ABSTRACT INTERNAL - AGES

AGES Focus MeetingENDOSCOPY FOR FERTILITY20 & 21 November 2008Sheraton Perth HotelWestern AustraliaAGES WorkshopROBOTICSURGERY19 November 2008St John of God HospitalSubiaco, PerthWestern AustraliaOvum II by Ana DuncanInternational FacultyProfessor Togas Tulandi, CanadaAssoc Professor John Boggess, USAABSTRACTS& PROGRAMPlatinum Sponsor of AGESMajor Sponsor of AGESAUSTRALIANGYNAECOLOGICALENDOSCOPYSOCIETY LTD

SPONSORS & EXHIBITORSAGES gratefully acknowledges the following companies:Platinum Sponsor of AGESMajor Sponsor of AGESSPONSORSBaxter BiosurgeryCovidienFisher & Paykel HealthcareEXHIBITORSCytycB Braun AescalupColocap PharmaceuticalsConMed LinvatecCook AustraliaExperienGyrus ACMIInSight OceaniaInterventMerck SeronoOlympus AustraliaOvum II by Ana Duncan

AGES Focus Meeting Sheraton ENDOSCOPY Perth Hotel, FOR West Australia FERTILITY 20 & 21 November 20081ContentsSPONSORS AND EXHIBITORSinside coverFACULTY, AGES BOARD AND COMMITTEE MEMBERS 2WELCOME MESSAGE 3OPTIONAL WORKSHOP PROGRAM 5CONFERENCE PROGRAM 6ABSTRACTS 8THURSDAY 20 NOVEMBER 8FRIDAY 21 NOVEMBER 14FUTURE AGES MEETINGS 20CONFERENCE INFORMATION & CONDITIONS inside back coverOvum II by Ana Duncan

2AGES BoardAssoc Professor Alan LamDr Jim TsaltasAssoc Professor Christopher MaherDr Anusch YazdaniDr Fariba Behnia-WillisonDr Robert FordProfessor David HealyDr Krishnan KarthigasuDr Michael McEvoyAssoc Professor Harry MerkurMrs Michele BenderPresidentVice PresidentHon SecretaryTreasurerExecutive DirectorOrganising CommitteeDr Krishnan KarthigasuChairProfessor Tony McCartneyAssoc Professor Roger HartDr Bernadette McElhinneyDr Stuart SalfingerDr Iris MenningerCo-ChairScientific ChairInternational FacultyProfessor Togas TulandiCanadaAssoc Professor John BoggessUSAAustralian FacultyDr Jason AbbottDr Fariba Behnia-WillisonMr Harsha ChandraratnaDr Michael CooperDr Phil DabornDr Robert FordAssoc Professor Roger HartDr Krishnan KarthigasuAssoc Professor Alan LamDr Robyn LeakeAssoc Professor Chris MaherProfessor Tony McCartneyDr Bernadette McElhinneyDr Iris MenningerAssoc Professor Harry MerkurDr Sanjay NadkarniDr Jay NatalwallaDr Rob O’SheaMr Richard PembertonDr Stuart SalfingerDr Graeme ThompsonDr Jim TsaltasDr Simon TurnerDr Michael Wynn-WilliamsDr Anusch YazdaniNSWSAWANSWWANSWWAWANSWWAQLDWAWAWANSWWAWASAWAWAWAVICWAQLDQLDAGES SECRETARIATPhone: +61 2 9967 2928 Fax: +61 2 9967 2627Email: conferences@ages.com.auAddress: 282 Edinbugh Road,Castlecrag NSW 2068, AUSTRALIAMembership of AGESMembership application forms are available from theAGES website or from the AGES Secretariat,282 Edinburgh Road, CASTLECRAGNSW 2068 AUSTRALIAPR&CRM AND CPD PointsThe AGES Focus Meeting 2008, ‘Endoscopy for Fertility’ has been approved as a RANZCOG Approved O&G Meeting andeligible Fellows of the College will earn points as follows:ATTENDANCE:Full: 18 CPD points in the Meetings categoryThursday 20 November: 9 CPD points.Friday 21 November: 8 CPD pointsBreakfast Session Friday 21 November: 1 CPD pointAttendance rolls must by signed each day and at the breakfast session for points to be awarded.Completion of the Pre and Post Questionnaires: 5 PR&CRM pointsThe college approved Pre- and Post-Questionnaires are comprised of 25 multiple choice questions from lectures given onThursday 20 November and Friday 21 November 2008.The Pre-Questionnaire must be handed in at Morning Tea on Thursday 20 November. The Post-Questionnaire must behanded in at the close of the meeting on Friday 21 November. No exceptions can be made to these deadlines.Ovum II by Ana Duncan

AGES Focus Meeting Sheraton ENDOSCOPY Perth Hotel, FOR West Australia FERTILITY 20 & 21 November 20083WelcomeDear Colleagues,The AGES Board is delighted to welcome you to Perth, Western Australia for the AGES Focus Meeting entitled ‘Endoscopyfor Fertility’.Prior to the commencement of the meeting we are holding an AGES workshop in robotic surgery at St John of God Hospital,Subiaco, facilitated by experts from the USA, Assoc Professor John Boggess designed to:• examine the role of the robot in gynaecology surgery• provide one to one practical interaction with the robot, and• demonstrate a case of live gynaecological robotic surgery.Approximately 10-15% of couples will require some form of assistance in achieving a pregnancy, and this figure may behigher in certain groups of patients.Endoscopic surgery has provided not only improved means of diagnosis of problems, but also surgical options to treatconditions where improved fertility outomes are needed.The meeting in Perth aims to show the current and future role of endoscopic surgery in sub-fertile couples, with nationaland international experts in the area.Topics to be discussed include management of uterine anomalies, training in minimal access surgery for fertility specialists,hysteroscopic surgery, management of pelvic and adnexal diseases, management of tubal disease, fertility preservingcancer surgery, interactive sessions involving complications of surgery in those wishing to conserve fertility and newtechniques for fertility surgery and robotic surgery.We aim to explore the breadth and depth of Endoscopy in this field of gynaecology, so those attending the meeting will havea greater practical and theoretical knowledge of the area to apply in practice.We are privileged to have a number of international experts at this meeting. Professor Togas Tulandi is well known inthe field of endoscopic surgery and fertility with countless publications and books written on this topic, and most involvedwith fertility work with are aware of his reputation. A/Professor John Boggess is a leader in the burgeoning world ofrobotic surgery, with Assoc Professor Boggess lecturing and operating internationally on robotic surgery.The Gala Dinner will be held at the award winning Matilda Bay Restaurant overlooking the Swan River and the City.We also encourage you to explore Perth and surrounding areas during your stay. It is the perfect time of year to visit thewineries and sites in the south–west of Western Australia, and to enjoy the beaches and restaurants of Perth.We tust you will enjoy the AGES Focus Meeting 2008 in our beautiful city.Krishnan Karthigasu Tony McCartney Roger Hart Alan LamConference Chair Co-Chair Scientific Chair AGES President

4PainPump 2Pain Managementfor OB/GYN SurgeryThe Stryker PainPump 2 gives you theversatility of PCA in a portable,electronic, disposable system.Perfect for use in continuousperipheral nerve blocks and insite-specific postoperative infusion

