As part of the new session format for ACOG 2015, each day of the conference will have a specialized topic, and as you may already guessed, today's topic is operative gynecology. It's an important topic because many of the procedures and devices that MRG reports cover fall under this category. And since the exhibitor booths are still being built, I was able to take on a full day of clinical sessions to learn about important developments in surgery technique and approach.
For example, have you ever considered that electrosurgery is one the most common tools a surgeon uses, but also the one they understand the least? Yesterday, it really surprised me that in a room full of gynecologists, only a handful of surgeons had taken a formal course on electrosurgery and more surgeons were laser certified than that number. The presentation by Dr. Greg Raff really stressed the importance of understanding how "electric current always follows the path of least resistance". As he demonstrated with a real radiofrequency generator and active electrodes how easily it is for capacitive coupling and insulation failure to hurt the surgeon or patient, it sparked my attention on how easily unwanted effects can occur if someone is unaware of the risks.
Today, I also attended a surgical tutorial on robotic laparoscopic surgery by Dr. Arnold Advincula. Despite the controversy, robotics are not disappearing and the focus can no longer be whether to get a robot, but rather how to effectively use one. Simple things that you could easily overlook like the amount and placement of egg crate foam padding can make a huge difference on whether a patient moves during surgery. Patient movement during robotic surgery would create unwanted tension on the abdominal wall because the robot cannot move with the patient. This continues to affirm that many negative incidents with robotics have been related to a learning curve and the importance of making sure that simple, non-surgical factors are also considered for the success rate of the surgery.
I wrapped up today with a number of great video presentations and the focused debate on morcellation. As power morcellation devices continue to be removed by institutions wary of the liabilities, surgeons are left with the decision of whether to continue power morcellation by finding another institution that allows it or finding alternatives to remove large fibroids. As it came up time and time again throughout the day, I've noticed that the hand morcellation technique utilizing a cold knife and a containment bag has become the new alternative approach. Will this give rise to device innovation to improve this technique? That's something I'll be waiting patiently to find out. Looks like ACOG is kicking off with a great start!