Douglas E. Ott, MD, MPA

:  “This is Douglas E. Ott from Macon, Georgia at the International Human Reproductive meeting with Dr. Larry Demco from Calgary, Canada for 

.  Larry, I understand from discussions today that there’s some new technology that’s available laparoscopically to help diagnose things in the pelvis that we haven’t seen before.  Could you explain that to us?”

:  “Yes, pelvic pain has really been a complexing problem for most physicians.  We were always taught that we could adequately do a history and physical examination and lead to a laparoscopy as the initial approach for pelvic pain.  Most often or not, we see diseases such as endometriosis or adhesions but we were never able to distinguish what we were seeing was actually causing the pain.  With recent developments, patients have now been able to be kept awake and were really instrumental in bridging the gap from what we saw and heard the patient complain about in the office and what we saw at laparoscopy.  Pain mapping and conscious sedation laparoscopy has really shed some new light.  We would see lesions of endometriosis, the classic black lesions and now the newer ones seen are red or clear lesions, and we’ve traditionally just treated the black lesion.  Patients who were awake told us the black lesions really weren’t where all the pain was; it was somewhere distant.  It actually went quite a ways from the lesion out onto the normal peritoneum, and as a result, when the physician would be looking at this and trying to treat it he would treat what he saw.  This resulted in a poor and very high recurrence rate for patients waking up saying, “What’d you do, doc?  You didn’t touch anything.”  With the patient being awake we are then able to actually treat according to the patient’s guidance.  This was fraught with some difficulties because it was very highly technical work being able to keep a patient awake, and it required certain skills and communicative skills that not all physicians have so they had a lot of difficulties with it.  This was mainly in certain research areas and in pain clinics that were very specialized in dealing with pain and not to the common everyday gynecologist seeing the 40% of patients that enter their offices with pelvic pain.  What has been recently developed is a new system, which actually uses less light than what we’ve used before.  Not so white light contains many colors of the spectrum - blue, red, and green.  We’re finding out that these lesions actually can show up.  When patients were stained when they were in patient assisted laparoscopy and awake, these areas looked totally normal.  We now are able to see the endometriosis under the influence of a blue light that we couldn’t see before.  This has made endometriosis a much larger disease, and we always thought it was a pinpoint disease.  We could touch it with a cautery, we could touch it with a little tiny laser, and we took great care in trying to make sure we didn’t go beyond the border of the lesion because we might damage something.  The pain mapping and the laparoscopic spectral analysis have now showed us that this is a very large disease; it extends well beyond what we can see.  Now with the blue light we can see what these patients were complaining about.  This makes the disease gone from a needlepoint disease to a very large disease, and we have to adapt our techniques of treatment based on the fact that this is a large disease now.  So we have to put away our needlepoint cautery and we have to now look at ways of treating that incorporates a large area.  Historically, the wide excision was used and had great results as we saw today being presented.  We always wondered why excision was a little bit better than electrocautery or laser and it was because they were incorporating a lot of this area of normal peritoneum in order to excise the deeper endometriosis.  What we’ve done here is we’ve now seen that with the aid of a blue light and the laparoscopic spectral analysis we can now treat and scan the entire peritoneum for subtle changes of endometriosis that we didn’t see before.  We’re now using the argon plasma coagulator; this is very fast and rapid to actually blight the area.  It’s much cheaper than a laser system and more capable of being used in any average gynecology practice rather than a specific laser.  As a result, we can now use a system that’s becoming available to do the laparoscopy and scan for areas of endometriosis, be it subtle or very readily visible.  With the argon plasma coagulator we can then vaporize those areas.  The only problem or setback with the blue light is if you cause any bleeding this also shows up as blue so we have to be able to treat so that there’s not any blood, and this is why we can’t really excise using the blue light system.  We are currently developing a marking system so we could see it under the blue light; determine the borders of where the endometriosis end, mark it, and then you have the opportunity to excise.  With excision before, there were no guidelines to tell us where to start our excision or where we should start treatment - it was basically a guess.  With the laparoscopic spectral analysis, we finally do have some guidelines to at least give us an idea where to start the treatment, and in early lesions and also in more advanced disease we can actually know where at least start our excision.”

