Thomas L. Lyons, MD
Center for Womenís Care & Reproductive Surgery
Hi, Iím Tom Lyons, Center for Womenís Care & Reproductive Surgery, Atlanta, Georgia.
Iím here at the annual AAGL meeting in Las Vegas. The meeting is always, probably,
the best meeting of the year for me and I enjoy being here because the energy level
is great. Itís a brotherhood of international people who are interested in the same
thing—taking care of womenís health and doing so in a minimally invasive manner.
We had a ďmeet the professorsĒ roundtable-type discussion associated with lunch.
The ďmeet the professorĒ types are specific per table with different topics.
My topic was quite an interesting one, regarding the treatment of patients with
MRKH syndrome, an absent vagina, and the treatment for those patients, in terms
of creation of a neovagina using laparoscopic and vaginal techniques. Itís a very
exciting treatment, I think, very new and aggressive. I think itís very positive
for these patients to have a minimally invasive alternative to what has been a terribly
invasive procedure in the past. There are a number of procedures that are offered
for this problem, one of which is called the McIndoe procedure, where a full-thickness
skin graft is used over a stint that is placed in an incision in the area of the
vagina. It takes a long time for that skin graft to perhaps take or not take, and
itís really a grueling process. Whereas the new procedure is a laparovaginal procedure,
it takes about 30 to 45 minutes, and patients are able to use the new vagina in
2 weeks. Itís really a remarkable procedure, developed by a member of the AAGL who
happens to be from Russia. I go to Russia every year for a meeting there and I glean
this information from her.
Thatís one of the favors of this meeting that make it quite exciting. It is an international
group of individuals who can bring new and very exciting ideas to the table. Medicine
is a little conservative and staunchy; itís great to see some new things come along.
Today, we had another one of the venues, one that is called a crossfire debate.
I participated in a debate regarding the use of hysterectomy versus endometrial
ablation for management of non-medically manageable dysfunctional uterine bleeding.
My antagonist was Rich Gimpelson, who is a dedicated hysteroscopic surgeon out of
Missouri, formerly a political candidate. I think he ran for office in Missouri.
I think, on the side, he must also be a stand-up comedian—heís one of the
funniest guys Iíve seen! It was going to be difficult in the debate because Rich
is always funnier than I am. It was difficult. We presented our sides and had some
discussion. Afterwards, thereís a fair amount of questions and answers after these
things that really get peopleís minds working and make it a fun type of meeting
to be at. Thereís always good questions. Iím personally associated with laparoscopic
cervical hysterectomy because I started the procedure in 1990. So I pretty much
always get questions about that procedure, which was one of the types of hysterectomies
I was talking about.
Itís a good session. The thing that changes are the people that ask the questions.
Youíll see some older physicians and thereís always some new physicians. This particular
meeting is always a hotbed for young physicians, residents in training, registrars
in training from the international fields. Thereís a lot of energy provided by that
young group of physicians that makes it pretty exciting.
Tomorrow, weíll have another attempt at another venue. We provide whatís called
a surgical tutorial. In that session, Iíll be paired with a physician from Italy,
Fulvio Zullo. At any rate, weíre going to be discussing the laparoscopic hysterectomy.
Heíll be handling predominantly laparoscopic total hysterectomy and lap-assisted
vaginal hysterectomy. Iíll be handling laparoscopy supracervical hysterectomy and
probably vaginal hysterectomy. And then, we try in the surgical tutorials to provide
tips and pearls with regard to the technical aspect of performing the procedures,
not so much rationale and why the procedures should be performed, things of that
Itís a very technically oriented session versus an academically oriented session.
You get a number of different venues and interspersed, of course, in the midst of
all of this is live surgery being done at various venues. Now with the aid of computers,
etc, we can beam the surgeries right into this facility, and there will literally
be thousands of people watching as people actually perform live surgery. And thereís
a little bit of live surgery every day. I know thereís live surgery tomorrow. The
big live surgery session is on Saturday. All that makes for quite an interesting,
lively session, as I said, with both younger physicians and older physicians, male
physicians, women physicians, US physicians, international physicians—physicians
from literally all over the world, Russia, Asia, Australia, Canada, the Americas,
South Africa, the Middle East, virtually everywhere they are taking care of women,
there are individuals trying to use minimally invasive surgery to hopefully better
the lives of those women. Itís exciting. Iíd have to say I look forward to this
every year—to get out and come to it. Itís one of the meetings on my list
I never miss, and havenít since 1981.