoscopy Centre, Pune, India 

Author address: Dr Yasmin T. Tan, Paediatric and Adolescent 

Gynaecology Fellow, Royal Hospital for Women Email: 

Yasmin.Tan@SESIAHS.HEALTH.NSW.GOV.AU Tel: (02) 9382 6111 Page: 

43268. Address: Royal Hospital for Women Barker Street, Randwick 

NSW 2031. Affiliations: Department of Endo-Gynaecology, Royal Hospital 

for Women, Sydney 

Laparoscopic detorsion and oophoropexy 

for treatment of ovarian torsion 


Tan YT, Lyons SD, De Decker AP, Vancaillie TG 

A medical management of interstitial 

ectopic pregnancy: A five year clinical study 


Introduction: Adnexal torsion is the fifth most common 

gynaecologic surgical emergency, with an incidence of 2.7%1. It 

remains both a diagnostic and management challenge. Salpingooophorectomy 

is commonly performed, as the torted adnexum 

is considered unsalvageable. Alternatively, conservative surgery 

may occur with additional cystectomy or cyst drainage. We 

describe a treatment method aimed at conservation of adnexal 

structures and preservation of reproductive potential. 

Method: Laparoscopy is established in the standard fashion. 

Upon confirmation of ovarian torsion, attention is turned 

towards management of the ovarian cyst. If prior imaging and 

clinical characteristics are consistent with a benign entity then 

treatment of the cyst via fenestration may be attempted. 

Alternatively, the cyst may be left intact so as not to further 

compromise ovarian tissue. Detorsion of the involved structures 

should then be performed and the ovary and fallopian tube 

observed for revascularisation. In the absence of reperfusion 

then oophorectomy/salpingectomy is required. If the ovary is 

conserved the potential for recurrent torsion should be 

addressed. Oophoropexy may be performed by placing a 

concertina suture in the ovarian ligament. The ovarian ligament 

is consequently shortened and the axis of torsion disrupted2. 

The patient is observed in hospital for a further 24 hours, and 

then discharged. Sonographic follow-up is arranged to monitor 

for cyst resolution and resumption of normal ovarian vascularity, 

architecture and follicular formation. 

Conclusion: Conservative laparoscopic surgical management 

of adnexal torsion should be attempted as it may protect 

reproductive potential. We describe a safe and effective method 

of detorsion and oophoropexy. 

References: 

1. Hibbard LT. Adnexal torsion. American Journal of Obstetrics 

and Gynaecology 1985; 152:456-61. 

2. Vancaillie T & Schmidt EH. Recovery of ovarian function after 

laparoscopic treatment of acute adnexal torsion. Reproductive 

Medicine 1987; 32:561-62. 

Tang A, Baartz D, Khoo SK 

Background: Interstitial ectopic pregnancy is rare; however, it 

poses a challenge in diagnosis and management due to its 

anatomic location. Medical treatment with local or systemic 

methotrexate has been considered a safer alternative to surgical 

resection by laparotomy or laparoscopy, an example of “the limits 

of endoscopic surgery”. 

Aim: From an audit of management of interstitial pregnancies, to 

determine the treatment success rate with a single dose intravenous 

methotrexate / folinic acid regimen and to identify predictors of 

treatment outcome. 

Methods: A 5 year retrospective audit (April 2000 – August 2005) 

of 13 consecutive interstitial pregnancies was carried out, collecting 

data on serum beta human chorionic gonadotrophin (‚-hCG) level, size 

of gestation sac, gestational age and presence of fetal heart motion 

so they could be tested for their influence on treatment success. 

Time taken for complete ‚-hCG resolution was recorded and a 

negative ‚-hCG result was used as an endpoint of successful outcome. 

Results: Of the 13 cases, 2 required urgent surgery for rupture on 

presentation. In the remaining 11 cases, intravenous methotrexate 

(300mg) was used, with oral folinic acid rescue (15mg x 4 doses). 

There were no side effects. Complete ‚-hCG resolution was achieved 

in 10 of the 11 medically treated cases (91% success rate), 

requiring 21 – 129 days. Successful outcome was seen with initial ‚- 

hCG level as high as 106 634 IU/L and gestation sac as large as 

6cm and a live fetus. 

Conclusion: The methotrexate / folinic acid regimen used as a one 

dose treatment is safe and effective for unruptured interstitial 

pregnancy, with no side effects and the advantage of avoiding invasive 

surgery. Subsequent tubal patency and reproductive function are yet 

to be ascertained. 

Author address: Amy Tang, David Baartz and Soo Keat Khoo 

Department of Obstetrics and Gynaecology, University of Queensland, 

Royal Brisbane and Women’s Hospital, Brisbane, Australia 

34 







E 

Saline infusion vaginography 

(sonovaginography): can we predict 


Saturday 19 August / Free Communications E / 1420 - 1430 


Objectives: The aim of this pilot study was to perform saline 

infusion vaginography or sonovaginography in order to establish the 

presence or absence of recto-vaginal endometriosis. We also wanted 

to establish normative data for the recto-vaginal septum. 

Methods: To achieve these aims we performed saline infusion 

transvaginal sonography or sonovaginography during the general 

anaesthetic at the time of the woman’s laparoscopy. Women 

underwent 2-D greyscale sonovaginography intra-operatively and just 

before laparoscopy was performed. The rectovaginal septum was 

measured (mm) at three points in the longitudinal plane: at the 

posterior fornix; at the mid rectovaginal septum; and at the level 

above perineal body. The ultrasonographer (GC) predicted whether 

there was a rectovaginal nodule or not. The women proceeded to 

laparoscopy (AL) and the presence of a normal or abnormal 

rectovaginal septum was recorded with histological confirmation of 

endometriosis in the rectovaginal septum being the gold standard. 