5optional WORKSHOP ProgramWEDNESDAY 19 NOVEMBER 2008AGES WorkshopROBOTIC SURGERYSt John of God Hospital, 12 Savado Road, Subiaco WAOrganising CommitteeProfessor Tony McCartney WADr Krishnan KarthigasuWAAssoc Professor Roger Hart WADr Bernadette McElhinney WADr Stuart SalfingerWADr Iris MenningerWAInternational FacultyAssoc Professor John Boggess USAAustralian FacultyDr Tom ManolitsasDr Justin VivianVICWA‘Come See and Play with the Robot’AGES would like to welcome you to Perth and one ofthe first Gynaecology Robotic Surgery Workshops inAustralia.AGES has always been at the forefront of innovationin gynaecological surgery and is considered a leader inthe field.In recent years one of the major advances in surgeryhas been the use of robotic technology. At this moment intime it is in its infancy in Australia, but is being used on aregular basis in the USA.We are privileged to have one of the world experts ingynaecologic robotic surgery from USA – AssocProfessor John Boggess – in Perth to demonstrate and toperform live surgery using the robot. These the first casesof robotic gynaecological surgery in Western Australiawill be performed at St John of God Hospital, Subiaco.This workshop aims to not only discuss the theory anduses of the robot, but also to get a “hands on” experiencewith the robot and see live surgery using the robot.This workshop will be of use to anyone interested in thefuture of gynaecological surgery.We hope you will gain valuable knowledge at this AGESWorkshop.Tony McCartneyKrishnan KarthigasuMORNING SESSION0800 Introduction A McCartney, K Karthigasu0815 Evolution of robotic surgery T Manolitsas0830 Robotic surgery in Western Australia so farJ Vivian0900 Anatomy overview and port placementJ Boggess1000 MORNING TEA1030 Practical ‘hands on’ with the robot1130 Robotic surgery in gynaecological oncologyJ Boggess1230 Robotic surgery in general gynaecology –is there a future?T Manolitsas1300 LUNCH AND DISCUSSION WITH THE EXPERTSAFTERNOON SESSION1400 Live robotic surgery –Total laparoscopic hysterectomyA McCartney, J BoggessCommentary: T Manolitsas1530 AFTERNOON TEA1600 ‘Hands on with the robot’1700 Closing comments A McCartneyThe AGES Robotic Workshop has been approved as aRANZCOG Approved O&G Meeting and eligibleFellows of the College will earn points as follows:Attendance Wednesday 19 November 8 CPD points.Attendance roll must be signed for points to beawarded.

6conference ProgramTHURSDAY 20 NOVEMBER 2008AGES Focus MeetingENDOSCOPY FOR FERTILITYGolden Ballroom, Sheraton Perth0800 Welcome A LamK Karthigasu0815 PR&CRM Points – Pre-Questionnaire R Ford0830 SESSION 1Sponsored by StrykerTRAINING IN ENDOSCOPIC SURGERYChairs: A Lam, R O’Shea0830 Training tools for laparoscopic surgeryK Karthigasu0855 Endoscopic training for CREI A Yazdani0920 Setting up a training program inlaparoscopic surgeryI MenningerB McElhinney0935 Hysteroscopic training J Abbott1000 MORNING TEA AND TRADE EXHIBITION1030 KEYNOTE LECTURE1315 SESSION 3HIGHLIGHTS FROM THE AGES/WES 10 TH WORLDCONGRESS ON ENDOMETRIOSISChairs: H Merkur, B McElhinney1315 Highlights from the scientific program J Tsaltas1345 Highlights from the clinical program J Tsaltas1415 SESSION 4FIBROIDS AND FERTILITYChair: M Cooper1415 Evidence for fibroids and infertility R Hart1435 Surgery for fibroids – practical tips inoperating on fibroids for fertilityM Wynn-Williams1455 Radiological treatment of fibroids S Nadkarni1515 Case discussion and questions I MenningerPanel discussionPanel: R Hart, M Wynn-Williams, S Nadkarni,J Tsaltas, K KarthigasuIntroductionK Karthigasu1530 AFTERNOON TEA AND TRADE EXHIBITIONManagement of uterine myoma 20081100 SESSION 2Sponsored by Johnson & Johnson MedicalHYSTEROSCOPIC SURGERY FOR FERTILITYChairs: J Abbott, I MenningerT Tulandi1100 Hysteroscopic treatment of fibroids R Hart1115 Ashermann’s Syndrome J Abbott1130 Hysteroscopic surgery for uterine anomaliesT Tulandi1150 Laparoscopic creation of neo-vagina M Cooper1210 Questions1215 LUNCH AND TRADE EXHIBITION1600 SESSION 5Sponsored by StrykerROBOTICSChairs: A McCartney, K Karthigasu1600 KEYNOTE LECTUREIntroductionRobotics and gynaecology in 2008A McCartneyJ Boggess1630 Robotic use in WA – a urology view R Pemberton1700 Practical use of the robot in USA / videopresentationsJ Boggess1730 Close1900 FOR 1930 GALA DINNERMATILDA BAY RESTAURANTComplimentary coach transfers will depart fromthe Sheraton Perth Hotel at 1830Ovum II by Ana Duncan

AGES Focus Meeting Sheraton ENDOSCOPY Perth Hotel, FOR West Australia FERTILITY 20 & 21 November 20087FRIDAY 21 NOVEMBER 2008AGES Focus MeetingENDOSCOPY FOR FERTILITYGoldsworth Room Sheraton Perth0730 OPTIONAL BREAKFAST SESSIONSponsored By Baxter BiosurgeryA Simple Solution to Reduce AdhestionsSpeakers: GH Trew & AA Luciano(numbers limited - bookings at registration desk essential)Golden Ballroom, Sheraton Perth0830 Housekeeping K Karthigasu0845 SESSION 6Sponsored by Johnson & Johnson MedicalTUBAL SURGERY AND MANAGEMENT OF THEYOUNG WOMAN WITH ENDOMETRIOSISChairs: R Ford, S Salfinger0845 Ectopic pregnancy – current management toretain fertilityG Thompson0915 Laparoscopic tubal surgery in the IVF era T Tulandi0945 The young woman with endometriosis –long term managementK Karthigasu1015 MORNING TEA AND TRADE EXHIBITION1045 SESSION 7OBESITY AND FERTILITYChairs: A Yazdani, S Turner1045 Effects of obesity on fertility R Hart1105 Minimally invasive surgical options fortreatment of obesityH Chandraratna1125 SESSION 8IVFChair: J Tsaltas, G Thompson1125 Endoscopic surgery prior to IVF:who, when & how?1145 Single woman in her mid 30s,what are the options?A YazdaniS Turner1230 LUNCH AND TRADE EXHIBITION1330 SESSION 9FERTILITY PRESERVING CANCER SURGERYChairs: A Lam, C Maher1330 Cervix/endometrial issues –hyperplasia/neoplasia1350 Ovarian masses, early ovariancancer/borderline tumorsT McCartneyS Salfinger1410 CIN treatment and fertility B McElhinney1430 SESSION 10FERTILITY PRESERVING PROLAPSE SURGERYChairs: F Behnia-Willison, R Leake1430 Vaginal approach to fertility preservingprolapse surgery1450 Laparoscopic approach to uterinepreserving prolapse surgeryC MaherA Lam1510 Can we use mesh safely in fertility preservingprolapse surgery? Benefits and pitfalls P Daborn1530 AFTERNOON TEA AND TRADE EXHIBITION1600 SESSION 11Sponsored by StrykerANATOMY OF COMPLICATIONS INFERTILITY PATIENTSChairs: P Daborn, R Leake1600 Tiseal and Flowseal treatment forhaemorrhageH Chandraratna1630 Interactive sessions – ComplicationsChairs: P Daborn, R LeakePanel: T Tulandi, J Abbott, A Lam, T McCartney,1730 Close – Final remarks A Lam1205 Case presentations – dilemmas forIVF – panel discussionPanel: R Hart, S Turner, T Tulandi, A Yazdani,J Natalwalla, M Cooper

