Andrew Bill, MD

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"I'm  Franklin Loffer, Executive Vice-President of our annual program in San  Francisco this year, and Medical Director of the AAGL.  I'd like to  invite you to our annual program in San Francisco this year; it begins  Friday, November 16th through Monday, November 19th.  Our program's  first day consists of our post-graduate courses; we have twelve - six in  the morning and six in the afternoon, a debate over a variety of  subjects - hysteroscopy, surgical management of infertility, when to do  hysterectomies, why and how, improving your skills in managing patients  with urinary incontinence, and a whole host of things of that venue.  I  would like to ask one of the people I have with me today, Andrew Brill  who will be doing a cadaver dissection that morning and this was started  last year, Andy, how do you think it brought our group together from  your perspective as the one doing the dissection?"
       
       

  "Frank, we did have the honor to do  this dissection and being that it preceded the post-graduate programs, I  think, it served to basically put all of the programs together in a  unified fashion since in a certain sense everything that we do as  endoscopic surgeons revolves around the basic fundamental anatomic  considerations."
       
       

  "C.Y. Liu will be one of our  participants in the Monday portion which will be a live surgery and  along with C.Y. will be Karen Abbott, Camran Nezhat, Paul Indman, and  Liselotte Mettler from Germany.  C.Y., what type of surgery are you  planning on doing?"
       
       

  "This year I'm doing a total  laparoscopic hysterectomy and a vaginal vault suspension.  If we have  time left after that then we'll proceed to the retropubic surgery, many  will be paravaginal repair and since Karen Abbott is going to do a  Burch, I will skip that part.  I think the good thing about starting  with a fresh cadaver dissection will be teaching the participant  physician the anatomy.  After they learn anatomy they will come to our  live surgery then we can show the participant physician step-by-step how  we do it and, hopefully, they can pick up some of the pearls from this  type of surgery since we have a lot of experience doing these surgeries.   We basically limit our practice in laparoscopic surgery so I hope I  can show the participant physician some of my experience and the pearls  that I have learned throughout all those years of doing surgery."
       
       

  "C.Y., I've watched you operate  many times and you make it look so very simple.  It almost looks like  it's something that's planned ahead of time.  Do you think through each  case or do you follow a certain routine as you do these cases?  What  goes through your mind?"
       
       

  "Of course, I've been doing this type of  surgery for so long and I don't do anything else except this, so after a  while it becomes natural but the important thing is I went through the  stage of struggling just like anybody else.  After a while, you start to  develop a certain kind of a routine, which will reduce your struggling.   That's what I want to show to you as a participant physician, what you  can do in a certain situation.  For example, I would try to show you  with hysterectomy how to dissect out the ureters, how to dissect out the  bladder, and how to get into a vascular space - the surgical plan so we  can partly do a bloodless hysterectomy.  The beautiful thing about  laparoscopic surgery is magnification; you can see the operative field  so well.  You can see anatomy so you can see the uterine artery, every  anatomical detail.  We'll then show you how to either suture or even  with bipolar electrosurgery to take care of the major blood vessels.  In  answering your question, I just justify experience, we learned how to  do it and, hopefully, you can pick up some of our habits from that."
       
       

  "Andy, with regards to cadaver  dissection, you participate in some of the programs AAGL puts on which  are two-day programs.  How much do you think you're going to be able to  show in the way of pelvic anatomy?  If I recall correctly, it's about an  hour, hour and a half session on the very first day of the  post-graduates courses, what is your main thrust at that point in time?   What are you trying to demonstrate to the audience, and what points are  you trying to highlight?"
       
       

  "It really reflects what C.Y. had to  say in the sense that we're looking for all of the avascular spaces in  the pelvis, whether it's in the lateral pelvic sidewall or the  rectovaginal space over the space of Retzius so how to enter these  spaces, how to identify the vascular structures, and how to create  relaxing incisions to mobilize structures out of harms way.  Really the  main thrust is to communicate where these fundamental planes and spaces  reside so surgeons can hopefully in an effortless and bloodless way  perform their surgery."
       
       

  "The reality of it is in  watching both of these gentlemen operate, neither one of them seems to  be losing much blood in their cases.  They look very similar in that  respect.  Now the remainder of our program, of course, consists of  panels and debates plus papers that those who wish to participate can  submit.  Tell our audience a little bit of what that consists of."
       
       

  "I believe this will be the third  year that we'll be having this Pre-Congress course, and it is an honor  and a profound opportunity for everyone who would attend.  We have fresh  cadaver specimens - they're not embalmed - that are provided with  appropriate services to allow us to literally go through all of the  fundamental anatomy in a stepwise fashion with participants with very  close attention to teaching for a period of two days.  Attention is paid  not just to fundamental anatomy and mobilizing fundamental anatomy but,  secondly, the course is focused on training the physician to think and  also perform pelvic reconstructive surgery, at least in the context of a  Burch colposuspension, laparovaginal repair, and how to identify the  uterosacral ligaments and utilize them to re-support the vaginal vault.   This is done in conjunction with an organization that has been vital to  this effort, which is IMET.  All I can say is that it's been my honor  to be part of this and, of course, we've all learned in the process.  I  can say that for myself, every time that I participated in these courses  as a faculty member I have grown as a surgeon because I've been that  much closer to fundamental anatomy."
       
       

  "C.Y., the anatomy course  probably is a good entre to a live surgery.  The cadaver courses should  be a good entre to the live surgical program, what would you want to  see the participants gain in the cadaver portion before they watch your  live surgery?"
       
       

  "I think the cadaver course is really a  compliment for the live surgery or live surgery is a compliment, again,  for the cadaver course.  The most important thing for the participant  physician, of course, is to learn the anatomy and then pick up some of  the surgical skill, especially laparoscopic suturing, that is very  important.  Andy mentioned that with the cadaver course we do teach a  lot of pelvic support procedures like a paravaginal, Burch, vaginal wall  suspension, these kind of things and those all require suturing.  There  is no such thing as an already made suture instrument to do it so it  will be a very good opportunity to learn the anatomy, plus, how to use  anatomy by suturing.  I will be there only as an instructor and I always  enjoy it, and every time, just like Andy said, I participate in a  cadaver course I always learn something.  I'm pretty sure you will learn  something too."
       
       

  "We certainly look forward to having you there with us."     

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OBGYN.net Conference CoverageFrom ISGE 2001 Congress - Chicago, Illinois, 2001

The 30th AAGL Annual Meeting

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Author | Andrew Bill, MD

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The 30th AAGL Annual Meeting

The 30th AAGL Annual Meeting Video