OBGYN.net
Conference Coverage
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http://www.obgyn.net/avtranscripts/FIGO_mettler.htm |
"Endoscopic Surgery"
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Amar
Sawhney: “My
name is Amar Sawhney, and I’m here at the FIGO 2000 meeting at the OBGYN.net
booth with a very prominent endoscopic surgeon from Kiel, Germany -
Professor Liselotte Mettler. We
would like to talk to her a little bit about some of the pioneering things
she has done in endoscopic surgery. Professor
Mettler, can you give us a little bit of a historical context on
endoscopic surgery and gynecology and how you came to enter into this
field?” Professor
Liselotte Mettler: “Endoscopic
surgery was started and propagated by my teacher, Kurt Semm in Kiel,
Germany. It has had some previous successors like Raoul
Palmer and
Hans Frangenheim
but the real going of the gynecologists was from 1970 on, and when
the surgeons came into the field around 1985, then the field really
exploded. Nowadays,
endoscopic surgery is the modern surgery that has replaced, I would say,
about 50% of all surgical procedures and certainly in the field of
gynecology.” Amar
Sawhney: “Excellent,
what are some of the procedures that endoscopic surgery is very well
suited for?” Professor
Liselotte Mettler: “It
is suited for all gynecological surgery and going of course into general
surgery. We use in surgery an
organ orientated catalogue of indications.
So it’s surgery on the cervix for benign and malignant
indications, on the uterus, tubes, ovaries, in the whole pelvis, and also
on the breasts. Especially at
this Conference, we put some emphasis that also in malignant disease
endoscopic surgery can be applied as a minimally invasive technique with
the same possibilities.” Amar
Sawhney: “That’s
very interesting, so from the patient’s prospective, what can the
patient expect when she undergoes endoscopic surgery as opposed to open
surgery? What are some of the
benefits for the patient?” Professor
Liselotte Mettler: “Her
benefits are a minor invasive procedure so she has several holes of
incision in her abdomen but no long cuts.
Of course, this surgery is already producing less adhesions than a
laparotomy would and the pain following it is less provocative.
Her reintegration into family and professional life is much faster,
and I would say because of the better vision of the magnification at
laparoscopic surgery, the treatment possibilities are better also.” Amar
Sawhney: “So you
can actually get a much better outcome as well as give the patient a
chance for an early return to work so I think there are several benefits
that come about from that. What
are some of the advances that you have seen happening in endoscopic
surgery? You’re at the
cutting edge of endoscopic surgery, what are some of the techniques that
you’re involved with right now?” Professor
Liselotte Mettler: “The
instrument development in the last twenty years has been great and we are
still on an ascending branch. Instruments
with multiple degrees of liberty are
coming in, and nowadays robotics are coming into the picture and tomorrow
we have robotic surgery. In
Germany, we have the Karlsruhe Research Institute which has put about
one-hundred engineers on this topic so we are using trainers and
simulators like the pilot’s are using and this is enabling us not to
learn on the patient but learn outside, and then do this keyhole surgery
which in reality is a much better picture surgery directly on the video
screen.” Amar
Sawhney: “Wow,
that sounds very exciting. Do
you think it will ever be a situation where endoscopic surgery becomes
something that every surgeon can do or will it take some specialized
training and only some people who can do the more advanced techniques?” Professor
Liselotte Mettler: “I
think it is already a surgery that has set foot in every hospital and it
depends on the leadership of the hospitals how much they innovate but it
is a modern surgical tool which I think in America has kept much faster
ground that it does in my German country, for instance, because people are
open to new things while in Germany they stick to the traditional ways a
lot.” Amar
Sawhney: “That’s
excellent. What do you see
with endoscopic surgery in cancer types of surgeries?” Professor Liselotte Mettler: “For instance, in young patients 20-25 years of age with early cervical cancers, the possibility of preserving the uterus is given with a technique called trapolectomy. We can get access to the lymph nodes to really see how far the disease has spread with laparoscopic surgery, so the lymph adenectomy done under laparoscopy and the actual treatment in the small cancers was just the cervical resection. With larger cancers a hysterectomy trans-vaginally is giving the patient the possibility of not having a big cut from laparotomy but still having the lymph nodes out with the same results.” Amar
Sawhney: “That’s
excellent, that seems like a logical way to proceed.
If you were to dream for a second, what are some of the unmet needs
right now, what would you like to see develop in endoscopic surgery, and
what are some of the things that you wish were out there? Professor
Liselotte Mettler: “Some
of the problems that patients have are adhesions.
Now my teacher, Kurt Semm, always told me that laparoscopy takes
away adhesions 100%. I would
say it takes it away 40% but we do have fewer adhesions then at laparotomy
but we still have them. If we
have to go in for that second procedure, we see how these adhesions are
impeding fertility, how they are producing pain, and how bowels obstruct
each other. So we are really thinking about a good product for
adhesiolysis, and I recently
had a chance to test the product, which I’d like to talk about.
It’s a spray gel that you send up high and in a way it’s an
interesting product that you take the two components into the body.
It forms a protective gel which is effective for a moment but for
the important moments till adhesions would form.” Amar
Sawhney: “Is
there a time limit for which adhesions should be prevented, and what do
you think that time limit is?” Professor
Liselotte Mettler: “I
think they start to be formed in the first days if not hours after the
surgery. So if at that time
we can bring an agent there to take them away, we could take a lot of
morbidity of our patients away.” Amar
Sawhney: “So
you’re currently involved in a clinical trial, if I understand that
right?” Professor
Liselotte Mettler: “Yes,
with a clinical trial at the present time we investigate myoma surgery and
we see that the adhesion formation is minimal and we hope to get a good
result of that study.” |