8ABSTRACTSTHURSDAY 20 NOVEMBER 2008TRAINING TOOLS FOR LAPAROSCOPIC SURGERYThursday 20 November / Session 1 / 0830-0855Karthigasu KIn recent years training in surgery has come undergreater scrutiny by both the public as well as thespecialist colleges. The previous system of mentorship ispresently increasingly difficult to implement with theincrease in trainee numbers, reduced working hours,reduced number of surgical cases plus its inherentsubjectiveness. Laparoscopic surgery requires additionalskills to conduct advanced surgery. In this presentation Iwill discuss the various training tools available to aquireskills in surgery, particularly laparoscopic surgery andsome evidence of their effectiveness.Author Affiliation: Dr K Karthigasu. King EdwardMemorial Hospital for Women, Subiaco WA, Australia.SETTING UP A TRAINING PROGRAM IN LAPAROSCOPICSURGERYThursday 20 November / Session 1 / 0920-0935McElhinney B, Menninger IEndoscopic gynaecological procedures were introducedmore than twenty years ago. The number of endoscopicprocedures performed and their diversity has increasedover the years. As early as 1981 surgical societies andhospitals worldwide introduced guidelines regardinglaparoscopic surgery. Endoscopic operations are anintegral part of our daily work and require a structuredtraining programme.New modalities by which doctors in training are taughtare required to avoid medical error, teach more complexsurgical techniques and make up for less exposure tohands on surgical training of junior doctors requires.At King Edward Memorial Hospital for Women we havedeveloped a comprehensive endoscopic training programfor junior doctors to acquire basic and advancedlaparoscopic skills.The aim is for the trainees to improve their surgical safety,operative confidence and efficiency. The course focuses onthe techniques necessary to safely carry out endoscopicprocedures. The different modalities used to acquire basiclaparoscopic skills include lectures and box trainingsimulators to improve hand-eye coordination and depthperception and get acquainted with different entrytechniques, trochar placements and instruments. Animaland cadaver practice sessions as well as life surgery areused to teach advanced laparoscopic skills like dissection,cutting, coagulation, suturing and knot-tying. The training isobjectively assessed using multiple choice questions beforeand after the training module. Endoscopic skills are alsoassessed by an experienced trainer in the operating room.Good clinical training and supervision can be consideredan essential part of a junior doctors’ training. It would bedesirable if national/international training programs forendoscopic surgery could be developed overseen by theindividual surgical colleges.Author Affiliation: Dr B McElhinney, Dr I Menninger. KingEdward Memorial Hospital for Women, Subiaco, WA,Australia.MANAGEMENT OF UTERINE MYOMA 2008Thursday 20 November / Session 2 / 1030-1100Tulandi TLeiomyoma or fibroid is the most common benign tumoroccurring in the uterus and in the female pelvis. Fibroidsare the primary indication for hysterectomies and theyrepresent over 30% of the total number of hysterectomies.There are other treatments of uterine fibroids includingexpectant management, medical treatment, conservativesurgical treatment, uterine artery embolization (UAE), andMR guided focused ultrasound (MRgFUS).For women in reproductive age, myomectomy is an optionand in selected cases it can be done by laparoscopy.However, it is essential that the surgeon has an expertise inlaparoscopic suturing. Submucous myoma should betreated by hysteroscopic approach. To date, there is a lackof a prospective trial concerning the effect of intramuralfibroids on fertility compared to women with no fibroids.Although, UFE has been associated with premature ovarianfailure in

AGES Focus Meeting Sheraton ENDOSCOPY Perth Hotel, FOR West Australia FERTILITY 20 & 21 November 20089Contrary to UAE, MRgFUS is myoma-specific treatment. Intheory, it should not affect the ovarian blood supply andovarian reserve. It is associated with myoma shrinkage ofup to 25%. Newer treatments include temporary uterineocclusion with Doppler-guided transvaginal clamp, andintrauterine-ultrasound guided radiofrequency ablation offibroids. These treatments are still in the investigationalphase.Myolysis is associated with adhesion formation that mightfurther decrease fertility. For women who have completedtheir family, hysterectomy is a viable option.References:1. Agdi M, Valenti D, Tulandi T. Intra-abdominalAdhesions after Uterine Artery Embolization. Am JObstet Gynecol (In Press).2. Alessandri F, Lijoi D, Mistrangelo E, Ferrero S, Ragbi N.Randomized study of laparoscopic versusminilaparotomic myomectomy for uterine myomas. JMin Invasive Gynecol 2006:13:92-7.3. Goldberg J & Pereira L. Pregnancy outcomes followingtreatment for fibroids: uterine fibroid embolizationversus laparoscopic myomectomy. Curr Opin ObstetGynecol.2006; 18: 402-406.4. Goodwin SC, Bradley LD, Lipman JC, Stewart EA,Nosher JL, Sterling KM, Barth MH, Siskin GP &Shlansky-Goldberg RD. Uterine artery embolizationversus myomectomy: a multicenter comparative study.Fertil Steril. 2006; 85: 14-21.5. Pritts EA. Fibroids and infertility: a systematic review ofthe evidence. Obstet Gynecol Surv 2001;56: 483-4916. Seracchioli R, Manuzzi L, Vianello F, Gualerzi B, SavelliL, Paradisi R, Venturoli S. Obstetrics and deliveryoutcome of pregnancies achieved after laparoscopicmyomectomy. Fertil Steril 2006:86,159-657. Spies JB, Bruno J, Czeyda-Pommersheim F, Magee ST,Ascher SA & Jha RC. Long –term outcome of uterineartery embolization of leiomyomata. Obstet Gynecol.2005; 106: 933-935.8. Stewart EA, Rabinovici J, Tempany CMC, Inbar Y,Regan L, Gastout B, Hesley G, Kim HS, Hengst S &Gedroye WM. Clinical outcomes of focused ultrasoundsurgery for the treatment of uterine fibroids. FertilSteril. 2006; 85 : 22-29.9. Tulandi T. Treatment of uterine myomas. Is surgeryobsolete? NEJM 2007;356:411-3.Author Affiliation: Togas Tulandi MD, MHCM, FRCSC,FACOG. Professor of Obstetrics and Gynecology, MiltonLeong Chair in Reproductive Medicine, McGill University,Montreal, Quebec, Canada.HYSTEROSCOPIC TREATMENT OF FIBROIDSThursday 20 November / Session 2 / 1100-1115Hart RThis review will focus on the procedure of hysteroscopicresection of fibroids and will include a discussion on patientselection, the procedure, the risks of hysteroscopic surgeryand the success of the procedure. The discussion will alsoinclude a brief mention of alternative techniques.Author Affiliation: R Hart, Associate ProfessorReproductive Medicine, School of Women's and InfantsHealth, the University of Western Australia. King EdwardMemorial Hospital, Subiaco, WA, Australia.HYSTEROSCOPIC SURGERY FOR UTERINE ANOMALYThursday 20 November / Session 2 / 1130-1150Tulandi TBesides septate uterus, most uterine anomalies do notrequire correction. Septate uterus has the highest rate ofrecurrent pregnancy losses and poor obstetrical outcome.Treatment is performed by hysteroscopic approach. Theterm delivery rates after hysteroscopic metroplasty areapproximately 80% with a miscarriage rate ofapproximately 15%.It is paramount to establish the diagnosis preoperatively.The best non-surgical technique for diagnosing anddifferentiating different types of uterine anomalies ismagnetic resonance imaging. It is particularly useful todifferentiate septate, bicornuate or didelphys uterus.The septum is avascular. Bleeding usually occurs when theincision reaches the level of the myometrium at the fundus.The procedure is terminated at this point. Reproductiveoutcome is favorable with a residual septum of

