AAGL2014: Endometriosis in focus

Of 804 accepted abstracts at the 43rd Annual Meeting of the AAGL, 72 addressed endometriosis and 15 were about pelvic pain.

In a meeting that was attended by 1,827 delegates from 61 countries – 25% of whom were first-time attendees – scientific Programme Chair, Dr Arnold Advincula, had a philosophic vision for post-graduate courses on endometriosis being not just about endometriosis surgery, but PGCs that incorporated the workup and the diagnosis.

A delay in the diagnosis (and consequent treatment) of endometriosis is familiar to most women with the disease – it typically takes seven years from first presenting with symptoms suggestive of endometriosis before women are treated. This shift in focus is welcomed in the endometriosis community.

Dr Arnold Advincula, Scientific Programme Chair for the 43rd Annual Meeting of the AAGL

Said Dr Advincula, who is now the President of the AAGL:

This year we had a big emphasis on ultrasonography, which people say, ‘Why would you have ultrasound at a minimally invasive surgery meeting?’, but it is integral to the evaluation, particularly in most countries outside of the United States.

Where we use MRI, most everybody else does ultrasound. We actually had ultrasound machines this year and they used cadavers to teach how to diagnose and just get the attendees a sense of how to do this even if it is not the optimal model.

Knowledge as a key to effective treatment

Keeping in line with this year’s AAGL meeting’s theme of ‘knowledge and innovations’ the other focus this year was on ‘the road map to anatomy’.

Dr Advincula explained:

You have to have that fundamental knowledge of anatomy. It was not so much about showing delegates how to excise the disease, but more about where to find it and how to open up the space to get to it. The tutorials were truly interactive and highlighted video surgical nuances that attendees could take home.

I did not want our expert surgeons to get up there and show laparoscopic gymnastics – which sometimes happens when people come to the meeting – and delegates consequently go home and they cannot do anything. I wanted course attendees to be able to have something that they could take home and use in a meaningful way.

Spare those nerves

Endometriosis-Mosbrucker-Hummelshoj-Sinervo

Endometriosis.org editor, Lone Hummelshoj, flanked by Drs Cindy Mosbrucker and Ken Sinervo at AAGL2014

Pelvic pain was a welcome theme at this year’s AAGL meeting.

The presentations by Dr Marcello Ceccaroni from Italy, who performed nerve sparing dissections during bowel resection (and other dissections of endometriosis), caught the attention of Dr Ken Sinervo of the Center for Endometriosis Care.

Nerve sparing dissections are particularly important, since I have seen many problems in the past with overly aggressive dissections of normal tissue which has included these important nerves which when removed un-necessarily, can result in bladder and bowel dysfunction.

I believe that one of the reasons that we have minimal problems with bladder and bowel dysfunction following complete excision of endometriosis has to do with excising only diseased tissue and being careful with the areas that maintain the parasympathetic nerves and hypogastric plexus, which are responsible for these functions.

Knowledge of these nerves and other nerves in the lateral pelvic wall such as the obturator nerve, sacral roots and sciatic nerve as well is important for those affected by endometriosis in these areas, and complete excision in these areas can be done in a meticulous fashion with minimal risk of injury to these important structures.

said Dr Sinervo.

Pain, pain, pain – and morcellation

Dr Catherine Allaire, President of the 13th World Congress on Endometriosis

Dr Catherine Allaire, who will be the president of the 13th World Congress on Endometriosis (WCE2017) in 2017, emphasised that this year’s AAGL meeting had the largest number (50%) of first time presenters in its history, thus giving a podium for up and coming surgeons and scientists to share their knowledge – a policy also practiced by WCE2017.

Said Dr Allaire:

One of the highlights for me was the half-day pre-congress workshop on chronic pelvic pain, chaired by drs Maurice Chung and Sawsan As-Sanie. It was great to see such a large crowd of surgeons interested in learning about the concepts of central sensitisation and multidisciplinary care for these challenged patients.

Another highlight was the thorough attention paid to the issue of morcellation of fibroids and the potential dissemination of undiagnosed sarcomas. There was strong evidence presented that the incidence of sarcoma may be much lower than previously reported and various alternative extraction techniques, such as enclosed morcellation, were presented.

I heard many positive comments about our beautiful Vancouver Trade and Convention Centre and its spectacular mountainous backdrop. I am very proud that our World Congress of Endometriosis will be held in this wonderful venue in 2017 and hope that everyone will want to return for another great educational experience!