On-site reporting from the Society of Gynecologic Surgeons (SGS) 41st Meeting

3/24/15, Day 3 at SGS

Many topics, many learning opportunities   

The morning’s focus topics at SGS were divided up in small-group academic roundtables, with 15 experts in the field providing authoritative know-how and guidance to attendees. Topics ranged from tips for in-bag tissue extraction, endometriosis surgery, surviving health care transformation, cost-effectiveness, and single-site surgery to innovative treatments for fecal incontinence.

In the main hall, the fourth scientific session included oral presentations and videos that focused on anatomic landmarks and variations and included data presentation from an interesting prospective randomized trial in which the authors found bladder support is reduced by pregnancy, regardless of delivery method.

The highlight of the morning was certainly the debate over "power" morcellation. Dr. Cheryl Iglesia moderated in her charming and comical manner. Dr. Andrew Sokol and Dr. Jubilee Brown argued that power morcellation still should be available to a select group of appropriately chosen, low-risk women, and backed their arguments up with solid data. Dr. Eric Sokol, Andrew’s twin (and better looking, per him) brother, and Dr. Carl Zimmerman argued against the use of power morcellation, instead urging everyone in the audience to perform more vaginal hysterectomies. Though spirited and based largely on sound medical evidence, the debate did not have a clear winner. The overall consensus seemed to be that this controversial topic needed further evaluation and more data to support either claim.

"Sesame street graduates” and andragogy

We were then honored to have Vice President for Education, American College of Obstetricians and Gynecologists Dr. Sandra Carson as the esteemed TeLinde Lecturer. Her talk, “Teaching Medicine and Surgery to Sesame Street Graduates,” outlined the challenges in teaching surgery to a new generation of ObGyn residents as well as identified opportunities for improvement. She restated what seems to be the running theme at SGS this year: young faculty and residents are losing the skill for vaginal hysterectomy.

Dr. Carson introduced members of the audience to the adult theory of learning called andragogy. Adults like active learning, which is problem centered, rather than content oriented; linking new concepts to prior experience; and learning what is relevant to them, she noted. Then she shared ACOG’s strategies for applying these learning principles in resident education. She discussed ACOG’s recently formed Vaginal Hysterectomy Teaching Taskforce, which has put together a simulation consortium online toolkit and a surgical skills module to help educate residents on vaginal hysterectomy techniques. This toolkit and module can be accessed by doing a quick search after signing into the ACOG Web site.

Dr. Carson, a reproductive endocrinologist formerly at Brown University, is also now an honorary member of SGS.

Wise words from a wise physician

In his presidential address Dr. Stephen Metz acknowledged that all physicians are subject to even subtle “conflicts of interest,” reminding us to treat our patients as people not as a disease or a procedure.

“What does my patient really want from me? She wants me to get to know her to develop the right recommendations for her,” he said. His career has spanned multiple decades, and his service to the field of gynecology is outstanding. He received a well-deserved standing ovation at the end of his address.

Sport and socialization a necessity in sunny Florida!

The afternoon adjourned after the business meeting, and members were able to play golf, tennis, paddleboard in Winter Park, or just relax at the resort. Congratulations to the winners of the golf tournament (Drs. Hopkins, Rasmussen, Hurd, and Flora) and the tennis tournament (Dr. Ted Lee)!

Everyone convened at the outside terrace for the evening “Mojito Night in the Caribbean” reception, sharing good times, cocktails, and hors d’oeuvres. Proceeds from each ticket sold helped support Surgeons Helping Advance Research and Education (SHARE).

Tomorrow looks to be an excellent conclusion to a well-planned and very well-executed meeting. Kudos, and large thanks, to the SGS leadership.

3/23/15, Day 2 at SGS

Surgeons from 17 countries converge

The first day of the SGS scientific sessions was another energetic and interactive day. Sixteen new SGS members were recognized and welcomed in the main conference hall. Dr. Charles Rardin presented a brief overview and some basic statistics related to this year’s meeting—the largest ever in the history of SGS. A total of 401 attendees representing 17 countries are here in Orlando for SGS 2015! 