Results: 11 women to date enrolled in the study. The mean age 

was 38.8 years (26 – 48). 72.7% (8/11) had a history of 

endometriosis. All women underwent intra-operative 

sonovaginography followed by laparoscopy. The mean thickness of the 

rectovaginal septum at the posterior fornix, mid rectovaginal septum, 

and just above perineal body were 5.4 mm (3.6 – 8.5), 3.4 mm (1.7 

– 6.6) and 4.6 mm (2.8 – 6.9) respectively. 9/11 had a negative 

sonovaginogram for rectovaginal nodule, i.e. normal rectovaginal 

septum and 2/11 had a positive sonovaginogram for rectovaginal 

nodule, i.e. abnormal rectovaginal septum. 9/11 had a normal 

rectovaginal septum at laparoscopy and 2/11 had an endometriotic 

rectovaginal nodule excised at laparoscopy with histological 

confirmation. 

Conclusions: Sonovaginography may be the tool which delineates 

normative data for the rectovaginal septum. In the future, 

sonovaginography may be the pre-operative tool of choice to 

diagnose rectovaginal disease. 

Author address: George S Condous and Alan Lam. Centre for 

Advanced Reproductive Endosurgery, Royal North Shore Hospital, 

University of Sydney, Sydney 

Laparoscopic resection of bowel 

endometriosis 


Shukla-Kulkarni A, Johnston K, Cooper M, Reid G 

Aim: Surgical treatment of patients with rectal endometriosis is 

challenging. The aim of this study was to review the laparoscopic 

management of rectal endometriosis by resection. 

Method: All cases of complex tertiary referral pelvic 

endometriosis requiring laparoscopic surgical intervention of the 

bowel were identified and reviewed from a prospective database. 

Results: 79 patients between January2000 and May 2006 had 

surgical procedures performed for severe rectal endometriosis. 

This was a multi disciplinary approach involving two senior 

gynecologic laparoscopic surgeons and colorectal surgeons.All 

rectal procedures were completed laparoscopically.15% had 

shaving of rectal wall lesion, 45% had disc resection of anterior 

rectal wall using the ILS system, 35% had laparoscopic assisted 

segmental low anterior resection.5% of patients had other sites of 

endometriosis on bowel which were managed laparoscopically by 

excision. There were no rectal anastomotic leaks. 

Conclusions: Patients with complex endometriosis of the bowel 

can be safely managed laparoscopically using a multidisciplinary 

approach.This case.series suggests that a history of rectal pain 

during defecation that occurs only during menstruation is 

predictive of females with more extensive rectal disease. 

Author address: A Shukla-Kulkarni, Keith Johnston, Michael Cooper, 

Geoff Reid Sydney Women’s Endosurgery Centre, St George Hospital, 

Kogarah,NSW, Sydney Australia 

Outcomes of patients requiring surgery for 



Jagasia N, Ang WC, Chen F, Healey M 

Objective: A retrospective analysis was performed to evaluate 

the outcomes of patients with suspected or previously 

diagnosed rectovaginal endometriosis undergoing surgical 

treatment at the Royal Women’s Hospital in Melbourne between 

January 2004 and June 2006. 

Methods and Materials: The hospital’s operating theatre 

database and unit’s theatre list bookings diary was used to 

36 







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Results: The postoperative course of the patient was smooth 

and uneventful. She was discharged 4 days after operation. 

Conclusions: The incidence of bowel damage during laparoscopic 

surgery is 0.5%.33 Damage is most likely to occur while entering 

the peritoneal cavity or adhesiolysis. Primary closure either by 

laparoscopy or laparotomy was recommended if the patient got 

adequate colon prepare before surgery and the golden time is 

within 8 hours. Laparoscopic repair should be considered in the 

selective management of colon perforation. Prophylactic 

antibiotics,profuse peritoneal irrigation and a functioning drainage 

should be provided to reduce the risk of infection. 

Author address: Lim Woh Koh M.D., Ying Lun Sun M.D.,Shi Yau 

Chen M.D., Min Ho Huang M.D. Show Chwan Memorial Hospital, 

Changhua, Taiwan Corresponding author: Lim Woh Koh M.D,Department 

of Obstetrics and Gynecology, Show Chwan Memorial Hospital, Changhua, 

Taiwan, No.542,Section 1, Chung-shan Road,Changhua, Taiwan 

Tel:+88647256166 e-mail:klw416@gmail.com 

Laparoscopic reanastamosis for low 

ureter injury 

Saturday 19 August / Free Communications F / 1410 - 1420 

Wu TP, Sa L, Lee CL 

Purpose: To report our experience with laparoscopic reanastamosis 

of the ureter conducted at the ureterovesical junction. 

Patient and method: A 40-year-old woman who developed 

abdominal distention with ascites 19 days after laparoscopic 

hysterectomy. Laparoscopy uretero-ureteral anastomosis carried out. 

Cystoscopy and double-J stent removal was done after 4 weeks. 

Result: There was no significant intraoperative or 

postoperative morbidity. Follow-up imaging revealed good 

drainage without consequence. 

Conclusion: With obvious benefit, Laparoscopic reanastamosis 

could be a more feasible method than reimplantation. 

Author address: Tung Pi Wu*, MD MPH, Li Sa, MD*, Chyi-Long 

LEE, MD.** *Department of Obstetrics and Gynecology, Sinlau Christian 

Hospital, Tainan, Taiwan. Duckwu0415@seed.net.tw 

Successful repair of vesico-vaginal fistula at 

the critical site under endoscopic guiding - 

a video presentation 


Lee JC, Lin WC, Yeh LS, Shih CL 

Study Objective: To report some key points to the successful 

repair of vesico-vaginal fistula under endoscopic guiding. 

Design: A case report of vesico-vaginal fistula beneath the 

right ureter orifice after laparoscopic assisted vaginal 

hysterectomy (LAVH). 

