The American Association of Gynecologic Laparoscopists (AAGL) held its 51st Global Congress on minimally invasive gynecologic surgery (MIGS) in Aurora, Colorado, from December 1 to 4, 2022.
The AAGL is the largest medical association advancing health care for women through excellence in clinical practice, education, research, innovation, and advocacy. The theme for the congress was “Dissemination of MIGS Care: Improving Access for All.” The theme was reflected throughout the scientific program, with sessions on new instrumentation, surgical techniques, reproductive surgery updates, quality improvement, patient safety in minimally invasive and complex gynecologic surgery panels.
Contemporary OB/GYN® attended the congress in person, bringing our readers the latest clinical news and data. Here are some of the top meeting highlights:
Shattering the glass ceiling in MIGS
Fariba Mohtashami, MD, obstetrics and gynecology, University of British Columbia, Vancouver, Canada, spoke about women in ob-gyn surgery and shattering the glass ceiling in her AAGL MED Talk.1
“My financial disclosure is that I earn significantly less than my male colleagues,” Mohtashami said.
Later in her presentation, Mohtashami shared findings from a study that, because women are paid less, investigated whether the gender of the patient influenced compensation as well. According to the findings, surgeons operating on women were reimbursed significantly lower at
28% when compared to operating
Mohtashami concluded her presentation with a call to action: separate obstetrics from gynecology. “It overloads curriculum,” and, according to Mohtashami, “shouldn’t be blended.”
“Every woman deserves a competent obstetrician when they are pregnant, just as they deserve a competent gynecologist at all the other times in their lives when they’re not pregnant. One should not come at the cost of another,” she concluded. “We need to encourage gender balance in our specialty.”
Tips and tricks for diagnostic laparoscopy for endometriosis
All ob-gyns will encounter endometriosis in their practice, but not all of them may have the tools to evaluate for and treat it laparoscopically. However, Olga Fajardo, MD, a second-year MIGS fellow at Vanderbilt University Medical Center in Nashville, Tennessee, discussed diagnostic laparoscopy for endometriosis in her presentation at AAGL’s 51st Global Congress on MIGS.2
Fajardo offered tips and tricks for effective preoperative planning, minimally invasive surgical evaluation and treatment, and postoperative management
For preoperative planning, Fajardo suggested gathering a thorough history from the patient, including symptoms of dysmenorrhea, pelvic pain, dyspareunia, and gastrointestinal symptoms such as constipation. Endometriosis can have physical signs on exam, Fajardo continued. During the history and physical exam, the ob-gyn should evaluate the pelvic floor for myalgia, a common disorder associated with endometriosis, which Fajardo said can be treated with pelvic floor physical therapy.
“If you encounter pathology outside of your comfort zone, refer to a MIGS colleague,” Fajardo said. “If there is concern for bowel or bladder involvement, refer the patient to urology
As far as diagnostic laparoscopy, Fajardo said, the main instruments needed are Maryland graspers and monopolar scissors. She recommended entering through the abdomen with a 5- to 10-mm scope. She also advised starting with an accessory port to evaluate the pelvis and add more ports if needed.
“Remember, do not be afraid to add a fifth port if it makes the procedure more efficient and effective,” Fajardo added.
Also, if there are lesions near the ureter or bowel, Fajardo offered tips for excision, including hydrodistension with normal saline to bring the lesion away from underlying structures.
One of Fajardo’s final tips was to drain the endometrioma prior to excision. “This will better delineate the cyst wall and make the excision more efficient,” she concluded.
Cryotherapy for postoperative pain
Laura Kenyon, MD, University of Texas Southwestern Medical Center, discussed the findings from a randomized, controlled trial during an oral session at AAGL’s 51st Global Congress on MIGS.3
The study included patients at 2 large academic institutions undergoing outpatient laparoscopic hysterectomy via conventional laparoscopic technique with the minimally invasive gynecologic surgery team between February 2019 and November 2020. Patients with chronic pain or current opioid use of more than 1 week or requiring planned overnight hospitalization were excluded. Primary outcome data were available for 51 participants, 24 control and 27 intervention.
According to the findings, 84.8% of participants felt their pain was adequately controlled. All subjects were prescribed 20 tablets of oxycodone. On average, they used 2.9 (SD, 3.4) tablets after discharge. Of participants, 87% said they would use oxycodone again.
Kenyon and her team said ice packs are an acceptable supplement for postoperative pain management with high patient satisfaction and no adverse effects, and 82.6% of patients say they would recommend ice to others. It is worth noting, however, that cryotherapy did not significantly impact postoperative reported pain or narcotic use.
Providers caring for postoperative patients should be aware, Kenyon said, of the unintentional consequences of overprescribing opioids and should consider reducing the number of tablets prescribed, especially with consistent evidence that patients require less than half the quantity prescribed.
1. Mohtashami F. Shattering the glass ceiling for surgeons. Presented at: AAGL 51st Global Congress on MIGS; December 1-4, 2022; Aurora, CO.
2. Fajardo O, Chaves KF, Arruga Novoa y Novoa V, Fox V, Yunker AC. Tips and tricks for diagnostic laparoscopy for endometriosis. Presented at: AAGL 51st Global Congress on MIGS; December 1-4, 2022; Aurora, CO.
3. Kenyon L, Shields J, Porter JSC, et al. Ice-pop: Ice packs for post-operative pain, a randomized controlled trial. Presented at: AAGL 51st Global Congress on MIGS; December 1-4, 2022; Aurora, CO. Texas.