10ABSTRACTS continuedTHURSDAY 20 NOVEMBER 2008Further septum resection is not recommended. A completeseptum involves the cervix. Some surgeons believe thatresection of the cervical portion is associated with cervicalincompetence. However, leaving the cervical portion of theseptum might cause dystocia preventing vaginal delivery.Our practice is to resect the cervical septum.References:1. Atlas of Laparoscopy and Hysteroscopy Technique, 3rdedition (Ed. T. Tulandi), Informa, London, 2007.2. Homer HA, Li TC, Cooke ID. The septate uterus: areview of management and reproductive outcome.Fertil Steril 2000;73(1):1-143. Pabuccu R, Gomel V. Reproductive outcome afterhysteroscopic metroplasty in women with septateuterus and otherwise unexplained infertility. Fertil Steril2004;81(6):1675-8Author Affiliation: Togas Tulandi MD, MHCM. Professor ofObstetrics and Gynecology & Milton Leong Chair inReproductive Medicine McGill University, Montreal,Quebec, Canada.LAPAROSCOPIC CREATION OF NEO-VAGINATHE VECCHIETTI PROCEDUREThursday 20 November / Session 2 / 1150-1210Cooper MMayer-Von Rokitansky-Kuster-Hauser (MRKH) Syndromeis a rare congenital abnormality characterised by normalsecondary sexual characteristics, vaginal aplasia, normalovaries and a rudimentary uterus. The prevalence of thisanomaly is one case per 4-5,000 live female births. Toproduce a functioning neovagina in affected subjects,management relies on one of several approaches; nonsurgicali.e. Frank technique (1), a split-thickness skingraft i.e. McIndoes technique (2), sigmoid colon grafts(3,4) or a combination of surgical and non-surgical(Vecchietti technique). Numerous variations of thesetechniques have also been described.Giuseppe Vecchietti first described his technique forcreating a neovagina in subjects with Mayer-VonRokitansky-Kuster-Hauser Syndrome (MRKH) in 1965 (5).The initial description was of an open abdominalprocedure involving a Pfannenstiel incision, dissection ofthe vesico-rectal space and placement transabdominallyof two sutures passing from the anterior abdominal wallthrough the vaginal groove and into an external 'dilationolive'. Post-operatively the 'olive' is progressively drawninto the vaginal groove by continuous and increasingtension on the abdominal sutures wound. A neovagina isthus formed and is maintained patent by subsequentdilator use. This procedure has been used for subjectswith vaginal aplasia secondary to Mayer-Von Rokitansky-Kuster-Hauser and Morris syndrome (6) but also insubjects with a shortened vagina secondary to surgery orradiotherapy (7). The open procedure has been seen to behighly effective in producing an anatomical and functionalneovagina in more than 600 cases. The laparoscopicapproach was first described in 1992 (8,9) and has beenshown to have similar outcomes to the open procedure(10). Vecchietti procedures have been predominantlyperformed in Europe with only one case being reported inthe Australasian literature to date (11).The authors experience will be described during thepresentation.References:1. Frank, R. T. The formation of an artificial vagina withoutoperation. Amer. J Obst Gynec 1938; 35: 1053.2. McIndoe, A. The treatment of congenital absence andobliterative conditions of the vagina. Brit J Plast Surg1950; 2: 254.3. Wesley, J. R. and Coran, A. G.: Intestinal vaginoplasty forcongenital absence of the vagina. J Ped Surg 1992;27: 885.4. Hendren, W. H. and Atala, A.: Use of bowel for vaginalreconstruction. J Urol 1994; 152: 752.5. Vecchietti G. [Creation of an artificial vagina inRokitansky-Kuster-Hauser syndrome]. Attual OstetricGinecol. 1965; 11(2): 131-47, Mar-Apr.6. Marzetti L. Veneziano M. Boni T. Pecorini F. Framarinodei Malatesta MF. Giobbe M. Fabiani C. [The creationof a neovagina with laparoscopic technique]. ChirurgItal 1999; 51(3): 253-8.7. Veronikis DK. McClure GB. Nichols DH. The Vecchiettioperation for constructing a neovagina: indications,instrumentation, and techniques. Obstet Gynecol 1997;90(2): 301-4.8. Gauwerky JF. Wallwiener D. Bastert G. Anendoscopically assisted technique for construction ofa neovagina. Arch Gynecol Obstet 1992; 252(2): 59-63.9. Popp LW. Ghirardini G. Creation of a neovagina bypelviscopy. J Laparoendosc Surg 1992; 2(3): 165-73.10. Borruto F. Chasen ST. Chervenak FA. Fedele L. TheVecchietti procedure for surgical treatment of vaginalagenesis: comparison of laparoscopy and laparotomy.Intl J Gynaecol Obstet 1999; 64(2): 153-8.11. Cooper MJ. Fleming S. Murray J. Laparoscopicassisted Vecchietti procedure for the creation of aOvum II by Ana Duncan

AGES Focus Meeting Sheraton ENDOSCOPY Perth Hotel, FOR West Australia FERTILITY 20 & 21 November 200811neovagina. J Obstet Gynaecol Res 1996; 22(4): 385-8.12. Fedele L. Bianchi S. Zanconato G. Raffaelli R.Laparoscopic creation of a neovagina in patients withRokitansky syndrome: analysis of 52 cases. Fertil Steril2000; 74(2): 384-9.13. Bartos P. [Congenital vaginal aplasia: laparoscopicreconstruction of a neovagina using the Vecchiettitechnique in the Mayer-von Rokitansky-Kuester-Hausersyndrome]. Ceska Gynekol. 2000; 65(1): 45-7.14. Rechberger T. Kotarski J. Tarkowski R. Jakowicki JA.[Laparoscopic modification of Vecchietti operation in thetreatment of congenital vaginal aplasia]. Ginekol Pol1999; 70(5): 279-83.15. Khater E. Fatthy H. Laparoscopic Vecchietti vaginoplasty.J Am Assoc Gynecol laparoscop 1999; 6(2): 179-82.16. Chatwani A. Nyirjesy P. Harmanli OH. Grody MH.Creation of neovagina by laparoscopic Vecchiettioperation. J Laparoendoscop Adv Surg Techn. Part A.1999; 9(5): 425-7.17. Weijenborg PT. ter Kuile MM. The effect of a groupprogramme on women with the Mayer-Rokitansky-Kuster-Hauser syndrome. Br J Obst Gynaecol 2000;107(3): 365-8.Author Affiliation: Dr Michael Cooper, Clinical SeniorLecturer, Department of Obstetrics and Gynaecology,Sydney Univeristy.EVIDENCE FOR FIBROIDS AND INFERTILITYThursday 20 November / Session 4 / 1415-1435Hart RThis presentation will focus on the origins of fibroids, theirassociation with subfertility and the treatment strategiescurrently available. The evidence for the effect ofsubmucosal, intramural and subserosal fibroids onconception will be discussed and the evidence for andagainst surgical intervention will be described.Author Affiliation: R Hart, Associate ProfessorReproductive Medicine, School of Women's and InfantsHealth, the University of Western Australia. King EdwardMemorial Hospital, Subiaco, WA, Australia.SURGERY FOR FIBROIDS – PRACTICAL TIPS FOROPERATING ON FIBROIDS FOR FERTILITYThursday 20 November / Session 4 / 1435-1455Wynn-Williams MThe surgical management of uterine fibroids for thefertility can present many challenges to thegynaecological surgeon. Firstly the decision to performsurgery and improve the fertility must be balanced againstthe risks of surgery and the potential risks to a futurepregnancy. Ultrasound and MRI may be used to map thesize and position of fibroids to carefully plan the surgicalapproach and inform the patient of the potential risks.Laparoscopic and laparoscopic assisted myomectomy areboth effective techniques for managing intramural,subserosal and pedunculated fibroids. The size andposition of the fibroid can limit the ease with which theprocedure can be performed. Open myomectomy hastraditionally been used for numerous and larger fibroids.Temporary uterine artery occlusion at laparoscopicmyomectomy is a novel method of performinglaparoscopic myomectomy on larger fibroids.At completion of the procedure, removal of myomatafrom the abdominal cavity can be a time-consuming. Anumber of techniques including the use of a laparoscopicknife, mechanical morcelation and kevlar retrieval bagshave been used to expedite the process . Adhesionsfollowing myomectomy are unfortunately common. Antiadhesionbarriers such as Adept and Seprafilm could beof benefit for future fertility by reducing adhesions.Author Affiliation: Dr Michael Wynn-Williams – EveGynaecology, Brisbane, Australia.THE FOLLOWING ABSTRACTS ARE FROM PUBLISHEDARTICLES SUBMITTED BY ASSOCIATE PROFESSOR JOHNF BOGGESS IN SUPPORT OF THE PLENARY LECTURE:ROBOTICS AND GYNAECOLOGY IN 2008Thursday 20 November / Session 5 / 1600-1630ROBOTIC SURGERY IN GYNECOLOGIC ONCOLOGY:EVOLUTION OF A NEW SURGICAL PARADIGMBoggess JFRobotic surgical platforms were first developed withtelesurgery in mind. Conceptualized by NASA and themilitary to provide surgical expertise to remote locations,some telesurgical success has been documented, butprogress has been held back by communication band