Setting: China Medical University Hospital, Taiwan. Tertiary 

Medical Center 

Case: A 44 Y-O female patient who received LAVH for 

adenomyosis and myoma on May 30th, 2005. Clear watery vaginal 

discharge noted on the 10th post-operative day. 

Intervention: Voiding cystourethrogram and cystoscopy revealed 

a vesico-vaginal fistula at the bladder base just beneath the righr 

ureteral orifice 2 cm away. Late-repair was performed via vagina 3 

months later. 

Measurements and Managements: Right ureteral stent 

was inserted to identify the right ureter.Under cystoscopic aid,the 

V-V fistula was excised and repaired through vagina.It was done 

under the guiding of a foley catheter inserted in the fistula. We 

repaired the fistula by 3 layers suture in a crossed direction 

fashion. The detailed technique will be presented in the vedio. After 

surgery, a supra-pubic cystostomy was performed. 

Results: The ureteral stent was removed on the third postoperative 

day. She was discharge once the urine was clear. The 

suprapubic cystostomy was removed 2 weeks later. The whole 

course was smooth and the patient was uneventful after following 

for 1 year. 

Conclusion: When facing a vesico-vaginal fistula near the 

ureteral orifice, we always choose transabdominal repair to 

prevent ureteral injury. With the aid of ureteral stent insertion and 

foley catheter inserted in fistula, this kind of fistula can be repaired 

safely through vagina. 

Author address: Jui- Chi Lee M.D. Dep.OB/GYN, China Medical 

University Hospital Taiwan. No.2, Yuh-Der Road, Taichung City, 404 

Taiwan, R.O.C. Tel: 886-4-22052121 Ext.2058, 886-920-122812 (Cell 

phone) E-mail: rickylee7890@yahoo.com.tw. 

Wu-Chou Lin, Assistant Professor, Director of GYN Endoscopy, 

Dep.OB/GYN, China Medical University Hospital Taiwan Chairman of 

Taiwan Association of Minimally Invasive Gynecologic Laparoscopy 

(TAMIG). Lian-Shung Yeh, Assistant Professor, Director of Dep.OB/GYN, 

China Medical University Hospital Taiwan. 

Chao-Lan Shih Dep.OB/GYN, China Medical University Hospital Taiwan 

38 







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Results: The median operative time was 130 min and median 

blood loss was 50 ml. The patients were discharged on day 3 with 

the stents and urinary catheter. All patients had complete 

cessation of urinary leak immediate postoperatively. The urinary 

catheter was removed after 3 weeks and the DJ stents after 6 

weeks. All patients were asymptomatic after 6 months follow-up. 

MCU was also done at 6 months to demonstrate that there was 

no reflux. 

Conclusion: The repair of ureterovaginal fistula can be done 

laparoscopically with equal results as open technique and thus 

decreases the morbidity of the patients. 

Author address: Dr.Shailesh Puntambekar. Galaxy Laparoscopic 

Institute Pune. India 

Organ Damage: Immediate – Bowel, bladder and ureteric injury, 

Entry into liver, omentum during Verres needle insertion, 

insufflation of wrong space. 

Delayed - Fistulas. 

Conclusion: Complications are inevitable part of laparoscopic 

surgery. Wherever necessary open surgery has to be 

considered to overcome complications. Laparoscopic surgery 

has limitations and proper patient selection should stand first 

before proper technique. 

Author address: Dr. Ravi Sathe. Dr. Shailesh Puntambekar. Galaxy 

Laparoscopy Institute, Pune. India 

Complications of advanced gynaecological 




Introduction: Laparoscopy has proved its value in surgery to 

improve patient care. With the package also come numerous 

complications if unrecognized can become serious. This study was 

done to evaluate different complications associated with advanced 

laparoscopic surgery. 

Materials and Methods: 200 cases of laparoscopic radical 

hysterectomy and 220 non oncological cases a total of 440 cases 

were studied from the year 2002. Complications found were 

evaluated for the cause and treated accordingly. 

Results: Complications can be divided in to Haemmorhagic, 

Oncological, and Organ damage. 

General complications: Infections- port site and general, 

positional injuries, thromboembolism, Co2 retention, surgical 

emphysema nerve injuries, thermal injuries due to energy and 

light sources, anaesthetic complications. 

Heammorhagic complications: 

Causes- Accidental, congestion and neovascularization. 

Sites – Uterine A and Internal Illiac Vessels injury, Port site due to 

inferior epigastric A. injury. 

Inference – Venous bleeding difficult to control. 

Oncological Complications: Entry in to tumour, Missed lesion, 

incomplete resection and port site metastasis. 

A prospective multi-centre study of major 

complications experienced during excisional 

laparoscopic surgery for endometriosis 

Saturday 19 August / Free Comminications F / 1500 - 1510 

Shukla-Kulkarni A, Kaloo PD, Cooper MJW, Reid G 

Objective: To clarify the rate of major intra-operative and postoperative 

complications experienced during excisional surgery 

for endometriosis. 

Design: Prospective multi-centre observational study set in 

two University teaching hospitals and three private hospitals in 

Sydney, Australia. 

All consecutive subjects undergoing laparoscopic excisional 

surgery for minimal to severe endometriosis were recruited 

(790 subjects). 

Complications were recorded intra-operatively or post-operatively 

on a secure computerised patient database. 

Major intra- and post-operative complications i.e. inadvertent 

visceral or vascular injury or other complications directly related to 

surgery that either significantly prolonged the operating time, 

delayed discharge or necessitated re-admission. 

Results: Seven hundred and ninety subjects were recruited over 

a 3-year period. Seven major complications were experienced 

(8.8/1000); four bowel injuries, one cystotomy, one ureteric 

transection, and one major vascular injury. All visceral or vascular 

injuries were diagnosed prior to completion of the surgery. No 

significant longterm sequelae were experienced. 