In the first scientific session, oral presentations touched on the subjects of preoperative dexamethasone use, vaginal packing, surgical site infections, and a new treatment modality for fecal incontinence. An excellent technique video on laparoscopic ureterolysis by Dr. Cara King then followed, in which she demonstrated excellent surgical skills with amazingly clear anatomy. Her video was recognized later in the day with a well-deserved award—congratulations! 

A short break in the exhibit hall allowed for mingling with other attendees, many of whom have been active on social media surrounding the meeting, and for visiting the booths of the industry sponsors. The second scientific session then picked up where the first left off, with more scientifically sound research presented on such topics as mechanical bowel preparation use in laparoscopy and pelvic floor disorders in women with gynecologic malignancies.

No room for fads in gyn surgery

Dr. David Grimes, a true leader in our field, provided an exceptional keynote address, “Is Teaching Evidence-Based Surgery Possible?" He shared his expertise of evidence-based medicine, and described (in sometimes very comical but always stimulating and provocative terms) the need for incorporating evidence-based surgery in gynecology. He urged us to strive to do best by our patients by applying evidenced-based practices rather than following fads and gizmos.

Gyn surgery training: Have we reached a “perfect storm”?

The afternoon brought with it a panel discussion on "Teaching the Next Generation of GYN Surgeons," with Dr. Hal Lawrence moderating and Dr. Mark Walters and Dr. Dee Fenner serving as panelists. They discussed the future of ObGyn residency training in great detail: increasing subspecialization, a stable birth rate, declining hysterectomy rates, increasing safety and quality monitoring, and increased access to data and informed consumers. All of these trends were highlighted as reasons for a perfect storm in gynecologic surgery training. In addition, the panel presented some surprising statistics: 

• The majority of hysterectomies in the United States are being done by surgeons who perform less than 1 per month.
• The higher volume surgeons provide higher value and tend to utilize more minimally invasive approaches.

Videofest!

The scientific day concluded with a videofest that included complex robotic, laparoscopic, hysteroscopic, cystoscopic, and vaginal surgeries, demonstrating the surgical talents and ingenuity of SGS members.

Simultaneously, the Fellows’ Pelvic Research Network (FPRN) met to update their ongoing projects and to review new proposals. The meeting sought to unite FPRMS and MIS fellows to conduct multicenter studies. This was an enlightening and engaging session, which should give everyone great hope to see the creativity and energy of the next generation of researchers.

A grounder for attendees

All in attendance were treated to a unique, eye-opening, motivational, and very moving talk by Professor (and Sir) Ajay Rane, MD, PhD from Australia on female genital mutilation. He stressed the importance of respecting women for who they are, not what they do.

“My idea of feminism is applauding a woman who gives birth. Celebrate women for who they are," he said. He highlighted the work being done by his team in Australia and India, and urged everyone in attendance to become more aware of the staggering statistics and reality of female genital mutilation.

The jam-packed day wrapped with the awards ceremony in the main hall. Lifelong mentors were honored by their mentees and SGS President Dr. Stephen Metz and Scientific Program Chair Dr. Charles Rardin presented various awards to those who had submitted and presented novel and groundbreaking research.

One last surprise

The President’s Reception in the exhibit hall was lively, with meeting sponsors, colleagues, and friends in attendance. And, of course, a visit from special guest! (Thanks to SGS Fellow Christina Saad, MD @XtinaSaad for the pic!)

See you all tomorrow for another educational, enlightening, and spirited day at #SGS2015! 

3/22/15. DAY 1 AT SGS

A focus on evidence-based medicine

Strong analytic skills (of your own research as well as the published literature) translates to better patient care, was the underlying theme of the opening postgraduate course here in Orlando, Florida, for day 1 of the 41st annual meeting of the Society of Gynecologic Surgeons.

Building on the success of last year’s course on evidence-based medicine (EBM), Dr. Vivian Sung and Dr. Ike Rahn put together an amazing team to review and apply the principles of so-called EBM, a workshop that was in part sponsored by ABOG.