14ABSTRACTSFRIDAY 21 NOVEMBER 2008This presentation will focus specifically on the establishmentof the Robotic programme in Perth solely by urologistsperforming radical prostatectomy prior to this meeting.Results from large single centre studies report potentialadvantages of this approach and include reduced hospitalstay and recovery, earlier catheter removal, improvedpotency rates with equivalent cancer control.The transition from pure laparoscopic radicalprostatectomy will be discussed and early results fromprospective data collection presented from theprogramme’s inception.ECTOPIC PREGNANCY - CURRENT MANAGEMENT TORETAIN FERTILITY(OLD IS THE NEW NEW)Friday 21 November / Session 6 / 0845-0915Thompson GRObjective: To present a balanced, objective approach tothe management of ectopic pregnancy (EP) with regard tothe future fertility of the patient.Methods: Literature search (both historical andcontemporary) and presentation of previously publisheddata from our group and others.Application of deductive reasoning to the problem.Conclusions: Even with the availability of assistedreproductive technology, it is difficult to make a case forradical treatment of ectopic pregnancy. Conservativemanagement is feasible and has proven efficacy.References:1 Tait R.L. Five cases of extrauterine pregnancy operatedupon at the time of pregnancy. Br Med J 1884 1 12502 Stromme W.B. Salpingotomy for tubal pregnancy.Obstet Gynecol 1 472 19533 Bruhat M.A. et al. Treatment of ectopic pregnancy bymeans of laparoscopy. Fertil Steril 33 411 19804 Meyer W.R. De Cherney A.H. Diamond M.P. Tubalectopic pregnancy: Contemporary diagnosis, treatmentand reproductive potential. J Gynecol Surg 5 343 19895 Fernandez E. et al. Spontaneous resolution of ectopicpregnancy. Obstet Gynecol 71 2 19886 Tanaka T. et al. Treatment of interstitial ectopicpregnancy with methotrexate, report of a successfulcase. Fertil Steril 1982. 37 851-852. Ory S.J. et al. Conservative management of ectopicpregnancy with methotrexate. Am J Obstet Gynecol1986.154 1299-13068 Feichtinger W. Kemeter P. Conservative treatment ofectopic pregnancy by transvaginal aspiration undersonographic control and methotrexate injection.Lancet 1 381 19879 Leeton J. Davison G. Nonsurgical management ofunruptured tubal pregnancy with intraamnioticmethotrexate, preliminary report of two cases. FertileSteril 1988 50 167 – 16910 Thompson G.R. O’Shea R.T. Seman E. Methotrexateinjection of tubal ectopic pregnancy. A logicalevolution? Med J Aust 1991 154: 469 – 47111 Thompson G.R. O’Shea R.T. Harding A. Beta hCG levelsafter conservative treatment of ectopic pregnancy; is aplateau normal Aust NZ J Obstet Gynaecol 1994 3412 Stovall T.G. Ling F.W. Single dose methotrexate for thetreatment of ectopic pregnancy. Obstet Gynecol 199177 754 – 75513 Pouly J.L. Conservative laparoscopic treatment of 321ectopic pregnancies. Fertil Steril 46 1093 198614 Tulandi T. Reproductive performance of women aftertwo ectopic pregnancies. Fertil Steril 1983 40 28915 Dubuisson J.B. et al. Reproductive outcome afterlaparoscopic salpingectomy for tubal pregnancy. FertilSteril 53 6 199016 Pansky M. et al. Reproductive outcome afterlaparoscopic local methotrexate injection for tubalpregnancy. Fertil Steril 60 1 199317 Stovall T.G. Ling F.W. Buster J.E. Reproductiveperformance after methotrexate treatment of ectopicpregnancy. Am J Obstet Gynecol 1990 162 1620 – 162418 Murray H. Baakdah H. Bardell T. Tulandi T. Diagnosisand treatment of ectopic pregnancy. CMAJ 2005 Oct 11905 – 912Author Affiliation: G.R. Thompson. Concept Fertility Centre& Clinical Lecturer University of Western Australia, Perth,WA, Australia.Ovum II by Ana Duncan

AGES Focus Meeting Sheraton ENDOSCOPY Perth Hotel, FOR West Australia FERTILITY 20 & 21 November 200815LAPAROSCOPIC TUBAL SURGERY IN THE IVF ERAFriday 21 November / Session 6 / 0915-0945Tulandi TDue to availability of assisted reproductive technologies,the need for reproductive surgery in infertile women hasdeclined over the past decades. However, it still has aplace in the management of infertile women. For example,young women with a history of pelvic inflammatorydisease might have pelvic adhesions or blocked Fallopiantubes that impair their fertility; and they will benefit fromearly surgical intervention. On the other hand, womenover the age of 35 with a long history of infertility or thosewho require a laparotomy for correction of their disordersare better treated with in-vitro fertilization.The radiologic findings of proximal tubal occlusion (PTO)have to be interpreted with caution. Indeed, we found thatfalse diagnosis was 26.5%. In those with true cornualocclusion, selective tubal catheterization should be done.It leads to an overall pregnancy rate of 31.9%. The valueof diagnostic laparoscopy is low. We perform laparoscopyonly in young women with a history of pelvic inflammatorydisease, or with ovarian endometrioma.Due to the generally poor results of reconstructive surgeryof distal tubal occlusion (hydrosalpinx), the patients arebetter treated with IVF. Salpingectomy is first performed toenhance the IVF pregnancy rate. The fluid in thehydrosalpinx decreases the implantation rate. Laparoscopictubal anastomosis leads to a good pregnancy rate. Inaddition, it might lead to more than one pregnancy.The increasing use of IVF for infertile women isassociated with increasing rate of ectopic pregnancy.Most ectopic pregnancies however could be treatedmedically. Those who have contraindication to medicaltreatment can be treated by laparoscopy.The concept of fertility management has changed. Weperform reduced number of tubal surgery and instead oflaparotomy, we repair the fallopian tube with laparoscopyapproach. As Christina Baldwin once said, “Change is theconstant, the signal for rebirth, the egg of the phoenix.”References:1 Al-Fadhli R, Tulandi T. Tubal disease in relation toinfertility. In: Clinical Reproductive Medicine andSurgery. Ed. T. Falcone and W. W. Hurd, Mosby, 2007.2 Al-Jaroudi D, Herba MJ, Tulandi T. Reproductiveperformance after selective tubal catheterization. JMin Inv Gynecol. 2005;12:150-23 Hurst BS, Tucker KE, Schlaff WD. Hydrosalpinx treatedwith extended doxycycline does not compromise thesuccess of in vitro fertilization. Fertil Steril.2001;75:1017-9.4 Johnson NP, Mak W, Sowter MC. Surgical treatmentfor tubal disease. In: Surgical treatment for tubaldisease in women due to undergoing in vitrofertilisation. The Cochrane Database of SystematicReviews 2004, Issue 3. Art. No.: CD002125.pub25. Sacks G, Trew G. Reconstruction, destruction and IVF:dilemmas in the art of tubal surgery. BJOG 2004;111:1174-81.6 Zeyneloglu HB, Arici A, Olive DL. Adverse effects ofhydrosalpinx on pregnancy rates after in vitrofertilization-embryo transfer. Fertil Steril. 1998;70:492-9.Author Affiliation: Togas Tulandi MD, MHCM. Professor ofObstetrics and Gynecology & Milton Leong Chair inReproductive Medicine McGill University, Montreal,Quebec, Canada.YOUNG WOMEN WITH ENDOMETRIOSIS - LONG TERMMANAGEMENTFriday 21 November / Session 6 / 0945-1015Karthigasu KThe diagnosis of endometriosis in adolescents and youngwomen is not uncommon, however the longer termmanagement to provide symptom relief and retain optimalfertility can be variable amongst gynaecologists. Inrecent years more data has become available about theeffectiveness of both surgical management and medicalmanagement of endometriosis. In this presentation, viathe use of case presentations, I aim to have an interactivesession to explore options of treatment available to youngwomen diagnosed with endometriosis and discuss therelevant data available for the treatment options.Author Affiliation: Dr K Karthigasu. King Edward MemorialHospital for Women, Subiaco, WA, Australia.