Conclusion: The incidence of major complications in this study of 

8.8/1000 compares favourably with other similar reports. In view 

of the potential symptom relief obtained, the authors continue to 

40 







G 

This video displays a laparoscopic technique for hystero-colpopexy. 

Bone anchors are shown to permit efficient, precise and 

hemostatic anchoring to the bony sacrum. This video should be 

useful to surgeons wishing to refine this approach or to use it as 

an alternative to an open abdominal procedure. 

Author address: Wu-Chou Lin , Jui-Chi Lee 

d0562@www.cmuh.org.tw Endoscopic Section, OB-Gyn Depart. China 

Medical University Hospital, Taiwan 

Our experiences in treating cases of 

uterine prolapse – 

Round ligament suspension with LAVH 

Saturday 19 August / Free Communications G / 1420 - 1430 

Wu CM, Kan YY 

Uterine prolapse typically is not an isolated event and is most often 

associated with a variety of pelvic support defects. While we perform 

laparoscopic assisted vaginal hysterectomy ( LAVH ) for uterine 

prolapse, other procedures to treat pelvic floor prolapse, including 

enterocele repair, vaginal vault suspension, and cystourethropexy, can 

be done simultaneously. As we know that round ligaments correspond 

with uterosacral ligaments for proper position of uterus in pelvic 

cavity. We will present one simple and convenient method --- round 

ligament suspension combined with LAVH --- for cases of uterine 

prolapse. We use prolene 1-0 to suture the round ligament with the 

upper margin of vaginal cuff bilaterally. Anterior and posterior 

colporrhaphy can be done, or not. Post-hysterectomy vaginal vault 

prolapse, anterior and posterior vaginal wall prolapse, enterocele, 

urinary stress incontinence were all surveyed. We have used these 

method for over 20 cases, with follow-up time ranging from 6 

months to 5 years. 

Author address: Chin-Ming Wu M.D., Yuan-Yen Kan M.D M.P.H. 

OB-Gyn Depart. Kaohsiung Yuan’s General Hospital, OB-Gyn Depart. 

Kaohsiung Veterans General Hospital 

Techniques of exposure in laparoscopy 

Saturday 19 August / Free Communications G / 1430 - 1440 

Thoma V, Waters N, Hummel M, Garbin O, 

Wattiez A 

Study Objective: To improve widespread acceptance of 

laparoscopy for major and minor gynecological surgery by 

demonstrating basic principles to exposure of the surgical field. 

The reputation of laparoscopic surgery for being complex, difficult 

to perform and to teach can be overcome by returning to 

fundamental surgical principles such as ergonomics and more 

importantly, adequate exposure. 

Design: We demonstrate exposure techniques adapted to the 

surgical steps required in the treatment of various pathologies. 

Setting: University Hospital of Strasbourg, France. 

Patients or Participants: Patients have been selected on the 

basis of their pathology. 

Interventions: Different laparoscopic exposure techniques are 

demonstrated in pictures and in brief videos along with the 

resultant improvements in surgical outcomes. 

Measurements and Main Results: By commencement of 

surgery with correct exposure of the surgical field, the surgeon 

can expect four major benefits. Firstly, the assistant goes from 

being a sleeping and passive agent to an active and efficient cosurgeon. 

Secondly, surgical performance quickly improves by the 

attainment of greater comfort and confidence and by the improved 

ability of the surgeon to operate with both hands. Thirdly, surgical 

safety principles are reinforced, particularly during difficult 

moments. Fourthly, although this technique consumes several 

minutes at the start of surgery, good exposure will ultimately save 

time over the course of procedure. 

Conclusion: One of the reasons for the limited of success of the 

operation is due to complexity and duration of procedure. One of 

the main factors affecting the capacity of the surgeon is ability to 

work with majority of instruments available and have good 

exposure which spares the assistant. 

In laparoscopy, as in conventional surgery the exposure is the key 

factor for the success of the procedure. Teaching adequate 

exposure should be an integral part of laparoscopic training. 

42 







H 

multiple. All patients with rapid growth or suspicion of malignancy 

were selected for laparotomy. Both groups had similar utilization 

rates of uterine artery occlusion strategies and of LHRH analogs. 

Blood loss as reflected by actual haemoglobin drop was similar 

between the two groups, but the length of stay was 1.9 times 

longer in the laparotomy group (p





H 

The rectus sheath block in preventing postoperative 

wound pain after laparoscopic 

gynaecological surgery 

Take 500 – the experience of laparoscopic 

entry amongst gynaecological surgeons of a 

single unit 

Saturday 19 August / Free Communications H / 1430 - 1440 

Saturday 19 August / Free Communications H / 1440 - 1450 

Ng PS, Chan S, Sahota DS, Yuen PM 

Burke C, Garry R, Hart R, Karthigasu K 

Objective: The aim of the study is to assess the efficacy of the 

rectus sheath block in postoperative pain relief in patients 

undergoing the gynaecological laparoscopic surgery. 

Methods: This was a double blinded randomised placebo 

controlled study. Eighty-six patients who underwent the 

laparoscopic adnexal surgery were randomised to either the 

Ropivacaine group or placebo group. Both groups were received 

rectus sheath block with 10ml of 0.75% Ropivacaine or 10ml of 

Normal saline. All the patients underwent laparoscopic surgery 

under general anaesthesia using a standardised anaesthetic 

regimen. The laparoscopy surgery is performed in the usual 

manner in all cases. A standardised analgesia regimen will be 

used for post-operative pain relief. This includes intramuscular 

injection of Pethidine on demand and Dologesic is also prescribed 

orally as required. Postoperative pain of the umbilical wound and 

was assessed immediately at 1, 6, 12 and 24 hours after the 

operation using a 10-cm visual analogue scale. The incidence of 

postoperative nausea and vomiting was also assessed at the same 

time with the pain assessment. 