A quick introduction to EBM principles by Dr. Thomas Wheeler was followed by small break-out groups, where attendees used the PICO-DD model to define a Population, Intervention, Comparator, Outcomes, Duration, and study Design. Further talks focused on the benefits and caveats of randomized controlled trials (RCTs), surrogate and intermediate outcomes, and systematic reviews and meta-analyses.

Dr. Ethan Balk cautioned us to consider the costly and underpowered RCT, and lack of generalizability needed to define rigorous study inclusion and outcome criteria. Dr. Sung then pointed out that, while the perfect surrogate outcome would allow us to shorten study lengths (and save money), the seduction of association and causation can lead to some questionable conclusions.

When using a clinical practice guideline, Dr. Miles Murphy indicated that a systematic review needs to be included, although a meta-analysis is not always required. The poor quality and paucity of RCTs for most patient populations is what limits us.

Dr. Rahn gave an excellent presentation on subgroup analysis, recommending to attendees that they perform these analyses cautiously, describe which groups are analyzed, and have statistical back-up for power and P value calculations.

Dr. Kristen Matteson then spoke about interpreting the literature on screening and diagnostic tests, giving a thorough but understandable review of the basics of statistics. Dr. John Wong rounded out the course, suggesting that because RCTs are expensive and comprise less than 5% of published studies, the analysis of observational studies as RCTs would allow us to better inform our patients and our colleagues on the best treatments, using patient-centered outcomes, efficacy data, and multiple providers. He urged us all to be more skeptical and ask critical questions when dealing with evidence in medicine.

Sharpening ultrasonography skills

Simultaneously, others attended a hands-on learning course on comprehensive pelvic floor ultrasonography, including transperineal, endovaginal, and endoanal imaging, organized by Dr. Abbas Shobeiri.

Tips for the difficult hysterectomy

Dr. Ted Lee (with help from Drs. Arnold P. Advincula, Rosanne Kho, and Matthew Seidhoff) prepared a surgical tutorial on laparoscopic, robotic, and vaginal strategies and techniques for approaching the difficult hysterectomy. The course was phenomenal, as described by many of the members fortunate enough to learn some of the tips and tricks demonstrated by the master surgeons.

Training for the NIH application process

Following the postgraduate courses, Dr. Katherine Hartmann led an “NIH Application Training Camp,” an offering supported by SGS research donations and a generous donation from Dr. Holly Richter. Dr. Hartmann provided in-depth insight into the world of NIH grant funding and provided background prep for a K or R award application. A mock NIH application study section, in which two actual applications were reviewed, demystified the process of grant review (and rejection). 

A social end to day 1

To end the first day, a welcome reception was held where residents, fellows, and attendings from different fields of ObGyn mingled and shared drinks, stories, and good laughs.

The "social" activities continue on social media for the rest of the conference. Follow #SGS2015, @gynsurgery, @obgmanagement, and @sukrantmehta for more!

3/24/15, Day 3 at SGS

Many topics, many learning opportunities   

The morning’s focus topics at SGS were divided up in small-group academic roundtables, with 15 experts in the field providing authoritative know-how and guidance to attendees. Topics ranged from tips for in-bag tissue extraction, endometriosis surgery, surviving health care transformation, cost-effectiveness, and single-site surgery to innovative treatments for fecal incontinence.

In the main hall, the fourth scientific session included oral presentations and videos that focused on anatomic landmarks and variations and included data presentation from an interesting prospective randomized trial in which the authors found bladder support is reduced by pregnancy, regardless of delivery method.

The highlight of the morning was certainly the debate over "power" morcellation. Dr. Cheryl Iglesia moderated in her charming and comical manner. Dr. Andrew Sokol and Dr. Jubilee Brown argued that power morcellation still should be available to a select group of appropriately chosen, low-risk women, and backed their arguments up with solid data. Dr. Eric Sokol, Andrew’s twin (and better looking, per him) brother, and Dr. Carl Zimmerman argued against the use of power morcellation, instead urging everyone in the audience to perform more vaginal hysterectomies. Though spirited and based largely on sound medical evidence, the debate did not have a clear winner. The overall consensus seemed to be that this controversial topic needed further evaluation and more data to support either claim.