16ABSTRACTS continuedFRIDAY 21 NOVEMBER 2008EFFECT OF OBESITY ON FERTILITYFriday 21 November / Session 7 / 1045-1105Hart RThis presentation will describe the adverse influence ofbeing overweight on the chance of natural conception,the effect of obesity upon the success of assistedreproduction, its influence on the chance of miscarriageand a brief mention of the adverse pregnancy outcomesrelated to obesity.Author Affiliation: R Hart, Associate ProfessorReproductive Medicine, School of Women's and InfantsHealth, the University of Western Australia. King EdwardMemorial Hospital, Subiaco, WA, Australia.MINIMALLY INVASIVE SURGICAL OPTIONS FOR THETREATMENT OF OBESITYFriday 21 November / Session 7 / 1105-1125Chandraratna HObesity is the plague of the 21st Century. It’s true causeslargely unknown, it’s promoters obvious and despite awide array of treatments it persists. It’s secondary effectsspill over into every field of medicine and it is a rapidlyincreasing cause of infertility. Because of this everydoctor today needs to be familiar with it’s associatedmorbidities and have an understanding of the treatmentsavailable. Surgical management has been shown to bethe only reliable sustained method of weight loss, but theoperations performed subtly change physiology anddoctors need to account for this when managing patientsperi-operatively.In this talk we will cover the causes and surgicaltreatment options available for obesity, and how nonobesity surgeons should manage patients who are obeseand also those who have had a surgical intervention. Wewill also cover the relationship between obesity andinfertility and management options to achieve asuccessful pregnancy.Author Affiliation: Dr H Chandraratna. University of NotreDame, Freemantle, WA, Australia.EARLY OVARIAN CANCER AND BORDERLINE TUMORSFriday 21 November / Session 9 / 1350-1410Salfinger SRequests for preservation of fertility are most common inyoung women with ovarian tumors of low malignantpotential or nonepithelial ovarian cancers. Fertilitypreservation is also an option for women with stage IA EOC.It should be remembered that this treatment should beregarded non standard and limited data is available tobase advice upon. Conservative surgery such as USOshould be accompanied by full surgical staging includingwashings, omentectomy, appendicectomy and possiblynode biopsies. Thorough laparotomy with exploration andbiopsy of any suspicious areas is also required andendometrial sampling should be performed. A review ofstudies of women with early stage epithelial ovariancarcinoma who underwent conservative treatmentincluded 282 women and 113 deliveries. There were 33relapses and 16 disease-related deaths. Studies ofwomen having fertility conserving surgery forgynaecologic cancer have shown that only 50% evenattempt to become pregnant.Low malignant potential or borderline tumours have anexcellent prognosis. USO or even cystectomy may beconsidered. Any visible disease should be removed. Sometrials have shown an increased incidence of cyst rupturewith laparoscopic surgery but the implications onrecurrence rate is unclear; there are no RCT’s assessingthis. The appendix should always be removed in patientswith mucinous tumours. Frozen section diagnosis may oftenbe altered on final complete histopathological analysis.Recurrence rates vary from 5-30% with Cystectomyhaving a significantly higher recurrence rate thanoophorectomy. Recurrences are most commonlyborderline tumours (90%) with recurrence as malignanttumour similar to the incidence of ovarian carcinoma inthe general population, one of the largest series showingonly a 2% risk of recurrence as malignancy. Progressionto invasive cancer may represent true transformation, denovo development of an ovarian cancer, or a primaryperitoneal cancer.Currently there is no evidence that women who have hadfertility sparing surgery are at increased risk of mortalityfrom disease progression if they become pregnant.Ovulation induction and other fertility treatments appearsafe.Author Affiliation: Dr Stuart Salfinger, GynaecologicOncologist.Ovum II by Ana Duncan