Results: The postoperative pain was significantly less in the 

Ropivacaine group at 1 after the operation. (The mean pain score 

at 1 hour, NS 2.8+/-2.1 versus R 1.7+/- 1.6) The pain score at 6, 

12 and 24 hours were less in the Ropivacaine group, but was not 

statistically significant. There were more patient required oral 

Dologesic in the Ropivacaine group then Normal Saline group (22 

versus 13). However, most of the patients require the oral 

analgesic at least 6 hours after the operation. There was no 

difference in the requirement of the postoperative intramuscular 

Pethidine injection. There was no different in the incidence of 

postoperative nausea and vomiting and the requirement of 

postoperative antiemetic. 

Conclusion: By using the rectus sheath block with Ropivacaine 

can relieve the early postoperative pain in patients undergoing the 

gynaecological laparoscopic surgery. 

Author address: P.S. Ng 1 ; S. Chan 2 ; D.S. Sahota 1 and P.M. Yuen 1 

1 Department of Obstetrics and Gynaecology, Prince of Wales Hospital, 

The Chinese University of Hong Kong, Hong Kong SAR 

2 Department of Anaesthesia, North District Hospital, New Territories 

East Cluster, Hong Kong SAR 

Introduction: Entry into the abdomino-pelvic cavity is regarded 

as the most perilous point of any laparoscopic procedure. Planning 

the type of entry to be utilised as well as verification tests used to 

confirm entry are regarded as important surgical principles. 

Variations exist in entry techniques and the number and type of 

entry verification tests used. Factors presumed to contribute to 

difficult or complicated laparoscopic entry include previous 

surgery, patient obesity, and experience of the surgeon. The 

objective of this study was to prospectively audit laparoscopic 

entry among surgeons at our gynaecological unit in order to 

identify entry techniques, entry verification tests used, occurrence 

of difficult laparoscopic entry and the relationship of the factors 

mentioned above to the ease of laparoscopic entry. 

Methods: All gynaecologists and trainees were requested to 

complete an anonymised datasheet following each laparoscopy they 

performed. Data which was recorded included indication for surgery, 

patient weight, previous surgery, entry technique, entry verification 

tests used, intra-abdominal pressures achieved before primary trocar 

insertion and entry-related intra-operative findings (presence or 

absence of omental emphysaema, omental or bowel adhesions and 

the occurrence of visceral or vascular complications.) 

Results: Laparoscopic entry in 528 women was prospectively 

assessed over a ten month period. Consultants performed 36.4% 

of laparoscopic entries, with 35% by senior registrars, 26.4% by 

registrars and 2.1% by RMOs. Median patient age was 36 yrs. 

Median patient weight was 67kg (range 29 to 150kg). 

Laparoscopy was for diagnostic purposes in 28% and for the 

treatment of known pathology in 72%. Previous surgical entry into 

the abdominal cavity had occurred in 55% of women. Thirty eight 

percent of women had had at least one prior laparoscopy (median 

# laparoscopies=1, range=1-6) and 30.2% had had at least one 

prior laparotomy (median # laparotomies=1, range 1-5). Midline 

laparotomy scar was present in 6% of women. 

Standard closed Veress entry was the initial entry technique of 

choice in 95% of cases. Six per cent of women had Hasson entry 

of whom 56% had undergone laparotomy previously. Veress 

placement was successful after a single insertion in 86.9% with 

8.9%, 3.8%, 0.2% and 0.2% requiring second, third, fourth and 

fifth placements respectively. A range of entry tests were used by 

practitioners, the commonest being the double-click test used at 

92.5% of entries followed by intra-abdominal pressure >>>>>>> THE LIMITS OF 






H 

female karyotype later. However, the hematometra recurred after 

T-tube removal. The secondary intervention was arranged. This 

time, Gortex tube was placed instead of rubber T-tube. 

She was well two months after last surgery. The abdominal pain 

subsided after secondary intervention. The Gortex tube would be 

removed three months after last intervention to see if the 

menstruation restored normally. 

Discussion: Here presented was an unusual case of secondary 

amenorrhea. The cervical synechiae was considered for normal 

chromosome study and normal female organs. The nature was not 

well documented in this case. Gortex tube was the drainage of 

choice for less tissue reaction. The effect of this method was to 

be evaluated later to see if menstruation restored. 

Author address: Chao-po Lin, M.D. Chia-yi Christian Hospital Dept 

Ob/Gyn No 539 Jhongsiao Rd. Chiayi City 60002 Taiwan. Tel: 886-9- 

63411262 Fax: 886-5-2781893 E-mail: bors.tw@yahoo.com.tw 

Cheng-Yang Chou, Department of Obstetrics & Gynecology2, 

National Cheng Kung University 

48 





PROLAPSE 


Clinical outcome 8 years post laparoscopic 

burch colposuspension 

Free Communications - Poster 

Johnston K, Cario G, Carlton M, Rosen D, Chou D 

Laparovaginal approach to anterior 

compartment defects 


Behnia-Willison F, Seman EI, Cook J, O’Shea RT, Lam C 

Study Objectives: To report on patient outcome 8 years post 

Laparoscopic Burch Colposuspension, in terms of stress 

incontinence,urge incontinence, prolapse symptoms and reoperation 

rate. 

Design: Postal questionnaire with graded responses, collecting 

subjective data on patients’ symptoms. The questionnaire was sent 

out (January 2005), 8 years after original operation 

Patients: 23 of 36 (64%) patients responded to questionnaire. 

All patients underwent a Laparoscopic Burch Colposuspension 

between 1st January 1996 – 31st December 1996. All patients 

had urodynamics proven Genuine Stress Incontinence. 