"Sesame street graduates” and andragogy

We were then honored to have Vice President for Education, American College of Obstetricians and Gynecologists Dr. Sandra Carson as the esteemed TeLinde Lecturer. Her talk, “Teaching Medicine and Surgery to Sesame Street Graduates,” outlined the challenges in teaching surgery to a new generation of ObGyn residents as well as identified opportunities for improvement. She restated what seems to be the running theme at SGS this year: young faculty and residents are losing the skill for vaginal hysterectomy.

Dr. Carson introduced members of the audience to the adult theory of learning called andragogy. Adults like active learning, which is problem centered, rather than content oriented; linking new concepts to prior experience; and learning what is relevant to them, she noted. Then she shared ACOG’s strategies for applying these learning principles in resident education. She discussed ACOG’s recently formed Vaginal Hysterectomy Teaching Taskforce, which has put together a simulation consortium online toolkit and a surgical skills module to help educate residents on vaginal hysterectomy techniques. This toolkit and module can be accessed by doing a quick search after signing into the ACOG Web site.

Dr. Carson, a reproductive endocrinologist formerly at Brown University, is also now an honorary member of SGS.

Wise words from a wise physician

In his presidential address Dr. Stephen Metz acknowledged that all physicians are subject to even subtle “conflicts of interest,” reminding us to treat our patients as people not as a disease or a procedure.

“What does my patient really want from me? She wants me to get to know her to develop the right recommendations for her,” he said. His career has spanned multiple decades, and his service to the field of gynecology is outstanding. He received a well-deserved standing ovation at the end of his address.

Sport and socialization a necessity in sunny Florida!

The afternoon adjourned after the business meeting, and members were able to play golf, tennis, paddleboard in Winter Park, or just relax at the resort. Congratulations to the winners of the golf tournament (Drs. Hopkins, Rasmussen, Hurd, and Flora) and the tennis tournament (Dr. Ted Lee)!

Everyone convened at the outside terrace for the evening “Mojito Night in the Caribbean” reception, sharing good times, cocktails, and hors d’oeuvres. Proceeds from each ticket sold helped support Surgeons Helping Advance Research and Education (SHARE).

Tomorrow looks to be an excellent conclusion to a well-planned and very well-executed meeting. Kudos, and large thanks, to the SGS leadership.

3/23/15, Day 2 at SGS

Surgeons from 17 countries converge

The first day of the SGS scientific sessions was another energetic and interactive day. Sixteen new SGS members were recognized and welcomed in the main conference hall. Dr. Charles Rardin presented a brief overview and some basic statistics related to this year’s meeting—the largest ever in the history of SGS. A total of 401 attendees representing 17 countries are here in Orlando for SGS 2015! 

In the first scientific session, oral presentations touched on the subjects of preoperative dexamethasone use, vaginal packing, surgical site infections, and a new treatment modality for fecal incontinence. An excellent technique video on laparoscopic ureterolysis by Dr. Cara King then followed, in which she demonstrated excellent surgical skills with amazingly clear anatomy. Her video was recognized later in the day with a well-deserved award—congratulations! 

A short break in the exhibit hall allowed for mingling with other attendees, many of whom have been active on social media surrounding the meeting, and for visiting the booths of the industry sponsors. The second scientific session then picked up where the first left off, with more scientifically sound research presented on such topics as mechanical bowel preparation use in laparoscopy and pelvic floor disorders in women with gynecologic malignancies.

No room for fads in gyn surgery

Dr. David Grimes, a true leader in our field, provided an exceptional keynote address, “Is Teaching Evidence-Based Surgery Possible?" He shared his expertise of evidence-based medicine, and described (in sometimes very comical but always stimulating and provocative terms) the need for incorporating evidence-based surgery in gynecology. He urged us to strive to do best by our patients by applying evidenced-based practices rather than following fads and gizmos.

Gyn surgery training: Have we reached a “perfect storm”?