:  “Good, so the take-home message is technology will help us diagnose more accurately and treat our patients better.”

:  “Yes, that’s it.  Thank you very much.”

Articles

OBGYN.net Conference CoverageFrom the 11th World Congress on Human Reproduction, June 2002

Laparoscopic Spectral Analysis

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Laparoscopic Spectral Analysis Video

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     "Today I'd like to interview Dr. Paul Wetter who is the Chairman of the     Society of Laparoendoscopic Surgeons, and have him give us an overview of     what the society is, where it's going, and the future of the Internet in     regard to medicine on the Internet. Dr. Wetter, will you please tell us a     little bit about the society?"
     
     

 "Thank     you, Dr. Demco. The SLS - The Society of Laparoendoscopic Surgeons - was     founded approximately ten years ago, at the same time as the tremendous     surge in the advent of new technologies in endoscopic surgery. Along with     that growth, the society has grown itself, and today it's the largest     laparoscopy society in North America, with over 6,000 members. SLS's mission     is to provide information and education in the field of minimally invasive     surgery. And to that end, we publish a peer review medical journal, called     "JSLS," that goes out to over 8,000 surgeons in multiple     specialties - general surgeons, gynecologists, urologists, and other     practitioners of minimally invasive surgery. The idea behind the concept of     SLS is for the various specialties to share information, and there have     already been tremendous benefits to surgeons and patients because of this.     There's been standardization of equipment and technologic areas where one     technology was invented for a specific surgery, but was then adapted to     other surgeries. Each year at our annual meeting we get together and discuss     various topics related to endoscopic surgery - where it comes from, where it     is today, where it's going, and how that relates to the various specialties.     So it's a rare opportunity for surgeons of various specialties to get     together and cross-pollinate with ideas. It's really an exciting time and an     exciting experience for most of the participants."
     
     

 "You     and I are both laparoscopic gynecologists. What could a general surgeon who     also does laparoscopy teach us?"
     
     

 "Larry,     you know, for years when we ran into some problem that was not in the     gynecologic area - for instance, something related to the ureters, the     bowel, or patients with severe endometriosis - we often referred to our     colleagues in other specialties as a resource. So it's not a usual leap of     faith to realize the benefit of being able to discuss some of these issues     beforehand or at international meetings. The exchange has really been     excellent. It gives the gynecologists an advantage of being able to discuss     the kinds of dilemmas they might come across with regard to the ureter or     the bowel or other areas, and get some education right from the experts     rather than gynecologist to gynecologist, from general surgeon to     gynecologist with related to bowel injuries, with urologists to     gynecologists relating to ureter injuries, and the list goes on and on and     on. I think it also gives the gynecologist an extra level of confidence and     understanding to have that type of interaction beforehand, rather than     during an event."
     
     

 "The     SLS has really become user friendly to the Internet. Where do you see the     Internet and the education of doctors and the transfer of communication     between doctors and patients?"
     
     

 "Larry,     the possibilities for the Internet are unlimited, and we recognized this     early on. We're one of the first societies to have an Internet, which we've     had now for approximately four years. As you know, the Internet has really     blossomed within the past year or two. I would say now that well over 90% of     all physicians utilize the Internet, and we're developing new ways for     physicians to interact on the Internet and use that. It's also made this a     very small planet with regard to the advent of medical literature. So we're     working on ways to have our journal and our information more interactive,     and also to relay information from different parts of the world to     gynecologists and to surgeons so that there's more accurate and accessible     information. And the Internet... the possibilities are unlimited for this.     It just allows that type of communication - it eliminates time barriers and     distance barriers."
     
