Pelvic Reconstruction news

London : 2-5 June2006 :Workshop in Advanced Vaginal Pelvic Reconstructive Surgery

In the attendance of 72 gynaecologists from Great Brittian, The Netherlands, Germany and Italy a very successful workshop was held under the guidance of Dr Richard Reid, Proff Carl Zimmermann and S.Robert Kovack.

Over a four day period Pelvic Reconstructive Surgery came under the spotlight as never before in Europe. A full day session was done on the anatomical considerations necessary for successful vaginal surgery, followed by sessions on the pathogenesis of structural damage to the female pelvis, especially with a focus on the birthing process.

With this as a backdrop the surgical techniques as applied to pelvic floor damage reparation was discussed in detail.For two days delegates was treated to videos and interactive discussions on different techniques as applied to pelvic organ prolaps restoration, with native tissue repair as primary requirement and the judicious use of especially biomesh materials to support tissue repair.

The main take home message for this delicate is that

1. Pelvic floor surgery as been taught by his teachers, and their teachers, did not follow the basic principles of anatomic damage repair: pelvic organ mutilation techniques to repair the damaged pelvic floor were done and taught by them re-inventing the female anatomy! The main focus of present techniques are based on “ treating the bulge”: it is ignoring the underlying problem that leads to the prolaps and focus only on rectifying the prolaps. Treating only symptoms and not the decease thus.

2. The first commandment of pelvic organ prolaps should be based on a solid knowledge of pelvic organ support system anatomy, recognition of the forces present in damaging the pelvic organ supports, especially during childbirth, and the techniques necessary to repair these supports by restoring the normal anatomy. Any operation done for restoration of pelvic organ prolaps should be guided by this simple principle.

3. The preferred route of Pelvic floor surgery is the vaginal route.

4. The high failure rate in the surgical techniques using only host tissue, especially if the tissue is being put under tension, can only being prevented if one keep the repaired area tension free, and if necessary one need to bridge tissue with graft tissue. Using the hernia repair principles as laid down by our surgical colleagues is paramount to our surgery’s outcome prediction.

5. If a graft are necessary the “do no harm” principle is paramount.

In following this one will rarely need to use synthetic meshes. Synthetic meshes as being used in hernia repairs are being put into gaps that are between non dynamic spaces. In the pelvis the gaps are between dynamic hollow organs and the long-term risk of damage to the bladder, vagina and rectum is not known, especially if the time index is 10 years or more.
In following the “do no harm” principle one need to individualize, keeping in mind the tissue engineering advantages provided by the second generation biomeshes, and the area into which one need to put the mesh support.

Follow-up seminars will be held: these will include a repetition of the London Workshop, Live Surgery workshops ( the first will be in Terneuzen in September 2006) and theatre demonstrations in Terneuzen on a weekly basis.