The afternoon brought with it a panel discussion on "Teaching the Next Generation of GYN Surgeons," with Dr. Hal Lawrence moderating and Dr. Mark Walters and Dr. Dee Fenner serving as panelists. They discussed the future of ObGyn residency training in great detail: increasing subspecialization, a stable birth rate, declining hysterectomy rates, increasing safety and quality monitoring, and increased access to data and informed consumers. All of these trends were highlighted as reasons for a perfect storm in gynecologic surgery training. In addition, the panel presented some surprising statistics: 

• The majority of hysterectomies in the United States are being done by surgeons who perform less than 1 per month.
• The higher volume surgeons provide higher value and tend to utilize more minimally invasive approaches.

Videofest!

The scientific day concluded with a videofest that included complex robotic, laparoscopic, hysteroscopic, cystoscopic, and vaginal surgeries, demonstrating the surgical talents and ingenuity of SGS members.

Simultaneously, the Fellows’ Pelvic Research Network (FPRN) met to update their ongoing projects and to review new proposals. The meeting sought to unite FPRMS and MIS fellows to conduct multicenter studies. This was an enlightening and engaging session, which should give everyone great hope to see the creativity and energy of the next generation of researchers.

A grounder for attendees

All in attendance were treated to a unique, eye-opening, motivational, and very moving talk by Professor (and Sir) Ajay Rane, MD, PhD from Australia on female genital mutilation. He stressed the importance of respecting women for who they are, not what they do.

“My idea of feminism is applauding a woman who gives birth. Celebrate women for who they are," he said. He highlighted the work being done by his team in Australia and India, and urged everyone in attendance to become more aware of the staggering statistics and reality of female genital mutilation.

The jam-packed day wrapped with the awards ceremony in the main hall. Lifelong mentors were honored by their mentees and SGS President Dr. Stephen Metz and Scientific Program Chair Dr. Charles Rardin presented various awards to those who had submitted and presented novel and groundbreaking research.

One last surprise

The President’s Reception in the exhibit hall was lively, with meeting sponsors, colleagues, and friends in attendance. And, of course, a visit from special guest! (Thanks to SGS Fellow Christina Saad, MD @XtinaSaad for the pic!)

See you all tomorrow for another educational, enlightening, and spirited day at #SGS2015! 

3/22/15. DAY 1 AT SGS

A focus on evidence-based medicine

Strong analytic skills (of your own research as well as the published literature) translates to better patient care, was the underlying theme of the opening postgraduate course here in Orlando, Florida, for day 1 of the 41st annual meeting of the Society of Gynecologic Surgeons.

Building on the success of last year’s course on evidence-based medicine (EBM), Dr. Vivian Sung and Dr. Ike Rahn put together an amazing team to review and apply the principles of so-called EBM, a workshop that was in part sponsored by ABOG.

A quick introduction to EBM principles by Dr. Thomas Wheeler was followed by small break-out groups, where attendees used the PICO-DD model to define a Population, Intervention, Comparator, Outcomes, Duration, and study Design. Further talks focused on the benefits and caveats of randomized controlled trials (RCTs), surrogate and intermediate outcomes, and systematic reviews and meta-analyses.

Dr. Ethan Balk cautioned us to consider the costly and underpowered RCT, and lack of generalizability needed to define rigorous study inclusion and outcome criteria. Dr. Sung then pointed out that, while the perfect surrogate outcome would allow us to shorten study lengths (and save money), the seduction of association and causation can lead to some questionable conclusions.

When using a clinical practice guideline, Dr. Miles Murphy indicated that a systematic review needs to be included, although a meta-analysis is not always required. The poor quality and paucity of RCTs for most patient populations is what limits us.

Dr. Rahn gave an excellent presentation on subgroup analysis, recommending to attendees that they perform these analyses cautiously, describe which groups are analyzed, and have statistical back-up for power and P value calculations.

Dr. Kristen Matteson then spoke about interpreting the literature on screening and diagnostic tests, giving a thorough but understandable review of the basics of statistics. Dr. John Wong rounded out the course, suggesting that because RCTs are expensive and comprise less than 5% of published studies, the analysis of observational studies as RCTs would allow us to better inform our patients and our colleagues on the best treatments, using patient-centered outcomes, efficacy data, and multiple providers. He urged us all to be more skeptical and ask critical questions when dealing with evidence in medicine.