     

     would like to learn more about the SLS, how do they contact it?"
     
     

 "The SLS     website can be contacted in two ways - one is through 

 "Is     there both patient and physician access to your site, or is it just strictly     for physicians?"
     
     

 "Our site     is open to patients and physicians, and often there are very interesting     questions that are posed by patients or potential patients. All of our     active members are listed on the website, so if a patient poses a question,     it then goes up for discussion on the list, but if they want more     information they can also look on our website for SLS members in their area.     It gives them information on how to contact that particular person."
     
     

     "Thank you, Dr. Wetter, for giving us an overview of the society. We're     looking forward to its growth as the Internet grows. I appreciate your time,     thank you."

OBGYN.net Conference CoverageFrom Society of Laparoscopic SurgeonsNew York, December, 1999

What is the SLS - The Society of Laparoendoscopic Surgeons?

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 "I       have with me the Editor and Chief of the Journal of the Society of       Laparoendoscopic Surgeons, Dr. Michael Kavic. I'd like to ask Michael to       tell us a little bit about his journal, some of the history behind the       journal, and for whom this journal is published."
       
       

       "Certainly, Larry. It's a pleasure to talk with you and your       organization. The JSLS is the Journal of the Society of Laparoendoscopic       Surgeons, and it was founded to promote the scientific interests of our       society and to provide an outlet for creativity. Our society, as you are       aware, is a multi-disciplinary organization, one of the very few       multi-disciplinary surgical societies in the world today, and the journal       represents the activities of the society. We first thought of the journal       about four years ago - it took a year in planning, and we initiated it       three years ago. I'm very proud of the fact that the journal has attracted       a very high quantity of papers of good scientific content. They're       actually of such great merit that when we applied for indexing in Index       Medicus, we were accepted our very first time, we had only been in       existence a year and a half. Even more impressive was the fact that the       journal was accepted, and accepted retroactively - that is to say, all the       articles published in the journal from day one have been and are now       indexed in Index Medicus and MEDLINE. It's really quite a feat."
       
       

       "Does the journal have any connections with the Internet at this       time?"
       
       

       "Yes we do. Through the website of the society - 

       - you can use a hot link to get to the journal which gives abstracts of       all the articles, authors, and biographical material. So that's available       instantly on the Internet."
       
       

       "Are there plans in the future to have access to the actual original       articles through the Internet?"
       
       

       "Yes, there are. We plan, as soon as our website capabilities permit,       to put the entire journal on the web for perusal by any interested       parties."
       
       

       "Why is it important for a journal to be established where we have a       mixture of articles from gynecologists, general surgeons, and urologists,       all reading the same material?"
       
       

       "I'm glad you brought that up, Larry. What we've found with our       society, and in particular with gynecologists and general surgeons, is       that there are important advances in one area that would benefit all       surgeons, and here to for, we just didn't have the time or perhaps the       inclination to read one another's specialty work. To give you an example,       some outstanding gynecological surgeons have done brilliant work with       laparoscopic pain mapping. What they've shown is that people with pain, in       particular in this instance women with pain, the product or the cause of       the pain is usually something different than what you might think using       intuitive reasoning. We're beginning to understand now that pain is much       more complex than we'd noted here to for, and there are different ways to       tackle and to handle this. Gynecologists have taught us general surgeons       the importance of it. Just one of many, many examples of the benefit of a       cross fertilization of ideas and techniques..."
       
       

"Thank       you, Dr. Kavic. We'll be looking forward to reading the journals and       looking forward to you editing some of the leading articles. Thank you       very much."
       
       

       "Thank you, Dr. Demco. It's a pleasure being with you."

Douglas E. Ott, MD, MPA

Articles

Laparoscopic Spectral Analysis

Laparoscopic Spectral Analysis Video

What is the SLS - The Society of Laparoendoscopic Surgeons?

What is the Journal of the SLS (JSLS)