Surgical Techniques

Top gynecologic surgeons gather for 2012 PAGS

A roundup of the Pelvic Anatomy and Gynecologic Surgery (PAGS) symposium held December 13–15, 2012, in Las Vegas


More than 300 physicians attended the 15th annual Pelvic Anatomy and Gynecologic Surgery (PAGS) symposium December 13–15, 2012, in Las Vegas. One likely reason was an abundance of offerings, including:

  • a laparoscopist’s view of pelvic and abdominal anatomy
  • case-based discussion of the evaluation of female pelvic floor disorders
  • a surgical video fest with expert discussion and audience participation
  • an in-depth look at fibroid management
  • a focus on hysterectomy, from the vaginal approach to single-port laparoscopy and robotics
  • a panel discussion of pelvic pain and its management
  • tips on avoiding and managing laparoscopic and other complications
  • a breakout session on endometriosis surgery
  • the latest on evaluation and management of fetal incontinence.

Here are a few additional highlights of the 2012 program:

Surgery for stress incontinence: Which sling is for which patient?

When it comes to slings, one size does not fit all. That point was emphasized by Mark Walters, MD, in a comprehensive session that described the surgical techniques behind various bladder-neck and midurethral sling procedures, as well as the associated cure rates, complications, and pros and cons. To watch a 7-minute video in which Dr. Walters elaborates on patient-selection criteria, CLICK HERE .

Surgical approach to prolapse—what I do and why I do it

John Gebhart, MD, MS, outlined his approach to the surgical correction of pelvic organ prolapse, but underscored his belief that the surgeon has to base her approach not only on the data, but on her own experience and resources.

“That’s something you have to come to grips with in your own practice—what’s best in your hands?” he said.

While showing videos of actual surgeries, he described specific techniques, pearls, and pitfalls, and emphasized the importance of cystoscopy to rule out bladder injury.

Keynote address: The economics of surgical gynecology

Dr. Barbara S. Levy, Vice President of Health Policy at the American Congress of Obstetricians and Gynecologists (ACOG), delivered an impassionate appeal to attendees of PAGS: Gynecologists need to take the lead in advocating for best practices in their specialty—before forces outside the specialty impose definitions and standards upon them.

She also described the current payment environment, explained why the current trend in health-care spending is unsustainable, and stressed the need to find areas in surgical gynecologic practice that may benefit from improvements in health-care delivery. CLICK HERE for Dr. Levy’s overview of the issues on video.

PAGS participants weigh in

After Dr. Levy’s keynote address on the economics of surgical gynecology, OBG Management gathered the opinions of four participants: Gary Bostrom, MD, of California; Richard Robinson, MD, of Georgia; Timothy Hall, MD, of North Carolina; and Todd Slater, MD, of Ohio. To hear their points of view, CLICK HERE .

Myomectomy: Open to robotic approaches

“Myomectomy is not a dying art by any stretch,” said PAGS Co-Chair Tommaso Falcone, MD, in opening this session. “In fact, it’s expected to increase,” he added, as more women seek to preserve their uterus.

He then proceeded to describe management approaches (including watchful waiting), indications for myomectomy, and surgical options, including data on both perioperative and reproductive outcomes.
CLICK HERE for a video summary of Dr. Falcone’s talk.

Laparoscopic supracervical hysterectomy

As more women seek to preserve their cervix at the time of hysterectomy, the supracervical approach is becoming increasingly common. Amy Garcia, MD, described the indications, technique, benefits, and risks associated with this procedure. CLICK HERE to hear Dr. Garcia highlight the key points of her talk.

Join me in Las Vegas for FUUS 2013!

Mickey Karram, MD, invites you to attend the 12th annual Female Urology and Urogynecology Symposium (FUUS) at the ARIA in Las Vegas, April 18–20, 2013.

“This is a unique meeting,” says Dr. Karram, “as it addresses both urologic and gynecologic issues related to female pelvic medicine and reconstructive surgery.” It’s also timely—with the first board exam for the subspecialty of female pelvic medicine and reconstructive surgery being held in June 2013. Prepare yourself to meet the demand for physicians who have the expertise to evaluate pelvic floor disorders.

“The meeting is attended by 50% gynecologists and 50% urologists, has many breakout sessions, and covers a variety of topics—everything from vaginal surgery for prolapse, voiding dysfunction, and types of reconstructive procedures with laparoscopic and robotic approaches,” says Dr. Karram, who is excited for this year’s special symposium by Karl J. Kreder, Jr, MD, on April 20 that addresses pelvic pain syndromes. For a complete agenda and registration details, visit

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