Sharpening ultrasonography skills

Simultaneously, others attended a hands-on learning course on comprehensive pelvic floor ultrasonography, including transperineal, endovaginal, and endoanal imaging, organized by Dr. Abbas Shobeiri.

Tips for the difficult hysterectomy

Dr. Ted Lee (with help from Drs. Arnold P. Advincula, Rosanne Kho, and Matthew Seidhoff) prepared a surgical tutorial on laparoscopic, robotic, and vaginal strategies and techniques for approaching the difficult hysterectomy. The course was phenomenal, as described by many of the members fortunate enough to learn some of the tips and tricks demonstrated by the master surgeons.

Training for the NIH application process

Following the postgraduate courses, Dr. Katherine Hartmann led an “NIH Application Training Camp,” an offering supported by SGS research donations and a generous donation from Dr. Holly Richter. Dr. Hartmann provided in-depth insight into the world of NIH grant funding and provided background prep for a K or R award application. A mock NIH application study section, in which two actual applications were reviewed, demystified the process of grant review (and rejection). 

A social end to day 1

To end the first day, a welcome reception was held where residents, fellows, and attendings from different fields of ObGyn mingled and shared drinks, stories, and good laughs.

The "social" activities continue on social media for the rest of the conference. Follow #SGS2015, @gynsurgery, @obgmanagement, and @sukrantmehta for more!

3/24/15, Day 3 at SGS

Many topics, many learning opportunities   

The morning’s focus topics at SGS were divided up in small-group academic roundtables, with 15 experts in the field providing authoritative know-how and guidance to attendees. Topics ranged from tips for in-bag tissue extraction, endometriosis surgery, surviving health care transformation, cost-effectiveness, and single-site surgery to innovative treatments for fecal incontinence.

In the main hall, the fourth scientific session included oral presentations and videos that focused on anatomic landmarks and variations and included data presentation from an interesting prospective randomized trial in which the authors found bladder support is reduced by pregnancy, regardless of delivery method.

The highlight of the morning was certainly the debate over "power" morcellation. Dr. Cheryl Iglesia moderated in her charming and comical manner. Dr. Andrew Sokol and Dr. Jubilee Brown argued that power morcellation still should be available to a select group of appropriately chosen, low-risk women, and backed their arguments up with solid data. Dr. Eric Sokol, Andrew’s twin (and better looking, per him) brother, and Dr. Carl Zimmerman argued against the use of power morcellation, instead urging everyone in the audience to perform more vaginal hysterectomies. Though spirited and based largely on sound medical evidence, the debate did not have a clear winner. The overall consensus seemed to be that this controversial topic needed further evaluation and more data to support either claim.

"Sesame street graduates” and andragogy

We were then honored to have Vice President for Education, American College of Obstetricians and Gynecologists Dr. Sandra Carson as the esteemed TeLinde Lecturer. Her talk, “Teaching Medicine and Surgery to Sesame Street Graduates,” outlined the challenges in teaching surgery to a new generation of ObGyn residents as well as identified opportunities for improvement. She restated what seems to be the running theme at SGS this year: young faculty and residents are losing the skill for vaginal hysterectomy.

Dr. Carson introduced members of the audience to the adult theory of learning called andragogy. Adults like active learning, which is problem centered, rather than content oriented; linking new concepts to prior experience; and learning what is relevant to them, she noted. Then she shared ACOG’s strategies for applying these learning principles in resident education. She discussed ACOG’s recently formed Vaginal Hysterectomy Teaching Taskforce, which has put together a simulation consortium online toolkit and a surgical skills module to help educate residents on vaginal hysterectomy techniques. This toolkit and module can be accessed by doing a quick search after signing into the ACOG Web site.

Dr. Carson, a reproductive endocrinologist formerly at Brown University, is also now an honorary member of SGS.

Wise words from a wise physician

In his presidential address Dr. Stephen Metz acknowledged that all physicians are subject to even subtle “conflicts of interest,” reminding us to treat our patients as people not as a disease or a procedure.

