第12届国际妇科内镜协会年会纪要

第12届国际妇科内镜协会年会于2003年4月2—5日在美丽的墨西哥海滨旅游胜地勘昆召开,到会的442位代表,来自全世界23个国家。会议邀请世界著名妇科腔镜专家进行专题报告37讲,宣读论文97篇,墙报交流12篇,播放录像资料19部。会议内容共涉及5个方面,现将有关内容介绍如下。     

Gynecologic Endoscopy Skills Training and Assessment: Review

Training in and assessment of endoscopic skills is currently undergoing a period of evolution. Several recognized factors driving this evolution include working pattern, training opportunities, cost, and patient safety. In addition, the need to continuously monitor competence is punctuated by the rapid technologic changes and rising consumer expectation. These challenges present an opportunity to positively enhance the learning and performance of surgical practice.     

Core Competencies for Gynecologic Endoscopy in Residency Training: A National Consensus Project

Residents and educators in obstetrics and gynecology have identified the need to improve endoscopic surgical education. The Canadian Endoscopy Education Project aims to create a national standardized endoscopy curriculum. The objective of the current project was to identify the core competencies for a gynecologic endoscopy (GE) curriculum in residency training programs. This expert consensus project (Canadian Task Force Classification III) included all 16 academic obstetrics and gynecology residency programs in Canada. Each university program selected their leading endoscopy educator to participate in the consensus process. Competencies for proficiency in GE were identified and then reviewed in 3 sequential rounds of consensus building using the Delphi technique. Overall, 213 objectives were reviewed and 199 (93%) of the items achieved consensus agreement. Competencies that were deemed outside the realm of general residency education were also collated and may represent a guide to subspecialty fellowship training in the future. The core competencies for GE training in obstetrics and gynecology residency were determined through national expert consensus. This provides the basis for a national standardized endoscopy curriculum for general obstetrics and gynecology training.     

Colostomy Closure on a Gynecologic Oncology Service

From 7/1/85 to 6/31/92 25 colostomy closures were performed. Twenty-one of the colostomies were performed in relation to gynecologic cancer and the remaining 4 were performed for benign pelvic disease. Nineteen patients underwent simple closure of a transverse loop colostomy. The other 6 patients had their colostomy closed in association with a laparotomy. There were no intraoperative complications related to the colostomy closure. There was 1 postoperative mortality secondary to adult respiratory distress syndrome following reoperation for stricture in the early postoperative period. Three other patients also experienced significant postoperative complications for an overall complication rate of 16%. These included one subcutaneous wound dehiscence, one subcutaneous wound infection, and one anastomotic stricture. One patient required a second colostomy due to recurrence of an obstruction by ovarian cancer in the rectosigmoid area. From the results of this small study, it would appear that colostomy closure is a reasonable endeavor in a selected group of gynecologic cancer patients.     

Gynecologic laparoscopic surgery with a palm-controlled laparoscope holder

During laparoscopic surgery, the operator relies on the skills of an assistant, particularly during laparoscope manipulation. If possible, the surgeon would prefer to hold the scope while at the same time operating with both hands similar to open surgery conditions. A palm electronic interface (Lapman) was developed to allow remote control of a laparoscope manipulator and to make laparoscope displacement and instrument manipulation synchronous for the surgeon. It was tested in gynecologic surgery, where it restored vision and instrument manipulation and allowed laparoscopic surgery to be performed with fewer personnel.     

Gynecologic aspects of breast disease

The principal problem of the gynecologist in the field of breast diseases is the diagnosis of early breast cancer; then he must direct the patient to receive the best and immediate treatment. Obvious carcinoma has a direct approach, but differentiation of lesions which may possibly represent early carcinoma requires judgment and a high degree of suspicion. Haagensen [Diseases of the breast, Saunders, Philadelphia, PA (1971)] has stated that early diagnosis should be followed by cure in 85% of patients. Evaluation of reactions in the breast due to hormones are discussed in this paper. This includes fibrocystic disease, commonly known as chronic cystic mastitis, macrocysts of the breasts, effects of contraceptive and estrogenic hormones, and, finally, hormonal situations in 100 patients with carcinoma of the breast.     

Gynecologic presentation of pelvic lymphoma

Advanced pelvic lymphoma is rarely encountered by the gynecologist. Two cases of pelvic lymphoma involving the reproductive tract are reported. Long-term survival is achieved by minimal surgical intervention, correct histologic examination and treatment with local radiation therapy and systemic chemotherapy.