Setting: Single hospital specialising in endoscopic surgery. All 

surgery was performed by 2 advanced laparoscopic surgeons. 

Measurements and Main Results: Subjective data was 

reviewed from 23 patients. Patients responded to questions on 

stress incontinence, urge incontinence, prolapse, pre and post 

operation. Information regarding any subsequent operations for 

urinary incontinence or prolapse was also gathered. A complete 

cure to stress incontinence was reported in 11/23 (48%), 9/23 

(39%) reported an improvement and 3/23 reported no 

improvement or a worsening of their stress incontinence. Urge 

incontinence coexisted in 17/23 (74%) of patients pre-operatively. 

This was cured in 8/17 (47%) and improved in 8/17 (47%) and 

deteriorated in 1 patient. De-novo urge incontinence developed in 

3/23 (13%). Symptoms of prolapse coexisted pre-operatively in 

16 (74%) of patients and were cured or improved in 15/16 (94%) 

post operatively. De-novo symptoms of prolapse developed in 5 

(21%) of patients. No patients sought a repeat operation for 

incontinence, and 2 patients had vaginal hysterectomies for middle 

compartment prolapse 6 and 7 years after their original operation. 

Conclusions: Burch Colposuspension still remains the “Gold 

Standard” operation in terms of long term success for the 

management of stress incontinence. This series although small 

demonstrates a the considerable success of the laparoscopic 

approach to this operation. We report an overall subject success 

rate of 87% eight years post operatively. 

Author address: K. Johnston, G. Cario, M. Carlton, D. Rosen, 

D. Chou. Sydney’s Women Endosurgery Centre (SWEC), St George Private 

Hospital,Sydney, New South Wales, Australia 

Objective: To assess the results of laparovaginal repair of 

anterior vaginal prolapse in terms of durability of repair and 

perioperative morbidity 

Method: Prospective study of 274 women with anterior 

compartment prolapse who underwent laparoscopic paravaginal 

repair bilaterally. 20/84 women with a residual central defect 

subsequently underwent a graft-reinforced anterior colporrhapy 

(mean interval 14 months). All women are assessed with the 

pelvic organ prolapse quantification (POPQ) system before and 

after surgery. 

Results: Major complications occurred in 15 (out of 274) 

women. 76% prolapse cure was achieved by laparoscopic repair 

alone but increased to 82% by adding the vaginal repair. 

Conclusion: An overall prolapse cure of 82% was achieved with 

the laparoscopic paravaginal repair and graft-reinforced anterior 

colporrhapy when indicated. This procedure was also associated 

with low perioperative morbidity. 

Quality of life study – Pelvic floor dysfunction 


Cook J, Behnia-Willison F, Seman E, O’Shea RT 

Background: Pelvic floor dysfunction (PFD) is a general term 

that describes conditions which adversely affect the female urinary 

and faecal continence mechanisms, together with genital prolapse. 

It is not uncommon for several pelvic floor disorders to coexist in 

the same woman or to develop sequentially over time. Disorders of 

the pelvic floor rarely result in severe morbidity or mortality. 

Rather, they affect the quality of a woman’s life and it has long 

been assumed that sexual function and satisfaction are 

compromised by these disorders. 

Hypothesis: Pelvic floor dysfunction adversely affects life in 

terms of bladder, bowel and sexual function. 

Method: Over a 12 month period, 61 women underwent 

laparoscopic Pelvic Floor Repair (PFR). Four questionnaires were 

administered pre-operatively. These were the Pelvic Floor Distress 

Inventory (PFDI), Pelvic Floor Impact Questionnaire (PFIQ), Pelvic 

Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire 

(PISQ) and the WHOQOL-BREF, which is a general health related 

50 





PROLAPSE 




UTERINE SURGERY 


Inadvertent cystotomy at laparoscopic 

hysterectomy 


Soo S, Hardas G, Merkur H 

Study objective: This study was undertaken to investigate the 

inadvertent cystotomy rates and outcomes associated with 

Laparoscopic Hysterectomy. To compare this with other series in 

the literature and to identify risk-factors, site of injury, method of 

repair, post-operative course and long-term sequelae. 

Design: 616 patients who had Laparoscopic Hysterectomy were 

identified. The data was prospectively collected between 1999 and 

2006 and retrospectively analyzed. All cases complicated by an 

inadvertent cystotomy were documented and follow up was 

performed at 3to 6 months in all cases. Analysis is by intention 

to treat. 


Patients: 616 patients undergoing Laparoscopic Hysterectomy 

with either Laparoscopic Assisted Vaginal Hysterectomy or Total 

Laparoscopic Hysterectomy. 

Measurements and main results: Of the 616 patients who 

had laparoscopic hysterectomy, the inadvertent cystotomy rate 

was 1.46% (9/616) with no reported long term sequelae. 

Results & discussion: The rate of inadvertent cystotomy in 

this study is comparable to that in recent published data. Our 

results also compare well with those published on abdominal 

hysterectomy (1.5-2%). All injuries occurred at the bladder dome 

where repair is relatively simple with minimal risk of ureteric 

disruption. This contrasts with vaginal hysterectomy where bladder 

injury, although rare, may involve the trigone with a greater risk of 

ureteric disruption following repair. Further data and discussion of 

the management in each of the 9 cases of inadvertent cystotomy 

will be presented. 


Fellow, George Hardas, Harry MerkurSydney West Advance 

Gynaecological Endoscopy Unit : Sydney West Advanced Pelvic Surgery 

Unit : Sydney West Area Health Service 

Review of 100 cases of laparoscopic 

hysterectomy in patients with previous 

caesarean sections 


Soo S, Merkur H, Herdas G 

Study objective: This study was undertaken to investigate the 

complication rates associated with Laparoscopic Hysterectomy in 

patients who have had caesarean section(s). To identify if there are 

specific complications that are higher in this group of patients 

and to compare these rates with patients who have not had 

Caesarean section(s). 