“What does my patient really want from me? She wants me to get to know her to develop the right recommendations for her,” he said. His career has spanned multiple decades, and his service to the field of gynecology is outstanding. He received a well-deserved standing ovation at the end of his address.

Sport and socialization a necessity in sunny Florida!

The afternoon adjourned after the business meeting, and members were able to play golf, tennis, paddleboard in Winter Park, or just relax at the resort. Congratulations to the winners of the golf tournament (Drs. Hopkins, Rasmussen, Hurd, and Flora) and the tennis tournament (Dr. Ted Lee)!

Everyone convened at the outside terrace for the evening “Mojito Night in the Caribbean” reception, sharing good times, cocktails, and hors d’oeuvres. Proceeds from each ticket sold helped support Surgeons Helping Advance Research and Education (SHARE).

Tomorrow looks to be an excellent conclusion to a well-planned and very well-executed meeting. Kudos, and large thanks, to the SGS leadership.

3/23/15, Day 2 at SGS

Surgeons from 17 countries converge

The first day of the SGS scientific sessions was another energetic and interactive day. Sixteen new SGS members were recognized and welcomed in the main conference hall. Dr. Charles Rardin presented a brief overview and some basic statistics related to this year’s meeting—the largest ever in the history of SGS. A total of 401 attendees representing 17 countries are here in Orlando for SGS 2015! 

In the first scientific session, oral presentations touched on the subjects of preoperative dexamethasone use, vaginal packing, surgical site infections, and a new treatment modality for fecal incontinence. An excellent technique video on laparoscopic ureterolysis by Dr. Cara King then followed, in which she demonstrated excellent surgical skills with amazingly clear anatomy. Her video was recognized later in the day with a well-deserved award—congratulations! 

A short break in the exhibit hall allowed for mingling with other attendees, many of whom have been active on social media surrounding the meeting, and for visiting the booths of the industry sponsors. The second scientific session then picked up where the first left off, with more scientifically sound research presented on such topics as mechanical bowel preparation use in laparoscopy and pelvic floor disorders in women with gynecologic malignancies.

No room for fads in gyn surgery

Dr. David Grimes, a true leader in our field, provided an exceptional keynote address, “Is Teaching Evidence-Based Surgery Possible?" He shared his expertise of evidence-based medicine, and described (in sometimes very comical but always stimulating and provocative terms) the need for incorporating evidence-based surgery in gynecology. He urged us to strive to do best by our patients by applying evidenced-based practices rather than following fads and gizmos.

Gyn surgery training: Have we reached a “perfect storm”?

The afternoon brought with it a panel discussion on "Teaching the Next Generation of GYN Surgeons," with Dr. Hal Lawrence moderating and Dr. Mark Walters and Dr. Dee Fenner serving as panelists. They discussed the future of ObGyn residency training in great detail: increasing subspecialization, a stable birth rate, declining hysterectomy rates, increasing safety and quality monitoring, and increased access to data and informed consumers. All of these trends were highlighted as reasons for a perfect storm in gynecologic surgery training. In addition, the panel presented some surprising statistics: 

• The majority of hysterectomies in the United States are being done by surgeons who perform less than 1 per month.
• The higher volume surgeons provide higher value and tend to utilize more minimally invasive approaches.

Videofest!

The scientific day concluded with a videofest that included complex robotic, laparoscopic, hysteroscopic, cystoscopic, and vaginal surgeries, demonstrating the surgical talents and ingenuity of SGS members.

Simultaneously, the Fellows’ Pelvic Research Network (FPRN) met to update their ongoing projects and to review new proposals. The meeting sought to unite FPRMS and MIS fellows to conduct multicenter studies. This was an enlightening and engaging session, which should give everyone great hope to see the creativity and energy of the next generation of researchers.

A grounder for attendees

All in attendance were treated to a unique, eye-opening, motivational, and very moving talk by Professor (and Sir) Ajay Rane, MD, PhD from Australia on female genital mutilation. He stressed the importance of respecting women for who they are, not what they do.

“My idea of feminism is applauding a woman who gives birth. Celebrate women for who they are," he said. He highlighted the work being done by his team in Australia and India, and urged everyone in attendance to become more aware of the staggering statistics and reality of female genital mutilation.

