The 30th AAGL Annual Meeting

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Dr. Franklin Loffer: "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?"

Dr. Andrew Brill: "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."

Dr. Franklin Loffer: "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?"

Dr. C.Y. Liu: "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."

Dr. Franklin Loffer: "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?"

Dr. C.Y. Liu: "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."

Dr. Franklin Loffer: "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?"

Dr. Andrew Brill: "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."

Dr. Franklin Loffer: "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."

Dr. Andrew Brill: "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."

Dr. Franklin Loffer: "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?"

Dr. C.Y. Liu: "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."

Dr. Franklin Loffer: "We certainly look forward to having you there with us."