Design: 616 patients had Laparoscopic Hysterectomy of which 

100 patients have had one or more previous Caesarean section. 

The data was prospectively collected between 1999 and 2006 and 

retrospectively analyzed. All peri-operative complications were 

documented and follow up was performed at 4 to 8 weeks in all 

cases. Analysis is by intention to treat. Major complications 

include inadvertent cystotomy, ureteric injury, bowel injury, 

haemorrhage greater than 500mls. 


Patients: 100 patients with one or more previous Caesarean 

Section undergoing Laparoscopic Hysterectomy. 

Interventions: Laparoscopic Hysterectomy completed with 

either Laparoscopic Assisted Vaginal Hysterectomy or Total 

Laparoscopic Hysterectomy. 

Measurements and main results: Of the 100 patients who 

had laparoscopic hysterectomy with previous Caesarean(s), the 

major complication rate was 14% (14/94) with a conversion to 

laparotomy rate of 7% (7/94). 

Results: A higher major complication rate of 14% and a 

significant higher rate of inadvertent cystotomy of 5% was 

observed in the group of patients undergoing Laparoscopic 

Hysterectomy with one or more previous Caesarean. 

Conclusions: This study suggest that there is a higher major 

complication rate when performing Laparoscopic Hysterectomy in 

patients with previous Caesarean sections. This has important 

implications towards counseling and consenting in these patients 

for Laparoscopic hysterectomy. There is currently inadequate data 

to suggest whether a laparoscopic, laparotomy or vaginal 

approach is safest in these patients and a randomized controlled 

trial comparing the above is needed. 


Fellow, Harry Merkur, George Hardas: Sydney West Advance 

Gynaecological Endoscopy Unit: Sydney West Advance Pelvic Surgery Unit: 


52 











Result: Operation time and amount of blood loss were 

significantly greater in the group with fibroid 80 g than in the 

group < 80 g (121.5 ± 58.9 min versus 79.1 ± 28.6 min P < 

0.001, and 346.3 ± 299.6 mL versus 123.0 ± 89.7 mL P < 

0.001, respectively). However, there was no difference in the 

length of hospital stay and overall incidence of operative 

complications between these two groups. None of the women had 

any major complications. Nevertheless, 11 minor complications 

were noted including two pelvic abscess formations requiring 

another laparoscopic treatment. There was no incidence of 

switching to laparatomy during the operation. Extreme intraoperative 

hemorrhage of more than 1000 mL occurred in eight 

patients; however, they had full recovery after blood transfusion. 

Rate of blood transfusion was significantly lower in the group with 

fibroid < 80 g (3.2% versus 22.1%, P < 0.001). 

hospital stay , intravenous fluid usage over 48 hrs or not and the 

complication . Is different schedule time affecting the performance 

of surgeon doing LAVH Is it associated with a surgeon’s 

pressure, exhaustion or fatigue Further study results and findings 

will be presented. 

Author address: Department of Obstetrics and Gynecology, China 

Medical University Hospital, Taichung, Taiwan 

Conclusion: Despite the increased operation time and blood 

loss, LM can be safely performed for large uterine fibroid. 

However, high risk of blood transfusion in these patients has to be 

kept in mind. 

Key words: Laparoscopy; myomectomy; fibroid 

Author address: Chun-Chen Hsu, M.D. 1 ,Chin-Jung Wang, M.D. 2 , 

Chyi-Long Lee, M.D. 2 ,and Yung-Kuei Soong, M.D. 2 

1Department of Obstetrics and Gynecology, Chang Hwa Hospital; 

2Department of Obstetrics and Gynecology, Division of Gynecologic 

Endoscopy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang 

Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan 

Schedule effect and laparoscopic-assisted 

vaginal hysterectomy 


Chang WC , Lin WC , Yeh LS , Hung YC 

Background: Ensuring patient safety in the operating room and 

maintaining quality of care are currently emphasized under the 

medical environment of cost containment. Is different schedule 

time a possible factor affecting the performance of a surgeon 

doing the procedure of LAVH Does it matter the quality of care 

Method: This was a retrospective study consisting of a sample 

of 218 patients who underwent LAVH in a medical center. They 

were divided into 3 groups according to the starting time of 

implementing the procedure of LAVH. The 3 different starting time 

were Am8:30~9:30, 11:30~13:30 and 15:00~17:00. The 

clinical outcomes were compared and analysed. 

Results and conclusion: The clinical outcomes of the 3 groups 

measured and compared were the operating time , the estimated 

blood loss , the Ht. shift , the flatus passage time , the length of 

54 





GENERAL 




GENERAL 


Measurement of the force required for 

trocar insertion during gynaecological 



Sahota DS, Ng PS, Yuen PM 

Objective: To measure the force required for trocar insertion 

during laparoscopic surgery using a single transducer made from 

piezo-resitive material. 

Study design: A 3cm circular transducer was designed and 

constructed from piezo-resistive material, which changes its 

impedance as force is exerted on its surface. The transducer was 

connected via an interface box to a personal computer to digitally 

record the pressure (Pressure = Force/Area) profile continuously 

during the trocar insertion. The transducer was positioned in the 

center of the operator's palm such that each flat surface was in 

contact with either the hand or the top of the trocar. Each study 

subject had three trocars inserted. A 10mm trocar was inserted 

at the umbilicus after the creation of the pneumoperitoneum with 

intra-abdominal pressure of 15mmHg. Two additional 5mm 

trocars, either pyramidal or conical tip, were inserted at the left 

and right side of the lower abdomen. The insertion of the trocars 

was performed by the same operator. 