AGES Focus Meeting Sheraton ENDOSCOPY Perth Hotel, FOR West Australia FERTILITY 20 & 21 November 200817CIN TREATMENT AND FERTILITYFriday 21 November / Session 9 / 1410-1430McElhinney BDetection and treatment of CIN greatly decreases the riskof cervical cancer. The peak incidence of severedysplasia occurs in women aged 25-29, a time when manywomen are considering pregnancy. Therefore the impactof CIN treatment on fertility is of great importance.Historically, hysterectomy or cold knife conisation wasthe standard of care. Since the 1980’s, more conservativeout-patient excisional treatments of the transformationzone have become popular.Currently LLETZ is the treatment of choice worldwide.The procedure is easy, inexpensive, effective asearlier/alternative methods and provides a surgicalspecimen. However, excisional treatment of any kind mayaffect the mechanical support of the cervix withimplications for future pregnancies.Absolute indications for cold knife conisation includesuspicion of an early invasive cancer, significantglandular abnormality and incompletely seen lesions inthe presence of a high grade squamous abnormality.Early case series and retrospective cohort studiesdescribe the impact of cold knife conisation on pretermbirth. However, the studies were small & inadequatelypowered with variable composition of comparativegroups; few undertook multivariate analyses to adjust forpotential confounders. Total number of cases was 558and the relative risk of preterm births was 2.9.There are ten cohort studies published in the EnglishLanguage peer reviewed literature on the effect of LLETZon preterm birth. The largest and most recent studiesboth show a significant association between LLETZ andspontaneous preterm birth and with pPROM.In summary it is probable that excisional therapiesincrease the risk of spontaneous preterm birth. However,the data regarding the amount of tissue removed areimprecise. Further research is needed to confirm thelikely effect of excisional treatments on the subsequentrisk of spontaneous preterm birth.Author Affiliation: Dr Bernadette McElhinney. KingEdward Memorial Hospital for Women, Subiaco, WA,Australia.UTERINE PRESERVATION. VAGINAL APPROACHFriday 21 November / Session 10 / 1430-1450Maher CUterine preservation at prolapse surgery is increasinglybeing considered by women due to a delay inchildbearing to a later age, a belief that the uterus plays arole in sexual satisfaction and successful conservativetreatments for the control of menorrhagia. In womenwishing uterine preservation a variety of surgical optionsare available including the Manchester repair andsacrospinous hysteropexy vaginally, and uterosacralhysteropexy and sacral hysteropexy abdominally.The Manchester repair has largely been abandoned dueto recurrence of prolapse in excess of 20% in the first fewmonths, decrease in fertility, pregnancy wastage as highas 50% and future sampling of the cervix and theendometrium can be difficult due to vaginal reepithelializationor cervical stenosis.The sacrospinous hysteropexy is a safe and effectiveprocedure as compared to vaginal hysterectomy andsacrospinous colpopexy for uterine prolapse. Twocomparative studies involving 165 women with at least amean 2-year review are available and demonstrate theoperating time, blood loss and complications are reducedin the hysteropexy group with success rates of 90%being reported in both groups1,2. Only limited data isavailable on pregnancy outcome following sacrospinoushysteropexy as Hefni et al who contributed 109 women tothe literature only reported in women over 60 years.Seven pregnancies have been reported with 2 (29%)undergoing further prolapse surgery, one each followingvaginal and caesarian delivery1,3.Anterior compartment prolapse has been problematicfollowing sacrospinous hysteropexy. Also recent RCTShave demonstrated at 1 year that the use ofpolypropelene mesh significantly reduces the rate ofrecurrent prolapse at 1 year as compared to anteriorcolpoharraphy4-6 . Finally vaginal hysterectomy has beenassociated with 5x higher rate of mesh erosions ascompared to mesh repairs with no hysterectomy7. Thesethree factors have encouraged us to perform vaginaluterine preservation and anterior mesh for themanagement of uterovaginal prolapse. Information on ouroutcomes for sacrospinous hysteropexy, anterior meshand posterior repair will be reported.Several authors have reported objective success rates ofover 90% with sacral hysteropexy8,9 where meshsecures the cervix to the sacrum. Roover’s et al in a

18ABSTRACTS continuedFRIDAY 21 NOVEMBER 2008randomized control trial compared sacral hysteropexyand vaginal hysterectomy and repair10 reported asignificantly higher re-operation rate for prolapse in thehysteropexy group at 2 and 5years.The literature demonstrates that the vaginal approach issuperior to abdominal approach in the management ofuterovaginal prolapse in those requesting uterinepreservation.References:1 Maher CF, Cary MP, Slack MC, Murray CJ, Milligan M,Schluter P. Uterine preservation or hysterectomy atsacrospinous colpopexy for uterovaginal prolapse? IntUrogynecol J Pelvic Floor Dysfunct 2001;12(6):381-4.2 Hefni M, El Toukhy T, Bhaumik J, Katsimanis E.Sacrospinous cervicocolpopexy with uterineconservation for uterovaginal prolapse in elderlywomen: an evolving concept. Am J Obstet Gynecol2003;188(3):645-50.3 Kovac SR, Cruikshank SH. Successful pregnancies andvaginal deliveries after sacrospinous uterosacralfixation in five of nineteen patients. Am J ObstetGynecol 1993;168(6 Pt 1):1778-83.4 Hiltunen R, Nieminen K, Takala T, et al. Low-weightpolypropylene mesh for anterior vaginal wall prolapse:a randomized controlled trial. Obstetrics AndGynecology 2007;110(2 Pt 2):455-462.5 Nguyen JN, Burchette RJ. Outcome after anteriorvaginal prolapse repair: a randomized controlled trial.Obstet Gynecol 2008;111(4):891-8.6 Sivaslioglu A, Unlubilgen E, Dolen I. A randomisedcomparison of polypropelene mesh surgery with sitespecificsurgery in treatment of cystocele.International Urogynecology Journal And Pelvic FloorDysfunction 2007;published online(DOI 10.1007/s00192-007-0465-y).7 Belot F, Collinet P, Debodinance P, Ha Duc E, Lucot JP,Cosson M. [Risk factors for prosthesis exposure intreatment of genital prolapse via the vaginalapproach]. Gynécologie, Obstétrique & Fertilité2005;33(12):970-974.8 Leron E, Stanton SL. Sacrohysteropexy with syntheticmesh for the management of uterovaginal prolapse.BJOG 2001;108(6):629-33.9 Barranger E, Fritel X, Pigne A. Abdominalsacrohysteropexy in young women with uterovaginalprolapse: long-term follow-up. Am J Obstet Gynecol2003;189(5):1245-50.10 Roovers JP, van der Vaart CH, van der Bom JG, vanLeeuwen JH, Scholten PC, Heintz AP. A randomisedcontrolled trial comparing abdominal and vaginalprolapse surgery: effects on urogenital function. BJOG2004;111(1):50-6.Author Affiliation: Associate Professor ChristopherMaher, Brisbane, Qld, Australia.LAPAROSCOPIC APPROACH TO UTERINE PRESERVINGPROLAPSE SURGERYFriday 21 November / Session 10 / 1450-1510Lam ATraditional approach to significant utero-vaginal prolapse,defined as ≥ stage 2 POP-Q prolapse, often involvesvaginal hysterectomy and vaginal repair. Increasinglymore and more women are interested in uterinepreservingprolapse surgery. The variety of reasons whichmay influence women in seeking this line of surgicalmanagement includes:• Fertility-preserving option – nulliparous or multiparouswomen• Fear of loss of femininity• Cultural factor• Psychological factor• Potential de-novo bladder or bowel dysfunction• Potential impact on sexual function• Anatomical considerations – loss of vaginal length,loss of central support leading to possible subsequentvault prolapse• Morbidity associated with hysterectomy• Hysterectomy may not necessarily reduce the risk oflong-term prolapse recurrenceAnatomical considerations: Uterine prolapse occurs as aresult of damage to Delancey level I support ie theutero-sacral cardinal complex.Uterine prolapse may occur in isolation or as part of amulti-level, multi-compartment pelvic floor damage.Uterine prolapse may therefore occur along with level IIanterior and /or posterior compartment defects, and levelIII defects.Women who have uterine prolapse may also havecervical elongation which can result in the leading edgeof the prolapse, namely the cervix (point C of POP-Q)presenting outside while vaginal posterior fornix (point D)remaining above the hymenal remant.Management options: Frequently, most women withsignificant utero-vaginal prolapse are advisedOvum II by Ana Duncan

