Thomas L. Lyons, MD
Center for Women’s Care & Reproductive Surgery
Atlanta, Georgia

Hi, I’m Tom Lyons, Center for Women’s Care & Reproductive Surgery, Atlanta, Georgia. I’m 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. It’s a brotherhood of international people who are interested in the same thing—taking care of women’s health and doing so in a minimally invasive manner. We had a “meet the professors” roundtable-type discussion associated with lunch. The “meet the professor” 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. It’s a very exciting treatment, I think, very new and aggressive. I think it’s 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 it’s 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. It’s 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.

That’s 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; it’s 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—he’s one of the funniest guys I’ve 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, there’s a fair amount of questions and answers after these things that really get people’s minds working and make it a fun type of meeting to be at. There’s always good questions. I’m 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.

It’s a good session. The thing that changes are the people that ask the questions. You’ll see some older physicians and there’s always some new physicians. This particular meeting is always a hotbed for young physicians, residents in training, registrars in training from the international fields. There’s a lot of energy provided by that young group of physicians that makes it pretty exciting.

Tomorrow, we’ll have another attempt at another venue. We provide what’s called a surgical tutorial. In that session, I’ll be paired with a physician from Italy, Fulvio Zullo. At any rate, we’re going to be discussing the laparoscopic hysterectomy. He’ll be handling predominantly laparoscopic total hysterectomy and lap-assisted vaginal hysterectomy. I’ll 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 nature.

It’s 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 there’s a little bit of live surgery every day. I know there’s 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. It’s exciting. I’d have to say I look forward to this every year—to get out and come to it. It’s one of the meetings on my list I never miss, and haven’t since 1981.