Results: Recordings were successfully obtained from the first 45 

subjects. The mean peak pressure for the insertion of the 

subumbilical port was 9.3 pounds per square inch and 7.8 pounds 

per square inch in nulliparous and multiparous women respectively. 

The mean peak pressure for the insertion of conical tip trocar in the 

lower abdomen was 10.6 pounds per square inch and 7.7 pounds 

per square inch in nulliparous and multiparous women respectively. 

The mean peak pressure for the insertion of pyramidal tip trocars 

was 8.5 pounds per square inch and 7.4 pounds per square inch in 

nulliparous and multiparous women respectively. 

Conclusions: A model has been developed by which trocar 

insertion force can be objectively measured. Preliminary findings 

would suggest that different type and size of trocars require 

different insertion force. Moreover, higher insertion force are 

required for the insertion of trocars in nulliparous women. 

Author address: Sahota DS, Ng PS, Yuen PM. Department of 

Obstetrics and Gynaecology, The Chinese University of Hong Kong Prince 

of Wales Hospital, Shatin, Hong Kong SAR 

Follow-up on an observational prospective 

study of a laparoscopic excisional approach 

in the treatment of pelvic pain associated 

with endometriosis 


Johnston KM, Phung H, Cooper MJW, Reid GD 

Study Objective: To assess the clinical outcome of an excisional 

approach to endometriosis in the treatment of pain associated 

with pelvic endometriosis. 

Design: Observational prospective clinical study. 

Settings: Tertiary advanced laparoscopic referral centres: Prince 

Alfred, Liverpool, St Lukes and St Vincents Hospitals, Sydney, New 

South Wales, Australia. 

Patients: Review of 112 patients with pain (dysmenorrhoea, 

deep dyspareunia, dyschezia, mid cycle, thigh and back pain) who 

underwent excision of mild, moderate and severe pelvic 

endometriosis. Endometriosis was excised in all patients using 

high power density monopolar electrosurgery and adhesiolysis 

performed were necessary. All patients had endometriosis 

confirmed by biopsy. All operations were performed by two 

advanced laparoscopic surgeons with a special interest in 

endometriosis. Patients filled in a preoperative baseline subjective 

scoring questionnaire, this was repeated at 3, 6 and 12 months 

post operatively. Main outcome measured was the improvement of 

pain at 3, 6 and 12 months post-operation. 

Measurents and Main Results: At 3 months (n=81), 6 

months (n=66) and 12 months (n=52) all patients reported a 

statistically significant improvement in dysmenorrhoea. At 3 

months (n=43) and at 6 months (n=21) there was a statistically 

significant improvement of deep dyspareunia however by 12 

months (n=31) this improvement was no longer significant. At 3 

months (n=39), 6 months (n=30) and 12 months (n=33) all 

patients reported a statistically significant improvement of 

dyschezia. Mid cycle pain was significantly improved at 3 months 

(n=59), 6 months (n=54) and 12 months (n=44). Thigh pain was 

significantly improved at 6 months (n=42) and 12 months (n=29). 

Back pain was significantly improved by 3 months (n=70), but by 6 

months (n=62) this improvement was no longer significant. There 

were no intraoperative complications. 

Conclusions: Excision of endometriosis when performed by 

experienced surgeons is a safe, effective treatment for pelvic and 

referred pain for up to 12 months. 

Author address: Johnston KM, 1 Phung H, 2 Cooper MJW, 1 Reid GD. 3 

1 Sydney Womens Endosurgery Centre (SWEC) and 2 The Simpson Centre 

for Health Services Research, Sydney, New South Wales, Australia 

56 





GENERAL 


AGES HOSTS WORLD ENDOMETRIOSIS 2008 

Mark it in your DIARY NOW! 

Our vision: 

The energy of AGES in Surgery, Science and Patient 

Care in the 21st Century. 

Our theme: 

ART AND SCIENCE OF ENDOMETRIOSIS 

Clinical acumen, surgical flare and 

biomedical advances unite to engage 

endometriosis: do not miss this event! 

MELBOURNE AUSTRALIA 

11-14 MARCH 2008 

10 TH 

WORLD CONGRESS 

ON ENDOMETRIOSIS 

Artwork: Fiona Hall born Australia 1953 | Paradisus Terrestris Entitled: Miwulngini (Ngan’gikurunggurr) / Nelumbo nucifera / lotus (1996) | aluminium and tin 24.6 x 12.1 x 3.6 cm | Purchased through The Art Foundation of 

Victoria with the assistance of the Rudy Komon Fund, Governor, 1997 | National Gallery of Victoria, Melbourne. | Fiona Hall is a leading Australian contemporary artist with a formidable career spanning three decades. 

ART & SCIENCE 

OF ENDOMETRIOSIS 

WCE 2008 

AGES President: 

Dr Rob O’Shea 

Chairman: 

Prof. David Healy 

Organiser: 

Mrs Michele Bender 

Platinum Sponsor 

World 

Endometriosis 

Society 

Australian 


Endoscopy 

Society


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MEMBERSHIP OF AGES 

more than endoscopic surgery 

AGES at its scientific meetings considers all aspects of gynaecological 

surgery. The successful AGES Pelvic Floor Group has provided a 

benchmark forum for gynaecologists predominantly interested in vaginal 

and reconstructive surgery. 

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acts of God, act of Government or any authorities, 

accidents to or failure of machinery or equipment 

or industrial action (whether or not involving our 

employees and even though such action may be 

settled by acceding to the demands of a labour 

group. Please note that the prices quoted are 

subject to change without notice. 

PRIVACY ACT 1988, Corporations Act 2001: 

Collection, maintenance and disclosure of certain 

personal information are governed by legislation 

included in these Acts. Please note that your 

details may be disclosed to the parties mentioned 

in this brochure.

ENDOSCOPIC SLIDE Flyer - AGES

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