The jam-packed day wrapped with the awards ceremony in the main hall. Lifelong mentors were honored by their mentees and SGS President Dr. Stephen Metz and Scientific Program Chair Dr. Charles Rardin presented various awards to those who had submitted and presented novel and groundbreaking research.

One last surprise

The President’s Reception in the exhibit hall was lively, with meeting sponsors, colleagues, and friends in attendance. And, of course, a visit from special guest! (Thanks to SGS Fellow Christina Saad, MD @XtinaSaad for the pic!)

See you all tomorrow for another educational, enlightening, and spirited day at #SGS2015! 

3/22/15. DAY 1 AT SGS

A focus on evidence-based medicine

Strong analytic skills (of your own research as well as the published literature) translates to better patient care, was the underlying theme of the opening postgraduate course here in Orlando, Florida, for day 1 of the 41st annual meeting of the Society of Gynecologic Surgeons.

Building on the success of last year’s course on evidence-based medicine (EBM), Dr. Vivian Sung and Dr. Ike Rahn put together an amazing team to review and apply the principles of so-called EBM, a workshop that was in part sponsored by ABOG.

A quick introduction to EBM principles by Dr. Thomas Wheeler was followed by small break-out groups, where attendees used the PICO-DD model to define a Population, Intervention, Comparator, Outcomes, Duration, and study Design. Further talks focused on the benefits and caveats of randomized controlled trials (RCTs), surrogate and intermediate outcomes, and systematic reviews and meta-analyses.

Dr. Ethan Balk cautioned us to consider the costly and underpowered RCT, and lack of generalizability needed to define rigorous study inclusion and outcome criteria. Dr. Sung then pointed out that, while the perfect surrogate outcome would allow us to shorten study lengths (and save money), the seduction of association and causation can lead to some questionable conclusions.

When using a clinical practice guideline, Dr. Miles Murphy indicated that a systematic review needs to be included, although a meta-analysis is not always required. The poor quality and paucity of RCTs for most patient populations is what limits us.

Dr. Rahn gave an excellent presentation on subgroup analysis, recommending to attendees that they perform these analyses cautiously, describe which groups are analyzed, and have statistical back-up for power and P value calculations.

Dr. Kristen Matteson then spoke about interpreting the literature on screening and diagnostic tests, giving a thorough but understandable review of the basics of statistics. Dr. John Wong rounded out the course, suggesting that because RCTs are expensive and comprise less than 5% of published studies, the analysis of observational studies as RCTs would allow us to better inform our patients and our colleagues on the best treatments, using patient-centered outcomes, efficacy data, and multiple providers. He urged us all to be more skeptical and ask critical questions when dealing with evidence in medicine.

Sharpening ultrasonography skills

Simultaneously, others attended a hands-on learning course on comprehensive pelvic floor ultrasonography, including transperineal, endovaginal, and endoanal imaging, organized by Dr. Abbas Shobeiri.

Tips for the difficult hysterectomy

Dr. Ted Lee (with help from Drs. Arnold P. Advincula, Rosanne Kho, and Matthew Seidhoff) prepared a surgical tutorial on laparoscopic, robotic, and vaginal strategies and techniques for approaching the difficult hysterectomy. The course was phenomenal, as described by many of the members fortunate enough to learn some of the tips and tricks demonstrated by the master surgeons.

Training for the NIH application process

Following the postgraduate courses, Dr. Katherine Hartmann led an “NIH Application Training Camp,” an offering supported by SGS research donations and a generous donation from Dr. Holly Richter. Dr. Hartmann provided in-depth insight into the world of NIH grant funding and provided background prep for a K or R award application. A mock NIH application study section, in which two actual applications were reviewed, demystified the process of grant review (and rejection). 

A social end to day 1

To end the first day, a welcome reception was held where residents, fellows, and attendings from different fields of ObGyn mingled and shared drinks, stories, and good laughs.

The "social" activities continue on social media for the rest of the conference. Follow #SGS2015, @gynsurgery, @obgmanagement, and @sukrantmehta for more!