AGES Focus Meeting Sheraton ENDOSCOPY Perth Hotel, FOR West Australia FERTILITY 20 & 21 November 200819conservative management if they wish to preservefertility. The conservative measures include pelvic floorexcercise with or without the use of vaginal pessary.Surgery is often delayed until childbearing is completebecause of:• The risk of recurrence of prolapse with furtherchildbirth which in turn may necessitate repeatsurgery• Possible impact on fertility from cervical surgery(shortening, amputation)• Possible development of cervical incompetenceresulting necessitating cervical cerclage• Possibility of cervical stenosis and hematometra• Hysterectomy is frequently considered an inevitablecomponent of surgery for significant utero-vaginalprolapseLaparoscopic approach: Laparoscopic approach offerswomen who are symptomatic of their prolapse the choiceof uterine preserving surgery. This can be achieved by• Suture repair – level I hysteropexy uterosacralsuspension +/- level II anterior and posterior paravaginalattachment and level III repair• Mesh repair – in cases where the quality ofuterosacral ligaments is inadequate:o sacro-cervicopexy with mesho sacro-hysteropexy with mesh attachment to boththe anterior and posterior cervix.o sacro-hystero-colpopexy with mesh attachment toboth the anterior and posterior vaginal wall and thecervixIt is important to assess the length of the cervix. Ingeneral, women wishing to preserve fertility should avoidcervical repair. Where necessary, only the removal of thehypertrophic, elongated infra-vaginal portion of thecervix maintaining a minimum of 2 cm of endocervicalcanal to the internal os to minimise the risk of cervicalincompetence.Results: There are a number of case series in theliterature reporting on open or laparoscopic approach touterine-preserving prolapse surgery. In this presentationwe will examine the literature as well as present our owntechniques and experience to date.Author Affiliation: Associate Professor Alan Lam; CARE,Royal North Shore Hospital, Northern Clinical School,University of Sydney, NSW, Australia.CAN WE USE MESH SAFELY IN FERTILITY PRESERVINGPROLAPSE SURGERY?Friday 21 November / Session 10 / 1510-1530Daborn PThis interactive session will review the limited availableliterature for the use of mesh in fertility preservingprolapse surgery. In particular the options ofSacrohysteropexy and vaginal placement of meshincluding the new mesh kit systems will be covered.Pertinent clinical issues will be discussed in the setting ofa case presentation highlighting the “pros and cons” ofmesh graft augmentation.Author Affiliation: Dr J Phillippe Daborn. King EdwardMemorial Hospital for Women, Subiaco, WA, Australia.CONTROLLING INTRA-OPERATIVE HAEMORRHAGEFriday 21 November / Session 11 / 1600-1630Chandraratna HHemorrhage can come in many shapes and forms, from aminor annoying ooze to life threatening bleeding that canterminate a life in minutes. The modern surgeons needs toknow an array of maneuvers and have an understandingof the modern tools available to them to get out ofunexpected (and expected) events safely and succinctly.This may involve not only intra-operative techniques butalso the need to give advice to anesthetists who may notbe familiar with catastrophic events.In this talk we will cover preoperative preparation.Emergency surgical maneuvers, advanced techniques oflocal control, simple vascular reconstruction techniques,stabilizing measures as well as correcting coagulopathy.Author Affiliation: Dr H Chandraratna. University of NotreDame, Freemantle, WA, Australia.Conclusion: Laparoscopic approach to uterine preservingprolapse surgery is a feasible and effective surgicaloption which can be offered to women wishing topreserve fertility or those without significant uterinepathology wishing to avoid hysterectomy.

20AustralianGynaecologicalEndoscopySociety LtdUpcoming AGES MEETINGSLeading the way in gynaecological surgery3 RD AAGL INTERNATIONAL CONGRESSON MINIMALLY INVASIVE GYNECOLOGYin conjunction with theAUSTRALIAN GYNAECOLOGICALENDOSCOPY SOCIETYXIX ANNUAL SCIENTIFIC MEETINGBRISBANE 21-23 MAY 2009SEX, SURGERY & GYNAECOLOGYAUSTRALIAN GYNAECOLOGICALENDOSCOPY SOCIETYPELVIC FLOOR SYMPOSIUM &WORKSHOP XCROWN PROMENADE/CROWN TOWERSMELBOURNE 7-8 AUGUST 2009AUSTRALIAN GYNAECOLOGICALENDOSCOPY SOCIETYFOCUS MEETING 2009COOLUM, QUEENSLAND30-31 OCTOBER 2009SURGICAL TECHNIQUES:BASED ON FACT OR FICTIONINTERNATIONAL SOCIETY FORGYNECOLOGIC ENDOSCOPY (ISGE)19 th ANNUAL CONGRESSin conjunction with theAUSTRALIAN GYNAECOLOGICALENDOSCOPY SOCIETYXX ANNUAL SCIENTIFIC MEETINGSYDNEY 27-29 MAY 2010

AGES Focus Meeting Sheraton ENDOSCOPY Perth Hotel, FOR West Australia FERTILITY 20 & 21 November 2008CONference INFORMATION& CONDITIONSDEPOSITS AND FINAL PAYMENTS:All costs are payable in advance. If, for any reason, yourentire payment has not been received by the due date,we reserve the right to treat your booking fee ascancelled and will apply the appropriate cancellationfee.CANCELLATION POLICY:Should you or a member of your party be forced tocancel, you should advise the Conference Organisers inwriting. Single Meeting Registrations: The cancellationpolicy for this AGES Focus Meeting allows acancellation fee of $100.00 of registration fees forcancellations received up to 8 weeks’ prior to the firstday of the Meeting and of 50% of registration fees forcancellations up to 4 weeks’ prior to the Meeting. Norefund will be made after this time. Multiple meetingregistrants: No refunds apply.Hotels and other suppliers of services, depending ondate of cancellation, may also impose cancellationcharges. Accommodation payments will be forfeited ifthe room is not occupied on the requested check-indate. Please note that a claim for reimbursement ofcancellation charges may fall within the terms oftravel insurance you effect. AGES reserves the right tocancel any workshop or course if there are insufficientregistrations.INSURANCE:Registration fees do not include insurance of any kind.Insurance is strongly recommended to cover: loss ofpayments as a result of cancellation of yourparticipation in the Conference, or throughcancellation of the Conference itself, loss of airfares forany reason, loss or damage to personal property,additional expenses and repatriation should travelarrangements need to be altered, medical expenses, orany other related losses.PRICING POLICY:It is impossible to predict increases to cost elementssuch as government taxes and other service providertariffs. In the event of such fluctuations or increasesaffecting the price of the Conference , we reserve theright to adjust our prices as may be necessary at anytime up to and including the first day of theConference, even though the balance payment mayhave been made. If we are forced to change yourbooking or any part of it for any reasons beyond ourcontrol, for instance, if an airline changes its schedule -we reserve the right to vary your itinerary and will giveyou, or cause to be given to you, prompt notice thereof.COSTS DO NOT INCLUDE:Insurance, telephone calls, laundry, food and beverageexcept as itemised in the brochure, and items of apersonal nature.TRAVEL AND ACCOMMODATION:AGES and Conference Connection are not themselvescarriers or hoteliers nor do we own aircraft, hotels, orcoaches. The flights, coach journeys, other travel andhotel accommodation herein are provided byreputable carriers and hoteliers on their ownconditions. It is important to note, therefore, that allbookings with the Conference Organisers are subjectto the terms and conditions and limitations of liabilityimposed by hoteliers and other service providerswhose services we utilise, some of which limit orexclude liability in respect of death, personal injury,delay and loss or damage to baggage.OUR RESPONSIBILITY:AGES and Conference Connection cannot accept anyliability of whatever nature for the acts, omissions ordefault, whether negligent or otherwise of thoseairlines, coach operators, shipping companies,hoteliers, or other persons providing services inconnection with the Conference pursuant to acontract between themselves and yourself (which maybe evidenced in writing by the issue of a ticket,voucher, coupon or the like) and over whom we haveno direct and exclusive control.AGES and Conference Connection do not accept anyliability in contract or in tort (actionable wrong) forany injury, damage, loss, delay, additional expense orinconvenience caused directly or indirectly by forcemajeure or other events which are beyond our control,or which are not preventable by reasonable diligenceon our part including but not limited to war, civildisturbance, fire, floods, unusually severe weather, actsof God, act of Government or any authorities,accidents to or failure of machinery or equipment orindustrial action (whether or not involving ouremployees and even though such action may besettled by acceding to the demands of a labourgroup). Please note that the Prices quoted aresubject to change without notice.PRIVACY ACT 1988, CORPORATIONS ACT 2001:Collection, maintenance and disclosure of certainpersonal information are governed by legislationincluded in these Acts. Please note that your detailsmay be disclosed to the parties mentioned in thisbrochure.