Pelvic Floor Support

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Dr. Mark Smith:  “Good morning, we’re back at the AAGL this morning and honored to have with us Dr. C.Y. Liu. Dr. Liu, thanks for joining us today.”

Dr. C.Y. Liu:  “It’s nice to be with you.”

Dr. Mark Smith:  “Dr. Liu’s very well known here as far as his extensive laparoscopic techniques. There’s a couple of things we’d like to cover today, one, I think is Dr. Liu’s done so much work in pelvic support and urogynecology, give us some of the new things that you see coming down the line and some of the new attitudes right now as far as pelvic floor support repairs.”

Dr. C.Y. Liu:  “I can see physicians are much more aware of the importance of anatomy in the pelvic floor area, and they are gradually understanding the importance of doing site specific repair for pelvic floor defects and prolapse.”

Dr. Mark Smith:  “But you’ve been preaching that for a long time, as we’ve said, and even Dr. Cullen Richardson for years has preached about the importance of that. It seems to me, and let me ask your opinion, more people are now aware of the importance of that. Even the younger people coming down are aware of how important these techniques are. Are you seeing that from the courses?”

Dr. C.Y. Liu:  “Indeed, you mentioned Cullen Richardson, actually in the 1970’s he tried to preach about the importance of identifying the defect before we repaired it but most of the gynecologists at that time did not pay attention to him until the late 1980’s, then we all thought and realized our result was not as good as we should expect. Then we started to look back and we found out that, indeed, we missed other defects and we did not repair it. Since then it’s all started to turn around and on top of that, I think, the students of Cullen Richardson like John DeLancy and Bob Rogers are very forceful and keep on pushing it very severely about appreciating the importance of identify the defects before you repair it. I think the formation of urogynecology has pushed it even further and so at the present time the vast majority of gynecologists doing this type of repair now are doing site specific repair.”

Dr. Mark Smith:  “That underlies the importance of the knowledge of anatomy.”

Dr. C.Y. Liu:  “That’s right and with laparoscopic surgery because we can see so well because of the very bright light that’s shining directly on the operative field and with a magnified image on the TV monitor, it enables us to see a defect well, and it makes us able to do a very precise plane dissection and bloodless dissection. That’s another thing that’s very important, if the operative field is bloody, you cannot see the defect and because of that, I think, the importance of laparoscopic pelvic floor reconstruction really moved up a big step.”

Dr. Mark Smith:  “I agree. I was fortunate my associate went and studied with Cullen Richardson in 1980 so I was doing vaginal repairs in the early eighties open and I never saw the white line on an open case until I did it laparoscopically.”

Dr. C.Y. Liu:  “I have the same problem, that’s right. Before laparoscopic surgery, I never saw fascia, or the pelvis just like you, and I never realized there was a such thing as the arcus tendineus fascia of levator ani and never in a muscle before. We almost dissect all those structures out in every case before we repair it. One thing I want to mention is the problem with laparoscopic surgery is that we are looking at a two-dimensional image on a TV monitor but here we’re doing three-dimensional work on the patient’s body and that kind of a conversion from two-dimensional image to three-dimensional work takes some time for the physician to learn so the problems of the learning curve will be a little bit more steep. Fortunately, we have a lot of young physicians that are really interested in this type of a surgery so that’s the reason we started the fellowship program in advanced endoscopic surgery and gynecology. I’m very pleased I’m part of that program there.”

Dr. Mark Smith:  “I know you’ve been an integral part of the program. He’s being very humble, he helped start it but this is a program for graduates to learn advanced endoscopic techniques at a very early time.”

Dr. C.Y. Liu:  “That’s right.”

Dr. Mark Smith:  “And it’s going very well through the AAGL.”

Dr. C.Y. Liu:  “Yes, actually it’s co-sponsored by the AAGL and the SRS - the Society of Reproductive Surgeons. This is my fifth year of the program so if anyone is interested in learning this kind of procedure, just give us a call, we may be able to get you in.” 

Dr. Mark Smith:  “We’ve all watched your techniques, and I don’t think anyone operates quite like you do.”

Dr. C.Y. Liu:  “You are very, very kind.  Thank you.”

Dr. Mark Smith:  “Thank you for joining us.”

Dr. C.Y. Liu:  “Thank you again, Mark.”